Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-01-2012 | Trauma Surgery

Displaced femoral neck fractures in the young: significance of posterior comminution and raised intracapsular pressure

Authors: Saurabh Rawall, Kamal Bali, Bidre Upendra, Bhavuk Garg, C. S. Yadav, Arvind Jayaswal

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2012

Abstract

Background

Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Various factors affect the outcome; with AVN (avascular necrosis) and non-union primarily contributing to adverse results in such patients. To identify factors affecting outcome of displaced fracture NOF, a prospective cohort study was carried out in the setting of a tertiary care centre in developing country.

Methods

27 consecutive patients with displaced fracture NOF suitable for osteosynthesis underwent closed reduction and fixation with three 6.5 mm cancellous cannulated screws. A record of posterior comminution and its extent (as seen on CT scan) and the intracapsular pressure difference between the fractured and the opposite side was kept in all the patients. The patients were followed-up for 1 year. The main outcomes measured at 1 year were non-union (as identified by CT scan) and AVN (as identified by bone scan).

Results

Cases with pressure difference >30 mm were found to have a higher rate of AVN and this result was found to be statistically significant (p value 0.034). The patients with significant posterior comminution were found to have higher non-union rates and this result was also found to be statistically significant (p value 0.04).

Conclusions

Prognosis of displaced fracture NOF is significantly associated significant with posterior comminution and intracapsular pressure difference between fractured and normal side.

Bachiller FG, Caballer AP, Portal LF (2002) Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res 399:87–109PubMedCrossRef

Estrada LS, Volgas DA, Stannard JP, Alonso JE (2002) Fixation failure in femoral neck fractures. Clin Orthop Relat Res 399:110–118PubMedCrossRef

Skála-Rosenbaum J, Dzupa V, Bartonícek J, Dousa P, Pazdírek P (2005) Osteosynthesis of intracapsular femoral neck fractures. Rozhl Chir 84(6):291–298PubMed

Karaeminogullari O, Demirors H, Atabek M, Tuncay C, Tandogan R, Ozalay M (2004) Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery. Adv Ther 21(5):335–342PubMedCrossRef

Mao YJ, Wei J, Zhou L, Wang MY, Su JG (2005) Related factor analysis of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures. Zhonghua Yi Xue Za Zhi 85(46):3256–3259PubMed

Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ (2004) Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 86(8):1711–1716PubMed

Parker MJ, Raghavan R, Gurusamy K (2007) Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res 458:175–179PubMed

Farooq MA, Orkazai SH, Okusanya O, Devitt AT (2005) Intracapsular fractures of the femoral neck in younger patients. Ir J Med Sci 174(4):42–45PubMedCrossRef

Nikolopoulos KE, Papadakis SA, Kateros KT, Themistocleous GS, Vlamis JA, Papagelopoulos PJ, Nikiforidis PA (2003) Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury 34(7):525–528PubMedCrossRef

10.

Schep NW, Heintjes RJ, Martens EP, van Dortmont LM, van Vugt AB (2004) Retrospective analysis of factors influencing the operative result after percutaneous osteosynthesis of intracapsular femoral neck fractures. Injury 35(10):1003–1009PubMedCrossRef

11.

Drake JK, Meyers MH (1984) Intracapsular pressure and hemarthrosis following femoral neck fracture. Clin Orthop Relat Res 182:172–176PubMed

12.

Holmberg S, Dalen N (1987) Intracapsular pressure and caput circulation in nondisplaced femoral neck fractures. Clin Orthop Relat Res 219:124–126PubMed

13.

Maruenda JI, Barrios C, Gomar-Sancho F (1997) Intracapsular hip pressure after femoral neck fracture. Clin Orthop Relat Res 340:172–180PubMedCrossRef

14.

Bonnaire F, Schaefer DJ, Kuner EH (1998) Hemarthrosis and hip joint pressure in femoral neck fractures. Clin Orthop Relat Res 353:148–155PubMedCrossRef

15.

Beck M, Siebenrock KA, Affolter B, Nötzli H, Parvizi J, Ganz R (2004) Increased intraarticular pressure reduces blood flow to the femoral head. Clin Orthop Relat Res 424:149–152PubMedCrossRef

16.

Strömqvist B, Nilsson LT, Egund N, Thorngren KG, Wingstrand H (1988) Intracapsular pressures in undisplaced fractures of the femoral neck. J Bone Joint Surg Br 70(2):192–194PubMed

17.

Crawfurd EJ, Emery RJ, Hansell DM, Phelan M, Andrews BG (1988) Capsular distension and intracapsular pressure in subcapital fractures of the femur. J Bone Joint Surg Br 70(2):195–198PubMed

18.

Grispigni C, Lazzerini A, Gianolli L, Paesano PL, Nobili F (1991) High-pressure hemarthrosis: possible consequences to the vascularization of the femoral head. Ital J Orthop Traumatol 17(4):533–545PubMed

19.

Egund N, Nilsson LT, Strömqvist B, Wingstrand H, Malmgren N (1988) Hemarthrosis after femoral neck fracture fixation. Acta Orthop Scand 59(5):526–529PubMedCrossRef

20.

Caviglia HA, Osorio PQ, Comando D (2002) Classification and diagnosis of intracapsular fractures of the proximal femur. Clin Orthop Relat Res 399:17–27PubMedCrossRef

21.

Frangakis EK (1966) Intracapsular fractures of the neck of the femur. Factors influencing non-union and ischaemic necrosis. J Bone Joint Surg Br 48(1):17–30PubMed

22.

Scheck M (1980) The significance of posterior comminution in femoral neck fractures. Clin Orthop Relat Res 152:138–142PubMed

23.

Alho A, Benterud JG, Müller C, Husby T (1993) Prediction of fixation failure in femoral neck fractures. Comminution and avascularity studied in 40 patients. Acta Orthop Scand 64(4):408–410PubMedCrossRef

24.

Garden RS (1971) Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br 53(2):183–197PubMed

25.

Jackson M, Learmonth ID (2002) The treatment of nonunion after intracapsular fracture of the proximal femur. Clin Orthop Relat Res 399:119–128PubMedCrossRef

26.

Savolaine ER, Ebraheim N (2000) Assessment of femoral neck nonunion with multiplanar computed tomography reconstruction. Orthopedics 23(7):713–715PubMed

27.

Bartonícek J (2001) Pauwels’ classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 15(5):358–360PubMedCrossRef

28.

Zlowodzki M, Bhandari M, Keel M, Hanson BP, Schemitsch E (2005) Perception of Garden’s classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch Orthop Trauma Surg 125(7):503–505PubMedCrossRef

29.

Oakes DA, Jackson KR, Davies MR, Ehrhart KM, Zohman GL, Koval KJ, Lieberman JR (2003) The impact of the garden classification on proposed operative treatment. Clin Orthop Relat Res. 409:232–240PubMedCrossRef

Title: Displaced femoral neck fractures in the young: significance of posterior comminution and raised intracapsular pressure
Authors: Saurabh Rawall
Kamal Bali
Bidre Upendra
Bhavuk Garg
C. S. Yadav
Arvind Jayaswal
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1395-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Displaced femoral neck fractures in the young: significance of posterior comminution and raised intracapsular pressure

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2012

Cross-cultural adaptation and validation of the Korean version of the Oxford shoulder score

Which is more effective in adolescent idiopathic scoliosis surgery: batroxobin, tranexamic acid or a combination?

Enhanced wound healing associated with Sharpey’s fiber-like tissue formation around FGF-2-apatite composite layers on percutaneous titanium screws in rabbits

Mismatch of anatomically pre-shaped locking plate on asian femurs could lead to malalignment in the minimally invasive plating of distal femoral fractures: a cadaveric study

Comparison between conservative and surgical treatment in Perthes disease

Short reconstruction nail for intertrochanteric fracture: does it really fit Asian feature?