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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 7, 1035-1040.
doi: 10.1302/0301-620X.86B7.15047  
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery
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Delayed internal fixation of fractures of the neck of the femur in young adults

A PROSPECTIVE, RANDOMISED STUDY COMPARING CLOSED AND OPEN REDUCTION

A. Upadhyay, MS (Orth), Senior Resident; P. Jain, MS (Orth), Senior Resident; P. Mishra, MS (Orth), Senior Resident; L. Maini, MS (Orth), Assistant Professor; V. K. Gautum, MS (Orth), DNB, Professor; and B. K. Dhaon, MS (Ortho), FNAMS, Director Professor and Head

Department of Orthopaedic Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital and Sushrut Trauma Centre, Bahadur Shah Zafar Marg, New Delhi, India.

Correspondence should be sent to Dr A. Upadhyay at 53/1, Ivy Lane, Osler Road, Headington, Oxford OX3 9DT, UK.

We have compared the results and complications after closed and open reduction with internal fixation in young adults with displaced intracapsular fractures (Garden grades III and IV) of the neck of the femur. We also studied the risk factors which influenced nonunion and the development of avascular necrosis (AVN). A total of 102 patients aged between 15 and 50 years was randomised to receive either closed or open reduction. Both groups were compared for age, gender, time to surgery and posterior comminution as well as for union and complications. Using univariate and multivariate analysis the factors influencing nonunion and AVN were assessed.

Of the 102 patients, 92 were available for review. There was no significant difference between the groups in terms of union (p = 0.93) and AVN at two years (p = 0.85). Posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion. The overall incidence of AVN was 16.3% (15 of 92 patients) and it was not influenced by these factors. A delay of more than 48 hours before surgery did not influence the rate of union or the development of AVN when compared with operation within 48 hours of injury.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General