Displaced Intracapsular Hip Fracture in Patients Younger than 60: Does Fixation Technique Matter?

Introduction: Displaced intracapsular hip fractures (ICHF) in the elderly are associated with major decline in quality of life, disability, and high morbidity and mortality. In young active patients, where preservation of the femoral head and its blood supply are of high importance, urgent surgical treatment with anatomic reduction and internal fixation is the preferred intervention. Due to the strong varus displacement shear forces exerted across the hip, there are relatively high complication rates after fixation. There is no consensus regarding the optimal fixation device or technique. This retrospective study compared closed reduction internal fixation method using cannulated cancellous screw (CCS) with the Targon Femoral Neck (TFN) hip fixed angle screw.

Patients and Methods: Data regarding, gender, operational data, duration of surgery, complications, VAS pain score, modified harris hip score (MHHS) and SF-12 score were retrieved for patients younger than 60 with displaced ICHF. Patients older than 60 years or patients with pathological fractures were excluded.

Results: Eighty two patients were included in the study, 30 patients treated with CCS (mean age 48.3 SD 7.7) were compared to 52 patients treated with TFN (mean age 48.8 SD 8.7 p=0.425). Garden and Pauwel classifications, mean time to surgery, screw configuration and reduction position did not differ significantly between the two groups (p>0.05). Operative time did differ significantly with 56 minutes in the CCS group compared to 92 minutes in the TFN group (p<0.001). At last follow-up the CCS group suffered less pain (VAS 2.3 vs 3.5 (p< 0.05) and better Mental Health Composite score of SF-12 (P<0.05) compared to the TFN group.

Post-operative revision rates and perioperative complications were not statistically different (p>0.05)

Conclusion: Complication rates and clinical outcomes for the treatment of displaced ICHF with TFN and CCS showed no significant differences. Based on this evidence in consideration of the substantial cost differential between the Targon FN and CCS we suggest CCS for treatment of nondisplaced ICHF.