Failed internal  fixation of femoral neck fractures.
BACKGROUND
There are two types of surgical treatment for fractures of the femoral neck; internal fixation and arthroplasty. Internal fixation is associated with a higher risk of complications such as secondary displacement, non-union and avascular necrosis. To improve treatment results of internal fixation, we have tried to identify procedure related risk-factors associated with fixation failure.


METHODS
A retrospective study was conducted based on the medical records and X-ray images of 337 patients sustaining intracapsular fractures of the hip during the period 1999-2000. The patients were treated with closed reduction and internal fixation at Oslo University Hospital, Aker. The reduction of the fracture and the placement of the fixation implants were evaluated and scored (six points representing best achievable result).


RESULTS
Fixation failed in 23 (18,3 %) out of 126 patients with displaced fractures awarded six points for the reduction. In contrast, fixation failed in five (50 %) out of ten patients given a score of three points or less (p &equals; 0.017). The risk of non-union increased when patients were treated more than 48 hours after the initial injury. In this group, 5 (25 %) out of 20 patients developed non-union compared to 16 (8 %) out of 200 patients treated within 48 hours (p &equals; 0.014).


CONCLUSIONS
Our findings emphasize the importance of achieving anatomical reduction of displaced femoral neck fractures, and to perform surgery within 48 hours unless an acute medical condition needs to be stabilized.
Orthopaedic Department, Oslo University Hospital, Aker, Norway. s.e.hoelsbrekken@medisin.uio.no
Sigurd Erik
SE
Hoelsbrekken
Jan-Henrik
JH
Opsahl
Morten
M
Stiris
Øyvind
Ø
Paulsrud
Knut
K
Strømsøe
D000368:Aged; D000369:Aged, 80 and over; D005265:Femoral Neck Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D005599:Fractures, Ununited / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011379:Prognosis; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome