Treatment of displaced femoral neck fractures in young patients with DHS and its association to osteonecrosis

Abstract

ObjectiveThe purpose of this study is to evaluate the performance of dynamic hip screw for the treatment of dislocated femoral neck fractures in young patients, focusing on osteonecrosis.MethodsA series of 53 patients with less than 55 years of age were retrospectively evaluated. All patients had dislocated femoral neck fractures (Garden III or IV) and were treated with DHS. Ficat's staging system was used to evaluate avascular necrosis.ResultsThere were 38 (71.7%) males and 15 (28.3%) females, with an overall mean age at the onset of fracture of 41.9 years (±12.8). According to Garden's classification, 21 (39.6%) fractures were classified as type III and 32 (60.4%) were considered totally dislocated, Garden IV. Fracture healing was achieved in 39 patients (73.6%). Thirteen cases of avascular necrosis were observed (24.6%).ConclusionsThe incidence of avascular necrosis in young patients with a displaced femoral neck fractures treated with DHS was 24.6%. No statistically significant association was found between times elapsed to surgery, fracture displacement, and presence of derotation screw with osteonecrosis. Level of evidence IV.

Fratura de colo de fêmur proximal em crianças: um relato de caso / Proximal femoral neck fracture in children: a case report

“…Os índices de complicações nas fraturas do colo femoral em crianças são elevados (20-60%) e dependem da gravidade da fratura, do método de tratamento proposto e da idade do paciente. Segundo estudos, nos pacientes com idade maior ou igual 12 anos houve um aumento de 31% nos casos de necrose avascular de cabeça de fêmur 12 .…”

“…A fratura do colo do fêmur na infância é muito rara, correspondendo a menos 1% das que ocorrem na infância 12 . São graves tem altas taxas de complicações, porque geralmente são provocadas por traumas de alta energia cinética como quedas de altura, acidentes automobilísticos e a prática de esportes radicais 3 .…”

Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures

“…More stable fixation using a DHS with or without antirotational screws has also been advocated. 21 However, larger skin incisions, extensive soft tissue dissection, a greater need for blood transfusion, and a longer hospital stay have limited its clinical use. 7 Swiontkowski et al.…”

“…More stable fixation using a DHS with or without antirotational screws has also been advocated. 21 However, larger skin incisions, extensive soft tissue dissection, a greater need for blood transfusion, and a longer hospital stay have limited its clinical use. 7 Swiontkowski et al 22 also concluded that similar to the use of three parallel cannulated screws, the DHS did not resist torsional forces in unstable femoral neck fractures.…”

Clinical results of cannulated screw internal fixation via direct anterior approach for femoral neck fractures in young adults: a retrospective study

“…For improved medial support and stability, many implants have been used for irreducible displaced femoral neck fractures, such as dynamic condylar screws (DCSs) [4], dynamic hip screws (DHSs) [5], medial buttress plate augmentation with cannulated screws [6], anteromedial femoral neck plates with cannulated screws [7], and percutaneous compression plates (PC.C.P.) [8].…”