Fractures In Young Adults Research Articles

Femoral diaphyseal fractures in young adults: Predictors of complications

Background: Intramedullary nailing is an accepted method of management for femoral diaphyseal fractures. There are, however, risks associated with surgery such as nonunion, infection, and venous thromboembolism (VTE). Objectives: Our objective was to identify independent predictors of complications following intramedullary nailing of femoral diaphyseal fractures in young adults. Patients and Methods: During a 3-year period, 59 patients (aged 13–55 years) underwent intramedullary nailing for high energy femoral diaphyseal fracture. These patients were identified from a radiographic database. Patient demographics, socioeconomic status, smoking status, alcohol intake, diagnosis of diabetes, intravenous drug use, fracture comminution, and if it was open were recorded retrospectively. Complications assessed were nonunion, deep infection, VTE, amputation, and revision of the nail. Results: Univariate analysis identified that socioeconomic status, excess alcohol intake, intravenous drug use, fracture comminution, and an open fracture were predictors of complications. Logistic regression analysis identified that intravenous drug use (P = 0.036) and open fractures (P = 0.05) were significant independent predictors of nonunion. There was a trend toward significance (P = 0.07) for excess alcohol intake as a predictor of deep infection. Fracture comminution (P = 0.015) was an independent predictor of VTE. Logistic regression analysis failed to identify any significant independent predictors of amputation or revision after adjusting for confounding variables. Conclusions: Intravenous drug use, open fractures, and fracture comminution are independent predictors of nonunion and/or VTE. These patient factors could be used to identify those at risk of nonunion and VTE who may benefit from early preventative measures.

Hip fractures in young adults

Hip fractures in young adults comprise a small proportion of the total hip fracture population. However they form a distinct and important sub-group, often presenting as a result of high-energy trauma, with other associated injuries. This article describes the specific challenges and pitfalls encountered in the management of these patients. The goals of treatment are discussed, as well as detailing the key factors needed to achieve a good outcome following this significant injury.

Interfragmentary motion assessment for three different fixation techniques of femoral neckfractures in young adults.

Vertical femoral neck fractures in the youth could be happened in high-energy accidents, and because of dominant shearing forces, this fracture is considered as a troublesome injury with a controversy regarding selection of the best fixation method. The long term goal of this quasi-experimental study was to find the more stable fixation method among cannulated screws (CSs), proximal femoral locking plate (PFLP), and dynamic hip screw with derotational screw (DHS+DS) for this kind of fracture. Twelve fresh-frozen cadaveric femurs were assigned to three groups that were matched for mean bone mineral density and stiffness of intact bone. Vertical fractures were artificially mimicked in the specimens and fixed using three different implants, i.e. CSs, PFLP, and DHS+DS. Then, the samples were tested under incremental, cyclic, and failure loading phases. The differences in all biomechanical parameters were statistically significant among tested groups (p<0.05). All biomechanical parameters for the DHS+DS method of fixation are significantly different from those corresponding to CSs (p<0.05). There were no significant differences in failure load and failure energy between the PFLP and CSs techniques (p>0.05). Also, there were no significant differences in relative stiffness and femoral head displacement between the PFLP and DHS+DS groups (p>0.05). Based on the clinical assumption that restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the results of this study suggest that the priority order of selection for the stable fixation implant of vertical femoral neck fracture in young patients is DHS+DS, then PFLP, and finally CSs.

Incidence and excess mortality of hip fracture in young adults: a nationwide population-based cohort study.

BackgroundThis study assessed the incidence and excess mortality of hip fractures among inpatients aged 20–40 years in a nationwide population database in Taiwan.MethodsSubjects were selected from Taiwan’s National Health Insurance Research Database for the period 2001–2008 and were followed up until the end of 2010. A total of 4,523 subjects were admitted for the first time with primary diagnosis of hip fracture and treated with operation.ResultsThe overall annual incidence, mortality, and standardized mortality ratio (SMR) decreased from 7.68 to 7.23 per 100,000, from 1.37 % to 0.94 %, and from 9.06 to 6.71, respectively, from 2001 to 2008. The 1-year, 2-year, 3-year, 5-year, and 10-year mortality rates were 1.28 %, 2.44 %, 3.54 %, 5.32 %, and 10.50 %, respectively for the whole cohort. The 1-year, 2-year, 3-year, 5-year, and 10-year SMRs were 8.33, 7.59, 7.28, 6.39, and 5.82, respectively, for the whole cohort. Risk factors for overall death were male gender, trochanteric fracture, hemiarthroplasty, and higher Charlson comorbidity index (CCI) scores.ConclusionsThe high SMRs found in the present study suggest that young adults with former hip fracture should be closely followed up to prevent early mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1166-9) contains supplementary material, which is available to authorized users.

Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review.

Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0–31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56–96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

Treatment of displaced femoral neck fracture in young adults with close reduction and femoral neck locking plate fixation

To investigate the clinical effects of close reduction and proximal femoral locking plate fixation for the treatment of femoral neck fractures in young adults. From August 2010 to 2014 August, 54 patients with displaced femoral neck fracture were treated with closed reduction and proximal cannulated screw locking plate fixation. There were 34 males and 20 females, aged from 18 to 55 years with an average of 39.8 years. The informations of fracture healing and complications were recorded after operation. According to Harris criteria, the function of hip joint was evaluated. All patients were followed up from 4 to 24 months with an average of 11.3 months. Three cases occurred fracture nonunion, fracture union rate was 94.4%(51/54), union time was from 3 to 6 months with an average of 4.1 months. Among the healed 51 cases, the median of femoral neck shorten was 0.8 mm with the mean of (0.48±0.46) mm. No complications such as infection, internal fixation displacement were found during follow up. According to Harris criteria, 40 cases obtained excellent results, 9 good, 2 fair, 3 poor. Close reduction and proximal femoral locking plate fixation is an effective method in treating femoral neck fracture in young adults, it has advantages of avoiding the femoral neck crispation, reliable fixation, high rate of fracture union and good functional recovery.

Meta analysis of different methods used for joint preserving procedures in the management of delayed, neglected and non-united femoral neck fractures in young adults

BackgroundNeglected fractures in young adults can be amongst the most difficult to treat in the spectrum of fractures of the femoral neck. Because of its complex anatomy and blood supply, timely fixation is paramount. When this does not occur, non-union and avascular necrosis are common complications. Here, we present a meta-analysis of three common options available to the surgeon treating such complications.MethodsWe identified 97 relevant papers by the keywords ‘femoral neck fractures’; ‘neglected’; ‘joint preserving’ and ‘young adults’; 23 met the inclusion criteria and reported on an overall population of 725 patients.ResultsOsteotomy with internal fixation had a union rate of 91.33% (95% CI 84.91–92.87). Fractures fixed by internal fixation with pedicled muscle graft proceeded to union in 86.25% (95% CI 78.92%–88.54%) of cases and those managed with free fibular graft in 88% (95% CI 78.35%–90.84%), respectively. Internal fixation alone, in this study, used as an illustrative control group, was successful in 76.5% (95% CI 65.58%–83.81%) of cases.ConclusionThese findings show superiority of osteotomy with internal fixation in the management of non-united femoral neck fractures, and more complex options with potentially higher morbidity confer no patient benefit.

Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws?

BackgroundWe sought to compare the incidence of complications after fixation of displaced femoral neck fractures in young adults treated with fixed-angle devices versus multiple cancellous screws and a trochanteric lag screw (Pauwel screw). MethodsWe conducted a retrospective cohort study at a level I trauma centre. Sixty-two skeletally mature patients (age range, 16–60 years) with displaced femoral neck fractures were included in the study. Forty-seven were treated with a fixed-angle device (sliding hip plate with screw or helical blade) and 15 with multiple cancellous screws placed in a Pauwel configuration. The main outcome measure was postoperative complication of osteonecrosis or nonunion treated with a surgical procedure. ResultsSignificantly fewer failures occurred in the fixed-angle group (21%) than in the screws group (60%) (p=0.008). Osteonecrosis was rare in the fixed-angle group, occurring in 2% of cases versus 33% of cases in the screws group (p=0.002). Consistent with previous studies, good to excellent reductions were associated with a failure rate of 25% and fair to poor reductions were associated with a failure rate of 55% (p=0.07). The best-case scenario of a good to excellent reduction stabilised with a fixed-angle device yielded a success rate of 85%. ConclusionIn young patients with displaced high-energy femoral neck fractures, fixed-angle devices resulted in fewer treatment failures than did Pauwel screws.

Treatment of nonunion of neck fracture of the femur in young patients with valgus osteotomy

Background Nonunion of the femoral neck fractures usually can be diagnosed within 1 year of fracture, although a fairly accurate prediction of healing can be made only after 6 months or less. Valgus osteotomy increases the healing power of femoral neck fractures by translation of the shearing force to compression force. Patients and methods This study included 20 patients with ununited femoral neck fractures, with their ages ranging from 22 to 50 years. All patients had fractures with high-angle fractures (Pauwel’s III). They were 16 males and four females. They were treated through valgus osteotomy and internal fixation with dynamic hip screw with angle of 150°. Results Overall, 18 fractures were healed and all osteotomies were healed. Two patients with ununited fractures could not walk. Conclusion Valgus osteotomy with internal fixation with dynamic hip screw is a very useful solution for treatment of ununited femoral neck fractures in young adults with excellent results.

Biodegradable magnesium screws and vascularized iliac grafting for displaced femoral neck fracture in young adults.

ObjectiveAvascular necrosis of femoral head and nonunion is a major complication after the treatment of displaced femoral neck fracture in young adults.The purpose of this study was to introduce a new technique using biodegradable magnesium screws and vascularised iliac grafting for displaced femoral neck fracture in young adults.MethodsTotally 19 patients with displaced femoral neck fracture treated with this technique were retrospectively reviewed. The major steps of this technique included the harvesting of vascularized iliac graft, fixing of the fracture and biodegradable magnesium screws combined with vascularized iliac grafting implantation.ResultsAll patients were followed for an average of 16 months (range: 8–24 months). Clinical and radiological outcomes were evaluated. In 18 cases (94.7 %), the hip union was achieved at an average duration of 4.1 months (range: 3.6-5 months). The nonunion was observed in 1 hip (5.3 %) and the revision to a hip replacement was conducted after twelve months of the operation. According to the Harris hip score (HHS) that was available for 17 hips with satisfactory union, excellent results were achieved in 14 cases (HHS ≥ 90), fair results in 3 cases (HHS: 80–90), and poor result in 1 hip (HHS < 80). No patient developed avascular necrosis of femoral head after operation.ConclusionBiodegradable magnesium screws and vascularized iliac grafting based on the ascending branch of lateral femoral circumflex artery for displaced femoral neck fracture in young adults can provide the satisfactory results with a low rate of complications including avascular necrosis and nonunion.Trial registrationThis prospective and randomized controlled study was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-13003238). Date of registration: 2013-3-21.

Outcomes of war related femoral neck fractures.

In the civilian trauma literature, femoral neck fractures in young adults are considered an orthopedic 'urgency'. To our knowledge, there have been no studies looking at the outcomes of these injuries in the combat setting. The purpose of this study is to determine the outcomes of war related femoral neck fractures; the rates avascular necrosis associated with these injuries as well as the effect time to fixation has on the development of avascular necrosis. We performed a retrospective review of 21 patients who sustained combat related femoral neck fractures from October 2001 through October 2013. We collected demographic data, time to fixation, time to union, incidence of avascular necrosis, as well as complications and final recreational activity status. Our study included 21 males (100%). The average length of follow up was 19.0 (2.7-62.3) months, and the average length of radiographic follow up was 21.4 months. The average age was 25.2 (21-36) years. Displaced fractures were sustained in 71.4% of patients and 95.2% had a Pauwels' type 3 fracture. 56.9% had initial reduction and fixation within 24h of injury. Percutaneous screw fixation and dynamic hip screws were definitive fixation in 57.1% and 23.8% of patients, respectively, while the remainder had a cephalomedullary device or a salvage procedure. The average time to union was 5.5 months. There was 1 case of nonunion and 1 case of delayed union. Three of the patients (16.7%) developed avascular necrosis of the femoral head, 2 of which were initially reduced within 24h of injury. There were no statistically significant differences between time to fixation, type of reduction, or presence of displacement as a predictor of the development of avascular necrosis. We found a high rate of displaced and high Pauwels' angle fractures, consistent with the high-energy injury mechanisms. With nearly a two-year average radiographic follow-up, the incidence of avascular necrosis was 16.7%, despite only half of our patients receiving initial reduction within 24h of injury. Urgent reduction and fixation continues to be of utmost importance to decrease the risk of femoral head avascular necrosis.

Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations.

Femoral neck fractures in young patients are usually caused by a high-energy trauma, which results in a perpendicular fracture. Although efforts are focused on preserving the femoral head in young patients, vertical femoral neck fracture is a problematic orthopedic injury due to the domination of shear forces. Due to controversy regarding which fixation method is the best choice, the purpose of this study was to find the most stable fixation method for this kind of fracture. This study includes experimental testing on cadaveric bone samples and finite element analysis (FEA) for three fracture fixation techniques, namely cannulated screws (CSs), dynamic hip screw with derotational screw (DHS + DS), and proximal femoral locking plate (PFLP). Experimental results of bone-implant stiffness, average femoral head displacement, failure load, failure energy, and relative position of the fractured fragments indicate that DHS + DS offers the strongest structure for stabilizing a vertical femoral neck fracture. Experimental data and FEA results both indicate that under static loading, the DHS + DS method of fixation produces the lowest femoral head displacement and interfragmentary movement, followed by PFLP and then CSs. The results of this research suggest that, based on the clinical assumption that a restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the DHS + DS method of fixation is a better choice compared to CSs and PFLP for a vertical femoral neck fracture fixation in young adults.

Use of proton pump inhibitors is associated with fractures in young adults: a population-based study.

Proton pump inhibitors (PPIs) are associated with risk for fracture in osteoporotic adults. In this population-based study, we found a significant association between PPIs and fracture in young adults, with evidence of a dose-response effect. Young adults who use PPIs should be cautioned regarding risk for fracture. Proton pump inhibitors (PPIs) are associated with fracture in adults with osteoporosis. Because PPI therapy may interfere with bone accrual and attainment of peak bone mineral density, we studied the association between use of PPIs and fracture in children and young adults. We conducted a population-based, case-control study nested within records from general medical practices from 1994 to 2013. Participants were 4-29 years old with ≥ 1 year of follow-up who lacked chronic conditions associated with use of long-term acid suppression. Cases of fracture were defined as the first incident fracture at any site. Using incidence density sampling, cases were matched with up to five controls by age, sex, medical practice, and start of follow-up. PPI exposure was defined as 180 or more cumulative doses of PPIs. Conditional logistic regression was used to estimate the odds ratio and confidence interval for use of PPIs and fracture. We identified 124,799 cases and 605,643 controls. The adjusted odds ratio for the risk of fracture associated with PPI exposure was 1.13 (95% CI 0.92 to 1.39) among children aged < 18 years old and 1.39 (95% CI 1.26 to 1.53) among young adults aged 18-29 years old. In young adults but not children, we observed a dose-response effect with increased total exposure to PPIs (p for trend <0.001). PPI use was associated with fracture in young adults, but overall evidence did not support a PPI-fracture relationship in children. Young adults who use PPIs should be cautioned regarding potentially increased risk for fracture, even if they lack traditional fracture risk factors.

Mo1146 Localization of a Novel Potassium Competitive Acid Blocker, Vonoprazan, in the Rat Gastric Mucosa: A Radiographic Study

G A A b st ra ct s at least one year of follow-up within THIN who also lacked chronic conditions associated with use of long-term acid suppression. Cases of fracture were defined by the first Read code for incident fracture at any site and the control pool consisted of individuals without a diagnosis of fracture at the time when the corresponding case had his or her first fracture. Using incidence density sampling, cases were matched with up to 5 control subjects by age (within 1 year), sex, THIN practice, and start of follow-up in THIN (within 1 year). PPI exposure was defined as 180 or more cumulative doses of PPIs. We additionally examined the PPI-fracture relationship at varying levels of PPI exposure. As potential confounders, we extracted information related to age, sex, body mass index, and use of other medications. The primary outcome was calculated using conditional logistic regression as the odds of PPI exposure in cases compared to controls. Because the epidemiology of fracture varies by age, we stratified analyses using a cut-off of 18 years old or more. RESULTS: 508,740 children age 4 to 17 years old and 207,181 young adults age 18 to 29 years old within the THIN database were included in the study. We identified 124,799 cases of incident fracture and 605,643 matched controls. In young adults but not children, PPIs were a risk factor for fracture in both unadjusted and adjusted models. The adjusted odds ratio for the risk of fracture associated with PPI exposure was 1.13 (95% CI 0.92 to 1.39) among children and 1.39 (95% CI 1.26 to 1.53) among young adults. In young adults but not children, we observed a dose-response effect with increased total exposure to PPIs (p for trend <.001). CONCLUSIONS: PPI use was associated with non-osteoporotic fracture in young adults but not children. Young adults who use PPIs should be cautioned regarding potentially increased risk for fracture, even if they lack traditional fracture risk factors.

Displaced Femoral Neck Fracture in Young Adults

Displaced Femoral Neck Fracture in Young Adults

Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction.

Background:Subcapital femoral neck fracture in young adults has many complications, and the incidence is increasing year-by-year. The selection of the proper operation method to avoid them is an ambiguous matter. This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and internal fixation in young adults.Methods:From March 2003 to February 2010, 65 young patients with subcapital femoral neck fractures were treated, including 39 males and 26 females with average age of 34.5 years (range, 19–50 years); 29 cases of the left side and 36 cases of the right side. They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting. The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score. The observation criteria involved the length of the incision, blood loss, operation time, nonunion rate, avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score.Results:Four of 65 patients were lost follow-up, and the follow-up rate was 93.8%, the average follow-up time was 38.7 months (range, 33–47 months). In Group A, the incision length was 5.1 ± 2.2 cm, blood loss was 84.0 ± 13.2 ml, and operation time was 52.9 ± 10.2 min. In Group B, the incision length was 15.4 ± 4.6 cm, blood loss was 396.0 ± 21.3 ml, and operation time was 116.5 ± 15.3 min. Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B. ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B. Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B. The above index of two groups was considered statistically significant (P < 0.05).Conclusions:Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing, reduce ANFH in young adults. It is a safe and effective operation for subcapital femoral neck fracture.

Application of a medial buttress plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults

Femoral neck fractures in young adults with normal bone are mostly vertically oriented and may have variable amounts of comminution, which result from shearing forces during high-energy trauma. These factors play a role in the high rate of complications after this injury, including nonunion, malunion, failure of fixation, and avascular necrosis. These problems often occur together and inter-relate, for example, nonunion or malunion frequently result from fixation failure and varus collapse of the femoral head after reconstruction. The orthopaedic surgeon’s goals of obtaining and maintaining anatomic reduction until bony union have been addressed by a number of surgical approaches and fixation constructs, however, complications are still common and no consensus exists on how these problematic fractures may be best treated. For optimal treatment of vertical femoral neck fractures, anatomic reduction must be achieved and fixation must be able to resist the high shear forces across the fracture with hip motion, weight-bearing, and muscle tone. Buttress plate fixation is a common method for stabilizing fractures that require resistance to shear forces and stands as one of the basic principles of fracture care. This technique has not been widely applied to this injury pattern. We propose that the concepts of modern fracture care should be applied together for vertical femoral neck fractures in young adults. Specifically, we propose that anatomic reduction and fixation of vertically oriented femoral neck fractures with the addition of a medial buttress plate to resist shearing forces will improve on the historically high rate of complications after these difficult injuries.

A 42-year-old patient presenting with femoral head migration after hemiarthroplasty performed 22 years earlier: a case report.

IntroductionTreatment of femoral neck fractures in young adults may require total hip arthroplasty or hip hemiarthroplasty using a bipolar cup. The latter can, however, result in migration of the femoral head and poor long-term results.Case presentationWe report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient (a Japanese man) was 20 years old. He experienced peri-prosthetic fracture of the femur, subsequent migration of the prosthesis, and a massive bone defect of the pelvic side acetabular roof. After bone union of the femoral shaft fracture, the patient was referred to our hospital for reconstruction of the acetabular roof. Intra-operatively, we placed two alloimplants of bone from around the transplanted femoral head into the weight-bearing region of the acetabular roof using an impaction bone graft method. We then implanted an acetabular roof reinforcement plate and a cemented polyethylene cup in the position of the original acetabular cup. Eighteen months post-operatively, X-rays showed union of the transplanted bone.ConclusionsTreatment of femoral neck fractures in young adults is usually accomplished by osteosynthesis, but it may be complicated by femoral head avascular necrosis or by infection or osteomyelitis. In such cases, once an infection has subsided, either hip hemiarthroplasty using a bipolar cup or total hip arthroplasty may be required. However, if the acetabular side articular cartilage is damaged, a bipolar cup should not be used. Total hip arthroplasty should be performed to prevent migration of the implant.

Comparative study of fresh femoral neck fractures managed by multiple cancellous screws with and without fibular graft in young adults

Aim of our study was to assess the role of addition of fibular strut graft to multiple cancellous screws in functional outcome, union and complications associated with those managed by only multiple cancellous screws in fresh femoral neck fractures. A randomized control trial study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws (group A) and multiple cancellous screws with fibular graft (group B). Patients aged between 20 and 50 years, having Gardens type III or IV fracture with duration of injury less than two weeks were included in the study. Eighty seven cases were analysed n=45 were in group A and n=42 in group B. Functional outcome (Harris hip score) was excellent in 30 patients in group A as compared to 12 in Group B which was statistically significant favouring group A. The time of full weight bearing, union and non union rates showed no statistical significance (p>0.05). On statistical grounds none of the procedures proved to be better than other. Fresh femoral neck fracture in young adults managed with multiple cancellous screws fixation with fibular graft has no added advantage over multiple cancellous screws fixation alone.

Femoral Neck fracture in young patients, managed by osteosynthesis using Primary double angle barrel plate combined with valgus inter trochanteric osteotomy-Long term result

Introduction: Femoral neck fracture at any age always shows relatively higher rate of complications like non union, avascular Necrosis of femoral head, loss of fixation, screw cut-out and delayed secondary osteoarthritis. These fractures in physiologically old age are managed by replacement of femoral head. In Femoral neck fractures in young adult the main aim is to preserve the natural head and these cases are managed by Multiple cancellous screw, CanulatedCancellous Screw(CCS) with fibular graft either free fibular or vascularised fibular graft. Replacement surgeries in these cases are a difficult choice as young age and also high cost of implants. Also in these patients it is difficult to restrict squatting for lifelong due to social culture and lack of toilets. Now days also preferences are given to head sparing surgeries and osteosynthesis. We use primary double angle barrel plate with intertrochanteric valgus osteotomy for the management of femoral neck fracture in young adults. Material and method: Cases were selected from the patients attending in Orthopaedics OPD and emergency trauma centre of UPRIMS & R, Saifai, Etawah from May 2006 to August 2013. During this period total 44 cases of fracture neck femur were selected for primary fixation with dauble Angle Barrel Plate (DABP). Out of 44 cases 30 were female and 14 were male with age range from 18 yrs to 48 yrs and average age of 42 yrs. Average duration from injury to operative procedure was 1.3 weeks (10 Days) and range from 2 days to 15 weeks. These cases were operated by Double angle barrel plate with intertrochanteric valgus osteotomy and long term result evaluated using Modified Askin and Bryan criteria. Result: Out of 44 cases operated 42 cases followed up to the average duration of 48 months and all these 42 cases show good(18) to Excellent(20) results after 4 yrs according to Harris hip score. 4 cases shows fair result and other secondary procedure were required in these cases. Complication seen