Abstract
Intoduction: There is a general consensus with regard to the treatment of extacapsular fractures of the hip, however the surgical treatment and the choice of implant in displaced intracapsular fractures remains controversial. Evidence has not definitively established the relative merits of the optimal device for internal fixation. The management of displaced intracapsular femoral neck fractures depends on surgeon’s preference.
Methods: We have done a study using synbone (Corticocancellous with similar properties of natural bone) comparing three methods of fixation (three parallel cannulated screws, two hole dynamic hip screw with and without a derotation screw, four constructs of each fixation). We looked at the ultimate peak loads that a construct can withstand before failure.
Results: There is a significant difference between the cannulated screws and two hole Dynamic hip screw, the latter being stronger of the two. However there is no biomechanical advantage of using the derotation screw.
Discussion: Although this study provides evidence of superiority of dynamic hip screw over cannulated screws, this is limited to the biomechanical properties of the construct. The ultimate clinical failure can depend on numerous other factors. Based on our study we recommend two-holed Dynamic Hip Screw fixation for displaced intracapsular fractures of proximal femur.
Correspondence should be addressed to Mr John Hodgkinson, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
