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Individualised therapy of femoral neck fractures - The Wiesbaden concept
By Michael Schneider, Karl Philipp Kutzner, Alexander Walz, Yves Gramlich, Joachim Pfeil in category POINT OF VIEW
Clinic for Orthopedics and Traumatology; St. Josefs Hospital Wiesbaden, Germany
The incidence of femoral neck fractures increases continuously (Johnell et al. 2005). There is a wide variation across the world showing highest rates for Europe and North America. Within Europe incidence rates vary between North and South, showing highest rates in Sweden and Norway (women 920/100.000 and men 399.3/100.000) and lowest in France and Switzerland (women 346/100.000 and men 137,8/100.000) (Sambrook and Cooper 2006).
Ageing of our population will increase numbers and there is an expected rise from 1.7 million hip fractures in 1990 up to 6.2 million in 2050. Assuming an age related incidence increase by 1% 8.2 million cases are predicted (Filipov, 2014).
Femoral neck fractures and pertrochanteric fractures are of approximately equal incidence. Treatment options of femoral neck fractures include conservative treatment, joint preservation techniques using osteosynthesis (i.e. DHS and screws) or joint replacement techniques with total (THA) or hemi arthroplasty (HA).
The minority of patients is treated conservatively. Non displaced cases (Garden I), valgus impacted fractures (Pauwels 1) or decreased general health status with contraindications for operative treatment are considered options. However pseudarthrosis (32%) and AVN (10%) can occur quite...
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