Outcome Analysis Of Dynamic Hip Screw Fixation In Femoral Neck Fractures
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2016, Vol 2, Issue 2
Abstract
Background Fracture neck femur constitute nearly half of the fractures around hip with majority in elderly patients after simple fall. In elderly patients, replacement is the treatment of choice but in young patients hip preservation is advocated. Out of the various fixation options , Multiple cannulated screws and Dynamic hip screw is the preferred modality. DHS although involves more soft tissue dissection is a more stable construct and thus gives better anti-rotation stability and fixation in fracture neck femur. The purpose of this study was to assess functional outcomes after fixation of transcervical fracture neck femur using Dynamic Hip Screw. Materials and Methods A prospective study of transcervical neck femur fracture treated with DHS fixation at a tertiary level hospital between 2012-2014. Exclusion criteria included basicervical, subcapital fracture pattern, patients with pathologic fracture, with same side shaft femur fracture, and who were using walking aid before injury. Functional outcome was assessed using Harris Hip Score and radiologically, reduction was accepted as adequate if the distance between fragments is less than 3 mm and if the femoral neck angle was >150 valgus or <100 varus as compared to opposite hip. Results Out of 42 cases, 37 were available for final follow-up, 18 cases (48.6%) were of Garden type IV, 13 cases of (35.1%) of Garden type III, and 6 cases (16.3%) of Garden type II. Mean age at presentation was 37.5 years (range 20-65), with mean time lag before surgery was 4.6 days (1-18 days). Closed reduction was successful in achieving adequate reduction in all the cases. Fixation was done with 1350 DHS plate in 35 cases and 1400 DHS plate in 2 cases. Adequate fixation was achieved in 31 cases (83.8%) and inadequate in 6 cases (16.2%) as either the tip apex distance was >25 mm and/or the screw was placed in superior and/or anterior quadrant. Union was achieved in 33 cases (89.1%) at mean duration of 13.4 months. There was a significant difference in non-union rates if TAD was >25 mm and/or screw placed in superior/or anterior quadrant. Mean Harris hip score at 1 year follow-up was 84.6 (58-96). Conclusion DHS gives better functional outcome with less complication rates in transcervical fracture neck femur and the placement of the screw is the most important criteria other than reduction for better outcomes in such fractures.
Authors and Affiliations
Mayank Vijaywargiya, Deependra Sonkkar, Akhil Bansal, Pankaj Mishra, Sanjiv Gaur
Keywords
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