Review on Basicervical Femoral Neck Fracture: Definition, Treatments, and Failures

Abstract

Basicervical femoral neck fracture is an uncommon fracture that accounts for only 1.8% of all proximal femoral fractures. Previous studies have recommended that the choice of implant to treat this fracture should be similar to that of intertrochanteric fracture. However, in previous studies on basicervical fractures, the definition and treatment results of these fractures were different, and there were also debates on the implant that had to be used. Therefore, the purpose of this study was to review the studies that performed surgical treatment of basicervical femoral fractures and to assess the definition of basicervical fracture, the use of implants, and failure rates and clinical results. Study selection was based on the following inclusion criteria: (1) treatment outcome for basicervical femoral neck fracture was reported; and (2) dynamic hip screw, proximal femoral nail, or multiple screw fixation was used as treatment. PubMed Central, OVID MEDLINE, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched to identify relevant studies published up to March, 2020 with English language restriction. A total of 15 studies were included in this study. Differences were found in the definition of basicervical fracture, treatment results, rehabilitation protocol, and fixation failure rate. Definitions and treatment methods for basicervical fractures varied, and treatment outcomes also differed among the enrolled studies. Further research is needed that would be restricted to those fractures that conform to the definition of basicervical fracture.

Keywords: Femoral neck fractures; Fracture fixation; Hip fracture; Internal.

Fig. 1. The flow chart of the study selection process.

Fig. 2. The radiographs in included studies. (A) Normal bony structure of the proximal femoral head. The intertrochanteric line is shown in black and the line of the basicervical fracture in white. (B) Schematic figure depicting a radiograph in the study of Watson et al.. The fracture line started in the inferior area of the intertrochanteric line (black arrow). (C) Schematic figure showed the radiograph in study of Massoud. The fracture line crossed the intertrochanteric line (black arrow). (D) Schematic figure depicting the radiograph in the study of Davis et al. The lesser trochanteric area was involved in the fracture (black arrow). (E) Schematic figure depicting the radiograph in the study of Kuokkanen. Fracture involved the greater trochanter (black arrow). (F) Schematic figure depicting the radiograph in the study of Su et al.. The inferior area of the fracture line involved the intertrochanteric line (black arrow). Fractures not matching the definition of basicervical fracture.

Fig. 3. The radiographs in included studies. (A) Schematic figure depicting the radiograph in the study of Hu et al.. Proximal fragment included part of the lesser trochanter (black arrow). (B) Schematic figure depicting the radiograph in the study of Yoo et al.. The lesser trochanter fragment is displaced (black arrow). (C) Schematic figure depicting the radiograph in the study of Lee et al.. They showed radiograph of a 2-part basicervical fracture (black arrow).