Evaluation of the Outcome of Fracture Neck of Femur Treated by Internal Fixation with Multiple Cannulated Screws

Abstract

Background: Fracture neck of femur is an important orthopaedic injury associated with risks of nonunion and avascular necrosis. Multiple cannulated screw fixation is a commonly employed femoral head-preserving treatment, particularly in patients considered suitable for internal fixation. Objective: To evaluate the radiological and functional outcomes of fracture neck of femur treated by internal fixation using multiple cannulated screws. Materials and Methods: This prospective study was conducted in the Department of Orthopaedics, Agartala Government Medical College and G.B. Pant Hospital from September 2015 to December 2016 and postoperative follow-up through June 2017. Twenty-six patients aged >18 years with transcervical fracture neck of femur treated using three 6.5-mm partially threaded cannulated screws were included. Fractures were classified according to Garden classification. Patients underwent serial clinical and radiological follow-up. Fracture union, implant position, complications, and functional outcome using the Modified Harris Hip Score were evaluated. Results: Of the 26 patients, 15 (57.7%) were females and 11 (42.3%) were males. Garden type III and IV fractures constituted 69.2% of cases. Radiological union was achieved in 21 (80.8%) patients, whereas nonunion occurred in 5 (19.2%). Avascular necrosis developed in 5 (19.2%), shortening in 4 (15.4%), and implant loosening in 2 (7.7%) patients. According to the Modified Harris Hip Score, 6 (23.1%) patients had excellent, 9 (34.6%) good, 5 (19.2%) fair, and 6 (23.1%) poor outcomes. Excellent or good outcomes were therefore achieved in 57.7% of patients. Garden type I and II fractures demonstrated better functional outcomes than displaced type III and IV fractures. Conclusion: Multiple cannulated screw fixation is an effective femoral head-preserving treatment for appropriately selected fractures of the femoral neck, with satisfactory union and functional outcomes. Better results were observed in younger patients and less displaced fractures, while nonunion and avascular necrosis remained important complications. Keywords: Femoral neck fracture; Cannulated screws; Internal fixation; Garden classification; Fracture union; Avascular necrosis; Modified Harris Hip Score.