A comparative study of rate of fracture union in femur neck fractures- operated within 24 hours and after 24 hours and within 7 days, effect of tamponade on rate of union in cases fixed with cannulated cancellous screws

Abstract

Background: Osteosynthesis of femoral neck fractures is particularly indicated in patients aged under 60years. A prolonged interval between the fracture and surgical fixation has been associated with avascular necrosis (AVN) of the femoral head. The primary objective of this study was to evaluate the association between the time to surgery and the rate of union in femur neck fractures.Methods: Patients with displaced fractures of the femoral neck (Garden III or IV) who underwent fixation with cannulated screws from August 2016 to August 2018 were evaluated retrospectively for the rate of union in femoral neck fractures.Patients were divided into two groups according to the time to surgery (within 24 hours and within 7days after 24 hours). Union rates were compared between the two groups.Results: 50 patients were included in the study; the duration of follow-up ranged from 12 to 24 months. The time from fracture to surgery ranged from 24 hours to 7 days. Fourty nine patients underwent surgery within 24 hours, and fourty eight patients underwent surgery within 7 days. There were two cases of femoral head necrosis. One patient had an associated infection. There were no statistically significant differences in the overall rate of union between the groups (p=0.999). None of the preoperative parameters or fracture characteristics were predictive factors for union. The only factor which affects the rate of union is inadequate reduction/fixation(odds ratio [OR]= 35.50, 95% confidence interval [CI]= 2.56 to 548.36, p=0.008).Conclusions: The interval between the occurrence of the injury and surgical fixation is not associated with rate of union in fractures of the femoral neck. Inadequate fracture reduction is a predictive factor in rate of union in femur neck fractures fixed with CC screws.