Percutaneous internal fixation of femoral neck fractures with cannulated screws and a small tension band plate

Summary

Objectives

Closed reduction and percutaneous fixation of femoral neck fractures with 2 parallel introduced cannulated screws and a small plate using the tension band principle.

Indications

Femoral neck fractures of Garden types I to IV within 48 hours after injury. Displaced femoral neck fractures beyond 48 hours of injury in older patients in poor general health. Undisplaced or minimally displaced impacted femoral neck fractures in older patients in good health, even beyond 48 hours after injury.

Contraindications

Impossibility of closed reduction. Advanced osteoarthritis. Rheumatoid arthritis. Femoral neck fractures in adolescents and young adults.

Surgical Technique

Positioning on a fracture table and reduction. At the lateral aspect of the thigh stab incision of skin and fascia as well as splitting of vastus lateralis at level of lesser trochanter. Internal fixation with 2 cannulated screws placed parallel, and small plate attached to the distal screw acting as a tension band.

Results

In 1993 and 1994, the percutaneous technique was used prospectively in 489 patients (363 women, 126 men). Follow-up after 3 to 4 as well as after 5 years and comparison with results of 165 patients (116 women, 49 men) who underwent an internal fixation with 2 Smith-Petersen nails in 1990. Duration of surgery, length of hospital stay and postoperative mortality were lower with the percutaneous technique. Complications seen: loss of reduction in 6.5% of the entire group and in 7.3% of Garden type III and IV fractures; pseudarthrosis 1.3%: avascular necrosis 19.8%; migration of screw into joint 3.1%.