Locking Plate Fixation with Multiple Telescoping Sliding Screws for Femoral Neck Fractures.

BACKGROUND

Non-displaced femoral neck fractures are mostly treated with internal fixation, while in dis-placed fractures this surgical option is under debate and the benefits are still not clear. The purpose of this study was to identify the factors that affect the treatment of non-displaced and displaced hip fractures using a head-preserving plate.

MATERIAL AND METHODS

From August 2011 to May 2015, we reviewed eighty-two adult patients who had sustained undisplaced and displaced intracapsular femoral neck fracture treated with a locking plate system with telescoping sliding screws. Fracture reduction, healing rate and implant related complications were primary objectives. Other complications (e.g. avascular necrosis, nonunion, hematoma, infection) and revision surgery were recorded as well.

RESULTS

According to the Garden classification system, a total of 51.2% fractures were classified as non-displaced (type 1 and 2) and 48.8% were displaced fractures (type 3 and 4). Anatomic reduction was achieved in 58.5% and valgus in 41.5% of patients and it did not influence the healing. Varus reduction was not observed in any case. The total average complication rate was 18.1%, where screw cutout was the most frequent complication (8.5%). The timing of surgery did not affect the healing of femoral neck fractures. Age over 60 years combined with a displaced fracture was associated with impaired healing potential and a higher complication rate. Revision surgery was performed in 17.1% of patients, mainly those with displaced fractures.

CONCLUSIONS

1. The use of a locking plate system with telescoping sliding screws was associated with lower rates of postoperative complications in undisplaced, but also in displaced femoral neck fractures in patients younger 60 years. 2. Patients over 60 years with displaced fractures were more likely to have healing problems and implant failure.