Long term clinico-radiological outcome of osteosynthesis in patients with femoral neck fracture: A retrospective study

Introduction: Fracture of the neck of femur continues to be one of the major orthopaedic injuries. It occurs in elderly patients with osteoporosis or in young patients suffering high energy trauma. Aims and Objectives: To evaluate long term clinico-radiological outcome of osteosynthesis in patients with femoral neck fracture. Material and Methods: Fifty patients of femoral neck fracture who underwent osteosynthesis with lag screw fixation or with valgus intertrochanteric osteotomy were studied. The patients were divided into 2 groups; Group-I (n=16) comprised of patients in whom osteosynthesis with lag screws was done and Group-II (n=34) patients had undergone valgus intertrochanteric osteotomy. Results: In Group-I at an average follow up of 41.8 weeks no patient had non-union or AVN, all heads were viable, 6.25% had OA hip & intraarticular implant penetration, 93.7% had Harris hip score from good to excellent, d’Aubigne & Postel score from good to very good & SF-36 score below 10 whereas at an average follow up of 142.37 weeks 6.25% had non-union, 75% heads were viable, 25% had AVN & OA hip, 6.25% had intraarticular implant penetration, 75% had Harris hip score from good to excellent, d’Aubigne & Postel score from good to very good & SF-36 score below 10. In Group-II at an average follow up of 55.44 weeks 2.94% had non-union, 94.12% heads were viable, 5.88% had AVN, 8.82% had OA hip, no intraarticular implant penetration, 88.23% had Harris hip score from good to excellent, 91.17% had d’Aubigne & Postel score from good to very good & 79.41% had SF-36 score below 10 whereas at an average follow up of 159.3 weeks 2.94% had non-union, 82.36% heads were viable, 17.64% had AVN, 41.17% had OA hip, 2.94% had intraarticular implant penetration, 73.53% had Harris hip score from good to excellent, 72.22% had d’Aubigne & Postel score from good to very good & 70.58% had SF-36 score below 10. Conclusion: Rate of union was found to be better in patients managed with valgus intertrochanteric osteotomy than with lag screw osteosynthesis. The incidence of avascular necrosis seems to be higher in patients of group-I as compared to group-II patients. The overall clinical & radiological outcomes in both groups became worse on long term follow up.