J Korean Orthop Assoc.  2015 Jun;50(3):178-191. 10.4055/jkoa.2015.50.3.178.

Current Treatment Strategy for Young Adult Femur Neck Fractures

• Yeo I
• Lim SJ

• KMID: 1851952
• DOI: http://doi.org/10.4055/jkoa.2015.50.3.178

Abstract

Femoral neck fracture in young adults represents a relatively uncommon, high-energy injury associated with higher incidence of complications including nonunion, avascular necrosis of the femoral head, and significant shortening. Preservation of the natural hip anatomy and mechanics is a priority in their management and anatomic reduction and stable internal fixation are critical to achieving the goals of treatment in this young patient population. Current evidence is insufficient to recommend an ideal management method; however, in this article we present the rationale and evidence for timing of surgery, role of capsulotomy, open versus closed reduction, and available internal fixation options.

Keyword

femoral neck fractures; young adult; treatment

MeSH Terms

Femoral Neck Fractures*
Head
Hip
Humans
Incidence
Mechanics
Necrosis
Young Adult*

Figure

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  Figure 1 A 64-year-old woman presented with a painful right hip after a fall. (A) No fracture was clearly visible on radiograph. (B) An undisplaced femoral neck fracture was identified on magnetic resonance imaging.

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  Figure 2 A 35-year-old man showing an ipsilateral femoral neck and shaft fractures on radiograph (A) and computed tomography (B).

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  Figure 3 Classification of femoral neck fracture according to anatomical position of the fracture line. Subcapital (A), transcervical (B), and basicervial fracture (C).

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  Figure 4 The Pauwels' classification of femoral neck fracture based on vertical orientation of fracture line. Type I is Pauwels' angle less than 30 degrees, Type II is Pauwels' angle between 30 and 50 degrees, and Type III is Pauwels' angle more than 50 degrees.

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  Figure 5 The Garden's classification of femoral neck fracture. (A) Garden type I is an incomplete fracture, typically shown as valgus impacted type. (B) Garden type II is a nondisplaced complete fracture, typically associated with medial gap of the femoral neck. (C) Garden type III is a partially displaced complete fracture. (D) Garden type IV is a totally displaced complete fracture with definite superior displacement of the proximal femur, typically trabecular pattern of the femoral head lining up with those of the acetabulum.

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  Figure 6 (A) A displaced femoral neck fracture in a 46-year-old woman was seen on radiograph. (B) Open reduction was performed through a Watson-Jones approach. (C) Illustration demonstrating the Watson-Jones approach. (D) Intraoperative photograph showing a well-reduced fracture line (arrow). (E) Postoperative radiograph after fixation with three cannulated screws. ASIS, anterior superior iliac spine; G., gluteus; V., vastus.

• 

  Figure 7 A communited femoral neck fracture in a 33-year-old woman was seen on radiograph (A) and computed tomography (B). (C, D) The fracture was reduced through a Watson-Jones approach using a Hohmann Retractor and a ball-spike pusher, temporally fixed with multiple K-wires. (E, F) Partially threaded cannulated screws and cancellous screws were placed to achieve stable fixation at the fracture site. (G) At 6 months follow-up, no evidence of avascular necrosis of the femoral head was observed on 3 phase bone scan.

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  Figure 8 A displaced femoral neck fracture was reduced and fixed with three cannulated screws in a reverse triangle configuration on anteroposterior (A) and lateral (B) radiographs. (C) Illustration demonstrating the reverse triangle configuration.

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  Figure 9 A femoral neck fracture was fixed with three cannulated screws. (A) The most inferior cannulated screw was placed below the lesser trochanter. (B) Screws were placed in a triangle configuration. (C, D) Subtrochanteric fracture occurred at 3 years postoperatively.

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  Figure 10 (A) A displaced femoral neck fracture in a 51-year-old man was seen on radiograph. (B, C) Posterior wall communition was identified on computed tomography. Postoperative anteroposterior (D) and lateral (E) radiographs showing four cannulated screws fixed in a diamond configuration. (F) Illustration demonstrating the diamond configuration.

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  Figure 11 A basicervical femoral neck fracture was seen on radiograph (A) and computed tomography (B, C). (D, E) The fracture was fixed with a dynamic hip screw.

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  Figure 12 A Pauwels type III femoral neck fracture was seen on radiograph (A) and computed tomography (B). (C, D) The fracture was fixed with a dynamic hip screw and a superior derotation screw.

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  Figure 13 (A) A valgus impacted femoral neck fracture in a 64-year-old man with end stage renal disease was seen on radiograph. (B, C) Multiple diamond shaped cannulated screws were placed. (D) Radiograph at 6 months showing collapse with loss of fixation and nonunion.

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  Figure 14 (A) A displaced femoral neck fracture in a 57-year-old woman was seen on radiograph. (B) The fracture was reduced and fixed with three cannulated screws. (C) Radiograph at 7 months showing collapse of the femoral head indicating avascular of the femoral head.

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  Figure 15 A 20-year-old man presented with a painful right hip after a military training. An inferior femoral neck stress fracture was seen on radiograph (A), computed tomography (B), and magnetic resonance imaging (C).

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