Objective: To determine differences in outcome between undisplaced (Garden I and II) and displaced (Garden III and IV) femoral neck fractures in elderly patients treated with internal fixation.
Setting: University hospital.
Design: Prospective clinical study.
Patients: Ninety patients with an acute femoral neck fracture after a fall. The inclusion criteria were age older than sixty-five years, absence of severe cognitive dysfunction, independent living, and unhindered walking capability preoperatively. The mean follow-up was twenty-six months.
Intervention: The patients were treated with closed reduction and percutaneous internal fixation with two cannulated screws.
Main outcome measurements: Fracture healing complications, pain (visual analogue scale), walking capability, activities of daily living, and quality of life according to EuroQol.
Results: The rate of fracture healing complications in displaced femoral neck fractures in patients available at the final follow-up was 36 percent compared with 7 percent in patients with undisplaced fractures. The quality of life, according to EuroQol, of patients with uneventfully healed fractures was significantly lower in patients with primarily displaced fractures (0.51) than in patients with undisplaced ones (0.76).
Conclusion: There was a major difference in outcome on comparing undisplaced and displaced femoral neck fractures in elderly patients treated with internal fixation. The rate of fracture healing complications in patients with undisplaced fractures was low, and patients with healed fractures regained their prefracture quality of life level. The rate of fracture healing complications and reoperations in patients with displaced fractures was high, and even in patients with uneventfully healed fractures, there was a substantial decrease in the quality of life.