Indian Journal of Orthopaedics Surgery

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IP Innovative Publication Pvt. Ltd.

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Indexed - 2021 : IPI Value (3.5)

Fracture neck of femur: Outcome of results of fixation with 3 cancellous screws versus 2 cancellous screws and fibular graft in cases presenting late

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Original Article

Author :

Debanga Sarma Barua, Tirupati Shivanand Shirdinayak*, Abhijit Das, Vaisakh A, Jehirul Ahmed, Devesh Pandey, Vijay Shah

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Abstract :

Introduction: Intracapsular neck of femur fracture is a semi-emergency in patients below 60 years (mostly due to RTA) due to the precarious nature of blood supply, kinking of blood vessels between bone fragments, presence of angiogenesis inhibiting factors, and absence of cambium layer. Immediate internal fixation along with the preservation of the femoral head in this age group is mandatory to prevent non-union and avascular necrosis. Materials and Methods: 26 patients of the 18-60 year age group with Garden type III and IV fracture neck of femur of 1-3 weeks old were included in the prospective study of 1 year (May 2020 to May 2021). Each group of 13 patients were treated with 3 CC screws and 2 CC screws with fibular graft respectively. Results: The mean duration of surgery and intraoperative blood loss was more in fibular graft cases (80minutes; 90mL) than cases of CC screws (55 minutes; 60mL). Mean time to fracture union was 22.75 weeks in CC screws cases and 15 weeks in fibular graft cases (P=0.028). Good and excellent results (Harris hip score and Kyle’s criteria) were obtained in 56% cases of CC screws and in 100% cases of fibular graft. 4 cases treated with CC screws had non-union (P=0.025). Conclusion: 2 CC screws with fibular graft is optimum alternative in fixation of femoral neck fracture presenting late as it provides an osteogenic environment, structural support, and biological healing with minimal complications.  

Keyword :

Fracture neck of femur, Fibular graft, Harris hip score, Kyle’s criteria.

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