Abstract
Cannulated screw fixation is a widely accepted surgical method for management of fractures of the neck of femur especially in patients with poor premorbid conditions, minimally displaced fractures and those from a younger age group. A five year retrospective study was carried out in 53 consecutive patients between 2006 to 2010 to determine the pattern of injuries, management, outcomes and the associated predictive factors.All the patients underwent cannulated screw fixation, with 37 (69.8%) having had surgery within 24 hours and the remaining 16 (30.2%) 24 hours after the initial injury. All patients were followed up to union of fractures and complications thereafter if any. Good outcome was observed in 43 (81.1%) patients leaving only 10 (18.9%) patients with a poor outcome, of whom nine developed avascular necrosis (90%) and one non-union (10%). We found no significant relationship between the incidence of avascular necrosis and age of patient, fracture displacement, numbers of cannulated screws used, fracture reduction acceptability and anatomical location of the fracture. The time interval from injury to surgery and the presence of posterior comminution did seem to influence the rate of avascular necrosis but due to the small number of patients, was not statistically significant.We conclude that cannulated screw fixation is a viable option of treatment for fractures of the neck of femur. femoral neck fractures, screw fixation.
Highlights
Fracture of the neck of femur is a challenging injury to manage
We found no significant association between age of patient and avascular necrosis (p = 0.462)
We found that the incidence of Avascular necrosis (AVN) increased with increasing time lapse
Summary
This is a retrospective review of all cases of femoral neck fractures that underwent cannulated screw fixation at our centre between the years 2006 till 2010. Review of all case records was carried out with the aid of a questionnaire and the radiographs by three. Cannulated Screw Fixation for Femoral Neck Fractures independent observers, including a senior orthopaedic consultant. The fractures in all our patients were analysed for displacement and stability, using the Garden Classification and Pauwel Classification respectively. Garden’s Alignment Index was used to assess fracture reduction postoperatively, with 155° - 180° in both antero-posterior and lateral view as the criterion - for adequate reduction
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