Displaced intra-capsular fractures of femoral neck are treated by osteosynthesis in young adults. Using a standard protocol, we have compared the results of internal fixation after closed (CRIF) and open reduction (ORIF) in these patients. We have also studied the risk factors that influence non-union and avascular necrosis (AVN).

Patients in the age group of 15–50 years, who were scheduled for internal fixation within 1 week of injury, were randomized into two groups, one for closed reduction and the other for open reduction. The two groups were compared for factors such as age, gender, time of surgery and posterior comminution as well as union and complications. Using univariate and multivariate methods the factors influencing non-union and AVN were analyzed.

The average duration of surgery in patients undergoing CRIF was less than half of that in the ORIF group. The rates of union (p=0.93) and avascular necrosis at 2 years (p=0.85) were comparable. Rates of complications like deep vein thrombosis and infection were also found to be comparable. Guide wire breakage was found in 2 patients undergoing CRIF. Posterior comminution, poor reduction and improper screw placement were the major factors influencing non-union. An accurate reduction in both the planes and placement of screws parallel or slightly divergent to each other had a positive influence on union. An overall AVN rate of 16.3% (15/92) was encountered and it was not influenced by any of the factors. A delay of more than 48 hrs in surgery did not influence the rates of union or AVN.

Conclusion: Both CRIF and ORIF are credible methods of treatment. Although the duration of surgery in CRIF is less than ORIF, the added time taken in achieving the reduction on the fracture table may actually make the whole procedure longer than ORIF. Posterior comminution, early loss of reduction and convergent screw placement are leading reasons for non-union.

Twenty one cases of ipsilateral hip and femoral shaft fractures, between January 1998 and December 2001, managed by reconstruction nail were reviewed. All patients underwent simultaneous surgery for both fractures and operative treatment was executed as early as general condition of the patient permitted. Delay in treatment was generally because of associated injuries [head, chest or abdominal]. There were 20 males and 1female patients with an average age of 34.5 years. There was delayed diagnosis of neck fracture in 2 cases and these cases were not included in the study.

Our average follow-up is 30.9 months. There was one case of nonunion of a femoral neck fracture, one case of avascular necrosis and one neck fracture that united in varus. There were 4 nonunions and 6 cases of delayed union of femoral shaft fractures. Mean time for union of femoral neck fracture was 15 weeks and for shaft fracture was 22 weeks. In our results, shaft fracture determined the total union period. Though complications involving the femoral shaft fracture were greater than the femoral neck fractures, the shaft complications were more manageable compared to neck complications. This stresses the need to realize the significance and seriousness of both components of this complex injury, in evaluation, management and postoperative care.

Conclusion: Though technically demanding the reconstruction nail is an optimal alternative for management of concomitant fracture of femoral neck and shaft with low rates of complications and good results.