Skip to main content

Advertisement

SpringerLink
Log in

Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient

  • Expert's Opinion • HIP - FRACTURES
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Femoral neck fractures in the young adult are a less common, but potentially functionally significant injury commonly occurring after high-energy trauma. The management goals of these injuries are the maintenance of a native hip joint absent avascular necrosis and nonunion. The primary determinant to this end is an anatomic reduction in displaced fractures with stable fixation. In this paper, the authors provide a set of technical tips and tricks to aid orthopedic surgeons in the surgical management of these injuries while reviewing the most recent literature available to inform clinical decision making. The paper includes the recommendations of the authors from the Denver Health Orthopaedic Trauma Service.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733. doi:10.1007/s00198-006-0172-4

    Article  CAS  PubMed  Google Scholar 

  2. Mauffrey C (2009) The management of subcapital fractures in the elderly population. Eur J Orthop Surg Traumatol 20(5):359–364. doi:10.1007/s00590-009-0570-3

    Article  Google Scholar 

  3. Robinson CM, Court-Brown CM, McQueen MM, Christie J (1995) Hip fractures in adults younger than 50 years of age. Clin Orthop Relat Res 312:9

    Google Scholar 

  4. Protzman RR, Burkhalter WE (1976) Femoral-neck fractures in young adults. J Bone Joint Surg Am 58-A(5):7

    Google Scholar 

  5. Swiontkowski MF, Winquist RA, Hansen ST (1984) Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Am 66-A(6):10

    Google Scholar 

  6. Gerber C, Strehle J, Ganz R (1993) The treatment of fractures of the femoral neck. Clin Orthop Relat Res 292:10

    Google Scholar 

  7. Pihlajamaki H, Ruohola J-P, Kiuru MJ, Visuri TI (2006) Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am 88-A(9):10

    Google Scholar 

  8. Slobogean GP, Sprague SA, Scott T, Bhandari M (2015) Complications following young femoral neck fractures. Injury 46(3):484–491. doi:10.1016/j.injury.2014.10.010

    Article  CAS  PubMed  Google Scholar 

  9. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ (2004) Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 86-A(8):7

    Google Scholar 

  10. Haidukewych GJ (2009) Salvage of failed treatment of femoral neck fractures. AAOS Instr Course Lect 59:8

    Google Scholar 

  11. Dedrick DK, Mackenzie JR, Burney RE (1986) Complications of femoral neck fracture in young adults. J Trauma 26(10):6

    Article  Google Scholar 

  12. Peljovich AE, Patterson BM (1998) Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg 6:8

    Article  Google Scholar 

  13. Ly TV, Swiontkowski MF (2008) Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am 90-A(10):13. doi:10.1016/S0021-9355(08)72690-0

    Google Scholar 

  14. Bedford MR, Brewster MBS, Grimstvedt LO, O’Dwyer K (2011) Re-evaluating the lateral hip view in the management of femoral neck fractures. Eur J Orthop Surg Traumatol 21(3):165–169. doi:10.1007/s00590-010-0680-y

    Article  Google Scholar 

  15. Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Am 43-B(4):17

    Google Scholar 

  16. Bartonicek J (2001) Pauwels’ classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 15:3

    Google Scholar 

  17. Gaspar D, Crnkovic T, Durovic D et al (2012) AO group, AO subgroup, Garden and Pauwels classification systems of femoral neck fractures: are they reliable and reproducible? Med Glas (Zenica) 9:5

    Google Scholar 

  18. Collinge C, Mir H, Reddix R (2014) Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma 28(5):6

    Google Scholar 

  19. Baitner AC, Maurer SG, Hickey DG, Jazrawi LM, Kummer FJ, Jamal J, Goldman S, Koval KJ (1999) Vertical shear fractures of the femoral neck: a biomechanical study. Clin Orth Rel Res 367:6

    Article  Google Scholar 

  20. Bonnaire FA, Weber AT (2002) Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck. Injury 33(Suppl 3):9

    Google Scholar 

  21. Stankewich CJ, Chapman J, Muthusamy R, Quaid G, Schemitsch E, Tencer AF, Ching RP (1996) Relationship of mechanical factors to the strength of proximal femur fractures fixed with cancellous screws. J Orthop Trauma 10:10

    Google Scholar 

  22. Damany DS, Parker MJ, Chojnowski A (2005) Complications after intracapsular hip fractures in young adults: a meta-analysis of 18 published studies involving 564 fractures. Injury 36(1):11

    Google Scholar 

  23. Schweitzer D, Melero P, Zylberberg A, Salabarrieta J, Urrutia J (2013) Factors associated with avascular necrosis of the femoral head and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation. Eur J Orthop Surg Traumatol 23(1):61–65. doi:10.1007/s00590-011-0936-1

    Article  PubMed  Google Scholar 

  24. Gao YS, Ai ZS, Zhu ZH, Yu XW, Zhang CQ (2013) Injury-to-surgery interval does not affect postfracture osteonecrosis of the femoral head in young adults: a systematic review. Eur J Orthop Surg Traumatol 23(2):203–209. doi:10.1007/s00590-012-0948-5

    Article  PubMed  Google Scholar 

  25. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN (2002) Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am 84-A(9):8

    Google Scholar 

  26. Bedi A, Karunakar MA, Caron T, Sanders RW, Haidukewych GJ (2009) Accuracy of reduction of ipsilateral femoral neck and shaft fractures–an analysis of various internal fixation strategies. J Orthop Trauma 23(4):5

    Google Scholar 

  27. Krischak G, Beck A, Wachter N, Jakob R, Kinzl L, Suger G (2003) Relevance of primary reduction for the clinical outcome of femoral neck fractures treated with cancellous screws. Arch Orthop Trauma Surg 123(8):404–409. doi:10.1007/s00402-003-0571-3

    Article  CAS  PubMed  Google Scholar 

  28. Lowell JD (1980) Results and complications of femoral neck fractures. Clin Orthop Relat Res 152:11

    Google Scholar 

  29. Weinrobe M, Stankewich CJ, Mueller B, Tencer AF (1998) Predicting the mechanical outcome of femoral neck fractures fixed with cancellous screws: an in vivo study. J Orthop Trauma 12(1):10

    Google Scholar 

  30. Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ (2015) Femoral neck fractures: current management. J Orthop Trauma 29(3):9

    Google Scholar 

  31. Harper WM, Barnes MR, Gregg PJ (1991) Femoral head blood flow in femoral neck fractures. An analysis using intra-osseous pressure measurement. J Bone Joint Surg Br 73:3

    Google Scholar 

  32. Bonnaire FA, Schaefer DJ, Kuner EH (1998) Hemarthrosis and hip joint pressure in femoral neck fractures. Clin Orthop Relat Res 353:8

    Google Scholar 

  33. Stromqvist B, Nilsson LT, Egund N, Thorngren KG, Wingstrand H (1988) Intracapsular pressures in undisplaced fractures of the femoral neck. J Bone Joint Surg Br 70:3

    Google Scholar 

  34. Robinson CM, Adams CI, Craig M, Doward W, Clarke MCC, Auld J (2002) Implant-related fractures of the femur following hip fracture surgery. J Bone Joint Surg Am 84-A(7):7

    Google Scholar 

  35. Selvan VT, Oakley MJ, Rangan A, Al-Lami MK (2004) Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury 35(2):136–141. doi:10.1016/s0020-1383(03)00059-7

    Article  CAS  PubMed  Google Scholar 

  36. Zdero R, Keast-Butler O, Schemitsch EH (2010) A biomechanical comparison of two triple-screw methods for femoral neck fracture fixation in a synthetic bone model. J Trauma 69(6):1537–1544. doi:10.1097/TA.0b013e3181efb1d1

    Article  PubMed  Google Scholar 

  37. Papanastassiou ID, Mavrogenis AF, Kokkalis ZT, Nikolopoulos K, Skourtas K, Papagelopoulos PJ (2011) Fixation of femoral neck fractures using divergent versus parallel cannulated screws. J Long Term Eff Med Implants 21(1):7

    Article  Google Scholar 

  38. Oakey JW, Stover MD, Summers HD, Satori M, Robert M, Patwardhan AG (2006) Does screw configuration affect subtrochanteric fracture after femoral neck fixation? Clin Orthop Relat Res 443:5

    Google Scholar 

  39. Kauffman JI, Simona JA, Kummer FJ, Pearlman CJ, Zuckerman JD, Koval KJ (1999) Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study. Clin Orthop Relat Res 13(3):5

    Google Scholar 

  40. Hawks MA, Kim H, Strauss JE, Oliphant BW, Golden RD, Hsieh AH, Nascone JW, O’Toole RV (2013) Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures? A biomechanical analysis in cadaveric bone. Clin Biomech (Bristol, Avon) 28(8):886–891. doi:10.1016/j.clinbiomech.2013.08.007

    Article  Google Scholar 

  41. Zlowodzki MP, Wijdicks CA, Armitage BM, Cole PA (2015) Value of washers in internal fixation of femoral neck fractures with cancellous screws: a biomechanical evaluation. J Orthop Trauma 29:4

    Google Scholar 

  42. Bray TJ (1997) Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res 339:12

    Google Scholar 

  43. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fracture of the hip. J of Bone Joint Surg Am 77-A(7):8

    Google Scholar 

  44. Liporace F, Gaines R, Collinge C, Haidukewych GJ (2008) Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am 90(8):1654–1659. doi:10.2106/JBJS.G.01353

    Article  PubMed  Google Scholar 

  45. Blair B, Koval KJ, Kummer F, Zuckerman JD (1994) Basicervical fractures of the proximal femur: a biomechanical study of 3 internal fixation techniques. Clin Orthop Relat Res 306:8

    Google Scholar 

  46. Deneka DA, Simonian PT, Stankewich CJ, Eckert D, Chapman JR, Tencer AF (1997) Biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. J Orthop Trauma 11(5):7

    Google Scholar 

  47. Stockton DJ, Lefaivre KA, Deakin DE, Osterhoff G, Yamada A, Broekhuyse HM, O’Brien PJ, Slobogean GP (2015) Incidence, magnitude, and predictors of shortening in young femoral neck fractures. J Orthop Trauma 29(9):6

    Google Scholar 

  48. Zlowodzki M, Brink O, Switzer J, Wingerter S, Woodall J, Petrisor BA, Kregor PJ, Bruinsma DR, Bhandari M (2008) The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg Br 90-B:8. doi:10.1302/0301-620X.90B11

    Article  Google Scholar 

  49. Kunapuli SC, Schramski MJ, Lee AS, Popovich JMJ, Cholewicki J, Reeves NP, Crichlow RJ (2015) Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma 29(3):7

    Google Scholar 

  50. Ye Y, Hao J, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ (2015) Optimizing stability in femoral neck fracture fixation. Orthopedics 38(10):625–630. doi:10.3928/01477447-20151002-05

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock St., Denver, CO, 80204, USA

    Stephen C. Stacey, David Hak & Cyril Mauffrey

  2. Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA

    Christopher H. Renninger

Authors
  1. Stephen C. Stacey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher H. Renninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Hak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cyril Mauffrey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cyril Mauffrey.

Ethics declarations

Ethical statement

Dr. Hak reports personal fees from Globus, personal fees from Merck, personal fees from Invibio, outside the submitted work. Dr. Mauffrey reports personal fees from Springer, personal fees from Slack, personal fees from Elsevier, and institutional support from Striker, institutional support from Synthes, institutional support from Abbott, institutional support from AO organization, and institutional grant support from Hebei province and CoI, all outside the submitted work.

Conflict of interest

Dr. Renninger and Dr. Stacey have nothing to disclose.

Human and animal rights

This article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stacey, S.C., Renninger, C.H., Hak, D. et al. Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol 26, 355–363 (2016). https://doi.org/10.1007/s00590-016-1745-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-016-1745-3

Keywords

Search

Navigation