Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs). In the first series, 98 hip fixation procedures were performed using CCS. After fluoroscopic reduction of the fracture, three CCSs were placed. In the second series, 105 VOOF procedures were performed using a closing wedge intertrochanteric osteotomy with a compression lag screw and lateral femoral plate. The alignment goal was to create a modified Pauwel’s fracture angle of 30°. After fluoroscopic reduction of fracture, lag screw was placed to achieve the calculated correction angle, followed by inter-trochanteric osteotomy and placement of barrel plate. Patients were followed for a minimum of two years.Aims
Methods
There is a high risk of the development of avascular
necrosis of the femoral head and nonunion after the treatment of
displaced subcapital fractures of the femoral neck in patients aged
<
50 years. We retrospectively analysed the results following
fixation with two cannulated compression screws and a vascularised
iliac bone graft. We treated 18 women and 16 men with a mean age
of 38.5 years (20 to 50) whose treatment included the use of an
iliac bone graft based on the ascending branch of lateral femoral
circumflex artery. There were 20 Garden grade III and 14 grade IV
fractures. Clinical and radiological outcomes were evaluated. The
mean follow-up was 5.4 years (2 to 10). In 30 hips (88%) union was
achieved at a mean of 4.4 months (4 to 6). Nonunion occurred in
four hips (12%) and these patients had a mean age of 46.5 years
(42 to 50) and underwent revision to a hip replacement six months
after operation. The time to union was dependent on age with younger
patients achieving earlier union (p <
0.001). According to the
Harris hip score which was available for 27 of the 30 hips with
satisfactory union, excellent results were obtained in 15 (score ≥ 90
points), fair in ten (score 80 to 90 points), and poor in two hips
(≤ 80 points). One patient aged 48 years developed avascular necrosis
of femoral head six years after operation and underwent total hip
replacement. The management of displaced subcapital fractures of the femoral
neck, in patients aged <
50 years, with two cannulated compression
screws and an iliac bone graft based on the ascending branch of
lateral femoral circumflex artery, gives satisfactory results with
a low rate of complication including avascular necrosis and nonunion. Cite this article:
