Fracture Neck Femur Between 60 and 75 Years Treated by Dynamic Hip Screw Along with Autologous Hemi-fibular Graft: Analysis of Results.

Abstract

Aim and objective: The aim of our study is to evaluate the efficacy of dynamic hip screw (DHS) combined with autologous half-fibular grafting in treating displaced femoral neck fractures in elderly patients aged 60-75 years, focusing on the potential for achieving stable fracture union and preserving joint functionality.

Materials and methods: 32 patients with displaced femur neck fracture aged 60-75 years were treated from 2014 to 2024. 21 were transcervical, and 11 were subcapital. A prospective clinical study consisted of 19 males and 13 females. Patients were selected as per the inclusion and exclusion criteria. Two holed DHS plates with long barrels were used in all cases. The tip-apex distance (TAD) was maintained at a lowest possible level with the screw subchondral. The size of the lag screw was chosen, so that the lateral end of the screw  was at a distance of 8-10 mm medial from the lateral cortex. A half-fibular autograft was used in all cases. All cases were treated with closed reduction on a fracture table with C-arm IITV. Derotation screws were avoided in all cases to reduce the metal work in the femoral head. All surgeries were performed within 72 h of hospitalization, and the patients were discharged on the 6 th postoperative day (range 4-9 days). The mean duration for DHS fixation is 70 min and for fibular grafting is 35 min. All patients who achieved union were advised to undergo implant removal at the end of 18 months. Only six patients turned up for implant removal.

Results: Fracture union achieved in 30 cases (94%). The mean shortening of the neck was 5 mm. Functional outcome was measured using the Harris Hip Score at 1 year; 20 (63%) patients had excellent results, 6 (19%) had good results, 3 (9%) had fair results, and 3 (9%) had poor results. The patients were advised to come for follow-up for a period of 5 years. Two cases failed to unite. One patient was advised hemiarthroplasty, and the other was advised total hip arthroplasty. Avascular necrosis (stage II) was observed in two cases, but pain subsided with implant removal and decompression.

Conclusion: Joint preservation can be considered in patients with femur neck fractures in the age group of 60-75 years. DHS plating along with half-fibular grafting has given a good functional outcome with a lower complication rate, thereby preserving the hip joint.