Session X - Pelvis/Geriatrics

Functional Outcomes of Nondisplaced Femoral Neck Fractures in Elderly Patients

Jesse G. Eisler, MD, PhD; Roger Cornwall, MD; Elton Strauss, MD; Kenneth Koval, MD; Albert Siu, MD; Marvin S. Gilbert, MD, The Mount Sinai Medical Center and The Hospital for Joint Diseases, New York, NY

Purpose: In a prospective cohort study of geriatric patients, we evaluated the outcome of nondisplaced femoral neck fractures in isolation from other hip fracture types.

Methods: Seventy patients with nondisplaced femoral neck fractures were followed prospectively from the time of injury to the 6-month follow-up. Pre-injury Functional Independence Measure (FIM) scores and co-morbidities were recorded. All patients were treated with percutaneous cannulated screw fixation. Operative time, anesthesia type, estimated blood loss, transfusion requirements, and postoperative complications were recorded. At 3- and 6-month follow-up, FIM scores were again assessed and mortalities were noted.

Results. The mean age of the patients was 78 years, and overall mortality was 5.7%. All patients had lost a mean of 14% of initial overall FIM score at 3 months, but ultimate FIM scores at 6 months were 90% of the initial FIM scores. Locomotion FIM scores at the 3- and 6-month follow-up were slightly worse, at 70% and 85% of initial score, respectively. Multiple regression analysis found age and initial overall FIM score to be independent predictors of overall FIM score at the 3-month follow-up (P <0.05). However, at the 6-month follow-up, only the initial FIM score was predictive of the ultimate overall FIM score. This result suggests that age may affect the speed of return to function but not the ultimate function regained. Of the co-morbidities, only the presence of neurological disease significantly affected 3- and 6-month functional outcome (P <0.05, linear regression). Operative time, estimated blood loss, type of anesthesia, and patient gender did not affect functional outcome (P >0.05, multiple linear regression).

Conclusions. Although nondisplaced femoral neck fractures can be readily stabilized by a minimally invasive operation, with early weight-bearing allowed, patients who sustain this injury experience a predictable and lasting loss of function. Low overall functional status and presence of neurologic disease at the time of injury are predictive of poorer outcomes.