Factors Influencing the Outcome of Osteosynthesis in the Fracture of the Femoral Neck in Young Adult Patients^[*]

Abstract

Objectives To evaluate the factors that influence the outcome of osteosynthesis after closed reduction of the fracture of the femoral neck in young adult patients.

Methods A retrospective study was conducted, reviewing the data of patients operated in a large orthopedic hospital from 2003 to 2011; a total of 81 patients met the inclusion criteria. The time interval between the fracture and the surgery, the initial fracture deviation, the quality of the reduction, and the placement of the implant were evaluated.

Results The present study observed a strong relationship between the quality of the reduction and therapeutic success. The degree of the initial deviation and the time elapsed between the initial trauma and the osteosynthesis did not influence the surgical outcome regarding bone consolidation. The correct positioning of the implants was associated with a satisfactory evolution in the postoperative period.

Conclusion The quality of the reduction and the positioning of the implants are factors that influence the results of osteosynthesis in fractures of the femoral neck in young adult patients.

Keywords

femoral neck - femoral head necrosis - femoral neck fractures - pseudoarthrosis

^* Work performed at the Centro de Atenção Especializada de Trauma (CAE Trauma), Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil .Originally Published by Elsevier Editora Ltda.

• Referências

• 1 Loizou CL, Parker MJ. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Injury 2009; 40 (11) 1143-1146
• 2 Karagas MR, Lu-Yao GL, Barrett JA, Beach ML, Baron JA. Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am J Epidemiol 1996; 143 (07) 677-682
• 3 Protzman RR, Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg Am 1976; 58 (05) 689-695
• 4 Stockton DJ, Lefaivre KA, Deakin DE. , et al. Incidence, magnitude, and predictors of shortening in young femoral neck fractures. J Orthop Trauma 2015; 29 (09) e293-e298
• 5 Rogmark C, Fenstad AM, Leonardsson O. , et al. Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop 2014; 85 (01) 18-25
• 6 Heetveld MJ, Rogmark C, Frihagen F, Keating J. Internal fixation versus arthroplasty for displaced femoral neck fractures: what is the evidence?. J Orthop Trauma 2009; 23 (06) 395-402
• 7 Zielinski SM, Keijsers NL, Praet SF. , et al; FAITH Trial Investigators. Femoral neck shortening after internal fixation of a femoral neck fracture. Orthopedics 2013; 36 (07) e849-e858
• 8 Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am 2002; 84 (09) 1605-1612
• 9 Araujo TP, Guimarães TM, Andrade-Silva FB, Kojima KE, Silva JdosS. Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws. Injury 2014; 45 (05) (Suppl. 05) S36-S39
• 10 Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am 1994; 76 (12) 1793-1803
• 11 Garden RS. The structure and function of the proximal end of the femur. J Bone Joint Surg Br 1961; 43 (03) 576-589
• 12 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 (03) 215-221
• 13 Frank T, Osterhoff G, Sprague S, Garibaldi A, Bhandari M, Slobogean GP. ; FAITH Investigators. The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures. Clin Orthop Relat Res 2016; 474 (06) 1396-1404
• 14 Ficat RP, Arlet J. Forage-biopsie de la tete femorale dans I'osteonecrose primative, Observations histo-pathologiques portant sur huit forages. Rev Rhum 1964; 31: 257-264
• 15 Bosch U, Schreiber T, Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res 2002; (399) 59-71
• 16 Heetveld MJ, Raaymakers EL, Luitse JS, Gouma DJ. Rating of internal fixation and clinical outcome in displaced femoral neck fractures: a prospective multicenter study. Clin Orthop Relat Res 2007; 454 (454) 207-213
• 17 Upadhyay A, Jain P, Mishra P, Maini L, Gautum VK, Dhaon BK. Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint Surg Br 2004; 86 (07) 1035-1040
• 18 Razik F, Alexopoulos AS, El-Osta B. , et al. Time to internal fixation of femoral neck fractures in patients under sixty years--does this matter in the development of osteonecrosis of femoral head?. Int Orthop 2012; 36 (10) 2127-2132
• 19 Papakostidis C, Panagiotopoulos A, Piccioli A, Giannoudis PV. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome. Injury 2015; 46 (03) 459-466
• 20 Bhandari M, Tornetta III P, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws?. J Orthop Trauma 2009; 23 (06) 403-407
• 21 Wong TC, Yeung SH, Ip FK. The effectiveness of capsular decompression for internal fixation of intracapsular hip fractures. J Orthop Surg (Hong Kong) 2007; 15 (03) 282-285
• 22 Kakar S, Tornetta III P, Schemitsch EH. , et al; International Hip Fracture Research Collaborative. Technical considerations in the operative management of femoral neck fractures in elderly patients: a multinational survey. J Trauma 2007; 63 (03) 641-646
• 23 Crosby JM, Parker MJ. Femoral neck collapse after internal fixation of an intracapsular hip fracture: Does it indicate a poor outcome?. Injury 2016; 47 (12) 2760-2763
• 24 Kahlenberg CA, Richardson SS, Schairer WW, Cross MB. Rates and Risk Factors of Conversion Hip Arthroplasty After Closed Reduction Percutaneous Hip Pinning for Femoral Neck Fractures-A Population Analysis. J Arthroplasty 2018; 33 (03) 771-776
• 25 Gardner S, Weaver MJ, Jerabek S, Rodriguez E, Vrahas M, Harris M. Predictors of early failure in young patients with displaced femoral neck fractures. J Orthop 2014; 12 (02) 75-80
• 26 Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 2004; 86 (08) 1711-1716
• 27 Yang JJ, Lin LC, Chao KH. , et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am 2013; 95 (01) 61-69