Cannulated cancellous screws versus dynamic hip screw in femoral neck fractures: a comparison in productive age group at tertiary care hospital of North India

<p class="abstract"><strong>Background:</strong> Since intracapsular fracture neck femur was recognized by Ambrose Pare almost 4 centuries back, the management of intracapsular neck femur fracture has undergone many changes. The multitude of various implants designed and techniques available for its treatment themselves indicate the inadequacy of the various methods of treatment. Objective was to compare cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group.</p><p class="abstract"><strong>Methods:</strong> This observational study with both prospective and retrospective data analysis of patients operated by different surgeons in same hospital setup has been conducted from March, 2018 to February, 2020 at the department of Orthopedics, Government Medical College (GMC), Jammu. 105 cases satisfying the inclusion criteria admitted in GMC Jammu were included clinically and radiologically. Total number of patients included in the study was 97 patients as 8 patients were lost to follow-up. Functional outcome was evaluated by using Harris hip scoring.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study 8 CCS cases were lost to follow up. Total 97 of cases were followed up till one year both radiologically and clinically after a given time intervals and final assessment done on the basis of Harris hip score. Among 97 cases 71 were males most of them in age group of 41-45 years and 26 were females with 46-50 years age group predominance. 47.42% fractures were classified as type III in garden’s staging. </p><p class="abstract"><strong>Conclusions:</strong> DHS is a better implant than CCS in hands of doctors who lack of expertise and precision i.e. required for CCS in fracture neck femur in young adult patients.</p>

A MORPHOMETRIC STUDY OF THE PROXIMAL END OF DRY ADULT FEMORA

Background: A good understanding of morphometric measurements of the proximal femur is essential in order to decrease the risk of complications associated with orthopedic surgeries performed in the proximal femur due to traumatic injury, metabolic or vascular causes, and to achieve proper alignment of prosthesis to be implanted. The purpose of this study is to evaluate morphometry of neck of femur in Eastern Indian population. Materials and Methods: The study was conducted on 50 dry adult femora [30 Right(R) and 20 Left(L)] available in the department of Anatomy of Medical College Kolkata, India. Results: a) Mean and Standard Deviation (SD) of Vertical length of Head of femur was Right side: 38.56±2.50mm and Left side: 38.07±3.43mm. b) Mean and SD of Width of neck of femur was Right side: 28.84±2.71mm and Left side:28.09±2.29mm. c) Mean and SD of length of Neck of femur on anterior aspect was Right side:26.37±2.92mm and Left side:26.12±3.42mm. d) Mean and SD of length of Neck of femur on posterior aspect was Right side:31.65±2.75mm and Left side:26.69±3.11mm. e) Neck-shaft angle on both sides were calculated. Conclusion: Indian dimensions of proximal end of femur are different as compared to that of the values in other parts of the world. Present study will be useful for crafting suitable implants used for surgical correction of fracture neck femur in East Indian population. KEYWORDS: Morphometry, Neck-shaft angle, Implant, Prosthesis, Width of neck, Vertical length of head of femur, Length of neck.

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

<p class="abstract"><strong>Background:</strong> 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).</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p><p class="abstract"> </p>

Total Hip Arthroplasty in Femoral Neck Fractures in Zagazig University Hospitals

Femoral neck fractures are common in the geriatric population and are associated with high morbidity and mortality. The worldwide incidence of hip fractures is expected to approach 6.26 million by 2050. Studies showed that the functional outcome and pain scoring improved in cases of femoral neck fracture treated by total hip arthroplasty than any other methods. This study was performed on 18 patients presented with history of fracture neck femur who were admitted to orthopedic department, Zagazig university hospital in the period between January 2019 to December 2019. All cases in this prospective study were treated by THA. Prior to commencing the study, ethical clearance was taken from the Zagazig University hospitals and informed consent was obtained from all patients and their guardians before participation in the study. All the patients were operated through Harding’s approach. Both cemented and un-cemented types of arthroplasty were performed. Functional outcomes of hip were evaluated at 3 months and 6 months after surgery. The studied age ranged between 18-62 years with mean ± SD 41.5±12.4 and (44.4%) of them females and (55.6 %) males. (55.6%) of studied group were from rural areas and (44.4%) of studied group were from urban. Regarding occupation (38.8%) of the studied cases were clerk, (11.1%) were hand worker, (16.6%) were farmer, (5.5%) were student, (22.2%) were house wife and (5.5%) were teacher. 66.7 % of studied group had history of previous fixation. Previous operative fixation for fracture N F were 50 % Cannulated screw, 25 % DHS and 25% IMN. Regarding cause of lesion most frequent were failure of other fixation for N F fracture (66.7%) then acute fracture N F associated with OA (22.2%) and neglected N F fracture (11.1%).