A study of internal fixation of intracapsular fracture neck of femur in adults by multiple cannulated cancellous lag screews.
The quotation "we came in to the world under the brim of pelvis and go out through the neck of femur" reflects the defeatist attitude that has long been held by medical and lay personal towards femoral neck fractures. (2) Though most of these fractures are due to trivial trauma the elder age group in which they commonly occur, leads to catastrophic consequences unless early mobilization out of the bed is made possible. Moreover successful union with conservative management is uncommon. So operative intervention has become the routine for all types of femoral neck fractures early anatomical reduction, compression of the fracture and result internal fixation are used to promote union. (3,4)
TREATMENT (5,6,7) : Pre-Operative: Patient was admitted and below knee skin fraction applied with 3kg weight. Analgesics were given for pain relief. Prepared for surgery.
SURGERY: Under spinal anesthesia patient was shifted on to the fracture table. The fracture reduced with Lead better technique and reduction was conformed to Image intensifier both AP and lateral.
Through lateral approach fracture fixation was done with two cannulated Cancellous screws under Image intensifier. (8,9,10)
Post-operative: ISO metric quadriceps exercises were advised. Suture removed was done on 10th post OP day. Discharge with an advice not to weight bear for two months.
FOLLOWUP: Follow-up was done upto 4 months.
COMMENT: A 32 years old male was admitted with Intra Capsular fracture neck of femur with garden Type-IV. Surgery was done and the post-operative period was uneventful. Patient regained full range of movements and is able to bear the weight at 4 months and the result was excellent.
MATERIAL AND METHODS: The present work on "A Study of Internal fixation of Intracapsular fracture neck of femur in adults by Multiple Cannulated Cancellous Lag Screws" is carried out during the years 2011 to 2014.
All the patients were pre-operatively assessed to grade the type of fracture by "GARDEN'S CLASSIFICATION" and prepared for surgery. All fractures were reduced by LEADBETTER (In flexion) method.
A total of 22 cases of Intracapsular fracture neck of femur in adults were treated after accurate reduction and rigid internal fixation under X ray control with 2 or 3 cannulated cancellous screws.
Post operatively all patients were mobilized in the bed with Quadriceps exercises. Sutures were removed on the 10th day. A pair of crutches was advised and no weigh bearing till the fracture got united.
Age Incidence Age Incidence No. of Cases 20-30 Years 8 31-40 Years 6 41-50 Years 5 51-60 Years 3 Sex Incidence Sex No. of Cases Male 17 Female 5 Relation Of Union with Garden's Grading of Fracture Grade No. of Cases Union Non-Union I -- -- -- II 2 2 Nil III 13 13 -- IV 7 5 2 TOTAL 22 20 2 Result of Cases Treated Result No. of Cases Percentage Excellent 5 22.63% Good 13 59.09% Fair 2 9.09% Poor 2 9.09%
GRADING OF RESULTS:
EXCELLENT: There is sound bony union of the fracture, No avascular necrosis of head. Full range of movements and strength. Full weight bearing. No pain or tenderness.
GOOD: There is a sound bony union of the fracture. No avascular necrosis of the head. No pain or tenderness. Minimal restriction of movement's particularly last degree of flexion and abduction.
FAIR: Sound bony union, Gross restriction of hip movements and pain on walking with discomfort to squat.
POOR: Severe restriction of function with corroborative radiographs requiring salvage procedures.
COMPLICATIONS NOTED IN THIS SERIES (11):
1. Non-union and loosening of screws in one case.
2. Non-union and Extrusion of screws in one case.
3. Cut through of screws into articular surface leading to painful joint in one case.
DISCUSSION: The total number of cases of Intracapsular fracture neck femur followed is 22. The cases were treated by Multiple cannulated cancellous screws and follow up from 6 months to 2 years. Male patients are more than female patients. The commonest age group of the followed cases in between 30-50 years.
This serious contains patients who are hardworking labourers and sedentary females. The mechanisms of injury in most cases are in the form of fall from height. There is also slightly violent injury leading to intracapsular fracture. The commonest radiological type of fracture is Garden's grade-III followed by type-II.
All the patients were explained the precaution to the followed after surgery. The reduction of fracture was done by lead better method without fail. The reduction was confirmed by an Image intensifier both Anteroposterior and lateral views.
Though lateral approach, the fracture was fixed by multiple cannulated cancellous screws. In most of the cased the fixation of fracture was done by 2 or more than two to prevent notion of the proximal fragment. The threaded portion of the screws was seen to cross the fracture line to get a better lag effect.
One case have developed absorption of the neck and loosening of the screws and for that Girdle Stone excision arthoplasty done. One case developed collapse at the fracture site and extrusion of screws due to early weight bearing and the case not turned up for further follow up
SUMMARY: In this series, we have operated 22 cases who were in the age group of 18-60 years. We have used cannulated cancellous screws with a pitch of 16 TPL. We have got excellent results.
We have encountered 2 cases of poor results with a complication of nonunion and loosening of the screws. One case landed up in Girdlestone Excision arthroplasty and one case not turned up for further follow up.
The prerequisites for sound healing of intracapsular fracture neck of femur are (12,13,14):
1. Anatomical Reduction.
2. Rigid Fixation.
4. Strict post-operative physiotherapy.
5. No premature weight bearing.
CONCLUSION: The injuries around the hip were mostly extra capsular neck of femur followed by intracapsular neck of femur and posterior dislocations of hip:
1. The most of the cases of intracapsular neck of femur were in the age group of 30-50 years.
2. There was male preponderance as shown in this study of intracapsular neck of femur.
3. The nature of violence in this study shows, mainly, fall from a height. This injury usually not associated with any other injuries.
In our institute accurate reduction and rigid internal fixation of intracapsular fracture neck of femur was done with the help of Image Intensifier and the results were encouraging even up to the age of 60 years. In early mobilization of the patients the complications of prolonged immobilization like thromboembolism, hypostatic pneumonia etc., were avoided.
By the usage of multiple cancellous lag screws has compression effect at the fracture site avoid re displacement and rotations.
The implant occupies less volume in the small sized femoral necks of South Indian Patients allowing better osteosynthesis of intrascapsular fracture neck of femur.
The results have been encouraging and better than the implants which do not causes compression at fracture site or occupies large volume in the femoral neck or allows rotations.
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C. Sanjeevaiah , K. Praneeth Reddy 
[1.] C. Sanjeevaiah
[2.] K. Praneeth Reddy
PARTICULARS OF CONTRIBUTORS:
[1.] Assistant Professor, Department of Orthopaedics & Traumatology, RIMS, Medical College, Kadapa, Andhra Pradesh.
[2.] Senior Resident, Department of Orthopaedics & Traumatology, RIMS, Medical College, Kadapa, Andhra Pradesh.
FINANCIAL OR OTHER COMPETING INTERESTS: None
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. C. Sanjeevaiah, H. No-501, Sai Residency, Arvind Nagar, Kadapa, Andhra Pradesh.
Date of Submission: 04/06/2015. Date of Peer Review: 05/06/2015. Date of Acceptance: 24/06/2015. Date of Publishing: 01/07/2015.
Master Sheet Sl. Age in Garden's No. Name Years Sex Grading 1. Rajendra 45 Male III 2. A. Sathemma 45 Female III 3. D. Raju 33 Male IV 4. Ch. Srinivas 34 Male III 5. P. Nagaiah 51 Male IV 6. P. Venkanna 18 Male III 7. K. Radha 22 Female II 8. T. Ramana 54 Male III 9. Sabasirin 19 Female II 10. Ravi Kumar 26 Male III 11. D. Satish 18 Male III 12. J. Ravi 22 Male III 13. B. Laxmi 40 Female III 14. A. Surya-narayana 45 Male IV 15. B. Valsingh 32 Male IV 16. S. Krishnaiah 52 Male III 17. E. Ram Murthy 40 Male III 18. G. Balu 28 Male IV 19. B. Rajanna 35 Male IV 20. N. Laxmi 40 Female IV 21. Shiva Koteshwar Rao 30 Male IV 22. Narsimha Rao 24 Male III Sl. Union Follow No. occurred up Results 1. 4 Months 2 years Good 2. 3 Months 1% year Good 3. -- -- Poor 4. 4 Months 1% year Good 5. 3 Months 1% year Good 6. 3 Months 1 year Excellent 7. 3 Months 1 year Good 8. 3 Months 1 year Excellent 9. 3 Months 1 year Excellent 10. 3 Months 1 year Good 11. 3 Months 1 year Excellent 12. 3 Months 1 year Good 13. 4 Months 9 Months Good 14. Non Union 9 Months Poor 15. 3 Months 9 Months Excellent 16. 3 Months 6 Months Good 17. 3 Months 6 Months Good 18. 3 Months 6 Months Good 19. 3 Months 6 Months Good 20. 3 Months 6 Months Fair 21. 3 Months 6 Months Good 22. 4 Months 10 Months Fair
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Sanjeevaiah, C.; Reddy, K. Praneeth|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Jul 2, 2015|
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