Abstract
Aim
To assess whether disruption of the posterior cortex of intracapsular femoral fractures
leads to an increased incidence of complications following closed reduction and internal
fixation by multiple cannulated screws in young adults.
Methods
A total of 146 consecutive adult patients with 146 femoral neck fractures were treated
by closed reduction and internal fixation with parallel cannulated screw in inverted
triangle or diamond configurations. All enrolled patients were divided into three
groups: those with a non-displaced femoral neck fracture (Garden types I or II), those
with a displaced femoral neck fracture (Garden types III or IV) but no posterior cortex
disruption and those with a displaced femoral neck fracture (Garden types III or IV)
and a disrupted posterior cortex.
Results
Based on an average follow-up of 4.76 years (range, 2–6 years), displaced femoral
neck fractures with a disrupted posterior cortex demonstrated an increased risk for
avascular necrosis of the femoral head, shortening, redisplacement and conversion
of prosthetic replacement as compared with those fractures without posterior cortex
disruption (p = 0.002, 0.016, 0.001 and <0.0001, respectively).
Conclusions
As compared with a femoral neck fracture with an intact posterior cortex, a displaced
femoral neck fracture with a disrupted posterior cortex increases the risk for avascular
necrosis, redisplacement and shortening and raises the likelihood that prosthetic
replacement will be needed. Orthopaedic surgeons should be aware of this prognostic
factor.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prediction of fixation failure in femoral neck fractures. Comminution and avascularity studied in 40 patients.Acta Orthop Scand. 1993; 64: 408-410
- Salvage of failed hip fracture fixation.J Orthop Trauma. 2009; 23: 471-478
- Intracapsular fractures of the femoral neck. Results of cannulated screw fixation.J Bone Joint Surg Am. 1994; 76: 1793-1803
- Factors influencing the result in fractures of the femoral neck.J Bone Joint Surg Am. 1962; 44: 931-964
- Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis.J Bone Joint Surg Am. 2003; 85-A: 1673-1681
- Reduction and fixation of displaced intracapsular fractures of the proximal femur.Clin Orthop Relat Res. 2002; : 59-71
- Femoral neck fracture fixation. Clinical decision making.Clin Orthop Relat Res. 1997; : 20-31
- The blood supply of the femoral neck and head in relation to damaging effects of nails and screws.J Bone Joint Surg Br. 1960; : 42
- Delayed fixation of displaced femoral neck fractures in younger adults.Injury. 2008; 39: 238-243
- Surgical treatment of basicervical fractures of femur – a prospective evaluation of 269 patients.J Trauma. 2008; 64: 427-429
- Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases.Injury. 1996; 27: 583-588
- Pre-radiologic stage of femur head osteonecrosis: diagnostic and therapeutic possibilities.Rev Chir Orthop Reparatrice Appar Mot. 1973; 59: 26-38
- Intracapsular fractures of the neck of the femur. Factors influencing non-union and ischaemic necrosis.J Bone Joint Surg Br. 1966; 48: 17-30
- Low-angle fixation in fractures of the femoral neck.J Bone Joint Surg Br. 1961; 43: 647-663
- Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years.J Bone Joint Surg Am. 2004; 86-A: 1711-1716
- Lavelle D. Delayed union and nonunion of fractures. 10th ed. Mosby, Philadelphia2003
- Leighton R Fractures of the neck of the femur. Lippincott Williams and Wilkins, Philadelphia2006
- Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method.J Orthop Trauma. 1995; 9: 215-221
- Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures.Injury. 2003; 34: 525-528
- Undisplaced femoral neck fractures – no problems? A consecutive study of 224 patients treated with internal fixation.Injury. 2009; 40: 274-276
- Intracapsular fractures of the femoral neck. Comminution of the posterior neck cortex as a cause of unstable fixation.J Bone Joint Surg Am. 1959; 41-A: 1187-1200
- The significance of posterior comminution in femoral neck fractures.Clin Orthop Relat Res. 1980; : 138-142
- Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis.J Bone Joint Surg Am. 1970; 52: 457-467
- Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction.J Bone Joint Surg Br. 2004; 86: 1035-1040
- Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function.J Trauma. 2008; 64: 163-169
- The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study.J Bone Joint Surg Br. 2008; 90: 1487-1494
- The value of washers in cannulated screw fixation of femoral neck fractures.J Trauma. 2005; 59: 969-975
Article info
Publication history
Accepted:
October 13,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
