Fracture neck of femur treated with hemiarthroplasty and cannulated cancellous screw fixation: a comparative study

Authors

  • S. K. Rai Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai
  • Rohit Vikas Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai
  • Vyom Sharma Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai
  • S. S. Wani Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai
  • Rohit Varma Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20172885

Keywords:

Fracture neck femur, Cannulated screw fixation, Avascular necrosis head femur, Garden classification of fracture neck femur, Hemiarthroplasty

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 2nd 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.

Author Biographies

S. K. Rai, Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai

lt Colonel

Rohit Vikas, Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai

Dr. (Lt Colonel) Department of Orthopaedics, Indian Naval  Hospital Ship Asvini, Colaba, Mumbai, 400005, India

Vyom Sharma, Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai

Dr (Lt Colonel) Orthopaedics surgeon & Assistant Professor, Department of Orthopaedics, Base Hospital Lucknow ,226002, India

S. S. Wani, Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai

Dr (Lt Colonel)Department of Orthopaedics, Indian Naval  Hospital Ship Asvini, Colaba, Mumbai, 400005, India

Rohit Varma, Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai

Dr (Surg Cdr)Department of Orthopaedics, Indian Naval  Hospital Ship Asvini, Colaba, Mumbai, 400005, India

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Published

2017-06-23

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Original Research Articles