Hip Pelvis.  2016 Mar;28(1):35-42. 10.5371/hp.2016.28.1.35.

The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures

• Jo S
• Lee SH
• Lee HJ

• KMID: 2161313
• DOI: http://doi.org/10.5371/hp.2016.28.1.35

Abstract

PURPOSE
This study aims to determine the correlation between the fracture patterns and the complications in patients with femoral neck fracture treated with internal fixation.
MATERIALS AND METHODS
The study comprises 45 patients with femoral neck fracture treated with multiple screws or compression hip screw between May 2008 and April 2012. The mean age was 48 years at the time of the surgery and the mean duration from initial injury to surgery was 20 hours. The fracture patterns were identified according to the anatomical location, the Garden classification and the Pauwels classification. The occurrence of nonunion and avascular necrosis were reviewed with clinical results including Harris hip score and Lunceford hip function test. The correlation between the fracture pattern and occurrence of complications were analyzed.
RESULTS
Fracture site union was achieved in 40 hips with the average union time of 17 weeks. Five nonunions occurred which showed high likelihood to occur in subcapital type, displaced (Garden stage III or IV) and Pauwels type III fractures (P<0.05). Avascular necrosis was developed in 10 hips which was mostly in subcapital type and Pauwels type III fracture but no statistical significance was found (P>0.05). The mean Harris hip score was 91 points, and Lunceford functional results were excellent in 15 hips, good in 24, fair in 4 and poor in 2.
CONCLUSION
There was high risk of nonunion in subcapital type fracture, displaced fracture (Garden stage III and IV) and vertically oriented fracture (Pauwels type III). Careful attention is needed in these fracture types.

Keyword

Avascular necrosis; Femur neck fractures; Internal fixation; Nonunion

MeSH Terms

Classification
Femoral Neck Fractures*
Femur Neck*
Hip
Humans
Necrosis

Figure

• 

  Fig. 1 (A) Simple anteroposterior radiograph of pelvis shows nondisplaced femoral neck fracture. (B, C) Immediate postoperative radiographs showing internal fixation with 3 cannulated screws. (D, E) Postoperative 2 years and 8 months radiograph showing bone union without complications.

• 

  Fig. 2 (A) Simple anteroposterior radiograph of pelvis shows displaced basiceervical type femoral neck fracture. (B, C) Immediate postoperative radiographs showing internal fixation with compression hip screw. (D, E) Postoperative 2 years and 3 months radiograph showing bone union without complications.

• 

  Fig. 3 (A) Simple anteroposterior radiograph of pelvis shows displaced femoral neck fracture. (B, C) Immediate postoperative radiographs showing internal fixation with 4 cannulated screws. (D) Postoperative 3 years and 6 months radiograph showing avascular necrosis of right femoral head. (E) Secondary postoperative radiograph of pelvis showing total hip arthroplasty.

Reference

1. Kaplan T, Akesen B, Demirağ B, Bilgen S, Durak K. Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures. Ulus Travma Acil Cerrahi Derg. 2012; 18:65–70.

2. Pauyo T, Drager J, Albers A, Harvey EJ. Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop. 2014; 5:204–217.

3. Yang JJ, Lin LC, Chao KH, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am. 2013; 95:61–69.

4. Bhandari M, Devereaux PJ, Tornetta P 3rd, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005; 87:2122–2130.

5. Huang TW, Hsu WH, Peng KT, Lee CY. Effect of integrity of the posterior cortex in displaced femoral neck fractures on outcome after surgical fixation in young adults. Injury. 2011; 42:217–222.

6. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am. 2002; 84-A:1605–1612.

7. Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am. 2005; 87:1680–1688.

8. Szita J, Cserháti 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.

9. Alho A, Benterud JG, Solovieva S. Internally fixed femoral neck fractures. Early prediction of failure in 203 elderly patients with displaced fractures. Acta Orthop Scand. 1999; 70:141–144.

10. Min BW, Bae KC, Kang CH, Song KS, Kim SY, Won YY. Valgus intertrochanteric osteotomy for non-union of femoral neck fracture. Injury. 2006; 37:786–790.

11. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. 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.

12. Bray TJ. Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res. 1997; (339):20–31.

13. 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.

14. Khoo C, Haseeb A, Ajit Singh V. Cannulated screw fixation for femoral neck fractures: A 5-year experience in a single institution. Malays Orthop J. 2014; 8:14–21.

15. Nikolopoulos KE, Papadakis SA, Kateros KT, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury. 2003; 34:525–528.

16. van Embden D, Roukema GR, Rhemrev SJ, Genelin F, Meylaerts SA. The Pauwels classification for intracapsular hip fractures: is it reliable? Injury. 2011; 42:1238–1240.

17. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am. 2008; 90:2254–2266.

18. Callaghan JJ, Liu SS, Haidukewych GJ. Subcapital fractures: a changing paradigm. J Bone Joint Surg Br. 2012; 94:11 Suppl A. 19–21.

19. Leonardsson O, Sernbo I, Carlsson A, Akesson K, Rogmark C. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients. J Bone Joint Surg Br. 2010; 92:406–412.

20. Parker MJ, Dynan Y. Is Pauwels classification still valid? Injury. 1998; 29:521–523.