Low avascular necrosis rates in femoral neck fractures: efficacy of cannulated screw fixation

Sean Scattergood, Alexander Berry, Oliver Flannery, Abigail Burdon, Stephen Mitchell, James Fletcher

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Purpose: Cannulated screw fixation for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 5–40% of fixed intracapsular fractures. This study aims to assess the outcomes, particularly the AVN rate, associated with current surgical techniques within our unit.

Methods: We conducted a single-center cross-sectional study, manually searching operative records between July 14, 2014, and December 1, 2018, identifying patients with intracapsular fractured neck of femur fixed with cannulated screws, with a minimum of two years follow-up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN, non-union, post-operative metalwork infection, and screw penetration of the head. Additionally, fracture pattern and displacement, screw configuration, reduction techniques, and adequacy of reduction were recorded, with radiographs independently analyzed by four orthopedic surgeons.

Results: Fifty-six patients were included; average age of 67 years (range 30–100). Forty-two patients (75%) sustained displaced fractures and 14 patients (25%) had undisplaced fractures. Two (4%) patients developed AVN, with no cases of non-union, post-operative metalwork infection or screw penetration of the head. Eight patients (14%) sustained a high-energy injury, though none of these patients developed AVN. All fractures required closed reduction; no open reductions performed. Twenty-seven (64%) of reductions were adequate.

Conclusion: Our observed AVN rate is notably lower than the widely reported figures, even among a significant proportion of displaced fractures that were fixed. This study underscores that with adequate fixation, cannulated screws represent an excellent option for treating intracapsular neck of femur fractures, even in cases of displaced fracture patterns with imperfect reduction.
Original languageEnglish
Number of pages7
JournalEuropean Journal of Orthopaedic Surgery & Traumatology
Early online date2 May 2024
Publication statusE-pub ahead of print - 2 May 2024


  • Avascular necrosis
  • Cannulated screws
  • Hip Fracture
  • Intracapsular
  • Neck of femur fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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