LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES

Sean Scattergood; Oliver Flannery; Alexander Berry; James Fletcher; Stephen Mitchell

doi:10.1302/1358-992X.2021.2.070

Article alerts Social media

Current issue

Research

LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES

The British Orthopaedic Research Society (BORS) Annual Meeting 2020, held online, 7–8 September 2020.

Sean Scattergood
Oliver Flannery
Alexander Berry
James Fletcher
Stephen Mitchell

LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES

Scattergood S, Flannery O, Berry A, Fletcher J, Mitchell S. LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES. Orthop Procs. 2021;103-B(SUPP_2):70-70. doi:10.1302/1358-992X.2021.2.070

Scattergood, Sean, et al. “LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES.” Orthopaedic Proceedings, vol. 103-B, no. SUPP_2, 2021, pp. 70-70., https://doi.org/10.1302/1358-992X.2021.2.070

Scattergood, S., Flannery, O., Berry, A., Fletcher, J., & Mitchell, S. (2021). LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES. Orthopaedic Proceedings, 103-B(SUPP_2), 70-70. https://doi.org/10.1302/1358-992X.2021.2.070

Scattergood, S., Flannery, O., Berry, A., Fletcher, J. and Mitchell, S. (2021) “LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES.” Orthopaedic Proceedings, 103-B(SUPP_2), pp. 70-70. Available at: https://doi.org/10.1302/1358-992X.2021.2.070

Scattergood, Sean, Oliver Flannery, Alexander Berry, James Fletcher, and Stephen Mitchell. “LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES.” Orthopaedic Proceedings 103-B, no. SUPP_2 (2021): 70-70. https://doi.org/10.1302/1358-992X.2021.2.070

Scattergood S, Flannery O, Berry A, Fletcher J, Mitchell S. LOW RATES OF AVASCULAR NECROSIS FOLLOWING INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH CANNULATED SCREWS AT AN INNER CITY TRAUMA UNIT: A RETROSPECTIVE CASE SERIES. Orthop Procs. 2021 Mar 1;103-B(SUPP_2):70-70. https://doi.org/10.1302/1358-992X.2021.2.070

Copy to clipboard

BibTeX

EndNote

RIS

Abstract

Objectives

The use of cannulated screws for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 10–20% of fixed intracapsular fractures. The aim of this study was to investigate the rate of AVN with current surgical techniques within our unit.

Methods

A single centre retrospective review was performed. Operative records between 1st July 2014 and 31st May 2019 were manually searched for patients with an intracapsular neck of femur fracture fixed with cannulated screws, with minimum one year follow up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN and/or non-union. Fracture pattern and displacement, screw configuration and reduction techniques were recorded, with radiographs independently analysed by five orthopaedic surgeons.

Results

Sixty-five patients were identified, average age of 72 years (range 48–87). Thirty-six patients (55%) sustained displaced fractures and 29 patients (45%) had undisplaced fractures. Two (3%) patients developed AVN, with no cases of fracture non-union. Ten patients (15%) sustained a high-energy injury, though none of these patients developed AVN. Screws configurations were: two (3%) triangle apex-superior, 39 (60%) triangle apex-inferior, 22 (34%) rhomboid and two (3%) other, with nine (14%) cases using washers. All fractures required closed reduction; no open reductions performed.

Conclusions

Our observed AVN rate is much lower than widely reported, especially given the proportion of displaced fractures that were fixed. With adequate fixation, even in displaced fracture patterns with imperfect reduction, cannulated screws are an excellent option for intracapsular neck of femur fractures.

Declaration of Interest

(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.