TREATMENT OUTCOMES OF NECK OF FEMUR FRACTURE (GARDEN TYPE IV) TREATED WITH CANNULATED SCREWS VERSUS CANNULATED SCREWS PLUS BONE GRAFT

Abstract

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 Orthopaedic Surgery, Mayo Hospital, Lahore

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 observed with the Radiologic Union Score for Hip fractures (RUSH) score, while functional outcome was evaluated by the Harris Hip Score.

Results: Patients in Group B had significantly better results than those in Group A in terms of 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 like non-union and osteonecrosis.

Keywords: Femoral neck fracture, Cannulated screws, Bone graft, Harris Hip Score, RUSH score, Avascular necrosis