Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods

Introduction: Although the preferred treatment for displaced femoral neck fractures in the elderly is hip arthroplasty, the treatment for impacted or undisplaced femoral neck fractures (UFNF) is still a subject of controversy. Our purpose was to systematically review studies of elderly patients with UFNF treated with internal fixation using screws: (i) what is the reported mortality; (ii) what is the reoperation rate; (iii) what are the clinical and radiological outcomes; and (iv) what is the methodological quality of the included studies? Methods: This systematic review was performed through a search of PubMed and the Cochrane database using a structured search algorithm including studies enrolling patients older than 60 years old, with UFNF treated with internal fixation using screws. Our literature search returned 950 studies and 11 were selected for final abstraction. Results: 6 studies reported mortality rate. At 1-year follow-up mortality was reported by 3 studies: 18.8%; 22%, and 19%. At 5 years, 1 study reported mortality rate of 42%. Overall reoperation rate was reported by 9 studies and ranged from 8%-19%, while conversion to hip arthroplasty was performed in the range between 8% and 16% according to 6 studies. Conclusions: Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.

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Role of preoperative posterior tilt on the outcomes of internal fixation of non-displaced femoral neck fractures: A systematic review and meta-analysis

Injury ◽

10.1016/j.injury.2020.11.063 ◽

2020 ◽

Author(s):

Jelle P. van der List ◽

Salih El Saddy ◽

Stan J. Vos ◽

Olivier P.P. Temmerman

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

Internal Fixation ◽

Meta Analysis ◽

Femoral Neck Fractures ◽

Displaced Femoral Neck Fractures ◽

Posterior Tilt

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Biomechanical Evaluation of a New Device for Internal Fixation of Femoral Neck Fractures

Artificial Cells Blood Substitutes and Biotechnology ◽

10.3109/10731199.2010.538404 ◽

2010 ◽

Vol 39 (4) ◽

pp. 252-258 ◽

Cited By ~ 3

Author(s):

Ming Yang ◽

Jianhai Chen ◽

Dianying Zhang ◽

Jing Wang ◽

Kai Yu ◽

...

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Femoral Neck Fractures ◽

New Device ◽

Biomechanical Evaluation

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Pauwels’Type-3 Femoral Neck Fractures in Young Population: A Comparative Study of Three Internal Fixation Methods

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v7i8.21 ◽

2019 ◽

Vol 7 (8) ◽

Author(s):

Dr Imtiyaz Ahmad BEIGH ◽

Keyword(s):

Femoral Neck ◽

Comparative Study ◽

Internal Fixation ◽

Femoral Neck Fractures ◽

Young Population ◽

Fixation Methods

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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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Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02517-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Huaijian Hu ◽

Jingbo Cheng ◽

Mingli Feng ◽

Zhihua Gao ◽

Jingwei Wu ◽

...

Keyword(s):

Body Mass Index ◽

Femoral Head ◽

Clinical Outcome ◽

Femoral Neck ◽

Internal Fixation ◽

Body Mass ◽

Statistical Difference ◽

Femoral Neck Fractures ◽

Femoral Head Necrosis ◽

Fixation Methods

Abstract Background The clinical outcome of a new fixation device (femoral neck system, FNS) for femoral neck fractures remains unclear. The main purpose of this study was to evaluate two different internal fixation methods for the treatment of femoral neck fractures in patients aged under 60 years. Methods We retrospectively studied patients who underwent internal fixation surgery in our hospital for femoral neck fractures between January 2017 and January 2020. Cannulated compression screws (CCS) and FNS groups were divided according to different internal fixation methods. General data (such as sex, age, body mass index, type of fracture) of all patienFemoral neck shorteningts were collected, and joint function was evaluated using the Harris Hip Score (HHS) before and 1 year after surgery. We recorded related surgical complications, including femoral head necrosis, nonunion, and femoral neck shortening. Results There were no significant differences in age, sex, or body mass index between the two groups. There was no statistical difference in HHSs between the two groups before surgery. Patients who underwent FNS treatment had longer surgery time (79.75 ± 26.35 min vs. 64.58 ± 18.56 min, p = 0.031) and more blood loss (69.45 ± 50.47 mL vs. 23.71 ± 28.13 mL, p < 0.001). The degree of femoral neck shortening in the FNS group was significantly lower than that in the CCS group (10.0% vs 37.5%, p = 0.036). Regarding postoperative complications, there was no statistical difference in the incidence of femoral head necrosis and fracture nonunion between the two groups. Conclusion Patients younger than 60 with femoral neck fractures can obtain satisfactory clinical results with CCS or FNS treatment. FNS has excellent biomechanical properties and shows significantly higher overall construct stability.

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