Results of Screw Fixation for Displaced Femoral Neck Fracture

Ick-Hwan Yang; Hoon Park; Chang-Dong Han; Kyu-Hyun Yang; Chong-Hyuk Choi

doi:10.4055/jkoa.2007.42.6.772

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Yang, Park, Han, Yang, and Choi: Results of Screw Fixation for Displaced Femoral Neck Fracture

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(6): 772-780.

Published online: 31 December 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.6.772

Results of Screw Fixation for Displaced Femoral Neck Fracture

Ick-Hwan Yang, M.D., Hoon Park, M.D., Chang-Dong Han, M.D., Kyu-Hyun Yang, M.D., Chong-Hyuk Choi, M.D.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to Chong-Hyuk Choi, M.D. Department of Orthopaedic Surgery, Yongdong Severance Hospital, 146-92, Dogok-dong, Gangnam-gu, Seoul 135-720, Korea. Tel: +82.2-2019-3415, Fax: +82.2-573-5393, 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.

Keywords: Femoral neck fracture, Closed reduction, Internal fixation

Figures and Tables

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).

Table 1

Criteria of the Functional Results

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