Biplane Double-Supported Screw Fixation for Femoral Neck Fractures – Radiological and Early Functional Outcomes

Open Access

Abstract

Background: Hip fractures are a major cause of disability worldwide, and intracapsular femoral neck fractures often lead to nonunion, avascular necrosis, and fixation failure. Biplane double-supported screw fixation uses two oblique planes with a dual cortical buttress to improve stability during early mobilization. Methods & Materials: This prospective observational study was conducted at NITOR, Dhaka, from July 2018 to June 2020. Thirty-one adults with recent closed femoral neck fractures (Garden I–II and Garden III–IV in patients <65 years) underwent biplane double-supported screw fixation. Patients were followed for six months, with outcomes assessed by radiological union, complications, pain, hip range of motion, and the Harris Hip. Results: Among 31 patients (mean age 42.7 years; 61.3% male), most fractures were due to motor vehicle accidents (83.9%), with Garden I–II fractures comprising 87.1%. Radiological union was achieved in 96.8% of cases, with a mean union time of 17.9 weeks, occurring faster in Garden I–II than Garden III fractures. Complications were infrequent (16.1%), including wound infection, delayed union, and one case of nonunion, with no deep vein thrombosis. Functional outcomes were favorable, with a mean Harris Hip Score of 86.5 and 74.2% of patients achieving good-to-excellent results, alongside minimal limp, limited need for walking support, and preserved hip motion. Conclusion: Biplane double-supported screw fixation demonstrated high rates of early union, prompt radiological healing, and favorable early functional outcomes with a low incidence of nonunion in adult femoral neck fractures. BDSF represents an effective head-preserving intervention for appropriately selected patients.