Fracture of the neck femur in young active adults is treated by internal fixation. The surgery has been associated with various complications like delayed union, non-union and avascular necrosis [1]. Various implants and fixation methods have been described in literature to minimize the complications and reduce the reoperation rates. The recent article titled ‘Role of Biplane Double-Supported Screw Fixation (BDSF) in Management of Fracture Neck Femur and Its Comparison with Conventional CC Screw Fixation’ by Garg et al. [2] explores a novel fixation method compared with the conventional one. It is a well-structured article and presents conclusive evidence in support of the new technique of ‘Biplane Double-Supported Screw Fixation (BDSF)’ for minimally invasive fixation of fracture neck of femur. The technique was first described by Filipov in 2011 [3] and its superiority over the conventional cannulated cancellous screw construct proved [4].
Although Garden classification system was used to classify the fractures, the Pauwell system of classification guides the treatment and choice of implant (cannulated cancellous screw or dynamic hip screw with or without valgus osteotomy) [5]. The high incidence of non-union and osteonecrosis in the conventional screw fixation group (18% as compared to 8% in the BDSF group) needs further analysis. The use of cannulated cancellous screw in vertical fracture configuration (type III Pauwell fractures) has been shown to have higher incidence of non-union [6]. The use of biomechanically stronger implants such as dynamic hip screws and femoral neck system in patients with higher Pauwels angle is recommended for better outcomes [7].
The authors have not explained the randomization process and the level of blinding applied [8]. The study subjects were divided into two groups on the basis of the surgical interventions. The selection of the patients and their division into two groups without randomization and baseline equity between the two groups is a potential source of bias. Two different sets of surgeons performed the surgeries in the two groups and the level of expertise of the surgeons can have an effect on the outcomes and be a potential source of bias.
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Conflict of Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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This article does not contain any studies with human or animal subjects performed by the any of the authors
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