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Functional outcomes and perceived quality of life following fixation of femoral neck fractures in adults from 18 to 69 years using dynamic hip screw (DHS) and an additional anti-rotation screw- a retrospective analysis of 53 patients after a mean follow-up time of 4 years

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of the study was to explore the functional outcome after osteosynthesis with dynamic hip screw (DHS) for adults up to 69 years, and identify potential predictive indicators of either positive impact on quality of life or increase the incidence of complications.

Materials and methods

Out of 85 patients 53 could be contacted, 36 were followed up clinically and radiologically, 17 patients could be interviewed by phone. All fractures have been treated by osteosynthesis with DHS and one additional anti-rotation screw. Functional outcome and quality of life were measured with use of Harris Hip Score (HHS) and Short Form 12 Health Survey (SF 12). The mean values were compared to two random sample t tests and ANOVA for independent random samples. The connection between an aim variable and selected variables of influence was examined by regression analysis.

Results

The mean HHS showed good functional results with 88 points (median 95.6). Good or excellent results were achieved in 80.4% of cases. The current investigation also delivers promising results with regard to the complication rate: avascular femoral head necrosis (AVN) in 11.3% of cases (n = 6), 9.4% showed non-union (n = 5) and cut out (n = 3) occurred in 5.7%. A secondary conversion to hip arthroplasty (n = 7) had a strong negative impact on everyday life (HHS = 63.3 points, Physical Health Summary Score SF-12 = 34.9 points).

Conclusions

The results of this study are promising showing uncomplicated fracture healing in 84.9% of intracapsular femoral neck fractures and a low incidence of complications after osteosynthesis with DHS in patients aged up to 69 years. The quality of the fracture reduction achieved in the axial view and a small tip apex index after an osteosynthetically treated femoral neck fracture with DHS are significant predictive indicators for complications. Diabetes, age > 65 years, osteoporosis, ASA III may also be significant factors for worse results, but showed no statistical significance in our analysis.

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Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery and Hand Surgery, Dresden Municipal Hospital, Friedrichstrasse 41, 01067, Dresden, Germany

    Anne Fjeld, Tim Fülling, Philipp Bula & Felix Bonnaire

  2. Department of Trauma and Reconstructive Surgery, Orthopaedic, Plastic, Aesthetic and Hand Surgery, Guetersloh Municipal Hospital, Guetersloh, Germany

    Philipp Bula

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Fjeld, A., Fülling, T., Bula, P. et al. Functional outcomes and perceived quality of life following fixation of femoral neck fractures in adults from 18 to 69 years using dynamic hip screw (DHS) and an additional anti-rotation screw- a retrospective analysis of 53 patients after a mean follow-up time of 4 years. Eur J Trauma Emerg Surg 48, 1893–1903 (2022). https://doi.org/10.1007/s00068-021-01855-1

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