CANNULATED SCREWS FIXATION OF FEMORAL NECK FRACTURE. A CLINICAL ANALYSIS OF TWO DIFFERENT CONFIGURATIONS.

Abstract

Introduction: There is still controversy regarding which method of internal fixation of intraarticular hip fracture is ideal. The purpose of this study was to evaluate the outcome and complications following the fixation of such fractures with cannulated cancellous screws with two different types of triangular configurations of these screws: one superior and two inferior and vice versa.

Methods: Between January 2006 and December 2008, one hundred and twelve femoral neck fractures in 125 patients (mean age of 67 years) were treated by closed reduction and internal fixation (CRIF) by titanium cannulated screws, using alternately these configuration types of fixation. Twelve patients were lost to follow-up. Ninety-eight fractures in 93 patients were followed to union or revision surgery, with a mean duration of follow-up of twenty one months. There were 52 Garden I fractures, 34 Garden II fractures and 12 Garden III and IV fractures. Fifty-one were treated with standard configuration of 2 inferior and one superior screws (group 1), while 47 were treated with reverse placement (group 2). There was no statistic difference regarding age, sex and Garden’s classification between the two groups. The quality of reduction, accuracy of implant placement and rates of nonunion and osteonecrosis were evaluated.

Results: 83/98 fractures (85%) had at follow-up good-to-excellent reduction and fifteen (15%) had a fair or poor reduction. There was a nonunion of seven fractures (7 %) and avascular necrosis of the femoral head (AVN) in five (5%). There were no deep infections. Seventy one patients (83%) had a good functional outcome (as compared to 85/93 Pts- 91% – prior to fractures). Six patients (four with nonunion and two with avascular necrosis) went through revision surgery (THR). There was no difference in the quality of reduction, number of nonunion and AVN and functional outcome between both groups of fixation. There was a difference in the outcome which depended on the Garden type of fraction and the accuracy of reduction. Most complications were observed in Garden’s III and IV fractures with inaccurate reduction.

Conclusions: Excellent reduction and accurate implant placement is the main reason for a good outcome after close reduction and internal fixation of intraarticular hip fractures. We didn’t find any difference in the outcome following fixation in two different configurations of the screws.