Delayed presentation of displaced neck of femur fractures in patients under sixty years of age- A prospective functional outcome assessment study after osteosynthesis

Author(s): Dr. Manojkumar HV, Dr. Hemanth HP, Dr. Ponnilavan Jayakanthan, Dr. Bhaskar Jyoti Pegu and Dr. Prathmesh MH

Abstract: Introduction: An intracapsular fracture of the neck of the femur in the young adult is a difficult injury to manage. Although internal fixation is the standard treatment for young adults, controversy remains concerning the mode of fixation, the approach to be used (closed vs open), method of reduction, time to fixation, post-operative protocols. Avascular necrosis can occur following this injury because of disruption of the femoral head blood supply. Some believe that emergent fracture reduction is necessary to minimize the risk of avascular necrosis. Objective: In a developing country like ours with many cases presenting late to the hospital after injury, there are very few studies assessing the outcome in such cases. So we did a prospective study to assess the functional outcome in patients with neck of femur fractures presenting after 48hrs to the hospital. Methods: This is a prospective study with patients below the age of sixty years with displaced neck of femur fractures (Garden’s grade 3 and 4) presenting after 48 hrs treated with closed reduction and fixation with cannulated cancellous screws. Patients were followed up periodically for a minimum period of 3 years. Results: 28 patients participated in the study of which 18 were males and 10 female patients. Average time to surgery was 2.5days +/-0.3days. Time to union is 15.8 +/- 4.2 weeks. AVN developed in 4(14.2%) and non-union in 3 (10.7%) cases. Functional outcome with Harris Hip score was excellent-good in 22 (78.5%) cases. Conclusion: Accurate reduction with establishment of the smooth curve between the head and neck of femur and accurate placement of screws in the neck with guarded weight bearing protocols in cases with posterior comminution can give good results with this fracture irrespective of the delay in surgery.

DOI: https://doi.org/10.22271/ortho.2017.v3.i3h.86