Abstract
Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. Study Type: therapeutic study.
Highlights
Surgical management of displaced subcapital fractures of the femoral neck continues to be challenging
Hemiarthroplasty, and total hip replacement could be considered as appropriate solutions
Deneka et al [4] published a biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures
Summary
Surgical management of displaced subcapital fractures of the femoral neck continues to be challenging. Hemiarthroplasty, and total hip replacement could be considered as appropriate solutions. Most orthopaedic surgeons choose either a dynamic hip screw (DHS) or multiple cannulated screws (MCS). Osteosynthesis with MCS fixation is a less invasive technique and reduces blood loss and soft tissue stripping [1,2,3]. With the use of DHS the screw-plate system achieves a more stable condition. Deneka et al [4] published a biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. The results support the use of DHS. Its disadvantages are large skin incisions, more extensive soft tissue dissection, a greater need for blood transfusion, and a longer stay in hospital
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