The relationship between femoral neck fracture in adult and avascular necrosis and nonunion: A retrospective study

Abstract

BackgroundOne of the most serious sequelae of femoral neck fractures (FNFs) is avascular necrosis (AVN), and this complication translates to significant morbidity and mortality. This study was conducted to determine the relationship between the etiologies and management of FNFs at our institution and the development of AVN or nonunion.Materials and methodsThis study was a retrospective medical chart review of all adult patients admitted and managed for FNF.ResultsThere were a total of 69 FNF patients reviewed. FNF was caused by a fall in 37 patients (53.6%), a road traffic accident in 16 (23.2%), motorcycle and motorbike accidents in 8 (11.6%), and heavy exercise in 8 (11.6%). Twenty-four patients (34.8%) had fixation within 24 h of injury, and 45 (65.2%) went more than 24 h before fixation. The mean RUSH score at 6 months was 21.4 ± 5.1. There were 4 patients (5.8%) with a collapsed FNF and 4 patients (5.8%) had a nonunion FNF. AVN was documented in 12 patients (17.4%). Of the 12 patients who had AVN, 8 (66.7%) received fixation within 24 h from the time of the injury, whereas only 4 (33.3%) received fixation more than 24 h after the injury. There was a significant negative correlation between the time of fixation and AVN.ConclusionWe report a 17.4% incidence of AVN over 10 years in patients managed with FNF. AVN was found to be significantly correlated with the mode of injury (fall and RTA among younger male patients).

Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis

“…Of the 16 included studies, 4 reported [16, 19, 26, 33] the correlation between gender and ONFH after IFFNF. Because of nonsignificant heterogeneity among the studies, the fixed effect model was utilized ( I 2 = 25%, P = 0.26).…”

“…Data on Garden classification were available for the systematic analysis from 14 studies [16–20, 22–24, 26–30, 32]. The fixed effect model was chosen due to nonsignificant heterogeneity in intra-study comparisons ( I 2 = 1%, P = 0.44).…”

“…Five references [19, 20, 26–28] concerning the data on injury-operation interval were available for the analysis . The fixed effect model was used as nonsignificant heterogeneity was found in intra-study comparisons ( I 2 = 36%, P = 0.18).…”

“…Three studies [16, 21, 26] containing statistics on fracture reduction mode were available for the analysis using the fixed effect model, without significant heterogeneity among the studies ( I 2 = 33%, P = 0.23). The results exhibited no statistically significant differences in fracture reduction mode between the two patient groups (OR:1.98, 95%CI: 0.92–4.26, P = 0.08).…”

Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis

“…Displaced femoral neck fracture patients were reported to have a higher risk of vascular necrosis than non-displaced femoral neck fracture ones, which might be due to the blood supply to the femoral head is disrupted after displacement [ 22 ]. However, not all patients with severely displaced femoral neck fractures will suffer from ONFH in clinical practice [ 23 ].…”