Factors influencing femoral neck fracture healing after internal fixation with dynamic locking plate

Objective To examine the imaging evidence of the use of percutaneous compression plate (PCCP) in promoting femoral neck fracture healing compared with cannulated screws (CS). Methods This retrospective study enrolled patients with femoral neck fractures undergoing internal fixation procedures. The patients were divided into a PCCP group and a CS group with imaging as the primary outcome and Harris hip score (HHS) as the secondary outcome. Results This study included 162 patients: 80 in the PCCP group and 82 in the CS group. There were no significant differences between the patients in their preoperative baseline characteristics. Patient follow-up ranged from 24–56 months (mean 30.7 months). Differences in reduction quality, screw slipping, neck shortening and avascular necrosis (AVN) were not significant between the two groups. There were significant differences between the treatment groups in bone absorption, nonunion, healing time, screw withdrawal and fixation failure in favour of the PCCP group. Postoperative HHS at 6 and 12 months were significantly better for the PCCP group than the CS group, but the differences were not significant at 24 months and last follow-up. Conclusion Stable internal fixation with dynamic compression was the key to PCCP promoting femoral neck fracture healing.

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Results of the application of a new method of internal fixation of femoral neck fractures - self-tapping antirotation cannulated screws (SAF)

Acta chirurgica iugoslavica ◽

10.2298/aci1302071k ◽

2013 ◽

Vol 60 (2) ◽

pp. 71-79

Author(s):

Igor Kostic ◽

Milan Mitkovic ◽

Milorad Mitkovic

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Fracture Healing ◽

Femoral Neck Fracture ◽

Functional Recovery ◽

Femoral Neck Fractures ◽

New Method ◽

Cannulated Screws ◽

Neck Fracture

Introduction: Femoral neck fractures are one of the most common fractures primarily the elderly, coupled with a high degree of morbidity and mortality. The treatment is applied a number of methods of internal fixation (multiple cannulated screws available, DHS system, cefalomedullary). At the Department of Orthopedics and Traumatology of Nis developed a new method of fixation of femoral neck fracture, which allows stable fixation of dislocated and nondislocated femoral neck fracture. Self-tapping antirotation fixation (SAF) using two cannulated screws to initial compression fractures intraoperative and postoperative dynamic linear compression of the fracture with early full support to the patient. Matherial and methods: In the period between 2008 to 2012, 53 patients treated for femoral neck fracture in the Clinic for orthopedic and traumatology, Clinical center in Nis, Serbia, by SAF (the self-tapping cannulated screws antirotation; ORTOKON doo Nis). All patients were followed up after surgery in a minimum period of 13 weeks (13-106 weeks). The outcome was evaluated on the basis of clinical and radiological signs of fracture healing and the Harris hip score of functional recovery of the patient. Results: Of the total number of patients (53) treated with this method of fixation, 31 of them were females and 22 males, mean age 52.7 years (28-75 years). The average time of surgery was 36.4 minutes (19-70 minutes). During the postoperative follow-up of all patients (53) operated by this method, six patients were lost in the further postoperative monitoring, so that 47 patients remained for final evaluation. The total incidence of nonunion of femoral neck fracture after surgery this method was 6.4% (three patients). Shortening of the femoral neck after fixation by this method was recorded in 27 cases, and what amounted to an average of 2.8 mm (1, 2 mm in nondislocated to 4.55 with dislocated fracture) and did not affect the functional outcome. During radiographic follow-up was not detected fracture implants. Conclusion: Self-tapping screws cannulated antirotacioni (SAF method) represent a reliable method of fixation of dislocated and nondislocated femoral neck fracture. The main prerequisite for the proper healing of femoral neck fractures with this method is that anatomical fracture reduction is achieved by a closed or open method. This way of fixation allows the early full weight bearing patient operated limb and faster postoperative functional recovery of the fracture healing in optimal time.

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Computer-assisted cannulated screw internal fixation versus conventional cannulated screw internal fixation for femoral neck fractures: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02806-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Qing-hao Cheng ◽

Peng-biao Li ◽

Ting-ting Lu ◽

Shi-fang Guo ◽

Wen-fei Di ◽

...

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Fracture Healing ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Operation Time ◽

Healing Time ◽

Cannulated Screw ◽

Computer Assisted ◽

Neck Fracture

Abstract Objective To compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture. Methods The search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups. Results A total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time. Conclusion Compared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture. Study registration PROSPERO registration number CRD42020214493.

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Application of Robot Positioning for Cannulated Screw Internal Fixation in the Treatment of Femoral Neck Fracture: Retrospective Study (Preprint)

10.2196/preprints.24164 ◽

2020 ◽

Author(s):

Lei Wan ◽

Xiangyun Zhang ◽

Dalong Wu ◽

Zhihao Li ◽

Dongtao Yuan ◽

...

Keyword(s):

Surgical Treatment ◽

Femoral Neck ◽

Internal Fixation ◽

Fracture Healing ◽

Femoral Neck Fracture ◽

Cannulated Screw ◽

Control Group ◽

Study Group ◽

Robot Assisted ◽

Neck Fracture

BACKGROUND Femoral neck fracture is a common type of hip fracture. Conventional surgical treatment aims at fixing the fracture site with screws and then gradually promoting bone healing. A robot-assisted orthopedic surgery system is computer technology applied to surgical treatment. OBJECTIVE This study aimed to explore the therapeutic effect and prognostic value of percutaneous cannulated screw internal fixation using robot-assisted positioning in patients with femoral neck fractures. METHODS From July 2018 to September 2019, 42 cases of femoral neck fracture admitted to the Second Affiliated Hospital of Luohe Medical College were randomly and averagely divided into control and study groups. The patients in the control group were treated with conventional percutaneous cannulated screw internal fixation, while the patients in the study group were treated with robot-assisted percutaneous cannulated screw fixation during surgical treatment. We compared the treatment conditions and results of the operation between the 2 groups. The Harris score was used to evaluate the treatment efficacy. The state of fracture healing was followed up and compared between the 2 groups. RESULTS The duration of the operation was shorter, there was less fluoroscopy use, and there were fewer drilled holes in the study group than in the control group (all, P<.001). There was no statistical difference in the amount of intraoperative bleeding between the 2 groups (P=.33). The Harris score (P=.045) and number of excellent and good ratings (P=.01) were significantly higher in the study group than in the control group. The difference in the fracture healing rate between the 2 groups was not statistically significant (P=.23). The fracture healing duration of the study group was shorter than that of the control group (P=.001). CONCLUSIONS The use of robotic positioning aids in the treatment of femoral neck fractures with percutaneous cannulated screw fixation can effectively improve the efficiency of surgery, shorten the duration of surgery, and reduce the radiation damage to patients. Meanwhile, it improves postoperative treatment and recovery rates of the patients and shortens the fracture healing time.

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Application of Robot Positioning for Cannulated Screw Internal Fixation in the Treatment of Femoral Neck Fracture: Retrospective Study

JMIR Medical Informatics ◽

10.2196/24164 ◽

2021 ◽

Vol 9 (1) ◽

pp. e24164

Author(s):

Lei Wan ◽

Xiangyun Zhang ◽

Dalong Wu ◽

Zhihao Li ◽

Dongtao Yuan ◽

...

Keyword(s):

Surgical Treatment ◽

Femoral Neck ◽

Internal Fixation ◽

Fracture Healing ◽

Femoral Neck Fracture ◽

Cannulated Screw ◽

Control Group ◽

Study Group ◽

Robot Assisted ◽

Neck Fracture

Background Femoral neck fracture is a common type of hip fracture. Conventional surgical treatment aims at fixing the fracture site with screws and then gradually promoting bone healing. A robot-assisted orthopedic surgery system is computer technology applied to surgical treatment. Objective This study aimed to explore the therapeutic effect and prognostic value of percutaneous cannulated screw internal fixation using robot-assisted positioning in patients with femoral neck fractures. Methods From July 2018 to September 2019, 42 cases of femoral neck fracture admitted to the Second Affiliated Hospital of Luohe Medical College were randomly and averagely divided into control and study groups. The patients in the control group were treated with conventional percutaneous cannulated screw internal fixation, while the patients in the study group were treated with robot-assisted percutaneous cannulated screw fixation during surgical treatment. We compared the treatment conditions and results of the operation between the 2 groups. The Harris score was used to evaluate the treatment efficacy. The state of fracture healing was followed up and compared between the 2 groups. Results The duration of the operation was shorter, there was less fluoroscopy use, and there were fewer drilled holes in the study group than in the control group (all, P<.001). There was no statistical difference in the amount of intraoperative bleeding between the 2 groups (P=.33). The Harris score (P=.045) and number of excellent and good ratings (P=.01) were significantly higher in the study group than in the control group. The difference in the fracture healing rate between the 2 groups was not statistically significant (P=.23). The fracture healing duration of the study group was shorter than that of the control group (P=.001). Conclusions The use of robotic positioning aids in the treatment of femoral neck fractures with percutaneous cannulated screw fixation can effectively improve the efficiency of surgery, shorten the duration of surgery, and reduce the radiation damage to patients. Meanwhile, it improves postoperative treatment and recovery rates of the patients and shortens the fracture healing time.

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Combination of CRP with NLR is a sensitive tool for screening fixation-related infection in patients undergoing conversion total hip arthroplasty after failed internal fixation for femoral neck fracture

The Bone & Joint Journal ◽

10.1302/0301-620x.103b.bjj-2021-0105.r1 ◽

2021 ◽

pp. 1-7

Author(s):

Hong Xu ◽

Jin-Wei Xie ◽

Li Liu ◽

Duan Wang ◽

Ze-Yu Huang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Sensitivity And Specificity ◽

Hip Arthroplasty ◽

Lymphocyte Ratio ◽

Total Hip ◽

Sensitive Tool ◽

Neck Fracture

Aims Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture. Methods We retrospectively included 340 patients who underwent conversion THA after internal fixation for femoral neck fracture from January 2008 to September 2020. Those patients constituted two groups: noninfected patients and patients diagnosed with FRI according to the 2013 International Consensus Meeting Criteria. Receiver operating characteristic (ROC) curves were used to determine maximum sensitivity and specificity of these two preoperative ratios. The diagnostic performance of the two ratios combined with preoperative CRP or ESR was also evaluated. Results The numbers of patients with and without FRI were 19 (5.6%) and 321 (94.4%), respectively. Areas under the ROC curve for diagnosing FRI were 0.763 for MLR, 0.686 for NLR, 0.905 for CRP, and 0.769 for ESR. Based on the Youden index, the optimal predictive cutoffs were 0.25 for MLR and 2.38 for NLR. Sensitivity and specificity were 78.9% and 71.0% for MLR, and 78.9% and 56.4% for NLR, respectively. The combination of CRP with MLR showed a sensitivity of 84.2% and specificity of 94.6%, while the corresponding values for the combination of CRP with NLR were 89.5% and 91.5%, respectively. Conclusion The presence of preoperative FRI among patients undergoing conversion THA after internal fixation for femoral neck fracture should be determined. The combination of preoperative CRP with NLR is sensitive tool for screening FRI in those patients.

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Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly

Chinese Medical Journal ◽

10.4103/0366-6999.192788 ◽

2016 ◽

Vol 129 (21) ◽

pp. 2630-2638 ◽

Cited By ~ 13

Author(s):

Chen-Yi Ye ◽

An Liu ◽

Ming-Yuan Xu ◽

Nwofor Samuel Nonso ◽

Rong-Xin He

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

The Elderly ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture

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Guidance for the Treatment of Femoral Neck Fracture with Precise Minimally Invasive Internal Fixation Based on the Orthopaedic Surgery Robot Positioning System

Orthopaedic Surgery ◽

10.1111/os.12451 ◽

2019 ◽

Vol 11 (3) ◽

pp. 335-340 ◽

Cited By ~ 8

Author(s):

Xin‐bao Wu ◽

Jun‐qiang Wang ◽

Xu Sun ◽

Wei Han

Keyword(s):

Femoral Neck ◽

Minimally Invasive ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Orthopaedic Surgery ◽

Positioning System ◽

Robot Positioning ◽

Neck Fracture ◽

Minimally Invasive Internal Fixation

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Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1377-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Hsuan-Hsiao Ma ◽

Te-Feng Arthur Chou ◽

Shang-Wen Tsai ◽

Cheng-Fong Chen ◽

Po-Kuei Wu ◽

...

Keyword(s):

Mortality Rate ◽

Femoral Neck ◽

Elderly Patients ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Reoperation Rate ◽

Fixation Group ◽

Neck Fracture

Abstract Background Although internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures. Methods We performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration. Results Our results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD − 0.800, 95% CI − 1.011 to − 0.589) and operation duration (SMD − 2.497, 95% CI − 2.801 to − 2.193) were shorter in the internal fixation group. Conclusions Compared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.

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