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

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

10.21203/rs.2.20870/v1 ◽

2020 ◽

Author(s):

Ya-Ping Xiao ◽

Ming-Jian Bei ◽

Tao Ji ◽

Yong-Jun Peng ◽

Bing Ma ◽

...

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 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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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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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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Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Medicina ◽

10.3390/medicina49030022 ◽

2013 ◽

Vol 49 (3) ◽

pp. 22

Author(s):

Jaunius Kurtinaitis ◽

Narūnas Porvaneckas ◽

Giedrius Kvederas ◽

Tomas Butėnas ◽

Valentinas Uvarovas

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Femoral Neck Fractures ◽

Total Hip ◽

Significant Difference ◽

Surgery Rates

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

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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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The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01958-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shuai Cui ◽

Dehui Wang ◽

Xuejie Wang ◽

Zehui Li ◽

Wenlai Guo

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Hip Replacement ◽

Operation Time ◽

The Elderly ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Controlled Trials ◽

Short Term ◽

Randomized Controlled

Abstract Background Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors. Materials and methods Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared. Results There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up. Conclusions In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.

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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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Valgus Impacted Femoral Neck Fractures: Surgery or Non-Operative Approach?

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v7i2.6998 ◽

2021 ◽

Author(s):

Arvin Najafi ◽

Mohsen Tavakoli ◽

Danoosh Zargar ◽

Dorsa Hadavi ◽

Ehsan Seif ◽

...

Keyword(s):

Treatment Group ◽

Femoral Neck ◽

Internal Fixation ◽

Operative Treatment ◽

Weight Bearing ◽

Operative Management ◽

Femoral Neck Fractures ◽

Significant Difference ◽

Non Operative Management ◽

Partial Weight

Background: Non-operative management of valgus impacted femoral neck fracture leads to prolonged bed rest which may lead to deep vein thrombosis. The preferred method is the internal fixation because of pain control, enhanced mobilization, and better fracture healing but fails in older patients and individuals with medical comorbidities. The present study aims to assess the functional outcomes after the internal fixation or the non-operative management. Methods: A retrospective cohort study was conducted at a Level I trauma center from January 2013 to December 2019 on all patients with valgus-impacted femoral neck fractures [Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association Classification (AO/OTA 31-B1)]. Overall, 81 patients were managed operatively with three partially threaded, cannulated screws in a parallel configuration and 21 patients were managed non operatively with instant mobilization, physical therapy, and partial weight-bearing protocol. Results: 6 (28.0%) patients in the non-operative group and 3 (4.0%) cases in the operative group experienced fracture displacement (P < 0.001). 48 (59.2%) patients of the operative treatment group returned to baseline ambulatory function at 3 months, while this figure was 43.0% in the non-operative treatment group, not significantly different (P = 0.100). There was no significant difference in the mortality rates at one month and three months between the two groups (2 patients in each group, P = 0.140). Conclusion: The ideal treatment of valgus-impacted femoral neck fractures is still controversial. The main purpose in the treatment of hip fractures is to return the patient to functional level equal to the level he or she was before the fracture. Surgically treated patients had lower failure rates in comparison with the other group.

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In vitro biomechanical comparison of three methods for internal fixation of femoral neck fractures in dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-11-03-0045 ◽

2012 ◽

Vol 25 (01) ◽

pp. 36-41

Author(s):

R. M. McLaughlin ◽

S. H. Elder ◽

S. C. Fisher

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Kirschner Wire ◽

Compressive Force ◽

Femoral Neck Fractures ◽

Osteotomy Site ◽

Significant Difference ◽

Load To Failure ◽

Compressive Pressure

SummaryThe in vitro biomechanical properties of three methods for internal fixation of femoral neck fractures were evaluated. Fifty cadaveric femora from Beagle dogs were used. Ten intact femora served as controls. In 40 femora, an osteotomy of the femoral neck was performed to simulate a transverse fracture. With the remaining 30 femora, three repair methods (two medium Orthofix pins, a 2.7 mm cortical bone screw placed in lag fashion and an anti-rotational Kirschner wire, or three divergent 1.1 mm Kirschner wires) were used to stabilize the osteotomies, and 10 osteotomies were stabilised per repair method. These 30 femora where then subject to monotonic loading to failure. Construct stiffness and load to failure were measured. In the remaining 10 femora, pressure sensitive film was placed at the osteotomy site prior to stabilization with either two Orthofix pins (n = 5) or a screw placed in lag fashion (n = 5) to determine the compressive pressure (MPa), compressive force (KN) and area of compression (cm2).There was no significant difference in the stiffness or load to failure for the three repair methods evaluated. There was no significant difference in the compressive pressure, compressive force or area of compression in osteotomies stabilized with Orthofix pins and 2.7 mm bone screws.

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HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.6.8 ◽

2014 ◽

pp. 47-50

Author(s):

Duy Binh Ho ◽

Nghi Thanh Nhan Le ◽

Maasalu Katre ◽

Koks Sulev ◽

Märtson Aare

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Hip Fractures ◽

Age Groups ◽

Femoral Fractures ◽

Femoral Neck Fractures ◽

University Hospital ◽

High Risk Population ◽

Intertrochanteric Fractures ◽

Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

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