Osteosynthesis of unstable intracapsular femoral neck fracture by dynamic locking plate or screw fixation. Early results.
ABSTRACT 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.
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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 · 2.46 Impact Factor
- Journal of orthopaedic trauma 05/2014; DOI:10.1097/BOT.0000000000000150 · 1.54 Impact Factor
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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 · 2.46 Impact Factor