PURPOSE To evaluate the factors which influence on the fixation failure after internal fixation using multiple cannulated screws in the patients with femoral neck fracture. MATERIALS AND METHODS Ninty-six patients (male: 63, female: 33) who underwent closed reduction and internal fixation of femoral neck fracture between Feb. 1994 and Jun. 2002 with use of multiple cannulated screws. The mean age was 68 years (17~90) and mean follow-up period was average 50 months (36 months~6 years). The fixation failure was defined by change in fracture position above 10 mm, change in each screws position above 5%, backing above 20 mm, or perforation of the head, respectively.
They were evaluated with the age, gender, fracture type, accuracy of reduction, placement of screws, posterior comminution and also studied the risk factors which influenced nonunion and the development of avascular necrosis. RESULTS Twenty-four patients out of 96 patients had radiographic signs of fixation failure. The incidence of nonunion in the fixation failure group was 41% (10/24) and AVN was 33% (8/24). There were statistically significant correlations between fixation failure and nonunion and that posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion. CONCLUSION In case of femoral neck fracture of internal fixation using multiple cannulated screws, posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion and fixation failure.
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Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures Joon Soon Kang, Kyoung Ho Moon, Joong Sup Shin, Eun Ho Shin, Chi Hoon Ahn, Geon Hong Choi Clinics in Orthopedic Surgery.2016; 8(2): 146. CrossRef
Internal Fixation for Femoral Neck Fracture in Patients between the Ages of Twenty and Forty Years Ui-Seoung Yoon, Jin-Soo Kim, Hak-Jin Min, Jae-Seong Seo, Jong-Pil Yoon, Joo-Young Chung Journal of the Korean Fracture Society.2010; 23(1): 1. CrossRef
Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures Tae-Ho Kim, Jong-Oh Kim, Sung-Sik Kang Journal of the Korean Fracture Society.2009; 22(2): 79. CrossRef
Posterior hip dislocation with femoral head and neck fracture(Pipkin type III) was considered as a rare injury, However, the advance of high speed motor vehicle accidental injury has contributed to its increased incidence and the choice of treatment is still controversial.
Mechanism of injury was considered as a kind of secondary trauma of inversion or internal rotation force with hip joint was flexed position state. Three cases of posterior hip dislocation with femoral head and neck fracture(Pipkin type III)have been experienced and follow up still now at Soon Chun Hyang University hospital. The results were evaluated by Thomson Epsteins clinicoradiologic criteria and Harris hip score and follow up radiologic findings.
As a results of this study, we are more prefer primary open reduction and rigid internal fixation than primary joint replacement arthroplasty due to be occured in young age group. And futher evaluation should be needed.