Journal of AdvancedMedical and Dental Sciences Research

Background: Fractures are commonly seen following road accidents, fall from building or tree, fight etc. Long bone fractures are commonly seen during road side accidents. The present study was conducted to assess risk factors associated with early failure following internal fixation using cannulated screws in the treatment of intracapsular fractures of the proximal femur. Materials & Methods: This study was conducted in the department of orthopaedics in 2015. It included 240 patients having fracture femur. All patients underwent internal fixation of an intracapsular fracture of the proximal femur with cannulated hip screws. Pre-operative radiographs were analyzed for the degree of displacement according to the Garden classification.5 Operation notes and intra-operative radiographs were assessed for the number of screws used. Placement of the screws was noted whether it was placed in a parallel, diverging or converging manner. The angle made by the screws was recorded with a parallel placement defined as less than five degrees of divergent or convergent angle in both anteroposterior (AP) and lateral views. Results: This study consisted of 240 patients (males-72 (30%) and females 168 (30%). 180 patients showed no failure (males-54, females-126) and 60 patients showed failure (males-42, females-18). The difference was significant (P-0.01). Fractures were divided into type I, II, III and IV. Type I was seen with failure (4) and no failure (26). Type II was seen with failure (8) and with no failure (42). Type III was seen with failure (26) and with no failure (71). Type IV was seen with failure (22) and with no failure (39). The difference was highly significant (P<0.001). AP reduction with no failure and not in range was 27% and with failure was 73%. AP reduction with no failure and in range was 73% and with failure was 27%.  Number of patients with no failure and in range was 74 while with failure was 6. Screws are in parallel to both AP and lateral view with anterior angle with no failure was 34 and with failure was 29. Screws are in parallel to both AP and lateral view with posterior angle with no failure was 70 and with failure was 36. The difference was highly significant (P<0.001). Number of screws used was 2 or 3. When 2 screws were used failure was seen in 4 cases and no failure in 138 cases. When 3 screws were used failure was seen in 46 cases and no failure was seen in 44 cases. The difference was significant (P<0.01). Conclusion: Our study revealed that successful reduction is key to prevent early failure of femur union. Whether fracture is displaced or we want to treat undisplaced fracture, reduction is mandatory.
Key words: Femur, Fractures, screws

Corresponding Author: Dr. Rajnish Jindal, Associate Professor, Department of Orthopedics, Mayo Institute of Medical Sciences, Barabanki, U.P., India

This article may be cited as: Jindal R. Risk factors for failure of cannulated screws for the management of fractured femur: A clinical study. J Adv Med Dent Scie Res 2016;4(6):175-178.