Comparison of intracapsular fracture neck of femur treated with dynamic hip screw versus cannulated cancellous screw: A retrospective study

Abstract

Objective: The aim of this study was to compare clinical outcomes of young patients with intracapsular neck of femur fractures operated with dynamic hip system (DHS) or cannulated cancellous screw. Methods: One hundred patients with femoral neck fractures were treated by closed reduction internal fixation with a DHS (n=50; 36 males and 14 females; mean age: 39.1 years) or cannulated cancellous screws (n=50; 36 males and 14 females; mean age: 33.2 years) between January 2014 and December 2018 at JLN Medical College and Hospital, Ajmer, Rajasthan. The groups were retrospectively studied till September 2019 (with minimum follow-up of 9 months) and compared by clinical and radiological outcome and modified Harris hip score. Results: The average follow-up time was 23 months (range, 9-60 months). No statistically significant differences in the rates of nonunion (2% vs. 8%) and avascular necrosis of the femoral head (4% vs. 6%) were observed in DHS and CCS groups. DHS group has significantly less (12%) complication rate than CCS group (28%). The mean modified Harris Hip score was significantly higher in DHS group (90.05) compared to CCS group (85.34) (p value 0.015) with greater range of motion in former group. Conclusion: The DHS and cannulated cancellous screws might be equally effective in terms of postoperative fracture union. However, the DHS has advantages over cannulated compression screws for lesser no. of complications, especially neck shortening, non-union and osteonecrosis, higher range of motion, more clinical and radiologically favourable outcome and a better mean modified Harris hip score.