Hui-Ling Huang

Internal Fixation of Undisplaced Femoral Neck Fractures with DHS or Multiple Cannulated Screws: Outcome Comparison in the Elderly

Background and Purpose: Multiple cannulated screws or dynamic hip screw (DHS) has been commonly used to treat undisplaced femoral neck fractures. Although these two techniques advocated in the literature could achieve good results, it is unclear which one is the best. It is the purpose of our study to compare the clinical outcomes of undisplaced femoral neck fractures that were treated with DHS or multiple cannulated screws. Methods: Between 1997 and 2002, a total of 42 elderly patients (＞60 years of age) with complete followup data meeting our inclusion criteria, had an undisplaced femoral neck fracture surgically treated by either the DHS or the cannulated screws. Functional results were evaluated using the Harris hip scoring system. The incision length, surgery time, hemoglobin level drop, blood transfusion, hospital stay, and overall success rates were recorded. Results: The surgery time, hospital stay, overall success rate, and hip score were similar between the two groups (p values＞0.34). The DHS group had larger operative wound, more hemoglobin level drop and higher blood transfusion rate than cannulated screw group (p values＜0.05). Conclusion: The advantages of cannulated screwing were less invasive surgery associated with a small incision, less blood loss, and lower rate of blood transfusion. The major advantage of the DHS was stable fixation with a high rate of overall success.

Mini-incision Hip Hemiarthroplasty for Femoral Neck Fracture Using an Anterolateral Approach

Background and Purpose: Minimally invasive surgery (MIS) is the future trend in all fields of surgery. No report was found to use MIS approach to treat femoral neck fractures with bipolar hemiarthroplasty. The objectives of this study are to present our technique in mini-incision hip hemiarthroplasty for femoral neck fracture using an anterolateral approach and to assess the early results using this technique. Methods: A total of 32 patients meeting our inclusion criteria, a traumatic femoral neck fracture treated by a cementless bipolar hemiarthroplasty using the anterolateral hip approaches between April 2004 and April 2005, were studied. Results: The mini-incision (MIS) anterolateral approach was performed on 14 (43.8%) patients and standard anterolateral approach on 18 (56.2%) patients. The wound size was significantly shorter in the MIS group (7.0±1.2 cm) than the standard group (14.3±1.2 cm). The operation duration was significantly shorter in the standard group (65.6±13.1 minutes), in comparison with the MIS group (77.4±14.9 minutes). A significant difference was seen in the post-operative and total blood loss for the MIS patients (303.6±181.2 mL, 490.1±195.0 mL) and for the standard group (571.4±269.4 mL, 814.2±277.4 mL). No statistical difference was noted between outcome scores. In the MIS group, 12 (85.7%) patients had an excellent result, and 2 (14.3%) had a good result. In the standard group, 15 (83.3%) patients were rated as an excellent result and 3 (16.7%) as a good result. Conclusion: Our data support that even though big skin incision was made, minimal soft tissue injures could achieve the same results as the small skin incision. Our data prove again that the lengths of skin incision are not the key in the MIS. We believe that bipolar hemiarthroplasty using the MIS anterolateral technique to treat displaced femoral neck fractures is a safe and feasible method.

Surgical Treatment of Midclavicular Fractures in the Elderly

Operative treatment of midclavicular fractures in patients older than 60 years poses an increased risk of fixation failure. Although plating of midclavicular fractures in the elderly is still a popular fixation method, osteopenic bone may result in plate loosening and fixation failure. The purpose of this study is to prospectively evaluate and compare the clinical outcomes of midclavicular fractures in patients older than 60 years who are treated with either a locking compression plate or nonlocking plate. Sixty-four elderly patients with midclavicular fractures were surgically treated with either a locking compression plate or nonlocking plate, which included dynamic compression plates and reconstruction plates. The locking compression plate group included 29 patients with an average age of 69.1 years. The nonlocking plate group included 35 patients with an average age of 66.3 years. Both groups were similar for age, gender, injury mechanism, fracture patterns, and confounding medical condition (P>.5). However, the locking compression plate group had lower complication rates compared to the nonlocking plate group (P=.087). In addition, the locking compression plate group had higher rates of return to work and exercise (P=.02, P=.016, respectively). If surgery of elderly patients with midclavicular fractures is indicated, internal fixation with a locking compression plate is preferable to a nonlocking plate.