Biomechanical analysis of two medial buttress plate fixation methods to treat Pauwels type III femoral neck fractures

Background Femoral neck fractures in young people are usually Pauwels Type III fractures. The common treatment method are multiple parallel cannulated screws or dynamic hip screw sliding compression fixation. Due to the huge shear stress, the rate of complications such as femoral head necrosis and nonunion is still high after treatment. The aim of our study was to compare the stabilities of two fixation methods in fixating pauwels type III femoral neck fractures. Methods All biomimetic fracture samples are fixed with three cannulated screws combined with a medial buttress plate. There were two fixation groups for the buttress plate and proximal fracture fragment: Group A, long screw (40 mm); Group B, short screw (6 mm). Samples were subjected to electrical strain measurement under a load of 500 N, axial stiffness was measured, and then the samples were axially loaded until failure. More than 5 mm of displacement or synthetic bone fracture was considered as construct failure. Results There were no significant differences in failure load (P = 0.669), stiffness (P = 0.842), or strain distribution (P > 0.05) between the two groups. Conclusions Unicortical short screws can provide the same stability as long screws for Pauwels Type III Femoral Neck Fractures.

A case of fracture talus with medial malleolus treated with headless screws and cancellous cannulated screws using single anteromedial approach

<p>Talar fractures are complex injuries with an array of management options and complications. We present a case of talar fracture with medial malleolus fracture fixed via common anteromedial approach through the fracture site. The incidence of associated malleolar injury has ranged from 19% to 28% in prior studies. The skin condition is often poor and prone to swelling in such cases which makes the management challenging. Along with poor wound healing, joint stiffness, osteonecrosis and osteoarthritis of the ankle are complications affecting the outcome of the patient.</p>

Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults

Background To compare the clinical efficacy of a femoral neck system (FNS) and cannulated screws (CS) in the treatment of femoral neck fracture in young adults. Methods Data from 69 young adults, who were admitted for femoral neck fracture between March 2018 and June 2020, were retrospectively analyzed. Patients were divided into two groups according to surgical method: FNS and CS. The number of intraoperative fluoroscopies, operative duration, length of hospital stay, fracture healing time, Harris score of hip function, excellent and good rate of hip function, and postoperative complications (infection, cut out the internal fixation, nail withdrawal, and femoral neck shortening) were compared between the two groups. Hip joint function was evaluated using the Harris Hip Scoring system. Results All 69 patients had satisfactory reduction and were followed up for 12–24 months, with a mean follow-up of 16.91 ± 3.01 months. Mean time to fracture healing was13.82 ± 1.59 and 14.03 ± 1.78 weeks in the FNS and CS groups, respectively. There was a statistical difference in the number of intraoperative fluoroscopies between the 2 groups (P = 0.000). There were no significant differences, in operation duration, hospital length of stay, fracture healing time, complications, Harris Hip Score for hip function and excellent and good rate between the two groups (P > 0.05). The incidence of complications was 6.1%(2/33) in the FNS group lower than 25%(9/36) in the CS group, a difference that was statistically significant (P = 0.032). At the last follow-up, the Harris Hip Score of the hip joint in the FNS group was 90.42 ± 4.82and 88.44 ± 5.91 in the CS group. Conclusions Both treatment methods resulted in higher rates of fracture healing and excellent hip function. Compared with CS, the FNS reduced the number of intraoperative fluoroscopies, radiation exposure to medical staff and patients, and short-term complications including femoral neck shortening and bone nonunion.

Outcome of Transverse Patella Fractures Fixed With Cannulated Screws and Stainless Steel Tension Band Wiring

Background: Tension band supplemented by K-wires has long been the definitive technique for patellar fractures fixation. However, it is not without drawbacks. The stainless streel cable-cannulated screw tension band technique, may shorten healing time, decrease the complications and provide early range of knee motion. Herein, the current study evaluates the clinical and radiological outcome of this surgical modality. Methods: This prospective study was conducted on 21 patients (13 males and 8 females) with transverse fracture patella from June 2017 to April 2021. The surgical fixation consisted of two 4.0-mm parallel partially threaded cannulated cancellous screws with a figure-of-eight stainless steel tension band wiring. Follow-up was at least 10 months. Assessment criteria included the Lysholm score for knee function, ROM, VAS for pain, fracture reduction, fracture healing time, and complication rates. After 3 postoperative weeks, slab was removed and immediate rehabilitation were commenced.Results: The average Lysholm scores were 82.9 ± 4.4 SD, 87.8 ± 5.3 SD, and 92.7 ± 3.6 SD after 3, 6, and 10 months, respectively. VAS scores for pain were 2.6 ± 3.0 SD, 1.4 ± 2.6 SD, and 0.5 ± 2.3 SD at 3, 6 and 10-month, respectively. The patients had gained total ROM after 3, 6 and 10 months. The mean fracture healing time was 2.1 months (range, 1.5 - 3.1 months). Two patients experienced skin irritation by wire tails.Conclusion: The stainless steel cannulated screws and tension band construct provides a good alternative in treatment of transverse patellar fractures. It could yield stable fixation, low complication rate while providing early mobilization and accelerated rehabilitation.

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

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.

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

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.