Comparative study of Union Rate and Functional Outcome of Fracture Neck of Femur treated with Cannulated Cancellous Screws Alone and Cancellous Screws with Fibular Grafting

INTRODUCTION: Despite a plethora of technical and biomechanical advances in orthopaedics in the last two decades, femoral neck fracture still remains in many ways the “unsolved fracture” as far as treatment and results are concerned. Replacement surgery either partial or total remains the treatment of choice for femoral neck fractures in the elderly patients. Undisplaced femoral neck fractures heal uneventfully with fracture fixation devices we normally use. But displaced and old femoral neck fractures present greater problems during the treatment and they have increased incidence of complications like non-union, aseptic necrosis of femoral head and late segmental collapse of head. The struggle to find the best treatment in the relatively younger patient continues as relentlessly as it did half a century ago. The management becomes more difficult as often happens in our country when the patient presents later, eg. several weeks or months often with resorption of the neck and sometimes with the radiological evidence of aseptic necrosis. OBJECTIVES: Aim of our study was to assess the role of addition of fibular strut graft to multiple cancellous screws in functional outcome, union and complications associated with those managed by only multiple cancellous screws in fresh femoral neck fractures. MATERIALS AND METHODS: A comparative study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws (group A) and multiple cancellous screws with fibular graft (group B). Patients aged between 30 and 60 years, having Gardens type III or IV fracture with duration of injury less than three weeks were included in the study. RESULTS: Twenty four cases were analysed n = 12 were in group A and n = 12 in group B. Functional outcome (Harris hip score) was excellent in 11 patients in group A as compared to 11 in Group B which was statistically not significant . The time of full weight bearing, union and non union rates showed no statistical significance (p > 0.05). On statistical grounds none of the procedures proved to be better than other. CONCLUSIONS: Fresh femoral neck fracture in young adults managed with multiple cancellous screws fixation with fibular graft has slightly earlier union rate than those patients treated with multiple cancellous screws alone