Locking Plate Fixation System for Intracapsular Fracture Neck of Femur in Young Patients.

Abstract

Intra-capsular fractures of the femoral neck in young patients are almost always treated with surgical fixation to preserve the native hip anatomy and biomechanics. Multiple Cannulated hip screws and the sliding hip screw have been the hallmark fixation devices for these injuries. The use of locking cannulated hip screws to a side plate was developed to mitigate the biological and mechanical downfalls of these devices. To report the outcome following the use of a locking plate fixation system in the management of intracapsular fractures of the femoral neck in young patients. A case series study of all the patients treated in our institution between 2014 and 2017. All eligible patients with hip intracapsular fractures aged between 18 and 65 were treated with a proximal locking hip plate system. The main reported outcomes were union rate, failure of fixation, and development of avascular necrosis of the femoral head. Fifty-six patients (36 men and 20 women) at a mean age of 39.1 years (range 20-65 years) completed 24 months' follow-up. Mean time to surgery was 16 hours. No intraoperative complications were reported. The mean time to union was 15.9 weeks (range 12-23). Three patients (5.3%, one Garden type III, and two type IV) did not achieve union at 6 months. Two patients had revision surgery with valgus osteotomy and the third patient required total hip replacement because of screw penetration. Five patients (8.9%) developed avascular necrosis of the femoral head (2 patients Garden type III, and 3 patients Garden VI). Only two patients required conversion to total hip replacement. 1. The results in this study showed lower rates of non-union, AVN and secondary operation as compared to published data on both SCH and DHS. 2. It also compares favorably with results reported for dy-namic locking screw systems. 3. The study had few li-mitations, including lack of comparative groups. Also, when considering fracture classification subgroups, the unstable fracture pattern had higher rates of non-union and AVN. 4. This calls for a further larger number of studies dedicated to these fracture categories to ascertain long-term outcome with this type of fixation.