Intraoperative assessment of femoral head vascularity after femoral neck fracture

Objectives: To develop an intraoperative technique to predict the development of avascular necrosis after internal fixation of femoral neck fractures. Design: Prospective study. Setting: All patients were treated at the same hospital. Patients/Participants: Sixty-four patients who presented for internal fixation of a femoral neck fracture were enrolled in the study. Intervention: A 2.0-millimeter drill was used to assess the presence and character of bleeding from the femoral head at open reduction and internal fixation of a femoral neck fracture. Main Outcome Measurements: Patients were evaluated postoperatively by history, examination, and roentgenography for the development of avascular necrosis of the femoral head fragment. A minimum two-year follow-up with radiography was required for entry into the study, with an average follow-up of 3.2 years. Results: None of the fifty-six patients with bleeding from the drill holes in the femoral head fragment developed avascular necrosis. Eight of eight patients with no bleeding after reduction developed avascular necrosis. There were no infections or nonunions. Conclusions: Intraoperative drilling of the femoral head is a highly sensitive and specific predictor for the development of avascular necrosis after femoral neck fractures.