Treatment of Femoral Neck Fractures with Intramedullary Fixation with Integrated Interlocking Lag and Compression Screws

Abstract

Objectives: (1) To describe our operative technique for femoral neck fractures using an intramedullary device with integrated compression screws. (2) Retrospective analysis of patients treated with intramedullary fixation with interlocking lag and compression screws for femoral neck fracture (3). To compare our results to published literature on more classic fixation techniques. Design: Single-center retrospective cohort. Setting: Level 1 trauma center. Patients/Participants: Thirty-eight patients with 39 femoral neck fractures were treated with internal fixation. Only patients treated with intramedullary fixation with integrated interlocking lag and compression screws were included; patients treated for femoral neck fractures with a sliding hip screw, screw fixation alone, or intramedullary devices without integrated interlocking screws were excluded. Our final cohort consisted of 19 patients (47% female) with an average age of 50 (27–82) who had 15 (79%) isolated femoral neck fractures and 4 (21%) femoral neck-shaft combined fractures. Intervention: Internal fixation with intramedullary fixation using interlocking lag and compression screws for femoral neck fracture. Outcome Measurements: Quality of reduction, radiographic healing, and radiographic assessment of nonunion/avascular necrosis (AVN). Results: Follow-up time was on average 50 months (range: 34–84), with a median of 50 months (interquartile range: 42–56). Nineteen patients (100%) had successful healing without further intervention. There were no nonunions, and 2 (10%) patients developed AVN leading to conversion to total hip arthroplasty. Conclusion: Femoral neck fractures are challenging to manage due to their intracapsular location and the tenuous blood supply to the femoral head. The use of intramedullary devices with integrated lag and compression screws is an effective method for the operative fixation of femoral neck fractures. Level of evidence: Level IV therapeutic.

Keywords

• compression screw
• femoral neck fracture
• hip fracture
• intramedullary nail
• lag screw