Factors predisposing to healing complications after internal fixation of femoral neck fracture. A stepwise logistic regression analysis.

A stepwise logistic regression analysis was made to assess the influence of various factors on the rate of healing complications after femoral neck fracture. A prospective series comprising 101 patients with fresh fractures treated by closed reduction and internal fixation was included in a roentgenographic follow-up study. The single most important factor was the quality of reduction, followed by the type of fracture, and the position of the internal fixation material. Age, gender, and type of internal fixation device (three screws or three nails) were not found to influence the healing complication rate. The predicted probability of a healing complication for different combinations of the three most important factors ranged from 0.05 to 0.99. The highest value was found for the combination Garden Type IV fracture, which had unacceptable reduction and position of the internal fixation material. The results show that failure to achieve adequate reduction should be a strong argument in favor of primary hip arthroplasty.