Short-term effectiveness of the Gotfried positive buttress reduction plus fixation with cannulated screws for femoral neck fracture in young and middle-aged people

Objective To evaluate the short-term effectiveness of Gotfried positive buttress reduction plus fixation with cannulated screws(CSs)for young and middle-aged patients with femoral neck fracture. Methods A retrospective analysis was made of the clinical data of 117 patients under 65 years old with femoral neck fracture who had been fixated by CSs between September 2009 and September 2014. They were divided into 3 groups according to the first postoperative anteroposterior view of hip X-ray: anatomic reduction(group A), Gotfried positive buttress reduction(group B), and Gotfried negative buttress reduction(group C). There were 29 men and 11 women with a mean age of 49. 5 ± 11. 4 years in group A, 25 men and 14 women with a mean age of 47. 6 ± 11. 7 years in group B, and 30 men and 8 women with a mean age of 48. 7 ± 11. 8 years in group C. There was no significant difference in general preoperative demographics( P> 0. 05). The 3 groups were compared in terms of femoral neck shortening one year postoperatively, fracture ununion, femoral head necrosis and Harris hip score at the final follow-ups. Results The incidences of femoral head necrosis in groups A, B and C were 15. 0% , 15. 4% and 18. 4%, respectively, showing no significant difference between groups(P> 0. 05). The incidences of degree II femoral neck shortening for groups A and B(7. 5% and 7. 7%)were significantly lower than that for group C(26. 3%)(P< 0. 05). The mean Harris hip scores at the final follow-up for groups A and B(84. 5 ±6. 8 and 86. 0 ±6. 6)were significantly higher than that for group C(78. 9 ±7. 8)(P< 0. 05). Conclusions Gotfried positive buttress reduction plus fixation with cannulated screws for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better ones than Gotfried negative buttress reduction. As a result, there is no need to pursue forcefully anatomic reduction in patients with irreducible femoral neck fracture when Gotfried positive buttress reduction has been achieved, but the negative status should be avoided. Key words: Femoral neck fractures; Fracture fixation, internal; Reduction; Postoperative complications; Shortening