Clinical Study of Posterior Comminution of the Femoral Neck Fractures

Kim, Hong Tae; Park, Bong Hoon; Byun, Young Soo; Jo, Young Ho

Abstract

The management of the femoral neck fractures remains a major challenge to the orthopaedic surgeons because there are many critical complications such as non-union and avasular necrosis in spite of the advanced technics of treatment. The posterior comminution of this fracture is known to be an important comtributing factor of these complications as the most important cause of the instalility of reduction after internal fixation as well as difficulty of stable reduction, Authors reviewed 61 cases of the femoral neck fractures which were able to identify the presence or absence of posterior comminution on x-ray or operative findings and were managed at Daegu Fatima Hospital during the 10 years from 1975 to 1984 and the following results were obtained. 1. The incidence of posterior comminution in 61 femoral neck fractures was 56% in x-rays of lateral view and operative findings. 2. Open reductions were performed in 31% of 39 cases in which reductions were necessary for internal fixation and 43% of the fractures with posterior comminution were unstable to reduce by closed method while 88% of the fractures without postrior comminution were reduced by closed method. 3. The positions of reductio were in valgus in 46% and anatomic in the rest of cases and valgus reductions were more common in the cases of posterior comminution. 4. Loss of the reduction after internal fixation noted in 48% of the fractures with posterior comminution and 9% without posterior comminution. 5. 77% of the fractures united including 14% of mal-union and the late complication of non-union noted in 14% and avascular necroris in 9% in 35 cases which were followed for over 1 year. 6. The normal unions were more common in the fractures without posterior comminution, the cases of open reduction and the reduction in valgus position. 7. Most of the mal-unions and non-unions noted in the fractures with posterior comminution, the cases of closed reduction and the reduction in anatomic position. 8. These results suggest that the posterior comminution of the femoral neck fracture causes considerable instability and the better results could be expected in the femoral neck fractures with posterior comminution by the reduction in valgus and by the open reduction if necessary.