J Korean Orthop Assoc.  2007 Dec;42(6):772-780. 10.4055/jkoa.2007.42.6.772.

Results of Screw Fixation for Displaced Femoral Neck Fracture

Affiliations
  • 1Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea. choi8422@yumc.yonsei.ac.kr

Abstract

PURPOSE: This study retrospectively reviewed the results of a closed reduction and internal fixation with cannulated screws for a displaced femoral neck fracture.
MATERIALS AND METHODS
Among 631 patients between January 1991 and December 2000, 27 patients classified as Garden stage III or IV were treated with a closed reduction and internal fixation with cannulated screws. The mean follow-up duration was 4.5 years. The mean age of the patients was 56.5 years.
RESULTS
Union and the restoration of function was observed in 15 cases (55.6%), and failure occurred in 12 cases (44.4%). The cause of failure was early stage reduction loss due to a failure to obtain anatomical reduction on the surgical field in 4 cases, reduction loss and displacement during the follow up period after an appropriate reduction at surgery in 4 cases and avascular necrosis in 4 cases. Seven cases were converted to a total hip arthroplasty, 4 cases were converted to bipolar hemiarthroplasty and 1 case is currently being followed up.
CONCLUSION
A closed reduction and internal fixation for displaced femoral neck fracture showed a high failure rate. Therefore, an accurate anatomical reduction, firm internal fixation and efforts to prevent further unnecessary vascular injury will be needed to reduce the high failure rate and complications.

Keyword

Femoral neck fracture; Closed reduction; Internal fixation

MeSH Terms

Arthroplasty, Replacement, Hip
Femoral Neck Fractures*
Femur Neck*
Follow-Up Studies
Hemiarthroplasty
Humans
Necrosis
Retrospective Studies
Vascular System Injuries

Figure

  • Fig. 1 A typical clinical example: 58-year-old woman, Garden IV fracture (A, B). Cannulated screw fixation was performed within 11 hours of the injury (C, D). 1 year postoperatively: fracture has consolidated (E), and the hardware was removed at 30 months (F).

  • Fig. 2 Examples of reduction failure and inadequate internal fixation. 45-year-old man, Garden IV fracture (A, B). After surgery, displacement and shortening of the lower extremity developed but the patient had no specific complaints except for limping (C, D). On the X-ray taken 18 months after surgery, nonunion was suspected but there was posteromedial support (E). Twenty four months after surgery, the X-ray shows union (F), and the hardware was removed (G).

  • Fig. 3 62-year-old-woman, Garden IV fracture (A). Cannulated screw fixation was performed and an anatomic reduction and acceptable internal fixation was obtained (B). Three months after surgery, a loss of reduction and displacement had developed (C). The treatment was converted to bipolar hemiarthroplasty (D).

  • Fig. 4 62-year-old-woman, Garden IV fracture (A). After fixation with 3 cannulated screws, successful union was noted (B). However, avascular necrosis developed at the followup (C). Total hip arthroplasty was performed (D).


Reference

1. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am. 1994. 76:1793–1803.
Article
2. Banks HH. Factors influencing the result in fractures of the femoral neck. J Bone Joint Surg Am. 1962. 44:931–964.
Article
3. Banks HH. Nonunion in fractures of the femoral neck. Orthop Clin North Am. 1974. 5:865–885.
Article
4. Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of the femur. A prospective review. J Bone Joint Surg Br. 1976. 58:2–24.
Article
5. Bosch U, Schreiber T, Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res. 2002. 399:59–71.
Article
6. Bray TJ, Smith-Hoefer E, Hooper A, Timmerman L. The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison. Clin Orthop Relat Res. 1988. 230:127–140.
7. Chang JS, Shon WY, Shin HC, Chae DJ, Lee SH. A clinical study of treatment of displaced fractures of femur neck with internal fixation in elderly patients. J Korean Orthop Assoc. 1992. 27:131–138.
Article
8. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002. 399:110–118.
Article
9. Fekete K, Laczko T, Floris I, Cserhati P, Tasnadi L. Treatment of femoral neck fractures in Hungary with the Manninger screw. Injury. 2002. 33:Suppl 3. C19–C23.
Article
10. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br. 1971. 53:183–197.
Article
11. Garden RS. Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am. 1974. 5:683–712.
Article
12. Garden RS. Stability and union in subcapital fractures of the femur. J Bone Joint Surg Br. 1964. 46:630–647.
Article
13. Jackson M, Learmonth ID. The treatment of nonunion after intracapsular fracture of the proximal femur. Clin Orthop Relat Res. 2002. 399:119–128.
Article
14. Lee JO, Cho HC, Lee DH, Gang SB, Lee JH, Yoon KS. Reduction and fixation of femoral neck fractures in patients older than 65 years. J Korean Hip Soc. 2005. 17:34–39.
15. Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res. 1980. 152:162–172.
16. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994. 76:15–25.
Article
17. Lunceford EM Jr. Use of the moore self-locking vitallium prosthesis in acute fractures of the femoral neck. J Bone Joint Surg Am. 1965. 47:832–841.
Article
18. Manninger J, Kazar G, Fekete G, et al. Significance of urgent (within 6h) internal fixation in the management of fractures of the neck of the femur. Injury. 1989. 20:101–105.
19. Manninger J, Kazar G, Fekete G, Nagy E, Zolczer L, Frenyo S. Avoidance of avascular necrosis of the femoral head, following fractures of the femoral neck, by early reduction and internal fixation. Injury. 1985. 16:437–448.
Article
20. Protzman RR, Burkhalter WE. Femoral neck fractures in young adults. J Bone Joint Surg Am. 1976. 58:689–695.
21. Smith FB. Effects of rotatory and valgus malpositions on blood supply to the femoral head:Observations at arthroplasty. J Bone Joint Surg Am. 1959. 41:800–815.
22. Stromqvist B, Hansson LI, Ljung P, Ohlin P, Roos H. Pre-operative and postoperative scintimetry after femoral neck fracture. J Bone Joint Surg Br. 1984. 66:49–54.
Article
23. Szita J, Cserhati P, Bosch U, Manninger J, Bodzay T, Fekete K. Intracapsular femoral neck fractures: the importance of early reduction and stable osteosynthesis. Injury. 2002. 33:Suppl 3. C41–C46.
Article
24. Whittaker RP, Abeshaus MM, Scholl HW, Chung SM. Fifteen years' experience with metallic endoprosthetic replacement of the femoral head for femoral neck fractures. J Trauma. 1972. 12:799–806.
Article
Full Text Links
  • JKOA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr