Failure of Femoral Neck System Fixation Due to Suboptimal Reduction in a Young Adult With a Garden Type IV Subcapital Fracture: Conversion to Total Hip Arthroplasty. A Case Report
Abstract
We report the case of a 38-year-old nonsmoking man with a body mass index of 31.1 kg/m² who sustained a low-energy Garden type IV subcapital fracture after a ground-level fall. Radiographs showed a Garden type IV fracture and a neck-shaft angle of 119°. Internal fixation with the Femoral Neck System was performed 12 days after injury. Postoperative radiographs revealed suboptimal reduction and off-center screw placement. At 8 months, mechanical failure, loss of fixation, nonunion, and avascular necrosis were documented. Conversion to total hip arthroplasty was performed at 18 months. One month later, the Harris Hip Score was 82/100, and the patient had resumed daily activities without complications. Conclusions: Suboptimal reduction and off-center implant placement, in the setting of delayed surgery, contributed to implant failure. Even with modern implants, the quality of anatomical reduction remains the most important determinant of successful femoral head preservation in young adults. Conversion to total hip arthroplasty is an effective salvage strategy when internal fixation fails.Downloads
References
Karout L, Naffaa L. Pediatric hip disorders: Imaging guidelines and recommendations. Radiol Clin North Am 2022;60(1):149-63. https://doi.org/10.1016/j.rcl.2021.08.007
Carpintero P, Leon F, Zafra M, Serrano-Trenas JA, Román M. Stress fractures of the femoral neck and coxa vara.
Arch Orthop Trauma Surg 2003;123(6):273-7. https://doi.org/10.1007/s00402-003-0514-z
Othman YA, Khalefa AH, Ahmed IM, Ahmed KFE. Femoral neck locking plate versus multiple cannulated screws for femoral neck fractures in young adults: a randomized controlled trial. BMC Musculoskelet Disord 2025;26(1):799. https://doi.org/10.1186/s12891-025-09019-7
Roser T, Collinge C, Giga K, Lebus G, Beltran MJ, Crist B, et al. Optimal fixation strategies for displaced femoral
neck fractures in patients 18-59 years of age: An analysis of 565 cases treated at 26 level 1 Trauma Centers. J Orthop Trauma 2024;38(8):403-9. https://doi.org/10.1097/BOT.0000000000002828 38(8)
Stockton DJ, O’Hara LM, O’Hara NN, Lefaivre KA, O’Brien PJ, Slobogean GP. High rate of reoperation and
conversion to total hip arthroplasty after internal fixation of young femoral neck fractures: a population based study of 796 patients. Acta Orthop 2019;90(1): 21-5. https://doi.org/10.1080/17453674.2018.1558380
Beals RK. Coxa vara in childhood: etiology and treatment. J Am Acad Orthop Surg 1998;6(2):93-9.
https://doiorg/10.5435/00124635-199803000-00003
Vazquez O, Gamulin A, Hannouche D, Belaieff W. Osteosynthesis of non-displaced femoral neck fractures in the
elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes. J Orthop
Surg Res 2021;16(1):477. https://doi.org/10.1186/s13018-021-02622-z
Stoffel K, Michelitsch C, Arora R, Babst R, Candrian C, Eickhoff A, et al. Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational study. Arch Orthop Trauma Surg 2023;143(7):4185-94. https://doi.org/10.1007/s00402-022-04686-w
Weinstein JN, Birnbaum MJ. Biomechanics of the hip. En: Weinstein JN (ed). Orthopaedic knowledge update: hip
and knee reconstruction. 5th ed. Rosemont: American Academy of Orthopaedic Surgeons; 2016, p. 23-34.
Paley D. Principles of deformity correction. Berlin: Springer; 2002, p. 411-25.
Kim SJ, Choi JY. Comparative short-term outcomes of Femoral Neck System (FNS) and cannulated screw fixation in patients with femoral neck fracture. Clin Orthop Surg 2024;16(1):96-104. https://doi.org/10.4055/cios23190
AO Foundation. Complications and technical failures in femoral neck fracture fixation. Surgery Reference. 2024.
Stoffel K, Zderic I, Gras F, Sommer C, Eberli U, Mueller D, et al. Biomechanical evaluation of the femoral neck
system in unstable Pauwels III femoral neck fractures: a comparison with the dynamic hip screw and cannulated
screws. J Orthop Trauma 2017;31(3):131-7. https://doi.org/10.1097/BOT.0000000000000739
Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta 3rd P, Obremskey W, Koval KJ, et al. Internal fixation
compared with arthroplasty for displaced fractures of the femoral neck: a meta-analysis. J Bone Joint Surg Am
;85(9):1673-81. https://doi.org/10.2106/00004623-200309000-00004
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