STUDY OF MANAGEMENT OF EXTRACAPSULAR FRACTURE OF NECK OF FEMUR BY DYNAMIC HIP SCREW

Background: Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.Methods: This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients >60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.Results: Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.Conclusions: Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.

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In vitro biomechanical comparison of various implants in Pauwels type 3 fracture neck femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203062 ◽

2020 ◽

Vol 6 (5) ◽

pp. 907

Author(s):

Birju Manjhi ◽

S. C. Goel ◽

Abhijeet Kunwar ◽

Vakil Singh

Keyword(s):

Dynamic Hip Screw ◽

The Other ◽

Unstable Fracture ◽

Neck Of Femur ◽

Comparable Group ◽

Fracture Neck Of Femur ◽

Fracture Neck Femur ◽

Hip Screw ◽

Type 3

Background: The objective of this study was to find out the correlation among type of implant, type of fracture and quality of bone in a cadaveric model of unstable fracture neck of femur (Pauwels type 3) fixed with either; proximal femoral nail (PFN), dynamic hip screw (DHS), dynamic hip screw with an anti-rotation screw (DHS and ARS) or cannulated cancellous screws (CCS).Methods: This study was conducted on 24 cadaveric bones (6 in each group) in which unstable fracture neck of femur (Pauwels type 3) were created and fractures in each group were fixed with different implants after creating a comparable group using DEXA scan. These were tested on a cyclic physiological loading machine at 2 cycles per second with a load of 200kg. The test was observed for 10,000 loading cycles or till failure whichever occurred earlier. Subsidence was measured and analyzed.Results: Five specimens in the PFN group, 3 specimens in the DHS and ARS and DHS group completed 10,000 cycles while all the specimens in CCS group failed before 10000 cycles. Mean subsidence of the PFN group was significantly lower than the other groups.Conclusions: PFN constructs were stronger than the other constructs. However, these data must be interpreted as strictly biomechanical, representing only part of the scenario at work in vivo. Nonetheless, the significant findings of increased strength of fixation over the DHS, DHS with ARS and CCS certainly appear to support the use of PFN clinically.

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Dynamic hip screw in the management of reverse obliquity intertrochanteric neck of femur fractures

Injury ◽

10.1016/j.injury.2003.10.032 ◽

2005 ◽

Vol 36 (1) ◽

pp. 105-109 ◽

Cited By ~ 19

Author(s):

R. Willoughby

Keyword(s):

Dynamic Hip Screw ◽

Neck Of Femur ◽

Femur Fractures ◽

Hip Screw

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OUTCOME COMPARISON OF TREATMENT BASICERVICAL NECK OF FEMUR FRACTURE USING HEMIARTHROPLASTY VERSUS DYNAMIC HIP SCREW

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i6.1963 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Manpreet Singh ◽

Anurag Dhaker ◽

Pradeep Kumar Mundotiya

Keyword(s):

Femur Fracture ◽

Age Groups ◽

Clinical Score ◽

Dynamic Hip Screw ◽

Neck Of Femur ◽

Medical College ◽

Significant Difference ◽

Outcome Comparison ◽

Hip Screw ◽

Neck Of Femur Fracture

Background: The present study was conducted to compare outcome of hemiarthroplasty with dynamic hip screw for basicervical neck of femur fracture. Methods: Hospital based, randomized prospective, comparative interventional study conducted on Basicervical neck of femur fracture cases attending with orthopaedics department of S.M.S. Medical College and Hospital, Jaipur (Rajasthan, India) Results: As per the post operative complications in Hemiarthroplasty and DHS groups respectively, no significant difference was observed among the group. As per the age groups clinical score (merle's d aubigne), at 6m and 12 m Group H was better than group D. As per average functional outcome at 3,6 ,12months. Score improved with the time. Conclusion: We concluded that Hemiarthroplastymay allow better restoration of function and should be favoured for treatment of fracture neck of femur in patients that meet the indications for surgery whenever the technical competence and facilities exist. Keywords: Femur, Hemiarthroplasty, DHS

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Surgical management of basicervical fracture neck of femur with dynamic hip screw and derotation screw: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192690 ◽

2019 ◽

Vol 5 (4) ◽

pp. 712

Author(s):

Vijaykumar S. Kulambi ◽

Ajay Shringeri Satish ◽

Prathik Rangaraja

Keyword(s):

Functional Outcome ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Care Hospital ◽

Fracture Union ◽

Neck Of Femur ◽

Fracture Neck Of Femur ◽

Hip Screw ◽

One Year ◽

Modified Harris Hip Score

Background: Basicervical region of femur is that part of femur which is intermediate between neck and intertrochanteric region. Fracture in this region carry substantially higher chances of failure due to greater fracture angle and are rotationally unstable. If treated inadequately they carry very high chances of fracture non-union and theoretically risk of osteonecrosis. The objective of the study was to analyse functional outcome of basicervical fracture neck of femur fixation with dynamic hip screw and de-rotation screw in a tertiary care hospital.Methods: 35 cases of basicervical fracture neck of femur admitted in Chigatteri General Hospital and Bapuji Hospital affiliated to JJM Medical College Davangere, in the period of October 2015 to October 2018. Functional outcome was assessed according to Modified Harris Hip Score after one year of follow up.Results: The fracture union was found in 100% cases, average time period for fracture union was 12.28±3.71 weeks (11-15 weeks range). The results according to Modified Harris hip score were excellent in 70%, good in 11.4%. good in 5.7% and poor in 2.8% at the end of one year. The correlation analysis with Pearson’s correlation coefficient (r) was 0.74 which show a highly positive correlation between the union of basicervical fracture neck of femur with dynamic hip screw and derotation screw.Conclusions: With the study of 35 cases of basicervical fracture neck femur we conclude that these are a unique type of fractures mid-way between neck and intertrochanteric fractures with rotational and axial instability, and also risk of osteonecrosis. DHS allows for controlled collapse of the fracture for uneventful healing, and de-rotation screw gives rotational stability.

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