Fractures Of The Neck Of The Femur- Treated With Multiple Cannulated Screws In Younger Patients –A Study Of 40 Cases

摘要

Intracapsular fractures of the neck of the femur are an enigma (4, 6, and 7) to orthopedic surgeons and it is a curse for an individual. Still it remains an unsolved problem in modern day’s orthopedics. The treatment in younger patients lacks any consensus among us. Review of literature gives strong and clear mandate for three things.No. 1 - Osteosynthesis in extra capsular fractures of the neck of the femur (1, 4) , irrespective of the age. No 2 - Osteosynthesis in case of intracapsular fractures of the neck of the femur in younger (1, 4) individuals.No 3 - Replacement surgeries in intracapsular fractures of the neck of the femur in elderly greater than 60 years (1,4). The aim of this study was to see the efficacy of closed reduction and stabilization of intracapsular fractures of the neck of the femur in young adults <50 years of age with percutaneous multiple cannulated hip screw fixation. This study comprised of 40 patients over 5 years. Among 40 patients, 8 patients were either of Garden classification I or II type and rest of the patients were of type III & IV. The average age was 40 years ranging from 34 to 56 years. The average timing of surgery after trauma was 7 days. The results in all the 8 patients in Garden I & II were very good. They progressed to solid union with nearly normal hip. In the rest of the 32 patients of Garden III & IV they had variable results. 9 out of 32 patients (Garden III & IV) required some kind of revision surgery. In these 9 patients 7 had non-union and 2 patients had AVN. Introduction Intracapsular fractures of the neck of the femur are an enigma (4, 6, and 7) to orthopedic surgeons and it is a curse for an individual. Still it remains an unsolved problem in modern day’s orthopedics. The treatment in younger patients lacks any consensus among us. Review of literature gives strong and clear mandate for three things.No. 1 - Osteosynthesis in extra capsular fractures of the neck of the femur (1, 4) , irrespective of the age. No 2 - Osteosynthesis in case of intracapsular fractures of the neck of the femur in younger (1, 4) individuals.No 3 - Replacement surgeries in intracapsular fractures of the neck of the femur in elderly greater than 60 years (1,4). The aim of this study was to see the efficacy of closed reduction and stabilization of intracapsular fractures of the neck of the femur in young adults <50 years of age with percutaneous multiple cannulated hip screw fixation. This study comprised of 40 patients over 5 years. Among 40 patients, 8 patients were either of Garden classification I or II type and rest of the patients were of type III & IV. The average age was 40 years ranging from 34 to 56 years. The average timing of surgery after trauma was 7 days. The results in all the 8 patients in Garden I & II were very good. They progressed to solid union with nearly normal hip. In the rest of the 32 patients of Garden III & IV they had variable results. 9 out of 32 patients (Garden III & IV) required some kind of revision surgery. In these 9 patients 7 had non-union and 2 patients had AVN. Material & Methods This study consisted of 40 patients having an intracapsular fracture of the neck of the femur. Patients having extra capsular fractures were discarded from the study. Patients having co morbid medical component like diabetes, thyroid abnormalities, heart diseases were also excluded from the study. The upper limit of age was 50 years. 8 patients were female. The patients were in between 31 to 50 years of age with mean age of 40 years. The patients with polytrauma were excluded. The patients were investigated completely. The prognosis was explained to the patients and there parties. The average interval between trauma and surgery was 7 days. All patients were given regional anesthesia. On orthopedic table reduction of the fracture was achieved by standard methods under image intensifier. Fractures were stabilized with 3 or 4 partially threaded 6.5mm cancellus screws. Only 3 of these 40 p