The Role of Medial Buttress Plate Augmentation of Cannulated Screws in Unstable Femoral Neck Fractures: A Pilot Study

Background: About 20% of femoral neck fracture surgeries require re-operation. The use of medial buttress plate may reduce the reoperation rate. The purpose of this study is to examine the results of using the method of augmentation of the cannulated screws with medial buttress plate for treatment of unstable femoral neck fractures. Methods: This study included patients with femoral neck fractures of Pauwels type 2 and 3 in which closed reduction was not successful. The patients underwent open anatomical reduction and implantation of three screws, and then the medial placement of the buttress plate was performed. Patients were followed up after 2 weeks, 6 weeks, 3 months, and 6 months. Union and fracture healing and operative complications were assessed using plain radiography. Results: This study included 8 patients with Pauwels type 2 and 3 femoral neck fractures. All patients were men with the mean age of 38.0 ± 11.3 years. Re-hospitalization 30 days after surgery, surgical site infection, deep vein thrombosis (DVT), and deep infection were not observed in any of the patients. The angle between the neck and the femur shaft dramatically increased during the 6-month follow-up (P = 0.049). Union occurred in 6 (75%) patients after 6 months, while 2 patients were lost to follow up. Participants’ Harris Hip Score (HHS) had a significant improvement from 3 months to 6 months after surgery (P = 0.02). Conclusion: Augmentation of cannulated screws with medial buttress plate for unstable femoral neck fractures in patients has advantages in short-term clinical follow-up.

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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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Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study

Journal of International Medical Research ◽

10.1177/03000605211012210 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110122

Author(s):

Wenlu Liu ◽

Huanyi Lin ◽

Xianshang Zeng ◽

Meiji Chen ◽

Weiwei Tang ◽

...

Keyword(s):

Femoral Neck ◽

Clinical Outcomes ◽

Total Hip Replacement ◽

Hip Replacement ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Total Hip ◽

Metal On Metal

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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Functional Outcome of Intracapsular Femoral Neck Fractures Treated by Bipolar Hemiarthroplasty

10.53350/pjmhs21155988 ◽

2021 ◽

Vol 15 (5) ◽

pp. 988-991

Author(s):

Zamir Hussain Tunioi ◽

Rizwan Ali Jhatiyal ◽

M Azeem Akhund ◽

M Kashif Abbasi ◽

L Das Maheshwari ◽

...

Keyword(s):

Femoral Neck ◽

Functional Outcome ◽

Femoral Neck Fractures ◽

University Hospital ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Cross Sectional ◽

Average Hospital

Aim: To evaluate the functional outcome of bipolar hemiarthroplasty in intracapsular fracture neck of femur. Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopaedic Surgery & Traumatology, Peoples Medical University Hospital, Shaheed Benazir Abad from 1st December 2017 to 31st December 2020. Methodology: Sixty six cases of intracapsular femoral neck fractures with age ranging from 50 year to 75 year of either gender who were ambulatory before injury were included; while basicervical, younger than 50 years, with neuromuscular disorder, unfit for surgery, open fracture, bilateral injuries, osteoarthritis of hip, Rheumatoid, Gouty, pathological fractures, bedridden & who did not give consent for study, were excluded from the study. Functional outcome assessed by Harris hip score & data analyzed by SPSS version 23. Results: Twenty six (59.09%) were male and 40 (40.91%) were female with mean age of 64.3±7.77 year. Average time from injury to hospital arrival was 14.7±6.8 hours. Average time from hospitalization to surgery was 4.67±2.23 days. Average time of surgery was 55.67±9.9 minutes. Average hospital stay was 9.7±4.3 days. The average time of follow-up was 18.45±7.63 months. Conclusion: Bipolar implant is safe, effective, reliable, stable and cost effective implant for intracpsular fracture of femoral neck in elderly populace. The 66.66% of patients have satisfactory Harris hip score in follow up duration of 18.45±7.63 months. Keywords: Functional, Outcome, Femoral neck fractures, FNF, Bipolar, Hemiarthroplasty, HHS

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Comparison of the Effects of Two Different Hollow Nails in the Treatment of the Young Pauwels Type Ⅲ Femoral Neck Fractures

10.21203/rs.3.rs-592204/v1 ◽

2021 ◽

Author(s):

WENJING CHENG ◽

GUOZHENG - DING

Keyword(s):

Femoral Neck ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Avascular Osteonecrosis ◽

Significant Difference ◽

Group A ◽

Random Number Table ◽

Screw Withdrawal ◽

Group B

Abstract Background: At present, there is a higher complication rate after treatment of femoral neck fractures with three parallel hollow nails (PHN) in the young Pauwels type Ⅲ femoral neck fractures.For better effect,F-shape hollow nails(FHN) is used to treat femoral neck fractures.The purpose of this study is to compare the clinical efficacy of FHN and PHN and provide reference for clinical application.Methods: Thirty-eight consecutive patients admitted from January 2017 to January 2020 were selected for the study. According to random number table method, the patients were divided into two groups:group A (FHN) and group B (PHN). The gender, age, BMI, comorbidities, time from injury to operation and other general preoperative demographics were not statistically different (P>0.05). The data of the two groups can be comparable.The occurrence of avascular osteonecrosis of the femoral head (AVN), femoral neck shortening, hollow screw withdrawal was recorded in follow-up.Then, Harris hip score (HHS), pain visual analog score (VAS) of two group were obtained at the last follow-up. Results: The mean follow-up period after surgery was 21.4±10.1 (range, 14–29) months. There were 18 cases(mean age, 47.5±9.6) in group A, 20 cases (mean age, 48.6±10.1) in group B. There was no significant difference between the two groups in AVN, femoral neck shortening (P>0.05), the two groups had statistically significant differences in screw withdrawal (F=4.416, P<0.05). There was no significant difference in HHS and VAS between the two groups at the last follow-up (P>0.05).Conclusion: Three parallel hollow nails (PHN) and F-shape hollow nails (FHN) have similar short-term effects in the young Pauwels type Ⅲ femoral neck fractures, but the nail withdrawal rate of FNH is lower.

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The effect of Fracture Inclination in Multiple Planes on Fracture Stability and Reoperation Risks in Femoral-Neck Fractures of Nongeriatric Patients

10.21203/rs.3.rs-923914/v1 ◽

2021 ◽

Author(s):

Dajun Jiang ◽

Shi Zhan ◽

Hai Hu ◽

Hongyi Zhu ◽

Changqing Zhang ◽

...

Keyword(s):

Femoral Neck ◽

Inclination Angle ◽

Preoperative Evaluation ◽

Reoperation Rate ◽

Ct Images ◽

Femoral Neck Fractures ◽

Youden Index ◽

Inclination Angles ◽

Fracture Stability

Abstract BackgroundFor nongeriatric patients with femoral neck fractures (FNFs), internal fixation treatment is still the primary choice. Preoperative evaluation of fracture inclination and underlying stability is essential for selecting appropriate fixation strategies, thus improving clinical prognoses. The purpose of this study was to comprehensively investigate the 3-D inclination angle in both vertical and oblique planes from CT images, and its association with fracture stability and reoperation risks.MethodsWe retrospectively reviewed the medical records of 755 FNFs patients with over two years follow-up. The 3-D inclination angle in vertical (α) and oblique plane (β) were measured based on CT images. The optimal threshold for unstable 3-D inclination were identified by seeking the highest Youden Index in predicting reoperation and validated in the biomechanical test. According to the cut-off value proposed in the diagnostic analysis, forty-two bone models were divided into seven groups, and were all fixed with traditional three parallel screws. Interfragmentary motion (IFM) was used for comparison among seven groups. The association between reoperation outcome and 3-D inclination was analysed with a multivariate model.ResultsThe overall reoperation rate was 13.2%. Unstable 3-D inclination angles with an optimally determined Youden index (0.39) included α>70°; 50°<α<70° and β>20°/ β<-20°. Biomechanical validation showed these fractures had significantly greater (p<0.05) interfragmentary motion (1.374-2.387mm vs. 0.330-0.681 mm). The reoperation rate in 3-D unstable group (32.7%) is significantly (p<0.001) higher than that in 3-D stable group (7.9%). Multivariate analysis demonstrated that 3-D inclination angle was significantly (OR=4.699, p<0.001) associated with reoperation. ConclusionsFNFs with α>70°; 50°<α<70° and β>20°/ β<-20° are real unstable types with significantly worse interfragmentary stability and higher reoperation risks. Fracture inclination in multiple planes is closely related to reoperation outcomes and may enhance the way FNFs are currently evaluated.

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Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01980-4 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shuai Mao ◽

Baomin Chen ◽

Ying Zhu ◽

Liang Qian ◽

Jinluan Lin ◽

...

Keyword(s):

Femoral Neck ◽

Total Hip Replacement ◽

Hip Replacement ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Controlled Study ◽

Total Hip ◽

Uncemented Total Hip Replacement

Abstract Background Cemented or uncemented total hip replacement (CTR or UTR) for femoral neck fractures (AO/OTA type 31B/C) is a relatively common procedure in elderly individuals. The recent literature is limited regarding long-term outcomes following CTR versus UTR in the Asian population. Methods Using our institutional database, we performed long-term outcome analysis on 268 patients with femoral neck fractures (AO/OTA type 31B/C) who had undergone a primary UTR or CTR (CTR: n = 132, mean age, 67.43 ± 6.51 years; UTR: n = 136, mean age, 67.65 ± 6.13 years) during 2007–2014, and these patients were followed until 2019. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary endpoint was the Harris hip score (HHS); the secondary endpoint was the incidence of orthopaedic complications. Results The mean follow-up time was 62.5 months (range, 50.1–76.1 months). At the final follow-up, the HHS was 79.39 ± 16.92 vs 74.18 ± 17.55 (CTR vs UTR, respectively, p = 0.011). Between-group significant differences were observed regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (7.6% [95% CI, 6.4–8.2] for CTR vs 16.9% [95% CI, 14.7–17.3] for UTR, p = 0.020; 9.8% [95% CI, 8.3–10.7] for CTR vs 19.9% [95% CI, 18.2–20.9] for UTR, p = 0.022; 5.3% [95% CI, 4.4–6.7] for CTR vs 13.2% [95% CI, 12.1–13.8] for UTR, p = 0.026, respectively). Conclusion CTR showed superiority to UTR by improving the HHS and decreasing the incidence of orthopaedic complications. Our findings need to be confirmed in a prospective, randomized controlled study to verify whether they can be applicable to a broader population.

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The Role of The Medial Buttress Plate In The Treatment of Pauwels Type Ⅱ And Ⅲ Femoral Neck Fracture: A Retrospective Study And Preliminary Results

10.21203/rs.3.rs-571550/v1 ◽

2021 ◽

Author(s):

Chao Ma ◽

Yanshi Liu ◽

Jialin Liu ◽

Li Chen ◽

Jinyong Huang ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Statistical Significance ◽

Implant Failure ◽

Harris Hip Score ◽

Cannulated Screws ◽

Displaced Femoral Neck Fractures ◽

Anatomic Reduction ◽

Neck Fracture ◽

Buttress Plate

Abstract Background: The purpose of this study was to compare the effectiveness of multiple cannulated screws combined with medial buttress plate or not for the treatment of unstable femoral neck fracture.Methods: 69 nonelderly patients with Garden type III-IV femoral neck fracture were retrospectively analyzed. The patients were divided into MCS (multiple cannulated screws) group and CMBP (combined with medial buttress plate) group according to the surgical method. Patient’s demographic data, Harris Hip Score, EQ-5D index and complications at minimum of 2 years follow-up were analyzed.Results: There were 47 patients in the MCS group (35 male and 12 females) with a mean age of 40.28±12.64 years, whereas 22 patients in the CMBP group (17 male and 5 females) with a mean age of 43.86±12.55 years. In the MCS group, there were one avascular necrosis, five postoperative nonunion, five implant failure, and two femoral neck shortening. While one implant failure, two postoperative nonunion and two impingement in the CMBP group. The difference of HHS scores was statistically significant at 3 months after surgery between the two groups (P<0.05), whereas there was no statistical significance at 6 months, 1 year and 2 years (P>0.05). The same results were found in EQ-5D index.Conclusions: Anatomic reduction and stable fixation contribute to satisfactory outcomes in the treatment of nonelderly displaced femoral neck fractures. A buttress plate in the medial region of the femur neck with cannulated screws offers patients the best biomechanical microenvironment needed for fracture healing without obviously blood-supply disruption, especially in Pauwels type Ⅱ and III.

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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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Minimally invasive open reduction combined with proximal femoral hollow locking plate in the treatment of Pauwels type III femoral neck fracture

Journal of International Medical Research ◽

10.1177/0300060519850962 ◽

2019 ◽

Vol 47 (7) ◽

pp. 3050-3060 ◽

Cited By ~ 3

Author(s):

Gang Wang ◽

Yong Tang ◽

Bin Wang ◽

Huilin Yang

Keyword(s):

Femoral Neck ◽

Minimally Invasive ◽

Internal Fixation ◽

Open Reduction ◽

Locking Plate ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Clinical Effects ◽

Type Iii

ObjectiveThis study was performed to investigate the clinical effects of minimally invasive open reduction and internal fixation with a proximal femoral hollow locking plate on Pauwels type III femoral neck fractures.MethodsThe clinical data of 45 patients aged 32.0 ± 8.1 years (range, 19–45 years) with Pauwels type III femoral neck fractures treated from March 2012 to August 2016 were retrospectively analyzed. All patients underwent anterolateral minimally invasive open reduction and proximal femoral hollow locking plate fixation of the hip joint. Garden’s index was used to evaluate the quality of fracture reduction. Complications and fracture healing were recorded in all patients. At the last follow-up, the functional outcome was recorded using the Harris hip score.ResultsNo complications such as femoral neck shortening, internal fixation loosening, or refracture occurred. However, three patients required reoperation (one with nonunion and two with femoral head necrosis). At the last follow-up, the mean Harris hip score was 92.1 ± 4.5 (range, 76–98). The rate of excellent and good Harris hip scores was 93.3%.ConclusionThe herein-described strategy for Pauwels type III femoral neck fractures is advantageous in terms of high reduction quality, firm fixation, and prevention of neck shortening.

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Dual-Mobility Cup Total Hip Arthroplasty for Displaced Femoral Neck Fractures: A Retrospective Study With a Median Follow-Up of 5 Years

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211013244 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110132

Author(s):

Zhenfa Zhang ◽

Guixing Xu ◽

Lei Cao ◽

Wei Sun ◽

Xianshang Zeng ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Complication Rate ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Total Hip

Introduction: Patient outcomes following modern dual-mobility cup total hip arthroplasty (DM-THA) remains a concern. Few reports have focused on the use of modern DM-THA in the setting of Asian populations for displaced osteoporotic femoral neck fractures (FNFs). This study aimed to investigate the outcomes of Chinese population with displaced osteoporotic FNFs initially treated with modern DM-THA. Materials and Methods: Data from 112 consecutive patients (112 hips) with displaced osteoporotic FNFs initially treated with modern DM-THA during 2011-2018 were retrospectively analyzed. Follow-ups were performed at 3 months, 6 months, 12 months, and then every 1 year after surgery. The primary endpoint was the Harris Hip Score (HHS); the secondary endpoint was the main orthopedic complication rate. Results: The mean HHS improved from 58.62 (±15.79) prior to surgery to 86.13 (±9.92) at the final follow-up. The main complication rate was 14.2% (16/112). Sixteen complications in 10 patients were recorded. Of the 16 complications, there were 2 (1.7%) cases requiring revision DM-THA, 3 (2.6%) cases of loosening, 2 (1.7%) cases of migration, 3 (2.6%) intra-prosthetic dislocation (IPD), 4 (3.5%) cases of tilting, and 2 (1.7%) cases of severe wear. The need for revision was attributed to prosthesis loosening associated with poor bony quality. Conclusion: In patients with displaced osteoporotic FNFs, DM-THA may yield favorable functional outcomes and a low rate of main orthopedic complications, in particular, a low dislocation rate.

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