Early functional outcome of Operative treatment of displaced Femoral neck fractures in two Kenyan Orthopaedic centres

Abstract

Background: Worldwide, the incidence of fracture neck of femur (FNF) has been projected to increase significantly. FNF increases both morbidity and mortality especially to the elderly. Locally, majority of these fractures occur in young economically productive individuals, mainly following road traffic injuries. The functional outcome of these fractures has however not been well studied in Kenya. Objective: To determine the early functional outcome following operative treatment of displaced FNF. Design and setting: A six months prospective cohort study was conducted between 12th November, 2008 and 11th May, 2009 at Kenyatta National Hospital (KNH) and Kikuyu Mission Hospital (KMH), in Kenya. Patients and methods: Sixty consecutive patients were enrolled using a pre-tested questionnaire. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) was used to determine the functional state before injury and at three months post-operatively. The functional outcome measures included pain, stiffness and activities of daily living (ADL). Data were analyzed using the Statistical Package for the Social Sciences (SPSS). The Student's t-test and / test were used for comparison between variables as appropriate; a p value < 0.05 was considered statistically significant. The results are presented as tables, graphs, bar charts and pie charts. Results: There were 41 males and 19 females. The age ranged from 18 to 96 years (mean: 51.6:::: 18.2). Osteosynthesis, using multiple screws or Dynamic Hip Screws was the main method of treatment (24 patients). Eighty eight percent of the patients had a meannegative early functional outcome score. Hemiarthroplasty and THA had a similar earlypost-operative functional outcome while OS had a poorer ADL outcome. There was no correlation between the pre-operative duration and functional outcome. Prolonged hospital stay was associated with a poor ADL outcome (p value 0.020). The use of the antero-lateral approach to the hip was associated with a better ADL outcome compared to the lateral approach in patients above 50 years of age (p value 0.007). Both spinal and general anaesthesia resulted in similar early functional outcome. Conclusions: At three months post-operatively, most patients had not fully recovered their pre-injury level of function and independence. Both HA and THA were associated with better early functional outcome compared to OS.