Risk Factors for Nonunion in Patients with Intracapsular Femoral Neck Fractures Treated with Three Cannulated Screws Placed in Either a Triangle or an Inverted Triangle Configuration

2013 ◽  
Vol 95 (1) ◽  
pp. 61-69 ◽  
Author(s):  
Jui-Jung Yang ◽  
Leou-Chyr Lin ◽  
Kuo-Hua Chao ◽  
Shih-Youeng Chuang ◽  
Chia-Chun Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Cannulated Screws ◽  
Inverted Triangle

A model to evaluate Pauwels type III femoral neck fractures

2018 ◽  
Vol 232 (3) ◽  
pp. 310-317 ◽  
Author(s):  
Kevin M Magone ◽  
Jonas K Owen ◽  
Bernard P Kemker ◽  
Oliver Bloom ◽  
Sidney Martin ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Fracture Repair ◽  
Fourth Generation ◽  
Unstable Fracture ◽  
Cannulated Screws ◽  
Sliding Hip Screw ◽  
Neck Shaft Angle ◽  
Inverted Triangle ◽  
Hip Screw

While many femoral neck fractures can be reliably treated with surgical intervention, Pauwels III femoral neck fractures in the young adult population continue to be a challenging injury, and there is no consensus on optimal treatment. As such, there are past and ongoing biomechanical studies to evaluate the fixation provided by different constructs for this inherently unstable fracture. While many investigations rely on cadavers to evaluate the biomechanical performance of a construct, significant inter-subject variability can confound the analysis. Biomechanical femur analogs are being used more frequently due to more consistent mechanical properties; however, they have not been stringently evaluated for morphology or suitability for instrumentation. This study sought to determine the variability among composite femoral analogs as well as consistently create a Pauwels III injury and instrument the analogs without the need for fluoroscopic guidance. In total, 24 fourth-generation composite femoral analogs were evaluated for femoral height, neck–shaft angle, anteversion, and cortical thickness. A method was developed to simulate a Pauwels III fracture and to prepare three different constructs: an inverted triangle of cannulated screws, a sliding hip screw, and a hybrid inverted triangle with cannulated screws and a sliding hip screw. Radiographs were utilized to evaluate the variation in implant position. All but one of the morphological parameters varied by <1%. The tip-to-apex distance for all sliding hip screw hardware was 18.8 ± 3.3 mm, and all relevant cannulated screw distances were within 5 mm of the adjacent cortex. All screws were parallel, on average, within 1.5° on anterior–posterior and lateral films. Fourth-generation composite femora were found to be morphologically consistent, and it is possible to consistently instrument the analogs without the use of fluoroscopy. This analog and hardware implantation model could serve as a screening model for new fracture repair constructs without the need for cadaveric tissues or radiologic technology.

216 Fix or Replace: Is Internal Fixation Still A Viable Option in The Elderly with Un-Displaced Intracapsular Femoral Neck Fractures?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Morris ◽  
A Krishna ◽  
H Hamid ◽  
M Chawda ◽  
H Mumtaz
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Revision Surgery ◽  
Retrospective Review ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Cannulated Screws ◽  
Viable Option ◽  
Displaced Femoral Neck Fractures

Abstract Aim The treatment of impacted or un-displaced femoral neck fractures in the elderly osteoporotic patient is still largely debated, with arthroplasty versus internal fixation two surgical options1. Our aim was to retrospectively review patients over the age of 80 with un-displaced intracapsular hip fractures who had undergone internal fixation and assess their rate of mortality and revision surgery. Method We conducted a retrospective review of all patients with femoral neck fractures over a 4-year period between January 2015 to December 2018. We refined this to only patients over the age of 80 with un-displaced intracapsular femoral neck fractures fixed with cannulated screws. We noted their mental and mobility status, their follow-up attendance over 3 years, their mortality and rate of revision surgery. Results There were a total of 1232 femoral neck fractures in a 4-year period. Of these, 37 were &gt;80 with un-displaced intracapsular femoral neck fractures, with 23 fixed with cannulated screws and 14 with a Dynamic Hip Screw. Mean age – 85, M:F (1:4.75). All patients were either Garden Classification Type I or II. 4% had cognitive impairment. All patients were independently mobile. 83% were followed up for 3 years, with 1 patient (4%) undergoing revision surgery 3 years following cannulated screw fixation. The 30-day mortality rate was 5%. Conclusions The treatment choice for un-displaced intracapsular femoral neck fractures in the elderly remains debateable. Our retrospective review shows that the rate of re-operation is low in patients who have undergone fixation with cannulated screws and so this remains a viable option.

Recent Methods of Neck Femur Fixation A Systematic review and meta-analysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Salem Eid ◽  
Ahmed Mohamed Mohasseb ◽  
Ramy Mohamed Mohamed El-Bahnasy
Keyword(s):  
Systematic Review ◽  
Femoral Head ◽  
Femoral Neck ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Final Outcome ◽  
Cannulated Screws ◽  
Fixed Angle ◽  
Femur Fractures ◽  
Femoral Head Osteonecrosis

Abstract Background Femoral neck fractures in adults younger than age 50 years are uncommon and often the result of high energy trauma. They account for only 2-3% of all femoral neck fractures. Femoral neck fractures are associated with aging and osteoporosis and can occur after relatively trivial trauma in elderly patients. femoral neck fractures are associated with higher incidences of femoral head osteonecrosis and nonunion. Fixation options include cannulated screws, non parallel cannulated screws, medial augmentation plate, and fixed angle femoral neck fixation implants. A systematic review of literature done to evaluate which technique is better. Methods After literature search thirteen articles were found and were reviewed to evaluate final outcome of fixation of neck femur fractures by cannulated screws, non parallel cannulated screws, medial augmentation plate, and fixed angle femoral neck fixation implants. Results After evaluation of all studies the incidence of nonunion, osteonecrosis of femoral head, implant failure & revesion surgery is lower in comparing Targon plate with multiple cannulated screws while we need further studies for application of non parallel screws and medial plate. Conclusion Targon plate recorded low incidence of complications in the final outcome in comparison with multiple cannulated screw while we need further studies for application of Non parallel screws and medial plate.

Finite element analysis of the impact of screw insertion distal to the trochanter minor on the risk of iatrogenic subtrochanteric fracture

2018 ◽  
Vol 232 (8) ◽  
pp. 807-818 ◽  
Author(s):  
Ersin Sensoz ◽  
Fatih Mehmet Özkal ◽  
Volkan Acar ◽  
Ferit Cakir
Keyword(s):  
Finite Element ◽  
Femoral Neck ◽  
Screw Fixation ◽  
Subtrochanteric Fracture ◽  
Femoral Neck Fractures ◽  
Cannulated Screws ◽  
Screw Insertion ◽  
Subtrochanteric Fractures ◽  
Trochanter Minor ◽  
The Impact

Iatrogenic subtrochanteric fractures are rarely encountered after cannulated screw fixation of femoral neck fractures; however, when they do occur, there can be several complications. Many orthopedic surgeons have concerns about the potential for iatrogenic subtrochanteric fractures after screw fixation distal to the trochanter minor; therefore, some surgeons are typically reluctant to perform this procedure. This study focused on the risk of an iatrogenic subtrochanteric fracture after treating femoral neck fractures with cannulated screws. The main purpose of the study was to understand iatrogenic subtrochanteric fractures and evaluate the effects on these fractures of an inverted triangular–shaped configuration for placement of the cannulated screws. A femur bone with an femoral neck fracture at a 40° incline to the horizontal plane was generated along with a representation of a three-dimensional finite element model, and three inverted triangular–shaped configurations for placement of the cannulated screws were investigated using finite element analyses. Statistical results indicated that the occurrence risk of ISF increases when the screw is located distal to the trochanter minor. Moreover, the risk of occurrence of intertrochanteric fracture increases when the screw is located medial to the trochanter minor because of local concentrated stress on the surface of the screw canals. To avoid the vulnerability of the subtrochanteric region, it was found that proximal placement of the screws using the inverted triangular–shaped configuration could yield better results. In addition, the results of this study provide suggestions on improved screw configurations.

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

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.

Proximal Femoral Locking Plate With Cannulated Screws for the Treatment of Femoral Neck Fractures

Orthopedics ◽  
2012 ◽  
Author(s):  
Dasheng Lin ◽  
Kejian Lian ◽  
Zhenqi Ding ◽  
Wenliang Zhai ◽  
Jiayuan Hong
Keyword(s):  
Femoral Neck ◽  
Locking Plate ◽  
Femoral Neck Fractures ◽  
Cannulated Screws

scholarly journals Risk factors for osteoporosis are common in young and middle-aged patients with femoral neck fractures regardless of trauma mechanism

2013 ◽  
Vol 84 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Amer N Al-Ani ◽  
Gustaf Neander ◽  
Bodil Samuelsson ◽  
Richard Blomfeldt ◽  
Wilhelmina Ekström ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Trauma Mechanism ◽  
Middle Aged ◽  
Aged Patients

scholarly journals The Probability of and Risk Factors for Femoral Neck Shortening and Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With a Medial Buttress Plate

2021 ◽  
Author(s):  
Jinglei Xu ◽  
Xue Bai ◽  
Chenyang Xu ◽  
Xianzhong Ma
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Fracture Site ◽  
Cannulated Screws ◽  
Fixation Failure ◽  
Neck Fracture ◽  
Buttress Plate

Abstract Background: A range of postoperative complications make femoral neck fracture difficult to treat. Femoral neck shortening and internal fixation failure are two most prevalent complications associated with many surgical strategies. This study evaluates the probability of and risk factors for these complications after the treatment of femoral neck fracture using cannulated screws combined with a medial buttress plate.Methods: Data of 70 patients with femoral neck fractures treated using cannulated screws combined with a medial buttress plate in our hospital between March 2016 and March 2019 were retrospectively analyzed, and 40 patients who were followed up for more than 3 months were enrolled in the study. We evaluated the probability of postoperative femoral neck shortening and internal fixation failure and conducted multivariate logistic regression analysis to determine risk factors.Results: All 40 patients had Garden III/IV or Pauwels II/III fractures. Of these patients, 11 had femoral neck shortening greater than 5 mm and 8 had fracture nonunion or screw cutout requiring reoperation. There were no differences in age, sex, fracture site, Pauwels classification, and reduction quality between the shortening and non-shortening groups; however, there were significant differences in screw quality. Similarly, there were no differences in age, sex, Pauwels classification, reduction quality, and screw quality between the fixation failure and non-failure groups, but there were significant differences in fracture site and shortening. According to the multivariate analyses, screw quality was an independent risk factor for femoral neck shortening (odds ratio [OR]: 8.58; 95% confidence interval [CI]: 1.35–50.57; P=0.022), and femoral neck shortening was an independent risk factor for internal fixation failure (OR: 11.82; 95% CI: 1.66–84.36; P=0.014).Conclusions: Femoral neck fracture treatment using cannulated screws combined with a medial buttress plate led to a femoral neck shortening rate lower than that of other internal fixation methods and an internal fixation failure rate lower than or equivalent to that of other internal fixation methods. The quality of cannulated screws is a risk factor for postoperative shortening of the femoral neck, and femoral neck shortening is a risk factor for postoperative internal fixation failure.

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