Femoral Neck Fracture in Young Adult - 25 Cases Treated with Multiple Pinning -

Hyung Ku Yoon; Kwang Pyo Jeon; Dae Eun Jung; Ho Seung Jeon; Dae Young Jang

doi:10.4055/jkoa.1996.31.2.235

Journal List > J Korean Orthop Assoc > v.31(2) > 1105163

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Yoon, Jeon, Jung, Jeon, and Jang: Femoral Neck Fracture in Young Adult - 25 Cases Treated with Multiple Pinning -

Original Article

J Korean Orthop Assoc 1996;31(2):235-246.

Published online: 1 April 1996

DOI: https://doi.org/10.4055/jkoa.1996.31.2.235

Femoral Neck Fracture in Young Adult - 25 Cases Treated with Multiple Pinning -

Hyung Ku Yoon, M.D., Kwang Pyo Jeon, M.D., Dae Eun Jung, M.D., Ho Seung Jeon, M.D., Dae Young Jang, M.D.

Department of Orthopaedics, Sung-Ae General Hospital, Seoul, Korea

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

In general femoral neck fracture in young adult presents poor prognosis due to the high velocity

injury, high angle shear fractures, and poor candidate for arthroplasty. In addition to the relative rarity of the injury, the high incidence of aseptic necrosis and nonunion have been reported in the management of these fractures. 25 eases of femoral neck fracture in young adult were treated with multiple pinning and analyzed at Sung-Ae general hospital from 1987 to 1994 after 28 months follow up in average with review of charts, X-ray and clinical result.

There were 18 male and 7 female, 5 cases of them had significant polytrauma to other organs or skeletal system, authors tried to treat them as soon as possible to decrease the interval time between fracture and fixation (the average time was 39.7 hours.)

Union occurred in all of Garden stage I (4 cases) and II (4 cases), but in Garden stage III (7 among 3 cases) and IV (7 among 9 cases) the union rate was lower. Average union time was 16.5 weeks.

The incidence of complications (12%, 3 among 25 cases) was higher in displaced fractures group (Garden Stage III, IV) and also in poorly reduced group of Garden’s alignment index.

In conclusion, the prognosis of femoral neck fractures in young adult was related with mainly initial reduction and rigid fixation than the initial injury.

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Keywords: Femoral neck, Fracture, Young adult, Multiple pinning

REFERENCES

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Fig. 1-A

Initial post-operative 4 weeks X-ray of 40 old age male, Garden type, III, poor varus reduction in A-P plane, B. Post-operative 4 weeks X-ray of 40 male, lateral plane. C. Post-operative 6 months X-ray, nonunion state. D. Muscle pedicular bone graft was done, secondary post-operative 6 months, the union was obtained in A-P plane. E. Muscle pedicular bone graft was done, secondary post-operative 6 months, the union was obtained in lateral plane. F. Bone scanning show continued blood flow of femoral head, primary post-operative 6 months.

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Fig. 2-A

Pre-operative X-ray of 34 male. cause of injury was traffic accident, garden type IV in A-P plane. B. Pre-operative X-ray in later-al plane.

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Fig. 2-C

Immediated post-operative X-ray in A-P plane. D. Immediated post-operative X-ray. poor reductionin. in lateral plane.

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Fig. 2-E

Post-operative 48 months X-ray, this shows the segmental collapse fo the femoral head in A-P plane. F. Confirmed AVN of the femoral head in bone scanning.

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Fig. 3-A

Pre-operative X-ray of 29 male, cause of injury was ski injury in A-P plane. B. Post-operative 16 weeks X-ray shows the bony union.

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Fig. 3-C

Post implant removal state for continuous morderate hip pain in A-P plane. D. Post implant removal state for continuous morderate hip pain in lateral plane.

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Fig. 3-E

Increased the blood flow in femoral hean in bone scan. F. Double density sign on MRI means localized avascular necrosis in femoral head.

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Table 1

Causes of injury.

	High energy injury	Low energy injury	Total
Male	16	2	18
Female	4	3	7
	20	5	25

Table 2

Garden classification and acceptable reduction.

Garden classification/Reduction	Good	Acceptable	Poor	Total
I	4			4
II	2	2		4
III	2	5	1	8
IV		6	3	9
Total	8	13	4	25

Table 3-A

Garden classification and complications.

Garden classification/Complication	Nonunion	AVN
I
II
III	1
IV	1	1

Table 3-B

Garden alignment index and complications.

Garden’s alignment index	Nonunion	AVN
Good
Acceptable	1
Poor		2

Table 4

Complication & interval time between injury and fixation.

	24hr-	24-48hr	-48hr
Union group	14	3	5
Complication group		1	2

Table 5-A

Location of pins on A-P plane.

	1/3 Superior	1/3 Central	1/3 Inferior
Union	20	33	35
Complication group	6	6	3
	26	39	38

Table 5-B

Location of pins on lateral plane.

	1/3 Anterior	1/3 Central	1/3 Posterior
Union	27	30	33
Complication group	5	7	3
	32	35	38

Table 6-A

Union and Garden classification.

Garden Classification	No	Period(Wks)
Stage I	4/4	12.3
II	4/4	14.2
III	7/8	17.2
IV	7/9	19.5
	22/25	16.5

Table 6-B

Union and Garden’s alignment index.

Garden alignment index	No	Period(Wks)
Good	8/8	15.0
Acceptable	12/13	16.9
Poor	2/4	20.3
	22/25	16.5

Table 7-A

Clinical results and Garden classification. (By Lunceford)

Garden classification	Exellent	Good	Fair	Poor
I	1	3
II	1	3
III	1	5	1	1
IV	1	6		2
	4	17	1	3

Table 7-B

Clinical results and Garden’s alignment index.(By Lunceford)

Garden classification	Exellent	Good	Fair	Poor
Good	3	5
Acceptable	1	10	1	1
Poor		2		2
	4	17	1	3

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