Outcome of dynamic locked plate in treatment of intracapsular femur neck fracture

Abstract

Background: The ideal surgical treatment of femoral neck fractures is still debatable. When internal fixation is used, many implants are available. This study aimed to evaluate the outcome following fixation of intracapsular femur neck fractures using the Targon-FN system (B. Braun, AG. Melsungen, Germany) comparing the results with a similar study done by the manufacturer and to assess risk factors associated with complications. Methods: A prospective interventional case series involved 30 consecutive patients aged from 23 to 82 (Mean 49 years) treated at Al-Jalaa trauma hospital in Benghazi- Libya in period from January 2016 to July 2017, for an intracapsular femur neck fracture with Targon-FN system. According to Garden classification 9 fractures (30%) undisplaced and 21 (70%) were displaced fractures, with 2 patients (6.7%) had type I, 7 patients (23.3%) had type II, 7 patients (23.3%) had type III and 14 patients (46.7%) had type IV fracture. Epidemiological data were collected. Patients were followed-up for 2 years (average 16 months). Joint function was assessed clinically by using Harris hip score (HHS) and fracture healing by radiological assessment at sex weeks, 3 months, 6 months, 1 year and finally at 2 years. Complications were recorded. Statistical analysis done to predict risk factors associated with reoperation and complications. Results: Sixteen patients (53.3%) developed one or more complications. Complications were higher than those of manufacturer’s study and included avascular necrosis (53.3%, n=16), nonunion (30%, n=9), blown out implant (16.66%, n=5), loosening screw (3.3%, n=1), and deep infection (3.3%, n=1). In total, 5 patients required total hip replacements. At end of 2 years 19 patients (63%) had poor result, one patient (3.3%) had fair result, 1 patient (3.3%) had good result and 9 patients (30%) had excellent result according to HHS. Delayed surgery, fracture displacement, surgeon’s experience, age ≥40 years and time to postop weight bearing recognized as risk factors for complications. Conclusions: A minimally-invasive surgery of Targon FN justifies use of this system for the preservation of the patient’s hip joint, early rehabilitation and mobilization. Complications and re-operation could be minimized by performing surgery within 24-48 hours, provision of skillful surgeons, and proper timing of postoperative weight bearing. The main limitation is the small number of cases and short follow-up averaged at 16 months.