The New Approach To Hip Joint

Objective: To introduce a new approach to the hip joint for intra-capsular neck femur (ICNF) fracture fixation Design: Prospective study of 37 hips in 36 patients treated from January 2022 to December 2023. Patients were operated by new approach and fixed by Cancellous Cannulated screws or by angle stable side plate construct (DHS, FNS) along with anti-rotation screws with or without anteromedial buttress plate. Aim was to achieve anatomic reduction, absolute stability, compression at fracture site without losing neck length. Garden’s alignment index (GAI) used to assess the quality of reduction. Functional assessment done by Harris Hip Score (HHS). Regular follow up for wound healing, fixation failure, union of fracture, osteonecrosis, infection done. Setting: Single center Patient Selection Criteria – Patients between 18 to 65 years with AO/OTA type 31B1, 31B2, 31B3 & Gardens type III & type IV ICNF fracture included with minimum follow-up of 24 months. Patients with pathological fractures and previous hip surgery excluded. Outcome Measures and Comparisons - Garden’s alignment index (GAI) used to assess the quality of reduction. Functional assessment done by Harris Hip Score (HHS). Results: “AP’s Access” gives excellent exposure and ease of reduction. Out of 37 hips 36 went on to unite with one hip requiring arthroplasty. According to GAI, grade I reduction in 28 and grade II in 9 patients. HHS score suggests excellent outcome in 28, good in 5, fair in 2 and poor in 1 patient. No patient had limp, infection, paraesthesia, thromboembolism. Conclusions: “AP’s Access” is a new approach to hip which addresses the apprehensions related with anterior approaches. It’s a safe route with easy reproducibility, manoeuvrability, good exposure, and less complications. Level of Evidence – Level II