Fracture neck of femur treated with hemiarthroplasty and cannulated cancellous screw fixation: a comparative study
Keywords:Fracture neck femur, Cannulated screw fixation, Avascular necrosis head femur, Garden classification of fracture neck femur, Hemiarthroplasty
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.
Schmidt AH, Swiontkowski MF. Femoral neck fractures. Orthop Clin North Am. 2002;3:97–111.
Nather A, Seow CS, Iau P, Chan A. Mortality and morbidity for elderly patients with fractured neck of femur treated by hemiarthroplasty. Injury. 1995;26:187–90.
Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ. Unipolar or bipolar prosthesis in displaced intracapsular hip fractures in octogenarians: A randomised prospective study. J Bone Joint Surg Br. 1996;78:391–4.
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.
Christie J, Howie Cr, Armour PC. Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins. J Bone Joint Surg Br. 1998;70:199–201.
Parker MJ, Blundell C. Choice of implant for internal fixation of femoral neck fractures. Meta analysis of 25 randomised trials including 4,925 patients. Acta Orthop Scand. 1998;69:138–43.
Parker MJ, Porter KM, Eastwood DM, Schembi Wismayer M, Bernard AA. Intracapsular fractures of the neck of femur. Parallel or crossed garden screws. Bone Joint Surg Br. 1991;73:826–7.
Loken S, Andreassen GS. Surgery of femoral neck fractures-higher rate of osteosynthesis failure with the use of 4.5 mm screws compared to 6.5 mm screws. Tidsskr Nor Laegeforen. 2001;121:2474–5.
Lindequist S, Wredmark T, Eriksson SA, Samnegard E. Screw positions in femoral neck fractures. Comparison of two different screws. Acta Orthop Scand. 1993;64:67–70.
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;87:632–4.