Multiple cannulated screws for treatment of intracapsular femoral neck fractures in young adult patients: Improved outcomes?

Abstract

Background: Intracapsular femoral neck fractures (IFNF) in young adult patients generally due to high energy trauma are not uncommon. Traditionally, the preferred treatment method is closed reduction with stable internal fixation as early as possible. However, a complication rate is still hard to be greatly lowered due to unfavorable vascular route anatomically. Purpose: The aim of this retrospective study was to investigate whether a success rate had been improved following far advancement of modern medicine and technology. Methods: For the 3.8-year period, 133 consecutive young adult patients with IFNF due to high energy trauma were treated. Seventy patients (average = 46.5 years) matched for study criteria were enrolled. Closed reduction with multiple cannulated screw fixation for IFNF was performed at an average of 1.0 day after patients arrived at the emergency service. Postoperatively, early ambulation with protected weight bearing was encouraged. Regular follow-up with the interval of 4-6 weeks at the outpatient department (OPD) was scheduled. Results: For an at least 1.5-year (average = 2.4 years) follow-up, 90% (63/70) of IFNF healed at an average of 2.7 months. Osteonecrosis in varied Ficat stages occurred in 21% (15/70) of the femoral head and nonunion occurred in 10% (7/70) of the femoral neck. Complications were treated based on various personal situations. Displaced IFNF had a higher complication rate as compared to non-displaced IFNF (p = 0.03). Satisfactory hip function was achieved in 81% (57/70) of patients. Conclusion: Although fixation devices for IFNF are continuingly designed, complications after treatment are still not greatly decreased. The unfavorable anatomic route of vascularity may be the most important culprit. Any technique which may potentially improve femoral head and neck blood supplies should be continuingly explored.