![]() Parker and Blundell analysed the use of these implants for internal fixation. There are few published reports focusing on DHS in the treatment of femoral intracapsular displaced neck fractures. , after reviewing 90 fractures, concluded that DHS showed a trend for an increased rate of overall success in elderly patients with nondisplaced femoral neck fracture compared with MCS. defended the use of only two cannulated screws in nondisplaced femoral neck fractures but suggested DHS, as a more stable implant, for Garden III-IV fractures. suggested that surgeons in Europe were more likely to indicate a DHS device over MCS than North American surgeons. In a cross-sectional survey using a regressive analysis, Bhandari et al. Its disadvantages are large skin incisions, more extensive soft tissue dissection, a greater need for blood transfusion, and a longer stay in hospital. published a biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. With the use of DHS the screw-plate system achieves a more stable condition. Osteosynthesis with MCS fixation is a less invasive technique and reduces blood loss and soft tissue stripping. Internal fixation, hemiarthroplasty, and total hip replacement could be considered as appropriate solutions.įor internal fixation, most orthopaedic surgeons choose either a dynamic hip screw (DHS) or multiple cannulated screws (MCS). Surgical management of displaced subcapital fractures of the femoral neck continues to be challenging. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Avascular necrosis was observed in 16% of patients. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. ![]() In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). Patients underwent surgery with closed reduction and internal fixation with DHS. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. ![]()
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