Comparative Outcome of Basi-Cervical Neck of Femur Fractures Fixed Using DHS with and without De-Rotation Screw
Abstract
Basicervical fracture necks of femur are intermediate between femur neck fracture and intertrochantric fracture. These fractures having axial and rotational instability are traditionally being treated with DHS. DHS allow solid fixation in two planes only, additional derotation screw allow stability in third plane also.
Objective: To compare outcome of basicervical fracture neck of femur treated with and without derotation screw.
Material and Methods: Patients were divided in two groups i.e. group 'A' and group 'B' each group having 30 patients. Group 'A' patients were treated with DHS with derotation screw and group 'B' patients with DHS alone.
Results: At 12 months postoperatively patients were clinically and radiologically evaluated. All frcture were united in Group 'A' within an average period of 12.5 week while three patients (10%) ended up in non-union in group 'B'. Mean sliding distance in group 'A' was 5.6 mm while it was 6.2 mm in group 'B'. Mean shortening of limb was 3.8 mm in group 'A' which was 4.3 mm in group 'B'. In group 'A' there was no major displacement between the fracture but in group B there was >3 mm displacement in five patients (16.66%). According to modified Harris hip score in group 'A' 26 patients (86.66%) had excellent results, two patients(6.66%)had good results, one patient(3.33%) had fair results and in one patient(3.33%)poor results was obtained.
Conclusions: It can be concluded from study that there were better radiological and clinical outcome in DHS with derotation screw than DHS alone in basicervical fracture neck of femur.
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Introduction
Blair et al1 defined basicervical fracture neck of femur as proximal femoral fracture through the base of the femoral neck at its junction with the intertrochanteric region. Medical dictionary2 defined these fractures as fractures of femoral neck at the junction with trochanteric line. Traditionally, these fractures are treated with dynamic hip screw (DHS) as in intertrochanteric fractures.
Conclusion
Therefore it is conclude that basicervical fracture neck of femur is an unstable fracture. Treating this with DHS alone leaves a possibility of rotation and displacement of proximal fragment. Using a DRS along with DHS prevented this rotation and displacement of proximal femoral fragement. DHS allow solid fixation of the two major fragments in two planes and derotation screw in third plane.
Additional advantage rendered is the low cost of the DHS/ DRS combination compared to nails which renders this technique beneficial for patients in developing countries.