COMPARATIVE STUDY ON THE OUTCOME OF PAUWELLS OSTEOTOMY AND TOTAL HIP REPLACEMENT IN NEGLECTED FRACTURE NECK OF FEMUR IN YOUNG ADULTS
Keywords:Neglected fracture neck of femur, THR, Pauwells Osteotomy, Harris Hip Score
Introduction: Neglected fracture neck of femur remains a challenge for Orthopedicians. Various options are available; each having its own pros and cons. In young adults there is always a dilemma whether to salvage the head and perform osteotomy or opt for radical surgery like THR. The present study was done for a comparative analysis between two procedures: Pauwells osteotomy and total hip replacement and decide which is better opted for our Indian scenario.
Material and methods: 47 cases of neglected fracture neck of femur operated during December 2017– January 2021 were included in this study. Cases were divided into two groups based on the method of surgery, Group 1: Pauwells osteotomy 17 cases and Group 2: THR 30 cases. The comparision was done on the basis of operative and post operative parameters like duration of surgery, blood loss, pain, duration of hospital stay, hip functionality by Harris Hip Score and complications like infection, dislocation, limb length shortening.
Results: On assessing the operative parameters, it was found that duration of surgery was longer and statistically significant in Pauwells osteotomy; along with more blood loss. For the post-operative parameters, the duration of pain was longer and Hb level was less in Pauwells ostetomy which was statistically significant. However the hip functionality as assessed by Harris Hip Score was found to be not statistically significant.
Conclusion: Both modalities of treatment i.e Pauwells ostetomy and THR restore the hip functionality in neglected fracture neck of femur; however Pauwells osteotomy has the advantage of preservation of native hip which is an essential requisite for squatting and other hip activities in relatively younger neglected fracture neck of femur patients whereas THR remains indisputable choice in less physically demanding patients.