Operative management of femoral neck fracture with calcar comminution

Objective To study the methods and effects of operation on femoral neck fracture with calcar comminution.Methods 14 cases of femoral neck fracture with calcar comminution were operated.Among them,5 cases of undisplaced fractures were treated with close reduction and breaking compression screw fixation;5 cases with displaced calcar femoral bone flap were undergone open reduction with quadratus femoris muscle pedicle bone graft and cannulated screw fixation.4 cases were treated with cemented hip replacement,of which calcar femoral bone flap were removed in 2 cases.Results 14 cases were followed up for 9 months～3 years.9 cases with calcar comminution treated with first two types of operation methods got union,and 1 got avascular necrosis in the close reduction group.All femoral neck fracture got union,and 1 was complicated with femoral head necrosis.In 4 cases with cemented hip replacement,2 cases reserved calcar femoral bone flap got union,and 1 hip prosthesis had loosen.Conclusions The rate of femoral neck fracture with calcar comminution is lower.The fracture reduction and internal fixation must be selected in young adults,while cemented arthroplasty is used in the elderly,and calcar femoral bone flap is reserved as possible.