Comparison between directed anterior appoach assisted cannulated screw and intramedullary fixation for young adults with unstable femoral neck fractures

Abstract

Objective To analyze the clinical efficacy of direct anterior approach(DAA)-assisted cannulated screw and Intertan intramedullary fixation in the treatment of unstable femoral neck fractures in young adults. Methods From January 2014 to December 2016, 179 cases of displaced unstable (Garden III or IV)femoral neck fractures in young adults were treated by open reduction of direct anterior approach (DAA). Inclusion creteria: surgery is completed within 24 hours, age<60 years old and follow-up data intact; exclusion creteria: ipsilateral intertrochanteric fractures, subtrochanteric fractures, femoral shaft fractures, long-term use of large doses of hormones or alcohol abuse patients.Ninety cases were treated by DAA-assisted cannulated screw fixation in group A and 89 cases were treated by DAA-assisted Intertan intramedullary fixation in group B. Data were statistically analyzed using SPSS 21.0 statistical software with t test and χ2 test to compare the operation time, the number of fluoroscopy, the amount of bleeding, the hospitalization day, the fracture healing time, the fracture nonunion, the avascular necrosis rate of the femoral head, and the Harris score. Results There was no significant difference in age, gender, and Garden classification between the two groups (all P>0.05), which was comparable. Group A was superior to group B in terms of operation time[group A (35.4±15.6) min, group B(55.2±12.4) min], number of X-ray exminations [group A (6.5±3.4) times, group B(9.3±4.6) times], and bleeding volume[group A (70.5±24.5) ml, group B(129.7±40.2) ml](all P 0.05]. The healing time of group B (2.8±0.8) months was shorter than that of group A (3.8±0.7) months(t=5.375, P<0.01). In group B, nonunion and avascular necrosis of the femoral head occurred in four cases, which were significantly less than those in group A (15 cases)(χ2 =6.005, P<0.05). In group B, three cases were poor in Harris score, which were less than group A (15 cases were poor)(χ2 =7.338, P<0.01). Conclusion Young adults with unstable femoral neck fracture treated with DAA-assisted Intertan intramedullary fixation can achieve completely reduction of bone under direct vision, with fast postoperative recovery, high healing rate, and low incidence of femoral head necrosis; the effect is satisfactory. Key words: Femoral neck fractures; Surgical procedure; Internal fixators