Complications of internally fixed femoral neck fractures

BACKGROUND: Femoral neck fractures in young patients are the emergent injuries that require precise reduction and stable fixation. Despite all advances, nonunion and avascular necrosis (AVN) of the femoral head are the major complications necessitating salvage procedures. In this retrospective series, we evaluated the complications of internally fixed femoral neck fractures. METHODS: This study consisted of 32 cases that had displaced femoral neck fractures. Although some of them admitted to hospital more than 8 hours after initial trauma, all underwent internal fixation as early as possible. All the fractures were reduced and fixed by closed reduction under fluoroscopy control. However, 5 cases needed open reduction. AVN was determined by using Ficat and Arlet criteria. Clinical evaluation was performed based on the scoring system described by Harris. RESULTS: Mean follow-up period was 49±29 months (range 24-126). AVN of the femoral head was observed in 13 cases (40%). However, only 5 of them had unsatisfactory clinical results requiring salvage surgery as total hip replacement. Nonunion of fracture was seen in 5 cases. In the statistical analysis, a negative correlation was observed between the degree of AVN and clinical findings. We found no correlation between the duration of the preoperative period and late complications.
CONCLUSION: AVN is the most common complication of displaced femoral neck fractures. However, less than half of these cases require salvage procedures. Total hip replacement is the preferred treatment option for these cases.

Femur boyun kýrýklarýnda internal tespit sonrasý komplikasyonlar

AMAÇ: Genç hastalarda femur boyun kýrýklarý kesin redüksiyon ve stabil tespiti gerektiren acil yaralanmalardýr. Tüm geliþmelere raðmen femur baþý avasküler nekrozu (AVN) ve kaynamama kurtarýcý ameliyatlar gerektiren en önemli komplikasyonlardýr. Bu geriye dönük çalýþmada, internal tespit yapýlan femur boyun kýrýklarýnýn komplikasyonlarý deðerlendirildi. GEREÇ-YÖNTEM: Deplase femur kýrýklý 32 hasta çalýþmaya dahil edildi. Bazý hastalar ilk yaralanmadan sekiz saat sonra hastanemize baþvurmalarýna raðmen en erken zamanda ameliyata alýndýlar. Açýk redüksiyon gerektiren beþ hasta dýþýnda tüm olgulara kapalý redüksiyon ve tespit uygulandý. AVN, Ficat ve Arlet kriterlerine göre deðerlendirildi. Klinik deðerlendirme Harris tarafýndan tanýmlanan puanlama sistemine göre yapýldý. BULGULAR: Ortalama izlem süresi 49±29 aydý (daðýlým 24-126). On üç olguda femur baþý avasküler nekrozu belirlendi (%40); ancak yalnýzca beþ olguda yetersiz sonuca baðlý total kalça protezi uygulandý. Beþ olguda da kaynamama saptandý. Yapýlan istatistiksel analizde, AVN derecesi ve klinik puanlar arasýnda ters iliþki belirlendi. Ameliyata alýnma süresi ile geç komplikasyonlar arasýnda iliþki saptanmadý.
SONUÇ: Deplase femur boyun kýrýklarýnýn en sýk komplikasyonu AVN’dir. Ancak olgularýn yarýdan azýna kurtarýcý ameliyat gerekmiþtir. Bu olgularda total kalça protezi uygun tedavi seçeneðidir.