Comparison of cannulated screw and dynamic hip screw for the treatment of femoral neck fractures

Abstract

Objective: We aimed to compare the results of surgeries for intracapsular femoral neck fractures with cannulated screws(CS) and dynamic hip screw(DHS), due to lack of evidence which implant for internal fixation of femoral neck fractures is better .

Methods: In our clinic between September 2005 and November 2009, 38 patients were operated with intracapsular transcervical fracture of collum femoris between17 to 65 years of age. Eighteen were operated with DHS(47.4%) and 20 were operated with CS fixation(52.6%).

Results: 16 patients (42.1%) were female and 22 (57.9%) were male and the mean age was 37.13 (17-65) years. The mean duration of follow-up was 18.05 (2-57) months. 26 patients were operated in 1^st -3^rd day (68.4%), 9 patients were operated in 4 to 7 day (23.7%), 3 patients were operated in after 7^th day (7.9%). In the DHS group, 9 (50%) patients had avascular necrosis (AVN), 6 (33.3%) patients had implant failure, 3 (16.7%) patients had delayed union, 5 (27.8%) patients had nonunion, 1 (5.6%) patient had infection, and 1 (5.6%) patient had myositis ossificans. According to the criteria of Salvati Wilson hip joint assessment, in the DHS group 8 patients (44.4%) were very good, 5 patients (27.8%) were good, 5 patients (27.8%) were moderate. Salvati score was evaluated as average of 28 points (16-40). İn the CS group, 8 (40%) patients had AVN, 1 (5%) had delayed union, 3 (15%) of the cases had nonunion and 1 (5%) patients infection was detected. According to the criteria of the Salvati-Wilson, in the CS group13 (65%) of them are very good, 5 (25%) were good, 2 (10%) were assessed as moderate. Salvati score was evaluated as average of 33 points (18-40). In the CS group none of the patients had implant failure, in the DHS group 6 patients had implant failure (33.3%) (p<0,05).

Conclusion: Except for the high rate of implant failure detection in the DHS group method, no significant difference between complications and functional results between two groups.