femoral neck fractures in elderly patients

Now lets imagine this scenario… an elderly patient with multiple co-morbidities who is only able to ambulate independently inside her house.  She fell while at home on the evening before admission to the hospital and was not brought to the hospital until at least 12 hours had passed since the injury.  She takes Coumadin in order to thin her blood and her INR on admission is 3.1 and she thinks that she may have been experiencing some symptoms of chest pain just prior to the fall.  This patient is a member of a unique category of hip surgery candidates.  She is elderly, relatively limited in terms of her ability to perform activities of daily living and she is not at all concerned with an ability to hike or run.  In her case, a hemiarthroplasty of the hip would probably result in the most reliable course of rehabilitation.  It will allow her to put full weight on the fracture immediately, and in contrast to fixation with screws, this is a stable orthopedic construct.  In the elderly, the bone quality is often so poor that the screws have no “bite” in the bone and the screws are in reality not contributing much to the overall stability of the fracture.  The orthopedic literature has proven that screw fixation of femoral neck fractures in the elderly may not result in more mortality, but definitely do result in a higher operation rate because a significant number of these patients have to return for another operation to have their screws removed and a hemiarthroplasty performed.

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