Osteosynthesis of Unstable Intracapsular Femoral Neck Fracture by Dynamic Locking Plate or Screw Fixation

1Department of Orthopedic Surgery, 2Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv Univesity, Tel Aviv, Israel.
Journal of orthopaedic trauma (Impact Factor: 1.8). 07/2013; 28(2). DOI: 10.1097/BOT.0b013e3182a225fa
Source: PubMed


The purpose of this study was to compare the postoperative radiologic and clinical outcomes of telescopic femur neck screws and small locking plate device (Targon FN) (Group 1) with multiple cancellous screws (Group 2) for displaced intracapsular femoral neck fractures.
Comparison of a prospective collected data to a historical control group (retrospective).
One community teaching hospital.
Seventy-eight patients (group 1, 31; group 2, 47) underwent reduction and internal fixation of displaced intracapsular femoral neck fractures with either Targon FN device or multiple cancellous screws from March 2000 to July 2010. Their mean age was 53.7 years (SD 16.4) and the mean follow-up period was 28.6 months.
Treatment failure was considered to be either a nonunion, osteonecrosis or revision surgery of any type. Treatment was regarded as successful in patients who did not show failure and had at least one year follow-up.
One patient in Group 1 (3.2%) and 22 (46.8%) in Group 2 had a nonunion (p = 0.0001). Four Group 1 patients (12.9%) and 16 Group 2 patients (34.0%) underwent revision surgery (p = 0.036). Four patients in Group 1 (12.9%) and four Group 2 patients (8.5%) had osteonecrosis of the femoral head (p = 0.531). Multivariate logistic regression showed that internal fixation by the fixed angle fixation device decreased the odds ratio for overall complication by a factor of 0.23, i.e., by 77% (p = 0.018).
Performing internal fixation by a fixed angle fixation device decreased nonunion rates and revision rates. It did not affect the rate of osteonecrosis.

28 Reads
  • Source
    • "A randomised trial comparing these two fixation methods in this population is currently in the early stages, the results of which are likely to clarify the choice of treatment in these injuries [17]. A recent study reviewed 78 patients with displaced intracapsular hip fractures treated with a new Dynamic Locking Plate [18]. The mean age of patients was 53 years and they reported a 3.2% incidence of non union, compared to an incidence of 46.8% in a group of historical controls fixed with multiple cannulated screws. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Femoral neck non union is a relatively uncommon complication following intracapsular hip fracture in the young patient. Almost all patients with femoral neck non union are symptomatic for which they will require some form of revision surgery. This review discusses the role of valgus osteotomy in managing the younger patient with femoral neck non union. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Injury 12/2014; 46(3). DOI:10.1016/j.injury.2014.11.022 · 2.14 Impact Factor
  • Source
    • ". Although locked plating constructs have been proposed as a potential solution to prevent femoral neck fracture shortening [10], clinical results of locked plate fixation for femoral neck fractures have been suboptimal [13] [14]. A recent report documented successful treatment of femoral neck fractures with a locked plating construct; however, this construct still allowed for femoral neck fracture shortening through use of telescoping fixation screws [15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Femoral neck fractures in young adults are difficult to treat. There are substantial gaps in our knowledge regarding treatment and prevention of young adult femoral neck fractures. Avoiding malunion or nonunion of these fractures after fixation remains a challenge. Currently available fixation techniques may allow for healing to occur, but in a shortened position, with negative consequences on gait mechanics and physical function. Osteonecrosis remains a problem, affecting up to half of patients who sustain femoral neck fractures. Achieving reliable healing may require a reconsideration of fracture fixation implants as well as biological methods to address metabolic, endocrine, and/or genetic abnormalities that may be present in the young adult femoral neck fracture patient. Also, prevention of low-energy femoral neck fractures (e.g. stress fracture) remains an area ripe for investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Injury 11/2014; 46(3). DOI:10.1016/j.injury.2014.11.015 · 2.14 Impact Factor

  • Journal of orthopaedic trauma 05/2014; 28(8). DOI:10.1097/BOT.0000000000000150 · 1.80 Impact Factor
Show more