Calandruccio R A
Hip. 1983:9-33.
The following distinctions can be made between fractures of the femoral neck in elderly persons and similar fractures in younger patients: They are much more common in the elderly. They are more frequent in females than in males. There is a much higher incidence in the white than in the black population. Fractures of the opposite hip are more common in the elderly. Associated medical conditions in the elderly may make the patient more susceptible to falls and may increase the degree of osteopenia. There is a high rate of mortality in elderly patients within 1 year of the fracture. Minor trauma causes many of the fractures in elderly patients whereas severe trauma is usually the mechanism in younger ones. Osteopenia is more common in elderly women and places them at higher risk for fracture. Microfractures of the femoral head and neck may add to the high incidence of fracture in elderly persons. The anatomic configuration of the fracture is different in elderly patients, with impacted and displaced subcapital fractures more common. The incidence of union of the fracture is the same in older and younger patients, but in the older patient multiple pin fixation is necessary for impacted and nondisplaced fractures; also, in displaced fractures a device with side plate fixation is necessary to maximize fracture healing. The incidence of avascular necrosis is approximately the same in older and younger individuals, but revascularization of the avascular segment in older patients is a limited process. On the basis of these observations, fractures of the femoral neck in the elderly should be classified as pathologic fractures. There is a need for improved methods of reducing and treating nonunion and avascular necrosis, but also there is a need to obtain more data concerning factors related to the patient and to the quality of bone. Thus, it is hoped, some of these fractures can be prevented and better treatment can be provided.
在老年人中更为常见。女性比男性更频繁。白人中的发病率比黑人高得多。对侧髋部骨折在老年人中更常见。老年人的相关内科疾病可能使患者更容易跌倒，并可能增加骨质减少的程度。骨折后1年内老年患者的死亡率很高。轻微创伤导致许多老年患者骨折，而严重创伤通常是年轻患者骨折的机制。骨质减少在老年女性中更常见，使她们面临更高的骨折风险。股骨头和颈部的微骨折可能增加老年人骨折的高发病率。老年患者骨折的解剖结构不同，嵌插型和移位型头下骨折更常见。老年患者和年轻患者骨折愈合的发生率相同，但对于老年患者，嵌插型和无移位骨折需要多枚钢针固定；此外，对于移位骨折，需要使用带侧板固定的器械以最大限度促进骨折愈合。老年患者和年轻患者缺血性坏死的发生率大致相同，但老年患者缺血节段的再血管化过程有限基于这些观察结果，老年人股骨颈骨折应归类为病理性骨折。需要改进减少和治疗骨不连及缺血性坏死的方法，但也需要获取更多与患者及骨质质量相关因素的数据。因此，希望能够预防其中一些骨折并提供更好的治疗。
