Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution.

INTRODUCTION: Posterior comminution of the femoral neck fracture is a major cause of delayed and non-union owing to the loss of the buttressing effect against the posterior rotation. When a femoral neck fracture with posterior comminution is anatomically reduced, only the anterior portions of the femoral neck fracture surfaces are brought into contact leaving a posterior defect. The purpose of this study was to evaluate the use of fibular strut grafting and dynamic hip screw (DHS) for fresh femoral neck fractures with posterior comminution in young patient less than 50 years. MATERIALS AND METHODS: Between October 2012 and March 2016, 35 patients aged 20-50 years, 30 men and 5 women underwent fixation using DHS and fibular strut grafts for Garden grades III (25 patients) and IV (10 patients) femoral neck fractures with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. RESULTS: All patients were in the age group of 20-50 years (mean 37 years). The mean delay in presentation after injury was 1 day. The mean final follow-up for these 35 patients was 27.2 months. Healing of the femoral neck was attained in 34 cases, with an average time to union of 4.8 months (range 4-8 months). One patient underwent arthroplasty due to failure of fixation. According to the Harris hip score, outcome was good to excellent in 30 patients, fair in 4, and poor in 1. CONCLUSIONS: In our study, only one patient developed non-union and no patients had avascular necrosis of the femoral head. Closed reduction, fibular strut grafts, and DHS fixation is a reliable procedure for femoral neck fractures with posterior comminution in young adults.

Surgical treatment of displaced intra-articular calcaneal fracture using a single small lateral approach.

The objective of this study was to evaluate the outcome of semi-open reduction and minimal internal fixation through a single small lateral approach as a minimally invasive technique for treatment of displaced intra-articular calcaneal fractures. This prospective study was conducted on eighteen patients (16 men and 2 women). The average age was 37.7 (22-55). The most common cause of injury was a fall from height in fourteen patients. Patients were operated on within a mean time of 4.8 days of admission (1-11 days) and were followed up for an average period of 24.1 months (6-39 months). Patients were evaluated clinically using the Creighton-Nebraska Heath Foundation Assessment score of Crosby and Fitzgibbons (J Bone Joint Surg (Am) 72-A:852-859, 1990). The scoring system proposed by Knirk and Jupiter was used for radiological assessment of the posterior subtalar joint (Knirk and Jupiter in J Bone Joint Surg (Am) 68-A: 647-659, 1986). The skin incision healed in all cases without necrosis, infection, or sural nerve injury. All fractures healed after an average of 8 weeks (7-10 weeks), and patients returned to the routine daily activities after an average time of 4.3 months (3-7 months). In conclusion, semi-open reduction and minimal internal fixation through a small lateral approach is an effective treatment for carefully selected cases of displaced intra-articular calcaneal fractures.