A prospective study of functional outcome of intracapsular femoral neck fractures with delayed presentation in young adults

Abstract

Objectives: To assess the functional and radiological outcome of intracapsular femoral neck fractures with delayed presentation in young adults treated with cannulated cancellous screws. Methods: A prospective study included 21 patients with intracapsular neck of femur fractures who presented after 24 hours of injury but within 3 weeks of injury for which closed reduction and fixation was done with cannulated cancellous screws in Sanjay Gandhi Institute of trauma and orthopedics, Bangalore from May 2018 to December 2019. Patients were followed up at 6 weeks, 3 months, 6 months and 12 months. Clinical outcome was assessed using Modified Harris hip score and radiological assessment was done using x rays. Results: In our study we analysed the following parameters especially age, fracture type according to Garden and Pauwel, time of presentation, timing of surgery. In our study we found that patients with Pauwels type 3 (23.81%) and Gardens type 4 (42.86%) had low hip scores compared to others. 85% patients were pain free, 80% had good mobility post surgery. Incidence of non union was 2 out of 21 cases. The Modified Harris Hip Score evaluated at maximum follow-up of our patients averaged 90.13 with the maximum score being 96 and the minimum score being 67.8. Overall, 10 patients (47.62%) achieved excellent result, 6 patients (28.57%) achieved good result, 3 patients (14.29%) achieved fair result and 2 patients (9.48%) achieved poor result. 76.19% of the patients achieved either excellent or good results. According to radiographic evaluation AP view xray of pelvis with hip in 15 degree internal rotation, radiological parameters such as fracture union, non union changes, avascular necrosis of head, arthritic changes in the joint were analysed. Fracture union was seen in 19 patients (90.48%) and non union in 2 patients (9.52%). AVN changes were seen in 3 patients (14.29%). Average time of union was less than 3 months in 8 patients (44.4%), 3 to 4 months in 5 patients (27.7%), 4to 5 months in 4 patients (22.2%) and in one patient (5.55%) union achieved at 6 months.Conclusion: We conclude that canulated cancellous screw fixation is a viable option of treatment for fractures of intracapsular neck of femur in young adults with delayed presentation, showing excellent to good functional outcome and early radiological union with minimal complications.