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Surgical management of neck of femur fractures in patients younger than sixty-five years: a comparative study of three fixation methods

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Abstract

Purpose

Several surgical implants have been used for the treatment of neck of femur fracture (NOF) in younger patients such as dynamic hip screw (DHS) and cannulated compression screw. However, the superiority of one or another osteosynthesis device remains a matter of debate. The aim of this work is to evaluate and compare three fixation modalities: Cannulated Hip Screws (CHS), DHS and DHS associated to anti-rotating screw for surgical treatment of femoral neck fracture in young adults.

Methods

It is a retrospective comparative study of three series of NOF fractures treated surgically over a period of ten years; including young adult patients (age > 18 years and < 65 years) treated conservatively using closed or open reduction and internal fixation. All types of NOF fractures according to Garden classification were included. Pathological, basi-cervical fractures and fractures on previously operated hips were excluded. The minimum follow-up recommended was two years. Clinical evaluation was based on the Postel Merle d'Aubigné score (PMA), the visual analogue scale (VAS), the Parker score, and the Hip Disability and Osteoarthritis Outcome Score (HOOS score). Reduction quality was assessed on X-rays.

Results

Our series included 72 patients that were divided in three groups: Group A: Fixation using cannulated hip screws (33 patients). Group B: Fixation using DHS only (21 patients). Group C: Fixation using DHS associated to anti-rotation screw (18 patients). The patients of group A had better PMA and VAS scores, but there was no statistically significant difference. However, a significant difference (p=0.001) was found for the HOOS score. The fractures treated with DHS associated with anti-rotating screws, had the highest loss of reduction in the vertical axis (Yp) with the highest femoral head collapse (Zp) values. Group A had the lowest loss of reduction in the horizontal axis (Xp). There was no significant difference between the three methods of osteosynthesis in terms of loss of correction though.

Conclusion

We found comparable results in terms of healing and complication rates and loss of reduction for the three groups with no significant difference. However, the HOOS score was significantly better in the cannulated hip screw group.

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Authors and Affiliations

  1. Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

    Walid Bouaicha, Mohamed Jlidi, Marouen Elarbi, Karim Mallek & Selim Daas

  2. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

    Walid Bouaicha, Mohamed Jlidi, Salma Jaziri, Achraf Abdennadher & Selim Daas

  3. Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, El Kef, Tunisia

    Salma Jaziri

  4. Orthopedics and Traumatology Department, Military Hospital of Instruction, Tunis, Tunisia

    Achraf Abdennadher

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  1. Walid Bouaicha
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All the authors participated in the design, performance, analysis, and drafting of this manuscript.

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Correspondence to Mohamed Jlidi.

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Ethical approval was granted from the ethics committee of the institution.

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A written consent was taken from all participants prior to the surgical procedure as per department protocol. A signed written consent was obtained from all participants for the use and publication of all personal data including personal X-rays.

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The authors declare no competing interests.

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Bouaicha, W., Jlidi, M., Elarbi, M. et al. Surgical management of neck of femur fractures in patients younger than sixty-five years: a comparative study of three fixation methods. International Orthopaedics (SICOT) 47, 3099–3106 (2023). https://doi.org/10.1007/s00264-023-05997-2

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