Non-union and avascular necrosis of delayed reduction and screw fixation in displaced femoral neck fracture in young adults.

Management of displaced femoral neck fracture is crucial and vulnerable to develop complications. The present study was performed to evaluate the clinical outcome of delayed reduction with multiple screw fixations in young patients who had displaced femoral neck fracture. The authors conducted a retrospective study in young patients, aged less than 50 years old, who underwent delayed fixation for traumatic displaced femoral neck fracture (Garden classification III or IV) at Phetchabun Hospital between 1997 and 2002. Either closed or open reduction was performed to achieve an acceptable alignment and fixed with 2 or 3 cancellous screws. Study factors were age, gender Garden classification, time to reduction, type of reduction, number of screw fixation and Garden alignment index. Non-union and avascular necrosis was assessed by clinical and radiographic findings. There were 26 eligible patients. The average duration of delayed surgery was 13 days (range 2 to 30 days). Twenty-three patients had completed followed-up at average 28.4 months (range 14-52 months). All patients revealed complete union and independently ambulated within 10-16 months postoperatively. Clinical and radiographic avascular necroses of the femoral head developed in 2 patients (8.7%) at 20 and 24 months after surgery. Three patients who had early fixation failure underwent hemiarthroplasty except one patient refused to re-operate. Within 30-day delayed reduction and screw fixation for the treatment of displaced femoral neck fracture in the young is still good alternative treatment to preserve the femoral head with low rate of avascular necrosis.