Four Screws Diamond Configuration Fixation for Displaced, Comminuted Intracapsular Fracture Neck Femur in Young Adults

• Published in: Indian journal of orthopaedics Vol. 53; no. 1; pp. 70 - 76
• Main Authors: Rajnish, Rajesh K., Haq, Rehan U., Aggarwal, Aditya N., Verma, Nikhil, Pandey, Rohit, Bhayana, Himanshu
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.01.2019; Wolters Kluwer India Pvt. Ltd; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Biomechanics; Conservative Orthopedics; Diamonds; Fractures; Fractures (Injuries); Internal fixation; Medical research; Medicine & Public Health; Original; Original Article; Orthopedics; Patients; Surgeons; Surgery; Surgical Orthopedics; Wire; Young adults; Youth; India; Avascular necrosis; cannulated cancellous screw fixation; diamond configuration; Gardens Grade III or IV; displaced; fracture neck femur; comminution
• ISSN: 0019-5413; 1998-3727
• DOI: 10.4103/ortho.IJOrtho_333_17

Background Four cannulated cancellous screws (CCS) in diamond configuration have been recommended by some authors for fixation of intracapsular neck of femur (ICNF) fracture with posterior comminution in adults. This is also supported by biomechanical studies. However, the clinical usefulness of this biomechanical advantage is not known. This study evaluates the outcomes of displaced, comminuted ICNF fracture in young adults managed by four CCS fixation in diamond configuration. Materials and Methods 25 patients who met the inclusion criteria were operated during the study period. Four patients were lost to followup in the first 6 weeks postoperatively, and one patient died in first 6 months of followup unrelated to surgery. Thus, twenty patients were followed up for a mean period of 33.3 months (range 25–38 months). In all patients, fracture fixation was done with four CCS in diamond configuration. Union at fracture site and avascular necrosis (AVN) of femoral head was assessed on serial plain radiographs. Functional outcome was evaluated by Harris hip score. Results Eighteen patients had union, two patients had nonunion, and two patients had AVN of femoral head. All the sixteen patients who had union without AVN had good or excellent functional outcome. Conclusions The present study concludes that four CCS fixation in diamond configuration appears to be a reasonable choice of fixation for displaced fracture ICNF with comminution in young adults. However, further evaluation with better study design and larger patient population is required for definite conclusions.