Dynamic compression locking system versus multiple cannulated compression screw for the treatment of femoral neck fractures: a comparative study

Abstract Background: Femoral neck fractures are one of the problems in orthopedic treatment. The prognosis is uncertain. Currently, there is no one internal fixation for the treatment of femoral neck fractures that shows superiority over other internal fixations. Therefore, the internal fixation system needs to be further explored. The aim of this study was to compare clinical outcomes of femoral neck dynamic compression locking system （DCLS）and multiple cannulated compression screws（MCCS） in the treatment of femoral neck fractures.Methods: A prospective analysis of 54 cases of femoral neck fractures treated with either a DCLS (n=28) or MCCS (n=26) was conducted between December 2015 and November 2017 in authors’ hospitals. The perioperative and postoperative parameters of the two groups were recorded and evaluated.Results: Fifty-four patients were followed up for 24-47 months. The etiology was caused by a fall. There was no significant difference in follow-up time, operation time, incision length, surgical blood loss, the incidence of perioperative and postoperative healing complications, and mobility in the two groups (P> 0.05). The Harris score, fracture healing time, femoral neck shortening, partial weight-bearing time and complete weight-bearing time were significantly better in the DCLS group than in the MCCS group (P< 0.05). The fracture healing rate in the DCLS group was higher than that in the MCCS group.Conclusion: The DCLS and MCCS might be equally effective in terms of operation time, incision length, surgical blood loss, the incidence of perioperative and postoperative healing complications, and mobility in the treatment of femoral neck fractures. However, the DCLS is superior to the MCCS in Harris score, fracture healing time, femoral neck shortening, weight-bearing time and fracture healing rate. So, DCLS deserves further study.

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Dynamic compression locking system versus multiple cannulated compression screw for the treatment of femoral neck fractures: a comparative study

10.21203/rs.2.20870/v2 ◽

2020 ◽

Author(s):

Dong-Ping Shu ◽

Ya-Ping Xiao ◽

Ming-Jian Bei ◽

Tao Ji ◽

Yong-Jun Peng ◽

...

Keyword(s):

Femoral Neck ◽

Fracture Healing ◽

Healing Rate ◽

Dynamic Compression ◽

Weight Bearing ◽

Operation Time ◽

Healing Time ◽

Femoral Neck Fractures ◽

Incision Length ◽

Harris Score

Abstract Background Femoral neck fractures are one of the problems in orthopedic treatment. The prognosis is uncertain. Currently, there is no one internal fixation for the treatment of femoral neck fractures that shows superiority over other internal fixations. Therefore, the internal fixation system needs to be further explored. The aim of this study was to compare clinical outcomes of femoral neck dynamic compression locking system (DCLS)and multiple cannulated compression screws(MCCS) in the treatment of femoral neck fractures. Methods A prospective analysis of 54 cases of femoral neck fractures treated with either a DCLS (n=28) or MCCS (n=26) was conducted between December 2015 and November 2017 in authors’ hospitals. The perioperative and postoperative parameters of the two groups were recorded and evaluated. Results Fifty-four patients were followed up for 24-47 months. The etiology was caused by a fall. There was no significant difference in follow-up time, operation time, incision length, surgical blood loss, the incidence of perioperative and postoperative healing complications, and mobility in the two groups ( P > 0.05). The Harris score, fracture healing time, femoral neck shortening, partial weight-bearing time and complete weight-bearing time were significantly better in the DCLS group than in the MCS group ( P < 0.05). The fracture healing rate in the DCLS group was higher than that in the MCS group. Conclusion The DCLS and MCCS might be equally effective in terms of operation time, incision length, surgical blood loss, the incidence of perioperative and postoperative healing complications, and mobility in the treatment of femoral neck fractures. However, the DCLS is superior to the MCCS in Harris score, fracture healing time, femoral neck shortening, weight-bearing time and fracture healing rate. So, DCLS deserves further study.

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Clinical analysis of internal fixation femoral neck fractures with two or three cannulated screws

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200727018k ◽

2021 ◽

pp. 18-18

Author(s):

Igor Kostic ◽

Milan Mitkovic ◽

Sasa Milenkovic ◽

Milorad Mitkovic

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Operation Time ◽

Study Groups ◽

Clinical Analysis ◽

Healing Time ◽

Femoral Neck Fractures ◽

Fixation Group ◽

Significant Difference ◽

Harris Score

Introduction/Objective. Angular stability and dinamyc fixation are key factors to successful healing of femoral neck fractures. We evaluate the efficacy of internal fixation of femoral neck fractures with two parallel self-tapping antirotation screws (SAF) compared to standard, three cannulated cancellous screws (CCS) fixation. Methods. One-hundred fractures were retrospectivaly analysed, divided in two groups in which two SAF screws were used in parallel (n=50) or three standard AO screws in an inverted triangle configuration (n=50). The groups were compared with operation time, time of consolidation, femoral neck shortening, Harris score and reoperation rates. Results. SAF parallel fixation group of patients achieved consolidation rate of 86% compared to 74% in CCS fixation group, without statistically significant difference between the examined groups (p>0,05). Dynamization of implants was significantly positively correlated with the fracture healing time in both examined groups (SAF: r = 0.324, p = 0.025; CCS: r = 0.572, p = 0.001), with significantly shorter healing time in SAF patients - on average 15 weeks (15.02?1.44) in relation to the CCS group of patient - 19 weeks (19.81?2.94) (?2/z =7.048, p <0.001). There was no statistically significant difference in the Harris score and reoperation rate among the study groups (?2 = 2.44, p = 0.487; ?2 = 0.500, p = 0.696). Conclusion. Our results suggested that dual parallel fixation (SAF) is simpler, less invasive and it demands less time for performing. It is not inferior to fixation with 3 screws, from the point of biomechanics, possible complications, healing and functional recovery.

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Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

10.21203/rs.3.rs-1229275/v1 ◽

2022 ◽

Author(s):

Xuefeng Zhou ◽

Sichao Gu ◽

Li Li ◽

Lei Xu ◽

Xujin Wang ◽

...

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Clinical Efficacy ◽

Weight Bearing ◽

Operation Time ◽

Femoral Neck Fractures ◽

Teaching Hospitals ◽

Harris Hip Score ◽

Clinical Report ◽

Short Term

Abstract Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

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Computer-assisted cannulated screw internal fixation versus conventional cannulated screw internal fixation for femoral neck fractures: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02806-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Qing-hao Cheng ◽

Peng-biao Li ◽

Ting-ting Lu ◽

Shi-fang Guo ◽

Wen-fei Di ◽

...

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Fracture Healing ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Operation Time ◽

Healing Time ◽

Cannulated Screw ◽

Computer Assisted ◽

Neck Fracture

Abstract Objective To compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture. Methods The search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups. Results A total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time. Conclusion Compared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture. Study registration PROSPERO registration number CRD42020214493.

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Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200183 ◽

2020 ◽

pp. 1-9

Author(s):

Zhengbing Su ◽

Linlin Liang ◽

Yong Hao

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Healing Time ◽

Femoral Neck Fractures ◽

Type Iii ◽

Support Plate ◽

Neck Fracture ◽

Harris Score

BACKGROUND: Femoral neck fractures often occur in the elderly, which usually results in hip pain. OBJECTIVE: The purpose of this study was to evaluate the difference in the treatment of Pauwels type III femoral neck fractures with medial femoral support plate combined with cannulated screws and cannulated screws alone. METHODS: PubMed, ScienceDirect, China Academic Journals Full-text Database (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), Embase and Cochrane Library were used to collect clinical controlled trials of the medial femoral support plate combined with hollow screw internal fixation and simple hollow screw internal fixation for Pauwels type III femoral neck fracture. RESULTS: Seven articles (n= 409 cases) were evaluated for quality and included in this meta-analysis. Four hundred and nine patients with Pauwels type III femoral neck fractures were included: 202 in the experimental group and 207 in the control group. The results showed that, compared with simple hollow screw internal fixation, the medial femoral support plate combined with hollow screw internal fixation has a longer operation time (MD= 23.05, 95% CI= 13.86–32.24), and more intraoperative blood loss (MD= 91.55, 95% CI= 50.72–132.39), shorter healing time (MD=-1.48, 95% CI (-1.71, -1.26)), lower incidence of complications (RR= 0.34, 95% CI= 0.19–0.61), lower VAS score (MD=-1.28, 95% CI (-1.83, -0.72)), and higher Harris score (MD= 8.49, 95% CI (4.15, 12.83)). CONCLUSION: Medial femoral plate combined with cannulated screw for Pauwels type III femoral neck fracture can shorten healing time, reduce postoperative complications, and improve the postoperative Harris score.

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Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

Biomedicines ◽

10.3390/biomedicines9060691 ◽

2021 ◽

Vol 9 (6) ◽

pp. 691

Author(s):

Jan Barcik ◽

Devakara R. Epari

Keyword(s):

Fracture Healing ◽

Bone Healing ◽

Mechanical Stimulation ◽

Callus Formation ◽

Weight Bearing ◽

Healing Process ◽

Healing Time ◽

Mechanical Environment ◽

Clinically Significant ◽

The Impact

The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.

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A study of prospective analysis of unipolar versus bipolar hemiarthroplasty of hip joint in patients with fracture neck of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211621 ◽

2021 ◽

Vol 7 (3) ◽

pp. 629

Author(s):

Raja X. ◽

Arjun Sarvesh ◽

Karthikeyen M. ◽

A. E. Manoharan

Keyword(s):

Femoral Neck ◽

Weight Bearing ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Early Weight Bearing ◽

Group I ◽

Significant Difference ◽

Group Ii

Background: Femoral neck fractures occur most commonly in elderly females and are a major cause of morbidity and mortality in this age group and require immediate and appropriate management. Aim of the study was to compare the functional outcome of unipolar Austin Moore's prosthesis (AMP) hemiarthroplasty (HA) and bipolar (BHA) HA with femoral neck fractures using Harris hip score system.Methods: The study was conducted on 60 patients aged above 50 years with fractured neck of femur admitted in Vinayaka missions Kirupananda Variyar medical college and hospital from August 2017 to August 2019. Patients with femoral neck fracture were allocated randomly to have 30 cases of AMP.Results: Out of the 60 cases, the patients in the bipolar (nonmodular) HA group II showed better functional outcomes compared to unipolar (AMP) HA group I after six months follow-ups. At 12 months of follow-up, there was no significant difference between group I (AMP) and group II (BHA).Conclusions: Our study demonstrates, hemiarthroplasty of the hip for femoral neck fractures is a good option in elderly patients. The mortality and morbidity are not high, the operative procedure is simple, complications are less disabling, early weight-bearing and functional results are satisfactory and second surgery are less frequently required.

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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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Weight bearing in patients with femoral neck fractures compared to pertrochanteric fractures: A postoperative gait analysis

Injury ◽

10.1016/j.injury.2019.05.008 ◽

2019 ◽

Vol 50 (7) ◽

pp. 1324-1328 ◽

Cited By ~ 6

Author(s):

Daniel Pfeufer ◽

Chiara Grabmann ◽

Stefan Mehaffey ◽

Alexander Keppler ◽

Wolfgang Böcker ◽

...

Keyword(s):

Femoral Neck ◽

Gait Analysis ◽

Weight Bearing ◽

Femoral Neck Fractures ◽

Pertrochanteric Fractures

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Displaced femoral neck fractures in patients 60 years of age or younger: results of internal fixation with the dynamic locking blade plate

The Bone & Joint Journal ◽

10.1302/0301-620x.100b4.bjj-2016-1098.r3 ◽

2018 ◽

Vol 100-B (4) ◽

pp. 443-449 ◽

Cited By ~ 10

Author(s):

J. H. Kalsbeek ◽

A. D. P. van Walsum ◽

J. P. A. M. Vroemen ◽

H. M. J. Janzing ◽

J. T. Winkelhorst ◽

...

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Fracture Healing ◽

Avascular Necrosis ◽

Young Patients ◽

Case Series ◽

Neuromuscular Disorder ◽

Femoral Neck Fractures ◽

Blade Plate ◽

Displaced Femoral Neck Fractures

AimsThe objective of this study was to investigate bone healing after internal fixation of displaced femoral neck fractures (FNFs) with the Dynamic Locking Blade Plate (DLBP) in a young patient population treated by various orthopaedic (trauma) surgeons.Patients and MethodsWe present a multicentre prospective case series with a follow-up of one year. All patients aged ≤ 60 years with a displaced FNF treated with the DLBP between 1st August 2010 and December 2014 were included. Patients with pathological fractures, concomitant fractures of the lower limb, symptomatic arthritis, local infection or inflammation, inadequate local tissue coverage, or any mental or neuromuscular disorder were excluded. Primary outcome measure was failure in fracture healing due to nonunion, avascular necrosis, or implant failure requiring revision surgery.ResultsIn total, 106 consecutive patients (mean age 52 years, range 23 to 60; 46% (49/106) female) were included. The failure rate was 14 of 106 patients (13.2%, 95% confidence interval (CI) 7.1 to 19.9). Avascular necrosis occurred in 11 patients (10.4%), nonunion in six (5.6%), and loss of fixation in two (1.9%).ConclusionThe rate of fracture healing after DLBP fixation of displaced femoral neck fracture in young patients is promising and warrants further investigation by a randomized trial to compare the performance against other contemporary methods of fixation. Cite this article: Bone Joint J 2018;100-B:443–9.

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