Femoral head
necrosis is a rare but devastating complication following
femoral neck fracture. The reported incidence of avascular
necrosis after
femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. The aim of this study was to analyze the risk factors for femoral head
necrosis after internal fixation in
femoral neck fracture. This retrospective study included 166 patients with
femoral neck fractures treated with surgical reduction and internal fixation at the authors' institution from January 2004 to December 2008. Eight patients died for reasons unrelated to the surgery, and 12 patients were lost to follow-up. The remaining 146 patients (146 fractures) were followed until union or until conversion to
total hip arthroplasty. The patients included 61 males and 85 females with an average age of 47.5 years (range, 18-68 years). The authors analyzed the following factors: age, sex, Garden classification, reduction quality, surgical methods, injury-to-surgery interval, preoperative
traction, weight-bearing time, and implant removal. All patients were followed for a mean of 52 months (range, 6-90 months). The incidence of femoral head
necrosis was 14.4% (21/146). Garden classification (P=.012), reduction quality (P=.008), implant removal (P=.020), and preoperative
traction (P=.003) were significantly associated with femoral head
necrosis. Patient age (P=.990), sex (P=.287), injury-to-surgery interval (P=.360), weight-bearing time (P=.868), and surgical methods (P=.987) were not significantly associated with femoral head
necrosis. In multivariate logistic regression analysis, implant removal was not a significant risk factor for femoral head
necrosis development (
P=.498). Garden classification, reduction quality, and preoperative
traction had a significant effect on femoral head
necrosis development.