A review of reduction and internal fixation of adult femoral neck fractures in a county hospital.

Treatment of femoral neck fractures at a county hospital, Parkland Memorial Hospital, Dallas, Texas, from 1978 to 1983 was reviewed. A study of the use of the quadratus femoris muscle-pedicle graft (MPG) as adjunctive treatment to open reduction and internal fixation (ORIF) was in effect during that time. Patients who had primary prosthetic replacement of their femoral head were not included in the study. Two groups of patients were identified, one group that had ORIF without a muscle-pedicle graft (no-MPG) and another group that had ORIF with a muscle-pedicle graft (MPG). There were a similar number of patients in each group (MPG = 25 patients, no-MPG = 24 patients). Although the groups were not exactly similar, the overall outcome was unexpected. The no-MPG group had 76% good-to-excellent results whereas the MPG group had only 24%. A poor result or outright failure of the technique occurred in 68% of the MPG group and in only 16% of the no-MPG group. No accurate assessment of the incidence of avascular necrosis of the femoral head could be made.