Publication:

Failure of femoral neck fracture fixation in younger patients

Background Failure of femoral neck fracture fixation in younger patients frequently lead to significant morbidity. This study aims to evaluate the associated risk factors, to help achieve better outcomes.

Methods Records of 25 men and 6 women aged 23 to 50 (mean, 39.8) years who underwent fixation for femoral neck fractures using cancellous screws (n=29), a dynamic hip screw (n=1), or a locking plate (n=1) were reviewed. Patients with or without fixation failure were compared.

Results The mean follow-up period was 28.4 (range, 24–38) months. Of the 31 patients, 24 had bone union and 7 had fixation failure secondary to non-union (n=1), screw cut-out (n=4), and avascular necrosis (n=2). The Revised Trauma Score on admission was 4 in one patient with fixation failure and >6 in all other patients. Comparing patients with or without fixation failure, excess alcohol consumption (5/7 vs. 6/24, p=0.024), smoking (6/7 vs. 9/24, p=0.025), and operative time in minutes (57±16 vs 108±58, p=0.00004), fracture type of OTA 31 B2 or 31 B3 (7/7 vs. 14/24, p=0.027) were significant risk factors.

Conclusions Excess alcohol consumption, smoking, operative time >85 minutes, and displaced fractures were risk factors for femoral neck fixation failure.