J Korean Fract Soc.  2009 Apr;22(2):79-84. 10.12671/jkfs.2009.22.2.79.

Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures

• Kim TH
• Kim JO
• Kang SS

• KMID: 1470019
• DOI: http://doi.org/10.12671/jkfs.2009.22.2.79

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 (99m)Tc-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 (99m)Tc-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 (99m)Tc-MDP bone scan are major factors predicting complications.

Keyword

Femoral neck fracture; Multiple cannulated screw; Complication; Predicting factor

MeSH Terms

Displacement (Psychology)
Femoral Neck Fractures
Femur Neck
Head
Humans
Osteonecrosis

Figure

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  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.

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  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.

Reference

1. Alberts KA. Prognostic accuracy of preoperative and postoperative scintimetry after femoral neck fracture. Clin Orthop Relat Res. 1990; 250:221–225.

2. Alberts KA, Jervaeus J. Factors predisposing to healing complications after internal fixation of femoral neck fractures. A stepwise logistic regression analysis. Clin Orthop Relat Res. 1990; 257:129–133.

3. Alho A, Benterud JG, Ronningen H, Høiseth A. Radiographic prediction of early failure in femoral neck fracture. Acta Orthop Scand. 1991; 62:422–426.

4. Askin SR, Bryan RS. Femoral neck fractures in young adults. Clin Orthop Relat Res. 1976; 114:259–264.

5. Banks HH. Nonunion in fractures of the femoral neck. Orthop Clin North Am. 1974; 5:865–885.

6. 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.

7. Chua D, Jaglal SB, Schatzker J. Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures. J Orthop Trauma. 1998; 12:230–234.

8. Elmerson S, Andersson GB, Irstam L, Zetterberg C. Internal fixation of femoral neck fracture. No difference between the Rydell four-flanged nail and Gouffon's pins. Acta Orthop Scand. 1988; 59:372–376.

9. Gautam VK, Anand S, Dhaon BK. Management of displaced femoral neck fractures in young adults (a group at risk). Injury. 1998; 29:215–218.

10. Holmberg S, Kalént R, Thorngren KG. Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes. Clin Orthop Relat Res. 1987; 218:42–52.

11. Kim SJ, Kim SY, Cha GB, Oh CW, Park IH, Ihn JC. Complications and affecting factor for intracapsular femoral neck fractures treated by multiple pinning. J Korean Soc Fract. 2002; 15:201–208.

12. Lagerby M, Asplund S, Ringqvit I. Cannulated screws for fixation of femoral neck fractures. No difference between Uppsala screws and Richards screws in a randomized prospective study of 268 cases. Acta Orthop Scand. 1998; 69:387–391.

13. Lindequist S, Malmqvist B, Ullmark G. Fixation of femoral neck fracture. Prospective comparison of von Bahr screws, Gouffon screws, and Hessel pins. Acta Orthop Scand. 1989; 60:293–298.

14. Lindequist S, Törnkvist H. Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma. 1995; 9:215–221.

15. Martens M, Van Audekercke R, Mulier JC, Stuyek J. Clinical study on internal fixation of femoral neck fractures. Clin Orthop Relat Res. 1979; 141:199–202.

16. Massie WK. Treatment of femoral neck fracture emphasizing long term follow-up observations on aseptic necrosis. Clin Orthop Relat Res. 1973; 92:16–62.

17. Parker MJ. Prediction of fracture union after internal fixation of intracapsular femoral neck fractures. Injury. 1994; 25:Suppl 2. B3–B6.

18. Protzman RR, Burkhalter WE. Femoral neck fractures in young adults. J Bone Joint Surg Am. 1976; 58:689–695.

19. Rehnberg L, Olerud C. Subchondral screw fixation for femoral neck fractures. J Bone Joint Surg Br. 1989; 71:178–180.

20. Rehnberg L, Olerud C. Fixation of femoral neck fractures. Comparison of the Uppsala and von Bahr screws. Acta Orthop Scand. 1989; 60:579–584.

21. Scheck M. The significance of posterior comminution in femoral neck fractures. Clin Orthop Relat Res. 1980; 152:138–142.

22. Strömqvist B, Hansson LI, Nilsson LT, Thorngren KG. Hook-pin fixation in femoral neck fracture. A two-year follow-up study of 300 cases. Clin Orthop Relat Res. 1987; (218):58–62.

23. Strömqvist B, Hansson LI, Nilsson LT, Thorngren KG. Two-year follow-up of femoral neck fracture. Comparison of osteosynthesis methods. Acta Orthop Scand. 1984; 55:521–525.

24. Woodhouse CF. Dynamic influences of vascular occlusion affecting the development of avascualr necrosis of the femoral head. Clin Orthop Relat Res. 1964; 32:119–129.

25. Yim SJ, Woo SH, Kim MY, et al. Analysis of affecting factors of fixation failure of femoral neck fractures using internal fixation. J Korean Fract Soc. 2006; 19:297–302.