Internal Fixation of Femoral Neck Fractures

Abstract

__Abstract__ This thesis consists of three parts. Part 1 described aspects of the organization of trauma related trials. Part 2 analyzed the uniformity of current femoral neck fracture treatment and adherence to the Dutch guideline on hip fracture treatment. The implications of treatment with internal fixation on health care costs were also described. Part 3 focused on aspects on functional outcome after internal fixation of a femoral neck fracture. In summary, this thesis provides evidence that: • A central, financed trial coordinator to manage all trial related tasks in participating sites is a recommended strategy to improve trial progression (Chapter 2) • Adequate knowledge on the International Conference of Harmonization-Good Clinical Practice (ICH-GCP) guideline is important when conducting an implant trial in orthopedic trauma surgery (Chapter 3) • The current treatment of femoral neck fracture patients is in agreement with the Dutch national guideline in at least 74% of patients (Chapter 4) • The current treatment of non-simultaneous bilateral femoral neck fractures is uniform in 73-88% of patients (Chapter 5) • In and out of hospital cost of internal fixation of femoral neck fracture patients is approximately €16,000 at one year follow-up and €19,000 at two years follow-up (Chapter 6) • Internal fixation of femoral neck fracture patients leads to femoral neck shortening and secondary permanent physical limitations in a majority of patients (Chapter 7) • Salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture (Chapter 8) • Implant removal positively influences function-related quality of life in patients after internal fixation with persisting pain or unsatisfactory functional recovery (Chapter 9) • The physical therapy that femoral neck fracture patients receive after internal fixation generally consists of active movement, functional exercise, and independent practice for less than two times a week, during 20 weeks (Chapter 10