Abstract
This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years’ follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.
Similar content being viewed by others
References
Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years.J Bone Joint Surg Br. 2002;84(2):183–188.
Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis.J Bone Joint Surg Am. 2003;85-A(9): 1673–1681.
Partanen J, Saarenpaa I, Heikkinen T, Wingstrand H, Thorngren KG, Jalovaara P. Functional outcome after displaced femoral neck fractures treated with osteosynthesis or hemiarthroplasty: a matched-pair study of 714 patients.Acta Orthop Scand. 2002;73(5):496–501.
Skinner P, Riley D, Ellery J, Beamont A, Coumine R, Shafighian B. Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement.Injury. 1989;20(5):291–293.
Dedrick DK, Mackenzie JR, Burney RE. Complications of femoral neck fracture in young adults.J Trauma. 1986;26(10):932–937.
Holmberg S, Kalen R, Thorngren KG. Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes.Clin Orthop. 1987;(218):42–52.
Garden RS. Low-angle fixation in fractures of the femoral neck.J Bone Joint Surg Br. 1961;43: 647–663.
Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur.J Bone Joint Surg Br. 1965;47:560–573.
Trueta J, Harrison MHM. The normal vascular anatomy of the femoral head in adult man.J Bone Joint Surg Br. 1953;35(3):442–461.
Arnoldi CC, Lemperg RK. Fracture of the femoral neck. II. Relative importance of primary vascular damage and surgical procedure for the development of necrosis of the femoral head.Clin Orthop. 1977;(129):217–222.
Claffey TJ. Avascular necrosis of the femoral head: an anatomical study.J Bone Joint Surg Br. 1960;42:802–809.
Mussbichler H. Arteriographic investigation of the hip in adult human subjects.Acta Orthop Scand. 1970;132:32–36.
Parker MJ, Pryor GA, Myles JW. The value of a special surgical team in preventing complications in the treatment of hip fractures.Int Orthop. 1994;18:184–188.
Rogers FB, Shackford SR, Keller MS. Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls.J Trauma. 1995;39:261–265.
Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip.J Bone Joint Surg Am. 1995;77:1551–1556.
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.
Nilsson LT, Strömqvist B, Thorngren KG. Nailing of femoral neck fracture. Clinical and sociologic 5-year follow-up of 510 consecutive hips.Acta Orthop Scand. 1988;59:365–371.
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(1):15–25.
Finsen V, Borset M, Buvik GE, Hauke I. Preoperative traction in patients with hip fractures.Injury. 1992;23(4):242–244.
Hirata T, Konishiike T, Kawai A, Sato T, Inoue H. Dynamic magnetic resonance imaging of femoral head perfusion in femoral neck fracture.Clin Orthop. 2001;(393):294–301.
Kinik H, Polat O, Mergen E. Femoral neck fractures treated with cannulated screw.Acta Orthop Traumatol Turc. 1999;33(1):13–17.
Bray TJ. Femoral neck fracture fixation. Clinical decision making.Clin Orthop. 1997;(339):20–31.
Strömqvist B, Hansson LI, Nilsson LT, et al. Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases.Clin Orthop. 1987;(218):58–62.
Hudson JI, Kenzora JE, Hebel JR, et al. Eight-year outcome associated with clinical options in the management of femoral neck fractures.Clin Orthop. 1998;(348):59–66.
Hui AC, Anderson GH, Choudhry R, Boyle J, Gregg PJ. Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians.J Bone Joint Surg Br. 1994;76: 891–894.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Karaeminogullari, O., Demirors, H., Atabek, M. et al. Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: Effect of fracture displacement and time to surgery. Adv Therapy 21, 335–342 (2004). https://doi.org/10.1007/BF02850038
Issue Date:
DOI: https://doi.org/10.1007/BF02850038