Evaluation of treatment of fracture neck femur with fibular grafting and cancellous hipscrews

Abstract

Background: The present study is an attempt to evaluate the effectiveness of the fibular graft with supplementary fixation devices (cancellous hip screw), its advantages and disadvantages in the treatment of closed fracture neck femur.Methods--36 patients attending the outpatient, Department of Orthopedics , District Hospital Basti, AlinagarMarg, Murlijot, Basti, Uttar Pradesh and KGMU Lucknow,and a retrospective analysis of previous cases of fracture neck femur treated by fibular grafting and cancellous hip screws. A detailed evaluation of the patient was carried out on admission paying special attention to any associated injuries and medical illness. If the condition of the patient required pre-operative build-up the fractured limb was immmobilised by upper tibial pin traction (or above knee skin traction). Routine blood and urine examinations were carried out and any associated medical condition was adequately dealt with The patient was then subjected to pre-anaesthetic check-up and posted for surgery as early as possible.Results--In our study, we have gotsatisfactory results as in 13 cases of group I and 9 cases of group II. In 2 cases of group I, the fracture united in malposition with appreciable restriction of joint motion or early avascular necrosis resulted in pain on exertion. While in 4 cases of group II fracture united in malposition with appreciable restriction of joint motion or early avascular necrosis resulted in pain on exertion. Two fractures failed to unite and in one cases extensive avascular necrosis of the head resulted in severe rest pain and gross restriction of function in Group I, This figure was approximately double in group II (Five cases went in non-union and three cases showed avascular necrosis of the femoral head with gross restriction of movement and severe pain. Conclusion: Therefore we are concluding that fibular grafting procedures in intracapsular fractures neck femur, give good results, provided, done with meticulous technical skill. It gives good stability in cases of fracture neck femur with posterior comminution, which is so commonly seen and where metallic fixation devices are apt to loss their stability.