CANNULATED SCREW FIXATION

Indications

• Undisplaced fractures of neck of femur (Garden Grade I, II).

• Displaced fractures in patients with adequate bone density and no severe chronic illness (rheumatoid arthritis, renal failure).

• Active individuals up to mid 70s.

Pre-operative planning

Clinical assessment

• Groin pain localized in the affected hip site – radiation of pain to the knee.

• Limb is shortened and externally rotated.

• Assess and document neurovascular status of the leg.

• In young patients carefulexaminationforotherinjuries must be made, as they are a result of high-energy trauma.

• A complete medical examination in elderly patients.

Radiological assessment

• Anteroposterior radiograph and a lateral view of the affected hip (Fig. 9.16a,b).

• Evaluate head retroversion and posterior comminution.

• Assess primary and secondary compression and tension trabeculae on radiographs.

• CT or bone scans when physical signs are lacking.

Timing of surgery

• The outcome is improved if the surgery is performed within 8 hours.

• For young patients it is a true orthopaedic emergency.

Operative treatment

Anaesthesia

• Regional (spinal/epidural)and/orgeneral anaesthesia.

• At induction, administer prophylactic antibiotic as per local hospital protocol.

Table and equipment

• Use a 7.0 or 7.3 cannulated screw set – ensure the availability of the complete set of implants.

• A radiolucent table or a fracture table with the appropriate traction devices.

• An image intensifier.