Munin Borgohain1 , Aswin Deepak Rajan2 , Abhinab Gogoi3 , Sandeep Prasad4
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.
