Comparison of internal fixation results of intracapsular fracture of the femoral neck by two methods of cannulated screws and no-cannulated cancellous screws in osteoporotic patients

Abstract

The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in superior clinical outcomes and lower rates of complications compared to hip arthroplasty, besides preserving the patient’s own hip. Aim of the study: We conducted this randomized, double-blinded stratified clinical trial to compare the clinical outcomes of internal fixation with non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in osteoporotic patients with undisplaced intracapsular fractures of the femoral neck. Materials and methods: We included 57 patients with osteoporosis and undisplaced intracapsular fractures of the femoral neck, mean age of 71. 07 patients were randomized to the NCS group and 30 to the CS group. The Demographics of the patients, as well as their preoperative, perioperative, and post-operative characteristics, were evaluated and compared. The follow-up of the patients was conducted at 2 weeks, and 1, 3, 6, 12, and 24 months. Results: The surgical duration (NCS/CS: 46/41 minutes), the amount of intraoperative blood loss (NCS/CS: 58/49 ml), and the frequency of C-arm (NCS/CS: 13.48/3.30 times) were significantly lower in the group treated with CS, compared to the group treated with NCS (p < 0.05). The incidence of fixation failure (NCS/CS: 0/3) was higher in the CS group compared to the NCS group, however, it was not statistically significant (p = 0.13). The incidence of implant failure (NCS/ CS: 4/0) was significantly greater in the NCS group in comparison to the CS group (p = 0.04). The incidence of screw migration (NCS/CS: 0/5) was meaningfully higher in the CS group (P = 0.03). The HHS values of the NCS group were significantly higher than those of the CS group at both the 1-year (NCS/CS: 80.48 ± 7.30/75.03 ± 7.43) and 2-years (NCS/CS: 89.11 ± 5.73/83.93 ± 5.59) of follow-up assessments (1 year, P = 0.007; 2 years, P = 0.001).