Fractured neck of femur -- internal fixation versus arthroplasty.
Background: Surgery is the treatment of choice for fractured neck of femur. For middle-aged patients (aged ca. 40 to 65), there is considerable debate over the indications for arthroplasty or internal fixation. The choice of surgical technique varies widely from one region to another. In this articl...
| Publicado en: | Deutsches Ärzteblatt International Vol. 107; no. 23; pp. 401 - 409 |
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| Autores principales: | , , , , |
| Formato: | diagnostic images pictorial tables/charts Journal Article |
| Publicado: |
Deutscher Aerzte-Verlag GmbH
6/11/2010
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105040137&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105040137 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18660452 5F0N jtl: Deutsches Ärzteblatt International issn: 18660452 maglogo: N pubinfo: dt: 6/11/2010 vid: 107 iid: 23 pid: 25312 pub: Deutscher Aerzte-Verlag GmbH artinfo: ui: 105040137 105040137 2010698379 10.3238/arztebl.2010.0401 NLM20589205 PMC2893522 105040137 ppf: 401 ppct: 8 formats: fmt: @attributes: type: T tig: atl: Fractured neck of femur -- internal fixation versus arthroplasty. aug: au: Sendtner E Renkawitz T Kramny P Wenzl M Grifka J sug: subj: Arthroplasty Utilization Femoral Fractures Surgery Fracture Fixation Utilization Arthroplasty, Replacement, Hip Decision Making, Clinical Middle Age Middle Aged: 45-64 years ab: Background: Surgery is the treatment of choice for fractured neck of femur. For middle-aged patients (aged ca. 40 to 65), there is considerable debate over the indications for arthroplasty or internal fixation. The choice of surgical technique varies widely from one region to another. In this article, we discuss the main criteria that should be used in making this decision. Methods: We selectively reviewed the literature on the diagnosis and treatment of fractured neck of femur, including the current guideline of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU) and recent findings from the field of health services research. Results: The treatment of middle-aged patients with dislocated fractures should be based on rational decision-making. The patient's level of activity before the accident should be judged in terms of his or her previous mobility, independence in daily activities, and mental status. Internal fixation is recommended if the fracture can be adequately repositioned, the bone is of good quality, and there is no evidence of osteoarthritis. Fractures that are more than 24 hours old should be treated with total hip arthroplasty. Hemiprostheses are appropriate for very old patients. Physically frail, bedridden, and/or demented patients should undergo internal fixation of the fracture. For non-displaced or impacted fractures, functional treatment (i.e., prophylactic securing of the fracture with screws or nails) is indicated. Rapid diagnosis and a short time in bed before surgery lower the rate of complications. Internal fixation with preservation of the femoral head should ideally be performed within the first 6 hours of trauma, and within the first 24 hours at most. Conclusion: Despite the increasing scarcity of resources, treatment should still be based on well-founded clinical guidelines. Minimally invasive surgery enables better function in the early postoperative phase and can thereby lower complication rates. An interdisciplinary concept for the postoperative care of elderly patients also has a major effect on the outcome. pubtype: Academic Journal doctype: diagnostic images pictorial tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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