Results of subtrochanteric fractures treated with dynamic hip screw and dynamic condylar screw

To study the results of 48 patients with subtrochanteric fractures of the femur, treated surgically with fixation by dynamic hip screw [DHS] in 25 patients [52%], and by dynamic condylar screw [DCS] in 23 patients [48%], at Al-Razi Orthopaedic Hospital in the period between January 1990 and June 1995. The patients were reviewed with the mean follow-up of 16 months [range 6-30 months]. The mean duration of union was 4 months in 46 patients [95.8%]. Non-union was evident in 2 patients [4.2%]. Two patients [4.2%] developed delayed union, which was successfully united after re-operation by autogenous bone graft. One patient [2.1%] had wound infection. Metal failure occurred in the 2 non-union patients [4.2%]. Excellent and good clinical and radiological scoring was achieved in 41 patients [85.4%], fair in 5 [10.4%], and failure in 2 patients [4.2%]. Conclusions: We concluded that DHS and DCS are among the best fixation devices in the armamentarium for subtrochanteric fracture management. Although all the complications in our series occurred in the DCS group, with better clinical and radiological scoring in the DHS group, we could not conclude that DHS is better than DCS because more complex and unstable subtrochanteric fracture types were treated by DCS [8 patients with type B and 8 patients with type C, 69.6%], comparable to 19 patients with type A [76%] and only 6 patients [24%] in type B in the DHS group. The small number of patients in each group makes also the difference between them statistically insignificant

Results of closed reduction and pinning fixation of femoral neck fractures

In this study we report 31 cases of femoral neck fractures treated by closed reduction and internal fixation using hookpins [osteosynthesis]. During the postoperative follow-up period 3 patients died and therefore were not included in the clinical and radiological analysis of this study. The average follow-up for the remaining 28 patients was 18 months. There were 11 [39%] non-displaced fractures [Garden 1 and 2] and 17 [60.7%] displaced fractures [Garden 3 and 4]. There were no peri-operative or early post-operative complications. Incidence of non-union occurred in 6 patients [21%], and 3 patients [10.7%] underwent secondary arthroplasty surgery [1 hemiarthroplasty and 2 total hip replacements]. We conclude that the use of hook-pins in the internal fixation of femoral neck fractures in general and in displaced fractures, in particular, is a safe and simple procedure with low perioperaive and post-operative morbidity even when performed on elderly patients