Failed internal fixation of femoral neck fractures

Summary Background. There are two main types of surgical treatment for fractures of the femoral neck; internal fixation and arthroplasty. One of the disadvantages of internal fixation is that many patients subsequently require reoperation. We have attempted to identify procedurerelated factors that aincrease the risk of fixation failure. Material and method. 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 time 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. Internal fixation failed in 23 (18,3 %) out of 126 patients with displaced fractures awarded six points for the reduction. ,Internal fixation failed in 5 (50 %) out of 10 patients given a score of three points or less (p = 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=0.014). Discussion. Our findings emphasise the importance of achieving anatomical reduction of displaced femoral neck fractures, and to perform surgery within 48 hours unless there are medical contraindications.