Hip fractures in elderly people. The surgical treatment in Leuven, Belgium

From 1978 to 1990 inclusive more than 1,200 patients above 70 years of age have been treated surgically for a hip fracture at the University Hospitals of Leuven. Intracapsular fractures were classified as to Garden and extracapsular fractures as to Evans. The physical and mental conditions of the patients at the time of the accident were largely determining the choice of the treatment, a treatment that held quo ad vitam only little risk for the patient and that permitted early weight bearing on the operated limb. We concluded that: Stable intracapsular fractures have to be treated with simple cancellous bone screws. For unstable intracapsular fractures, a total hip prosthesis is the best solution; hemiarthroplasty must be reserved for high risk patients with a limited life expectancy. Nearly all type 1 pertrochanteric fractures can be treated with a (modified) dynamic hip screw technique. Prosthetic surgery is only indicated in very complex type 1d fractures. For type 2 fractures, the gamma-nail is (may be) the best solution.