Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures

Tae-Ho Kim; Jong-Oh Kim; Sung-Sik Kang

doi:10.12671/jkfs.2009.22.2.79

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Kim, Kim, and Kang: Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures

Original Article

Journal of the Korean Fracture Society 2009; 22(2): 79-84.

Published online: 30 April 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.2.79

Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures

Tae-Ho Kim, M.D., Jong-Oh Kim, M.D., Sung-Sik Kang, M.D.

Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.

Address reprint requests to: Jong-Oh Kim, M.D., Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, 911-1, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-650-5276, Fax: 82-2-642-0349, ewhamdos@korea.com

Received 22 October 2008 Revised 8 December 2008 Accepted 30 March 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the factors predicting complications after internal fixation using multiple cannulated screws in the patients with femoral neck fracture, the authors performed a comparative study of a success group and a failure group and reviewed the literature.

Materials and Methods

Sixty-eight patients with intracapsular femoral neck fractures were treated by multiple pinning from January 2000 to July 2007 and followed up more than one year. Relationships between the complications such as failure of union, collapse of femoral head due to osteonecrosis of femoral head and several affecting factors including the degree of displacement by Garden stage, state of reduction, position of screws, patient's age, time interval from injury to operation, anatomical fracture site and two weeks postoperative ^99mTc-MDP bone scan were analyzed.

Results

Statistically significant factors were the degree of displacement by Garden stage (p<0.001), reduction state (p<0.001) and postoperative two weeks ^99mTc-MDP bone scan (p<0.001).

Conclusion

An accurate anatomical reduction is needed to decrease complications with multiple cannulated screws fixation of femoral neck fracture. Displacement of fracture by Garden stage and ^99mTc-MDP bone scan are major factors predicting complications.

Keywords: Femoral neck fracture, Multiple cannulated screw, Complication, Predicting factor

Figures and Tables

Fig. 1

(A) A 54-year-old man had a subcapital, Garden stage III femoral neck fracture due to a slip.

(B) Postoperative plain radiograph shows poor Garden alignment index.

(C) Postoperative two weeks ^99mTc-MDP bone scan shows intensely increased uptake in right femur neck fixation site with photon deficient area of right femur head.

(D) Nonunion occurred at postoperative 6 months.

Fig. 2

(A) A 60-year-old woman had a Garden stage III femoral neck fracture due to a pedestrian motor vehicle accident.

(B) Postoperative radiograph shows good Garden alignment index.

(C) Postoperative two weeks ^99mTc-MDP bone scan shows heterogenous & irregular increased activity lesion at the 2/3 of the femoral head with normal or mildly decreased activity at the outer 1/3 portion.

(D) Postoperative 4 months radiograph shows an avascular necrosis of left femoral head.

Table 1

The factors predicting complications between success and failure group

Table 2

The factors predicting complications between success and failure group according to Garden stage

References

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