Displaced Femoral Neck Fractures Treated with Percutaneous Compression Plates in Elderly Individuals: An Effect Analysis Based on Imaging.

Background: The effects of percutaneous compression plate (PCP) internal fixation for femoral neck fractures (FNFs) in elderly individuals have rarely been reported. Therefore, this study aimed to investigate the efficacy of PCCP internal fixation for displaced FNFs in elderly individuals based on imaging.

Methods: The clinical data of 32 elderly patients with FNFs treated with PCCP from January 2015 to December 2022 were retrospectively analyzed. The average age of the participants was 68.7 ± 4.8 years (range, 65-80 years). Nineteen patients had Garden type III, and 13 patients had Garden type IV. Six patients had Pauwels type I, 15 patients had type II, and 11 patients had type III. Twelve patients had Singh index level IV, 14 patients had level V, and 6 patients had level VI. The time from injury to operation ranged from 3-14 days, with an average of 5.8 days. A radiological assessment was conducted. The relationships between efficacy and age, Pauwels classification, the Singh index, and the Garden alignment index were analyzed.

Results: At postoperative week 1, fracture reduction was acceptable in 31 patients. The time to start walking was 5.7 ± 3.7 days. The follow-up time ranged from 2.1 to 4 years, with an average of 2.7 years. There were 2 cases of delayed healing and no cases of nonunion or internal fixation failure. The healing time ranged from 4-8 months, with an average of 4.9 months. Fifteen patients (46.9%) showed healing with shortening of the femoral neck, and 3 patients (9.4%) had avascular necrosis (AVN). Correlation analysis revealed that healing with shortening of the femoral neck was positively correlated with age and the Singh index and that AVN was positively correlated with the Pauwels classification (p < 0.05).

Conclusion: The efficacy of PCCPs for internal fixation of displaced FNFs in elderly individuals without severe osteoporosis is satisfactory, especially for patients who can ambulate early postoperatively. The main complications are healing with shortening of the femoral neck and AVN, which are prone to occur in patients with severe osteoporosis and Pauwels type III FNFs, respectively.