Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: a preliminary comparative study

Abstract Background The femoral neck system (FNS) may be a valid alternative for treating femoral neck fractures, but few studies have compared the outcomes between FNS and cannulated cancellous screws. This study aimed to compare the clinical efficacy and complications of FNS with those of inverted cannulated cancellous screws (ICCS) for the treatment of femoral neck fractures in adults. Methods This retrospective study evaluated patients with femoral neck fractures who underwent FNS or ICCS internal fixation between June 2019 and January 2020. The operative time, intraoperative blood loss, number of fluoroscopies, length of surgical incision, length of hospital stay, time to fracture healing, and other indicators were compared between the two groups. The incidence of complications such as nonunion, avascular necrosis of the femoral head, loosening of the internal fixation, and shortening of the femoral neck during follow-up was also assessed in both groups. Results Among the 92 patients included, 47 and 45 patients were categorized into the FNS and ICCS groups, respectively. Follow-up ranged from 14 to 24 months. There were no significant between-group differences in sex, age, side of the injured limb, and type of fracture and in operative time, intraoperative blood loss, incision length, and length of hospital stay (all P > 0.05). The incidence of complications such as fracture nonunion, avascular necrosis of the femoral head, and screw loosening was also comparable between the two groups. However, the number of fluoroscopies was significantly lower in the FNS group than in the ICCS group (P < 0.05). The fracture healing time was also significantly lower in the FNS group than in the ICCS group (P < 0.05). Furthermore, the femoral neck shortening and Harris hip score at the last follow-up were significantly better in the FNS group than in the ICCS group (P < 0.05). Conclusions FNS for femoral neck fractures improves hip functional recovery and reduces the femoral neck shortening rate and fluoroscopy exposure postoperatively. Thus, FNS can be an alternative to ICCS for the treatment of femoral neck fractures.

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Comparison of early clinical results for the femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures

10.21203/rs.3.rs-129837/v2 ◽

2021 ◽

Author(s):

Xiaoqiang Zhou ◽

Zhiqiang Li ◽

Renjie Xu ◽

Yuanshi She ◽

Xiangxin Zhang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Hospital Stay ◽

Clinical Efficacy ◽

Operation Time ◽

Femoral Neck Fractures ◽

Femoral Head Necrosis ◽

Cannulated Screws ◽

Intraoperative Blood Loss

Abstract Objective: To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures.Methods: A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age and similar body mass index (BMI). A total of 30 pairs were successfully matched, and the average age was 53.84 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analogue scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the groups.Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up and lower complication rates (P<0.05). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P<0.05). No statistically significant difference in operation time, hospital stay or femoral head necrosis rate was observed between the two groups (P>0.05).Conclusion: For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fractures.

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Comparison of Early Clinical Results of Femoral Neck System and Cannulated Screws in the Treatment of Unstable Femoral Neck Fractures

10.21203/rs.3.rs-129837/v1 ◽

2020 ◽

Author(s):

Xiaoqiang Zhou ◽

Zhiqiang Li ◽

Renjie Xu ◽

Yuanshi She ◽

Xiangxin Zhang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Femoral Neck Fracture ◽

Complication Rate ◽

Operation Time ◽

Femoral Neck Fractures ◽

Cannulated Screws ◽

Intraoperative Blood Loss ◽

Neck Fracture

Abstract Objective: To compare the early clinical effects of femoral neck system and three cannulated screws in the treatment of patients with unstable femoral neck fractures.Methods: A retrospective analysis was conducted on 81 patients who received FNS or cannulated screws internal fixation for Pauwels Type-3 femoral neck fracture in our hospital from January 2019 to December 2019. A pair-matched clinical research was performed. People who received FNS were test group and people received cannulated screws were control group. Matching requirements were as follows： the same gender, the similar age and the similar BMI. A total of 30 pairs were successfully matched, with an average age of 53.84 years old. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative VAS score, time walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the two groups.Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all the patients were followed up for 10-22 months. Patients in the FNS group had lower postoperative VAS scores, earlier time to walk without crutches, higher Harris scores at the last follow-up and lower complication rate (P<0.05). However, intraoperative blood loss and hospitalization costs in the FNS group were more（P<0.05）. There was no statistically significant difference in operation time, hospital stay and femoral head necrosis rate between two group (P>0.05).Conclusion: For patients who were unstable femoral neck fracture, FNS has better clinical efficacy than cannulated screws, though FNS is more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fracture.Fund program: Key medical research project of Jiangsu Health Committee（K2019010）

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A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOMES IN CEMENTED VS. UNCEMENTED HEMIARTHROPLASTY IN FEMORAL NECK FRACTURES IN GERIATRIC AGE.

10.36106/paripex/1608537 ◽

2020 ◽

pp. 1-3

Author(s):

Siddhartha Shankar Mohanty ◽

Sunil Kumar Dash ◽

Hemanta Kumar Bamidi ◽

Kishore Chandra Dash

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Prospective Study ◽

Functional Outcomes ◽

Operative Time ◽

Study Groups ◽

Femoral Neck Fractures ◽

Uncemented Hemiarthroplasty ◽

Uncemented Group

Introduction: The optimum treatment choice for femoral neck fractures is often contested. In this study, we aimed to compare the functional outcome in geriatric patients who underwent either cemented or uncemented hemiarthroplasty in our department. Methods: This prospective study included patients who were scheduled to undergo hemiarthroplasty for femoral neck fracture in the Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha. Two study groups were made. One group had patients who underwent uncemented hemiarthroplasty and the second group had patients who underwent cemented hemiarhtroplasty. Surgery related information was collected from the operative notes of the surgeon. Post-operative complications, Visual Analogue Scale (VAS) scores and Harris Hip Score (HHS) were noted during the follow up period. Results: There were 30 patients in the uncemented group and 31 in the cemented group. All the baseline demographic and clinical variables were similar in both the study groups. Mean intraoperative blood loss and operative time was significantly higher among the patients who underwent cemented hemiarthroplasty as compared to uncemented group. Mean VAS score at the first month and sixth month follow up was significantly higher among patients in the uncemented group as compared to cemented group. Functional outcome was not significantly different according to the HHS performed 6 months post-operatively. Conclusions: Patients in the cemented group had a higher intra-operative blood loss and longer operative time. However, the pain score on the VAS were significantly lower at first and sixth month follow up. Functional outcomes were not significantly different between the two study groups.

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Comparing outcomes in cemented vs uncemented hemiarthroplasty in femoral neck fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185338 ◽

2018 ◽

Vol 5 (1) ◽

pp. 152

Author(s):

Udit Kapoor ◽

Amit Chug ◽

Govind Baranwal ◽

Shaunak Patil ◽

Shubham Kumar

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Functional Outcome ◽

Operative Time ◽

Study Groups ◽

Femoral Neck Fractures ◽

Uncemented Hemiarthroplasty ◽

Operative Notes ◽

Uncemented Group

Background: The optimal treatment choice for femoral neck fractures is often debated. In this study, we aimed to compare the functional outcome in elderly patients who underwent either cemented or uncemented hemiarthroplasty in our department.Methods: This prospective study included patients who were scheduled to undergo hemiarthroplasty for femoral neck fracture in the Department of Orthopedics, Dr DY Patil University School of Medicine, Navi Mumbai. Two study groups were made. One group had patients who underwent uncemented hemiarthroplasty and the second group had patients who underwent cemented hemiarhtroplasty. Surgery related information was collected from the operative notes of the surgeon. Post-operative complications, Visual Analogue Scale (VAS) scores and Harris Hip Score (HHS) were noted during the follow up period.Results: There were 30 patients in the uncemented group and 31 in the cemented group. All the baseline demographic and clinical variables were similar in both the study groups. Mean intraoperative blood loss and operative time was significantly higher among the patients who underwent cemented hemiarthroplasty as compared to uncemented group. Mean VAS score at the first month and sixth month follow up was significantly higher among patients in the uncemented group as compared to cemented group. Functional outcome was not signicantly different according to the HHS performed 6 months post-operatively.Conclusions: Patients in the cemented group had a higher intra-operative blood loss and longer operative time. However, the pain score on the VAS were significantly lower at first and sixth month follow up. Functional outcomes were not significantly different between the two study groups.

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Comparison of early clinical results for the femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures

10.21203/rs.3.rs-129837/v3 ◽

2021 ◽

Author(s):

Xiaoqiang Zhou ◽

Zhiqiang Li ◽

Renjie Xu ◽

Yuanshi She ◽

Xiangxin Zhang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Hospital Stay ◽

Clinical Efficacy ◽

Operation Time ◽

Femoral Neck Fractures ◽

Femoral Head Necrosis ◽

Cannulated Screws ◽

Intraoperative Blood Loss

Abstract Objective: To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures. Methods: A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age and similar body mass index (BMI). A total of 30 pairs were successfully matched, and the average age was 53.84 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analogue scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the groups. Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up and lower complication rates (P<0.05). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P<0.05). No statistically significant difference in operation time, hospital stay or femoral head necrosis rate was observed between the two groups (P>0.05). Conclusion: For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fractures.

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Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191784 ◽

2019 ◽

Vol 5 (3) ◽

pp. 458

Author(s):

Nikil Sanaba Paramesh ◽

Usman Taufiq

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Elderly Patients ◽

Operation Time ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Intraoperative Blood Loss ◽

Cerebrovascular Complications ◽

Uncemented Hemiarthroplasty ◽

Hip Function

Background: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.Methods: We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.Results: Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.Conclusions: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.

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Evaluation of percutaneous endoscopic lumbar discectomy in treatment of obese adolescents with lumbar disc herniation：A retrospective study

10.21203/rs.3.rs-389600/v1 ◽

2021 ◽

Author(s):

Haijiang Yu ◽

Bin Zhu ◽

Xiaoguang Liu

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Operative Time ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Obese Patients ◽

Intraoperative Blood Loss ◽

Endoscopic Lumbar Discectomy ◽

Time Point

Abstract Background: Obese patients are at risk of complications such as poor wound healing and increased infection rates after spinal surgery. Percutaneous endoscopic lumbar discectomy (PELD) has advantages over conventional open surgery in the treatment of obese adult patients with lumbar disc herniation (LDH) because it can decrease perioperative complications and enhance satisfaction degrees of patients. However, no clinical studies have evaluated the efficacy of PELD in obese adolescents with LDH. This study aimed to evaluate the efficacy of PELD in the treatment of obese ALDH.Methods: We retrospectively collected clinical data from 208 patients with single-segment ALDH who underwent PELD treatment in our hospital between January 2015 and December 2019. According to the body mass index classification standard of obesity for adolescents in our country, the patients were divided into obese and non-obese groups (control group). Based on the preoperative baseline data of the two groups, propensity score matching was performed to select patients from the two groups for the comparative study. Perioperative data included operative time, intraoperative blood loss and length of postoperative hospitalization. The visual analog scale (VAS), Oswestry disability index (ODI) and modified MacNab criteria were recorded as the main indicators of the surgical outcome, and the recurrence rate and incidence of complications were recorded as the minor indicators. Results: The obese and control groups included 45 patients each after 1:1 propensity score matching. Both groups showed improvements in VAS and ODI scores after surgery and at each follow-up time point (p < 0.05). However, there was no significant statistical difference in VAS and ODI scores between the two groups at each follow-up time point (p >0.05). In addition, the differences in operative time, intraoperative blood loss, length of postoperative hospitalization, incidence of complications, and recurrence rate were not statistically significant between the two groups (p >0.05). At the final follow-up, there was no significant difference in the excellent and good rate of MacNab classification between the two groups (p >0.05). Conclusion: PELD is a safe and effective minimally invasive technique for the treatment of obese patients with ALDH. The efficacy of PELD in obese and non-obese patients with ALDH was comparable.

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Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial

10.21203/rs.2.13759/v1 ◽

2019 ◽

Author(s):

Weikun Meng ◽

Zhong Huang ◽

Haoyang Wang ◽

Duan Wang ◽

Zeyu Luo ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Length Of Hospital Stay ◽

Operation Time ◽

Incision Length ◽

Total Hip ◽

Hip Function

Abstract Background: The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH). Methods: Patients with bilateral late-stage ONFH were prospectively recruited from our department during March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within groups. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA groups within 12-month postoperatively. Results: Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded significantly shorter incision length (7.62 vs. 11.12 cm, P = 0.049), longer operation time (103.25 vs. 66.50 min, P = 0.034), more blood loss (1108.50 vs. 843.50 ml, P = 0.023), deficient acetabular cup positioning (abduction angle, 38.75° vs. 44.50°, P = 0.035), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25, P = 0.025) at 12-month postoperatively. However, soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both groups. Conclusions: The SuperPath might not be truly minimal invasive with advantages over the PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches.

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Dyslipidaemia for patients with low-energy femoral neck fractures after the treatment of cancellous screws: a retrospective study with a 3-year minimum follow-up

BMC Musculoskeletal Disorders ◽

10.1186/s12891-017-1804-x ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Chi Zhang ◽

Xiaoxiao Zhu ◽

Genwang Pei ◽

Ping Xu ◽

Xianshang Zeng ◽

...

Keyword(s):

Retrospective Study ◽

Femoral Neck ◽

Femoral Neck Fractures ◽

Low Energy ◽

Cancellous Screws

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Cemented versus cementless bipolar hemiarthroplasty for femoral neck fractures in the elderly

EFORT Open Reviews ◽

10.1302/2058-5241.6.200057 ◽

2021 ◽

Vol 6 (5) ◽

pp. 380-386

Author(s):

Ahmed Fikry Elmenshawy ◽

Khaled Hamed Salem

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Operative Time ◽

Treatment Options ◽

The Elderly ◽

Similar Rate ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Systemic Complications ◽

Uncemented Hemiarthroplasty

The management of femoral neck fractures remains controversial. Treatment options include a wide variety of internal fixation methods, unipolar or bipolar hemiarthroplasty or total hip replacement. We carried out a systematic review of the available literature to detect differences between cemented and cementless fixation of bipolar prostheses in treating femoral neck fractures in patients aged 60 years or older. Thirteen studies involving a total of 1561 bipolar hemiarthroplasties (770 cemented and 791 uncemented) were identified. Uncemented hemiarthroplasty was associated with significantly lower blood loss (p < 0.0001), shorter operative time (p < 0.0001), less infection (p = 0.03) and lower risk of heterotopic ossification (p = 0.007). On the other hand, patients with cemented hemiarthroplasty suffered significantly less postoperative thigh pain than those with cementless implantation (p < 0.00001). The existing evidence indicates that uncemented bipolar hemiarthroplasty offers shorter operative time, less blood loss, lower local complications and a similar rate of systemic complications and reoperations as compared to cemented implantation. Cite this article: EFORT Open Rev 2021;6:380-386. DOI: 10.1302/2058-5241.6.200057

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