• T Kostuj, R Smektala, U Schulze-Raestrup, and C Müller-Mai.
• Abteilung für Unfallchirurgie, Chirurgische Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinik, Ruhr-Universität-Bochum, Bochum, Deutschland. tanja.kostuj@friedrichsheim.de
• Unfallchirurg. 2013 Feb 1; 116 (2): 131-7.

BackgroundThe current S2 guideline recommends treatment of a femoral neck fracture within the first 24 h; this becomes evident by the significant rise in general and early surgical complications, when the surgical treatment was delayed for more than 48 h. The influence of different surgical procedures was investigated. PATIENTS UND METHODS: A total of 22,566 records from the external Quality Assurance Program in North Rhine-Westphalia for treatment of femoral neck fractures in 2004/2005 (BQS specification 7.0 and 8.0) were risk-adjusted and evaluated.ResultsSurgery was performed within 48 h in 83.9% of the patients. A significant rise in general and early surgical complications was registered when the surgical treatment was delayed for more than 48 h. Mortality and general complications were significantly lower for percutaneous screw fixation. All kinds of joint replacement show significantly higher general and surgical complications.ConclusionThe analyzed data support the rating of femoral neck fracture as requiring the intervention of urgent early surgery, as stated in the guideline. Percutaneous screw fixation can be considered for immobile and multimorbid patients with undislocated fractures. Advantages of total hip replacement compared to hemiarthroplasty cannot be supported by the QS-NRW data.

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