Limitations and Complications in Treating Femoral Neck Fractures with the Femoral Neck System: A Case Report.

Introduction: The femoral neck system (FNS) represents an emerging fixation system designed for the management of femoral neck fractures. This innovative system combines the mechanical benefits of compression and anti-rotation properties in internal fixation. Biomechanical studies have demonstrated the superior axial and rotational stability of the FNS implant when compared to traditional cannulated screws and dynamic hip screw. Despite these promising mechanical advantages, there is currently a limited body of literature addressing the factors contributing to FNS failure. A thorough assessment of the safety and outcomes associated with this novel implant is essential. Case Report: In this context, we present three cases wherein FNS failure occurred, aiming to elucidate the potential causes behind these failures, and had to undergo either an implant removal or bipolar hemiarthroplasty. Conclusion: While considering the femoral neck system as the implant of choice, we should consider the age, injury to surgery time, and the location of the fracture line. However, we cannot conclusively ascertain whether age contributes independently to the risk of failure.

Dual Mobility Cup in Fractures of the Femoral Neck in Neuromuscular Disorders and Cognitive Dysfunction Patients above 60 years-old.

Objectives: Dislocation rate of total hip arthroplasty (THA) can be as high as 20% for patients with fracture neck of femur, which is a disastrous complication in these vulnerable patients. Numerous techniques, including bipolar arthroplasty and constrained liner, have been adopted to minimize the risk of dislocation. We aimed to evaluate the role of dual mobility Cups in treating patients with fractures of the femoral neck with high risk of postoperative dislocation due to neuromuscular instability disorders. Methods: A prospective cohort study was conducted (place is blinded as asked during submission), between 2016 and 2019, with a post-operative follow up period of two years. We included skeletally mature patients with femoral neck fractures having neuromuscular disorders and cognitive dysfunction who are candidates for THA above 60 years. Patients were then followed up clinically and radiographically at the clinic using Harris Hip Score (HHS) and x-rays at six weeks, six months, one year and two years postoperatively. Results: Twenty patients (20 hips) with femoral neck fractures with high risk of postoperative dislocation due to neuromuscular instability disorders undergoing dual mobility cup were included. The mean age of patients was 70.5 ±6.42 years. There is highly significant difference between HHS preoperatively and postoperatively (six weeks, six months and one, two years) p<0.001.Infection occurred in one case (5 %), sciatic nerve injury occurred in one case (5%), and none of the patients had postoperative dislocation. Conclusion: Dual mobility cup is effective in preventing early dislocation in patients suffered from fracture neck of femur with muscle weakness due to neurologic disorders.

Outcomes of BDSF technique for osteosynthesis of femoral neck fractures.

INTRODUCTION: Femoral neck fractures present a significant challenge for orthopedic surgeons, especially in young patients who want to preserve their natural femoral head. Conventional methods for fixing these fractures often lead to poor outcomes and high complication rates. The Biplane Double-supported Screw Fixation (BDSF) technique is a novel approach that involves placing screws in two planes simultaneously, creating a two-point support for the screws in the neck and head of the femur. METHODS: This study aimed to evaluate the effectiveness of the BDSF technique in treating femoral neck fractures in patients aged 20-60 years. A total of 28 patients with fresh femoral neck fractures (less than three weeks old) were treated with closed reduction and internal fixation using the BDSF method. The patients' functional outcomes were evaluated using the Harris hip score, and the radiographic outcomes of union, femoral neck shortening, screw back-out, and femoral head avascular necrosis (AVN) were also evaluated. RESULTS: The results showed that the BDSF technique is a safe and effective method for treating femoral neck fractures in young adults. Out of the 25 patients who were followed up for a mean time of 18 months (range 6-24 months), 20 (80%) achieved fracture union in a mean time of 5.2 months. Non-union occurred in five patients (20%), and AVN of the femoral head was observed in three patients (12%). Two patients experienced varus collapse, but their fractures united successfully. CONCLUSION: The BDSF technique offers several advantages over conventional methods, including increased stability and improved fixation strength. It can be considered as an alternative to conventional methods for managing femoral neck fractures in young adults, with a low incidence of non-union and avascular necrosis and no cases of fixation failure or varus collapse.

Spontaneous Bilateral Neck Femur Fracture Secondary to Chronic Liver Disease and Vitamin D3 Deficiency.

Introduction: Spontaneous bilateral neck femur fracture occurs following many conditions. It is very rare event. It can be seen in young, middle aged, and elderly people with no preceding trauma. We report a case in middle aged person who got fracture secondary to chronic liver disease and Vitamin D3 deficiency and who underwent bilateral hemiarthroplasty. Case Report: A 46-year-old man came with sudden onset of bilateral hip pain with no history of trauma. It was started with difficulty in moving the left lower limb since February 2020 and after about 1-month period patient got right hip pain which made the patient completely bedridden. He also complained of yellowish discoloration of eyes associated with weight loss, malaise. No history of tremors in hand. No history of seizures. Conclusion: It is a not a common condition. Spontaneous bilateral neck femur fracture occurs following chronic liver disease and Vitamin D3 deficiency. Both these conditions lead to increase osteoporosis and osteomalacia thus making it more susceptible to fracture.

Outcomes of Displaced, Comminuted, Intracapsular Neck Femur Fracture in Young Adults Managed with Three Screw Inverted Triangle Versus Four Screw Diamond Configuration: A Comparative Pilot Study.

Background: Three cannulated cancellous screws (CCS) inverted triangle configuration is considered to be the gold standard for management of displaced intracapsular neck femur (ICNF) fractures in young adults. However, some authors have recommended four CCS in diamond configuration in the presence of comminution. However, there are no comparative studies to assess the superiority of one over the other. Therefore, the aim of the present study was to compare the radiological and functional outcomes of displaced, comminuted, ICNF fracture in young adults managed with three screw inverted triangle versus four screw diamond configuration CCS fixation. Material and Methods: Twenty-three patients (group I) with displaced comminuted ICNF fractures were managed with three CCS fixation in inverted triangle fashion between October 2014 and October 2015 and were followed up for a mean duration of 33.5 months (range 25-38 months). Twenty-five patients (group II) with the same inclusion and exclusion criteria were managed with four CCS in diamond configuration between October 2013 and October 2014 and followed up for a mean duration of 33.3 months (range 25-38 months). Radiological outcomes of these patients were compared in terms of union rates and avascular necrosis, while functional outcome was measured by Harris Hip Score (HHS) at a minimum of 24 months. Results: Nineteen patients of group I and 20 patients of group II were available for final follow-up. Mean union time in group I was 15 weeks (12-24 weeks), while in group II, it was 14 weeks (12-24 weeks). There was total of four (4/19) cases of non-union in group I, while it was two (2/20) cases in group II. One patient (1/19) developed avascular necrosis in group I, while two (2/20) developed the same in group II. In group I, the mean HHS was 87.3 (range 84-94) points, while in group II, mean HHS was 93.5 (range 78-96) points. Conclusion: There is no difference in the clinical and radiological outcomes following three screw inverted triangle or four screw diamond configuration CCS fixation of displaced comminuted ICNF fracture in young adults. Thus, we conclude that both three screw inverted triangle or four screw diamond configuration CCS fixation are effective treatment modalities for fracture neck femur with comminution and in the absence of larger studies and long-term follow-up the superiority of one over the other cannot be recommended.

"Cage in Box" - A modification of AIIMS BOX technique for large gap nonunion in young patients with neglected femur neck fractures.

Neck of femur fractures have often been termed as "The Unsolved Fractures", since they have a guarded outcome even after improved understanding of biomechanics and biology of this area. Gap-nonunion is one such dreaded complication of this fracture, especially in younger (<60 years) population, where arthroplasty may not be the best go-to option. We have earlier described "The AIIMS BOX" technique to manage such cases of gap non-union in neglected neck femur fractures [1]. Here we intend to describe a more successful modification of this technique. We operated 7 cases of gap non-union with our new "Cage in Box" strategy and followed these cases for 5 years. 6 patients from this group achieved excellent to good outcomes and only 1 reported a poor outcome. All the patients, except the one with poor outcome, could walk without aid and do activities of daily living independently. 3 patients developed AVN but had no evidence of collapse. 3 patients also developed Coxa vara, but it was significant only in one case. 6/7 patients were able to squat. We describe this method in detail and feel this can be a viable option in the armamentarium of orthopedic surgeons, along with valgus osteotomy, vascularized and non-vascularized fibular strut graft as well as Meyer's Graft, to help them solve this unsolved fracture.

Osetosynthesis of Fractures neck femur with cannulated screws: Evaluation of risk factors for post-operative complications.

OBJECTIVE: To evaluate the risk factors for postoperative complications in fracture neck femur treated with cannulated screws. METHODS: This cross sectional series was performed at the Department of Trauma and Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi from January 2015 to December 2019. A Total of 149 patients with close fracture neck femur of either gender between 20-60 years of age were included in the study. Patients with hip arthritis and pathological fractures such as tumours were excluded. Minimum three cannulated screws were used to fix the fracture with parallel configuration in compression mode. Patients were followed and evaluated for fracture healing and related complications such as nonunion and Avascular necrosis for two years. Descriptive statistics were calculated and stratification was done. Post stratification chi square test was applied taking p-value ? ≤0.05 as statistically significant. RESULTS: There were 113 (75.8%) male and 36 (24.2%)female patients. Mean age was 37.54±10.66 years. Mean operation time was 38.56±4.61 minutes. Out of these, 93 (62.4%) injuries were caused by motor vehicle accident, 34(22.8%) fall and 22(14.8%) by sports injury. Garden type III fracture was observed in 69 (46.3%) patients followed by 41 (27.5%) fractures of grade-IV. Fracture union was observed in 126 (84.6%) patients at a mean time of 4.0±1.1months and non-union in 23 (15.4%) cases whereas rate of avascular necrosis was noted in 28 (18.8%) cases and were significantly associated with age, injury mode, time from injury to surgery and fracture classification. Non-union was significantly associated with open reduction and delayed fixation of fracture for more than 24 hours. CONCLUSIONS: Although cannulated screws are a universally accepted method of fixation for femoral neck fractures, the incidence of complications such as Avascular necrosis and non-union is quite high particularly in young males meeting a motor vehicle accident, undergoing open reduction for displaced fractures even with early diagnosis and treatment.

Controversies in the management of pediatric neck femur fractures- a systematic review.

PURPOSE: To review controversies systematically in the management of pediatric neck femur fracture from the literature and to develop consensus for the optimum management. METHODS: Authors searched literature by using keywords of pediatric neck femur fracture, proximal femur fracture, complications, management by following PRISMA guidelines. A common dilemma was listed. RESULTS: Age, mechanism of injury, fracture type, presentation, treatment method, implant, and nature of complications were compared. Inference from recent literature was extracted for optimum management. CONCLUSION: Immediate anatomical reduction with stable fixation must be accomplished. Complications continue to happen despite the best efforts and a longer follow-up is important.

Femur Neck Osteoid Osteoma Managed with Radiofrequency Ablation - A Case Report.

INTRODUCTION: Osteoid osteoma is a benign tumor of bones involving mainly the tubular bones and rarely axial skeletons. The patient mainly complains of night pain in the affected region or the joint nearby. Pain always subsides with analgesics and gradually increased over the period of time. It is mostly missed on the plain radiograph so magnetic resonance imaging or computed tomography (CT) scan are preferred for accurate and early diagnosis of the tumor. CASE REPORT: A 20-year-old male presented with pain in the left hip region which was gradually increased over the period of 6 months and was experiencing pain more in the night, used to relieve on medications. CT scan of the left hip showed the presence of osteoid osteoma of 0.5 cm diameter, which was managed with radiofrequency ablation. Moreover, the patient had pain relief immediately after the procedure. At present 1-year follow-up, the patient is symptomless with no recurrence. CONCLUSION: The neck of femur osteoid osteomas is best managed with radiofrequency ablation as it causes less morbidity to the patient and helps in early return to normal activities with fewer complications as compared to open procedures.

Recovery of pre-injury functional state following operative treatment of displaced femoral neck fractures; a prospective cohort study.

BACKGROUND: The incidence of fracture neck of femur (FNF) has been projected to increase significantly. This study sought to determine the recovery of preinjury functional state following operative treatment of displaced FNF. MATERIALS AND METHODS: A six-month prospective cohort study was conducted at Kenyatta National Hospital (KNH) and PCEA Kikuyu Mission Hospital (KMH) between November 2008 and May 2009. Sixty patients were enrolled using a pre-tested questionnaire. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores were used. The functional outcome measures included pain, stiffness and activities of daily living (ADL). Stratification and subgroup analysis were done especially based on age. Student's t-test and χ 2 test were used for comparison between variables as appropriate with a p < 0.05 being considered statistically significant. RESULTS: Majority of the patients recruited were males (68%) with a mean age of 51.6 years. Eighty eight percent of the patients had a mean negative early functional outcome score. Hemiarthroplasty (HA) and Total Hip Arthroplasty (THA) had comparable early post-operative functional outcome while Osteosynthesis (OS) had a poorer ADL outcome. Prolonged hospital stay was associated with a poor ADL outcome (p = 0.020). Use of the antero-lateral approach to the hip was associated with a better ADL outcome in patients older than 50 years (p = 0.007). CONCLUSIONS: At three months post-operatively, most patients have not fully recovered their pre-injury level of function and independence. Both HA and THA are associated with better early functional outcome compared to OS. STUDY TYPE: Original research.

Superior functional outcome with dual mobility THR as compared to conventional THR in fracture neck femur: a prospective cohort study.

INTRODUCTION: Total Hip Replacement (THR) in displaced Fracture Neck of Femur (FNOF) is associated with higher dislocation rates. Conventional THR with a large femoral head and anterior approach has reduced the instability, but it remains higher than THR done for other aetiology. Recent studies have shown reduced dislocation rates with dual mobility THR (DMTHR) for FNOF; however, there is a lack of comparative research to show its superiority over conventional THR. Further, its role in the Asian subcontinent, where the patient requires sitting cross-legged or squatting, has not been studied. METHODS: A prospective cohort study of 103 elderly patients with displaced FNOF with a minimum follow-up of 1-year. Fifty-two patients were operated on with DMTHR and fifty-one patients with conventional THR. Both the groups were matched in terms of demographic data, surgical approach, and postoperative protocol. Radiological and functional outcomes in terms of Harris Hip Score (HHS), Range of motion, Patient Reported Outcome Measures (PROM), and Dislocation rate were compared between the two groups. RESULTS: Mean HHS of the DMTHR group was 76.37 at three months and 87.02 at the end of the 1-year postoperatively, which was significantly better than the conventional THR group 65.65 at three months and 72.96 at 1-year. The range of motion was significantly better in the DMTHR group than the conventional THR group. There was no significant difference in radiological outcomes and postoperative dislocation rate between the two groups. CONCLUSION: Dual mobility implants give better results than conventional implants for primary THA in elderly patients of displaced FNOF regarding better function and greater range of motion.

Salvaging Chronic Nonunion of Femoral Neck and Infected Nonunion of Ipsilateral Femoral Shaft Fracture Using Intramedullary Antibiotic Cement Spacer and External Fixator Alone.

Concomitant ipsilateral fractures of femoral neck and shaft are rare injuries and pose challenging management. Infected non-unions of such fractures can further complicate the management options and have not been discussed in the literature. We present a case of an eight-month-old atrophic non-union of ipsilateral femoral shaft and femoral neck with evidence of intramedullary infection that was managed using a cost-effective, low strain rail fixator assembly and an intramedullary antibiotic cement spacer. Both fracture non-unions were salvaged without the need for any additional procedure. The patient returned to his regular activities within a year follow-up period. There was no clinical evidence of infection during the last follow-up at 16 months, and inflammatory markers were within normal limits. The current case study suggests that while aggressive debridement and intramedullary antibiotic cement spacer can control the intramedullary infection, and simultaneous union of even atrophic nonunion of femoral shaft and femoral neck, both, can be obtained using a tensioned Schanz pin-based external fixator without the need for any secondary procedure. Such a fixator and cement spacer assembly can thus address the dual purpose of fracture stabilization during infection control as well as the union of the non-union sites.

Fractures of the Proximal Femur in Childhood: A Review.

BACKGROUND: Femoral neck fractures in children are rare injuries, occurring due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is according to the Delbet system, which not only guides management but also gives prognostic clues. Multiple fixation methods have been described and there is no consensus on what constitutes the best treatment. Osteonecrosis, non-union, coxa vara and premature physeal arrest are the most frequent complications. PURPOSE: To review the current knowledge, discuss controversial aspects, and provide suggestions for future research. METHODS: We have reviewed the literature on paediatric proximal femur fractures and have provided an evidence-based guide to the diagnosis and management of these injuries. Common complications have been elaborated and options for their prevention and/or management discussed. CONCLUSION: There is universal agreement that anatomic reduction and stable internal fixation, supplemented by spica immobilization in younger children, are essential to obtain good outcomes. The role of capsular decompression, choice and configuration of implant, and appropriate timing of surgery are aspects that continue to be debated. Multicenter prospective studies are necessary to standardize treatment of these challenging injuries.

Dilemma for Fracture Fixation of Paediatric Ipsilateral Neck with Shaft Femur Fracture.

BACKGROUND: Ipsilateral femoral neck with shaft fracture (IFNSF) in the paediatric population is a rare injury. This high-impact trauma is often associated with other orthopaedic and systemic injuries. Prognosis is usually guarded as both these osseous injuries are serious and exist together. We report two such patients of IFNSF. METHODS: Two children with IFNSF were admitted at our hospital in 2018. The first patient had an associated head injury, while in the second patient, the shaft femur fracture was open. We report on the treatment and results in these two patients. Both the patients were serially assessed and followed 2 years after the injury. RESULTS: Union was achieved in neck and shaft femur fractures in both the patients by 3 months. Complications like avascular necrosis (AVN) of the femoral head, coxa vara, non-union or malunion of fractures, limb length discrepancy, knee and hip stiffness were not seen in either of the patients. CONCLUSION: IFNSF is a rare injury pattern seen in children, usually associated with concomitant orthopedic and other systemic injuries. Early operative stabilization is the preferred modality of treatment. For an undisplaced neck fracture, a provisional temporary fixation of a relatively less displaced neck fracture, definitively stabilizing the shaft fracture, and thereby returning to fix neck fracture is advocated. For displaced neck fractures, a direct open reduction is advocated. Anatomical fixation with separate implants and a relatively longer immobilization can provide the best-expected results. Long-term follow-up is needed to foresee any complications. LEVEL OF EVIDENCE: V (case series). Therapeutic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-020-00315-z.

Cemented unipolar or modular bipolar hemiarthroplasty for femoral neck fractures in elderly patients - which is better?

INTRODUCTION: Hemiarthroplasty is considered to be the treatment of choice for femoral neck fractures in elderly, however there is no consensus to support the choice between unipolar or bipolar hemiarthroplasty. Several studies found that patients with bipolar hemiarthroplasty had a better outcome of pain, a higher rate of return to the pre-injury state, and a greater range of hip motion. Some studies have demonstrated equal hip functional outcome between unipolar and bipolar hemiarthroplasty, but unipolar hemiarthroplasty was favoured due to its lower cost. The purpose of this study was to compare the functional and radiological outcome of cemented unipolar vs modular bipolar hemiarthroplasty in displaced femoral neck fracture in elderly patient population. METHODS: It is a prospective randomized study, with 44 patients in each group. Elderly Patients (>60 years of age) with traumatic displaced femoral neck fractures were included in the study. Cemented unipolar or modular bipolar hemiarthroplasty was performed in the respective patient groups using posterior or anterolateral approach. Functional outcome evaluation was done by Harris Hip Score and radiological outcome evaluation was done for acetabular erosion. The data was entered in MS EXCEL spread sheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM, Chicago). RESULTS: The mean age in the unipolar and bipolar group was 67.2 and 66.1 years respectively. The average follow-up period was 20.1 and 22.3 months in the unipolar and bipolar group respectively. Mean operating time was significantly more in the modular bipolar group (78.3 minutes) compared to the unipolar group (67.3 minutes). Two patients (4.5%) had acetabular erosion in each group. Mean Harris Hip score at 3 months follow-up was significantly higher (p value <0.05) in bipolar group (75.8±4.2) than the unipolar group (77.7±2.9). However, subsequent follow-ups at 6 months (80.9±2.8, 82.0±2.5, p value >0.05) 12 months (83.1±2.2, 83.2±1.2, p value >0.05) and 24 months (85.5±2.4, 85.2±2.8, p value >0.05) did not show any significant difference between the two groups. The incidence of general complications was 34% in bipolar and 20.4% in unipolar hemiarthroplasty group. CONCLUSION: Functional outcome in terms of Harris Hip Score are better in the bipolar group at 3 months follow up but there was no significant difference in the functional outcome between the two groups at 6, 12 and 24 months follow up. The operative time for unipolar is lower and statistically significant compared to bipolar hemiarthroplasty of the hip.

Bilateral Neck Femur Fracture during Prison Confinement: An Atypical Mechanism of Injury.

INTRODUCTION: Simultaneous bilateral neck femur fracture is a rare entity that has been associated with metabolic disorders, osteoporosis, drugs, trauma, and seizure disorders. Its occurrence following a physical assault is very rare. We present a case report of a prisoner presenting with bilateral neck femur fracture following a physical assault during prison confinement. CASE PRESENTATION: This article presents the case of a 64-year-old male prisoner who sustained bilateral intracapsular fracture neck femur following the physical assault. Bilateral uncemented total hip replacement was done using a posterior approach at separate sittings. The patient made an uneventful recovery with return of pain-free normal range of motion at the time of discharge. The weight-bearing mobilization was allowed immediately following bilateral hip arthroplasty. Harris hip score at the time of discharge and the last follow-up of 12 months was 83.4 and 90.3, respectively. No wound-related or other systemic complications were noted. CONCLUSION: bilateral fracture neck femur is commonly associated with metabolic conditions, rarely associated blunt trauma. This article highlights the need to suspect these fracture in all elderly cases presenting with hip pain.

Treatment of non-united femoral neck fracture by a novel subtrochanteric angulation lateral translation valgus osteotomy (SALVA osteotomy).

PURPOSE: The ideal treatment of non-united and neglected fracture neck femur in the young adult still remains unclear and is characterized by many biological and biomechanical challenges. METHODS: Twenty-one patients with non-united or neglected fracture neck femur aged between 19 and 50 years were treated by a novel subtrochanteric valgus osteotomy and were followed up for a mean of 26.7 months. Patients were assessed by radiological parameters, the Harris Hip Score, Oxford Knee Score, and Askin Bryan Criteria to categorize the overall outcome of the patients at 24 months. Other outcome measures included the occurrence of AVN, adductor lever arm, leg length discrepancy, and mechanical implant failure. RESULTS: All patients treated with the SALVA osteotomy consolidated and displayed a marked improvement of functional and radiological outcome measures. Nevertheless, there were 2 mechanical failures in patients with marked osteopenia and three developed AVN. CONCLUSIONS: In patients with un-united/neglected fracture neck femur, SALVA osteotomy appears to be reliable and reproducible. It also restores the abductor lever arm and improves the leg length discrepancy. Technically less demanding conversion to arthroplasty remains still possible prospectively.

Does the timing of treatment affect complications of pediatric femoral neck fractures?

OBJECTIVES: Pediatric femoral neck fractures were reviewed to compare complications with the time of presentation. METHODS: 34 pediatric femoral neck fractures were studied to detect union time, avascular necrosis, premature physis fusion, and the neck-shaft angle. All complications were comparable between both groups. RESULTS: The mean union time was more in late presented group. Four children developed AVN. The neck shaft angle and pre mature fusion of growth plate were same in both groups. CONCLUSIONS: The frequency of the complications except union time in pediatric neck femur fracture is comparable in early and late presented groups.

Nutritional Osteomalacia-induced Bilateral Neck Femur Fracture in an Elderly Patient: A Case Report.

INTRODUCTION: Simultaneous bilateral neck of femur fracture is rare. Majority of them are due to low energy incidents with underlying conditions such as malnutrition, chronic renal failure, cystic fibrosis, celiac disease, seizures, steroid abuse, or osteomalacia. CASE REPORT: A 68-year-old woman was referred with a 1-year history of bilateral hip pain and a 9-month history of inability to bear weight. She was diagnosed as a displaced bilateral femoral neck fracture secondary to osteomalacia. Due to the long duration of this condition and associated comorbidities, staged bilateral hip hemiarthroplasty was done. A good function was noted after surgery to 4-month follow-up. CONCLUSION: Osteomalacia should be suspected in any patient with long-standing bone pain and muscle weakness regardless of age. Numerous options in the form of percutaneous screws, bipolar hemiarthroplasty, and total hip arthroplasty have been mentioned in the literature regarding the management of simultaneous bilateral femoral neck fractures. Staged bipolar hemiarthroplasty was done due to the associated comorbidities.

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

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.