Femoral neck fractures in young adults

Abstract

Thirty young adults with fracture of the femoral neck were treated at Mackay Memorial Hospital during the period from 1971 to 1982. The age ranged from 16 to 40 years old (average 28.1 years). There were 20 males and 10 females. 16 patients (53.3%) had been involved in a high energy trauma and had major associated injury (11 of them suffered ipsilateral femoral shaft fractures). The fractures were classified into two groups: basilar neck and transcervical or subcapital; the latter was further subdivided into four types as proposed by Garden. In this series there were 6 basilar neck fractures. There was Garden type I fracture; both type II and type III had 6 cases each, the type IV had 12 cases. Twenty eight cases were treated by close reduction and fixed by multiple pins (Knowles pins) one was treated by skeletal traction and another one fixed with Smith-Peterson nail and plate. Follow-up period was 3 to 13 years (average 5.2 years). All had normal bone union except one who treated by skeletal traction had delayed union. The overall incidence of avascular necrosis was 16.7%. Among the 12 patients with a Garden type-IV fracture, 5 (41.7%) developed avascular necrosis. None of the other types of fractured neck had avascular necrosis. The difficulty in reducing and transfixing a completely displaced fracture of the femoral neck and the initial degree of displacement with variable vascular damage during injury may help to explain the different outcomes after treatment.