Elsevier

Injury

Volume 40, Issue 3, March 2009, Pages 274-276
Injury

Undisplaced femoral neck fractures—no problems? A consecutive study of 224 patients treated with internal fixation

https://doi.org/10.1016/j.injury.2008.05.023Get rights and content

Abstract

224 patients with undisplaced femoral neck fractures treated with two parallel Hansson hook pins were studied. After a mean follow-up time of 32 months (S.D. 5.2), 15% had a reoperation. 11% were considered failures, mostly avascular necrosis, and 9% had a secondary arthroplasty. Possible risk factors for poor outcome were analysed. Neither high age nor surgical delay was associated with increased failure rate.

Survivors received a questionnaire, and 40% stated that they had mild or severe pain in the hip when walking, 25% had pain at rest and 25 stated that they thought “always” or “often” about their injury. The younger the patient, the more frequent the report of subjective pain. 51% of individuals under 80 years reported pain when walking, compared to 27% aged 80 or older (p = 0.016). Corresponding numbers for pain at rest were 32 and 12% (p = 0.034). The failure rate did not differ between the age groups, but the younger patients had more reoperations (p = 0.046) and thought more frequently about their injury (p = 0.016). An undisplaced femoral neck fracture is a major injury with a long-term daily discomfort in about 25% and clinical failure in 11%.

Introduction

The major discussion concerning the undisplaced femoral neck fracture has been whether to treat it with or without operation. Once settled in favour of internal fixation,4, 5, 11 the fracture type is nowadays regarded as common, easy to treat and with few healing complications. Hence, there are a few studies presented,1, 2, 12 agreeing on a failure rate of 5–10% after internal fixation. Hui et al.9 suggested that women over 80 years had a worse outcome, with a failure rate of 31%. Eisler et al.6 on the other hand suggested that age did not affect the end result.

The aim of the study was to update the knowledge of the clinical results after surgically treated undisplaced femoral neck fracture, and in particular to determine if the ageing of the hip fracture population leads to a worse result in terms of clinical failures and reoperations.

Section snippets

Materials and methods

224 consecutive patients operated on between September 2000 and December 2002 at Malmö University Hospital were included in a retrospective study. All had an undisplaced femoral neck fracture (Garden 1–2)7 and were treated with two parallel Hansson hook pins® (Swemac Orthopaedics AB, Sweden) as an emergency procedure. 207 (92%) had spinal anaesthesia. Immediate weight bearing was allowed. Patients with pathological fractures were excluded. After a mean follow-up time of 32 months (S.D. 5.2),

Results

156 of the 224 patients (69%) were women. Median age was 81 years (31–98). 152 (68%) came from independent living and 82 had no walking aids (37%). 50 individuals (22%) had a diagnosis of senile dementia. 22 fractures (10%) were older than 5 days when diagnosed. 48 (21%) had a contralateral hip fracture, either before the index fracture or during follow-up. In 12 cases (5%) an additional MRI was needed to confirm the fracture diagnosis. One of these fractures finally led to avascular necrosis.

Discussion

Failure rate after undisplaced femoral neck fractures remains relatively low, 11%. Nevertheless, the fracture afflicts the patients’ lives. After nearly 3 years, one-quarter of the surviving patients had troubles with their injured hip, and four of ten had pain when walking. Younger patients reported significantly more pain. When invited to radiological and clinical examination, the vast majority had normal X-rays and clinical findings. Extraction of pins led to pain relief in half of these

Conclusion

The failure rate after internal fixation of an undisplaced femoral neck fracture is 11%, as described in previous studies. The increasing number of very old and osteoporotic patients during the last decades has not altered these findings. The reasons for failure after approximately 3 years are to the same extent avascular necrosis and non-union. When extraction of pins after healing of the fracture is included, 15% had secondary surgery and 9% had a secondary arthroplasty.

In the

Conflict of interest

All authors certify that they not have signed any agreement with a commercial interest related to this study which would in any way limit publication of any and all data generated for the study or to delay publication for any reason. Fundings has been given by County Council of Skåne and the Herman Järnhardts Foundation, neither had any involvement in the work with this study.

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