Lateral hip radiograph.
Anteroposterior hip radiograph.
An 82-year-old woman presents to the office 2 months after undergoing hip pinning for a nondisplaced femoral neck fracture. Anteroposterior and lateral hip radiographs show collapse of the fracture with nonunion.
For femoral neck fractures fixed with percutaneous pinning, which of the following has the most influence on fracture healing?
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Nondisplaced or valgus impacted femoral neck fractures with minimal displacement are often treated with percutaneous pinning. These fractures can generally be stabilized with pin fixation and will heal well as the femoral head blood supply usually remains intact with minimal displacement. Percutaneous pinning is successful in most patients with a union rate of 85% to 95%.1 However, complications of femoral neck fractures may arise in elderly patients.2 Nonunion, late collapse, and avascular necrosis can occur in up to 12% of patients treated with internal fixation.1 The 1-year mortality rate for hip fractures ranges from 10% to 46%.3 Initial fracture displacement has the most influence on fracture healing; a greater amount of initial displacement indicates the greater likelihood that the blood supply to the femoral head has been disrupted. Age and gender usually do not influence fracture healing rates.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Bray TJ, Chapman MW. Percutaneous pinning of intracapsular hip fractures. Instr Course Lect. 1984;33:168-179.
- Roberts KC, Brox WT, Jevsevar DS, Sevarino K. Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23(2):131-137.
- da Costa JA, Ribeiro A, Bogas M, et al. Mortality and functional impairment after hip fracture – a prospective study in a Portuguese population. Acta Rheumatol Port. 2009;34:618-626.