Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft (original) (raw)
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Journal of orthopaedic surgery (Hong Kong), 2012
To evaluate the use of fibular grafting for fresh femoral neck fractures with posterior comminution. 18 women and 15 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=21) and IV (n=12) femoral neck fractures associated with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. The mean delay in presentation after injury was 3.2 (range, 1-12) days. The mean delay in operation was 8.8 (range, 5-21) days. The mean follow-up period was 2 (range, 1-4) years. According to the Harris hip score, outcome was good to excellent in 20 patients, fair in 7, and poor in 6. 27 of the 33 patients achieved bone union after a mean of 4.7 (range, 4.2-7) months. In 5 patients, the bone was united with a mean of 10º of varus collapse and a mean of 1 cm of shortening. Six patients had non-union. Other complications inc...
Long Term Results of Fresh Femoral Neck Fractures Treated by Cancellous Screw and Fibular Autograft
MOJ Orthopedics & Rheumatology, 2014
Femoral neck fractures in adults have a poor prognosis because of high incidence of nonunion and aseptic necrosis. Prosthetic replacement of the femoral head is reserved for the physiologically older patients while osteosynthesis with preservation of femoral head is the treatment of choice for fracture neck femur in younger adults. Various types of bone graft supplementation have been advocated to reduce the incidence of nonunion and avascular necrosis. We tried cancellous screw fixation supplemented by fibular autologous grafting to overcome nonunion and avascular necrosis. Thirty-five (M-18: F-17) skeletally mature patients (mean age 49.38 years) of fresh femoral neck fracture were treated. Weight bearing was allowed only after 3 months, or later if the radiological signs of union was not seen. All fractures showed union at one year follow up. Complications included, avascular necrosis (2 cases), broken fibular graft (3 cases), screw back out with collapse (2 cases), penetration of the femoral head articular surface by screw and graft (1 case each). Patients are able to sit cross-legged and squatting position. Cancellous screw fixation and fibular autologous grafting is a safe, cost effective and reliable surgical technique for treating femoral neck fractures in properly selected patients.
Journal of Ayub Medical College Abbottabad
Background: Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. Methods: A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. Results: Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were i...
Neglected fracture neck of femur is a challenging condition to treat. Preservation of the head of femur is desirable in young patients.In order to preserve the femoral head in femoral neck non-union in young adults, the preferred option of treatment is open reduction and internal fixation. Where there are no facilities for microvascular surgery, non-vascularized fibular strut grafts can be used with screws. This paper describes the use of fibular strut graft and cancellous screws in the open reduction and internal fixation of a neglected femoral neck fracture associated with avascular necrosis of femoral head in a young adult that was followed up for four years. The use of non-vascularized fibular strut grafts and screws for fixation of non-united fractures of femoral necks, even in the presence of avascular necrosis, could lead to union.It is cost-effective and technically less demanding, and associated with good outcomes.
International Journal of Research in Orthopaedics
Background: Since intracapsular fracture neck femur was recognized by Ambrose Pare almost 4 centuries back, the management of intracapsular neck femur fracture has undergone many changes. The multitude of various implants designed and techniques available for its treatment themselves indicate the inadequacy of the various methods of treatment. Objective was to compare cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group.Methods: This observational study with both prospective and retrospective data analysis of patients operated by different surgeons in same hospital setup has been conducted from March, 2018 to February, 2020 at the department of Orthopedics, Government Medical College (GMC), Jammu. 105 cases satisfying the inclusion criteria admitted in GMC Jammu were included clinically and radiologically. Total number of patients included in the study was 97 patients as 8 patients were lost to follow-up. Functional out...
International Journal of Health Sciences (IJHS), 2022
Background: Dynamic hip screws (DHS) and multiple cannulated cancellous screws (MCCS) are commonly used in anatomic reduction of femur neck fractures. However, there is limited information on the complications of various fixation methods. Objective: To assess the outcome of two different modalities of femur neck fracture fixation. Methodology: This prospective, randomized, comparative interventional study included 32 subjects with recent trauma. Patients were randomized to DHS and MCCS treatment groups (16 patients each). Post-surgical radiographs were obtained and clinical evaluation for deformities was performed using the Harris hip score (HHS). The duration of surgery, average blood loss, and complications were noted and assessed. Chi-square test was used to check the association between attributes. Two-sample t-test was employed to compare the mean between two groups. P≤0.05 indicated statistical significance. Results: A significant difference (p<0.001) between the 2 groups was noted with regard to patients' age. The median operative time for DHS and MCCS groups was 75 mins (range 60-90 mins) and 60 mins (range 50-70 mins), respectively. Average blood loss was more in DHS (200 mL) than in MCCS (120 mL) group. Majority of the patients (75%) in the DHS group showed excellent HHS results. The average duration for radiological union was 12 weeks and 13 weeks in DHS and MCCS groups, respectively. Femoral neck shortening was absent in DHS group. No significant difference in complications was observed between the groups. Conclusion: Fixation 7051 with DHS showed better clinical outcomes compared to MCCS. Both the groups had similar complications with avascular necrosis and non-union.
Free Fibular Graft Augmentation in Delayed Fixation of Fracture Neck of Femur in Young Adults
Introduction: This clinical study was conducted to assess the long term follow up results of using free fibular graft to augment fracture fixation with cannulated cancellous screw or dynamic hip screw as a treatment option for femoral neck fractures in young adults who presented after 24 hours of injury but within 3 weeks. Methods: A prospective study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws or dynamic hip screw with fibular graft. Patients aged between 15 and 50 years, having Gardens type III or IV fracture with duration of injury less than three weeks were included in the study. They were assessed for radiological outcome and functional outcome using modified Harris Hip Score. Results: Twenty two cases were operated between day 2 to day 21 after sustaining injury. The mean time of union was 3.4 months. 19 fractures united uneventfully. 2 fractures went in for non union and one developed AVN of femoral head. According to Harris Hip Score,14 patients scored 'excellent', 3 patients scored 'good', 3 scored 'fair', and 'poor' score was recorded in 2 patients. Conclusions: Delay in surgery as a contributing factor for development of complications in fracture neck of femur cannot be ruled out with the present literature available. Using a free fibular graft as an adjunct to the implant construct helps in reducing the rates of non-union and AVN. However, this cannot be a substitute for the proper surgical precision that is required in treatment of fracture neck of femur. Further prospective studies involving large sample size are required.
Indian Journal of Orthopaedics Surgery, 2021
Scaphoid bone fracture is one of the commonest carpal bone fractures. It is predominantly seen in young population. Unstable or displaced scaphoid fractures can be treated either by primary use of cast immobilization alone, by use of Open Reduction Internal Fixation (ORIF) technique or by percutaneous fixation with Herbert screw under direct C arm fluoroscopic guidance. This study aims to review clinical, radiological and function outcome following ORIF technique Vs Percutaneous Fixation Technique in scaphoid fractures. Materials and Methods: Cases of acute scaphoid fractures who came to our department and met inclusion and exclusion criterias were identified and included in this study. Clinical details of these patients were obtained and scaphoid radiographs were taken. Injuries were graded as per Herbert and Fisher Classification. All our cases underwent grip-strengthening exercises and relevant physiotherapy Clinico-radiological details of our cases were obtained at each follow-up. Final follow-up of our cases was performed using Modified Mayo Wrist Score (MMWS). Grip strength was graded as per Medical Research Council (MRC) scale and range of motion was assessed using goniometer. Results: A total of 40 cases were enrolled in our study. 16 patients (40% cases) underwent percutaneous herbert screw fixation and rest of our cases underwent open reduction and internal fixation. Radiological union in cases treated with percutaneous fixation was faster as compared to cases treated by ORIF. Also patients treated with percutaneous method demonstrated higher mean range of motion score, mean grip strength score and activity score. Conclusion: In our study excellent results have been obtained in cases treated with percutaneous approach in terms of post-operative morbidity and this approach also allows earlier return to sports and work thereby necessitating importance of this approach over ORIF approach in a developing resource poor country like India. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
International Journal of Research in Orthopaedics, 2017
It is one of the more common injuries presenting to the emergency Department of Othopaedics OPD. It is usually seen in old age due to osteoporosis but in can also occurs in young age due to road traffic accident, sports related and fall from height. However, the optimal timing for surgical fixation of these fractures is still subject of debate in the literature. Femoral neck fracture is a common and severe injury in the elderly with associated high mortality and morbidity. The incidence of these fractures has increased with improvement in life expectancy and is expected to double ABSTRACT Background: Intracapsular fracture neck of femur has always presented great challenges to every Orthopaedic surgeons and it is remain a mystery whether to fix or to replace the fracture in the elderly. The aim of the study was to analyze the functional outcome of two widely used and accepted modalities of treatment in the age group 57-75 years, in Garden's type I and II fractures, namely (a) cannulated cancellous screw fixation(internal fixation) and (b) modular bipolar prosthetic replacement of the femoral head (hemiarthroplasty). Methods: The total 110 patients were including in the study from age groups 57-75 (mean age 66). The Garden classification of fracture neck of femur was used to evaluate the displacement of femoral neck fractures. Only grade 1 and 2 was included in the study. 55 patients were included in each group A and B. Osteosynthesis (fracture fixation) was carried out by closed reduction and insertion of cannulated cancellous screw and in other group hemiarthroplasty was done. Results: In group A 55 patient with fracture neck of femur was treated by osteosynthesis i.e. fixation using 02 or 03 cannulated cancellous screw and in group B, 55 patients with fracture neck of femur was treated by modular bipolar replacement hemiarthroplasty. In Group A out of 55, 41 patients union was achieved between 08 to 14 months (mean 11.5 month), 09 patients developed non-union even after 16 months and 05 patients develop collapse of head with AVN with shortening at end of 02 year, however in Group B out of 55 patients 51 patients started walking after 2 nd postoperative days, 02 patients developed infection, and 02 patients developed posterior dislocation. Conclusions: The fracture fixation may be tempting for fracture neck femur in age group 57-75 especially of Garden Type I but internal fixation put risk of non-union and AVN and second surgery may be required after few months or years if patients survive. Based on results in our study we therefore can conclude that in Garden Type I and II femur neck fractures in the patients between 57-75 years of age, hemiarthroplasty is the better modality of treatment.
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
Objectives: The objectives of this study were to study the functional outcome of surgically managed type I and II fracture neck of the femur by AO cannulated cancellous screws in young adults. Methods: A prospective study of 20 cases of type I and II Garden’s fracture neck of femur in young adults managed surgically by AO cannulated cancellous screws fixation in Chigateri Government Hospital and Bapuji Hospital, between September 2014 and September 2016 satisfying the inclusion and exclusion criteria which were studied. The functional outcome was evaluated using the Modified Harris hip scoring system. Results: In our study, we achieved 85% excellent results, 10% good, and 5% fair results. We had 95% satisfactory results in terms of the functional outcome. The results were comparable to other studies. Conclusion: Intracapsular fracture neck of femur in young adults treated surgically by closed reduction and 6.5 mm AO cannulated cancellous screw fixation gave excellent to good functional outcome in 95%. Hence, this would be the best procedure for intracapsular fracture neck of the femur, and this is going to stay for an extended period in orthopedic practice.