EFFECT OF POSTERIOR COMMINUTION ON THE HEALING OF INTERNALLY FIXED INTRACAPSULAR HIP FRACTURES: A PROSPECTIVE STUDY OF 1247 PATIENTS

Abstract

Background: Numerous researchers have documented posterior comminution to confer an increased incidence of non-union and avascular necrosis after internal fixation of both displaced and undisplaced intracpasular hip fractures. This prospective study of 1247 patients questions this association and shows that comminution does not cause a statistically significant increase in these complications of fracture healing.

Methods: Twelve hundred and forty-seven patients with 1247 intracapsular hip fractures (568 undisplaced and 679 displaced fractures) were treated with open reduction and internal fixation. All these had preoperative radiographs, which were evaluated for posterior comminution. All of them were followed up post-operatively for clinical and radiographic evidence of non-union and avascular necrosis. The incidence of complications in comminuted versus non-comminuted fractures was calculated in both undisplaced and displaced groups. These rates were then compared for statistical significance (p value =0.05).

Results: The undisplaced cases (n=568) comprised 557 non-comminuted and 11 comminuted fractures. The complication rates were 10.9% and 18.2% respectively. The difference was not significant, with a p value of 0.38. Displaced fractures (n=679) consisted of 588 non-comminuted and 91 comminuted cases. In this group, complication rates were 33% and 35% respectively, with a p value of 0.82.

Conclusions: For the 1247 patients studied, there was no association between the observation of comminution of the fracture on the pre-operative x-rays and the later development of fracture healing complications.