Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures

Watson, A., Zhang, Y., Beattie, S. and Page, R. S. 2013, Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures, ANZ journal of surgery, vol. 83, no. 9, pp. 679-683, doi: 10.1111/j.1445-2197.2012.06256.x.

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Title Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures
Author(s) Watson, A.
Zhang, Y.
Beattie, S.
Page, R. S.ORCID iD for Page, R. S. orcid.org/0000-0002-2225-7144
Journal name ANZ journal of surgery
Volume number 83
Issue number 9
Start page 679
End page 683
Total pages 5
Publisher Wiley-Blackwell Publishing
Place of publication Richmond, Vic.
Publication date 2013-09
ISSN 1445-1433
1445-2197
Keyword(s) fracture
bone screw
hip injury
independent living
injury
Summary Background
Neck of femur fractures (NOFFs) are a common cause of morbidity and mortality in our community. Minimally displaced intracapsular fractures are treated with internal fixation by a two-hole dynamic hip screw (DHS) or three partially threaded cancellous screws. Data to support the superiority of one are limited. This prospective randomized controlled trial compares outcomes with these two fixation methods.

Methods
We prospectively recruited patients over 50 years, with an acute fracture subcapital NOFF, who walked and lived independently, and were cognitively intact. They were randomized into DHS or cancellous screw groups and followed up for 2 years (overall 75.9%). Outcomes of mortality, revision, loss of fixation, avascular necrosis, surgical complications, WOMAC, Harris hip score and SF-12 were measured.

Results
We recruited 62 patients (31 DHS, 29 cancellous screws, 2 failed consent). Six deaths (19.3%) were seen in each group. A total of 3.2% of DHS (1 out of 31) and 10.3% (3 out of 29) of cancellous screw patients required re-operation (P = 0.272). There was no statistical significant difference in patient satisfaction, quality of life (QoL), radiological union or osteonecrosis. There are trends towards better functional scores and QoL in cancellous screws, particularly at 1 year (P = 0.0061), but with a higher re-operation rate. There was a combined mortality and transition to institutional care of 40.0% (24 out of 60) at 2 years.

Conclusions
This study found no difference in outcomes between DHS and cancellous screws in the treatment of subcapital NOFFs in a fit, independent population, but we found a high level of physical decline in previously fit, independently ambulating patients. A large, multicentre trial will be required to differentiate between these two fixation methods.
Language eng
DOI 10.1111/j.1445-2197.2012.06256.x
Field of Research 110314 Orthopaedics
Socio Economic Objective 920116 Skeletal System and Disorders (incl. Arthritis)
HERDC Research category C1.1 Refereed article in a scholarly journal
Persistent URL http://hdl.handle.net/10536/DRO/DU:30053456

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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