Comparative study of fully threaded and partially threaded cancellous cannulated screws versus partially threaded cancellous cannulated screws in femoral neck fractures in adults
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242395Keywords:
Femoral neck fracture, Cannulated cancellous screws, Fully threaded screw, HHSAbstract
Background: Femoral neck fractures constitute a significant portion of orthopaedic trauma, with intra-capsular fractures representing 50% of all hip fractures, their incidence is projected to rise dramatically due to the aging population. These fractures, particularly in the elderly, lead to high morbidity and mortality. Optimal surgical treatment for femoral neck fractures remains debated, especially in younger adults.
Methods: This hospital-based prospective comparative study was conducted over one year. Patients aged 18-60 years with femoral neck fractures were randomized into two groups: Group A were operated using combination of fully threaded and partially threaded cancellous cannulated screws and group B using partially threaded cancellous cannulated screws. Functional outcomes were assessed using the Harris hip score (HHS) and visual analog scale (VAS) for pain, and radiological union times were recorded. Complications such as non-union, screw back-out, and infection were also evaluated.
Results: The study included 30 patients, with 15 in each group. Group A showed significantly better HHS at 6 months (88.53±7.46) compared to group B (77.69±13.35) (p<0.05). VAS scores were lower in group A, indicating less pain, though the difference was not statistically significant. Radiological union time was shorter in group A (12.55±2.39 weeks) compared to group B (13.89±5.29 weeks) (p<0.05). Group A had fewer complications, with no cases of screw back-out compared to four in group B.
Conclusions: The combination of fully threaded and partially threaded cancellous cannulated screws when used appropriately offers better functional outcomes, faster radiological union, and fewer complications compared to partially threaded screws alone in femoral neck fractures in young adults.
References
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-33.
Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13.
Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43(4):647-63.
Gupta RK, Singh N, Singh H. Comparative analysis of proximal femoral locking plate and dynamic hip screw for the treatment of unstable intertrochanteric fractures. J Clin Orthop Trauma. 2020;11(1):10.
Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 2007;458:175-9.
Yuan K, Yang F, Fu K, Zhu DY, Jiang CY, Jin DX, et al. Internal fixation using fully threaded cannulated compression screws for fresh femoral neck fractures in adults. J Orthop Surg Res. 2022;17(1):108.
Robinson CM, Court-Brown CM, McQueen MM, Christie J. Hip fractures in adults younger than 50 years of age: Epidemiology and Results. Clin Orthop Relat Res. 1995;312:238-46.
Protzman RR, Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg Am. 1976;58:689-95.
Ly TV, Swiontkowski MF. Management of femoral neck fractures in young adults. Indian J Orthop, 2008;42(1):3-12
Dedrick DK, Mackenzie JR, Burney RE. Complications of femoral neck fracture in young adults. J Trauma Acute Care Surg. 1986;26(10):932-7.
Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. JBJS. 2004;86(8):1711-6.
Lee KBL, Howe TS, Chang HC. Cancellous Screw Fixation for Femoral Neck Fractures: One Hundred and Sixteen Patients. Ann Acad Med Singapore. 2004;33:248-51.
Shina KH, Honga SH, Han SB. Posterior fully threaded positioning screw prevents femoral neck collapse in Garden I or II femoral neck fractures. Injury. 2020;51:1031-7.
