High secondary displacement rate in the conservative treatment of impacted femoral neck fractures in 105 patients

Abstract

In our group of patients, secondary displacement was frequent and unpredictable.

Factors predicting secondary displacement after non-operative treatment of undisplaced femoral neck fractures

“…In our study, fractures classified as Garden II had a 3-times higher risk of experiencing SED, which may explain the higher rate of SED compared to previously published studies [5,9,10]. Our hospital internal guidelines recommended non-operative treatment only for Garden I fractures; however, 37 % of non-operatively treated patients likely had in fact a Garden II fracture which highlights the problem of inter-observer variation and accuracy of the diagnostic process.…”

“…Non-operative treatment avoids risks of an operation and postoperative complications, particularly in elderly patients; this treatment, however, was reported to fail in many patients leading to secondary displacement (SED) with rates reported between 14 and 52 % [5,[9][10][11], as observed in our clinic. SED is manifested by pain exacerbation associated with the loss of impaction of the fracture or displacement of a primary undisplaced fracture.…”

“…The previous studies considering these factors [5,[9][10][11] showed no impact on SED as well. This might be related to the fact that the nonoperative treatment is usually chosen in elderly patients affected by co-morbidities who in general, already have reduced activity.…”

“…Considering alternative regimens of non-operative treatment for Garden I femoral neck fractures, Verheyen et al [9] noted in retrospective series 46 % SED in patients treated with partial weight bearing collected data from four different hospitals. These pre-classified the patients as Garden I and treated them non-operatively, still 5 (4.5 %) from 110 [10] reported a similar rate of 41 % in a series of 115 patients treated with skin traction and delayed weight bearing until after callus formation was confirmed on plain X-rays.…”

Classification of femoral neck fractures according to pauwels: interpretation and confusion ——Reinterpretation: a simplified classification based on mechanical considerations

“…This statement is based most notably on two large studies, from Otremski, et al [3] and Raaymakers and Marti [11], which showed no correlation between fracture angle and secondary displacement and/or nonunion in impacted femoral neck fractures. Verheyen et al [12] determined that the critical angle between Grade I and Grade II injuries is impractical, since almost all cases of impacted femoral neck fractures lie in the gray area and it is too difficult to differentiate them. However, in his original 1935 work, Pauwels [1] emphasized the exceptional nature of impacted femoral neck fractures (Figure 1).…”