Introduction: Hip fractures are serious injuries that often occur in the elderly and are associated with significant morbidity and mortality. Although a majority of hip fractures occur in elderly patients a proportion of these injuries can affect younger patients. The treatment of hip fractures depends on multiple factors such as, location of the fracture, degree of displacement, and patient demographics. Intracapsular hip fractures occur within the joint capsule of the hip, involving the femoral neck and the head of the femur. Closed reduction and internal fixation is a common surgical procedure used to treat intracapsular hip fractures, particularly in younger patients or those with less displacement in an attempt to preserve the native femoral head. This case series describes a single surgeon experience on managing intracapsular hip fractures with closed reduction and internal fixation over a 5 year period.
Methods: A retrospective data collection was carried out to identify patients who underwent closed reduction and internal fixation for intracapsular hip fractures over a 5 year period at a single general orthopaedic unit.
Results: Eight patients over a 5 year period were identified that underwent a closed reduction and 2-hole DHS fixation with an anti-rotation screw. The mean age was 55. One patient had a Garden type 1 fracture, six patients had a Garden type 3 fracture, and one patient had a Garden type 4 fracture. Patients were followed up for an average of 12.1 months. All eight patients had evidence of radiographic healing on follow up x-rays. There were no cases of AVN reported, no cases of hardware failure identified, and no patients required a repeat operation.
Conclusion: This case series adds to the literature of patients with intracapsular hip fractures managed with closed reduction and internal fixation. Favourable outcomes are reported in this series with 100% rates of union and no cases of AVN or hardware complications. The surgical preference of Whitman’s reduction followed by fixation with a 2-Hole DHS along with an anti-rotation wire has demonstrated favourable outcomes.
Keywords: Femoral neck fracture; DHS; Closed reduction
