Vol. 6, Issue 1, Part A (2024)

Background: Femoral neck fractures, comprising 3.6% of all body fractures and 57% of hip fractures, are increasingly common among younger adults due to high-energy trauma. Pauwel’s type III fractures, characterized by a steep vertical angle, are particularly challenging, with high non-union rates and complications resulting from severe shear forces. Accurate measurement of Pauwel’s angle is essential for predicting outcomes. This study compares Dynamic Hip Screw (DHS) and Proximal Femur Plate (PFP) fixation methods in treating Pauwel’s type III fractures, focusing on intraoperative factors, outcomes, and complications.
Patients and Methods: This prospective study conducted at Al-Kindy Teaching Hospital, Baghdad, included 16 adults with Pauwel’s type III fractures. Over one year (April 2023–2024), patients were divided into two groups: Group A (7 patients) received PFP fixation, while Group B (6 patients) underwent DHS fixation with an anti-rotation screw. Preoperative evaluations included routine exams, imaging, and anesthesiologist consultations. Surgery was performed under anesthesia, followed by rehabilitation and regular follow-ups. Data on surgery time, blood loss, and complications were collected and analyzed using SPSS, with a p-value <0.05 considered significant.
Results: Groups A and B were similar in demographics, fracture characteristics, and mechanisms of injury. Group A had a slightly longer surgery time (1.45 vs. 1.32 hours) and more intraoperative blood loss, though differences were not statistically significant. Postoperative assessments showed comparable fracture healing times (12.2 vs. 13.1 weeks) and Harris Hip Scores. Group A experienced higher postoperative complications, including non-union (14.28%) and infection (14.28%), while Group B had one case of mal-union (16.66%). None of these differences were statistically significant, though Group A showed a trend toward more complications.
Conclusions: Both DHS and PFP fixation methods are effective for treating Pauwel’s type III femoral neck fractures. The study found no significant differences in operation time, blood loss, healing, or functional outcomes between the two methods, though Group A exhibited a slightly higher rate of complications.