Grote variatie in indicaties voor interne fixatie of artroplastiek bij de gedislokeerde mediale collumfractuur; enquête onder algemeen chirurgen in 20 ziekenhuizen

To describe the treatment protocols for displaced femoral neck fractures in all 8 university hospitals (UH) and 12 general hospitals (GH).

Design

Descriptive; questionnaire.

Method

Questionnaires were distributed to general surgeons who also perform traumatology surgery. They were requested to give succinct answers to questions about local protocol for the maximum permissible time interval between hip trauma and operation, indications for internal fixation and arthroplasty, operative technique and postoperative degree of weight-bearing in patients over 60 years of age with a displaced femoral neck fracture.

Results

Internal fixation and arthroplasty were performed within 24 and 48 hours respectively in 95 of all hospitals. A biological upper age limit of between 65 and 80 years old was the most commonly quoted indication for internal fixation in 70 of all hospitals. In 83 of GH dementia was considered an indication for arthroplasty as opposed to 0 in UH. Poor bone quality, immobility, comminution and inadequate reduction were incidentally quoted indications for arthroplasty. Rheumatoid arthritis, arthrosis and pathological fracture were contra-indications for internal fixation in all hospitals. Operative techniques for internal fixation and arthroplasty were similar in both UH and GH. After internal fixation, full weight-bearing was recommended in all UH and partial weight-bearing in 7 (58) of GH. Following arthroplasty all protocols prescribed full weight-bearing.

Conclusion

The variation in indications for internal fixation or arthroplasty reflects the lack of studies that demonstrate clearly which patient can be treated optimally with which treatment modality. There were few differences in the operative techniques of internal fixation and arthroplasty between the hospitals.

Ned Tijdschr Geneeskd 2005;149:984-91