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IntroductionAim of this study was to investigate the incidence and extent of femoral shortening in non-geriatric patients after internal fixation of femoral neck fractures in relation to the clinical outcome at mid-term follow-up.Materials and methodsReviewing our admission data, we identified non-geriatric patients (18–65 years) with femoral neck fractures treated with either dynamic hip screw or cancellous screws between 2007 and 2015. Patients were then contacted and invited to a follow-up clinical investigation including whole-leg standing X-rays.ResultsA total of 40 patients with a mean age at surgery of 52 ± 9 years returned for the follow-up examination. Overall, 31 patients (77.5%) had undergone a dynamic hip screw fixation, while 9 patients were treated with cancellous screws (22.5%). The median follow-up time was 65.5 months (5.5 years). We observed shortening of the ipsilateral femur neck in the majority of cases (92.5%). Still, functional outcome in the overall study population was excellent with a median Harris Hip Score of 96.ConclusionsFemoral neck shortening is common in non-geriatric patients after internal fixation of femoral neck fractures. Nonetheless, observed excellent functional outcome at mid-term follow-up supports joint-preserving strategies in non-geriatric femoral neck fractures.

In this study, femoral intramedullary pressure, fat embolization, and pulmonary response were measured during reamed and unreamed nailing and plating of femoral fractures after blunt thoracic trauma. Intramedullary peak pressures of 425 mm Hg (mean 205 mm Hg) occurred in the reamed nail group (group I) during reaming with the 9-mm reamer, while in the unreamed nail group (group II) peak values were seen during nail insertion (330 mm Hg) with a mean of 203 mm Hg. Plating never led to a pressure rise over 67 mm Hg (mean 37 mm Hg). In reamed nailing, the most intense embolism was identified under ultrasound imaging with the large awl and with the 9.0-mm reamer (mean 2.2) and in the unreamed nail group during nail insertion (mean 2.8). Minimal echoes appeared during plating. The pulmonary arterial pressure did not vary significantly postoperatively between the three groups (p < 0.08). Our findings indicate that intramedullary fracture fixation causes a higher increase of intramedullary pressure and more fat and bone marrow embolization than extramedullary ones. Nevertheless, only minimal differences in the pulmonary hemodynamic response (pulmonary arterial pressure) were noted even in the presence of thoracic trauma.