Does capsulotomy in closed reduction of garden type 3 femoral neck fractures decrease incidence of avascular necrosis? A randomized controlled trial

Abstract

Background: Femoral neck fractures, pose significant risks of AVN and non-union. Recent studies suggest that adding capsulotomy to CRIF could reduce complications by alleviating intracapsular pressure and enhancing femoral head vascularity. This study aims to assess the efficacy of capsulotomy combined with CRIF in reducing the incidence of AVN and non-union in Garden III femoral neck fractures compared to CRIF alone.

Methods: Participants aged 18-55 with Garden III femoral neck fractures were randomly assigned to either the CRIF-only group or the CRIF with capsulotomy group. Outcomes included rates of AVN and non-union, assessed at 3 and 6 months postoperatively. Functional outcomes were measured using the Harris Hip Score (HHS).

Results: 67 patients were included, with 32 in the capsulotomy group and 35 in the CRIF-only group. The capsulotomy group demonstrated significantly lower rates of AVN (6.25% vs. 11.4%) and non-union (0% vs. 5.7%) compared to the CRIF-only group. Additionally, the capsulotomy group achieved a significantly higher mean HHS at 3 months, indicating improved functional outcomes.

Conclusion: Adding capsulotomy to CRIF in the management of Garden III femoral neck fractures may reduce complications, specifically AVN and non-union, and enhance functional recovery. The combination of randomization and blinding methods in this study underscores the reliability of these findings, supporting capsulotomy as a potentially beneficial adjunct to CRIF in specific fracture patterns.

Keywords: Avascular necrosis; Capsulotomy; Femoral neck fractures; Hip osteonecrosis; Hip preservation.