Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16±8 weeks in both groups. There is no complication such as non-union, avascular necrosis of femoral head and/or broken fibular graft in both the groups occurrences. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost effective and technically less demanding and associated with good outcomes. There is no added advantage of non-vascularized fibular grafting with multiple hip screw fixation in fresh femoral neck fractures in young adults over multiple hip screw fixation alone.

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Modified F Configuration in the Treatment of Pauwels Type III Femoral Neck Fracture: a Finite Element Analysis

10.21203/rs.3.rs-135954/v1 ◽

2021 ◽

Author(s):

Shiyuan Lin ◽

Huizi Li ◽

Kai Tong ◽

Zihang Feng ◽

Gang Wang ◽

...

Keyword(s):

Finite Element ◽

Stress Distribution ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Femoral Neck Fractures ◽

Cannulated Screw ◽

Type Iii ◽

Neck Fracture ◽

Maximum Crack ◽

Hip Screw

Abstract Background: The optimal treatment of Pauwels type III femoral neck fracture in young patients remains a worldwide challenge in orthopedic surgery. Methods: Finite element models of four internal fixations were developed to treat Pauwels type III Femoral neck fracture: a: the traditional inverted triangular cannulated screw model, b: the F-technique cannulated screw model, c: the modified F-technique cannulated screw model using a fully threaded screw instead of a partially threaded distally, d: the dynamic hip screw coupled with anti-rotational screw model. Under the same conditions, finite element analyses were carried out to compare the displacement and von Mises stress distribution of four internal fixations and femurs, the maximum crack distances of the fracture surfaces, Z axis displacements of four models as well as the stress distribution in the subtrochanteric region. Results: The modified F-technique configuration resulted in a more stable fixation as compared to the other three approaches, with respect to the maximum displacement and stress peaks of femur and internal fixations, the maximum crack distances of the fracture surfaces, Z axis displacements of four configurations as well as the stress distribution in the subtrochanteric region.Conclusions: Our results suggested that modified F-technique configuration show a better performance in resisting shearing and rotational forces in treating Pauwels type III femoral neck fractures compared to those using traditional inverted triangular, the F-technique configuration or dynamic hip screw coupled with anti-rotational screw, providing a new choice for the treatment of femoral neck fractures.

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Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-017-2758-z ◽

2017 ◽

Vol 137 (10) ◽

pp. 1363-1369 ◽

Cited By ~ 5

Author(s):

Adham Elgeidi ◽

Abed El Negery ◽

M. Serry Abdellatif ◽

Nabil El Moghazy

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Dynamic Hip Screw ◽

Strut Graft ◽

Neck Fracture ◽

Hip Screw ◽

Fibular Strut ◽

Posterior Comminution

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Internal Fixation Versus Hemiarthroplasty for Displaced Intra-Capsular Femoral Neck Fractures in ASA 3-5 Geriatric Patients

The Open Orthopaedics Journal ◽

10.2174/1874325001610010765 ◽

2016 ◽

Vol 10 (1) ◽

pp. 765-771 ◽

Cited By ~ 1

Author(s):

W. Rezaie ◽

W. Wei ◽

B.I. Cleffken ◽

C.H. van der Vlies ◽

B.I. Cleffken ◽

...

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Geriatric Patients ◽

Mortality Rates ◽

Femoral Neck Fractures ◽

Inclusion Criteria ◽

Operation Rate ◽

Neck Fracture ◽

The Mean

Background: The treatment of choice for elderly with a displaced intra-capsular femoral neck fractures is prosthetic replacement. This is however a major surgical procedure for geriatric patients with multiple co-morbidities which can threaten hemodynamic stability and lead to death. In this study we compared the outcome of internal fixation (IF) versus hemiarthroplasty (HA) for the management of intra-capsular femoral neck fractures in the elderly with severe co-morbidities. Methods: We conducted a retrospective cohort study of all the patients who were admitted to our Level-II trauma centre with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria were: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either internal fixation or a cemented hemiprosthesis. The primary outcome was 6-month mortality rate. Secondary outcomes were 30-day mortality, post-operative complications, re-operation rate and length of hospital stay. Results: 80 patients met our inclusion criteria. The mean age of the IF group was 81.6 years and in the HA group it was 84.5 years (P=0.07). The medical records were retrieved 34-64 months after surgery. Two intra-operative deaths due to cement implantation syndrome were found in the HA group and none in the IF group. Twelve patients (21.8%) in the HA group died within 30 days after surgery and 2 (8.0%) in the IF group (P=0.21). The mean operating time was 83 min. for the HA group and 51 min. for the IF group (P=0.000). There were more implant-related complications in the IF than in the HA group (36% vs 9.1% respectively, P=0.008). The 6-month mortality rates didn’t differ between the IF and the HA groups (respectively 28.0% vs 34.5%, P=0.62). Conclusion: The post-operative mortality rates did not differ between the IF and the HA groups in elderly patients with a displaced femoral neck fracture and ASA 3 to 5. However, the HA associated with less implant-related complications than the IF in this group and it is therefore the treatment of choice.

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Subcapital Femoral Neck Fracture following Successful Trochanteric Fracture Treatment with a Dynamic Hip Screw: A Report of Five Cases

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500224 ◽

2007 ◽

Vol 15 (2) ◽

pp. 238-241 ◽

Cited By ~ 10

Author(s):

YT Lung ◽

WL Kam ◽

YF Leung ◽

OM Chung ◽

YL Wai

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Dynamic Compression ◽

Trochanteric Fracture ◽

Femoral Neck Fractures ◽

Fracture Treatment ◽

Trochanteric Fractures ◽

Neck Fracture ◽

Hip Screw ◽

Type Of Fracture

A subcapital femoral neck fracture complicating a healed trochanteric fracture is rare. Such cases are managed in a rather heterogeneous manner, i.e. there exists a mixture of cases treated by either fixed angle devices or dynamic compression screws. We describe 5 patients who developed subcapital femoral neck fractures after healed trochanteric fractures treated with dynamic compression screws. The subjects' clinical data, operative records, and radiographs have been studied retrospectively and the literature reviewed. The risk factors for such a complication include being of advanced age, female, osteoporotic, and having a small femoral head and neck, and a basicervical type of fracture.

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Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: A systematic review

International Journal of Surgery ◽

10.1016/j.ijsu.2018.01.050 ◽

2018 ◽

Vol 52 ◽

pp. 89-97 ◽

Cited By ~ 17

Author(s):

Jian-xiong Ma ◽

Ming-jie Kuang ◽

Fei Xing ◽

Yun-long Zhao ◽

Heng-ting Chen ◽

...

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Sliding Hip Screw ◽

Neck Fracture ◽

Hip Screw ◽

Cancellous Screws

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Multiple Cannulated Cancellous Screws and Dynamic Hip Screw with Derotation Screw for Fixation of Basicervical Femoral Neck Fracture in Young Adults- A Prospective Comparative Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/62 ◽

2020 ◽

Vol 7 (6) ◽

pp. 292-296

Author(s):

Munin Borgohain ◽

Aswin Deepak Rajan ◽

Abhinab Gogoi ◽

Sandeep Prasad

Keyword(s):

Young Adults ◽

Femoral Neck ◽

Comparative Study ◽

Femoral Neck Fracture ◽

Dynamic Hip Screw ◽

Neck Fracture ◽

Prospective Comparative Study ◽

Hip Screw ◽

Cancellous Screws

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Weekend Admission of Intracapsular Femoral Neck Fractures Not Associated With a Greater Rate of Mortality or Morbidity

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318781222 ◽

2018 ◽

Vol 9 ◽

pp. 215145931878122 ◽

Cited By ~ 1

Author(s):

Wahid Rezaie ◽

Gert Roukema ◽

Bart Van de Meulebroucke

Keyword(s):

Logistic Regression ◽

Femoral Neck ◽

Hospital Stay ◽

Femoral Neck Fracture ◽

Trauma Center ◽

Mortality Rates ◽

Femoral Neck Fractures ◽

Neck Fracture ◽

The Mean ◽

Intracapsular Femoral Neck Fracture

Introduction: For a number of emergency conditions, admission over the weekend has been associated with rising morbidity and mortality rates. However, different studies have provided conflicting results regarding the increased rates of mortality and morbidity for patients with intracapsular femoral fracture who were admitted over the weekend, compared to weekdays. This study investigated the effect of weekend admissions on the surgical outcomes of patients with intracapsular femoral neck fractures. Materials and Methods: We conducted a retrospective cohort study of all the patients who were admitted to our level-II trauma center with an intracapsular femoral neck fracture between January 2009 and June 2011. Admission was classified as at the weekend if it took place between 18:00 pm on Friday until midnight on Sunday or on bank holidays. We compared the mortality rates within 30 days and 6 months after surgery for weekday and weekend admissions. Secondary outcomes considered included length of hospital stay, postoperative complications, and reoperation rates. Statistical analysis was performed using logistic regression models, which were adjusted for patient and surgical characteristics. Results: In total, 315 patients met our inclusion criteria. The mean age of this group was 77.9 years (standard deviation ±13) and the female to male ratio was 5:2. The average follow-up period was 49 months. Under logistic regression analysis, weekend admission was not a significant independent risk factor for the 30-day mortality rate (odds ratio 1.85, 95% confidence interval, 0.74-4.62; P = .19). Seventy-seven patients admitted over the weekend were treated within 24 hours versus 125 patients for the weekday group (80.2% vs 57.9%; P = .005). There were no differences between the sample groups in relation to implant-related complications (24.9% vs 25.8%, respectively, P = .89) nor in relation to general complications (12% vs 18.6%, respectively, P = .06). The mean hospital stay of patients operated on during weekends or holidays was significantly shorter compared to patients operated on during weekdays (6.7 vs 8.5 days; P = .009). Conclusion: Patients with intracapsular femoral neck fractures who were admitted over the weekend at our trauma center did not have a higher risk of mortality or morbidity. Furthermore, temporary preoperative care provided over the weekend by an internal medical consultant can be safe and efficient even in the circumstances where there is a lack of dedicated geriatric support. The absence of an elective operating list at the weekend could be a potential factor in shortening waiting times for surgery for intracapsular femoral neck fracture at weekends and holidays.

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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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