Management of Femoral Neck Fracture Treated with Dynamic Hip Screw and Bone Grafting (original) (raw)
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Journal of Chittagong Medical College Teachers' Association
Background: Fracture neck of femur has always presented a great challenge to orthopedic surgeons due to its nature of going into non-union and osteonecrosis of femoral head even with the best fixation method and adequate reduction. Treatment of fracture neck of femur varies according to patient’s age and fracture pattern. Purpose of this study was to compare the outcome of DHS with side plate and de-rotation screw with multiple cannulated hip screws in fracture neck of femur in adult. Materials and methods: This quasi-experimental study was carried out in the Department of Orthopedic Surgery, Chittagong Medical College Hospital from July 2017 to June 2019. Sixty patients age limit between 18 to 55 years, with (AO/OTA 31-B) fracture was taken by purposive sampling technique as per set criteria and were treated either by DHS with side plate and de-rotation screw or by cannulated hip screws. Harris Hip Score was used for evaluation of functional outcome of surgery. Results: In this s...
Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients
ISRN Orthopedics, 2014
Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. Study Type: therapeutic study.
2018
Introduction: The aim of the present study was to evaluate the outcomes of displaced intracapsuar fracture neck femur managed by dynamic hip screw (DHS) with derotation screw treated within ten days of injury in patients younger than 60 years. Materials and methods: This was a prospective study, carried out between December 2010 to December 2016. A total of 42 patients younger than 60 yrs of age with displaced intracapsular fracture neck femur (Garden III and IV, Pauwels III, with the comminution) presenting to the hospital within 2-10 days were included in the study. Data analysis and statistical analysis was done by using SPSS using appropriate tests. Results: There were 27 males and 15 females, age ranging from 21 to 60 years (mean42.4±10.2 years). There were twenty seven Garden III while fifteen fractures were Garden IV. In forty fractures (95.2 %) average time to union was 3.7 months [3-5 months]. Radiographic evidence of avascular necrosis was seen in four cases(9.5%) and two ...
International Journal of Medical Sciences, 2012
Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise. Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model. Design: Testing of specifically designed fixation devices in a pig animal model. Interventions/Methods: We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each). Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively. Results: There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P < 0.05). There were also significant differences between the Hb-DHS and DHS groups in postmortem visually assessed indicators of bone healing at both 8 and 16 weeks postoperatively. Conclusions: The Hb-DHS device promotes femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.
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.
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...
Advanced Biomedical Research, 2013
Background: There is conflict of interest in the treatment of intracapsular femoral neck fractures and the outcomes. The aim of this study was evaluation the treatment outcomes of closed and open reduction and internal fixation with screw in 18-50-year-old patients. Materials and Methods: This clinical randomized study was conducted in Ayatollah Kashani Center in Isfahan from Nov 2010 to Nov 2011. In 42 patients selected in a randomized manner, fractures were reduced by closed reduction or open if necessary and C-ARM was controlled in AP and lateral plans. Movement range and femur pain severity were evaluated according to Visual analogue Scale (VAS) score at 3 and 6 months after surgery. Data were analyzed by SPSS 18. Chi-square, t-test, one-way analysis of variance (ANOVA), and descriptive statistics such as frequency distribution, mean, and mean deviation were used. Results: Forty-two patients with femoral neck fracture were treated by open [31 patients (73.8%)] or closed reduction [11 patients (26.2%)] and also osteosynthesis. Their mean age was 47.3 ± 9.8 years; 29 of them were males and 13 were females. Twelve patients had bad range of motion (ROM) (28.6%), 16 had intermediate ROM (38%), and 14 had good ROM (33.4%). After 6 months, 12 patients (28.6%) had bad ROM, 10 (23.8%) had intermediate ROM, and 20 (47.6%) had good ROM. There were 11 cases of non-union (35.5%) in the open reduction group and 4 in the closed group. Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.
International Journal of Research in Medical Sciences
Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16...
Functional Outcome of Total Hip Replacement in Fracture Neck of Femur
Background: Fracture neck of femur is common in elderly patients following trivial fall. Various methods of treatment are available for the fracture, however Arthroplasty gives better functional outcome and allows early mobilization of the patient, immediate weight bearing, less pain, less revision rate and finally earliest society participation to all patients. Aim: The aim of our study was to evaluate functional outcome of total hip replacement in fracture neck of femur. Patients and Methods: In this prospective interventional study, we enrolled 25 patients after satisfying the inclusion and exclusion criteria. Harris Hip Score was assessed postoperatively at 6, 12 and 24 weeks and postoperatively prosthesis position is observed and analyzed radiologically. Results: The Harris hip score increased in all intervals from 6, 12, 24 weeks followup and was statistically significant (p value<0.001). Out of 25 patients 20 patients had excellent outcome , 4patients had good outcome and 1 patient had poor outcome. Out of 25 patients 23 patietnts had acetabular inclination was between 30 0 to 50 0 (Mean = 42.6 ± 4.43), 1 patient had < 30 0 and 1 patient > 50 0. Horizontal COR was equal to opposite side in all 25 patients and vertical COR was equal to opposite side in 22 patients. Femoral stem was found to be neutral in 22 patients, 2 patients had varus and 1 patient had valgus. In 23 patients anteversion was between 5 0-25 0 (Mean = 14.6 ± 5.24), 2 patients had anteversion < 5 0. In 1 patient limb length discrepancy of >1 cm was seen. Conclusion: By our study total hip replacement for neck of femur fractures provided encouraging results. Adhering to proper surgical technique and maintaining post opeartive radiological parameters plays a crucial role in functional outcome. Hence we recommmend total hip replacement as method in treating neck of femur fractures.
Implants For Extracapsular Neck Of Femur Fracture Dynamic Hip Screw Versus Intramedullary Nailing
Journal of Ayub Medical College, Abbottabad : JAMC
Neck of femur fractures are the most prevalent type of injury in elderly trauma patients. Both intra and extra capsular type of fractures are equally distributed in the given population. Traditionally, Extra capsular fractures are fixed with Dynamic Hip screw or Intra medullary nailing based on the type of fracture. NICE (National Institute of Clinical Excellence) recommends fixing 31-A1 and 31-A2 fractures with DHS (Dynamic Hip Screw) whereas AO recommends fixing 31-A1 with DHS and 31-A2.1 subtype with DHS and 31-A2.2 and 31-A2.3with IMN (Intra medullary nail). In regional trauma centre 178 patients, 125 females and 53 males with extra capsular neck of femur fractures fixed were selected in a retrospective study. The data was spanning over a period of 1 year. Fractures were classified as per AO classification by two registrars. The implant selection was analysed in terms of the short term out come to find out the cost effectiveness of one over the other. The quality of reduction wa...