FFEMORAL NECK SYSTEM IN NECK FEMUR FRACTURES

NECK FEMUR FRACTURE

1. FEMORAL NECK SYSTEM IN THE MANAGEMENT OF NECK FEMUR FRACTURE IN ADULTS

2. INTRODUCTION Fractures of femur neck in young patients typically result from high-energy trauma . Most fractures are intracapsular and there is substantial shear stress and rotational instability at fracture fragments. It is challenging to obtain complete stability in surgical internal fixation and frequently associate with complications such as varus tilting, implant removal, fracture displacement, non-union and femoral head necrosis. Complications and high revision rates exert high physical and mental burden to patients, increases medical care costs as well as social and economic pressure.

3. preservation of hip joint functions is moreimportant than the surgical process new type of femoral neck osteosynthesis is associated with convenient surgical procedures, less trauma, and stronger fixation. It is designed to effectively preserve the femoral neck and enhance healing. 3CS, dynamic hip (DHS), DHS combined with anti-rotation screws and many different surgical techniques aimed at retaining the femoral neck are used to treat femoral neck fractures

4. the non-union rate after femoral neck fracture surgery is 33%, while the rate of revision surgery is as high as 18%11. This high failure rate is attributed to the inability to maintain sufficient biomechanical stabilities during postoperative fracture healing

5. 3CS procedures are less invasive with less blood loss, and shorter hospital stay time. However, for femoral neck fractures with shear force at the fracture end and unstable rotation , various complications occur when ordinary hollow screws are used for fixation, including displacement, screw loosening, femoral neck shortening, varus deformity, and non-union.

6. FNS advantages include anti-rotation, angular stability, dynamic fixation and minimally invasive surgical procedures. This system has a anti-rotation screw, an outer plate and a locking nail. A biomechanical study on FNS confirmed that FNS exhibits significant advantages in resisting varus deformation, femoral head dorsal tilting and femoral head rotation12. In addition , this study revealed that FNS and DHS have comparable outcomes with regards to fracture fixation and complications .

7. The goal of treatment in the younger patient is to preserve the femoral head, avoid osteonecrosis , achieve union, and return to full activity. To return to full activity, special attention must be paid, in these fractures, to preserving native hip anatomy and biomechanics that may be of less concern when treating elderly patients. These goals are made more challenging because of the unique anatomy of the femoral neck. The femoral neck is intracapsular and does not reliably form callus, because of the lack of a cambium layer.Therefore , fracture reduction to achieve absolute stability and eventual primary bone healing is required

8. Case 1 Tej prakash , 26/m , k/c/o of hypothyroiism was bought to casulaty with complaints of left hip pain an inability to bear weight following history of fall from bike . on general examination patient vitals were stable and on local examination left lower limb – shortening , external rotation of hip with restriction of movements . X-ray of Pelvis with both hips revealed basicervical neck of femur fracture left side

9. Case 2

10. Pre operative work up Routine pre operative blood parameters (CBC,LFT,RFT,PT/INR,TFT,VIRAL MARKERS) were done. Both patients were given adequate analgesia and skin traction was applied to affected limb. Patient was explained about the nature of fracture and future complications .various methodology available for fracture fixation(CCS,FNS, DHS) , its advantages and complications were explained. Informed and written consent were taken

11. Intraoperative technique Under spinal anaesthesia , IITV guidance The affected limb was put under traction table and fracture reduced to acceptable position A longitudinal incision of approximately 5cm was made under the greater trochanter . Subsequently, the lateral femoral surface was exposed anti-rotation wire inserted to fix the fracture. a second wire as the central guide wire using a 130° angled guide. The proper position of the guide wire was confirmed by IITV direct measuring device used to determine the length and choose the proper implant. We then inserted the implant over the central guide wire into the pre-reamed hole. we drilled a hole for the anti-rotation screw and inserted it. Interfragmentary compression was applied by turning the insertion screw counterclockwise. The implant position was monitored during compression using X-ray. Finally a protection sleeve and drilled a hole for the locking screw and inserted it.

12. Post operative management Both patients were given intravenous antibiotics 3 doses post op . On day 2 , dressing and xray was done Mobilization with walker , Knee and ankle range of movements were started on day 2 Patient were discharged on day 3 an followed up after a week for sutrure removal Xray was done 4 and 12 weeks post op to look for union and any complications

13. Discussion

14. Summary Femur neck fracture in middle age is an challenging situtaion due to availability of varoius modality of fixation devices and associated high rate of complications . FNS a new tool in the treatment of femur neck fracture has shown to be superior to CCS and DHS .