Comparison In Efficacy Of Two Methods In Treatment Of Pauwels Type Ⅲ Femoral Neck Fractures In Young Adults

Objective: To compare the clinical efficacy of short-armed dynamic hip screw combined with fibula bone graft and short-armed dynamic hip screw combined with cannulated screw fixation in the treatment of femoral neck fractures in young adults.Methods: In this study,a total of 25 young adults with Pauwels type Ⅲ femoral neck fractures were included,and randomly divided into group A and group B based on different surgical methods.After closed reduction,13 patients in the group A received short-armed dynamic hip screw combined with fibula bone graft,and 12 patients in the group B were treated with short-armed dynamic hip screw combined with cannulated screw fixation.Surgical duration,amount of bleeding,fracture healing time,Harris hip score and postoperative complications were recorded and compared in the 2 groups.Results: No statistically significant differences were found in surgical duration or the amount of bleeding between the group A(3.51 ± 1.32 h;453.85 ± 236.70 ml)and the group B(3.20 ± 1.38 h;441.70 ± 331.55 ml)(P1 = 0.57,P2 = 0.916,respectively).Fracture healing time was significantly shorter in the group A(5.30 ± 1.03 m)than that in the group B(8.27 ± 1.34 m),with a statistically significant difference(P = 0.00).The postoperative Harris hip score was higher in the group A(95.5 ± 2.38)compared with the group B(87.08 ± 9.22)(P = 0.03).The incidences of screw loosening and femoral head necrosis were significantly lower in the group A(0%;0%)than those in the group B(41.7%;25%)(P1 = 0.009,P2 = 0.03,respectively).The rate of nonunion showed statistically significant difference between the group A(0%)and the group B(25%)(P = 0.03).Both nonunion and femoral head necrosis occurred in the group B.Conclusion: Compared with short-armed dynamic hip screw combined with cannulated screw fixation,short-armed dynamic hip screw combined with fibula bone graft can shorten fracture healing time,reduce the incidence of nonunion and ischemic osteonecrosis,although it will increase surgical duration and blood loss to some extent.This study provides a new treatment for Pauwels type Ⅲ femoral neck fractures in young adults.