Anteromedial femoral neck plate with cannulated screws for the treatment of irreducible displaced femoral neck fracture in young patients: a preliminary study.

Abstract

Although most displaced femoral neck fractures of young patients can be repositioned successfully by closed reduction, there are still some can not repositioned successfully by this way and open reductions are required. This type of fracture was defined as irreducible displaced femoral neck fracture in this study. The purpose of this study was to introduce a new technique using anteromedial femoral neck plate with cannulated screws fixation by open reduction for the treatment of irreducible displaced femoral neck fractures in young patients. Totally 26 patients with irreducible displaced femoral neck fracture treated by this technique were retrospectively reviewed. This technique included three major steps: open reduction of femoral neck fracture was performed via the modified anterior approach of hip joint, anteromedial femoral neck plate was fixed to the femoral neck, and two cannulated compression screws were inserted in the femoral neck inside. All patients were followed up with an average of 18months (range 12-30 months). Radiological and clinical outcomes were evaluated. The fracture union was achieved in 24 patients (92.3%) with an average duration of 4.5 months (range 3.8-10 months). Nonunion was not observed in all cases. Avascular necrosis of femoral head was identified in two patients (7.7%). Clinical outcomes of 24 hips with satisfactory union were evaluated by the Harris Hip Scores (HHS), excellent outcomes were achieved in 20 cases (HHS ≧ 90), fair outcomes in 3 cases (80 ≦ HHS < 90), and poor outcome in 1 case (HHS < 80). Anteromedial femoral neck plate with cannulated screws fixation by open reduction is an alternative therapeutic method for the irreducible displaced femoral neck fracture in young patients, with low incidence of complications including nonunion and avascular necrosis.