Comparison of Outcomes of Internal Fixation Using Double-Angle Blade Plate Versus Double-Angle Dynamic Hip Screw With Pauwels Osteotomy in Neglected Fracture of the Neck of Femur

TL;DR

This study compares two surgical techniques for treating neglected femoral neck fractures and finds that one method offers better functional recovery and healing outcomes.

Contribution

The paper presents a comparative analysis of DABP and double-angle DHS with Pauwels osteotomy for neglected femoral neck fractures in young adults.

Findings

Double-angle DHS with Pauwels osteotomy showed slightly higher Harris Hip Scores, indicating faster functional recovery.

DABP provided better stability and allowed fibular grafting but was technically more challenging.

Both methods achieved satisfactory healing and functional outcomes with acceptable limb shortening.

Abstract

Introduction

Fracture of the neck of the femur is a significant orthopaedic injury with high morbidity and mortality rates, particularly among the elderly following low-velocity trauma. The complications of osteonecrosis and non-union are common in cases treated with any procedure of osteosynthesis. Surgical intervention through internal fixation is a common approach. Numerous procedures have been described for salvaging the femoral head to avoid or delay hip replacement in patients younger than 60 years. Operative methods to enhance vascularity and achieve healing at the fracture site include fixation with bone grafting, pedicle grafts to provide blood supply, or valgus intertrochanteric osteotomy. This paper compares the outcomes of two internal fixation techniques, double-angle blade plate (DABP) and double-angle dynamic hip screw (DHS) with Pauwels osteotomy, in the treatment of fracture neck of femur. We assess the outcomes based on functional recovery, complication rates, and overall patient satisfaction.

Materials and methods

Cases were selected from patients attending the OPD and Trauma Unit of IMS and SUM Hospital, Bhubaneshwar, from 2022 to 2023. The patients were divided into two groups: one group underwent internal fixation with a DABP, and the other group underwent fixation with a double-angle DHS with Pauwels osteotomy. All patients with a diagnosed fracture neck of femur who underwent internal fixation with either a DABP or double-angle DHS with Pauwels osteotomy, aged 17-60 years, and with a delay in presentation of more than three weeks, were included in the study. Patients aged over 60 years, with fresh fractures, pathological fractures, multiple fractures, or prior surgery on the affected hip, were excluded.

Results

A total of 30 patients were included in the study, with 16 in the DABP group and 14 in the double-angle DHS group. Both groups demonstrated improvement in Harris Hip Score (HHS) at 6-month and 12-month follow-ups, but the double-angle DHS group showed a slightly higher HHS, indicating faster functional recovery. The angle blade plate showed better stability and less bone removal. It allowed room for fibular grafting and early mobilization due to reliable fixation. However, it was technically more difficult to perform and was a less forgiving implant than DHS, which is technically simpler and provides compression at the fracture site. Healing time was similar in both groups. Overall, the results were markedly satisfactory, with good functional outcomes, active painless hip range of motion, and painless weight-bearing, with acceptable shortening in these cases managed with either double-angle DHS or DABP, each with some shortcomings.

Conclusion

This study concluded that Pauwels osteotomy and fixation with a double-angle DHS provided the patient with a relatively higher success rate concerning union, with acceptable limb length discrepancy and better functional outcomes in young adults with neglected fracture neck of femur. It serves as a head-salvaging procedure in properly selected patients.

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