RADIOGRAPHIC ASSESSMENT OF FRACTURE NECK OF FEMUR IN THE ELDERLY AND ITS CORRELATION WITH CLINICAL OUTCOME: A HOSPITAL-BASED CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.48047/500bvd80Keywords:
Garden classification, femoral neck fracture, arthroplasty, avascular necrosis, Harris Hip ScoreAbstract
Background: Fracture of the neck of the femur is a common, disabling injury of the elderly, driven by osteoporosis and low-energy falls. Plain radiographic classification—principally the Garden and Pauwels systems—guides the choice between internal fixation and arthroplasty and predicts complications such as avascular necrosis and nonunion. Understanding the relationship between radiographic pattern and clinical outcome is central to rational management. Objectives: To describe the radiographic profile of femoral neck fractures in elderly patients, and to correlate the radiographic classification with treatment and clinical outcome, at a tertiary care hospital in South India. Methods: In this hospital-based cross-sectional study, 250 elderly patients (≥60 years) with a femoral neck fracture underwent standardised anteroposterior and lateral radiographic assessment with Garden and Pauwels classification, and were followed for a protocol-defined interval. Treatment, functional outcome (Harris Hip Score, pain, mobility) and complications were recorded. Results: The mean age was 72.9 ± 7.3 years (60.0% female); 80.4% of fractures followed a trivial fall and 54.4% had diagnosed osteoporosis. By the Garden classification, 13.2% were type I, 17.2% type II, 35.6% type III and 34.0% type IV, giving a displaced-fracture rate of 69.6%; Pauwels type II predominated (38.0%). Arthroplasty was performed in 63.2% (hemiarthroplasty 38.0%, total hip replacement 25.2%) and internal fixation in 36.8%. At a mean follow-up of up to 12 months, the mean Harris Hip Score was 79.0 ± 10.7 and 60.0% had returned to their pre-fracture mobility. Complications included reoperation (14.8%), delirium (14.0%), avascular necrosis (5.6%), nonunion (5.6%), surgical-site infection (4.8%) and deep-vein thrombosis (3.6%); in-hospital/short-term mortality was 5.6%. Among displaced fractures treated by internal fixation, avascular necrosis occurred in 28.1%. Conclusion: Displaced (Garden III–IV) fractures predominated and were managed mainly by arthroplasty, with good functional recovery and low mortality, whereas internal fixation of displaced fractures carried a high avascular-necrosis and reoperation burden. Radiographic classification remains central to treatment selection and outcome prediction
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