Displaced Femoral Neck Fractures: Anatomic Reduction or Early Surgery?

Objective: Femoral neck fractures are treated with arthroplasty options in elderly patients. In young patients, the aim of the treatment is to protect the hip joint and its functions. In this study, the effect of the timing of surgery and reduction quality on the development of avascular necrosis in patients aged 15-60 years with Garden types 3 and 4 femoral neck fractures were retrospectively analyzed. Methods: Patients who underwent treatment in our clinic between 2009 and 2016 were retrospectively evaluated. The patients were classified into two groups, including those who underwent surgery within the first 8 hours after injury (mean time, 301 min) and those who underwent surgery 8 or more hours after injury (mean time, 1750 min). The patients were classified according to the Garden classification based on their preoperative radiographs. Reduction quality was evaluated through the Garden Alignment Index using postoperative radiographs. Postoperative radiographs were evaluated on the 1st, 2nd, 3rd, 6th, 12th, 18th, and 24th month after surgery, and the osteonecrosis classification was made using the Ficat-Arlet method. Results: No significant differences were found among these four groups in terms of operation time, fracture reduction quality, and the development of avascular necrosis (p>0.05). Conclusion: According to the this study the timing of surgery and anatomical reduction have no effect on the development of avascular necrosis in the treatment of displaced femoral neck fractures fixed with three cannulated screws. Keywords: Femoral neck fractures, trauma, avascular necrosis, internal fixation, anatomic reduction