Internal Fixation of Intracapsular Femoral Neck Fractures

Overview

Purpose of the study:
To evaluate outcomes of internal fixation of intracapsular femoral neck fractures.

Material and methods:
Between the beginning of 1998 and end of 2002 the authors performed internal fixation of intracapsular fracture of the femoral neck in 47 patients (21 women, 26 men). The average age of patients was 56 years, range, 17 to 86 years (men 54.5 years, women 58.2 years). Forty patients (18 women, 22 men) went through the follow-up at the minimal interval of 1 year after the surgery. Their average age was 56 years. The remaining 7 patients were lost to follow-up. In 21 patients the case was Garden 1 and 2 fractures, in 19 patients Garden 3 and 4 displaced fractures. Internal fixation by three lag screws was performed in 16 cases, fixation by DHS with antirotational screw in 24 cases.

Results:
The fracture healed in 70% of cases, non-union occurred 3times and avascular necrosis developed 9times. Garden 1 and 2 fractures were associated with 14.3% and Garden 3 and 4 fractures with 47.4% of complications. Of fractures treated by lag screws, 71% of cases healed, while in those treated by DHS the percentage was 69%. Both duration of surgery and x-ray exposure was in lag screws by 50% longer than in DHS. In terms of the development of avascular necrosis, the study did not prove any advantage of a shorter interval between the injury and surgery. However, development of avascular necrosis was influenced also by other factors and therefore the significance of urgent surgery within 6 hours after injury should not be questioned.

Conclusion:
Garden 3 and 4 displaced fractures have a worse prospect than Garden 1 and 2 fractures. Duration of surgery and x-ray exposure in DHS is shorter than in lag cancellous screws with the same percentage of good results. Of great importance is an exact reduction of the fracture in both projections, a correct position of implants and evacuation of intracapsular haematoma as a prevention of avascular necrosis of the femoral head.

Key words:
intracapsular femoral neck fractures – internal fixation – proximal femur fractures