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Indian Journal of Orthopaedics Surgery

Femoral Neck fracture in young patients, managed by osteosynthesis using Primary double angle barrel plate combined with valgus inter trochanteric osteotomy- Long term result

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Author Details: SPS Gill, Dinesh Kumar, Manish Raj, Pulkesh Singh, Jasveer Singh, Rakesh Vishwakarma

Volume : 1

Issue : 4

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 265

Article End Page : 272


Introduction: Femoral neck fracture at any age always shows relatively higher rate of complications like non union, avascular Necrosis of femoral head, loss of fixation, screw cut-out and delayed secondary osteoarthritis. These fractures in physiologically old age are managed by replacement of femoral head. In Femoral neck fractures in young adult the main aim is to preserve the natural head and these cases are managed by Multiple cancellous screw, CanulatedCancellous Screw(CCS) with fibular graft either free fibular or vascularised fibular graft. Replacement surgeries in these cases are a difficult choice as young age and also high cost of implants. Also in these patients it is difficult to restrict squatting for lifelong due to social culture and lack of toilets. Now days also preferences are given to head sparing surgeries and osteosynthesis. We use primary double angle barrel plate with intertrochanteric valgus osteotomy for the management of femoral neck fracture in young adults.
Material and method: Cases were selected from the patients attending in Orthopaedics OPD and emergency trauma centre of UPRIMS & R, Saifai, Etawah from May 2006 to August 2013. During this period total 44 cases of fracture neck femur were selected for primary fixation with dauble Angle Barrel Plate (DABP). Out of 44 cases 30 were female and 14 were male with age range from 18 yrs to 48 yrs and average age of 42 yrs. Average duration from injury to operative procedure was 1.3 weeks (10 Days) and range from 2 days to 15 weeks. These cases were operated by Double angle barrel plate with intertrochanteric valgus osteotomy and long term result evaluated using Modified Askin and Bryan criteria.
Result: Out of 44 cases operated 42 cases followed up to the average duration of 48 months and all these 42 cases show good(18) to Excellent(20) results after 4 yrs according to Harris hip score. 4 cases shows fair result and other secondary procedure were required in these cases. Complication seen during follow up were avascular necrosis in 7 cases and out of these 7, 4 cases given poor result as these were also shown loosening of fixation and crew cut out. Out of 42 cases 38 cases were able to perform squatting after 4 yrs of follow up and also there were no radiological sign AVN of head at all. Loss of reduction and screw cut out seen in two cases and these were in poor outcome group.
Discussion: Fracture neck femurs are not rare presentation in developing countries. Various modalities of treatment are fibular graft, ileac bone graft, multiple screws with fibular graft, muscle pedicle graft. We in our series done primary osteotomy combined with double angle barrel plate (DABP) achieved excellent to good results in 90% cases. Primary osteotomy with double angle barrel plate is a good alternative for the management of femoral neck fracture in young patients.