Femoral Neck Fracture Fixation Failure: A Review and Stepwise Approach
Abstract
Femoral neck fractures are challenging injuries to treat, as they commonly involve high-energy trauma mechanisms and displaced fracture patterns. Despite the effective treatment techniques and devices available to fix these fractures, the cases of fixation failure following femoral neck fractures are not uncommon. The most important underlying causes of fixation failure include nonunion, avascular necrosis, reoperation, infection, and implant failure. The management of this condition depends mainly on the features of the patient and fracture. In this educational corner, we are aimed to present a review of and stepwise approach to the management of fixation failure following femoral neck fracture.
1. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. Orthopedic Trauma Directions. 1994;3(3):29-33.
2. Davidovitch RI, Jordan CJ, Egol KA, Vrahas MS. Challenges in the treatment of femoral neck fractures in the nonelderly
adult. J Trauma. 2010;68(1):236-42. doi: 10.1097/TA.0b013e3181c428ce. [PubMed: 20065780].
3. Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015;46(3):484-91. doi: 10.1016/j.injury.2014.10.010. [PubMed: 25480307].
4. Sugano N, Kubo T, Takaoka K, Ohzono K, Hotokebuchi T, Matsumoto T, et al. Diagnostic criteria for non-traumatic osteonecrosis of the femoral head. A multicentre study. J Bone Joint Surg Br. 1999;81(4):590-5. doi: 10.1302/0301-620x.81b4.9393. [PubMed: 10463726].
5. Ehlinger M, Moser T, Adam P, Bierry G, Gangi A, de Mathelin M, et al. Early prediction of femoral head avascular necrosis following neck fracture. Orthop Traumatol Surg Res. 2011;97(1):79-88. doi: 10.1016/j.otsr.2010.06.014. [PubMed: 21087905].
6. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002;(399):110-8. doi: 10.1097/00003086-200206000-00013. [PubMed: 12011699].
7. Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res. 2002;(399):87-109. doi: 10.1097/00003086-200206000-00012. [PubMed: 12011698].
8. Nikolopoulos KE, Papadakis SA, Kateros KT, Themistocleous GS, Vlamis JA, Papagelopoulos PJ, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury. 2003;34(7):525-8. doi: 10.1016/s0020-1383(02)00367-4. [PubMed: 12832180].
9. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am. 1994;76(12):1793-803. doi: 10.2106/00004623-199412000-00005. [PubMed: 7989384].
10. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994;76(1):15-25. doi: 10.2106/00004623-199401000-00003. [PubMed: 8288658].
11. Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br. 1965;47:560-73. [PubMed: 14341080].
12. Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br. 1953;35-B(3):442-61. [PubMed: 13084696].
13. Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am. 2013;95(1):61-9. doi: 10.2106/JBJS.K.01081.
[PubMed: 23283374].
14. Stockton DJ, O'Hara LM, O'Hara NN, Lefaivre KA, O'Brien PJ, Slobogean GP. High rate of reoperation and conversion to total hip arthroplasty after internal fixation of young femoral neck fractures: A population-based study of 796 patients. Acta Orthop. 2019;90(1):21-5. doi: 10.1080/17453674.2018.1558380. [PubMed: 30712497]. [PubMed Central: PMC6366467].
15. Gjertsen JE, Lie SA, Vinje T, Engesaeter LB, Hallan G, Matre K, et al. More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: an observational study of 11,116 hemiarthroplasties from a national register. J Bone Joint Surg Br. 2012;94(8):1113-9. doi: 10.1302/0301-620X.94B8.29155. [PubMed: 22844055].
16. Liporace F, Gaines R, Collinge C, Haidukewych GJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008;90(8):1654-9. doi: 10.2106/JBJS.G.01353. [PubMed: 18676894].
17. Lindequist S, Tornkvist H. Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma. 1995;9(3):215-21. doi: 10.1097/00005131-199506000-00006. [PubMed: 7623173].
18. Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg. 1961;43(4):647-63.
19. Wang W, Wei J, Xu Z, Zhuo W, Zhang Y, Rong H, et al. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: A meta-analysis. BMC Musculoskelet Disord. 2014;15:167. doi: 10.1186/1471-2474-15-167. [PubMed: 24885566]. [PubMed Central: PMC4047776].
20. Song KS. Displaced fracture of the femoral neck in children: Open versus closed reduction. J Bone Joint Surg Br. 2010;92(8):1148-51. doi: 10.1302/0301-620X.92B8.24482. [PubMed: 20675763].
21. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma. 2006;20(5):323-9. doi: 10.1097/00005131-200605000-00005. [PubMed: 16766935].
22. Schoenfeld AJ, Vrabec GA. Valgus osteotomy of the proximal femur with sliding hip screw for the treatment of femoral neck nonunions: The technique, a case series, and literature review. J Orthop Trauma. 2006;20(7):485-91. doi: 10.1097/00005131-200608000-00006. [PubMed: 16891940].
23. Müller ME. Intertrochanteric osteotomy: indication,
preoperative planning, technique. In: Schatzker J, Aronson J, Bombelli R, Editors. The intertrochanteric osteotomy. Berlin, Germany: Springer; 1984. p. 25-66.
24. Yuan BJ, Shearer DW, Barei DP, Nork SE. Intertrochanteric osteotomy for femoral neck nonunion: Does "undercorrection" result in an acceptable rate of femoral neck union? J Orthop Trauma. 2017;31(8):420-6. doi: 10.1097/BOT.0000000000000869. [PubMed: 28430719].
25. Min BW, Bae KC, Kang CH, Song KS, Kim SY, Won YY. Valgus intertrochanteric osteotomy for non-union of femoral neck
fracture. Injury. 2006;37(8):786-90. doi: 10.1016/j.injury.2006.02.045. [PubMed: 16765958].
26. Chotigavanichaya C, Leeprakobboon D, Eamsobhana P, Kaewpornsawan K. Results of surgical treatment of coxa vara in children: Valgus osteotomy with angle blade plate fixation. J Med Assoc Thai. 2014;97(Suppl 9):S78-S82. [PubMed: 25365895].
27. Parker MJ, Blundell C. Choice of implant for internal fixation of femoral neck fractures. Meta-analysis of 25 randomised trials including 4,925 patients. Acta Orthop Scand. 1998;69(2):138-43. doi: 10.3109/17453679809117614. [PubMed: 9602770].
28. Bhandari M, Tornetta P 3rd, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: Multiple screws or sliding hip screws? J Orthop Trauma. 2009;23(6):403-7. doi: 10.1097/BOT.0b013e318176191f. [PubMed: 19550225].
29. Booth KC, Donaldson TK, Dai QG. Femoral neck fracture fixation: A biomechanical study of two cannulated screw placement techniques. Orthopedics. 1998;21(11):1173-6. [PubMed: 9845448].
30. Oakey JW, Stover MD, Summers HD, Sartori M, Havey RM,
Patwardhan AG. Does screw configuration affect subtrochanteric fracture after femoral neck fixation? Clin
Orthop Relat Res. 2006;443:302-6. doi:
10.1097/01.blo.0000188557.65387.fc. [PubMed: 16462455].
31. Zlowodzki M, Jonsson A, Paulke R, Kregor PJ, Bhandari M. Shortening after femoral neck fracture fixation: Is there a
solution? Clin Orthop Relat Res. 2007;461:213-8. doi:
10.1097/BLO.0b013e31805b7ec4. [PubMed: 17415006].
32. Zlowodzki M, Weening B, Petrisor B, Bhandari M. The value of washers in cannulated screw fixation of femoral neck
fractures. J Trauma. 2005;59(4):969-75. doi: 10.1097/01.ta.0000188130.99626.8c. [PubMed: 16374290].
33. Siavashi B, Aalirezaei A, Moosavi M, Golbakhsh MR, Savadkoohi D, Zehtab MJ. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop. 2015;39(10):2069-71. doi: 10.1007/s00264-015-2881-9. [PubMed: 26152248].
34. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res. 1996;(332):110-8. doi: 10.1097/00003086-199611000-00015. [PubMed: 8913152].
2. Davidovitch RI, Jordan CJ, Egol KA, Vrahas MS. Challenges in the treatment of femoral neck fractures in the nonelderly
adult. J Trauma. 2010;68(1):236-42. doi: 10.1097/TA.0b013e3181c428ce. [PubMed: 20065780].
3. Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015;46(3):484-91. doi: 10.1016/j.injury.2014.10.010. [PubMed: 25480307].
4. Sugano N, Kubo T, Takaoka K, Ohzono K, Hotokebuchi T, Matsumoto T, et al. Diagnostic criteria for non-traumatic osteonecrosis of the femoral head. A multicentre study. J Bone Joint Surg Br. 1999;81(4):590-5. doi: 10.1302/0301-620x.81b4.9393. [PubMed: 10463726].
5. Ehlinger M, Moser T, Adam P, Bierry G, Gangi A, de Mathelin M, et al. Early prediction of femoral head avascular necrosis following neck fracture. Orthop Traumatol Surg Res. 2011;97(1):79-88. doi: 10.1016/j.otsr.2010.06.014. [PubMed: 21087905].
6. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002;(399):110-8. doi: 10.1097/00003086-200206000-00013. [PubMed: 12011699].
7. Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res. 2002;(399):87-109. doi: 10.1097/00003086-200206000-00012. [PubMed: 12011698].
8. Nikolopoulos KE, Papadakis SA, Kateros KT, Themistocleous GS, Vlamis JA, Papagelopoulos PJ, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury. 2003;34(7):525-8. doi: 10.1016/s0020-1383(02)00367-4. [PubMed: 12832180].
9. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am. 1994;76(12):1793-803. doi: 10.2106/00004623-199412000-00005. [PubMed: 7989384].
10. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994;76(1):15-25. doi: 10.2106/00004623-199401000-00003. [PubMed: 8288658].
11. Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br. 1965;47:560-73. [PubMed: 14341080].
12. Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br. 1953;35-B(3):442-61. [PubMed: 13084696].
13. Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am. 2013;95(1):61-9. doi: 10.2106/JBJS.K.01081.
[PubMed: 23283374].
14. Stockton DJ, O'Hara LM, O'Hara NN, Lefaivre KA, O'Brien PJ, Slobogean GP. High rate of reoperation and conversion to total hip arthroplasty after internal fixation of young femoral neck fractures: A population-based study of 796 patients. Acta Orthop. 2019;90(1):21-5. doi: 10.1080/17453674.2018.1558380. [PubMed: 30712497]. [PubMed Central: PMC6366467].
15. Gjertsen JE, Lie SA, Vinje T, Engesaeter LB, Hallan G, Matre K, et al. More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: an observational study of 11,116 hemiarthroplasties from a national register. J Bone Joint Surg Br. 2012;94(8):1113-9. doi: 10.1302/0301-620X.94B8.29155. [PubMed: 22844055].
16. Liporace F, Gaines R, Collinge C, Haidukewych GJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008;90(8):1654-9. doi: 10.2106/JBJS.G.01353. [PubMed: 18676894].
17. Lindequist S, Tornkvist H. Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma. 1995;9(3):215-21. doi: 10.1097/00005131-199506000-00006. [PubMed: 7623173].
18. Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg. 1961;43(4):647-63.
19. Wang W, Wei J, Xu Z, Zhuo W, Zhang Y, Rong H, et al. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: A meta-analysis. BMC Musculoskelet Disord. 2014;15:167. doi: 10.1186/1471-2474-15-167. [PubMed: 24885566]. [PubMed Central: PMC4047776].
20. Song KS. Displaced fracture of the femoral neck in children: Open versus closed reduction. J Bone Joint Surg Br. 2010;92(8):1148-51. doi: 10.1302/0301-620X.92B8.24482. [PubMed: 20675763].
21. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma. 2006;20(5):323-9. doi: 10.1097/00005131-200605000-00005. [PubMed: 16766935].
22. Schoenfeld AJ, Vrabec GA. Valgus osteotomy of the proximal femur with sliding hip screw for the treatment of femoral neck nonunions: The technique, a case series, and literature review. J Orthop Trauma. 2006;20(7):485-91. doi: 10.1097/00005131-200608000-00006. [PubMed: 16891940].
23. Müller ME. Intertrochanteric osteotomy: indication,
preoperative planning, technique. In: Schatzker J, Aronson J, Bombelli R, Editors. The intertrochanteric osteotomy. Berlin, Germany: Springer; 1984. p. 25-66.
24. Yuan BJ, Shearer DW, Barei DP, Nork SE. Intertrochanteric osteotomy for femoral neck nonunion: Does "undercorrection" result in an acceptable rate of femoral neck union? J Orthop Trauma. 2017;31(8):420-6. doi: 10.1097/BOT.0000000000000869. [PubMed: 28430719].
25. Min BW, Bae KC, Kang CH, Song KS, Kim SY, Won YY. Valgus intertrochanteric osteotomy for non-union of femoral neck
fracture. Injury. 2006;37(8):786-90. doi: 10.1016/j.injury.2006.02.045. [PubMed: 16765958].
26. Chotigavanichaya C, Leeprakobboon D, Eamsobhana P, Kaewpornsawan K. Results of surgical treatment of coxa vara in children: Valgus osteotomy with angle blade plate fixation. J Med Assoc Thai. 2014;97(Suppl 9):S78-S82. [PubMed: 25365895].
27. Parker MJ, Blundell C. Choice of implant for internal fixation of femoral neck fractures. Meta-analysis of 25 randomised trials including 4,925 patients. Acta Orthop Scand. 1998;69(2):138-43. doi: 10.3109/17453679809117614. [PubMed: 9602770].
28. Bhandari M, Tornetta P 3rd, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: Multiple screws or sliding hip screws? J Orthop Trauma. 2009;23(6):403-7. doi: 10.1097/BOT.0b013e318176191f. [PubMed: 19550225].
29. Booth KC, Donaldson TK, Dai QG. Femoral neck fracture fixation: A biomechanical study of two cannulated screw placement techniques. Orthopedics. 1998;21(11):1173-6. [PubMed: 9845448].
30. Oakey JW, Stover MD, Summers HD, Sartori M, Havey RM,
Patwardhan AG. Does screw configuration affect subtrochanteric fracture after femoral neck fixation? Clin
Orthop Relat Res. 2006;443:302-6. doi:
10.1097/01.blo.0000188557.65387.fc. [PubMed: 16462455].
31. Zlowodzki M, Jonsson A, Paulke R, Kregor PJ, Bhandari M. Shortening after femoral neck fracture fixation: Is there a
solution? Clin Orthop Relat Res. 2007;461:213-8. doi:
10.1097/BLO.0b013e31805b7ec4. [PubMed: 17415006].
32. Zlowodzki M, Weening B, Petrisor B, Bhandari M. The value of washers in cannulated screw fixation of femoral neck
fractures. J Trauma. 2005;59(4):969-75. doi: 10.1097/01.ta.0000188130.99626.8c. [PubMed: 16374290].
33. Siavashi B, Aalirezaei A, Moosavi M, Golbakhsh MR, Savadkoohi D, Zehtab MJ. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop. 2015;39(10):2069-71. doi: 10.1007/s00264-015-2881-9. [PubMed: 26152248].
34. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res. 1996;(332):110-8. doi: 10.1097/00003086-199611000-00015. [PubMed: 8913152].
| Files | ||
| Issue | Vol 5, No 3 (2019) | |
| Section | Educational Corner | |
| DOI | https://doi.org/10.18502/jost.v5i3.4289 | |
| Keywords | ||
| Femoral Neck Fractures; Hip Fracture; Orthopedic Fixation Devices; Revision Surgery; Bone Screws | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Moazen Jamshidi SMM, Razzaghof M, Mortazavi SJ. Femoral Neck Fracture Fixation Failure: A Review and Stepwise Approach. J Orthop Spine Trauma. 2020;5(3):70-4.
