Intermediate Dynamic Compression and Decreased Posterior Tilt With Interlocked Pins in Femoral Neck Fixation in Synthetic Bone

Abstract Fixation failure with resulting non-union is the key complication after femoral neck fixation. It can be avoided by permitting dynamic compression and reducing rotation and posterior tilt of the femoral head. To achieve this, a novel implant that features an interlocking plate with three hook-pins (The Hansson Pinloc® System) was developed from the original two hook-pins. Only an enhanced torsional fixation by the implant modification is reported. The purpose was to compare the biomechanical compressive and bending stability of the original and modified implant in femoral neck fixation. To analyze the contribution of both modified components, three individual pins were included, although not in regular use. Forty-eight synthetic femurs with mid-cervical wedge osteotomies were fixated by two pins or identical triangular pin patterns with or without the plate. Eight specimens of each group were loaded cyclically in compression with an inferior wedge to simulate stance and anteroposterior bending with a posterior wedge to imitate sitting down. The clinically relevant stability measurements were stiffness and deformation. Fissure formation defined failure. The novel implant improved bending stability by 30% increased stiffness, 44% reduced deformation, and less frequent posterior neck fissure formation (p < 0.001) while increased compressive stability was only evident with 25% reduced deformation and less frequent inferior neck fissures (p < 0.001). These impacts were mainly mediated by the third pin, while the plate prevented a lateral fissure in compression (p < 0.001). The clinical stability was improved by dynamic compression and decreased posterior tilt by implant modification.

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Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0124 ◽

2016 ◽

Vol 98 (6) ◽

pp. 376-379 ◽

Cited By ~ 4

Author(s):

O Riaz ◽

R Arshad ◽

S Nisar ◽

R Vanker

Keyword(s):

Femoral Neck ◽

Serum Albumin ◽

Femoral Neck Fracture ◽

Femoral Neck Fractures ◽

Fixation Failure ◽

Non Union ◽

Preoperative Serum ◽

Neck Fracture ◽

Posterior Tilt ◽

Intracapsular Femoral Neck Fracture

Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%–19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60–101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

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Anterior Positioning Screw in Proximal Femoral Plating Restricts Posterior Tilt of Retroverted Femoral Neck Fractures: a Retrospective Cohort Study

10.21203/rs.3.rs-282853/v1 ◽

2021 ◽

Author(s):

Sheng-Bo Nie ◽

Jun-Feng Liu ◽

Jiang-Hua Zhu ◽

Zi-Fei Zhou ◽

Lei Zhang ◽

...

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Demographic Data ◽

Multivariable Analysis ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Fixation Failure ◽

Significant Difference ◽

Posterior Tilt ◽

Posterior Comminution

Abstract Background: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt.Methods: We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt.Results: Demographic data showed no significant difference. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1 – 4.3°) than that in the NTS group (5.3°, 4.2 – 8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1 – 4.7) mm vs. 4.3 (3.1 – 6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0 – 90.0 vs. 82.0, 76.0 – 84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6 – 70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6 – 56.1, p = 0.002), and NTS configuration (ref: ALTS configuration) (OR 21.9, 95% CI 4.1 – 116.4, p < 0.001) as risk factors for developing posterior tilt.Conclusions: Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (ref: ALTS) are risk factors for developing posterior tilt.Trial registration: Retrospectively registered.

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Enhanced Interfragmentary Stability and Improved Clinical Prognosis With Off-axis Screw Technique in the Treatment of Vertical Femoral Neck Fractures of Nongeriatric Patients

10.21203/rs.3.rs-490624/v1 ◽

2021 ◽

Author(s):

Dajun Jiang ◽

Shi Zhan ◽

Qianying Cai ◽

Hai Hu ◽

Weitao Jia

Keyword(s):

Femoral Neck ◽

Failure Rate ◽

Clinical Investigation ◽

Femoral Neck Fractures ◽

Patient Specific ◽

Fixation Failure ◽

Element Analysis ◽

Clinical Prognosis ◽

Non Union ◽

Significant Difference

Abstract Background: The optimal internal fixation strategy for vertical femoral neck fractures (VFNFs) in nongeriatric patients remains uncertain. The purpose of this study was to compare the clinical prognoses and underlying mechanical characteristics of the novel off-axis screw technique with dynamic hip screw (DHS) and traditional three parallel screws. Methods: This study included a clinical investigation and a patient-specific finite element analysis (FEA). In the clinical investigation, VFNF patients were grouped by fixation type: (1) three parallel screws (G-TRI); (2) augmentation with an off-axis screw (G-ALP); and (3) DHS with an anti-rotational screw (G-DHS). Fixation failures (non-union, femoral neck shortening (FNS), varus deformation, screw cut-out) and avascular necrosis (AVN) of the three types were compared. In the FEA, twenty-four fixation models with the three fixation types were created based on the data of eight healthy volunteers. Models were assessed under walking conditions. Stiffness, interfragmentary motion (IFM), and implant stress were evaluated. Results: In the clinical investigation, fixation failure rate was significantly (p<0.05) lower in G-ALP (18.5%) than in G-DHS (37.5%) and G-TRI (39.3%). No significant difference of AVN was observed among three fixation groups. In the FEA, stiffness and implant stress in G-DHS models was significantly (p<0.05) higher, and the IFM of G-ALP was significantly (p<0.05) lower among the groups. Conclusions: Among fixation types for VFNFs, the off-axis screw technique exhibited a better interfragmentary stability (lowest IFM), and lower fixation failure rate (especially, FNS). Analyzing interfragmentary stability in biomechanical experiments is more consistent with clinical prognosis than construct stability for VFNFs, suggesting that internal fixations should aim for this outcome.

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More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01673-5 ◽

2021 ◽

Author(s):

Jorn Kalsbeek ◽

Ariaan van Walsum ◽

Herbert Roerdink ◽

Inger Schipper

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Treatment Failure ◽

Femoral Neck Fractures ◽

Type I ◽

Non Union ◽

Initial Radiograph ◽

Neck Fracture ◽

Posterior Tilt ◽

Risk Of Treatment

Abstract Purpose In this study, we aimed to determine the correlation between the preoperative posterior tilt of the femoral head and treatment failure in patients with a Garden type I and II femoral neck fracture (FNF) treated with the dynamic locking blade plate (DLBP). Methods Preoperative posterior tilt was measured in a prospective documented cohort of 193 patients with a Garden type I and II FNF treated with the DLBP. The correlation between preoperative posterior tilt and failure, defined as revision surgery because of avascular necrosis, non-union, or cut-out, was analyzed. Results Patients with failed fracture treatment (5.5%) had a higher degree of posterior tilt on the initial radiograph than the patients with uneventful healed fractures: 21.4° and 13.8°, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20° and 12.5% if the preoperative posterior tilt was ≥ 20°. A posterior tilt of ≥ 20° was associated with an odds ratio of 4.24 (95% CI 1.09–16.83; p = 0.04). Conclusion Garden type I and II FNFs with a significant preoperative posterior tilt (≥ 20°) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt ≥ 20° of the femoral head should be considered as a significant predictor for failure of treatment in Garden type I and II FNFs treated with the DLBP.

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Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02456-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sheng-Bo Nie ◽

Jun-Feng Liu ◽

Jiang-Hua Zhu ◽

Zi-Fei Zhou ◽

Lei Zhang ◽

...

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Multivariable Analysis ◽

Femoral Neck Fractures ◽

Trial Registration ◽

Harris Hip Score ◽

Fixation Failure ◽

Significant Difference ◽

Posterior Tilt ◽

Posterior Comminution

Abstract Background Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt. Methods We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt. Results Age, gender, Garden classification, posterior comminution, and reduction quality showed no significant difference between the groups. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1–4.3°) than that in the NTS group (5.3°, 4.2–8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1–4.7) mm vs. 4.3 (3.1–6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0–90.0 vs. 82.0, 76.0–84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6–70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6–56.1, p = 0.002), and NTS configuration (reference: ALTS configuration) (OR 21.9, 95% CI 4.1–116.4, p < 0.001) as risk factors for developing posterior tilt. Conclusions Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (reference: ALTS) are risk factors for developing posterior tilt. Trial registration The trial registration number was ChiCTR2000039482.

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Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures

Acta Orthopaedica ◽

10.3109/17453674.2016.1155253 ◽

2016 ◽

Vol 87 (3) ◽

pp. 252-256 ◽

Cited By ~ 25

Author(s):

Filip C Dolatowski ◽

Mina Adampour ◽

Frede Frihagen ◽

Knut Stavem ◽

Stein Erik Utvåg ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fractures ◽

Fixation Failure ◽

Posterior Tilt

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Fixation of femoral neck fractures in patients younger than 65 years: a retrospective descriptive study at a high-volume trauma centre

SA Orthopaedic Journal ◽

10.17159/2309-8309/2020/v19n4a1 ◽

2020 ◽

Author(s):

N Ferreira ◽

K Jordaan ◽

G Du Preez ◽

M Burger

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Avascular Necrosis ◽

Hip Arthroplasty ◽

Femoral Neck Fractures ◽

Mechanism Of Injury ◽

Fixation Failure ◽

Non Union ◽

Total Hip ◽

Time From Injury

ABSTRACT BACKGROUND: The management of femoral neck fractures in the younger patient remains contentious, with high failure rates being reported in the literature. Patient age usually plays a major role during decision-making with regard to head-sparing versus head-sacrificing surgical strategies. The aim of this study was to review the outcomes of fixation of femoral neck fractures in patients younger than 65 years in an attempt to identify factors that might predict fixation failure. METHODS: A retrospective study, evaluating the outcome of fixation of femoral neck fractures in patients younger than 65 years of age was conducted. Factors affecting the outcome of treatment were explored in an attempt to identify variables that might predict fixation failure. RESULTS: The final cohort comprised 51 men (76%) and 16 women (24%) with a mean age of 43.9±12.2 years (95% CI 41.0-46.8; range 23-64) and a median follow-up of 8.7 months (IQR 6.2-17.4). Thirteen patients (19%) presented with undisplaced (Garden I and II) fractures while 54 (81%) presented with displaced (Garden III and IV) fractures. Twenty-four patients (36%) met the definition of failure. These included 15 cases (22%) of non-union, seven cases (10%) of femoral neck collapse and two cases (3%) of avascular necrosis. Sixteen patients (24%) underwent conversion to total hip arthroplasty. All cases of failure occurred in patients who presented with Garden III and IV displaced fractures. Factors associated with failure included the presence of fracture comminution (p<0.001) and the increased vertical orientation of the fracture line according to the Pauwels classification (p<0.001). Neither patient age (p=0.117), time from injury to surgery (p=0.204), mechanism of injury (p=0.136), smoking (p>0.999) nor alcohol abuse (p=0.528) was associated with failure CONCLUSION: The incidence of fixation failure following surgical management of femoral neck fractures in patients younger than 65 years of age remains high. While undisplaced fractures heal readily regardless of time from injury to surgery, mechanism of injury or fixation method, displaced fractures remain a difficult problem to solve. In our series, fixation failure was observed in one in three patients, while one in four required revision to total hip arthroplasty. Level of evidence: Level 4. Keywords: femoral neck fracture, fixation, failure, non-union, avascular necrosis

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Comparison of Ordinary Cannulated Compression Screw and Double-Head Cannulated Compression Screw Fixation in Vertical Femoral Neck Fractures

BioMed Research International ◽

10.1155/2020/2814548 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Yuelei Zhang ◽

Chao Yan ◽

Lecheng Zhang ◽

Wei Zhang ◽

Gang Wang

Keyword(s):

Femoral Neck ◽

Maximum Load ◽

Femoral Neck Fractures ◽

Axial Stiffness ◽

Screw Loosening ◽

Compression Screw ◽

Fixation Failure ◽

Fracture Displacement ◽

Load To Failure ◽

Double Head

Background. The treatment of vertical femoral neck fractures in young patients remains a challenge. This study is aimed at comparing ordinary cannulated compression screw (OCCS) and double-head cannulated compression screw (DhCCS) fixation in vertical femoral neck fractures both clinically and biomechanically. Materials and Methods. Clinically, the radiographs of 81 patients with Pauwel’s III femoral neck fractures, including 54 fractures fixed with three parallel OCCSs and 27 fractures fixed with three parallel DhCCSs, were reviewed retrospectively. Complications consisting of fixation failure (screw loosening, obvious fracture displacement, varus deformity, or femoral neck shortening), bony nonunion, and avascular necrosis (AVN) were determined. Biomechanically, twenty synthetic femur models of vertical femoral fractures with an 80° Pauwel’s angle were divided into two groups and subsequently fixed with three parallel OCCSs or DhCCSs. All specimens were tested for axial stiffness, load to 5 mm displacement, and a maximum load to failure with a loading rate of 2 mm/min. Results. Clinically, 22 fractures in the OCCS group experienced fixation failure, including 19 screw loosening, 18 femoral neck shortening, 14 varus deformities, and 8 obvious fracture displacements, whereas only 4 fractures experienced fixation failure in the DhCCS group, including 3 screw loosening, 3 femoral neck shortening, 3 varus deformities, and 1 obvious fracture displacement. Additionally, 11 fractures in the OCCS group exhibited nonunion, whereas only 3 in the DhCCS group exhibited nonunion. Nine fractures with AVN were noted in the OCCS group, whereas only 1 was observed in the DhCCS group. Biomechanically, the axial stiffness of the DhCCS group was greater than that of the OCCS group ( 154.9 ± 6.81 vs. 128.1 ± 7.41 N/mm), and the load to 5 mm displacement was also significantly greater in the DhCCS group ( 646.1 ± 25.87 vs. 475.8 ± 21.46 N). Moreover, the maximum load to failure in the DhCCS group exhibited significant advantages compared with that of the OCCS group ( 1148 ± 39.47 vs. 795.9 ± 51.39 N). Conclusion. Our results suggested that using three DhCCSs improved the outcome of vertical femoral neck fractures compared to three OCCSs, offering a new choice for the treatment of femoral neck fracture.

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Femoral Neck Fracture Fixation Failure: A Review and Stepwise Approach

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v5i3.4289 ◽

2020 ◽

Author(s):

Seyed Mir Mansoor Moazen Jamshidi ◽

Mohammadreza Razzaghof ◽

Seyed Mohammad Javad Mortazavi

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Fracture Fixation ◽

Fixation Failure ◽

Stepwise Approach ◽

Neck Fracture

The article's abstract is not available.

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Impact of Cigarette Smoking on Re-operation and Revision Surgery after Femoral Neck Fracture Treatment

Kansas Journal of Medicine ◽

10.17161/kjm.v13i.14563 ◽

2020 ◽

Vol 13 ◽

pp. 195-201

Author(s):

Mitchell Messner ◽

Alexander Chong ◽

Bruce Piatt

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Femoral Neck Fractures ◽

Non Union ◽

Initial Fixation ◽

Neck Fracture ◽

Group 3 ◽

Former Smokers ◽

Group 2 ◽

Group 1

Introduction. Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Methods. Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. Results. A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Conclusion. Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.

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