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  • Title: [Femoral neck fractures in adults: joint sparing operations. II. The significance of surgical timing and implant for development of aseptic femur head necrosis].
    Author: Bonnaire F, Kuner EH, Lorz W.
    Journal: Unfallchirurg; 1995 May; 98(5):259-64. PubMed ID: 7610386.
    Abstract:
    Statistical analysis of the results of the AO multi-center study (Part I) shows significant advantages of early (within 24 h) operative stabilization of the medial neck fracture (P < 0.05) and of use of the dynamic hip screw (DHS) as implant (P < 0.01). Secondary surgery necessitated by implant complications led to higher rates of aseptic femoral head necrosis (FHN) and non-unions (NU) (P < 0.05). According to the so-called logistic regression, the rate of NU is influenced most by the number of implant complications and the choice of implant, the rate of FHN by the interval time-lapse between fracture and follow up, the implant selected (the best being the DHS), primary dislocation (poorest results obtained in Garden types III and IV) and the time-lapse between fracture and operative stabilization. This puts the assumed paramount importance of dislocation in perspective and calls in question the dogma that a dislocated intracapsular neck fracture will necessarily be followed by FHN.
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