Journal of Orthopaedic Reports (Mar 2025)
Prospective randomised study comparing functional and radiological outcomes of fracture neck of femur fixation using poly-axial screw in bolt construct versus multiple cancellous screws
Abstract
Background: Hip fractures in the elderly pose a serious health risk, especially in elderly people. In the younger generation, however, these fractures are associated with high-velocity trauma in RTA (Road traffic accidents) or falls from great heights. A sedentary lifestyle, females and an osteoporotic femur are common risk factors for the incidence of such fractures. Currently, 6% of men and 18% of women worldwide suffer from hip fractures. According to epidemiological studies, the hip fracture incidence will climb to 2.6 million by 2025 as life expectancy rises and the senior population continues to expand. Methods: This randomized, prospective study comprised eighty-four patients. The patients were randomly assigned to one of the two groups. Group A patients were treated by a poly-axial screw in bolt construct commonly known as Femoral Neck System (FNS) and Group B patients were treated with Multiple Cancellous Screws (MCS). The fracture was classified based on the AO/OTA classification. The first clinical follow-up was done on the 15th day and then at one month, three months and six months intervals post-operatively. Assessment of the outcome, both radiological and functional (as per modified Harris Hip Score), was done and recorded. Results: The mean Garden alignment index in Group A was 164.67 in the AP view and 164.52 in the lateral view and Group B, it was 163.90 in the AP view and 165.00 in the lateral view which was also found to be non-significant (p > 0.05). Mean blood loss in Group A was 75.71 ml with an overall ranging from 40 to 120 ml whereas in Group B, mean blood was 63.81 ml with an overall ranging from 40 to 100 ml. Neck shortening was present in 14.28% of patients in Group A whereas 23.81% in Group B at 6 months post-surgery. The mean time of the procedure in Group A was 54.19 minutes with an overall range from 32 to 95 minutes whereas in Group B mean time of the procedure was 59.24 minutes with an overall range from 32 to 98 minutes. After the final follow-up, with mean HHS was 87.71 in Group A and the mean HHS was 82.24 in Group B which is significant (p < 0.05). Conclusion: Fracture Neck of Femur fixation using poly-axial screw in bolt construct has axial and rotational stability superior to traditional Multiple Cancellous Screws. It offers the mechanical benefit of reducing the deleterious effects of rotational displacement while yet allowing for dynamic compression of the fracture with weight-bearing. Being bio-mechanically superior, the poly-axial screw in bolt construct is on the verge of solving the unsolved mystery of fracture neck femur fixation.
