From the Research
Dynamic Hip Screw (DHS) plating is not the preferred treatment for intracapsular femoral neck fractures, and instead, arthroplasty or multiple cannulated screws are recommended. The treatment of intracapsular femoral neck fractures depends on patient age, fracture displacement, and bone quality. In younger patients (under 60), preservation of the femoral head is attempted using multiple cannulated screws placed parallel to each other 1. For older patients or displaced fractures, arthroplasty is preferred due to high rates of avascular necrosis and nonunion with internal fixation 1.
If DHS were to be used, the procedure would involve:
- Patient positioning on a fracture table under general or spinal anesthesia
- Closed reduction under fluoroscopic guidance
- A lateral incision at the proximal femur
- Insertion of a guide wire into the femoral neck and head
- Reaming over the guide wire
- Insertion of the lag screw
- Attachment of the side plate to the femoral shaft with cortical screws
Postoperatively, patients typically receive prophylactic antibiotics (such as cefazolin 1-2g IV) and thromboprophylaxis (enoxaparin 40mg daily or equivalent) 2. Weight-bearing restrictions would be implemented based on fracture stability, with physical therapy initiated early. The reason DHS is not preferred for intracapsular fractures is that these fractures have a tenuous blood supply, and the larger implant of a DHS can further compromise circulation to the femoral head 3.
Key considerations for the treatment of intracapsular femoral neck fractures include:
- Patient age and bone quality
- Fracture displacement and stability
- Risk of avascular necrosis and nonunion
- Need for early mobilization and weight-bearing
In general, the goal of treatment is to achieve stable fixation, promote healing, and minimize complications, with a focus on improving patient outcomes and quality of life 4, 5.