The Journal of Bone and Joint Surgery, Vol 76, Issue 12 1793-1803, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Intracapsular fractures of the femoral neck. Results of cannulated screw fixation
SE Asnis and L Wanek-Sgaglione
North Shore University Hospital-Cornell University Medical College, Manhasset, New York 11030.
The results of stabilization of an intracapsular fracture of the femoral
neck with cannulated screws placed in parallel in 141 patients between 1980
and 1985 were reviewed retrospectively. Fifty patients (35 per cent) had a
non-displaced fracture (Garden Stage I or II) and ninety-one (65 per cent)
had a displaced fracture (Garden Stage III or IV). The median age of the
patients was sixty-eight years (range, twenty-four to ninety-five years).
The mean duration of follow-up was eight years. No patient died or had a
wound infection during the stay in the hospital. Twenty-nine patients, who
had a median age of seventy-five years (range, fifty-six to ninety-five
years), died within sixty months after treatment; eleven of them (median
age, seventy-five years [range, sixty-five to eighty-six years]) died
within the first twelve months. There was a loss of position or a non-union
of the fracture in five patients (4 per cent) and healing of the fracture
in 136 patients (96 per cent). Thirteen patients (11 +/- 3 per cent) had
histological or roentgenographic evidence of osteonecrosis within
twenty-four months after treatment. Ten of these patients had had a
displaced fracture. Osteonecrosis developed in thirteen additional patients
during the remaining period of follow-up. Eight of these patients had had a
displaced fracture. The prevalence of osteonecrosis at the time of the most
recent follow-up (mean duration, eight years) was 22 +/- 4 per cent.
Osteonecrosis developed in eight of the forty-one patients who had had a
Garden Stage-II fracture, in six of the thirty patients who had had a
Garden Stage-III fracture, and in twelve of the forty patients who had had
a Garden Stage-IV fracture. The fifty-five surviving patients in whom the
fracture healed without complications were found to be functioning well
more than sixty months after the fracture.
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