Incidence and Risk Factors for Avascular Necrosis of the Femoral Head Following Internal Fixation of Femoral Neck Fractures in Patients Aged 18 to 50 Years in Ibadan

Avascular necrosis (AVN) of the femoral head following internal fixation of femoral neck fractures in young adults is a devastating complication with limited treatment options and profound functional consequences. The incidence and predictors of AVN in this age group in Nigerian tertiary settings remain insufficiently characterised. This prospective cohort study estimates the incidence and identifies risk factors for AVN of the femoral head following cannulated cancellous screw fixation of femoral neck fractures in patients aged 18 to 50 years at University College Hospital (UCH), Ibadan, South West Nigeria. Sixty patients will be enrolled and followed up clinically and radiologically at three, six, and twelve months post-operatively. MRI will be used to confirm early AVN in equivocal cases. Variables including Garden classification, time from fracture to fixation, pre-operative hip aspiration findings, quality of fracture reduction, and screw placement will be assessed as predictors. Cumulative incidence of AVN will be estimated using competing risks analysis. The study hypothesises that Garden IV classification and fixation delay exceeding 12 hours are the strongest predictors of AVN. Findings will inform patient selection for hemiarthroplasty versus internal fixation in this age group and will be submitted to a peer-reviewed journal. Keywords: avascular necrosis, femoral neck fracture, internal fixation, Garden classification, Ibadan.