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Research ArticleOriginal Article
Open Access

Treatment of non-displaced intracapsular femoral neck fractures with dynamic hip and cannulated screws resulting in avascular necrosis

A comparative study of complications

Hashem A. Bukhary, Fahd I. Aljuaid, Khalid M. Alhomayani, Abdulelah A. Saati, Amaal M. Aldosari, Wateen A. Hammadi, Hamed S. Qutbuddeen, Abdulhafiz A. Wazuddin, Haneen A. Hammadi and Amjad M. Jawhari
Saudi Medical Journal January 2024, 45 (1) 54-59; DOI: https://doi.org/10.15537/smj.2024.45.1.20230684
Hashem A. Bukhary
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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  • ORCID record for Hashem A. Bukhary
  • For correspondence: [email protected]
Fahd I. Aljuaid
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Khalid M. Alhomayani
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Abdulelah A. Saati
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Amaal M. Aldosari
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Wateen A. Hammadi
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Hamed S. Qutbuddeen
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Abdulhafiz A. Wazuddin
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Haneen A. Hammadi
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Amjad M. Jawhari
From the Department of Surgery (Bukhary, Aljuaid, Alhomayani), Orthopaedic Division; from the College of Medicine (Jawhari), Taif University, from the Department of Orthopedic Surgery (Saati), King Abdulaziz Specialist Hospital, Taif, from the Department of Orthopedic Surgery (Aldosari), Al Noor Specialist Hospital, from the Department of Orthopedic Surgery (Qutbuddeen), King Abdulaziz Hospital, from the Department of Orthopedic Surgery (Wazuddin), King Faisal Hospital, Makkah, from the Department of Orthopedic Surgery (W. A. Hammadi), King Fahd Specialist Hospital, Dammam, Kingdom of Saudi Arabia, and from the Department of Surgery (H. A. Hammadi), College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    - Intraoperative images displaying right femoral neck fractures fixed by cannulated hip screws. A) Anteroposterior and B) lateral views.

  • Figure 2
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    Figure 2

    - Intraoperative images displaying left femoral neck fractures fixed by dynamic hip screws with anti-rotational screws. A) Anteroposterior and B) lateral views.

  • Figure 3
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    Figure 3

    - Postoperative images display a fracture complicated by avascular necrosis of the right femur head. A) Coronal CT; B) an anteroposterior x-ray; and C) an axial MRI views of the right hip.

  • Figure 4
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    Figure 4

    - A fixed fractured neck of the femur is complicated by non-union and implant failure on an anteroposterior x-ray view.

Tables

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    Table 1

    - Patient’s characteristics.

    Variablesn (%)
    Total85 (100)
    Male35 (41.2)
    Female50 (58.8)
    DHS patients41 (48.2)
    CHS patients44 (51.8)
    DHS, mean±SD72±5.4
    CHS, mean±SD70.6±7.6
    Mean follow up period, mean±SD24±5.6 months

    Values are presented as numbers and precentages (%) or mean ± standard deviation (SD). DHS: dynamic hip screws, CHS: cannulated hip screws

      • View popup
      Table 2

      - Epidemiological data.

      TechniquesMechanismsPre-op T (hours)OR T (minutes)Anesthesia
      DHSHI-E (n=8) / Low-E (n=33)99.5 (44-155)75 (65-135)GA (n=8)S (n=33)
      CHSHI-E (n=11) / Low-E (n=33)105 (24-189)80 (60-160)GA (n=12)S (n=32)

      DHS: dynamic hip screws, CHS: cannulated hip screws, Pre-op T: preoperative waiting time until operation day, OR T: operation time, HI-E: high energy, Low-E: low energy, GA: general anesthesia, S: spinal, n: number

        • View popup
        Table 3

        - Rate of complications.

        Complicationsn (%)P-values
        Mortality
        DHS7/44 (15.9)>0.05*
        CHS7/41 (17.1)
        Non-union
        DHS2/42 (4.5)>0.05†
        CHS2/41 (4.9)
        Avascular necrosis
        DHS4/44 (9.1)<0.05*
        CHS2/41 (4.9)
        Revision
        DHS7/44 (15.9)>0.05†
        CHS6/41 (14.6)

        Values are presented as numbers and precentages (%).

        DHS: dynamic hip screws, CHS: cannulated hip screws

        • ↵* Significant.

        • ↵† Insignificant.

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      Treatment of non-displaced intracapsular femoral neck fractures with dynamic hip and cannulated screws resulting in avascular necrosis
      Hashem A. Bukhary, Fahd I. Aljuaid, Khalid M. Alhomayani, Abdulelah A. Saati, Amaal M. Aldosari, Wateen A. Hammadi, Hamed S. Qutbuddeen, Abdulhafiz A. Wazuddin, Haneen A. Hammadi, Amjad M. Jawhari
      Saudi Medical Journal Jan 2024, 45 (1) 54-59; DOI: 10.15537/smj.2024.45.1.20230684

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      Treatment of non-displaced intracapsular femoral neck fractures with dynamic hip and cannulated screws resulting in avascular necrosis
      Hashem A. Bukhary, Fahd I. Aljuaid, Khalid M. Alhomayani, Abdulelah A. Saati, Amaal M. Aldosari, Wateen A. Hammadi, Hamed S. Qutbuddeen, Abdulhafiz A. Wazuddin, Haneen A. Hammadi, Amjad M. Jawhari
      Saudi Medical Journal Jan 2024, 45 (1) 54-59; DOI: 10.15537/smj.2024.45.1.20230684
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      Keywords

      • femoral neck fracture
      • internal fixation devices
      • complications

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