Femoral Head Necrosis Associated with Intracapsular Non-Displaced Hip Fractures Treated by Osteosynthesis

Abstract

Background: Several causes have been described to explain the development of femoral head necrosis after intracapsular femoral neck fractures. However, in certain cases, especially in non-displaced fractures, a clear etiology does not appear. The aim of the present study is to ascertain the influence of proximal femoral morphology in femoral head necrosis development after non-displaced intracapsular femoral neck fractures treated with three 4.5 mm cancellous screws.
Patients and Methods: Sixty-seven patients (51 women) were treated consecutively. Patients had a mean age of 75 (35-94) years. Mean follow-up was 12 (9-48) months. Fracture consolidation, femoral head necrosis, cervical-diaphyseal angle, head diameter, femoral neck width, and head-neck length were analyzed.
Results: Nine cases of necrosis in the phase of segmentary collapse appeared, all of them in women. Necrosis cases presented a smaller diameter of the femoral head (44.7 mm) than non-necrosis cases (50.1 mm) (p < 0.05).
Discussion and Conclusion: These results may be due to a poorer vascularization and/or a smaller size of the femoral head in women, with the osteosynthesis material occupying a proportionally greater head volume.

Key words

Hip - intracapsular fracture - osteosynthesis - avascular necrosis

References

• 1 Alho A, Benterud J G, Roningen H, Hoiseth A. Prediction of disturbed healing in femoral neck fracture.  Acta Orthop Scand. 1992;  63 639-644
• 2 Anchuelo J, Ferrer M, Valdés I, Jiménez A. Fracturas del cuello femoral tratadas con tornillos de rosca parcial. Revisión de 200 casos.  Rev Ortop Traum. 1995;  39 91-98
• 3 Blundell C M, Parker M J, Pryor G A, Hopkinson-Woolley J, Bhonsle S S. Assessment of the AO classification of intracapsular fractures of the femur proximal.  J Bone Joint Surg [Br]. 1998;  80 679-683
• 4 Chung S MK. The arterial supply of the developing proximal end of the human femur.  J Bone Joint Surg [Am]. 1976;  58 961-970
• 5 DeLee J C. Fractures in adults. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD (eds). Fractures and dislocations of the hip. Lippincott-Raved, Philadelphia, New York 1996; 1659-1756
• 6 Fanjul J M, Moreno T J, Fernandez V, Gutierrez E. Fracturas del cuello femoral. Método de valoración y tratamiento frente a la resección sistemática cefálica.  Rev Ortop Traum. 1991;  34 27-36
• 7 Frandsen P A, Andersen E, Madsen F, Skjodt T. Garden's classification of femoral neck fractures. An assessment of inter-observer variation.  J Bone Joint Surg [Br]. 1998;  70 588-590
• 8 Harper W M, Barnes M R, Gregg P J. Femoral head blood flow in femoral neck fractures. An analysis using intra-osseous pressure measurement.  J Bone Joint Surg [Br]. 1991;  73 73-75
• 9 Hernigou P, Besnard P. Articular penetration is more likely in Garden-I fractures of the hip.  J Bone Joint Surg [Br]. 1996;  79 285-288
• 10 Hinton R Y, Lennox D W, Ebert F R, Jacobsen S J. Relative rates of fracture of the hip in the United States.  J Bone Joint Surg [Am]. 1995;  77 695-702
• 11 Lagerby M, Asplund S, Ringqvist I. Cannulated screws for fixation of femoral neck fractures.  Acta Orthop Scand. 1998;  69 387-391
• 12 Marco F, de Pedro J A, López-Oliva F, León C, Sánchez-Barrero J C, Sánchez-Barba A, López-Duran L. Valor de la RMN en la predicción de la viabilidad de la cabeza femoral tras la fractura cervical.  Rev Ortop Traum. 1991;  35 (Suppl 1) 59-63
• 13 Martinez J F, Navarro M, Gimenez A. Fracturas de la extremidad proximal del fémur en el anciano. Incidencia y mortalidad postoperatoria.  Rev Ortop Traum. 1995;  39 248-255
• 14 Parker M J, 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;  69 138-143
• 15 Parker M J. The management of intracapsular fractures of the proximal femur.  J Bone Joint Surg [Br]. 2000;  82 937-941
• 16 Rajan D T, Parker M J. Does the level of an intracapsular femoral fracture influence fracture healing after internal fixation? A study of 411 patients.  Injury. 2001;  32 53-56
• 17 Swiontkowski M. Intracapsular fractures of the hip.  J Bone Joint Surg [Am]. 1994;  76 129-138