Evaluation of Functional and Radiological Outcome of Late Fixation of Femoral Neck Fracture in Young Adults by Cannulated Lag Screws

Author(s): Dr. Subrata Saha, Dr. Md Tayef Mahmud, Dr. Md. Shadiqur Rahman, Dr. Dibakar Sarkar, Dr. Ifthear Irfan, Dr. Sharmistha Roy

Background: Femoral neck fractures are common injuries that affect hip stability, leading to impaired weight-bearing and mobility. It most commonly affects older adults, where replacement arthroplasty is the recommended standard treatment. In contrast, these fractures are relatively rare in younger individuals, accounting for only 2-10% of cases. For this group, early internal fixation is the preferred method to preserve the femoral head and its blood supply. However, bearing all these factors in mind, the present study aims to evaluate the functional and radiological outcomes of delayed fixation for femoral neck fractures in our setting.

Material & Method: The quasi-experimental study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, from September 2021 to September 2023. The study population included patients with femoral neck fractures who met the inclusion criteria. A total of 40 patients were enrolled. All cases were assessed using clinical features, X-ray, and Harris Hip Score (HHS). Follow-up continued for a minimum of 9 months with clinical, functional, and radiological outcomes recorded.

Results: The mean age was 32.7 ± 9.14 years with male predominance (66.7%). The main cause of injury was a road traffic accident (67%). The most common fracture was Garden type III (46.7%, n = 19). The mean duration of injury to operation was 10.5 ± 2.8 days, and follow-up was 43.3 ± 6.7 weeks. 76.7% of cases achieved radiological union. There were 4 (10%) avascular necrosis (AVN) of the femoral head and 1 (3.3%) wound infection. Non-unions and unsatisfactory functional outcomes were higher in the 3rd week fixation than 2nd week fixation. These were significantly associated (p <.05). Though not significantly associated, the nonunion rate was higher among displaced fractures and patients aged 31-40 years. Finally, 70% of cases had satisfactory (52.5% excellent and 17.5% good) and 30% satisfactory (10% fair and 20% poor) functional outcomes with a mean HHS of 85.25±12.09.

Conclusion: Although delayed fixation is not the preferred approach, it remains a clinically effective option for treating femoral neck fractures in young adults.