OS6-46 Filipov's method of biplane double-supported screw fixation extremely reduces the risk of fixation failure in femoral neck fractures. Clinical outcomes in 207 patients

Objective To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). Methods Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. Results The mean follow-up was 84.12 (67–100) months for UTR and 84.23 (66–101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). Conclusion In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.

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Cancellous Screw Fixation for Undisplaced Femoral Neck Fractures in the Elderly

Journal of Orthopaedic Surgery ◽

10.1177/230949901402200303 ◽

2014 ◽

Vol 22 (3) ◽

pp. 282-286 ◽

Cited By ~ 16

Author(s):

Ruben Manohara ◽

Shen Liang ◽

Deborah Huang ◽

Lingaraj Krishna

Keyword(s):

Femoral Neck ◽

Screw Fixation ◽

The Elderly ◽

Femoral Neck Fractures ◽

Cancellous Screw

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Multiple Cannulated Screw Fixation of Young Femoral Neck Fractures

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.316.8356 ◽

1969 ◽

Vol 31 (6) ◽

Author(s):

Gyu-Min KONG

Keyword(s):

Femoral Neck ◽

Screw Fixation ◽

Femoral Neck Fractures ◽

Cannulated Screw

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Finite element analysis of the impact of screw insertion distal to the trochanter minor on the risk of iatrogenic subtrochanteric fracture

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411918789963 ◽

2018 ◽

Vol 232 (8) ◽

pp. 807-818 ◽

Cited By ~ 4

Author(s):

Ersin Sensoz ◽

Fatih Mehmet Özkal ◽

Volkan Acar ◽

Ferit Cakir

Keyword(s):

Finite Element ◽

Femoral Neck ◽

Screw Fixation ◽

Subtrochanteric Fracture ◽

Femoral Neck Fractures ◽

Cannulated Screws ◽

Screw Insertion ◽

Subtrochanteric Fractures ◽

Trochanter Minor ◽

The Impact

Iatrogenic subtrochanteric fractures are rarely encountered after cannulated screw fixation of femoral neck fractures; however, when they do occur, there can be several complications. Many orthopedic surgeons have concerns about the potential for iatrogenic subtrochanteric fractures after screw fixation distal to the trochanter minor; therefore, some surgeons are typically reluctant to perform this procedure. This study focused on the risk of an iatrogenic subtrochanteric fracture after treating femoral neck fractures with cannulated screws. The main purpose of the study was to understand iatrogenic subtrochanteric fractures and evaluate the effects on these fractures of an inverted triangular–shaped configuration for placement of the cannulated screws. A femur bone with an femoral neck fracture at a 40° incline to the horizontal plane was generated along with a representation of a three-dimensional finite element model, and three inverted triangular–shaped configurations for placement of the cannulated screws were investigated using finite element analyses. Statistical results indicated that the occurrence risk of ISF increases when the screw is located distal to the trochanter minor. Moreover, the risk of occurrence of intertrochanteric fracture increases when the screw is located medial to the trochanter minor because of local concentrated stress on the surface of the screw canals. To avoid the vulnerability of the subtrochanteric region, it was found that proximal placement of the screws using the inverted triangular–shaped configuration could yield better results. In addition, the results of this study provide suggestions on improved screw configurations.

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Calcar buttressed screw fixation for femoral neck fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185337 ◽

2018 ◽

Vol 5 (1) ◽

pp. 145

Author(s):

K. K. Arvind Manoj ◽

R. Karthik ◽

A. Vishnu Sankar

Keyword(s):

Femoral Neck ◽

Functional Outcome ◽

Femoral Neck Fracture ◽

Screw Fixation ◽

Femoral Neck Fractures ◽

Fixation Strength ◽

Harris Hip Score ◽

Average Period ◽

Excellent Outcome ◽

Neck Fracture

Background: The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture as far as treatment and results are concerned. There are different views regarding the optimal method of internal ﬁxation in femoral neck fractures. Biomechanical data from literature suggest that calcar ﬁxation is superior to central screws placement. This study aims to analyse the functional and radiological outcome of femoral neck fractures treated by calcar buttressed screw fixation described by Filipov as biplane double supported screw fixation.Methods: This is a prospective study conducted in our institution from May 2015 to May 2018.The study included 43 patients (31 male, 12 female) with femoral neck fracture. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Patients were followed up for average period of 2 years. Functional outcome was evaluated using Harris Hip score.Results: Bone union occurred in 40 patients (93%) with average period of 3-4 months. 51.2% of cases had excellent outcome. 23.2% of cases had good and 16.3% of cases had fair outcome. 9.3% of cases ended with poor outcome. Non union was reported in 3 patients (7%) and AVN in one patient. Various factors like age, Garden and Pauwel fracture types, time of presentation and time of surgery were statistically significant to the final functional outcome in our study.Conclusions: By providing additional calcar buttress compared to conventional method, this technique of screw fixation enhances femoral neck fracture fixation strength and reduces the fixation failure.

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