The degree of initial fracture displacement is the most significant predictor of avascular necrosis (AVN) following a femoral neck fracture. Highly displaced fractures (e.g., Garden's Type III and IV, or Pauwel's Type III) are associated with a much higher incidence of AVN because the retinacular vessels supplying the femoral head are more likely to be completely disrupted. While patient's age (younger patients have better healing potential but higher functional demands), mechanism of injury (high energy vs. low energy), and time to surgical fixation (delay can increase AVN risk) are contributing factors, the initial displacement directly correlates with the extent of vascular damage.
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