RESULTS OF DELAYED FIXATION OF DISPLACED FEMORAL NECK FRACTURES IN ADULTS: A RETROSPECTIVE CLINICAL STUDY

Femoral neck fractures in young adults still remains a challenge due to high rates of non-union and avascular necrosis associated with it. Traditionally fracture neck of femur are treated as emergency operations but in our set up there is usually a delay in treating them. This paper evaluates the effect of timings of surgery on healing of fracture and functional outcome. METHODS: This retrospective study was conducted in Department of Orthopaedics & Traumatology, Bundelkhand Medical College, Sagar from November 2012 to May 2015 during which 34 cases were evaluated and treated with closed reduction and internal fixation. Only physiological young patients between the ages of 15 to 65 years with Garden's grade III & IV were included. Fractures associated with any pathological process or associated with other ipsilateral lower limb fractures were excluded. Patients treated with open reduction were also not included in this study. RESULTS: Out of 34 patients only 3 patient could be operated within 48 hours. The average delay in admission of patient was 4 days and average duration from injury to operation was 8.5 days. Non-union rates overall was 38.2%, for those operated within a week was 35.7% and for those operated after was 40%. If non-union due to mal reduction were excluded the rates were 19.2%, 10% and 25% respectively. CONCLUSION: In the treatment of fracture neck of femur quality of reduction proves to be the single most important variable affecting the outcome if operated within a week appears to be less significant variable if reduction was within acceptable range as non-union rate of only 14.2% was recorded. Thus good results can be achieved even after 48 hours though after a week non-union rates were high which suggests that after a week fibrosis around the fracture and hip and proximal migration of the distal fragment necessitate other open reduction or procedures such as intertrochanteric osteotomy or bone grafting in order to achieve union.