Does Capsulotomy in Closed Reduction of Femoral Neck Fractures Decrease Incidence of Avascular Necrosis?

Abstract Background: Femoral neck fractures are commonly encountered injuries resulting from high-energy or low-energy indirect trauma. Healing of these fractures is often complicated by avascular necrosis (AVN) or non-union of the femoral head. This study aims to investigate the impact of performing capsulotomy before closed reduction and internal fixation on the incidence of complications and functional outcomes. Methods: This randomized controlled trial allocated participants into two groups: the capsulotomy group (Group A) and the no capsulotomy group (Group B). We included skeletally mature patients with femoral neck fractures scheduled for urgent surgery within 48 hours. Both male and female patients of any Garden classification, aged 18-55 years, were included. Results: Forty patients were randomized equally into Group A and Group B. The mean age was 37.35 ± 11.8 & 36.65 ± 12.4 years respectively. Seventy percent of patients sustained high-energy trauma, while thirty percent sustained low-energy trauma. Group B had significantly lower intraoperative blood loss and shorter operative times compared to Group A. However, Group A showed significantly higher Harris hip scores, indicating better functional outcomes. Additionally, Group A had a significantly lower incidence of complications, including AVN and non-union. Regarding fracture-to-surgery time, 18 patients were operated upon after 24 hours and 22 before 24 hours. Delays were due to associated fractures (2 patients), medical comorbidities (12 patients), and presentation after 48 hours of trauma (4 patients). Conclusion: Our findings suggest that capsulotomy before internal fixation significantly reduces the risk of non-union and AVN. Furthermore, it is associated with improved functional outcomes, as evidenced by higher Harris hip scores in the capsulotomy group.