A critical analysis of operative management of fracture neck of femur at the Kenyatta National Hospital orthopaedic unit over a five-year period

Abstract

A total of 122 patients were operated for femoral neck fracture at the orthopaedic unit of Kenyatta National Hospital in the period January 1976 to December 1980. Available records of 71 patients were reviewed. Only 42 of these were followed up for periods ranging between one and six years. Sixty (84.5%) of the patients sustained fractures following road traffic accidents. The rest of the patients developed fractures either as a result of attacks by animals (7.0%), or following a fall (5.6%). Two patients (2.8%) had pathological fractures. All the patients presented themselves to hospital within 24 hours of injury but definitive and appropriate management was long delayed sometimes even up to 20 weeks for those referred from District and Provincial hospitals. Surprisingly two thirds of the patients were below the age of sixty. Four types of operative management were noted. 1. Traditional method of reducing the fracture on an orthopaedic table, temporary fixation by guide wires under x-ray control and fixation with Smith Patterson nail or McLaughlin's pin and plate. 2. Open reduction of the fracture and fixation with 130°fixed angle plate according to AO group. 3. Primary prosthetic replacement. 4. Excision arthroplasty. The results of these different treatments are critically analysed and conclusions drawn. Some suggestions are made as to the future planning of the treatment of femoral neck fractures in the Country.