Abstract
Introduction:The treatment of fracture neck femur varies according to the age of patient, the displacement of fracture fragments and the duration of the fracture. Various treatment options available for elderly are screw fixation, hemiarthroplasty and total hip arthroplasty.Materials and Methods:This is a prospective study done at authors institutes between January 2014- December 2016. 30 patients aged more than 50 years who sustained fracture neck femur were included in the study. 3 patients were lost to follow up and 2 patients died due to medical comorbidities. Out of the 25 remaining patients, 17 were males and 8 were females and they were operated by the biplane double supported screw fixation method (BDSF TECHNIQUE) and were followed up for a period of two years. The final Harris Hip Score at the last follow up was calculated.Results:Out of the 25 patients, the union was achieved in all the patients. The mean duration of union was 10 weeks. 1 patient had progressive femoral head resorption due to chondrolysis resulting in antalgic gait and unbearable pain and underwent total hip arthroplasty. The mean harris hip score was 81.2Conclusion:In elderly patients with osteoporosis and in those patients who can not afford arthroplasty or in those patients where arthroplasty is contraindicated, BDSF method is an alternate method for fixing fracture neck femur.
Highlights
The treatment of fracture neck femur varies according to the age of patient, the displacement of fracture fragments and the duration of the fracture
Inclusion criteria were poor socioeconomic status leading to non-affordability for arthroplasty, patients with mental illnesses like dementia, patients having risk cardiopulmonary status which places them at an extra risk for a longer surgery like arthroplasty and patients with severe osteoporosis
The method most widely practiced by surgeons for fixing the fracture neck femur is by three cancellous screws placed parallel to each other and various authors have reported the failure rate to be as high as 20-42% [20 - 24]
Summary
The treatment of fracture neck femur varies according to the age of patient, the displacement of fracture fragments and the duration of the fracture. Fracture of neck femur is a very common injury in patients more than 50 years of age. According to the present scenario, arthroplasty should be reserved for patients more than 80 years, while in patients age less than 60 sustaining fracture neck femur, joint salvage must be attempted while the ideal treatment of fracture neck femur in the age group 60-80 is still a matter of debate [1]. A number of controversies exist in relation to the cannulated screw fixation for fracture neck femur like number of screws to be used, position of screws in the head and neck and the configuration of screws to be used. Some authors believe that the screws should be placed parallel to each other [3, 4, 11 - 13], while others believe that screws should be divergent in lateral view [9, 14, 15]
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