A Comparison of Dynamic Hip Screw and Two Cannulated Screws in the Treatment of Undisplaced Intracapsular Neck Fractures-Two-Year Follow-Up of 453 Patients.

Harald Kurt Widhalm,Stefan Hajdu,Nikolaus Wilhelm Lang,Alexandru Munteanu,Hannes Beiglböck,Richard Arnhold

doi:10.3390/jcm8101670

Harald Kurt Widhalm, Stefan Hajdu + Show 4 more

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https://doi.org/10.3390/jcm8101670

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Abstract

One of the most common fractures is that of the intracapsular femoral neck; however, the optimal implant for head-preserving treatment remains controversial. The aim of the study was to compare the outcomes of treating undisplaced intracapsular femoral neck fractures with either the dynamic hip screw (DHS) or the double cannulated screw fixation (CSFN). This retrospective cohort study analysed the data of 453 patients, with a mean age of 76.9 years, whose intracapsular fractures were treated with the DHS or CSFN between 2005 and 2013. The analysis focused on the rates of revision surgeries and complications; however, the impact of confounding exogenous factors, such as smoking and alcohol, were also considered. No significant difference was observed between the revision rates of DHS and CSFN (15.0% vs. 13.1%; p = 0.565). According to the complication rate, the advantage in favour of the CSFN was not significant (20.5% vs. 13.1%, p = 0.038). The use of the DHS was associated with a 13 min longer surgery (p < 0.0001) and a one day longer hospitalization (p = 0.242). Excessive consumption of alcohol was associated with an increased incidence of avascular necrosis (18.6% vs. 8.7%, p = 0.035). The choice of implant showed no significant impact on rates of revision surgery and complications. In terms of socioeconomic factors, the fixation with two cannulated screws was more favourable, making it the more cost-effective and less stressful method.

Highlights

Due to the demographic development of an increasing elderly population, the treatment of the most common fracture among this age group, the intracapsular femoral neck fracture, is of ever-growing importance
A total of 453 patients with a medial femoral neck fracture were included in this retrospective cohort study
This study considered the effects of both dynamic hip screw (DHS) and double screw cannulated screw fixation (CSFN) on the complication and revision rates

Summary

Introduction

Due to the demographic development of an increasing elderly population, the treatment of the most common fracture among this age group, the intracapsular femoral neck fracture, is of ever-growing importance. The principle factor responsible for this trend is the age-related bone demineralisation of the proximal femur compounded by the high prevalence of vitamin D deficiency [3]. These changes are compounded by the higher rates of falls among the elderly [4]. These factors are responsible for approximately 90% of femoral neck fractures [5]

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