Treatment of displaced femoral neck fractures with percutaneous compression plate in young and middle-aged patients

Abstract

Objective To explore the operative treatment of displaced femoral neck fractures with percutaneous compression plate (PCCP) in young and middle-aged patients. Methods Forty-three young and middle-aged patients with displaced femoral neck fracture were treated with PCCP from May 2011 to May 2015. They were 24 males and 19 females, aged from 21 to 55 years (mean, 38.2 years). According to the Garden classification, 29 cases were type Ⅲ and 14 type Ⅳ. According to the Pauwels classification, 18 cases were type Ⅱ and 25 type Ⅲ. After reduction was conducted manually or using percutaneous joystick technique, nailing was carried out under the guidance of the three-dimensional position sticker which had been invented by ourselves for minimally invasive treatment of hip fractures. Clinical and radiographic outcomes were recorded after operation and postoperative hip function was evaluated using Harris score. Results Manual reduction succeeded in 38 cases and the other 5 cases experienced reduction by percutaneous joystick technique after failure of manual reduction. For this series, the operation time ranged from 35 to 60 minutes (mean, 53.2 minutes), explicit blood loss from 20 to 80 mL (mean, 65.3 mL), frequency of X-ray exposure from 6 to 20 times (mean, 11.8 times) during operation, the partial weight-bearing time from 14 to 30 days (mean, 22.5 days), and the full weight-bearing time from 2.5 to 4.0 months (mean, 3.2 months). The 43 cases were followed up for 12 to 46 months (mean, 28.5 months). Bone union was achieved in all after 3 to 7 months (mean, 4.3 months). The Harris hip scores at the final follow-ups ranged from 71 to 98 points (mean, 92.7 points). The excellent to good rate was 95.3%, with 26 excellent cases, 15 good ones and 2 fair ones. Two cases developed femoral avascular necrosis. No nonunion, implant failure or hip varus was observed during follow-ups. Conclusion Although it is difficult to treat displaced femoral neck fractures in young and middle-aged patients using PCCP, the surgery can be simplified with the aid of certain surgical techniques so that the advantages of PCCP can be realized, like minimal invasion, rigid fixation, low risk of complications and satisfactory therapeutic effect. Key words: Femoral neck fractures; Fracture fixation, internal; Bone plates; Surgical technique