Reduction of femoral neck fractures in adults. Valgus-or anatomical position?

In a retrospective study, 51 patients with femoral neck fractures received open reduction and internal fixation. They were divided into two groups. Gr oup A included all patients treated with anatomical reduction. In Group V, the bone fragments were positioned in greater than or equal to5 degrees val gus. The median age of the patients was 37.4 years (range 13-58). 51 patien ts were available for follow-up assessment at 10.1 (+/-4.3) years. There we re 33 patients in Group A and 18 in Group V. All patients were examined wit h regard to early and long-term complications. In the first five years, avascular necrosis was seen in 18% in Group A and not at all in Group V. Nonunion occurred in 9% of Group A and 5.5% of Group V. On average at 10 years after the operation, coxarthritis (Kellgren 2) w as evident in 21.2% of Group A and 55.6% of Group V (p = 0.04). According t o the Hip-Score of Merle d'Aubigne, the patients treated with anatomical re duction had a better functional outcome after 10 years. With respect to the results we recommend in younger patients (< 60 years) a natomical reduction in Pauwels I and Garden-II-fractures. Valgusreduction s hould be performed as well in Pauwels II and III as Garden-III- and -IV-fra ctures.