Intracapsular fractures of the femoral neck: Internal fixation or arthroplasty

Abstract

Objective: Significant advances in the surgical treatment of intracapsular fractures of the femoral neck began in the mid-twentieth century, because of the better understanding of the characteristics and biomechanics of the fractures. The aim of this study is to precisely identify the characteristics of the fractures, that will be taken into account in the individualization of treatment of intracapsular fractures of the femur. Materials and Methods: We analyzed, in a retrospective study, 148 patients with intraarticular fractures of the femoral neck from the registry of the Orthopaedic Department in Pozarevac, in the period from 2009 to 2014. Fractures were classified by the modified Garden’s classification. Garden type III fractures were divided into two sub-types. Garden type IIIa included fractures in which the distance between the fragments of the medial cortex was less than ½ the diameter of the femoral neck. Garden type III b included fractures in which the distance of the medial cortex of the fracture fragments was larger than ½ the diameter of the femoral neck. Patients with the Garden type I fracture (6 cases), Garden type II ( 22 cases), Garden type IIIa (35 cases) and Garden type IV (5 cases) were treated by closed reduction and internal fixation. Patients with Garden type IIIb (28 cases) and Garden type IV (52 cases) were treated by primary total hip replacement. Results : All fractures in patients with the fracture Garden type I (6 cases) and Garden type II (22 cases) have healed and avascular necrosis did not occur. In the group of patients with the Garden type III b fracture, 3 patients with non-union were treated with total hip arthroplasty. In the same group in two patients avascular necrosis occurred. In the group of patients with the Garden type IV fracture who were treated by closed reduction and inter- nal fixation (5 cases), two patients with non-union were treated with total hip arthroplasty. In patients with Garden sub-type III b, in the time of monitoring we found 4 dislocations after primary total hip arthroplasty. One patient underwent acetabular revision in the same group. In the group of patients with Garden type IV fracture, we found 7 dislocations after total hip arthroplasty and two patients underwent acetabular revision surgery. Conclusion: Our results indicate that fractures Garden type I, II and Garden type III a can be successfully treated with internal fixation. Fractures Garden type III b and IV should be treated by primary hip arthroplasty, because of internal fixation of these fractures lead to unsatisfactory results.