Posterior multifragmentation of the femoral neck: does it portend a poor outcome in internally fixed intracapsular hip fractures?

Abstract

To establish whether posterior multifragmentation of intracapsular proximal femoral fractures leads to an increased incidence of non-union and avascular necrosis following internal fixation by contemporary methods. After preoperative radiography which was evaluated for posterior fragmentation, 1042 intracapsular hip fractures (471 undisplaced and 571 displaced) were treated with reduction and internal fixation. The rates of non-union and avascular necrosis in the presence or absence of fragmentation were compared in both undisplaced and displaced groups. The undisplaced cases comprised 460 non-fragmented and 11 fragmented fractures. The complication rates were 14% and 18%, respectively. Displaced fractures consisted of 489 non-fragmented and 82 fragmented cases. In this group, complication rates were 43% and 40%, respectively. No difference was statistically significant. Using current methods of internal fixation of intracapsular hip fractures, there is no significant association between the posterior multifragmentation of the femoral neck observed on preoperative radiography and the later development of fracture healing complications.