Management of neglected neck femur fracture in different age group

Abstract

Background: Fracture neck femur has been termed as an ‘unsolved fracture’ as it has always presented a great challenge to the orthopaedic surgeons regarding the ideal management and the prognosis. Aims and objectives: To study the incidence, causes and management of neglected fracture neck femur. Materials and methods: Fifty patients having fractures of neck femur presenting after 3 weeks were studied in the Department of Orthopaedics, M.L.B. Medical College, Jhansi, between January 2018 to Aug 2019; after dividing them into two groups. Group A (n=20): patients 3week since injury treated with valgus inter-trochanteric osteotomy and DHS with 120° double angle barrel plate and Group B (n=30): patients >60 years of age with fracture neck of femur of >3week since injury treated with bipolar hemi hip replacement arthroplasty. A detailed history of patient regarding, age, sex, Mode of injury, duration, associated injuries, past history, clinical examination and radiological examination were done along with the X-Ray pelvis. All cases were followed up at monthly interval after surgery for 6 months and then at three monthly intervals for next 6 months, then 6 monthly interval and results evaluated by using Haris Hip Scoring System (HHS). Results: Mean age of patients in Group A was 38.9 years and that in Group B was 74.6 years. Mean Pauwel`s angle, neck shaft angle and limb length shortening and Harris Hip Score was improved post operatively in Group A. The mean HHS in group B preoperatively was 65.6 and after surgery it was increased to 91.4. Quality of internal fixation was satisfactory in 90% cases. Consolidation at osteotomy site was achieved in 95% cases. In 80% cases fracture united within 6 months. In Group B, 4 patients lost to follow up, out of 26 remaining patients, 14 patients had no pain and 10 patients had slight pain at the end of 6 months. Out of these7 patients had no limp and 19 patients had slight limp. At the end of one year, 21 (80.7%) patients could walk more than 1000 meter with single cane. Conclusion: Valgus osteotomy in young and bipolar hemi hip replacement arthroplasty in elders has high success rate in neglected fracture neck of femur.