BIOMECHANICAL ANALYSIS OF FEMORAL NECK FRACTURE FIXATION IN SYNTHETIC BONE

ABSTRACT Objectives To analyze the results of biomechanical assays of the fixation of Pauwels type II femoral neck fractures in synthetic bones, using two parallel cannulated screws or three cannulated screws in an inverted pyramid formation. Methods Ten Brazilian-made synthetic bones were divided into 2 groups. Groups A and B utilized three and two cannulated screws, respectively, after osteotomy in the middle third of the femur, perpendicular to the axis of the femoral neck, simulating a Pauwels type II femoral neck fracture. The resistance of these fixations was analyzed by compression on the axis of the force resulting from hip compression, simulated with a manual hydraulic press. The T-test and post hoc analysis were used to compare the groups, and the significance criterion adopted was p < 0.05. Results In group A, which used fixation with three screws, synthesis failure was seen at a mean force of 526 N. In group B, which used two screws, the mean force was 466 N. The results presented a statistically significant difference (p = 0.02). Conclusion The osteosynthesis of femoral neck fractures in synthetic bone fixated with two screws presented inferior results to fixation with three screws. Level of Evidence III; Case-control study.

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Comparative Analysis of Preoperative and Postoperative Muscle Around Hip Joint by Computed Tomography Between Intertrochanteric Fracture and Femur Neck Fracture

10.21203/rs.3.rs-65484/v1 ◽

2020 ◽

Author(s):

Sung Yoon Jung ◽

Hyeon Jun Kim ◽

Kyu Taek Oh

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Intertrochanteric Fracture ◽

Femoral Neck Fractures ◽

Final Visit ◽

Cross Sectional ◽

Fracture Group ◽

Significant Difference ◽

Neck Fracture

Abstract Background:This study assessed the changes in hip muscles by comparing the preoperative and postoperative CT scan results between patients with intertrochanteric versus femoral neck fractures. Methods:48 patients who received surgical treatment for intertrochanteric or femoral neck fractures from February 2013 to February 2019 and underwent pelvic computed tomography(CT) preoperative and postoperatively aged 65 and older with a minimum follow-up of 1 year were included. The subjects were divided into two groups: 26 patients with intertrochanteric fracture and 22 patients with femoral neck fracture. We measured the cross-sectional area(CSA) and attenuation of the gluteus medius(G.med), gluteus minimus(G.min), iliopsoas(IP), and rectus femoris(RF) on the contralateral side. Patient basic data were collected from medial records including sex, age, height, weight, BMI, BMD, Harris hip score (HHS), and length of follow-up until the final visit. Results: There was no significant difference in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up until the final visit between two groups. The femoral neck fracture group had significantly larger CSA and cross-sectional area per weight(CSA/Wt) of the G.med and G.min(G.med CSA, CSA/wt preoperative 1995.29 vs 1713.64, 38.87 vs 32.74; postoperative 2144.98 vs 1815.56, 37.48 vs 32.78/G.min preoperative 745.22 vs 566.59, 14.32 vs 10.96; postoperative 764.39 vs 619.17, 14.78 vs 11.25). On the contrary, the intertrochanteric fracture group had significantly greater CSA and CSA/Wt of the IP and RF(IP preoperative 810.86 vs 661.88, 17.73 vs 9.42; postoperative 681.98 vs 571.32, 12.68 vs 9.88/RF preoperative 503.66 vs 386.72, 9.42 vs 7.23; postoperative 426.24 vs 349.31, 7.17 vs 5.23). HHS related with function had no significant correlation with postoperative CSA and CSA/Wt. There was no significant difference in attenuation between two groups. All subjects had a significant decrease of muscle attenuation postoperatively.Conclusions: The CSA of the hip abductor(G.med and G.min) was significantly larger in the femoral neck fracture group, while the CSA of the hip flexor(IP and RF) was significantly higher in the intertrochanteric fracture group. Based on these findings, choosing the rehabilitation program suitable for the fracture site is expected to be beneficial in hip fracture rehabilitation.

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FEMORAL NECK FRACTURES GARDEN I AND II: EVALUATION OF THE DEVIATION IN LATERAL VIEW

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172502169349 ◽

2017 ◽

Vol 25 (2) ◽

pp. 107-109 ◽

Cited By ~ 2

Author(s):

Natália Zalc Leonhardt ◽

Lucas da Ponte Melo ◽

David Gonçalves Nordon ◽

Fernando Brandão de Andrade e Silva ◽

Kodi Edson Kojima ◽

...

Keyword(s):

Femoral Neck ◽

Comparative Study ◽

Femoral Neck Fracture ◽

Lateral View ◽

Femoral Neck Fractures ◽

Level Of Evidence ◽

X Ray ◽

Neck Fracture ◽

Anteroposterior View ◽

Retrospective Comparative Study

ABSTRACT Objective: To evaluate the rate of deviation in the lateral radiographic incidence in patients with femoral neck fracture classified as non-diverted in the anteroposterior view (Garden I and II). Methods: Nineteen selected patients with femoral neck fractures classified as Garden I and II were retrospectively evaluated, estimating the degree of deviation in the lateral view. Results: Fifteen cases (79%) presented deviations in lateral view, with a mean of 18.6 degrees (±15.5). Conclusion: Most fractures of the femoral neck classified as Garden I and II present some degree of posterior deviation in the X-ray lateral view. Level of Evidence III, Retrospective Comparative Study.

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Results of postoperative anti-rotation on the intracapsular femoral neck fracture fixed with cannulated screws

10.21203/rs.3.rs-33671/v1 ◽

2020 ◽

Author(s):

bu-fang ren ◽

quan-ping ma ◽

xin lv ◽

yunsheng yin ◽

yaozhu gao

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Bed Rest ◽

Femoral Neck Fractures ◽

Wound Infections ◽

Cannulated Screws ◽

Fracture Nonunion ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture ◽

Medical University

Abstract Background: To investigate effect of postoperative anti-rotation on the union of intracapsular displaced femoral neck fracture treated with three cannulated screws. Methods: A retrospective analysis was performed on all the intracapsular femoral neck fractures treated in the department of orthopedics of the second Hospital of Shanxi Medical University from July 2015 to December 2018. Fractures of femoral neck were reduced and fixed with three cannulated screws. The patients who wore anti-rotation shoes in the affected side were kept at bed rest for 10-12 weeks after surgery. The results were analyzed.Results: A total of 135 patients were included in the analysis. Six patients (4.4%) were not united. There were 12 cases of avascular necrosis (9.3%). No wound infections, screw breakages was found.Conclusion: Anti-rotation after surgery can significantly reduce the rate of femoral neck fracture nonunion, but not significantly improve the femoral head necrosis

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Pauwels screw combined inverted triangle cannulated screws for the treatment of Pauwels type-III femoral neck fracture:- a new surgical method based on the morphology of the fracture

10.21203/rs.3.rs-38297/v1 ◽

2020 ◽

Author(s):

Gang Xue ◽

Siting Chen ◽

Maosheng Zhou ◽

Zhengyu Wang ◽

Liangliang Wan ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Cannulated Screws ◽

Type Iii ◽

Operative Duration ◽

Neck Fracture ◽

Flexion And Extension

Abstract Background: Femoral neck fracture is a serious injury in adults with significant functional consequences.Internal fixtion is an established treatment for femoral neck fractures in young adult patients .However, the risk of complications following fixation has plague orthopedists for decades.In all femoral neck fracture ,Pauwels type-III femoral neck fractures with a large vertical shear force were more likely to cause clinical failure.The aim of this study is to intruduce a new surgical technique for the treatment of this fracture according to the morphology of the fracture using the combination of Pauwels screw and inverted triangle cannulated screws(PSTCS)，and report the clinical effects in a prospective cohort of 14 patients.Methods: From June 2017 to June 2019, a total of 14 patients (8 males and 6 females ) with Pauwels type-III femoral neck fracture underwent the surgical treatment of PSTCS according to the morphologyical types of fracture in clinical operation in our department. Patients were allowed to perform contraction exercises of quadriceps femoris on postoperative day1, passive flexion and extension exercises postoperative day 2 onwards, and active flexion and extension exercises postoperative day 7 onwards. Patients were allowed for partial-weight bearing walking postoperative 1month onwards with axillary crutches. After one month AP and lateral radiograph were taken. Full ambulation was permitted until the presence of radiological consolidation.Intraoperative (Operative duration,Blood loss),postoperation(Fracture union time,The Harris Hip Score,Visual analog score) were record for comparison.Results: All patients were followed up for at least 12 months.In the end point of the follow up ,12 of the 14 patients (85.7%)with pauwels type-III femoral neck fractures had achieved satisfactory hip function. Operative duration was a mean of 49.5 ±10.4 minutes.Intraoperative blood loss was between 26 and 110 ml (mean, 44.4±20.6ml) and without intraoperative blood transfusion . The Harris Hip Score was between 64 and 95(mean,87.6±8.9).Fracture healing was observed in all patients according to the X-ray . No internal fixation was loosened or screw cut-out in the follow-up period.The femoral head necrosis was observed in 1 patient in this study. In addition, there was no obvious fracture displacement, femoral neck shortening, or hip varus. Conclusions: The study showed that PSTCS can provide a satisfactory clinical outcomes for treatment of pauwels type-III femoral neck fractures.Most patients (85.7%) achieved good or excellent results with the use of PSTCS,which appears to be a reliable method and provides another choice for this problematic fracture.The new internal fixation method of PSTCS can provide mechanical stability and promote fracture healing

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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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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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Perforated H-beam implant can be used in femoral neck fracture

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

10.1177/0954411919827041 ◽

2019 ◽

Vol 233 (3) ◽

pp. 354-361

Author(s):

Afgan Jafarov ◽

Fatma Kübra Erbay Elibol ◽

Chingiz Alizadeh ◽

Mahir Gülşen ◽

Emre Toğrul ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Dynamic Loading ◽

Axial Compression ◽

Proximal Femur ◽

Cannulated Screws ◽

Significant Difference ◽

Neck Fracture ◽

H Beam ◽

Implant System

This biomechanical study evaluated comparison osteosynthesis of the femoral neck fracture model by 3 cannulated screw implants and new perforated H beam implants under different loading conditions with 45 third generation right proximal femur bones. A standardized Pauwels Type 3 of the femoral neck fracture was performed in the femur models. For assessing the rigidity and strength of fixation methods, the proximal femur bones after their osteosynthesis were then mechanically tested in axial compression, and torsional and dynamic axial compression loading. To determine the structural advantage of the new implant system, perforated and nonperforated new implant systems were comparing about pull out performance. When loading the samples, photographs were taken continuously. The reference parameters were described and measured from unloaded and loaded photographs of the static and dynamic tests. There was no significant difference between stiffness values of two fixation methods under static and rotational loading. Under dynamic loading, the displacement of the superior point of femoral head at the fracture line showed a significant decrease between the new implant system and cannulated screws. Comparing the relative motion at the mid line of the fracture in femoral neck between groups, a significant increase was found in H Beam implant group. Perforated H beam implants have similar static and torsion properties with golden standard. Although there was significant difference under dynamic loading which simulate movement early after surgery, the patient was not allowed to move early after surgery in the clinical practice. Therefore, the differences due to the perforated “H” beam implant would not cause clinical insecurity. Therefore, it is assumed that the perforated “H” beam implant can be used for internal fixation as an alternative to cannulated screws in the treatment of instable femoral neck fracture.

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Results of postoperative anti-rotation on the intracapsular femoral neck fracture fixed with cannulated screws

10.21203/rs.3.rs-29760/v1 ◽

2020 ◽

Author(s):

Bufang Ren ◽

Quan-ping Ma ◽

Xin Lv ◽

Yun-sheng Yin ◽

Yao-zhu Gao

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Bed Rest ◽

Femoral Neck Fractures ◽

Wound Infections ◽

Cannulated Screws ◽

Fracture Nonunion ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture ◽

Medical University

Abstract Background: To investigate effect of postoperative anti-rotation on the union of intracapsular displaced femoral neck fracture treated with three cannulated screws.Methods: A retrospective analysis was performed on all the intracapsular femoral neck fractures treated in the department of orthopedics of the second Hospital of Shanxi Medical University from July 2015 to December 2018. Fractures of femoral neck were reduced and fixed with three cannulated screws. The patients who wore anti-rotation shoes in the affected side were kept at bed rest for 10-12 weeks after surgery. The results were analyzed.Results: A total of 135 patients were included in the analysis. Six patients (4.4%) were not united. There were 12 cases of avascular necrosis (9.3%). No wound infections, screw breakages was found.Conclusion: Anti-rotation after surgery can significantly reduce the rate of femoral neck fracture nonunion, but not significantly improve the femoral head necrosis

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Impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture

Hip International ◽

10.1177/11207000211028502 ◽

2021 ◽

pp. 112070002110285

Author(s):

Pradip Ramamurti ◽

Safa C Fassihi ◽

David Sacolick ◽

Alex Gu ◽

Chapman Wei ◽

...

Keyword(s):

Renal Function ◽

Risk Factor ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Impaired Renal Function ◽

Independent Risk Factor ◽

Femoral Neck Fractures ◽

Stage 4 ◽

Ckd Stage ◽

Neck Fracture

Background: The metabolic abnormalities that occur secondary to chronic kidney disease (CKD) increase the risk of femoral neck fractures compared to the general population. The purpose of this study is to determine whether impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. Methods: The ACS-NSQIP database was reviewed for patients who underwent total hip arthroplasty, hemiarthroplasty and open reduction internal fixation (ORIF) for femoral neck fractures between 2007 and 2018. Patients were split into cohorts based on calculated estimated glomerular filtration rate. Demographic information, comorbidities, and 30-day complications were analysed with univariate and multivariate analyses using chi-square, Fischer’s exact and analysis of variance testing. Results: The total number of patients for the study was 163,717. Patients with CKD stage 4 and 5 had an increased rate of any complication (39.1 and 36.7% respectively) compared with higher eGFRs ( p < 0.001). Similarly, 30-day mortality was increased at 6.0% and 6.7% for both stage 4 and 5 ( p < 0.001). By multivariate regression, those with CKD Stage 4 and 5 were at increased risk for any complication compared to patients with a normal preoperative eGFR of 90–120 ( p < 0.001). Conclusions: This study demonstrated that patients with CKD Stage 4 and 5 are at increased risks of all complications, including death, renal, pulmonary and thromboembolic disease. Therefore, these patients should be cared for from a multidisciplinary approach with close attention to postoperative medications and fall prevention to help mitigate the risk of complications in the immediate postoperative period.

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