Comparative study of two different surgical methods for the treatment of Garden III and IV femoral neck fractures in young adults

Objective To compare internal fixation with hallow compression screws combined vascularized bone graft (observation group) with only three hallow compression screws (control group) in young patients’ Garden III and IV femoral neck fractures. Methods The patients with femoral neck fracture were treated from January, 2004 to December, 2013 were retrospectively reviewed. A total of 417 displaced femoral neck fractures in young and middleaged patients were long term followed-up. One hundred and thirty-seven patients were underwent open reduction and internal fixation with 3 hallow compression screws combined with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery; 280 patients were treated by closed reduction with 3 hallow compression screws. Results Patients had been followed-up for 5-12 years. At the last follow-up point, the Harris score of flap in observation group(93.68±5.12) were higher than that in control group(92.53±6.12), while it was no statistical difference(P>0.05). It was 0.7% of nonunion incidence rate in the observation group, and incidence of avascular necrosis of femoral head was 6.6%, and incidence of femoral neck shortening was 8.8%. In the control group, incidence of avascular necrosis of femoral head was 14.6%, nonunion incidence rate was 4.6%, and incidence of femoral neck shortening was 22.5%. The differences between two groups was statistically significance(P<0.05). Conclusion The open reduction and internal fixation which is hallow compression screws in combination with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery is an optimal treatment for young adults with Garden III and IV femoral neck fractures. Key words: Femoral neck fracture; Garden type; Internal fixation; Bone graft; Transposition