ORIGINAL ARTICLE
Osteosynthesis of Unstable Intracapsular Femoral Neck
Fracture by Dynamic Locking Plate or Screw Fixation:
Early Results
Ran Thein, MD,* Amir Herman, MD, PhD,* Paz Kedem, MD,* Aharon Chechik, MD,*
and Nachshon Shazar, MD*
Objectives: The purpose of this study was to compare the
postoperative radiologic and clinical outcomes of telescopic femur
neck screws and small locking plate device (Targon FN) (group 1)
with multiple cancellous screws (group 2) for displaced intracapsular
femoral neck fractures.
Design: Comparison of a prospective collected data to a historical
control group (retrospective).
Setting: One community teaching hospital.
Patients: Seventy-eight patients (group 1, 31; group 2, 47) underwent
reduction and internal xation of displaced intracapsular femoral neck
fractures with either Targon FN device or multiple cancellous screws
from March 2000 to July 2010. Their mean age was 53.7 years (SD:
16.4), and the mean follow-up period was 28.6 months.
Main Outcome Measures: Treatment failure was considered to
be either a nonunion, osteonecrosis, or revision surgery of any type.
Treatment was regarded as successful in patients who did not show
failure and had at least 1-year follow-up.
Results: One patient in group 1 (3.2%) and 22 (46.8%) in group 2
had a nonunion (P = 0.0001). Four (12.9%) group 1 patients and 16
(34.0%) group 2 patients underwent revision surgery (P = 0.036).
Four (12.9%) patients in group 1 and 4 (8.5%) group 2 patients had
osteonecrosis of the femoral head (P = 0.531). Multivariate logistic
regression showed that internal xation by the xed-angle xation
device decreased the odds ratio for overall complication by a factor
of 0.23, for example, by 77% (P = 0.018).
Accepted for publication June 25, 2013.
From the *Department of Orthopedic Surgery; and Talpiot Medical Leader-
ship Program, Chaim Sheba Medical Center, Tel Hashomer and Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Presented in part at the Expertise in Interlocking Nailing: Orthopaedic man-
agement of fractures in the elderly Meeting, May 2627, 2011, Winsdor,
England, United Kingdom; and also presented in part at the 31st Annual
Meeting of the Israel Orthopedic Association, November 30, 2011,
Tel-Aviv, Israel.
The authors report no funding or conicts of interest.
Ethical Board Review: Approval for the study was obtained from our local
Institutional Review Board.
Reprints: Ran Thein, MD, Department of Orthopedic Surgery, Chaim Sheba
Medical Center, Tel Hashomer, 52621 Israel (e-mail: ranthein@gmail.
com).
Copyright 2013 by Lippincott Williams & Wilkins
70 | www.jorthotrauma.com
Conclusions: Performing internal xation by a xed-angle xation
device decreased nonunion rates and revision rates. It did not affect
the rate of osteonecrosis.
Key Words: hip fracture, internal xation, unstable intracapsular fracture
Level of Evidence: Therapeutic Level III. See Instructions for
Authors for a complete description of levels of evidence.
(J Orthop Trauma 2014;28:7076)
INTRODUCTION
Displaced intracapsular femoral neck fractures, espe-
cially in young active patients, poses a considerable challenge
for the orthopedic surgeon. The therapeutic goal in most cases
is preservation of the femoral head,1 mandating reduction and
internal xation although preserving the blood supply to the
femoral head. Chua et al2 showed that accurate reduction and
stable xation reduce the relative risk of fracture healing com-
plications by a factor of 13. Others35 concluded that anatomic
reduction and internal xation was necessary to avoid non-
union and osteonecrosis of the femoral head. The incidence
of osteonecrosis and nonunion, however, remains as high as
16% and 33%, respectively.6 These devastating complications
lead to revision surgeries and early hip arthroplasty.14,6
Our routine practice for treating displaced femoral neck
fractures had been reduction and internal xation using partially
threaded cancellous screws, a common and acceptable approach
used by many others as well.1,5,710 The Targon Femoral Neck
Hip Screw (Targon FN; Aesculap Ltd, Tuttlingen, Germany)
was recently introduced for commercial use. It incorporates
multiple sliding cancellous femoral neck screws and a small
locking plate that acts as antirotation and xed-angle device.
Parker and Stedtfeld8 reported a series of 83 patients with both
displaced and nondisplaced intracapsular femoral neck fractures
that were internally xated with the Targon FN with promising
results. To the best of our knowledge, there have been no
clinical studies comparing traditional cancellous screw xation
with the Targon FN device.
The purpose of this study was to prospectively evaluate
the results of displaced intracapsular femoral neck fractures
treated by the Targon FN dynamic locking plate. We compared
these results with historical control fractures that were xed by
us with multiple cancellous screws. The primary endpoints
were the development of osteonecrosis, secondary displacement
J Orthop Trauma  Volume 28, Number 2, February 2014
J Orthop Trauma  Volume 28, Number 2, February 2014
(nonunion), and salvage (osteotomy or removal of internal
xation), or reconstruction (hemiarthroplasty or total hip
replacement) revision rates.
PATIENTS AND METHODS
A total of 108 patients with unstable intracapsular fracture
were initially evaluated for study suitability between 2000 and
2011, OTA classication 31-B2.3 or 31-B3.11 Fracture classica-
tions and Pauwel angle measurements were performed by 2 inde-
pendent reviewers (R.T. and A.H.). Disagreements were settled
by a third, trauma trained, orthopaedic surgeon (N.S.). All 3 were
blinded to surgery type. Exclusion criteria were pathological frac-
tures, previous surgery on the ipsilateral hip or femur, and failure
to complete 1 year of follow-up. Patients who had osteonecrosis,
secondary displacement (nonunion), and reoperation were
included in the study even if their follow-up was less than 1 year.
The study group (group 1) initially included 47 patients who were
treated at our medical center by fracture xation with the Targon
FN device between 2008 and 2011. They were followed-up pro-
spectively. Two of these patients were subsequently excluded
from the study: 1 had died 3 months after surgery due to unre-
lated chest surgery, and the other was lost to follow-up. Fourteen
patients did not complete 1-year follow-up. The historical con-
trols (group 2) included 47 of 60 consecutive patients treated by 3
cancellous screws xation between 2000 and 2008 and who had
been followed up for at least 1 year (the other 13 were excluded
due to insufcient follow-up). The selected data for group 2 was
obtained retrospectively by reviewing the hospital records and
radiographs. Data regarding the patients who were treated
between 2000 and June 2008 were collected retrospectively
and those from June 2008 were collected prospectively.
Approval for the study was obtained from our local
Institutional Review Board. Each patient who was being
planned to be followed prospectively signed an informed
consent form agreeing to participate in this study.
The patients in both groups were given either general or
regional anesthesia and positioned supine on a fracture table,
and limb length was restored by gentle longitudinal traction
under an image intensier. Restoring rotational malalignment
was accomplished by internal rotation in most cases and by
external rotation in the others. We proceeded to open
reduction, when closed reduction was unsuccessful. Our targets
for acceptable reduction were slight valgus or anatomic
reduction on the anterior-posterior view and no extension or
exion on the axial view. We had 4 patients from group 1 and
4 patients from group 2 who required an open reduction.
The surgical technique used for the patients in group 1
was previously described in depth by Parker and Stedtfeld.8
Briey, exposure of the femur shaft at the lesser trochanter
level was achieved by a 46 cm lateral incision. The femur
was approached directly, and the rst guide wire was inserted
by free hand or through the middle hole of the plate to achieve
a central position in both the anteroposterior and lateral radio-
graphs. Further guide wires were inserted through the plate up
to the subchondral bone of the femoral head. Afterwards, the
guide wires were measured and drilled, and 3 telescopic screws
were inserted. A 10-mm extension of the telescopic screw was
used when possible to allow shortening of the femoral neck for
2013 Lippincott Williams & Wilkins
Dynamic Locking Plate or Screw Fixation
facilitating compression and union. Distal xation was
obtained by inserting 2 locking screws through the alignment
jig to x the plate to the lateral femur (Fig. 1).
The fractures in the group 2 patients were xed with
either 7.5-mm partially threaded cannulated screws or free-hand
insertion of 6.5-mm partially threaded large fragment screws.
The surgical technique used for the patients in group 2 was as
follows. Just above the level of the lesser trochanter, a guide
wire was inserted by free hand or through a 135-degree angle
jig to achieve a central position in both the anteroposterior and
lateral radiographs. Further guide wires or drills were inserted
around it up to the subchondral bone of the femoral head. As
a rule, they were inserted as an inverted triangle, but the
surgeon had the freedom to insert them in another triangular
construct. Afterwards, the guide wires were measured and
drilled and 3 screws were inserted. The average minimum
distance from the screw tip to the femur head apex was
6.17 mm (SD: 2.9). The average maximum distance from the
screw tip to the femur head apex was 10.8 mm (SD: 4.1).
Postoperative ambulation was encouraged as possible for
all patients, but full weight bearing was not allowed for the rst
6 weeks. The follow-up for both groups was carried out in our
outpatient clinic. Visits for both groups were scheduled for
6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery
and as needed. Clinical evaluation included interview, physical
examination, and imaging (X-ray or computerized tomography)
as required. Information was obtained by telephone interview
for all patients who did not adhere to outpatient clinic follow-up.
Failure endpoints included nonunion, osteonecrosis of
the femoral head, and salvage (osteotomy or removal of
internal xation) or reconstruction (hemiarthroplasty or total
hip replacement) revision.
Statistical Analysis
Data were analyzed by SPSS 16.0 software (SPSS, Inc,
Chicago, IL). Categorical variables are given as number and
percent. Continuous variables are given as mean and SD. The
x2 and the Fisher exact tests were used to test for statistical
signicance among categorical variables. The latter was used
when the expected count was lower than 5 in at least 1 cell.
The WilcoxonMann-Whitney rank sum test was used to test
for statistical signicance among continuous variables. Total
major complications were calculated as either osteonecrosis or
nonunion. Major complication was dened as osteonecrosis,
nonunion, or revision surgery; its prevalence was also assessed.
A logistic multivariate analysis was performed to identify the
most important factors contributing to a major complication.
The total number of major complications was used as the
dependent variable. Independent covariates in the model were
as follows: age (younger or older than 50 years), gender, dis-
placed fracture (31.B3 vs. 31.B2.3), xation device used (xed
angle vs. screws), Pauwel angle, and time to surgery (below or
above 12 hours). All P values were 2-sided, and a P value of
,0.05 was considered statistically signicant.
RESULTS
The study included a total of 78 patients, and their
relevant demographic and clinical and functional data are
www.jorthotrauma.com | 71
Thein et al J Orthop Trauma  Volume 28, Number 2, February 2014

FIGURE 1. A, The 59-year-old

woman with displaced subcapital
femoral neck fracture. B, Fourteen
months after treating with closed
reduction and internal fixation with
Targon FN, the fracture unite and no
signs of osteonecrosis can be
observed.

presented in Table 1. The mean age of the patients was 53.7
years (SD: 16.4), and the rst and third quartiles of the
patients age were 46 and 63 years, respectively. The mean
duration of follow-up was 16.77 6 4.8 months for group 1
and 36.5 6 29.7 months for group 2 (P value = 0.006). Group
2 had more male patients, but there was no signicant differ-
ence in any other of the selected parameters (Table 1). A total
of 65 (83.3%) patients were dened as suffering from a dis-
placed subcapital fracture (OTA 31-B3). Thirteen (16.7%)
patients had transcervical fractures (OTA 31-B2). Overall
Pauwel angle had a mean of 59.08-degree angle (SD: 10.5).
There were no statistically signicant differences in fracture
classication, and Pauwel angle between the study groups
(Table 1). Table 2 compares the type of reduction (varus/
valgus/anatomic) and the pattern of screws insertion (triangle
or inverted triangle) between the 2 groups. Although no sta-
tistical signicance was found, it can be seen that there were
more reductions in slight valgus in group 1 than in group 2. In

TABLE 1. Demographics and Functional Data

Pinning Procedure
Targon FN (n = 31) (n = 47) P
Gender
Male, n 13 (41.9%) 31 (66.0%) 0.036
Female, n 18 (58.1%) 16 (34.0%)
Age at surgery (y) 50.9 (16.0) 55.6 (16.6) 0.156
Age group at surgery
Age ,50 12 (38.7%) 10 (21.3%) 0.156
Age $50 19 (61.3%) 37 (78.7%)
Preinjury walking 42/44 (95.5%) 26/28 (92.9%) 0.219
alone with no
walking aids
Admitted from own 45/45 (100%) 27/27 (100%) 1
home
Fractures classications
OTA 31-B2.3 5 (16.1%) 8 (17.0%) 0.970
OTA 31-B3.1 8 (25.8%) 11 (23.4%)
OTA 31-B3.2 or 3 18 (58.1%) 28 (59.6%)
Fracture with 26 (83.9%) 39 (83.0%) 0.918
displacement,
(OTA 31-B3)
Pauwel angle 60.6 (8.73) 58.06 (11.55) 0.362
(degrees)
Follow-up duration 16.77 (4.8) 36.5 (29.7) 0.006
(mo)
Categorical variables are presented as count (percent). Continuous variables are presented as mean (SD).

72 | www.jorthotrauma.com 2013 Lippincott Williams & Wilkins

J Orthop Trauma  Volume 28, Number 2, February 2014 Dynamic Locking Plate or Screw Fixation

a nonunion of their fracture (Fig. 2) and 16 (34.0%) of them

TABLE 2. Surgery Data
required revision surgery.
Pinning There were signicant differences between the groups in
Targon FN Procedure
(n = 31) (n = 47) P
the rates of nonunion and in the rate of revision surgery (P =
0.0001 and P = 0.036, respectively, Table 3). Four fractures in
Time from diagnosis to 30.3 (47.9) 25.9 (26.3) 0.665
surgery, h
group 2 developed osteonecrosis, and 2 additional fractures
Time to surgery .12 h 16/31 (51.6%) 24/47 (55.8%) 0.721
had a nonunion in addition to osteonecrosis. Three of these 6
Open reduction 4/31 (12.9%) 4/44 (9.1%) 0.598
required revision surgery. There was no signicant difference
Screw conguration
in the rate of osteonecrosis between the study groups (P =
Inverted triangle 13/31 (41.9%) 14/28 (50%) 0.428
0.531). Sixteen patients in group 2 had revision surgeries as
Straight triangle 18/31 (58.1%) 14/28 (50%)
follows: 9 patients had total hip replacement, 5 had hip hemi-
Reduction position
arthroplasty, 1 had valgus osteotomy, and 1 had removal of the
Varus 0 1/28 (3.6%) 0.072
implants. Overall, 2 (6.5%) patients in group 1 and 14 (29.8%)
Neutral 8/31 (25.8%) 14/28 (50.0%)
patients in group 2 required an arthroplasty. This difference
Valgus 23/31 (74.2%) 13/28 (46.4%)
was found to be statistically signicant (P value = 0.013).
The total number of major complications (osteonecrosis
Categorical variables are presented as count (percent). Continuous variables are of the femoral head, nonunion, or revision surgery) was 24
presented as mean (SD).
(51.1%) in group 2 and 5 (16.1%) in group 1 (P = 0.002).
Focusing only on displaced fractures (OTA 31-B3), the num-
bers of major complications were 19 of 38 (50.0%) and 4 of 26
addition, Table 2 shows that there was no difference between (15.4%) in groups 2 and 1, respectively (P = 0.005). Multivar-
the groups in the time from diagnosis to surgery and in num- iate analysis identied surgery type as the only statistically
ber of open reductions. signicant risk factor for complications (Table 4). Performing
All but 1 patient in group 1 demonstrated clinical and internal xation by the xed-angle xation device decreased
radiological consolidation of their fracture during the follow- the odds ratio for overall complication by a factor of 0.23, for
up period. This patient was a 48-year-old male with a non- example, by 77% (P = 0.018).
anatomic reduction of the fracture who developed a nonunion
and osteonecrosis of the femoral head. He underwent revision
surgery with a total hip arthroplasty 18 months after his DISCUSSION
primary fracture xation. Four patients developed osteonec- The goal of treatment in patients with a displaced
rosis at a mean time of 18.7 (SD: 6.5) months. Four of 31 femoral neck fracture, especially young active individuals,
(12.9%) group 1 fractures required revision surgery. In is to preserve the femoral head and restore natural hip
comparison, 22 (46.8%) fractures in group 2 developed function. It has been reported that fracture healing with no

FIGURE 2. A, The 59-year-old man

with fully displaced subcapital fem-
oral neck fracture went through
a closed reduction and internal fixa-
tion with cannulating screws. B,
Varus displacement and nonunion
appears 3 months after.

2013 Lippincott Williams & Wilkins www.jorthotrauma.com | 73

Thein et al J Orthop Trauma  Volume 28, Number 2, February 2014

in different studies which is comparable to our results in group

TABLE 3. Complications and Results
2. The nonunion rates reported in previous reports is lower
Targon Pinning compared with the results of group 2 and range from 5.5% to
FN Procedure
(n = 31) (n = 47) P
33%46,9,12,1521 Tooke and Favero4 reported 5.5% of nonunion
in patients aged 50 years or younger in 1985. Husby et al5
Osteonecrosis, n 4 (12.9%) 4 (8.5%) 0.531
reported 17.5% of nonunion in his study of 3 different types
Time to diagnosis of 18.7 (6.5) 24.0 (1.4) 0.133
osteonecrosis (mo),
of screws for xation of subcapital fracture. Parker et al9 con-
Nonunion (varus deformity) 1 (3.2%) 22 (46.8%) 0.0001
ducted a randomized control study between internal xation
Major complication 5 (16.1%) 24 (51.1%) 0.002
and hemiarthroplasty and found nonunion rates of 34.5% in the
(osteonecrosis, nonunion or internal xation group. Haidukewych et al12 (2004) found
revision) 9.8% of nonunion and 27% of osteonecrosis in 51 patients in
Revision surgery 4 (12.9%) 16 (34.0%) 0.036 the age of 1550 years who were treated with reduction and
Type of revision, total, N 4 16 internal xation for displaced fractures. Damany et al19
Total hip replacement, n 2 (50.0%) 9 (56.2%) reported 7% of nonunion in young adults on their meta-
Hemiarthroplasty, n 5 (31.2%) analysis of 564 patients. Upadhyay et al17 performed a ran-
Osteotomy, n 1 (6.2%) domize control study between open and closed reduction for
Removal of IF, n 2 (50.0%) 1 (6.2%) 0.132 displaced intracapsular femoral neck fracture in young
adults with average age of 38 years and found nonunion
Categorical variables are presented as count (percent). Continuous variables are
presented as mean (SD). and osteonecrosis rates of 17.4% and 16.3%, respectively.
IF, internal xation. Lu-yao et al6 performed a meta-analysis of 106 published
studies. They concluded that nonunion developed in 33% of
patients and osteonecrosis in 16%. Huang et al20 reported
osteonecrosis leads to a good functional outcome.1214 Fur- nonunion and early loss of xation of 33.2% and osteonecrosis
thermore, a better and more anatomic reduction leads to of 17.2% for young patients with intracapsular displaced femo-
higher union rates and lower failure.15 In this historical ral neck fracture who were treated with closed reduction and
control prospective study, we compared the outcome of internal xation with 3 screws. A randomized control study
reduction and internal xation of displaced femoral neck between internal xation, hemiarthroplasty, and THA by Keat-
fractures between patients who underwent surgery with ing et al21 showed failure rates of 37% in the internal xation
multiple cancellous screws with those whose surgery was group. In a recent report, Berkes et al22 have presented their
by a new xed-angle device. Despite the relatively small experience with another xed-angle device. They reported
number of patients in both groups, the differences in results a 36.8% rate of catastrophic failure. They concluded that
reached a level of statistical signicance in terms of non- xed-angle devices were not appropriate for intracapsular fem-
union and revision arthroplasty surgery rates. oral fractures. In our study, the rates of nonunion and osteonec-
Arthroplasty revision rates are of at most importance rosis were 3.2% and 12.9% for group 1; and 46.8% and 8.5%
because they represent a failure in the femur head preserving for group 2, respectively.
strategy. This point cannot be overemphasized. Compared with other published reports our nonunion
The failure rate of internal xated displaced intracapsular rate in group 2 (3 screws) is high. The reason for this
femoral neck fracture in the literature ranges from 33% to 52% difference between the studies is not fully understood. It can
be related to follow-up time, to time from diagnosis to
TABLE 4. Multivariate Analysis for Major Complication surgery, to quality of reduction, to the position of the
internal xation, and to the percentage of open reductions. In
Odds Ratio P
our study, 9% of the patients had open reduction and 56% of
Time to surgery the patients were operated more than 12 hours postinjury,
Time ,12 h 1 0.821 but none of those parameters proved to be statistically
Time $12 h 0.877 signicant when comparing the 2 groups. There is no
Age group consensus in the literature considering the time of surgery.
Age ,50 1 0.301 Upadhyay et al17 found no difference in nonunion and
Age $50 2.070 osteonecrosis rate between young patients who were treated
Fracture type by OTA within 48 hours or after. Moreover, no statistically signi-
32-B2.3 1 0.259 cant difference has been found between patients who were
32-B3 0.419 treated with open reduction comparing to close reduction.
Pauwel angle (for 1.017 0.545 Butt et al23 looked at 52 patients aged 2055 years with
each degree)
displaced femoral neck fractures. All patients had a delayed
Gender
closed reduction and internal xation. They reported 9.6% of
Female 1 0.362
nonunion and 13.4% of osteonecrosis which is comparable
Male 1.783
with rates of nonunion and osteonecrosis in studies with early
Surgery type
xation. In contrast, Jain et al24 found that delayed surgical
Pinning 1 0.018
treatment of subcapital hip fractures in patients aged 60 years
Targon FN 0.233
or younger was associated with a higher rate of osteonecrosis,

74 | www.jorthotrauma.com 2013 Lippincott Williams & Wilkins

J Orthop Trauma  Volume 28, Number 2, February 2014
although it did not signicantly affect functional outcome. The
importance of anatomic reduction when treating intracapsular
femoral neck fracture has been published in the past.5 Varus
position of the fracture increases the failure rate. When we
compared the reduction quality of the 2 groups, we were unable
to nd any statistically signicant difference, but we could nd
a trend of more valgus reduction positions in group 1 than in
group 2. We are not sure if this difference is important because
we could not nd any study presenting difference in results
when comparing the 2 positions (anatomic vs. valgus). Despite
this, we consider our cannulated screws surgical technique to
be one of the main reasons for the high failure rate of group 2
comparing to other reported results in the literature.
As we could not nd any other statistically signicant
difference between patients having fracture union or nonunion
other than the xation device, we assume that another major
reason for these poorer results of group 2 is insufcient
mechanical stability. Although in their Cochrane review in
2003, Parker and Stockton18 concluded that no clear conclu-
sions can be made on the choice of implant for internal xation
of intracapsular fractures from the available evidence within
randomized trials they were challenged by both in vitro and
in vivo biomechanics studies. Those studies have demonstrated
that xed-angle sliding screw devices were superior biome-
chanically compared with cancellous screw xation alone
and had a lower failure rate.2527 Moreover, unlike former
xed-angle devices,18,22 the telescopic screws of the studied
device provide dynamic xation that allow a controlled col-
lapse of the fracture along the line of the femoral neck without
any backing out of the screws into the soft tissues. These
mechanical advantages of the Targon FN device may explain
the relatively low failure rate among our group 1 patients. For
this reason, we believe the Targon FN device should be tested
in randomized control studies against other devices with side
plate or xed-angle technology like sliding hip screw with
derotational proximal screw.
We are aware of several limitations of this study. It is
a historical control prospective study, not randomized con-
trolled. However, the authors of 1 meta-analysis of 18 studies
on 564 patients were not able to nd 1 randomized study or
any comparative trials or population-based studies probably
because intracapsular hip fractures in young active patients are
rare.19 Another limitation is the small and unequal number of
the patients in each group. Although, as previously discussed,
the failure rate of group 2 is comparable with the failure rate
which was reported in many published studies on similar cases,
the reports on the results of intracapsular femoral neck fractures
treated by means of xed-angle devices are quite rare, and
some of the results were as promising as ours.27 One year
follow-up is not enough to evaluate the rate of osteonecrosis
because it can be found after 24 or even 36 months in a small
number of patients.28 We are also aware that although at least 1
year of follow-up was the inclusion criteria, group 2 had longer
follow-up time in average. This fact can be a bias when com-
paring the end results between the 2 groups.
We conclude that displaced intracapsular femoral neck
fractures, especially in young active patients, represent one of
the most devastating musculoskeletal injuries. Our former
method of xation was associated with a relatively high rate
2013 Lippincott Williams & Wilkins
Dynamic Locking Plate or Screw Fixation
of failure. The reason for the unacceptable high failure rate
might be due to poor surgical technique, poor reductions
achieved, or the disadvantages of 3 screws xation in unstable
fractures, or a combination of all 3. The Targon FN device
shows promising results which matched the best results of
other xation devices reported in the literature, including
cannulated screws, after a relatively early follow-up.
REFERENCES
1. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young
adults. J Bone Joint Surg Am. 2008;90:22542266.
2. Chua D, Jaglal SB, Schatzker J. Predictors of early failure of xation in
the treatment of displaced subcapital hip fractures. J Orthop Trauma.
1998;12:230234.
3. Swiontkowski MF. Intracapsular fractures of the hip. J Bone Joint Surg
Am. 1994;76:129138.
4. Tooke SM, Favero KJ. Femoral neck fractures in skeletally mature pa-
tients, fty years old or less. J Bone Joint Surg Am. 1985;67:12551260.
5. Husby T, Alho A, Nordsletten L, et al. Early loss of xation of femoral
neck fractures. Comparison of three devices in 244 cases. Acta Orthop
Scand. 1989;60:6972.
6. Lu-yao GL, Keller RB, Littenberg B, et al. Outcomes after displaced
fractures of the femoral neck. A meta-analysis of one hundred and six
published reports. J Bone Joint Surg Am. 1994;76:1525.
7. Gjertsen JE, Vinje T, Engesaeter LB, et al. Internal screw xation com-
pared with bipolar hemiarthroplasty for treatment of displaced femoral neck
fractures in elderly patients. J Bone Joint Surg Am. 2010;92:619628.
8. Parker MJ, Stedtfeld HW. Internal xation of intracapsular hip fractures
with a dynamic locking plate: initial experience and results for 83 pa-
tients treated with a new implant. Injury. 2010;41:348351.
9. Parker MJ, Khan RJK, Crawford J, et al. Hemiarthroplasty versus internal
xation for displaced intracapsular hip fractures in the elderly. A rando-
mised trial of 455 patients. J Bone Joint Surg Br. 2002;84:11501155.
10. Gurusamy K, Parker MJ, Rowlands TK. The complications of displaced
intracapsular fractures of the hip. J Bone Joint Surg Br. 2005;87:632634.
11. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classication
compendium2007: Orthopaedic Trauma Association classication,
database and outcomes committee. J Orthop Trauma. 2007;21(10
suppl):S1S133.
12. Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment
of femoral neck fractures in patients between the ages of fteen and fty
years. J Bone Joint Surg Am. 2004;86-A:17111716.
13. Broos PL, Vercruysse R, Fourneau I, et al. Unstable femoral neck frac-
tures in young adults: treatment with the AO 130-degree blade plate. J
Orthop Trauma. 1998;12:235240.
14. Bosch U, Schreiber T, Krettek C. Reduction and xation of displaced
intracapsular fractures of the proximal femur. Clin Orthop Relat Res.
2002;399:5971.
15. Duckworth AD, Bennet ST, Aderinto J, et al. Fixation of intracapsular
fractures of the femoral neck in young patients: risk factors for failure. J
Bone Joint Surg Br. 2011;93:811816.
16. Blomfeldt R, Trnkvist H, Ponzer S, et al. Internal xation versus hemi-
arthroplasty for displaced fractures of the femoral neck in elderly patients
with severe cognitive impairment. J Bone Joint Surg Br. 2005;87:523
529. Erratum in: J Bone Joint Surg Br. 2005;87:1166.
17. Upadhyay A, Jain P, Mishra P, et al. Delayed internal xation of frac-
tures of the neck of the femur in young adults. A prospective, randomised
study comparing closed and open reduction. J Bone Joint Surg Br. 2004;
86:10351040.
18. Parker MJ, Stockton G. Internal xation implants for intracapsular prox-
imal femoral fractures in adults. Cochrane Database Syst Rev. 2001;
CD001467.
19. Damany DS, Parker MJ, Chojnowski A. Complications after intracapsu-
lar hip fractures in young adults. A meta-analysis of 18 published studies
involving 564 fractures. Injury. 2005;36:131141.
20. Huang HK, Su YP, Chen CM, et al. Displaced femoral neck fractures in
young adults treated with closed reduction and internal xation. Ortho-
pedics. 2010;33:873.
21. Keating JF, Grant A, Masson M, et al. Randomized comparison of reduc-
tion and xation, bipolar hemiarthroplasty, and total hip arthroplasty.
www.jorthotrauma.com | 75
Thein et al
Treatment of displaced intracapsular hip fractures in healthy older pa-
tients. J Bone Joint Surg Am. 2006;88:249260.
22. Berkes MB, Little MT, Lazaro LE, et al. Catastrophic failure after open
reduction internal xation of femoral neck fractures with a novel locking
plate implant. J Orthop Trauma. 2012;26:e170e176.
23. Butt MF, Dhar SA, Gani NU, et al. Delayed xation of displaced femoral
neck fractures in younger adults. Injury. 2008;39:238243. Epub: Janu-
ary 31, 2008.
24. Jain R, Koo M, Kreder HJ, et al. Comparison of early and delayed
xation of subcapital hip fractures in patients sixty years of age or less.
J Bone Joint Surg Am. 2002;84-A:16051612.
76 | www.jorthotrauma.com
J Orthop Trauma  Volume 28, Number 2, February 2014
25. Baitner AC, Maurer SG, Hickey DG, et al. Vertical shear fractures of femoral
neck. A biomechanical study. Clin Orthop Relat Res. 1999;367:300305.
26. Aminian A, Gao F, Fedoriw WW, et al. Vertical oriented femoral neck
fractures: mechanical analysis of four xation techniques. J Orthop
Trauma. 2007;21:544548.
27. Liporace FL, Gaines R, Collinge C, et al. Results of internal xation of
Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am.
2008;90:16541659.
28. Loizou CL, Parker MJ. Avascular necrosis after internal xation of intra-
capsular hip fractures; a study of the outcome for 1023 patients. Injury.
2009;40:11431146.
2013 Lippincott Williams & Wilkins