Results of cephallomedullary nail fixation for displaced intracapsular femoral neck fractures.

摘要

OBJECTIVE: To evaluate the outcomes of displaced intracapsular femoral neck fractures treated with a cephalomedullary device. DESIGN: Retrospective study. SETTING: Level I trauma center. PATIENTS: Between 2002 and 2008, 18 patients with displaced intracapsular femoral neck fractures were treated at our Level I trauma center with a cephalomedullary nail. There were 12 males and six females. Six patients were younger than 60 years of age with a mean age of 63 years (range, 40-88 years). Thirteen fractures were midcervical (Orthopaedic Trauma Association [OTA] 31-B2.2 and B2.3), and five fractures were subcapital (OTA 31-B3). Patients with basicervical fractures (OTA 31-B2.1) and nondisplaced subcapital fractures (OTA 31-B1) were excluded. INTERVENTION: All patients underwent cephalomedullary nail fixation of their femoral neck fractures under the supervision of fellowship-trained orthopaedic trauma surgeons. MAIN OUTCOME MEASUREMENTS: Postoperative radiographs were evaluated for fracture reduction quality. Clinical follow-up was available on 13 patients with a minimum of 12 months (range, 12-25 months). A radiographic and chart review was done to identify complications and outcomes. RESULTS: Seven of eight fractures that healed were anatomically reduced. No failures occurred in the six patients younger than 60 years. Fixation failed in five of 13 fractures (38.4%) with varus collapse as the typical failure mode. The mean time to failure in these cases was 3.8 months (range, 1-7 months). Overall, the failure rate for the subcapital fractures was 100% (three of three) and for midcervical 20% (two of 10) with all failures being in patients older than 60 years (71.4%). Osteonecrosis without fixation failure or cutout occurred in one case. CONCLUSION: Cephalomedullary nail fixation of displaced intracapsular femoral neck fractures demonstrated mixed results. For younger patients with midcervical fractures that were well reduced, the fixation performed well. Displaced subcapital fractures in patients older than 60 years demonstrated a 100% failure rate. As a result, we cannot advocate cephalomedullary fixation for displaced intracapsular femoral neck fractures in patients older than 60 years, although in younger patients, these implants may provide an alternative to side-plate based fixation devices.