Richards compressive hip screw with an additional cancellous screw for the treatment of femoral neck fractures

Orhan Karsan, Naci Ezirmik, Bulent Alparslan, Namik Sahin,


44 patients with femoral neck fractures, divided into two groups with respect to sex, age and fracture type, were surgically treated with two different methods between 1988-1995. The fractures were classified according to Garden classification and only patients with type 3 or 4 fracture were included into the study. Group I consisted of 21 patients (6 female, 15 male) who had only Richards compressive hip screw. The mean age in this group was 41.3 (18-60) years. The average time period after fracture until surgical treatment was 6.7 days. Group II consisted of 23 patients (5female, 18 male) who had Richards compressive hip screw and an additional cancellous screw for increasing the rotational stability. The mean age in this group was 37.8 (18-63) years and the period after fracture until surgical treatment was on average 5.5 day. All cases in both groups had an average clinical and radiologic follow-up of 35 months. 19% avascular necrosis and 14% nonunion were seen in group I. These were 13% and 8.7% respectively in group II. Arnold criteria were used for evaluation, yielding 52.4% good, 33.3% moderate and 14.3% fair results in group I and 65.2% good, 26.1% moderate and 8.7% fair results for group II. We concluded that the use of a cancellous screw in addition to Richards compressive hip screw may increase the rotational stability and be applied infemoral neck fractures.

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