Advanced Biomedical Research

Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011

Authors

1 Department of Orthopedics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of General Physician, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: There is conflict of interest in the treatment of intracapsular femoral neck fractures and the outcomes. The aim of this study was evaluation the treatment outcomes of closed and open reduction and internal fixation with screw in 18-50-year-old patients.
Materials and Methods: This clinical randomized study was conducted in Ayatollah Kashani Center in Isfahan from Nov 2010 to Nov 2011. In 42 patients selected in a randomized manner, fractures were reduced by closed reduction or open if necessary and C-ARM was controlled in AP and lateral plans. Movement range and femur pain severity were evaluated according to Visual analogue Scale (VAS) score at 3 and 6 months after surgery. Data were analyzed by SPSS 18. Chi-square, t-test, one-way analysis of variance (ANOVA), and descriptive statistics such as frequency distribution, mean, and mean deviation were used.
Results: Forty-two patients with femoral neck fracture were treated by open [31 patients (73.8%)] or closed reduction [11 patients (26.2%)] and also osteosynthesis. Their mean age was 47.3 ± 9.8 years; 29 of them were males and 13 were females. Twelve patients had bad range of motion (ROM) (28.6%), 16 had intermediate ROM (38%), and 14 had good ROM (33.4%). After 6 months, 12 patients (28.6%) had bad ROM, 10 (23.8%) had intermediate ROM, and 20 (47.6%) had good ROM. There were 11 cases of non-union (35.5%) in the open reduction group and 4 in the closed group.
Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.

Keywords

1. Griffin XL, parsons N, Achten J, Costa ML. Hip trauma: A randomized clinical trial comparing interventions to improve outcomes in internally fixed intracapsular fractures of proximal femur. BMC Musculosketet Disord 2010;17:184-97.  Back to cited text no. 1
    
2. Wu cc, Paul J, Rio MN. Using biomechanics to improve the surgical technique for internal fixation of intracapsular femoral neck fractures. Change Gurg Med J 2010;33:241-55.  Back to cited text no. 2
    
3. Bliar JA, stinner DJ, Kirby JM. Quantification of femoral neck exposure through a minimally invasive smith - Peterson approach. J Orthop Trauma 2010;24:355-8.  Back to cited text no. 3
    
4. Stravrakis TA, Lyras DN, psillakis IG. Fractures of the femoral neck treated with hemi arthroplasty. Folia Med 2009;51:134-45.  Back to cited text no. 4
    
5. Frest A, Pavlou G, Richards PJ, Belcher J. Influence of acetabular and femoral version on fractures of the femoral neck. Clin Orthop Relat Res 2010;468:249-56.  Back to cited text no. 5
    
6. Keating J. Femoral neck fractures. In: Bucholz RW, Heckman JD, Court - Brown C, editors. Rackwood and Green's fractures in adults. 7 th ed. Philadelphia: Lippincott, Williams and Wilkins; 2010. p. 1581-90.  Back to cited text no. 6
    
7. Magu NK, Rohilla R, singh R, Tater R. Modified pauwel'sintertrochanteric osteotomy in neglected femoral neck fracture. Clin Orthop Relat Res 2009;467:1064-73.  Back to cited text no. 7
    
8. Lavelle DJ. Fractures and dislocations of the hip. In: Canale T, Beaty JL, editors. Campbell's Operative Orthopaedics. 11 th ed. Philadelphia: Mosby; 2008. p. 3237-75.  Back to cited text no. 8
    
9. Holmberg S, Dalen H. Intracapsular pressure and caput circulation in nondisplaced femoral neck fractures. Clin Orthop Relat Res 2007;399:324-6.  Back to cited text no. 9
    
10. Parker MJ, Stedtfeld HW. Internal fixation of intra capsular hip fractures with a dynamic locking plate. Injury 2010;41:348-51.  Back to cited text no. 10
    
11. Kutty S, Petttit P, Powell JN. Intracapsular fracture of the proximal femur fracture after hip resurfacing treated by cannulatedscrews. J Bone Joint Surg 2009;91:1100-2.  Back to cited text no. 11
    
12. Konan S, Rhee SI, Haddad FS. Total hip arthroplasty for displaced fracture of the femoral neck using size 32 mm femoral head and soft tissue repair after a posterior approach. Hip Int 2009;19:30-5.  Back to cited text no. 12
    
13. Thomas CD, Power I, Poole KE. Femoral neck trabecular bone. J Bone Miner Res 2009;24:1808-18.  Back to cited text no. 13
    
14. Beek M, Leuning M, Clarke E, Ganz R. Femoroacetabular impingment as a factor in the development of nonunion of the femoral neck. J Orthop Trauma 2004;18:L425-30.  Back to cited text no. 14
    
15. Leighton R. Classification and treatment and treatment of femoral neck nonunions in yonng patients. J Bone Joint Surg Br 2008;90:124-8.  Back to cited text no. 15
    
16. Cuckler JM, Tamara Palli JR. An algorithm for the management of femoral neck fractures. Orthopedics 2004;17:789-92.  Back to cited text no. 16
    
17. Haidukewych GJ, Rothwellws, Jacofsky DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 2004;86:1711-6.  Back to cited text no. 17
    
Advanced Biomedical Research
Volume 2013, March
March 2013
Pages 1-4