The Clinically Stable Femoral Neck Fracture

Purpose:
Reoperation rates after fixation of non-displaced femoral neck may be as high as 23%. Several predictors for failure were identified, including age and increased posterior tilt angle. The purpose of this study was to evaluate the role of clinical fracture stability as a factor predicting success of non-displaced femoral fracture fixation.

Methods:
Patients were asked to raise their lower limb, with the heel still supported by the bed and the knee bending as the thigh is elevated. Fractures were considered as clinically stable if pain did not prevent performance of this task. These patients were treated by fracture fixation. Patients who failed this test were treated with arthroplasty. Eighty nine patients over the age of 75 with clinically stables fractures who completed 1 year of follow-up were included. Posterior preoperative tilt angles were documented. Patients were followed-up clinically and radiologically for 1 year.

Results:
Mean posterior-tilt angle was 7.3°. Sixty seven fractures (75.2%) had a posterior tilt angle of less than 15°. Eighteen
fractures (20.2%) had a posterior tilt angle of between 15 and 30°. In 4 cases (4.5%) the tilt had a slight anterior angle.

Of 89 patients, only 1 patient had mechanical failure of fixation, associated with technical surgical error. Six other patients underwent further surgery due to aseptic necrosis, hardware irritation or periprosthetic fractures.

Conclusion:
Elderly patients over the age of 75 with clinically stable non-displaced femoral neck fractures may safely be considered for fracture fixation.