Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in one hundred and five consecutive cases

Purpose

Locking plate osteosynthesis has become the preferred method for operative treatment of clavicle fractures. The method offers stable fixation, and would theoretically be associated with a low rate of fracture-related complications and reoperations. However, this remains to be explored in a large cohort, and our purpose was to assess the overall rates of complications and reoperations following locking plate osteosynthesis of mid-shaft clavicle fractures.

Methods

We identified all locking plate osteosynthesis of mid-shaft clavicle fractures operated upon in our department from January 2008 to November 2010 (n = 114). Nine patients did not attend the follow-up at our institution. The study group of 105 fractures (104 patients, 86 males) had a median age of 36 years (14–75 years). Follow-up ranged from 0.5 to 3.5 years. No patients were allowed to load the upper extremity for six weeks. By studying patient files and radiographic material, we assessed complications and reoperations.

Results

Overall, there were 31 cases (30 %) of plate removals for discomfort. There were five cases (5 %) of failure of osteosynthesis: two occurred early after approximately six weeks and three late after ten to 13 months postoperatively.

Conclusion

The overall rate of failure of osteosynthesis is low (5 %). The burden of plate removals in approximately one third of patients should be included in the preoperative information.     

Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

Purpose

This retrospective study compares Kirschner wires versus 3.5-mm diameter AO cannulated screw internal fixation in treatment for the displaced lateral humeral condyle fractures.

Methods

The study included 62 patients (42 boys, 20 girls; mean age 6.93 years; age range two to 14 years) with displaced lateral humeral condyle fractures. All patients were treated by open reduction and Kirschner wires or cannulated screw fixation. The clinical outcomes were evaluated according to the criteria of Hardacre et al. The mean follow-up period was 39.4 months (range 21–95 months).

Results

There was no statistically significant difference in clinical outcome between these two groups (P > 0.05). Five patients (16.7%) developed skin infection around K-wires, while no infection occurred in fracture with screws. An obvious lateral prominence occurred in 11 (36.7%) patients with K-wires and four (12.5%) patients with screws. Nine (30%) patients with K-wires and two (6.3%) patients with screws had a lack of 10° of extension of the elbow compared with the other side.

Conclusion

Both K-wires and cannulated screw fixation are effective in treatment for displaced lateral humeral condyle fracture. K-wires can pass through the ossific nucleus of capitulum without damaging it, but a longer period of external fixation and local skin care will be required. The screws can reduce the possibility of lateral prominence and promote the function of elbow by continuously stabilising the fracture, but a second operation is need for screw removal.     

The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures

Purpose

Despite the high incidence of cases of minimally displaced lateral or posterior malleolus ankle fractures, treatment guidelines are still an issue of controversy. The purpose of this study was to delineate treatment preferences among orthopaedic surgeons in these fractures with and without concomitant posterior malleolus fractures. We hypothesized that concomitant minimally displaced fractures of the posterior malleolus can shift treatment preference towards operative intervention.

Methods

A questionnaire-based study was conducted among orthopaedic surgeons attending the 2012 European Federation of National Associations of Orthopaedics and Traumatology Conference (EFORT) in Berlin, Germany. Treatment preferences were reported for minimally displaced lateral malleolus fractures seen on radiographs and were then compared with treatment preferences when computed tomography (CT) was added revealing a concomitant minimally displaced posterolateral fracture of the posterior malleolus.

Results

The cohort comprised 177 surgeons from all six continents. When radiographs showing a minimally displaced lateral malleolus fracture were presented, nonoperative management was indicated by 35 % (62) of participants, whereas 65 % (115) preferred operative intervention. After CT views were added showing an accompanying minimally displaced posterolateral posterior malleolus fracture, 79 % (140) suggested operative intervention and only 21 % (37) advocated nonoperative management (p = 0.03).

Conclusions

Most surgeons prefer open reduction with internal fixation for minimally displaced lateral malleolar fractures. The presence of concomitant posterior malleolus fractures in these cases shifts treatment preference further towards open reduction with internal fixation. Because the posterior malleolus fragment might not be well delineated on standard ankle radiographs, a high index of suspicion is warranted, and the use of CT should be considered in these cases.     

Non-operative treatment versus percutaneous fixation for minimally displaced scaphoid waist fractures in high demand young manual workers

Background

Managing minimally displaced scaphoid fractures in young individuals doing physically demanding work remains an issue of debate due to duration of immobilisation and time required off work. Therefore, early diagnosis and appropriate treatment are important to avoid short- and long-term consequences. The literature lacks the exact definition of minimally displaced scaphoid waist fractures. The objective of this review article was to discuss nonoperative and minimally invasive treatment (percutaneous screw fixation) for minimally displaced scaphoid waist fractures and to systematically review the literature, focussing on young workers with physically demanding employment.

Materials and methods

We searched for articles through the most commonly used portals using appropriate terminologies to identify the most relevant articles in the English language comparing nonoperative and percutaneous fixation methods for these fractures in patients between 16 and 40 years of age. Strict inclusion and exclusion criteria were observed.

Results

Sixty relevant published articles were found. Twenty-one of these were considered valid for inclusion and comprised five randomised controlled trials, three prospective studies, four systematic reviews, three meta-analyses, and six retrospective studies. These studies provided a reasonable account of information on the managing undisplaced and minimally displaced scaphoid waist fractures, with satisfactory clinical and statistical analysis. However, it was difficult to assess the outcomes of minimally displaced fractures in isolation. Furthermore, few of these studies relied on plain radiographs for assessing union and did not report on patients’ work status.

Conclusion

Cast treatment has the disadvantages of longer immobilisation time, joint stiffness, reduced grip strength, and longer time to return to manual work. Percutaneous fixation is aimed at reducing damage to the blood supply and soft tissues, allowing early mobilisation of the wrist and early return to manual work. The best available evidence for percutaneous screw fixation versus cast treatment suggests that percutaneous fixation allows a faster time to union by 5 weeks and an earlier return to manual work by 7 weeks, with similar union rates. This systematic review indicates a potential requirement for a prospective randomised controlled trial to compare these two treatment modalities for minimally displaced scaphoid waist fractures in workers with physically demanding jobs in order to objectively assess functional outcomes, time to union and time to return to work.

Level of evidence

Level 3.     

Closed retrograde multiple intramedullary Kirschner wires fixation for humeral shaft fractures with the limb flexed over an articulated support

Objective

To evaluate the results of multiple closed intramedullary Kirschner wiring via a supracondylar entry point for humeral shaft fractures.

Patients and methods

The charts of 37 patients with humeral shaft fractures treated with the Hackethal''s technique between January 2007 and December 2011 were reviewed retrospectively. The operation was performed with the patient lying in supine (n = 22) or lateral (n = 15) position. The elbow was flexed over an articulated support with the arm kept in a vertical position. Thirty-three patients were available for final evaluation with a mean follow-up delay of 14 (range, 6–24) months. We were concerned about fracture union, range of motion of the shoulder and the elbow, and complications. Final evaluation used the criteria by Qidwai.

Results

Bone union rate was 94%. Restriction of ranges of motion of the shoulder more than 20° was noticed in two patients due to protruding wires. Three patients developed limitation of elbow extension owing to backing out of the wires. The overall results were excellent (n = 26; 79%), good (n = 4; 12%), and poor (n = 3; 9%).

Conclusion

Closed Hackethal''s technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction.     

Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation

Background

Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures.

Methods

Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months.

Results

Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases.

Conclusions

The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.     

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

Purpose

We investigated the incidence, natural history, and functional consequences of a newly developed flexion contracture after total knee arthroplasty (TKA).

Methods

Forty patients with full knee extension preoperatively who developed a postoperative flexion contracture were match-paired 1:2 with 80 patients who had full extension. The incidence of a newly developed flexion contracture, ROM, and Knee Society scores (KSS) at six weeks, four months, and one year were analysed.

Results

The incidence of a new flexion contracture at six weeks was 14 %, but diminished to 5 % and 0.3 % at four months and one year, respectively. One year after surgery, there was no difference in the KSS (p = 0.5).

Conclusions

This study showed that the majority of patients who developed a new flexion contracture after TKA have full knee extension one year postoperatively. Moreover, knee extension and KSS at one year are equivalent to those patients who did not developed a flexion contracture.     

Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique & mid term follow up results

Background

Stable trochanteric femur fractures can be treated successfully with conventional implants such as sliding hip screw, cephalomedullary nails, angular blade plates. However comminuted and unstable inter or subtrochanteric fractures with or without osteoporosis are challenging & prone to complications. The PF-LCP is a new implant that allows angular stability by creating fixed angle block for treatment of complex, comminuted proximal femoral fractures.

Method

We reviewed 30 patients with unstable inter or subtrochanteric fractures, which were stabilized with PF-LCP. Mean age of patient was 65 years, and average operative time was 80 min. Patients were followed up for a period of 3 years (June 2010–June 2013). Patients were examined regularly at 3 weekly interval for signs of union (radiological & clinical), varus collapse (neck-shaft angle), limb shortening, and hardware failure.

Result

All patients showed signs of union at an average of 9 weeks (8–10 weeks), with minimum varus collapse (<10°), & no limb shortening and hardware failure. Results were analysed using IOWA (Larson) hip scoring. Average IOWA hip score was 77.5.

Conclusion

PF-LCP represents a feasible alternative for treatment of unstable inter- or subtrochanteric fractures.     

Surgical treatment of lumbar spondylodiscitis: a comparison of two methods

Purpose

This study evaluates two basic hypotheses: (1) the risk of an isolated dorsal approach to ventral lumbar spondylodiscitis based on clinical and radiographic results and (2) the risk of anterior radical debridement due to using a titanium implant in the site of bone infection.

Methods

Group A consisting of 23 patients was treated only by a dorsal transmuscular approach and group B consisting of eight patients was treated by two-stage posteroanterior surgery. Both evaluated groups were assessed before surgery, six weeks and one year after surgery with the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and Kirkaldy-Willis functional criteria. To evaluate the sagittal balance restoration, measurement by the Cobb modified angle of the affected segment was performed.

Results

Differences (p < 0.001) in group A were found between JOA values before surgery (average 9.30) and at six weeks after surgery (average 11.82) and 12 months after surgery (13.27) and VAS differences before surgery (average 7.39), six weeks after surgery (average 3.82) and 12 months after surgery (average 2.36) in group A. According to the Kirkaldy-Willis functional criteria, 11 patients were evaluated as excellent, nine patients as good and two patients as poor. The values of the JOA score in group B showed an improvement compared with the JOA values before surgery (average 9.38) at six weeks after surgery (average 11.75) and 12 months after surgery (average 13.63), and the VAS score before surgery (average 7.38) was found to have improved six weeks after surgery (average 4.63) and 12 months after surgery (average 2.25). The functional evaluation according to the Kirkaldy-Willis functional criteria assessed three patients as excellent, four patients as good and one patient as fair. Radiographic examinations of group A revealed the following findings before surgery (average 1.75), six months after surgery (average −3.73) and 12 months after surgery (average −0.79) and in group B before surgery (average 3.71), six weeks after surgery (average −8.21) and 12 months after surgery (average −6.45).

Conclusions

The results demonstrate the minimum serious surgical complications and greater loss of sagittal balance without clinical correlation in group A. We did not find any relapse or persistence of the infection in the post-operative period in group B.     

Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study

Purpose

Increasing numbers of atypical femoral fractures have been reported among long-term bisphosphonate users. We evaluated clinical characteristics of atypical femoral fractures throughout Korean multicenter studies.

Methods

We retrospectively analysed the bone mineral density, prodromal symptoms before femoral fracture, and medication history of osteoporosis in 76 cases of atypical femoral fracture.

Results

The mean age of cases was 71.4 ± 8.8 (range, 43–89) years old. The mean follow-up period after the fracture operation was 24.5 ± 12.9 (range, 12–79) months. BMI was 23.2 ± 3.0 on average. The mean BMD of femur was −1.9 ± 1.4 (range, −4.8 to 1.3). Prodromal symptoms including thigh pain before femoral fracture appeared in 22 (28.9 %) of 76 patients. All patients included in the study used bisphosphonate. The duration of taking bisphosphonate before fracture was 36.8 ± 50.8 (one–204 months) months. Fifty-seven (75 %) of 76 patients were taking the medication for more than three years. Delayed union occurred in 43 (56.5 %) of 76 patients. Delayed union was defined as a fractured bone that did not completely heal within six months of injury. The group of having taken anti-osteoporotic medication for more than three years showed relatively longer union period compared to that for a shorter period medication group (4.8 ± 2.5 months vs 9.3 ± 3.7 months, p = 0.017). The delayed union developed in 43 (56.5 %) of 76 patients and showed a significantly higher incidence in the group with long-term therapy (five/43 vs 38/43, p = 0.021). The bilateral femoral fractures developed in 23 (30.2 %) of 76 patients and showed a high incidence in the group medicated more than three years (two/23 vs 21/23, p = 0.039).

Conclusions

The longer bisphosphonates are used, the more the cases of delayed union and the more frequent the development of bilateral fractures following unilateral fractures. With regard to the delayed union, the methods of the acceleration of fracture healing may be beneficial in atypical femoral fracture patients who had been receiving long-term bisphosphonates therapy. Careful observation is required for contra-lateral femurs due to a high incidence of bilateral atypical femoral fractures.     

A new volar plate made of carbon-fiber-reinforced polyetheretherketon for distal radius fracture: analysis of 40 cases

Background

Implants based on the polyetheretherketon (PEEK) polymer have been developed in the last decade as an alternative to conventional metallic devices. PEEK devices may provide several advantages over the use of conventional orthopedic materials, including the lack of metal allergies, radiolucency, low artifacts on magnetic resonance imaging scans and the possibility of tailoring mechanical properties. The purpose of this study was to evaluate the clinical results at 12-month follow-up using a new plate made of carbon-fiber-reinforced polyetheretherketon for the treatment of distal radius fractures.

Materials and methods

We included 40 consecutive fractures of AO types B and C that remained displaced after an initial attempt at reduction. The fractures were classified according to the AO classification: 21 fractures were type C1, 9 were type C2, 2 were type C3, 2 were type B1 and 6 were type B2.

Results

At a 12-month follow-up no cases of hardware breakage or loss of the surgically achieved fracture reduction were documented. All fractures healed, and radiographic union was observed at an average of 6 weeks. The final Disabilities of Arm, Shoulder and Hand score was 6.0 points. The average grip strength, expressed as a percentage of the contralateral limb, was 92 %. Hardware removal was performed only in one case, for the occurrence of extensor tenosynovitis.

Conclusion

At early follow-up this device showed good clinical results and allowed maintenance of reduction in complex, AO fractures.

Type of study/level of evidence

Therapeutic IV.     

Is nonoperative treatment of pediatric type I open fractures safe and effective?

Purpose

There is limited literature on nonoperative treatment of open type I pediatric fractures. Our purpose was to evaluate the rate of infection in pediatric patients with type I open fractures treated nonoperatively at our institution without admission from the emergency department (ED).

Methods

We performed a retrospective chart review of all patients who sustained a type I open fracture of the forearm or tibia from 2000 through 2013. Forty patients fit the inclusion criteria: <18 years old with type I open fracture treated nonoperatively with irrigation and debridement, followed by closed reduction and casting of the fracture under conscious sedation in the ED. All patients were discharged home. The primary outcome was presence of infection. Secondary outcomes included occurrence of a delayed union, time to union, complications, and residual angulation.

Results

There were no reported or documented infections. There was one case of a retained foreign body (<1 cm) in a mid-diaphyseal forearm fracture, which was removed in clinic at 4 weeks after the patient developed a granuloma with no infectious sequela. There was one case of a delayed union; all patients eventually had complete bony union. There was minimal residual angulation in both upper and lower extremities at last follow-up.

Conclusions

Nonoperative treatment of type I open fractures in pediatric patients can be performed safely with little risk of infection. This preliminary evidence may serve as a foundation for future prospective studies.     

Buried or unburied K-wires for lateral condyle elbow fractures

INTRODUCTION

Lateral humeral condyle fractures typically require a longer period of internal fixation than other distal humeral fractures due to the increased risk of non-union. K-wires can be buried and left in situ until union or they can be left unburied and require removal after four weeks, with plaster immobilisation until union. There is no consensus as to whether wire burial is preferable or not. The aim of this study was to determine whether K-wire burial is associated with more complications than non-buried wires in treating lateral condyle fractures of the elbow.

METHODS

All patients with lateral humeral condyle fractures treated with K-wire fixation at our institution from May 2008 to August 2011 were included in the study. Fracture configuration, mode of reduction, wire burial and complications were assessed.

RESULTS

Sixty-seven patients (19 girls and 48 boys, mean age: 6.5 years, range: 1–17 years) were included in the study. All had closed injuries and were treated with open reduction and K-wire fixation. K-wires were buried in 55 patients. Thirteen cases of buried wires eroded through skin and were removed on average 45 days (range: 30–58 days) post-operatively. Of the wire erosion cases, three developed microbiologically proven infections, one of which was a deep infection. There were a further three superficial wound infections in the absence of wire erosion through the skin. There were complications in 2 of the 12 cases in the unburied wires group: 1 microbiologically proven superficial wire site infection and 1 wire backed out after 11 days, requiring refixation.

CONCLUSIONS

Wire erosion through the skin is the most common complication of K-wire burial. This may be due to the decrease in swelling after fracture fixation, making the wires more prominent under the skin. Skin integrity should be monitored closely if wires are buried.     

The fate of B?hler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Purpose

Although the predictive value of Böhler’s angle on outcome remains subject of debate, the initial angle at the time of trauma still guides treatment. Changes in Böhler’s angle during follow-up are frequently reported following surgical treatment of displaced intra-articular calcaneal fractures (DIACF). The aim of the present study was to determine the changes in Böhler’s angle as a measure of secondary fracture displacement following conservative management of DIACF.

Methods

Thirty-eight patients with a total of 44 displaced intra-articular calcaneal fractures treated conservatively with a minimum of two lateral radiographs during follow-up were analysed. Böhler’s angle at different follow-up times was measured by three observers. The change in angle was compared with the angle at trauma, and influence of trauma mechanism and common calcaneal fracture classifications were determined.

Results

The results showed a significant decline over time of the Böhler’s angle in conservatively-treated patients of more than 11° on average at a mean follow-up of 29.2 weeks. This decrease was not related to gender, the initial angle, or the Essex-Lopresti or Sanders classification. A statistically significantly higher decrease was detected in high energetic trauma compared with low energetic trauma.

Conclusion

The conservative treatment of displaced intra-articular calcaneal fractures is still a viable option, yet a significant secondary displacement in time should be taken into account, as reflected in a decrease of Böhler’s angle of 11° up to one year following trauma.     

Is it worthwhile to screen the hip in infants born with clubfeet?

Purpose

There is some disagreement about whether idiopathic congenital talipes equinovarus (CTEV) increases the risk of neonatal developmental dysplasia of the hip (DDH). This study aimed to investigate the incidence of DDH in our infants with idiopathic CTEV.

Methods

We conducted an observational cohort study over a three-year period to assess the relationship between idiopathic CTEV and DDH. All neonates younger than six weeks with idiopathic CTEV who were treated in our medical centre were admitted to this study. Each subject underwent hip ultrasound examination using the Graf method at the age of six weeks. DDH was diagnosed when a hip was type IIa(−) or worse according to the Graf classification of sonographic hip type.

Results

A total of 184 patients were diagnosed with idiopathic CTEV and underwent hip sonography. In total, seven hips of five individuals underwent treatment (four girls and one boy). The results indicated that 2.7 % of babies (five of 184) with idiopathic CTEV had DDH. However, we did not find any statistically significant difference (p = 0.5776) in the Pirani scores between the DDH group and group with normal hips.

Conclusions

This study revealed that the idiopathic CTEV group had a greater incidence of DDH in comparison with the general population. It is recommended that hip sonography be undertaken particularly in patients with idiopathic CTEV.     

Plating for intra-articular calcaneal fractures…. Is it an overkill?

Objectives

Even after evolution of computerized tomography and improved surgical measures, treatment of intraarticular calcaneal fractures remains a controversy. Hence this study was carried out to compare functional outcomes of displaced intraarticular calcaneal fractures, treated with operative management with plating and conservative management with cast.

Material and methods

This study was carried out as a prospective, comparative study. Twenty nine (30 fractures) patients with acute, displaced intraarticular fractures of calcaneum aged 18–50 years, were enrolled in the study. Open fractures and fractures older than two weeks were excluded. 30 fractures were divided into two groups (operative and conservative; n = 15 in each). Evaluation in form of post treatment restoration of Bohler''s angle, heel varus angle and with Creighton–Nebraska (C–N) score for functional outcome was done at the end of 12 months.

Results

When we consider the clinical evaluation under the C–N score, the results of operatively managed calcaneal fractures are slightly better than those of the conservative group. But this did not have any statistical significance. Also, there was significant difference in pre and post treatment Bohler''s angle and heel varus angle in operative group. Three cases of plating suffered from post-operative wound dehiscence.

Conclusion

A relatively better functional outcome was observed in displaced and comminuted fractures in plating, provided that the Bohler''s angle was restored. In conservative group, functional outcome of minimally displaced fractures were better than displaced comminuted fractures. Post treatment Bohlers angle has prognostic importance in functional outcome.     

Birth-related femoral fracture in newborns: risk factors and management

Purpose

Femoral shaft fracture following birth in newborns is a very rare injury. However, the risk factors for, mechanism of and management of these injuries remain a matter of debate. We describe our observations in a tertiary centre.

Methods

Ten cases of femoral shaft fracture encountered during a study period from January 2005 to December 2009 were evaluated. The demographic details, risk factors during birth, systemic illness, mode of delivery, type of fracture and management used were documented, and an analysis was performed.

Results

Mean gestational age was 37.2 weeks. Mean time to diagnose was 4 days. Two patients had subtrochanteric fracture, and eight patients had mid-shaft fracture. Most patients had breech presentation and had been born by Caesarean section. All patients showed complete union at the end of 4 weeks. No residual angulation or limb length discrepancy was noted after mean follow-up of 5 years.

Conclusions

Thorough clinical examination and proper orthopaedic consult in the event of doubtful presentation help in early diagnosis and management. These fractures have good prognosis at long-term follow-up.     

Comparative study of fresh femoral neck fractures managed by multiple cancellous screws with and without fibular graft in young adults

Objectives

Aim of our study was to assess the role of addition of fibular strut graft to multiple cancellous screws in functional outcome, union and complications associated with those managed by only multiple cancellous screws in fresh femoral neck fractures.

Methods

A randomized control trial study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws (group A) and multiple cancellous screws with fibular graft (group B). Patients aged between 20 and 50 years, having Gardens type III or IV fracture with duration of injury less than two weeks were included in the study.

Results

Eighty seven cases were analysed n = 45 were in group A and n = 42 in group B. Functional outcome (Harris hip score) was excellent in 30 patients in group A as compared to 12 in Group B which was statistically significant favouring group A. The time of full weight bearing, union and non union rates showed no statistical significance (p > 0.05). On statistical grounds none of the procedures proved to be better than other.

Conclusions

Fresh femoral neck fracture in young adults managed with multiple cancellous screws fixation with fibular graft has no added advantage over multiple cancellous screws fixation alone.