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Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction.

Liu C, Liu MT, Li P, Xu HH - Chin. Med. J. (2015)

Bottom Line: The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score.The above index of two groups was considered statistically significant (P < 0.05).It is a safe and effective operation for subcapital femoral neck fracture.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China.

ABSTRACT

Background: Subcapital femoral neck fracture in young adults has many complications, and the incidence is increasing year-by-year. The selection of the proper operation method to avoid them is an ambiguous matter. This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and internal fixation in young adults.

Methods: From March 2003 to February 2010, 65 young patients with subcapital femoral neck fractures were treated, including 39 males and 26 females with average age of 34.5 years (range, 19-50 years); 29 cases of the left side and 36 cases of the right side. They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting. The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score. The observation criteria involved the length of the incision, blood loss, operation time, nonunion rate, avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score.

Results: Four of 65 patients were lost follow-up, and the follow-up rate was 93.8%, the average follow-up time was 38.7 months (range, 33-47 months). In Group A, the incision length was 5.1 ± 2.2 cm, blood loss was 84.0 ± 13.2 ml, and operation time was 52.9 ± 10.2 min. In Group B, the incision length was 15.4 ± 4.6 cm, blood loss was 396.0 ± 21.3 ml, and operation time was 116.5 ± 15.3 min. Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B. ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B. Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B. The above index of two groups was considered statistically significant (P < 0.05).

Conclusions: Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing, reduce ANFH in young adults. It is a safe and effective operation for subcapital femoral neck fracture.

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A 30-year-old female patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by closed reduction and internal fixation. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 years after operation showed avascular necrosis of femoral head; (d) X-rays of 2 years after operation showed femoral head replacement.
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Figure 1: A 30-year-old female patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by closed reduction and internal fixation. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 years after operation showed avascular necrosis of femoral head; (d) X-rays of 2 years after operation showed femoral head replacement.

Mentions: Avascular necrosis of the femoral head and nonunion are closely related to unsatisfied fracture reduction or fixation.[2425] Even though the procedure of the closed reduction and internal fixation under the C-arm image intensifier television fluoroscopy has less traumas to the blood supply of femoral head, it is difficult to make all the patients in anatomical reduction and some of them get the unsatisfied results. (1) C-arm image intensifier television fluoroscopy just shows the plane radiograph, so it's difficult to ensure whether the screws penetrate through the femoral head, which results in failing fixation or acetabular wear. (2) Three cannulated screws fix solidly in principle,[26] but with limited place they are easy to crash each other. (3) Using three screws require more accurate skills than using two. If the position and direction of guiding wires were frequently adjusted, the screws would get insufficiency pullout strength with excessively cannulated bone removed. (4) Three cannulated screws, which are also more likely to damage blood vessels in marrow and interfere with blood supply of the femoral head than two screws, will increase failure rate. (5) In addition, subcapital femoral neck fracture belongs to intracapsular fracture. The synovial fluid bathing the fracture may interfere with the healing process. Meanwhile, the soft tissues will grow into it. Both of them will prevent fracture from healing.[272829] Therefore, the closed group which includes 31 cases presented higher nonunion, ANFH rate and lower Harris Hip Score (8 cases account for 25.2%, 9 cases account for 29.1% and 89.0 ± 5.6 points respectively), even though better in trauma index (the incision length was 5.1 ± 2.2 cm, total amount of intra-operative blood loss was 84.0 ± 13.2 ml, and operation period was 52.9 ± 10.2 min) [Figure 1].


Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction.

Liu C, Liu MT, Li P, Xu HH - Chin. Med. J. (2015)

A 30-year-old female patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by closed reduction and internal fixation. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 years after operation showed avascular necrosis of femoral head; (d) X-rays of 2 years after operation showed femoral head replacement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836251&req=5

Figure 1: A 30-year-old female patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by closed reduction and internal fixation. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 years after operation showed avascular necrosis of femoral head; (d) X-rays of 2 years after operation showed femoral head replacement.
Mentions: Avascular necrosis of the femoral head and nonunion are closely related to unsatisfied fracture reduction or fixation.[2425] Even though the procedure of the closed reduction and internal fixation under the C-arm image intensifier television fluoroscopy has less traumas to the blood supply of femoral head, it is difficult to make all the patients in anatomical reduction and some of them get the unsatisfied results. (1) C-arm image intensifier television fluoroscopy just shows the plane radiograph, so it's difficult to ensure whether the screws penetrate through the femoral head, which results in failing fixation or acetabular wear. (2) Three cannulated screws fix solidly in principle,[26] but with limited place they are easy to crash each other. (3) Using three screws require more accurate skills than using two. If the position and direction of guiding wires were frequently adjusted, the screws would get insufficiency pullout strength with excessively cannulated bone removed. (4) Three cannulated screws, which are also more likely to damage blood vessels in marrow and interfere with blood supply of the femoral head than two screws, will increase failure rate. (5) In addition, subcapital femoral neck fracture belongs to intracapsular fracture. The synovial fluid bathing the fracture may interfere with the healing process. Meanwhile, the soft tissues will grow into it. Both of them will prevent fracture from healing.[272829] Therefore, the closed group which includes 31 cases presented higher nonunion, ANFH rate and lower Harris Hip Score (8 cases account for 25.2%, 9 cases account for 29.1% and 89.0 ± 5.6 points respectively), even though better in trauma index (the incision length was 5.1 ± 2.2 cm, total amount of intra-operative blood loss was 84.0 ± 13.2 ml, and operation period was 52.9 ± 10.2 min) [Figure 1].

Bottom Line: The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score.The above index of two groups was considered statistically significant (P < 0.05).It is a safe and effective operation for subcapital femoral neck fracture.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China.

ABSTRACT

Background: Subcapital femoral neck fracture in young adults has many complications, and the incidence is increasing year-by-year. The selection of the proper operation method to avoid them is an ambiguous matter. This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and internal fixation in young adults.

Methods: From March 2003 to February 2010, 65 young patients with subcapital femoral neck fractures were treated, including 39 males and 26 females with average age of 34.5 years (range, 19-50 years); 29 cases of the left side and 36 cases of the right side. They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting. The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score. The observation criteria involved the length of the incision, blood loss, operation time, nonunion rate, avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score.

Results: Four of 65 patients were lost follow-up, and the follow-up rate was 93.8%, the average follow-up time was 38.7 months (range, 33-47 months). In Group A, the incision length was 5.1 ± 2.2 cm, blood loss was 84.0 ± 13.2 ml, and operation time was 52.9 ± 10.2 min. In Group B, the incision length was 15.4 ± 4.6 cm, blood loss was 396.0 ± 21.3 ml, and operation time was 116.5 ± 15.3 min. Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B. ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B. Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B. The above index of two groups was considered statistically significant (P < 0.05).

Conclusions: Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing, reduce ANFH in young adults. It is a safe and effective operation for subcapital femoral neck fracture.

Show MeSH
Related in: MedlinePlus