Treatment of Neglected Femoral Neck Fractures in Young Adults

Abstract

Sixteen young adults with neglected femoral neck fractures were treated from 1974 to 1981. The ages ranged from 16 to 43 years. The periods of delay after fracture were three months to two years. Most of the patients were initially treated by a "Chinese bone setter" with subsequent development of leg shortening, upward displacement of the distal fragment, and a variable degree of absorption of the femoral neck or head. Treatment included skeletal traction followed by open or closed reduction, internal fixation, or angulation osteotomy with or without bone graft. Two to eight years later, there were no cases of nonunion. Four hips developed avascular necrosis with one requiring still further surgical treatment. Thirteen patients (81%) had good to excellent results. Preservation of the patients' own hip joints was worthwhile. A defeatist attitude toward the "unsolved" fracture should be qualified.Von Langebe~k?~ in 1878, reported the first attempt at internal fixation of a fractured neck of the femur; however, sepsis resulted in his failure. His method was not accepted by the surgical profession at that time, and the conservative approach of Whitman33 was the method of choice until 193 1, when Smith-Peterson and his co-workersZ9 introduced the triflanged nail. Early anatomic reduction, impaction of the fracture fragments, and rigid internal fixation have been used to handle fresh femoral neck fractures with great im-

Contemporary management of femoral neck fractures: the young and the old

“…Of the seven studies that looked at correlation between timing to surgery (within 12 hours or after 12 hours), no difference in rate of osteonecrosis was found. Finally, three case series have been published reporting on cohorts of patients treated after "inadvertent" delays of 6 days to two years, with rates of AVN and nonunion similar to those series in which patients were treated emergently (0 to 25 %) [33][34][35].…”

The Neglected Femoral Neck Fracture in Young Adults: Review of a Challenging Problem

“…[2][3][4][5] While there is no defined lag period for such a fracture to be called "neglected," Myers et al 6 introduced the term to indicate a delay of 30 days or more from the injury to seek medical help. We will use this definition for the purpose of this review.…”

Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture

“…The causes of limping in our patients were residual shortening of 2.5 cm (two patients), postoperative neck-shaft angle greater than 145°(four patients), screw migration into the joint causing hip pain (one patient), and osteoarthrosis of the hip (one patient). The incidence of preoperative AVN in neglected femoral neck fractures is 2.08% in our patients as compared with 0% to 20% in other series [8,9,25,28]. Preoperative AVN (44%) is not a contraindication to osteotomy and it may lead to good results despite older age and AVN [20].…”

“…In developing countries, it is not uncommon to see patients with femoral neck fractures after a delay of several months because of poverty, lack of facilities, ignorance, and faith in traditional healers [8,9,15,25,28,29]. Prosthetic replacement generally is the preferred treatment for patients older than 60 years [10,13,21], and salvage of the femoral head has been advocated for younger patients [10,14,21,27].…”