Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery

• Published in: Advances in therapy Vol. 21; no. 5; pp. 335 - 342
• Main Authors: Karaeminogullari, Oguz, Demirors, Huseyin, Atabek, Mesut, Tuncay, Cengiz, Tandogan, Reha, Ozalay, Metin
• Format: Journal Article
• Language: English
• Published: United States 01-09-2004
• Subjects: Adult; Aged; Female; Femoral Neck Fractures - complications; Femoral Neck Fractures - surgery; Femur Head Necrosis - diagnosis; Femur Head Necrosis - etiology; Fracture Fixation, Internal - adverse effects; Fractures, Ununited - diagnosis; Fractures, Ununited - etiology; Health technology assessment; Humans; Male; Middle Aged; Reoperation; Time Factors
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/BF02850038

This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years' follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.