Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate

Background: A significant increase in the prevalence of intracapsular femoral neck fractures in the elderly population was reported but the best treatment is still debated. Aim: To evaluate the mortality rate and the reoperation rate of stable neck fractures treated with cannulated screw fixation in elderly patients. Methods: This was a retrospective study of patients older than 60 years with a Garden I or II femoral neck fractures treated with cannulated screw fixation without capsulotomy. A total of 244 patients (246 hips) who underwent surgery between 2008 and 2018 were included. The average age at the time of surgery was 80 years (range 60–99 years). The mean ASA score was 2.64 (range 1–4). Mortality rate, complications, reoperation rate, the time elapsed between surgeries were recorded. Results: The mortality rate was 50.0%. There were 16 mortalities (6.6%) in the first-month follow-up. We observed higher mortality rates in ASA 4 (80.8%). In 22 patients (8.9%), complications after surgery were observed, and in 11 patients (4.5%) underwent conversion surgery to hemiarthroplasty at a mean of 14.6 months (range 2–48 months) after the femoral screw fixation. Two patients were treated with hardware removal and Gamma Nail for a peri-implant subtrochanteric femur fracture. Interpretation: Cannulated screw fixation should be considered a valid option in intraarticular femoral Garden I–II fractures in elderly patients. Level of evidence: Level IV, therapeutic study.