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Introduction: Treatment of choice for fracture neck of femur has always been a matter of debate since time immemorial. Till date there is no definite consensus regarding best implant for fixation of unstable intracapsular fracture neck of femur. We conducted this study to assess the results of fixation in such femoral neck fractures using proximal femur locking compression plate (PFLCP). Materials & Methods:The present study includes 10 cases of acute unstable fracture neck of femur in the age group of 18 to 65 years irrespective of sex treated by CRIF using PFLCP in our unit of Orthopedics department, Assam medical college and Hospital. Results: Six cases showed unfavorable results which later got converted to hip replacement in subsequent follow up. Four cases showed clinic-radiological union. Intra-articular penetration of screws was a common complication encountered in this study. Discussion & Conclusion:We conclude from our study that though this implant provides a rigid fixation at proximal femur but definitely requires some modifications during process of fixation while dealing with fracture neck of femur. Initially the results were encouraging but with subsequent follow up we encountered a higher failure rate with conventional sequence of fixation using PFLCP.

BACKGROUND In fractures of the femoral neck, anatomic reduction is compulsory and maintaining the reduction is crucial. It is an enigma to orthopaedic surgeons and a curse for an individual with complications like avascular necrosis and non-union. 1 Fracture neck of femur in young adults are uncommon and only 2-3% of all intracapsular hip fractures occur in younger adults. 2 There is lack of consensus in treating the young adult patients. 3 Basicervical fractures of femur are relatively rare injuries which account for only 1.8-7.6% of hip fractures. 4 Traditionally, most intracapsular neck femur fractures in young adults had been treated with multiple Cancellous Cannulated Screws (CCS) whereas inter-trochanteric (extracapsular) fractures had been managed well in the past with the Dynamic Hip Screw (DHS). METHODS A prospective comparative study was done in the Department of Orthopaedics at Assam Medical College, Dibrugarh for a 2 year duration from June 2017 to December 2019 with a minimum of one year follow-up. Informed consent for inclusion in the study was taken from every patient. A detailed history and thorough physical examination was done followed by relevant investigations and radiological evaluation. RESULTS A total of 34 patients were initially included in this study. 17 patients were treated with CCS (Group 1), 17 with DHS with DRS (Group 2). One patient in group 1 and one in group 2 was lost to follow up due to change in address / contact number and were excluded from the study for final evaluation. CONCLUSIONS Basicervical fractures act as an unstable extra-capsular fracture rather than a stable intracapsular fracture neck of femur. The present study supports the hypothesis that this type of fracture neck of femur surely needs anatomical reduction and fixation for which Dynamic Hip Screw with derotation screw is a best implant in terms of both radiological and functional outcome. Although initial clinical outcome scores were better in DHS group, both implants have almost similar outcome in long term follow up. However, it is difficult to draw a common conclusion from such a small sample size. A larger sample size is probably needed to identify the definitive method for these fractures.

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