Between 1980 and 1989 71 patients with a femoral neck fracture were treated at the University Hospital of Basel by a Dynamic Hip Screw (n = 54) or by three compression screws (n = 17). Fifty out of 71 patients (70%) were reviewed clinically and radiologically after an average of 116 months. 32/50 fractures (64%) had united. In 18/50 (36%) either avascular necrosis (12) or secondary fracture dislocation (6) had resulted in failure after an average of 29 months following injury. Despite these results, the patients assessment had been very good or good in 44 patients (88%) and fair only in six patients (12%). The cause of secondary dislocation proved to be mainly due to a technical failure at surgery. The incidence of avascular necrosis was significantly higher in displaced fractures compared to non-displaced fractures (p < 0.05), regardless of the quality of the reduction achieved (varus or valgus) or the time delay between accident and operation. However it was interesting to note, that more than one third of all avascular necrosis became apparent more than 3 years (4-10 years) after the accident.
This is a 39-year-old male, fell from a bike, left wrist with trans-styloid perilunate fracture dislocation that underwent open reduction internal fixation, 20 months after surgery the patient developed avascular necrosis of the lunate, final wrist fusion was performed secondary to the arthritic changes on the wrist. Anatomic dissection was performed and vascularity of the lunate was identified, its origin is from the volar palmar arch, when dislocated palmarly and more than 90 degrees the vessel is still intact. More than 512 patients with perilunate dislocation and perilunate fracture dislocation are included we identified in the literature transient avascular necrosis of the lunate in nine and seventeen of pure avascular necrosis of the lunate. Concluding that avascular necrosis of the lunate after perilunate dislocation or perilunate fracture dislocation is an infrequent finding especially when the volar ligaments are intact.