The Influence of Capsulotomy for Intracapsular Hip Fractures

Young patients with femoral neck fractures undergo operative stabilization urgently to prevent complications of avascular necrosis (AVN) and nonunion. The necessity of capsulotomy to prevent these sequelae is disputed. A retrospective chart review performed on 113 patients who underwent fixation of a femoral neck fracture found 62 patients following exclusion criteria, who were analyzed for demographic and fracture characteristics, operative variables, and radiographic outcomes. Sixty-two patients (age 18-85), with a mean follow-up of 21.2 months, had a mean time to union of 5.3 months. Capsulotomies were performed in 32 patients. Seven patients demonstrated AVN (5 with capsulotomy) (p = 0.285). Age was not a risk factor for nonunion or AVN. Additionally, nine fractures (four with capsulotomy) went on to nonunion (p = 0.602). We did not find increased risk of AVN in patients with diabetes or smoking, although a pre-existing diagnosis of hypertension was associated with a significantly increased risk of AVN (p = 0.04). Overall, AVN rates after operative stabilization of femoral neck fractures was 11% and not statistically influenced by capsulotomy. Hypertension was the only significant risk factor for nonunion.