Non-Union and Avascular Necrosis of Delayed Reduction and Screw Fixation in Displaced Femoral Neck Fracture in Young Adults
Terdtoon Wongwai MD*, Wiwat Wajanavisit MD**, Patarawan Woratanarat MD, PhD**
Affiliation : * Department of Orthopaedics, Phetchabun General Hospital, Phetchabun, Thailand ** Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : Management of displaced femoral neck fracture is crucial and vulnerable to develop complications. The present
study was performed to evaluate the clinical outcome of delayed reduction with multiple screw fixations in young patients who
had displaced femoral neck fracture.
Material and Method: The authors conducted a retrospective study in young patients, aged less than 50 years old, who
underwent delayed fixation for traumatic displaced femoral neck fracture (Garden classification III or IV) at Phetchabun
Hospital between 1997 and 2002. Either closed or open reduction was performed to achieve an acceptable alignment and
fixed with 2 or 3 cancellous screws. Study factors were age, gender, Garden classification, time to reduction, type of reduction,
number of screw fixation and Garden alignment index. Non-union and avascular necrosis was assessed by clinical and
radiographic findings.
Results : There were 26 eligible patients. The average duration of delayed surgery was 13 days (range 2 to 30 days). Twenty-
three patients had completed followed-up at average 28.4 months (range 14-52 months). All patients revealed complete union
and independently ambulated within 10-16 months postoperatively. Clinical and radiographic avascular necroses of the
femoral head developed in 2 patients (8.7%) at 20 and 24 months after surgery. Three patients who had early fixation failure
underwent hemiarthroplasty except one patient refused to re-operate.
Conclusion : Within 30-day delayed reduction and screw fixation for the treatment of displaced femoral neck fracture in the
young is still good alternative treatment to preserve the femoral head with low rate of avascular necrosis.
Keywords : Femoral neck fractures, Displaced, Delayed reduction, Young adults
