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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2014 August;65(4):271-7
Surgical treatment of displaced femoral neck fracture adopting a physiologic score system. A retrospective analysis of 323 patients
Liu Y. 1, 2, Li H. 1, 2, Zhang Y. 1, 2
1 Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China;
2 Key Orthopedics Biomechanics, Laboratory of Hebei Province, Shijiazhuang, P.R. China
AIM: The purpose of this report was to design a physiologic score system for displaced adult femoral fractures and achieve a standard surgical method.
METHODS: We performed a retrospective analysis (follow-up 34±4 months) on 323 patients who had displaced femoral fractures through a physiologic score system (PSS). The patients who achieved a PSS of 1-6 and 18-20 should be managed by reduction and internal fixation, PSS of 7-12 and 13-17 with total hip replacement and hemiarthroplasty respectively. Each group was further divided into a consistency group and inconsistency group based on whether treated with PSS or not.
RESULTS: For internal fixation, the non-union rate and reoperation rate of the consistency group were significantly lower than in the inconsistency group (14% vs. 35.5%, 24.7% vs. 51.6%, respectively), with significantly higher Harris Hip Score (HHS) (88.4±8.2 vs. 75.1±11.1) (P<0.05). For total hip replacement, the revision rate and HHS were both significantly different (3.5% vs. 22.2%, 92±6.4 vs. 84.6±12.3, respectively) (P<0.05). For hemiarthroplasty, the revision rate in the consistency group was significantly lower (3.6% vs. 17.3%) (P<0.05). The Kappa value (0.50) of the consistency test indicated that PSS had good consistency with clinical practice.
CONCLUSION: We concluded the management protocol of PSS is highly consistent with clinical practice, and maybe useful to help doctors choose optimal surgical method for patients with displaced femoral neck fractures.