Treatment Outcomes of Neck of Femur Fracture (Garden Type IV) Treated with Cannulated Screws versus Cannulated Screws Plus Bone Graft

Cannulated Screw Fixation of Displaced Femoral Neck Fractures with and without Bone Grafting

Abstract

Objective: To compare the outcomes of completely displaced (Garden type IV) femoral neck fractures treated with and without bone grafting in addition to cannulated screws fixation. Study Design: Prospective observational study. Settings: Department of Orthopedic Surgery, Mayo Hospital, Lahore Pakistan. Duration: August 2023 to December 2024. Methods: This study involved 66 patients (33 in Group A treated with cannulated screws alone, and 33 in Group B treated with screws plus bone grafting). Bone union was assessed using the Radiologic Union Score for Hip fractures (RUSH), while functional outcome was evaluated using the Harris Hip Score. Results: Patients in Group B had significantly better outcomes than those in Group A, including union and functional outcomes. The mean Harris Hip Score for Group B was 88.86 ± 3.16, in comparison to 84.57 ± 4.46 for Group A (p = 0.035), showing improved functional status. Union was quicker in Group B, with a mean RUSH score for bridging of 9.89 ± 0.86, versus 8.63 ± 1.14 in Group A (p = 0.019). In addition, fracture line reduction was better in Group B, with a mean score of 9.83 ± 0.66 compared to 8.71 ± 0.95 in Group A (p = 0.009). Conclusion: In completely displaced femoral neck fractures, bone grafting in addition to cannulated screws fixation enhances radiological and functional outcomes compared to screws fixation alone. This also reduces complications such as nonunion and osteonecrosis.