Background: Fracture of the neck of the femur remains a challenging injury due to risks of non-union and avascular necrosis. In young and physiologically active patients, internal fixation is preferred to preserve the native femoral head. Dynamic Hip Screw (DHS) fixation provides controlled compression at the fracture site; however, rotational instability of the femoral head during and after fixation may adversely affect outcomes. Supplementation with a derotation screw has been advocated to enhance rotational stability.

Objectives: To evaluate the functional and radiological outcomes of fracture neck of femur treated with Dynamic Hip Screw fixation supplemented with a derotation screw and to assess associated complications.

Materials and Methods: This prospective study included patients with fracture neck of the femur managed with DHS and an additional derotation screw. Patients were followed up at regular intervals with clinical and radiological assessments. Fracture union, implant position, and complications such as non-union, avascular necrosis, and implant failure were documented. Functional outcome was assessed using a standard hip scoring system.

Results: In a total of 20 patients, fracture union is achieved in 19 patients (95%) of the patients, with a mean union time of 15 weeks. According to the Harris Hip Score, Functional outcome showed excellent to good results in 15 patients (75%) with a mean HHS of 86. Complications were observed in 10% of the patients, which included non-union in 1 patient (5%) and avascular necrosis in 1 patient (5%). Better functional and radiological outcomes were noted in Garden II & III fractures compared to Garden IV. DHS with a derotational screw provided improved rotational stability with no incidence of implant failure.

Conclusion: Dynamic Hip Screw fixation supplemented with a derotation screw is an effective and reliable method for managing selected fractures of the neck of femur. The technique provides enhanced rotational stability, satisfactory union rates, and favourable functional outcomes with minimal complications.