DUGi

Functional Outcome of Total Hip Arthroplasty vs Dynamic Hip Screw with antirotation screw for Pauwels type III femoral fractures in active patients

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Pauwels type III femoral neck fractures are intracapsular injuries characterised by a vertical fracture line (angle >50°), which generates high shear forces and results in marked biomechanical instability.  Participants and methods Over an estimated recruitment period of 24 months a total of 72 patients aged between 50 and 75 years diagnosed with an acute Pauwels type III femoral neck fracture will be randomly assigned in a 1:1 ratio to undergo either THA or DHS with an antirotation screw. Clinical and functional follow-up assessments will be conducted at 3 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months postsurgery. Functional recovery will be primarily evaluated using the Harris Hip Score (HHS). Data analysis will include descriptive, bivariate and multivariate analysis by a blinded statistician In functionally active patients aged 50–75 years, surgical treatment must balance two objectives: fracture stabilization and fast functional recovery. For this, two surgical strategies are currently used. On one hand, internal fixation using a dynamic hip screw (DHS) combined with an antirotation screw: aimed at preserving the native hip joint. On the other hand, total hip arthroplasty (THA) provides immediate stability by replacing the joint. Currently, there is controversy regarding which of these two strategies offers better results in active patients with Pauwels type III femoral fractures.  Objective The aim of this study is to compare functional outcomes and complication rates of DHS+antirotation screw versus total hip arthroplasty in patients aged 50 to 75 years diagnosed with Pauwels type III femoral neck fractures, over a 24-month follow-up period, using the modified Harris Hip Score as the primary outcome measure.  Design This study is designed as prospective, randomized, single-blind and multicentric clinical trial carried out at two reference hospitals in the province of Girona: Hospital Universitari Dr. Josep Trueta and the Hospital Santa Caterina within the Orthopaedics and Trauma Surgery (OTS) Department

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