Shortening After Femoral Neck Fracture Fixation

When using parallel screws for treatment of femoral neck fractures, shortening of the femoral neck might occur. Given the high revision surgery rates associated with parallel screws, we developed a questionnaire to explore (1) surgeons’ viewpoints on difficulties in the fixation of femoral neck fractures, (2) their perception of the clinical importance of femoral neck shortening after internal fixation, and (3) their opinions regarding the ideal fixation device. Two hundred three surgeons responded. Eighty-three percent believed shortening of the femoral neck is common after screw fixation of femoral neck fractures; 89% believed shortening limits hip abductor function; and 69% believed shortening limits patients’ physical function. When asked for features of the ideal implant for treatment of a femoral neck fracture, allowing compression across the fracture site on insertion and providing angular stability with a fixed-angle device to minimize shortening of the femoral neck were favored by 89% and 79% of the respondents, respectively. A plate with multiple nonparallel lag screws that can be locked into the plate might be a solution. However, the findings of this study are surgeons’ opinions, which may or may not be confirmed by scientific evidence. The number of people older than 60 years is projected to increase from 605 million in 2002 to 1.2 billion by the year 2025, and the number of hip fractures is expected to rise to approximately 6.3 million per year worldwide by 2050, with women experiencing approximately 80% of all hip fractures. Operative treatment of hip fractures is the mainstay. Options for internal fixation include various implants, including sliding hip screws and parallel multiple screws. Although numerous reports and textbooks recommend parallel multiple screws as the preferred surgical technique, evidence remains inconclusive. Both implants allow for dynamic compression of the fracture site during weightbearing and therefore it is plausible that shortening of the femoral neck might occur. Despite a staggering yearly incidence, patients treated operatively for hip fractures continue to have high mortality (ie, 20%) and revision surgery rates (35%). Given the high revision surgery rates associated with internal fixation, lack of evidence favoring alternative implants, and the need to develop better implants and techniques to improve the care of patients with femoral neck fractures, we conducted a survey among orthopaedic surgeons to identify current problems and possible solutions. We hypothesized femoral neck shortening allowed by the sliding characteristics of common devices would be perceived as highly problematic by a high proportion of surgeons. In addition, we believed a high proportion of surgeons would prefer implants that prevent femoral neck shortening.