The Management of the Displaced Fracture Neck Femur by Dynamic Compression Hip Screw with Derotation Screw

Vol 4 | Issue 1 | May – Aug 2018 | page: 29-33 | Wasudeo mahadeo Gadegone, Bhaskaran Shivashankar, Rajendra Chandak, Piyush Gadegone.

doi-10.13107/ti.2018.v04i01.063


Author: Wasudeo mahadeo Gadegone [1], Bhaskaran Shivashankar [2], Rajendra Chandak [3], Piyush Gadegone [4].

[1] GMC Chandrapur, Maharashtra, India.
[2] Iyer Orthopaedic Hospital, Solapur, India
[3] Chandak Nursing Home Nagpur Maharashtra India.
[4] Sion Hospital, Mumbai, India

Address of Correspondence
Dr. W.M. Gadegone,
Vivek Nagar Mul-Road Chandrapur 442402, Maharashtra, India.
Email: gadegone123@yahoo.co.in


Abstract

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 patients(4.7%) developed non-union of the fracture .There were no cut-outs and breakage of implant .Two patients developed isolated coxa vara ( 120-124°) with backing of screws. Mean shortening of the injured limb was 2 -4 mm in twenty four patients without any functional impairment. Functional results were evaluated by Harris Hip Score. Excellent results were achieved in thirty four (81%), good/fair in six (14.2%) and poor in two (4.8%)patients.
Conclusion: Dynamic Hip Screw (DHS) with derotation screw is a good implant for the fixation of the displaced fracture neck femur with excellent to good radiological and functional outcome.
Keywords: Fracture neck femur, transcervical/ subcapital fracture, cannulated cancellous screw, dynamic hip screw, avascular necrosis, nonunion.


References

1. Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, Lian YT. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am. 2013;95:61-69
2. Deneka DA, Simonian PT, Stankewich CJ, et al ;Biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. J Orthop Trauma. 1997;11:337–343.
3. Wei J, Mao YJ, Jia ZZ (Treatment of 212 cases of fresh femoral neck fracture with compressed hollow screws. Chin J Traumatol 2000 16: 142-144 4
4. Makki D, Mohamed AM, Gadiyar R, Patterson M ;Addition of an anti-rotation screw to the dynamic hip screw for femoral neck fractures. Orthopedics. 2013;36:865–868.
5. Bonnaire FA, Weber AT. Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck. Injury. 2002;33 Suppl 3:C24–C32.
6. W.-C. Chen, S.-W. Yu, I.-C. Tseng, J.-Y. Su, Y.-K. Tu, and W.-J. Chen, “Treatment of undisplaced femoral neck fractures in the elderly,” Journal of Trauma, 2005 vol. 58, no. 5, pp. 1035–1039
7. Gurusamy K, Parker MJ, Rowlands TK. ;The complications of displaced intracapsular fractures of the hip: The effect of screw positioning and angulation on fracture healing. J Bone Joint Surg [Br] ;2005 87-B:632–634
8. Baumgaertner MB, Solberg BD .Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hips. J Bone Joint Surg [Br] 1997;79-B:969–971.
9. Ly, T. V., &Swiontkowski, M. F. Treatment of femoral neck fractures in young adults. Journal of Bone and Joint Surgery. American Volume,2008 90, 2254–2266
10. Haidukewych, G. J., Rothwell, W. S., Jacofsky, D. J., Torchia, M. E., & Berry, D. J. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. The Journal of Bone & Joint Surgery, 2004 86, 1711–1716.
11. Garden RS. Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am. 1974;5:683-712.
12. Liporace, F., Gaines, R., Collinge, C., &Haidukewych, G. J. Results of internal fixation of pauwels type-3 vertical femoral neck fractures. The Journal of Bone & Joint Surgery, 2008. 90: 1654–1659.
13. Shabnam Samsami,Sadegh Saberi,Sanambar Sadighi,Gholamreza Rouh; Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations .Journal of Medical and Biological Engineering. 2015 October, Volume 35, Issue5, pp 566–579
14. Bosch U, Schreiber T, Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. ClinOrthop RelatRes.2002 ;59-71.
15. Karaeminogullari O, Demirors H, Atabek M, Tuncay C, Tandogan R, Ozalay M. Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery. Adv Ther.2004 ;21:335-342. Andreas Panagiotopoulos
16. AndreaPiccioli,Peter V. Giannoudis;Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome;Injury 2015 March Volume 46, Issue 3, Pages 459–466
17. Razik F, Alexopoulos AS, El-Osta B, Connolly MJ, Brown A, Hassan S, Ravikumar K. Time to internal fixation of femoral neck fractures in patients under sixty years–does this matter in the development of osteonecrosis of femoral head? International orthopaedics ;2012;36:2127-2132.Slobogean GP
18. 1, Sprague SA2, Scott T3, Bhandari M2; Complications following young femoral neck fractures. Injury.2015. Mar;46(3):484-91.
19. Stiasny J., Dragan S., Kulej M., Martynkiewicz J., Płochowski J., Dragan S.ŁComparison analysis of the operative treatment results of the femoral neck fractures using side-plate and compression screw and cannulated AO screws. OrtopTraumatolRehabil.2008 ;10(4):350–361.
20. Upadhyay A, Jain P, Mishra P, Maini L, Gautum VK, Dhaon BK;Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint SurgBr. 2004;86:1035–1040.
21. Lee CH, Huang GS, Chao KH, Jean JL, Wu SS.Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases. Arch Orthop Trauma Surg.;2003.123:527-33 Lu-Yao GL
22. 1, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports.J Bone Joint Surg Am. 1994. Jan;76(1):15-25.
23. Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am. Aug. 2005.87(8):1680-8. Barnes R
24. Brown JT, Garden RS, Nicoll EASubcapital fractures of the femur. A prospective review. J Bone Joint Surg Br.1976 Feb;58(1):2-24.


How to Cite this article:  Gadegone WM, Shivashankar B, Chandak R, Gadegone P. The Management of the Displaced Fracture Neck Femur by Dynamic Compression Hip Screw with Derotation Screw. Trauma International JMay-Aug 2018;4(1):29-33.

 


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