Up-to-Date Management of Severe End-Stage Femoral Head Osteonecrosis, Subcapital and Femoral Neck Fracture in Extreme Elderly Patient with Low Income Treated at Kisarawe District Hospital, Tanzania from July 2025 - May 2026- Five Case Series Report.
DOI:
https://doi.org/10.47941/ijhs.3914Keywords:
Femoral Head Osteonecrosis, Subcapital Femoral Fracture, Transcervical Femoral Neck Fracture, Bipolar Hemiarthroplasty. (Partial Hip Replacement).Abstract
Purpose: Our current case series reports aim to report injury, explain the mechanism of injury, its clinical presentation, current goal-standard treatment, prognosis and the short-term functional outcome. In Tanzania and other developing countries, most fracture and pathology around hip joint in elderly population are not well-reported.
Methodology: Convenience sampling method was used whereby 5 patients who were 61 to 90 years of age was approached with 4 having displaced femoral neck fractures and 1 with severe femoral head osteonecrosis. All underwent partial hip replacement or hemiarthroplasty; all patients enrolled in the study were ambulant without assistance before injury. The study was conducted in the orthopaedic department clinic and emergency department at Kisarawe Hospital.
Findings: A complete and displaced nonunion femoral neck fracture was identified with avuscular femoral head with no sign of bone-to-bone union. It was therefore concluded that the preferred management of severe end-stage femoral head osteonecrosis, femoral neck and subcapital femoral fractures in extremely aged patients was open surgical removal of head and neck followed by replacement with total hip or partial hip arthroplasty. However, children and young adults need hip preservation surgery.
Unique Contribution to Theory, Practice and Policy: It is therefore recommended to orthopedic and trauma surgeon to take care for any patient with hip trauma in history taking, examination and radiological investigation to immediately diagnose the type of hip fracture or pathology and whether it is subcapital or femoral neck. In cases of severe end-stage osteonecrosis, subcapital or femoral neck fracture in extreme elderly patients, an emergency surgical posterior [Kocher-Langenbeck] or anterior [Watson-Jones] approach, etc., must be adopted immediately without delay to remove the avascular head and replace it with an artificial hip component [partial or total hip arthroplasty] depending on availability, experience and patient cost-effectiveness.
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Copyright (c) 2026 Dr Elibariki J. Munuo MD, Mmed, Dr. Faiton Ndesanjo Mandari, MD, MSc (Edin, UK), MMed, Dr Justin Myala, AMO
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