The intertrochanteric line approach for irreducible femoral neck fractures: a novel open reduction technique with favorable clinical outcomes.

PURPOSE: Despite the high incidence of femoral neck fractures, the optimal surgical strategy (open reduction vs. closed reduction) for patients with an irreducible femoral neck fracture (IFNF) remains a controversial topic. Furthermore, there is a lack of consensus regarding the surgical approach to open reduction. The purpose of this study was to introduce a novel open approach for the treatment of IFNF.

METHODS

We retrospectively reviewed 52 patients defined as IFNF who achieved anatomic reduction and definitive fixation through the intertrochanteric line approach. During surgical management, all patients underwent "sandwich mode" bone grafting. Post-operative Garden index and Hip Harris score (HHS) were recorded to assess the quality of femoral neck reduction and hip function. Patients were followed up for fracture healing time, avascular necrosis (AVN), and other complications.

RESULTS

All patients were followed up with an average of 32.37 months (range, 24-56 months). The fracture union was achieved in all patients with a mean duration of 4.35 ± 0.85 months. According to the Garden index, 37/52 cases achieved grade I reduction, and 15/52 cases achieved grade II reduction, respectively. Functional outcomes of 52 hips were evaluated by HHS, among which 39 cases were excellent, 7 cases were good, 3 cases were fair, and 3 cases who developed AVN were poor. None of them experienced postoperative Trendelenburg gait, infections, thrombosis, or paresthesia.

CONCLUSIONS

The intertrochanteric line approach is an effective and safe method for IFNF, providing excellent anatomic reduction, capsular decompression, which yields favorable outcomes in combination with the "sandwich mode" bone graft. More importantly, it has a short learning curve that is readily generalizable, while simultaneously minimizing complications, especially AVN and nonunion.