Comparison of Screws Alone versus Screws Plus Bone Graft for Garden Type III Femur Fractures

Abstract

Background & Objectives: Femoral neck fractures (FNF) are common injuries and are associated with complications such as non-union and osteonecrosis. The management of these fractures is a subject of ongoing debate, particularly concerning deciding whether to save or replace femoral head. In younger patients, surgical interventions that prioritize the preservation of hip anatomy and function are essential. This study evaluated the functional outcomes and union rates of Garden type III FNFs treated with cannulated screws alone versus cannulated screws with bone grafting. Methodology: A prospective comparative cross-sectional study was conducted at the Department of Orthopaedic Surgery, Mayo Hospital, Lahore. Seventy patients with Garden type III FNFs were randomly allocated into two groups. Group A underwent fixation with cannulated screws only, while Group B received cannulated screws with bone grafting. Functional outcomes were assessed using the Harris Hip Score (HHS), and radiological healing was evaluated with Radiographic Union Score for Hip (RUSH). Results: Group B demonstrated significantly better outcomes compared to Group A. The mean HHS was 88.86 ± 3.16 in Group B versus 84.57 ± 4.46 in Group A (p < 0.001). Bone healing was also superior in Group B, with mean RUSH bridging scores of 9.89 ± 0.86 compared to 8.63 ± 1.14 in Group A (p < 0.001). The fracture line reduction score was higher in Group B (9.83 ± 0.66 vs 8.71 ± 0.95, p < 0.001). Conclusion: Cannulated screw fixation supplemented with bone grafting significantly improves functional recovery and bone healing compared with screw fixation alone.