SUBCAPITAL FRACTURES OF FEMORAL NECK TREATED WITH TWO HOLE DHS PLATE AND ANTI ROTATION SCREW

Abstract

Introduction:- We reviewed 69 patients with subcapital fracture neck of femur treated with two hole plate DHS and parallel de-rotation screw into the cranial part of the femoral head between January 2000 to January 2005.

Methods:- Patients were selected for fixation by having Garden 1 to 4 fractures, being younger, more active and mobile. Reduction was classified as “good” when residual angulation in the lateral projection was less than 15 degrees, no varus angulation and good alignment in the calcar area. Screw position was considered “good” when there was less than 10 degrees deviation in the direction of screws, screw threads not bridging the fracture site, screw tips less than 5mm from subchondral bone and no signs of intra-articular penetration. The fracture was considered healed when bridging of trabecular bone was present. Patients were reviewed until they were pain free at rest or on walking and had radiological healing of fracture.

Results:- 13 had Garden 3 & 4, 46 had Garden 1 & 2 and 10 had impacted fractures. Sixty eight patients had operation within 24 hours in the next available trauma list. Average age at operation was 70 years (range 21– 89) and hospitals stay 13 days (range 2–52). Good reduction was achieved in 61 patients, 54 of these had good screw position, 8 patients (11%) had combination of poor reduction and poor screw position; five of them had loss of fixation within 6 to 12 weeks postoperatively, one each had segmental collapse and avascular necrosis between 12 to 24 months of operation.

Conclusion:- Their was no re-displacement, non-union, avascular necrosis or segmental collapse when fractures were well reduced and had good screw position. Two hole plate DHS and a parallel de-rotation screw has high rate of fracture union. We recommend its use for treatment of subcapital femoral neck fractures.