COMPARATIVE ANALYSIS OF SURGICAL VERSUS CONSERVATIVE MANAGEMENT IN DISPLACED FEMORAL NECK FRACTURES
Main Article Content
Keywords
Displaced femoral neck fractures, surgical management, conservative treatment, hip fractures, clinical outcomes
Abstract
Displaced femoral neck fractures represent challenging orthopedic conditions with significant morbidity and mortality implications. The optimal management approach remains controversial, with ongoing debates between surgical intervention and conservative treatment. This study aimed to compare clinical outcomes, functional recovery, complications, and cost-effectiveness of surgical versus conservative management in patients with displaced femoral neck fractures.
Methods: A prospective comparative study was conducted at Annamalai Medical College and Hospital, Chennai, from January 2017 to June 2017. Two hundred patients with displaced femoral neck fractures (Garden III-IV) were enrolled through consecutive sampling, with 100 patients in each treatment group. The surgical group underwent internal fixation or arthroplasty, while the conservative group received skeletal traction and gradual mobilization. Outcome measures included Harris Hip Score, pain assessment, radiological healing, complications, and cost analysis. Follow-up assessments were conducted at 3, 6, and 12 months post-treatment.
Results: The surgical group demonstrated superior functional outcomes with higher Harris Hip Scores (78.3±14.6 vs 52.4±18.9, p<0.001) and better return to pre-fracture mobility (67% vs 18%, p<0.001). Mortality was significantly lower in surgical patients at 30 days (4% vs 18%) and one year (8% vs 34%). Fracture union rates were superior with surgical management (78% vs 23%, p<0.001), with reduced nonunion (12% vs 67%) and avascular necrosis (15% vs 45%). Conservative patients experienced higher rates of immobilization complications including pneumonia (23% vs 6%) and pressure ulcers (34% vs 3%).
Conclusion: Surgical management of displaced femoral neck fractures demonstrated superior clinical outcomes, reduced complications, and better functional recovery compared to conservative treatment, supporting operative intervention as the preferred approach in appropriate candidates.
References
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Dr. Mahender Rohria
Assistant Professor, Department of Orthopaedics, Annaii Medical College & Hospital, Chennai, Tamil Nadu, India