Adverse Outcomes of Internal Fixation Using Cannulated Screws or Dynamic Hip Screw in Stable Intracapsular Femoral Neck Fractures

Abstract

OBJECTIVE: To determine the frequency of adverse outcomes of internally fixed stable intracapsular femoral neck fractures either using Cannulated Screws or Dynamic Hip Screws. METHODOLOGY: This cross-sectional study was conducted from 2013 to 2017 in the Department of Orthopaedics Khyber Teaching Hospital Peshawar. A total of 193 patients of both genders with age ≥60 years who had stable intracapsular femoral neck fractures and were performed internal fixation either using Cannulated Screws or Dynamic Hip Screws between 2013 and 2017 were selected for this retrospective study using hospital admissions and database. All X-rays were reviewed to establish the fracture classification and determine the cause of complication and reoperation. All data, including mortality, index hospitalization, revision surgery and causes of failure, were analyzed in frequency and percentages. RESULTS: The Mean±SD of age was 81.647±7.58 years. Of these patients' the female gender was dominant with 64.25%, while males were 35.75%. Overall, 5 year mortality rate was 26.42%. The percentage of patients requiring index hospitalization was 41.45%. Revision surgery was done in 20.2% of the patients. The main reasons for failure were noted to be avascular necrosis/pain/secondary arthritis (19.69%), early collapse (17.1%), infection (9.84%), failed fix (3.11%), decoupling (3.63%) and screw breakage (1.55%). CONCLUSION: Working on the reasons which result in index hospitalization, reoperations, and mortality will be helpful to minimize these adverse outcomes, which lead to a high burden on the healthcare sector due to indexation and high rate of mortality in elderly patients after internal fixation of their non-displaced femoral neck fractures.

Keywords

• femoral neck fracture
• intracapsular
• internal fixation