Quantitative Score System for the Surgical Decision on Adult Femoral Neck Fractures

Abstract

Surgical decision making for femoral neck fractures is currently based on factors such as patient age, fracture type, and medical condition, lacking a quantitative standard. The treatment protocol based on such qualitative assessment has poor operability, greatly affected by the surgeon's subjective factors. As a result, a quantitative score system (QSS) focusing on 5 factors--age, fracture type, bone mineral density, activities of daily living, and medical comorbidities--with a total score of 25 is designed to deal with adult femoral neck fractures. The higher the score, the worse the patient's physiological condition. According to our clinical experience, patients with 1 to 11 points should be treated with internal fixation; patients with 12 to 17 points with total hip arthroplasty (THA), and patients with 18 to 22 points with hemiarthroplasty. Patients with 22 to 25 points should be treated with internal fixation due to the high surgical risk of arthroplasty caused by poor physiological condition. Three hundred seventy-five adult femoral neck fractures were treated on the basis of QSS for this 2-year prospective study. Of these, 242 were treated with low-score internal fixation, 60 with THA, 55 with hemiarthroplasty, and 18 with high-score internal fixation. The revision rates 2 years postoperatively in the low-score internal fixation, THA, and hemiarthroplasty groups were 15.3%, 5.0%, and 5.5%, respectively, which were lower than those from a meta-analysis (internal fixation, 35%; THA, 16%). This QSS helps surgical decision making regarding the treatment choice for adult patients with femoral neck fractures, and good results in preliminary clinical practice have been achieved.

Non-sliding Fixation Shows Improved Clinical Outcomes for Displaced Femoral Neck Fractures as Compared to Sliding Fixation

“…Internal fixation of fractures and hip replacement are widely used. Liu et al ( 13 ) proposed that the patient's age, bone density, and other information can be quantified, and then the quantified score can be used for surgical decision-making for femoral neck fractures. In general, internal fixation is suitable for patients <65 years of age, and joint replacement is recommended for patients >70 years of age.…”

Outcomes of Femoral Neck Fractures Treated with Cannulated Internal Fixation in Elderly Patients: A Long‐Term Follow‐Up Study

“…Clinically, surgical decision making for FNF is currently guided by such factors as patient age, fracture type, and individual conditions. As such, the treatment has poor operability with less quantitative standardization and more subjectivity 19 . In this study, we selected internal fixation for FNF treatment based mainly on five related factors: bone quality, body mass index, Garden classification, Pauwels type, and medical status.…”