Locking Plate Versus Cannulated Screws in The Management of Transcervical Fracture Neck Femur

Document Type : Original Article

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Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt

Abstract

Background: Transcervical neck fracture is common in daily orthopedic practice. Internal fixation is the curative option. However, there is controversy exists regarding the ideal fixation device.  
The aim of the work: This study aims to compare the clinical, functional and radiological results of cannulated screws versus dynamic locking plate in fixations of femoral neck fractures.
Patients and Methods: Thirty patients with transcervical fracture neck femur were included. They were divided into two groups; the first for dynamic locked plate, and the second for cannulated screws. All were assessed preoperatively by radiological and clinical methods. Postoperative care consisted of routine vital data recording, intravenous antibiotics and appropriate analgesia. X-rays were done in the first postoperative to check fixation and after 12 weeks to check for union.  The follow-up evaluation included questioning the patient about pain during activity and rest and about ability to walk and stand determining the range of motion of the hip joint using modified Harris Hip Scoring System.
Results: The mean operative time in screws group was 38 minute compared to 72 minutes in plate group with significant difference between both groups. Both groups showed high successful union rate with no significant difference. In the screw group, 3 cases fail to union while in plate group only one case failed. The mean union time in screws group was 19.7 weeks while in plate group was 18.3 weeks. Screws group showed 8 cases of complication, compared to 5 cases in the plate group. There was a significant blood loss [more than 500ml] in plate group.
Conclusion: Although both groups were comparable regarding union rate, the screw group was associated with significantly shorter operative time, and lower blood loss. The anatomical reduction is the main determining factor of success regardless the type of device used in fixation.  

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