Comparative study of Pauwels type III femoral neck fractures managed by short dynamic hip screw with fibula bone graft or cannulated screws in young adults

Abstract

Background: The aim of our study was to compare the clinical effect of short dynamic hip screw (DHS) combined with fibula bone graft and short DHS combined with cannulated screws (CS) on the treatment of femoral neck fracture in young adults.

Methods: Thirty-five Pauwels type III femoral neck fracture patients between January 2014 and May 2019 were divided into two groups: group A (patients treated with DHS combined with fibula bone graft) and group B (patient treated with DHS combined with CS). The operative time, intraoperative blood loss, fracture healing time and complication of two groups were recorded.

Results: There were no significant differences in operative time, intraoperative blood loss in two groups. Fracture healing time in group A (5.28±1.07) was significantly shorter than group B (7.31±1.65). The rate of fracture nonunion (0), femoral head necrosis (0) and withdrawal rate (0) in group A were significantly lower than that in group B (4, 23.5) (4, 23.5) (6, 35.3) (P<0.01). Postoperative Harris function score in group A (95.44±2.57) was higher than group B (87.82±7.79) (P<0.01).

Conclusions: DHS combined with fibula bone graft can shorten the healing time of fracture, reduce the rate of bone nonunion and femoral head necrosis, and provide a new treatment method for Pauwels type III femoral neck fracture in young adults.

Keywords: Femoral neck fracture; cannulated screws (CS); dynamic hip screw (DHS); fibula bone graft; young adults.

Figure 1

A 40-year-old female patient with right femoral neck fracture was treated with DHS combined with fibula bone grafting. (A,B) Preoperative positive and lateral X-ray of the hip joint showed a fracture of the right femoral neck; (C,D) postoperative positive and lateral X-ray of the hip joint showed the internal fixator was present and well positioned; (E,F) 4 months after the operation, positive and lateral X-ray of the hip joint showed that the fracture had healed and the internal fixation was good; (G,H,I,J,K) 8 months after the operation, positive, lateral X-ray and CT of the hip joint showed that the fracture has healed and the internal fixation is good; (L,M) 15 months after the operation, positive and lateral X-ray of the hip joint showed that the fracture has healed and the internal fixation is good.

Figure 2

A 40-year-old male patient with left femoral neck fracture was treated with DHS combined with fibula bone grafting. (A,B) Preoperative positive and lateral X-ray of the hip joint showed a fracture of the left femoral neck; (C,D) postoperative positive and lateral X-ray of the hip joint showed the internal fixator was present; (E,F) 6 months after the operation, positive and lateral X-ray of the hip joint showed that the fracture had healed and the internal fixation was present and good; (G,H) 14 months after the operation, positive and lateral X-ray of the hip joint showed that the fracture had healed and the internal fixation was present and good; (I,J) 14 months after the operation, positive and lateral X-ray of the hip joint showed that the fracture had healed and the internal fixation was removed. Then the fibula implant is in a good position and does not break; (K,L,M) the general image before removal of the internal fixator showed no shortening of the affected limb and no obstruction of squat.