Abstract
We present 25 cases of irreducible variant femoral neck fractures that require surgical
management after routine manipulative manoeuvre attempts have failed. In our study,
an irreducible variant of femoral neck fractures is defined as a reduction that cannot
be achieved after multiple attempts at closed reduction. This was evident radiographically,
as seen in displaced–impacted femoral neck fractures when the proximal femur compacts
and rotates along with the distal part, and anatomical reduction cannot be achieved
with manipulative manoeuvres. Another rare situation also included is when the proximal
fragment disconnects from the femur and dislocates as a ‘floating’ component, consequently
resulting in failure of alignment of the distal fragment to the proximal femur.
Here, we describe a technique, applied as a minimally traumatic procedure to achieve
anatomic reduction in such cases. With the patient placed in supine position on the
fracture table under general anaesthesia, the injury site is exposed and the procedure
performed under intra-operative radiographic control. Location of the femoral artery
is done first by palpation. The insertion site of the K-wires or Steinman pins on
the proximal thigh is 1.5–3 cm lateral to the femoral artery. The K-wires or Steinman pins are inserted vertically
into the middle 1/2–2/3 of the femoral head and more than 1 cm inferior to the sub-chondral bone of the femoral head to a depth of approximately,
1/2 diameter of the femoral head. The pins are then used as a joystick to control
the movement of the proximal femur. With the help of the K-wires, surgeons can manually
control the movement of the proximal femur and ensure anatomic reduction with the
distal fragment using routine-closed reduction. Three cannulated screws are used to
stabilise the fracture after anatomic reduction is achieved and maintained in a stable
position. All cases were treated with this minimally invasive procedure and internal
fixation, 25 fractures united, uneventfully, whilst two of them developed femoral
head necrosis at 10 months and 4.5 years postoperatively, respectively.
Keywords
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Article info
Publication history
Accepted:
May 3,
2010
Identification
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© 2010 Published by Elsevier Inc. All rights reserved.
