Factors leading to failure of fixation of femoral neck fractures in young adults: a retrospective study among a cohort of Egyptian population

Abstract

Background: Failed internal fixation of femoral neck fractures in young, active adults is a multifactorial problem leading to poor outcome. Although anatomical reduction and stable fixation are essential for operative success, other factors can be associated with high failure rates. The ideal protocol for management is challenging and a continued topic of study. The aim of our study was to detect factors leading to failure of fixation of femoral neck fractures in young adults. Materials and Methods: This retrospective study involved 17 patients with failed femoral neck fracture fixation at Cairo University Hospital. Inclusion criteria were patients from 18 to 60 yr old with all types of femoral neck fractures. Patients data were recorded for demographics, timing of surgery, initial fracture displacement, method of reduction, method of fixation, bone mineral density, and the level of surgeon experience. Results: The mean age was 40±10 yr. Accuracy of reduction, junior surgeons, displaced fractures, and poor implant configuration were the main factors associated with failures. In addition, low bone mineral density also was a potential factor for failure. Delayed fixation did not seem to be a significant cause of failure. Conclusions: Initial fracture displacement and accuracy of reduction are potential factors for fixation failure of femoral neck fractures. Although dynamic hip screws result in fewer early failures than multiple cannulated screws, this difference did not reach statistical significance. Fixation of femoral neck fractures in young adults should be performed by senior trainees under supervision. We recommend operating when optimal conditions are provided rather than on an emergency basis. Level of Evidence: Level III.