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Wang G, Tang C, Tang Y, Wang R, Shen T, Xu C, Yu J, Li G. Evaluation of the clinical efficacy of using an inverted triangular cannulated compression screw in combination with positive or negative buttress reduction for the healing of femoral neck fractures. BMC Musculoskelet Disord 2024; 25:544. [PMID: 39010006 PMCID: PMC11247803 DOI: 10.1186/s12891-024-07673-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVE We aimed to compare the clinical efficacy of inverted triangular cannulated compression screws combined with Gotfried positive or negative buttress reduction in the healing of femoral neck fractures. METHODS Between October 2017 and March 2021, 55 patients with femoral neck fractures underwent treatment using inverted triangular cannulated compression screws combined with Gotfried positive or negative buttress reduction. Among these patients, 29 received inverted triangular cannulated compression screws combined with Gotfried positive buttress reduction treatment. This group consisted of 16 males and 13 females, with an average age of 43.45 ± 8.23 years. Additionally, 26 patients received inverted triangular cannulated compression nails combined with Gotfried negative buttress reduction treatment. This group included 14 males and 12 females, with an average age of 41.96 ± 8.69 years. Postsurgery, various measurements were taken, including the degree of shortening of the femoral neck, degree of bone nonunion, degree of fixation failure, degree of ischemic necrosis of the femoral head, and Harris score of the hip joint. RESULTS All patients were followed up for a minimum of 18 months. The group that underwent treatment with an inverted triangular cannulated compression screw combined with Gotfried positive buttress reduction did not experience any cases of bone nonunion, fixation failure, or ischemic necrosis of the femoral head. In the group that received treatment with inverted triangle cannulated compression screws combined with Gotfried negative buttress reduction, there was one case of bone nonunion, three cases of early fixation failure, and one case of ischemic necrosis. Ultimately, five patients (19.23% of the total) underwent joint replacement surgery. The average shortening lengths in the vertical plane were 4.07 ± 1.98 mm and 8.08 ± 3.54 mm, respectively. In the horizontal plane, the average shortening lengths were 3.90 ± 1.57 mm and 7.77 ± 3.31 mm, respectively. At the last follow-up, the group that received Gotfried positive buttress reduction had a greater Harris hip joint score. CONCLUSION The success rate of combining inverted triangular cannulated compression screws with Gotfried positive buttress reduction surgery is relatively high. This surgical approach effectively prevents femoral neck shortening and improves hip joint function. Moreover, it is crucial to avoid negative buttress reduction when managing femoral neck fractures.
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Affiliation(s)
- Gang Wang
- School of Life and Health, Huzhou College, No. 1, Bachelor Road, Huzhou, 313000, Zhejiang, China
| | - Cui Tang
- Zhejiang Xinda Hospital, No 288, Xinguang Avenue, Huzhou, 313000, Zhejiang, China
| | - Yong Tang
- Department of Orthopedics, 72nd Group Army Hospital of the PLA, No 9, Chezhan Road, Huzhou, 313000, Zhejiang, China
| | - Rui Wang
- School of Life and Health, Huzhou College, No. 1, Bachelor Road, Huzhou, 313000, Zhejiang, China
| | - Tugang Shen
- Department of Orthopedics, South Taihu Hospital affiliated with Huzhou College, No. 1566, Gangnan Road, Huzhou, 313000, Zhejiang, China
| | - Chundao Xu
- Department of Orthopedics, South Taihu Hospital affiliated with Huzhou College, No. 1566, Gangnan Road, Huzhou, 313000, Zhejiang, China
| | - Jian Yu
- Department of Orthopedics, South Taihu Hospital affiliated with Huzhou College, No. 1566, Gangnan Road, Huzhou, 313000, Zhejiang, China
| | - Gaokai Li
- School of Life and Health, Huzhou College, No. 1, Bachelor Road, Huzhou, 313000, Zhejiang, China.
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Hua Z, Zhang X, Li X, Wang J, Chen Y, Wang N, Chen Y. Association between surgical delays for femoral neck fractures and early postoperative complications in young and middle-aged adults: A study based on the national inpatient sample database. Injury 2024; 55:111690. [PMID: 39002323 DOI: 10.1016/j.injury.2024.111690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Femoral neck fractures (FNF) in young and middle-aged adults are primarily caused by high-energy injuries in traffic accidents. Surgical delays often occur due to transportation issues, preoperative evaluations, and economic burdens. METHODS A retrospective analysis was conducted on young and middle-aged FNF patients undergoing reduction and internal fixation surgeries from 2010 to 2019 with the use of the National Inpatient Sample database. Logistic regression analysis was used to assess the relationship between surgical delays and complications, and the independent risk factors contributing to delays. Categorical variables were investigated via a chi-square test, while continuous variables including Elixhauser Comorbidity Index (ECI) scores, length of hospital stay (LOS), and total medical costs were analyzed via t-test or rank-sum test. RESULTS 9,204 patients undergoing reduction and internal fixation surgeries were included. In the delayed group, patients had higher ECI scores, longer hospital stays, higher expenses, and increased inpatient mortality (1.61% vs. 0.28 %, P < 0.0001). Longer surgical delays were associated with higher risks of complications, including femoral head osteonecrosis, internal fixation loosening and breakage, and respiratory complications. Fluid and electrolyte disorders, metastatic cancer, pulmonary circulation disorders, and renal failure were identified as independent risk factors for surgical delays. Except for anemia (OR=2.37, P < 0.0001), no significant differences in early postoperative complications were found between open-reduction and closed-reduction internal fixation (ORIF/CRIF) surgeries. CONCLUSION Early surgical intervention, within a 2-days period after injury, seems to be crucial for young adults with FNF. If CRIF is challenging in some cases, ORIF can be another choice.
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Affiliation(s)
- Zhixun Hua
- Department of Orthopedic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Xishun Zhang
- Department of Orthopedic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, 528000, China; The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, 528000, China
| | - Xiaodan Li
- Department of Orthopaedics, Nanfang Hospital Zengcheng Campus, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jian Wang
- Department of orthopaedic surgery, Division of orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yuhang Chen
- Department of Orthopedic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, 528000, China; Department of orthopaedic surgery, Division of orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Ning Wang
- School of Nursing, Southern Medical University, Guangzhou Avenue North 1838, Baiyun Area, Guangzhou, Guangdong, 510515, China
| | - Yang Chen
- Department of Orthopedic Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, 528000, China.
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Phalak MO, Bhadauriya A, Gupta A, Gurnani S. Fixation of Gardens Type 4 Intracapsular Neck of Femur Fracture Using the GS Kulkarni Controlled Dynamic Hip Screw System. Cureus 2024; 16:e64848. [PMID: 39156434 PMCID: PMC11330312 DOI: 10.7759/cureus.64848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
The goal for surgical treatment of femoral neck fractures is achieving union through an anatomic reduction and stable fixation while avoiding osteonecrosis. This report describes the case of a 50-year-old male who presented with pain and swelling in his right hip and inability to bear weight over his right lower limb following a road traffic accident. The X-ray revealed a right-sided femoral neck fracture (Garden Type IV and Pauwels Type III). The patient was surgically treated with the GS Kulkarni (GSK) controlled dynamic hip screw. On follow-up, the bone healing time was 14 weeks and the patient achieved a Harris hip score of 93.65 with significant improvement.
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Affiliation(s)
- Mukesh O Phalak
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Abhishek Bhadauriya
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Archit Gupta
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sagar Gurnani
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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Wodarek J, Ostrander J, Atkinson P, Atkinson T. Should a low starting point be abandoned for cannulated screw fixation of femoral neck fractures? Comput Methods Biomech Biomed Engin 2024:1-13. [PMID: 38943377 DOI: 10.1080/10255842.2024.2372619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
A validated femoral neck fracture model stabilized with three inverted cannulated screws was used to consider different intraoperative scenarios when the inferior screw hole is inadvertently started too inferiorly. These scenarios were to: (1) abandon the misplaced inferior screw hole and restart this hole more proximally, or (2) accept the mispositioned placement of the inferior screw and insert the remaining superior screws parallel or convergent to the inferior screw. Utilizing the second option and accepting the errant hole was associated with the greatest interfragmentary motion and stresses in the bone and hardware. In contrast, the first option created an improved mechanical environment for healing.
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Aerden LK, Geelen H, DE Wachter G. Revision ratio after Femoral Neck System implantation for hip fracture treatment: a retrospective cohort analysis. Acta Orthop Belg 2024; 90:5-10. [PMID: 38669642 DOI: 10.52628/90.1.11289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The aim of the study is to determine the revision ratio after implantation of the femoral neck system (FNS) for the treatment of femoral neck fractures. A retrospective single center cohort analysis with a total of 71 patients who underwent the implantation of the FNS between December 2019 and December 2021, was performed. 31 males and 40 females were included. There was no exclusion based on BMI, ASA score, Garden classification or Pauwels classification. Primary outcome was the revision rate after FNS implantation. Secondary outcomes comprise the reason for revision surgery as well as the time toward revision surgery and the 30-day mortality. The revision ratio was 11 out of 71 patients (15.5%) with an average time to revision surgery of 10 months. Most common reason for revision was avascular necrosis (AVN) in 45.5%. Other reasons for revision surgery were implant failure due to a secondary fall on to the hip with the FNS implant in place, cut-out, cut-through and malunion in respectively 27.3%, 9%, 9% and 9% of the revision patients. The one- hole plate was used in 72% of the patients. Mean follow-up was 18.07 months (range 6-30 months). Full weight bearing instruction was given to 85.9% of the patients. Partial weight bearing in 14.1% of the patients. In conclusion, the FNS has similar revision ratio when used for femoral neck fractures compared to cannulated screw fixation in literature. The predominant reason for revision is AVN and implant failure with no difference between the use of the one- or-two-hole plate in this study.
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Hamburger E, Cohen N, Rosenthal Y, Mazilis B, Drexler M, Shemesh S. Femoral neck shortening as a sequela of internal fixation for femoral neck fractures and its effect on the coronal alignment of the limb: a pilot study. Arch Orthop Trauma Surg 2024; 144:723-729. [PMID: 38006435 DOI: 10.1007/s00402-023-05128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Femoral neck shortening is a common phenomenon following osteosynthesis for femoral neck fractures, which was shown to have a negative effect on hip function. There is paucity of literature on the effect of shortening on the ipsilateral limb mechanical axis and knee coronal alignment. We hypothesized that postoperative femoral neck shortening can alter the limb's mechanical axis into valgus. METHODS Of 583 patients screened, 13 patients with severe neck shortening (< 10 mm) following femoral neck fracture fixation, were found eligible and agreed to participate. A full-length lower limb radiographs were obtained and radiographic parameters (offset, neck-shaft angle, HKA, mLPFA, mDLFA, mMPTFA, MAD, MAD-r) as well as functional scores were obtained. RESULTS Statistically significant differences in mechanical axis deviation ratio (MAD-r) were found between the ipsilateral and the contralateral extremities (0.41 ± 0.16 versus 0.55 ± 0.11, p = 0.03). A correlation between femoral neck length differences and MAD was not statistically significant although a tendency towards lateral deviation of the mechanical axis was noted (r = - 0.5, p = 0.077). A negative correlation was found between a greater difference in the femoral neck length and the SF12 score, both in the physical and the mental parts (r = - 0.69, p = 0.008; r = - 0.58, p = 0.035, respectively). CONCLUSION We found a more lateralized mechanical axis in limbs that demonstrated post-operative ipsilateral femoral neck severe shortening. These findings may provide a possible explanation and rationale for knee pain and perhaps for the development of knee osteoarthritis as a sequalae of femoral neck shortening. Further investigation and larger cohort, long-term studies are needed to further explore this hypothesis.
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Affiliation(s)
- Ehud Hamburger
- Department of Orthopaedic Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel
| | - Nir Cohen
- Department of Orthopaedic Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel
| | - Yoav Rosenthal
- Department of Orthopaedic Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel
| | - Bar Mazilis
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, 7, Ha'Refua Street, 7747629, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Drexler
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, 7, Ha'Refua Street, 7747629, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shai Shemesh
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, 7, Ha'Refua Street, 7747629, Ashdod, Israel.
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Jin Y, Yin B, Shu L, Fan Z, Sherrier MC, Liu C, Sun H, Zhang W. Morphological characteristics of femoral neck fractures in young and middle-aged population: a retrospective descriptive study. BMC Musculoskelet Disord 2024; 25:100. [PMID: 38287282 PMCID: PMC10823608 DOI: 10.1186/s12891-024-07207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND A understanding of morphological characteristics are important to femoral neck fractures (FNFs) resulting in high rates of complications in the young and middle-aged adults and the detailed data is lack in the literature. We aimed to report on the detailed morphological characteristics and the relationship between them in young and middle-aged adults with femoral neck fractures (FNFs). METHODS The postoperative CT images of one hundred and fifty-two adults with FNFs were retrospectively reviewed. After image standardization, morphological characteristics including fracture orientation, cortex comminution, and intraosseous bone defects were measured and analyzed. Additionally, the distribution and correlation of these morphological features were analyzed using Pauwels classification, the right angle of the neck axis (VNA) classification, and the anteromedial oblique angle (AMA). RESULTS Pauwels III fractures accounted for approximately half (55.2%) of the FNFs analyzed. Pauwels II and III could be detected in all four VNA types, and the distribution of the Pauwels types in VNA classification showed significant differences (χ2 = 106.363, p < 0.001). The VNA (9.0° ± 12.1) showed positive correlation with the neck-shaft angle (139.5° ± 6.3) and modified Pauwels angle (49.8° ± 10.6) (r = 0.441, r = 0.855, all p < 0.001). Cortical comminutions were commonly observed in the posterior (86.7%) and the inferior (80.7%). AMAs within the cases without posterior and inferior cortex comminutions were significantly larger than those with comminution (t = 2.594, 2.1196; p = 0.01, 0.036), but no difference could be detected after the AMA being divided into three groups (< 85°, 85°-95°, > 95°). The MPA, VNA and AMA of the group with an intraosseous defect were significantly different compared with those without (t = 2.847, 2.314, 2.268; p = 0.005, 0.022,0.025). The incidence of intraosseous defects within the groups with coronal and axial cortex comminutions were significantly higher than those within the groups without comminutions (χ2 = 34.87, 25.303; p < 0.001). CONCLUSIONS The present study highlights the morphological diversity and complexity within FNFs in young and middle-aged adults, which allows for more accurate simulation of FNF patterns in the future biomechanical studies.
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Affiliation(s)
- Yingzhe Jin
- Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, 1111 JiangNan Road, Ningbo, 315040, China
| | - Bohao Yin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Linyuan Shu
- Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Zhiyuan Fan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Matthew C Sherrier
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Chenjun Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Hui Sun
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China.
| | - Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China.
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Li H, Chen H, She R, Li Y, Qin G, Gan F, Liang H, Hu B. Clinical observation of Gofried positive buttress reduction in the treatment of young femoral neck fracture: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36424. [PMID: 38050256 PMCID: PMC10695552 DOI: 10.1097/md.0000000000036424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Femoral neck fractures in young adults(<65 years), have always been a difficult problem, characterized by high rates of nonunion and avascular necrosis (AVN). The clinical efficacy of anatomical reduction and non-anatomical reduction methods needs to be supported by clinical data. Therefore, we conduct a meta-analysis on the clinical efficacy of different reduction methods to better guide clinical practice. METHODS Relevant studies published using internal fixation to treat femoral neck fracture in several databases were searched. The outcomes sought included Harris score and the rate of AVN, nonunion and femoral neck shortening (<5 mm). Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored. RESULTS The clinical results showed that compared with the anatomical reduction and positive buttress, there is no significant difference in the rate of AVN (OR = 0.87, 95%CI: 0.55-1.37, P = .55), nonunion (OR = 0.54, 95%CI: 0.21-1.41, P = .21), femoral neck shortening (<5 mm) (OR = 1.03,95%CI: 0.57-1.86, P = .92), the Harris score (MD = -0.28, 95%CI: -1.36-0.80, P = .61) and the excellent and good rate of Harris score (OR = 1.73, 95%CI: 0.84-3.56, P = .61). However, compared with negative buttress, the rate of AVN (OR = 0.62, 95%CI: 0.38-1.01, P = .05), nonunion (OR = 0.34, 95%CI: 0.12-1.00, P = .05) and femoral neck shortening (<5 mm) (OR = 0.27, 95%CI: 0.16-0.45, P < .00001) were significantly lower, and the Harris score (MD = 6.53, 95%CI: 2.55 ~ 10.51, P = .001) was significantly better in positive buttress. CONCLUSIONS In the case of difficult to achieve anatomical reduction, for young patients (< 65 years) with femoral neck fracture, reduction with positive buttress can be an excellent alternative and negative buttress should be avoided as much as possible.
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Affiliation(s)
- Huankun Li
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Hongjun Chen
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Ruihao She
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China
| | - Yanhong Li
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Gang Qin
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Fukai Gan
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Huahui Liang
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Baijun Hu
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
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Su M, He Z, Huang N, Lin X, Fang K, Dai Z. Superior short-term outcomes of FNS in combination with a cannulated screw in treating femoral neck fractures. BMC Musculoskelet Disord 2023; 24:823. [PMID: 37853367 PMCID: PMC10583408 DOI: 10.1186/s12891-023-06959-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the clinical efficacy of the femoral neck system alone or in combination with a cannulated screw compared with other internal fixation methods for treating femoral neck fractures. We further investigated the predictive effects of tip-apex distance (TAD) on clinical efficacy. METHODS Data from 129 young adults with femoral neck fractures followed up at The Second Affiliated Hospital of Fujian Medical University between January 2016 and June 2022 were retrospectively collected. The patients were categorized into four groups based on the different internal fixation methods. Analysis and comparisons of the four group were performed according to age, ASA score, operation time, blood loss, fracture classification, fracture healing time, Harris score, TAD value, presence of complications (osteonecrosis of the femoral head, screw failure, and femoral neck shortening), and changes in the neck-shaft angle. RESULTS All 129 patients were followed up for at least one year. The group who received treatment with the femoral neck system combined with a cannulated screw exhibited the shortest fracture healing time. Differences were observed in the change of neck-shaft angle among the four groups (P < 0.001), with the smallest change observed in the aforementioned group (0.76 ± 0.54°). The femoral neck shortening was also lower in groups with the femoral neck system or combined with a cannulated screw. At the last follow-up surgery, the combined treatment group achieved the highest HHS score. Subgroup analysis revealed that when the TAD was less than 25 and 49 mm for the femoral neck system and combined groups, respectively, there was less femoral neck shortening, less change in the neck-shaft angle, and a higher HHS score. CONCLUSIONS The femoral neck system alone or combined with a cannulated screw demonstrated better short-term efficacy in the treatment of femoral neck fractures. Furthermore, TAD may serve as a predictive indicator of the potential success of femoral neck fracture treatment.
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Affiliation(s)
- Min Su
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zexing He
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Nianlai Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Xiaocong Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Kaibin Fang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhangsheng Dai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
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Rhatomy S, Shiddieqy ABA, Prathama GB, Belantara LAS, Alkarni MD, Septian R, Canintika AF. Sartorius muscle pedicle iliac bone graft for treating neglected femoral neck fracture: A case series. Int J Surg Case Rep 2023; 109:108410. [PMID: 37437327 PMCID: PMC10362283 DOI: 10.1016/j.ijscr.2023.108410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Femoral neck fractures in patients less than 50 years account for less than 5 % of all hip fractures. Controversy remains regarding timing of surgery, operative technique, and optimal implant construct because of a lack of prospective clinical trials. The blood supply to the femoral head is tenuous and easily injured in the setting of displaced fractures. An alternative using sartorius muscle pedicle iliac bone graft has not been discussed widely. CASE PRESENTATION Four patients with neglected femoral neck fracture were included in the series; all underwent cannulated screws fixation and osteomuscular pedicled graft using sartorius muscle. All patients achieved bone healing after 6-months of follow-up. CONCLUSION Our series demonstrate that sartorius muscle pedicle graft may be a good choice for treating neglected femoral neck fractures. Further studies are required to investigate its outcome and complications.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | | | - Ginanjar Budhi Prathama
- Department of Orthopaedics and Traumatology, Siaga Medika Hospital, Banyumas, Central Java, Indonesia
| | | | - Muhammad Dedy Alkarni
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rian Septian
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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11
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Wang F, Liu Y, Huo Y, Wang Z, Zhang J, Xu M, Ma K, Wang L, Lu Y, Cheng L, Zhao D. Biomechanical study of internal fixation methods for femoral neck fractures based on Pauwels angle. Front Bioeng Biotechnol 2023; 11:1143575. [PMID: 36937751 PMCID: PMC10020692 DOI: 10.3389/fbioe.2023.1143575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Objective: To select the most appropriate internal fixation method based on the Pauwels angle, in order to provide a new concept for clinical accurate treatment of femoral neck fractures (FNFs). Methods: FNFs models of Pauwels 30 ° ; 40 ° ; 50 ° ; 60 ° were created respectively. For Pauwels ≤ 50 ° , 1, 2 and 3 Cannulated Compression Screws (CCS) and Porous Tantalum Screws (PTS) were used to fix the fracture for the models. For Pauwels 60 ° , 3CCS and Medial Buttress Plate (MBP) combined with 1, 2 and 3CCS were used to fix the fracture. Based on the results of the finite element (FE) analysis, the biomechanical properties of each model were compared by analyzing and evaluating the following four parameters: maximal stress of the bone (MBS), maximal stress of the implants (MIS), maximal displacement of bone (MBD), interfragmentary motion (IFM). Results: At Pauwels 30 ° , the larger parameters were found in 1CCS, which was 94.8 MPa (MBS), 307.7 MPa (MIS), 0.86 mm (MBD) and 0.36 mm (IFM). In 2CCS group, the parameters were 86.1 MPa (MBS), 254.4 MPa (MIS), 0.73 mm (MBD) and 0.27 mm (IFM), which were similar to those of PTS. At Pauwels 40 ° ; 50 ° , with the increase of the number of used CCS, accordingly, the parameters decreased. Particularly, the MIS (Pauwels 50 ° ) of 1CCS was 1,195.3 MPa, but the other were less than the yield range of the materials. At Pauwels 60 ° , the MBS of 3CCS group was 128.6 Mpa, which had the risk of failure. In 2CCS + MBP group, the parameters were 124.2 MPa (MBS), 602.5 MPa (MIS), 0.75 mm (MBD) and 0.48 mm (IFM), The model stability was significantly enhanced after adding MBP. Conclusion: Pauwels type Ⅰ (< 30 ° ) fractures can reduce the number of CCS, and PTS is an appropriate alternative treatment. For Pauwels type Ⅱ fractures ( 30 ° ∼ 50 ° ), the 3CCS fixation method is still recommended. For Pauwels type Ⅲ fractures (> 50 ° ), it is recommended to add MBP to the medial femoral neck and combine with 2CCS to establish a satisfactory fracture healing environment.
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Affiliation(s)
- Fuyang Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yuchen Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yi Huo
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Ziming Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jinge Zhang
- Department of anesthesiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Minghao Xu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Kaiming Ma
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Linbao Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yongtao Lu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Liangliang Cheng
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- *Correspondence: Dewei Zhao, ; Liangliang Cheng,
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- *Correspondence: Dewei Zhao, ; Liangliang Cheng,
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Fan ZY, Shu LY, Jin YZ, Sherrier MC, Yin BH, Liu CJ, Zhan S, Sun H, Zhang W. Biomechanical evaluation of compression buttress screw and medial plate fixation for the treatment of vertical femoral neck fractures. Injury 2022; 53:3887-3893. [PMID: 36195517 DOI: 10.1016/j.injury.2022.09.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the biomechanical properties of compression buttress screw (CBS) fixation with three plate fixation methods for the treatment of vertical femoral neck fractures (FNFs). METHODS A total of forty synthetic femoral models with simulated Pauwels type III fractures (angle of 70°) were equally assigned to one of four fixation groups: CBS fixation, anteromedial plate fixation (AMP), medial buttress plate fixation (MBP) and medial buttress plate fixation without proximal screw (MBPw). Within each group, half of the specimens were randomly assigned to two loading settings, an axial compression loading test and a hip-flexion torsion test. RESULTS There were no significant differences in axial load to failure, axial stiffness, torsional strength, or torsional stiffness when comparing CBS with MBP (p>0.05). In the axial compression loading test, both CBS and MBP showed higher load to failure and axial stiffness than MBPw (p<0.05). In torsional testing, AMP exhibited superior torsional strength and torsional stiffness than both MBPw and MBP (all p<0.05) and a higher torsional strength than CBS fixation (p<0.05). There were no significant differences in torsional stiffness between the CBS and AMP fixation groups (p>0.05). CONCLUSION The biomechanical parameters of CBS fixation are comparable to that of AMP and MBP, and demonstrate superior axial stiffness than MBPw fixation. Although the CBS method for surgical fixation of vertical FNF holds promise as a less invasive surgical technique than plate fixation with similar biomechanical assessments, further clinical evaluation is warranted.
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Affiliation(s)
- Zhi-Yuan Fan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Lin-Yuan Shu
- Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Ying-Zhe Jin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Matthew C Sherrier
- Department of Orthopaedic and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, United States of America
| | - Bo-Hao Yin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Chen-Jun Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Shi Zhan
- Orthopaedic Biomechanical Laboratory, Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Hui Sun
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China.
| | - Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China.
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Yildirim C, Demirel M, Karahan G, Cetinkaya E, Misir A, Yamak F, Bozdağ E. Biomechanical comparison of four different fixation methods in the management of Pauwels type III femoral neck fractures: Is there a clear winner? Injury 2022; 53:3124-3129. [PMID: 35803747 DOI: 10.1016/j.injury.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cannulated screws augmented with the medial buttress plate could confer greater biomechanical stability and higher union rates than the screw fixation alone for treating young patients with Pauwels type III femoral neck fractures (FNFs). No study has evaluated the effects of distal bicortical screw fixation and biomechanical properties of buttress plate augmentation under simultaneous vertical and rotational forces, physiologically acting on the hip joint. This study aimed to compare the biomechanical properties of four methods of three cannulated screw fixation under the combined axial and torsional loading in a synthetic femur model of type III FNF. METHODS Twenty-four third-generation composite femora were divided into four groups (6 femora in each group) based on the screw fixation configuration: inverted triangle configuration (Group A), Pauwels' configuration (Group B), inverted triangle configuration combined with medial buttress plate using distal unicortical (Group C), and distal bicortical screw placement (Group D). A Pauwels type III FNF was simulated on the sawbones. Each model was subjected to the combined axial and torsional cyclic loading and subsequently tested to failure. RESULT Significant differences were determined in axial stiffness (AS) among the four groups (p = 0.024), whereas there was no significant difference in torsional stiffness (p = 0.147). The mean AS was higher in group D (639.5 ± 86.2 N/mm) than in group A (430.6 ± 94.8 N/mm), group B (426.2 ± 41.9 N/mm), and group C (451.2 ± 156.7 N/mm). Failure forces (FFs) were significantly different among four groups (p = 0.007), while there was no considerable difference in failure moment values (p = 0.555). The mean FF was significantly higher in group D (1307.1 ± 96.4 N) than in group A (1076.9 ± 371.2 N) and group B (1075.5 ± 348.3 N) (p = 0.014 and p = 0.018, respectively). There was no significant difference in the mean FF between groups D and C. CONCLUSION Regardless of the medial plate use, multiple cannulated systems could provide similar biomechanical results regarding torsional stiffness and failure moments. Bicortical placement of the most distal screw in medial buttress plate application could improve axial stability but not significantly affect the rotational stability of the inverted triangle screw fixation system in managing type III FNFs.
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Affiliation(s)
- Cem Yildirim
- Department of Orthopaedics and Traumatology, Başakşehir Çam ve Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopedics and Traumatology, Istanbul University, İstanbul School of Medicine, Istanbul, Turkey.
| | - Gökhan Karahan
- Department of Orthopaedics and Traumatology, Başakşehir Çam ve Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Engin Cetinkaya
- Department of Orthopaedics and Traumatology, Medicalpark Göztepe Hospital, Bahçeşehir University, Istanbul, Turkey
| | - Abdülhamit Misir
- Department of Orthopaedics and Traumatology, Medicana International Istanbul Hospital, Istanbul, Turkey
| | - Fatih Yamak
- Faculty of Mechanical Engineering, Strength of Materials and Biomechanics, Istanbul Technical University, Istanbul, Turkey
| | - Ergün Bozdağ
- Faculty of Mechanical Engineering, Strength of Materials and Biomechanics, Istanbul Technical University, Istanbul, Turkey
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Nibe Y, Matsumura T, Takahashi T, Kubo T, Matsumoto Y, Takeshita K. A comparison between the femoral neck system and other implants for elderly patients with femoral neck fracture: A preliminary report of a newly developed implant. J Orthop Sci 2022; 27:876-880. [PMID: 34090779 DOI: 10.1016/j.jos.2021.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Femoral neck system (FNS) is an implant for patients with femoral neck fracture. It has superior angular and rotatory stability; it is less invasive because of its established locking plate system. To the best of our knowledge, there are no studies yet concerning the clinical outcomes of elderly patients with femoral neck fracture who have been treated using the FNS. METHODS Data of patients with femoral neck fracture aged >65 years and who had undergone internal fixation with the FNS and other implants were retrospectively analyzed in this study. The follow-up period was a minimum of six months between January 2006 and November 2020. In total, 52 patients were included in the clinical evaluations, using the FNS (group F) was 25 and using other implants (group O) was 27. Outcome measurements were surgical time, the amount of blood loss, union rate and the cases that underwent reoperation. RESULTS The average surgical time in the group F was 42 ± 13 min (range: 26-83 min) and was shorter than that in the group O (53 ± 21 min, range: 13-111 min, P = 0.032). The average blood loss in the group F was calculated to 36 ± 25 g (range: 0-91 g), while it was 41 ± 40 g (range: 0-169 g) in group O. No significant difference among the groups. The union rate of the group F was 100%, and the reoperation rate of the group F was significantly less than that of the group O (0% vs 22%, P = 0.023). CONCLUSION Internal fixation using the FNS can be an alternative option with shorter surgical time and lower reoperation rate for elderly patients with femoral neck fracture.
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Affiliation(s)
- Yoshiya Nibe
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Matsumura
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan.
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan.
| | - Tatsuya Kubo
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yuta Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Raja BS, Gowda AK, Singh S, Ansari S, Kalia RB, Paul S. Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis. J Clin Orthop Trauma 2022; 29:101876. [PMID: 35515344 PMCID: PMC9062326 DOI: 10.1016/j.jcot.2022.101876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. MATERIAL AND METHODS The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. RESULTS A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. CONCLUSION Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya K.S. Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India,Corresponding author.
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Xu X, Fan J, Zhou F, Lv Y, Tian Y, Ji H, Zhang Z, Guo Y, Yang Z, Hou G. Comparison of femoral neck system to multiple cancellous screws and dynamic hip screws in the treatment of femoral neck fractures. Injury 2022; 54 Suppl 2:S28-S35. [PMID: 35367076 DOI: 10.1016/j.injury.2022.03.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the short-term outcomes of the femoral neck system (FNS) with multiple cancellous screws (MCS) and dynamic hip screws (DHS) in the treatment of femoral neck fractures. METHODS A retrospective analysis was performed on 157 patients with fresh femoral neck fractures treated with FNS (from September 2019 to October 2020), MCS, and DHS (from January 2018 to October 2020). According to internal fixation methods, all patients were divided into the FNS group (54 cases), MCS group (51 cases), and DHS group (52 cases). Demographic data were also collected, recorded, and compared, including the follow-up time, days of hospitalization, operation time, blood loss, intraoperative fluoroscopy times (IFT), weight-bearing time (WBT), length of femoral neck shortening (LFNS), Harris hip score, and complications (such as internal fixation failure, bone nonunion, and avascular necrosis of the femoral head) between the three groups. RESULTS Overall, 157 patients with a mean age of 61.8 (range, 18-89) years were analyzed. In the FNS group, IFT (median 10.5) was significantly lower than that in the MCS group (median 21) and DHS group (median 20.5) (P<0.05), and WBT was significantly earlier than that of the MCS group (P<0.05). In the FNS group, the median hospitalization time, operation time, and blood loss were 2 (2, 4) days, 45 (40-59) min, and 30 (20, 50) ml, respectively. They were all significantly less than 3.5 (3, 6) days, 72 (55-88.75) min, and 50 (30, 50) ml in the DHS group, respectively (P < 0.05). There was no statistical difference in LFNS, quality of reduction, internal fixation failure rate, and Harris hip score at the latest follow-up (P>0.05). No surgical complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in any of the three groups. CONCLUSION FNS, MCS, and DHS are all effective for femoral neck fractures. However, a lower IFT of FNS shortens the operation time. Compared to MCS, FNS has the advantages of being a simple operation, with early WBT; compared to DHS, a minimally invasive operation is the main advantage of FNS.
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Affiliation(s)
- Xiangyu Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Jixing Fan
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
| | - Yang Lv
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Hongquan Ji
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhishan Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yan Guo
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhongwei Yang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Guojin Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
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Lin S, Li J, Wang R, Ou Y, Jia Z, Zhang Y, Xia H, Li B, Chen B. The effect of anteromedial support plate with three cannulated screws in the treatment of Pauwels type III femoral neck fracture in young adults. Eur J Trauma Emerg Surg 2022; 48:4011-4017. [PMID: 35288767 DOI: 10.1007/s00068-022-01931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study is aimed to evaluate the clinical effects of anteromedial support plate combined with three cannulated screws on Pauwels type III femoral neck fractures in young adults. METHODS We conducted a retrospective study of 27 patients with Pauwels type III femoral neck fracture treated by anteromedial support plate combined with three cannulated screws. The results of fracture healing and complications for all patients were assessed by postoperative imaging examination. The Harris hip score was used to evaluate the functional outcome of the hip at the last follow-up. RESULTS The fracture union was achieved in 25 patients (92.6%). However, two patients required reoperation (two for nonunion). Early implant failure occurred in one patient, neck shortening in one patient and coxa vara in one patient. The excellent or good outcome of the Harris hip score was 96% for the 25 patients with satisfactory fracture union. CONCLUSION Our preliminary results indicate that anteromedial support plate combined with three cannulated screws is a good alternative in the treatment of Pauwels type III femoral neck fractures in young adults with high union rate and low incidence of complications including nonunion and avascular necrosis of the femoral head.
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Affiliation(s)
- Shanghui Lin
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, People's Republic of China
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Jinmei Li
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, People's Republic of China
| | - Renkai Wang
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Yongliang Ou
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Zhenyu Jia
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Ying Zhang
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Hong Xia
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Baofeng Li
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China.
| | - Bei Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, People's Republic of China.
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Fjeld A, Fülling T, Bula P, Bonnaire F. Functional outcomes and perceived quality of life following fixation of femoral neck fractures in adults from 18 to 69 years using dynamic hip screw (DHS) and an additional anti-rotation screw- a retrospective analysis of 53 patients after a mean follow-up time of 4 years. Eur J Trauma Emerg Surg 2022; 48:1893-1903. [PMID: 35039893 DOI: 10.1007/s00068-021-01855-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of the study was to explore the functional outcome after osteosynthesis with dynamic hip screw (DHS) for adults up to 69 years, and identify potential predictive indicators of either positive impact on quality of life or increase the incidence of complications. MATERIALS AND METHODS Out of 85 patients 53 could be contacted, 36 were followed up clinically and radiologically, 17 patients could be interviewed by phone. All fractures have been treated by osteosynthesis with DHS and one additional anti-rotation screw. Functional outcome and quality of life were measured with use of Harris Hip Score (HHS) and Short Form 12 Health Survey (SF 12). The mean values were compared to two random sample t tests and ANOVA for independent random samples. The connection between an aim variable and selected variables of influence was examined by regression analysis. RESULTS The mean HHS showed good functional results with 88 points (median 95.6). Good or excellent results were achieved in 80.4% of cases. The current investigation also delivers promising results with regard to the complication rate: avascular femoral head necrosis (AVN) in 11.3% of cases (n = 6), 9.4% showed non-union (n = 5) and cut out (n = 3) occurred in 5.7%. A secondary conversion to hip arthroplasty (n = 7) had a strong negative impact on everyday life (HHS = 63.3 points, Physical Health Summary Score SF-12 = 34.9 points). CONCLUSIONS The results of this study are promising showing uncomplicated fracture healing in 84.9% of intracapsular femoral neck fractures and a low incidence of complications after osteosynthesis with DHS in patients aged up to 69 years. The quality of the fracture reduction achieved in the axial view and a small tip apex index after an osteosynthetically treated femoral neck fracture with DHS are significant predictive indicators for complications. Diabetes, age > 65 years, osteoporosis, ASA III may also be significant factors for worse results, but showed no statistical significance in our analysis.
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Affiliation(s)
- Anne Fjeld
- Department of Trauma and Reconstructive Surgery and Hand Surgery, Dresden Municipal Hospital, Friedrichstrasse 41, 01067, Dresden, Germany
| | - Tim Fülling
- Department of Trauma and Reconstructive Surgery and Hand Surgery, Dresden Municipal Hospital, Friedrichstrasse 41, 01067, Dresden, Germany.
| | - Philipp Bula
- Department of Trauma and Reconstructive Surgery and Hand Surgery, Dresden Municipal Hospital, Friedrichstrasse 41, 01067, Dresden, Germany.,Department of Trauma and Reconstructive Surgery, Orthopaedic, Plastic, Aesthetic and Hand Surgery, Guetersloh Municipal Hospital, Guetersloh, Germany
| | - Felix Bonnaire
- Department of Trauma and Reconstructive Surgery and Hand Surgery, Dresden Municipal Hospital, Friedrichstrasse 41, 01067, Dresden, Germany
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Agar A, Utkan A. The Effect of Anatomical Reduction on Functional Outcomes in Femoral Neck Fracture: A Novel Modified Garden Index. Cureus 2021; 13:e19863. [PMID: 34976490 PMCID: PMC8712223 DOI: 10.7759/cureus.19863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Femoral neck fracture is a common cause of morbidity in the younger population with potentially poor prognosis and functional results. The purpose of this study was to evaluate how the success of anatomic reduction affects hip functional outcomes by using a new numerical index modified from the Garden index. Methods: Twenty-six patients who underwent closed reduction and internal fixation by means of three cannulated screws due to femoral neck fracture between 2010 and 2014 were scanned retrospectively and included in the study. Harris hip scores of the patients at nine to 12 months were evaluated using the new index modified from Garden which is the sum of the differences from the ideal Garden index calculated on early postoperative anteroposterior and lateral pelvis radiographs. Results: The mean hip score was 73.1 (± 16.4), the minimum score was 32, the maximum score was 93. Postoperative anteroposterior radiographs revealed a mean Garden alignment index of 153.6°, the lowest value was 135° and the highest value was 168°. In the lateral radiographs, the mean Garden alignment index was 173.1°, the lowest value was 160° and the highest value was 178°. The mean value of the novel index was found as 14.2°, the lowest value was 2°, and the highest value was 40°. There was an inverse correlation between the novel index we defined and the Harris hip score (p<0.01). Conclusion: In femoral neck fractures, the success of anatomic reduction is an important factor affecting the patient’s functional outcome. We believe the new reduction index we proposed will contribute to literature comparing the success of reduction in femoral neck fractures.
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Affiliation(s)
- Anil Agar
- Orthopedic and Traumatology, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Ali Utkan
- Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
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Jaya Raj J, Kow RY, Ganthel Annamalai K, Kunasingh DE, Panicker GK, Lim BC, Low CL. Outcomes of Femoral Neck Fractures in Young Patients and the Factors Associated With Complications: A Multicenter Study From Malaysia. Cureus 2021; 13:e18110. [PMID: 34692321 PMCID: PMC8527184 DOI: 10.7759/cureus.18110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Femoral neck fractures are relatively rare in young adults, but they result in prolonged loss of function in these patients, thereby placing a huge burden on a country's healthcare and economy. Femoral neck fractures in young adults are normally treated with head salvage surgery. However, primary head replacement surgeries have been gaining traction recently to expedite the recovery of these patients. In this study, we aimed to investigate the outcomes in young patients with femoral neck fractures and factors associated with their complications. Patients and methods Patients with femoral neck fractures who underwent surgery in three tertiary hospitals [Hospital Tengku Ampuan Afzan (HTAA), Hospital Sultan Haji Ahmad Shah (HOSHAS), and Hospital Kuala Lipis] in Pahang state in Malaysia were reviewed and included in this study. The demographic profile of the patients, injury patterns, intervention details, functional outcomes, and complications were analyzed. The comparison between the sociodemographics, clinical assessment, and complication outcomes was analyzed using statistical software. Results The complications were associated with the mechanism of injury, capsulotomy, and type of fixation. A total of 46 patients were included in the study. Most of the patients were found to have severe displacement based on Garden and Pauwels classification. The majority of the patients underwent femoral head salvage surgeries. Almost half of the patients sustained complications and were unable to achieve weight-bearing status at six months postoperatively. Conclusion Despite a relatively short follow-up period in our study, femoral neck fractures in young adults were found to be associated with a high rate of complications. Primary head replacement surgeries should be considered in high-risk patients with femoral neck fractures.
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Affiliation(s)
- Jeffrey Jaya Raj
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Ren Yi Kow
- Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS.,Orthopaedics, International Islamic University Malaysia, Kuantan, MYS
| | | | | | | | - Bee Chiu Lim
- Clinical Research, Hospital Tengku Ampuan Afzan, Kuantan, MYS
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Yang J, Zhou X, Li L, Xu L, Zhu W, Xu W, Xia R, Wang X, Wang G, Hua X, Xu X, Fang S. [Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle Ⅲ femoral neck fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1111-1118. [PMID: 34523275 DOI: 10.7507/1002-1892.202102046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of the femoral neck system (FNS) and inverted triangle cannulated screws (ITCS) for the treatment of Pauwels type Ⅲ femoral neck fractures. Methods The clinical data of 59 patients with Pauwels type Ⅲ femoral neck fractures treated between May 2019 and November 2020 were retrospectively analysed. The patients were divided into FNS group (28 cases) and ITCS group (31 cases) according to the different internal fixation. There was no significant difference in gender, age, affected side, body mass index, cause of injury, smoking history, alcohol abuse history, Pauwels angle, Garden classification, AO/Orthopaedic Trauma Association (AO/OTA) classification, and time from injury to operation between the two groups ( P>0.05). The operation time, incision length, intraoperative blood loss, extra assisted reduction procedures (Kirschner wire prying reduction or open reduction), hospitalization stay, and early complications were recorded and compared between the two groups. Garden index and Haidukewych score were used to evaluate fracture reduction. Fracture healing time, lateral thigh irritation, time of partial or total weight-bearing postoperatively, shortening length and degree of femoral neck, change of caput-collum-diaphysis (CCD) angle (the difference of CCD angle between immediate after operation and last follow-up), incidence of osteonecrosis of femoral head and revision surgery were recorded and compared between the two groups. Hip joint function were evaluated by Harris score. Results The operation time of FNS group was significantly shorter than ITCS group, and the incision length was significantly longer than ITCS group ( P<0.05). There was no significant difference in intraoperative blood loss, assisted reduction, Garden index, Haidukewych score, and hospitalization stay between the two groups ( P>0.05). All the incisions healed by first intention. There were 2 deep vein thrombosis in the FNS group and 1 pulmonary infection and 1 deep vein thrombosis in the ITCS group. No significant difference was found in the incidence of early postoperative complications (7.1% vs. 6.5%) between the two groups ( P=1.000). Patients in both groups were followed up 3-14 months, and there was no significant difference in follow-up time between the two groups ( t=-0.553, P=0.582). The fracture healing time, Harris score, and the partial weight-bearing time after operation of the FNS group were significantly better than those of the ITCS group ( P<0.05). However, there was no significant difference in total weight-bearing time between the two groups ( Z=-1.298, P=0.194). No lateral thigh irritation was found in the FNS group, while 10 patients in the ITCS group had lateral thigh irritation, and the incidence between the two groups (0 vs. 32.3%) was significant ( P=0.001). At last follow-up, the shortening length and degree of femoral neck and the change of CCD angle in FNS group were significantly less than those in ITCS group ( P<0.05). There was no patient with osteonecrosis of femoral head or reoperation in the FNS group, while 4 patients in the ITCS group underwent reoperation (including 2 cases of osteonecrosis of the femoral head). However, the incidences (0 vs. 6.5%; 0 vs.12.9%) between the two groups were not significant ( P=0.493; P=0.114). Conclusion Using FNS to treat Pauwels type Ⅲ femoral neck fracture is simple as well as able to reduce the shortening of the femoral neck and the change of the CCD angle. Also, FNS is conducive to the recovery of hip joint function, which should be considered as a new choice for the treatment of young femoral neck fracture patients.
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Affiliation(s)
- Jiazhao Yang
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Xuefeng Zhou
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Li Li
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Lei Xu
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Wanbo Zhu
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Wei Xu
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Rui Xia
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Xujin Wang
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
| | - Gang Wang
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China
| | - Xingyi Hua
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China
| | - Xinzhong Xu
- Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230601, P.R.China
| | - Shiyuan Fang
- Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China
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Young Intertrochanteric Femur Fractures Are Associated With Fewer Complications than Young Femoral Neck Fractures. J Orthop Trauma 2021; 35:356-360. [PMID: 33165209 DOI: 10.1097/bot.0000000000002005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the complication profile of femoral neck (FN) and intertrochanteric (IT) femur fractures in young patients. DESIGN A retrospective database review. SETTING Large, national private insurer claims database with longitudinal follow-up. PATIENTS Individuals undergoing surgical fixation of IT or FN fractures from 2010 to 2017 were identified. Patients were included if they were 18-50 years of age and had 1-year postoperative follow-up. Those with comorbid conditions of chronic kidney disease, congestive heart failure, diabetes, or coronary artery disease were excluded from the primary analysis. MAIN OUTCOME MEASURES Complication data, including a diagnosis of nonunion, malunion, avascular necrosis (AVN), or need for revision surgery at 1-year follow-up, were compared. In addition, medical complication data at 90 days postoperatively were evaluated. RESULTS In total, 808 patients were identified: 392 (48.5%) patients with IT femur fractures and 416 (51.5%) patients with FN fractures. On multivariate analysis, FN fractures had nearly twice the risk of nonunion compared with IT femur fractures (odds ratio = 1.89; confidence interval, 1.09-3.30). IT femur fractures had a 5.4% rate of nonunion, a 3.6% rate of revision surgery, a 1% rate of AVN, and a 0.8% rate of conversion into total hip arthroplasty. By contrast, FN fractures had significantly higher rates of nonunion (10.3%; P = 0.009), revision surgery (9.4%; P = 0.001), AVN (5.8%; P < 0.001), and conversion to total hip arthroplasty (6%; P < 0.001). CONCLUSION The results of this study demonstrate that IT fractures in young patients have superior outcomes when compared with their intracapsular counterparts. This is the only series of its kind to evaluate the complication profile of young IT femur fractures on a large scale. This information will be helpful in counseling patients in the perioperative setting. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Omar Pacha T, Sonnow L, Poehler GH, Graulich T, Omar M, Stubig T, Krettek C, Liodakis E. Direct measurement of malrotation of traumatic femoral neck fractures after osteosynthesis: Introduction of a novel method and interrater reliability. PLoS One 2021; 16:e0250409. [PMID: 33901221 PMCID: PMC8075239 DOI: 10.1371/journal.pone.0250409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background In elderly patients, displaced femoral neck fractures are mostly treated by arthroplasty; however for younger patients (<50 years), open reduction and internal fixation is considered the gold standard approach. Despite there being no consensus on the specific procedure, everyday clinical practice in a level I trauma center has shown that postoperative maltorsion after internal fixation of femoral neck fractures can have a significantly worse impact on mobilization and outcome. Different methods for measurement of malrotations are reported in literature. However, any reported method for the assessment of a shaft malrotation in the femur does not work here. In femoral neck fractures, the pointer function of the femoral neck, which is absolutely essential for these techniques, is lost and cannot be set in relation to the condylar plane. These circumstances are not addressed in literature thus far. Therefore, we propose here a novel method to fill this diagnostic gap. Methods and findings Three investigators (1 orthopaedic surgeons and 2 radiologists) measured the torsion of 20 legs on 10 patients using the Jarret method and a new geometric technique. To determine the intraobserver reliability the torsional angles were calculated again after 3 months. We applied a new geometric technique, without the need to include the femoral condyles in the measurement, to directly measure the angulation. For torsional difference, the interrater reliability -ICC (interclass correlation) between all investigators was 0.887 (good) (significance level: 95%CI, 0.668–0.969; p<0.001), by using the method of Jarret et al. and 0.933 (good) for the novel technique (significance level: 95%CI, 0.802–0.982; p<0.001). If the examinations are classified according to the patient side, our data show that for established methods, an ICC between the examiners on the right lower extremity is 0.978 (good) (95%CI, 0.936–0.994; p<0.001) and that on the left extremity is 0.955 (good) (95%CI, 0.867–0.988; p<0.001). Comparing with the new method, the right side assumes an ICC of 0.971 (good) (95%CI, 0.914–0.992; p<0.001), while the left side assumes an ICC of 0.910 (good) (95%CI, 0,736–0.976; p<0.001). When it comes to the intraobserver reliability, the measured cohort shows a significant better ICC for the novel method compared to Jarrett et al, with 0.907 respectively 0.786 for comparison in torsional differences. Conclusion The established methods may fail in assessing this special aspect of malrotation after femoral neck fractures. Here, the method presented results in a significant difference between the injured and uninjured side and shows significant differences in results compared to conventional measurement methods. The inter- and intraobserver reliability determined in this study is excellent and even higher in the assessment of torsional differences than the established method. We believe that the measurement method presented in this study is a useful tool to objectify the postoperative deformities in this area and making therapy recommendations in the future.
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Affiliation(s)
- Tarek Omar Pacha
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
- * E-mail:
| | - Lena Sonnow
- Department of Radiology, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Gesa Helen Poehler
- Department of Radiology, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Timo Stubig
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
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Ni M, Sun W, Ye Y. [Research progress of medial buttress plate assisted fixation for femoral neck fractures in young adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1454-1457. [PMID: 33191705 DOI: 10.7507/1002-1892.202004141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress of medial buttress plate assisted fixation for femoral neck fractures in young adults. Methods The literature about buttress plate assisted fixation for femoral neck fractures in young adults was widely reviewed and analyzed. The design principle, background, biomechanical characteristics, and clinical results of buttress plate were summarized. Results Medial buttress plate assisted fixation is the latest treatment of femoral neck fractures in young adults, which can convert the shear force at the fracture sides into compression force and promote fracture healing. Medial buttress plate can improve the biomechanical stability of femoral neck fractures and reduce the maximum stress of fixation implants. In clinical, the medial buttress plate can maintain fracture reduction, reduce the incidences of nonunion and surgical failure, and improve hip joint function. Conclusion Medial buttress plate assisted fixation can achieve good effectiveness for femoral neck fractures in young adults. However, due to the preliminary application, its indications, fixation implants, and long-term effectiveness need to be further studied and improved.
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Affiliation(s)
- Ming Ni
- Department of Orthopedics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201299, P.R.China
| | - Wanju Sun
- Department of Orthopedics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201299, P.R.China
| | - Ye Ye
- Hip Injury Center, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 471002, P.R.China
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Abstract
BACKGROUND Femoral neck fractures in children are rare injuries, occurring due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is according to the Delbet system, which not only guides management but also gives prognostic clues. Multiple fixation methods have been described and there is no consensus on what constitutes the best treatment. Osteonecrosis, non-union, coxa vara and premature physeal arrest are the most frequent complications. PURPOSE To review the current knowledge, discuss controversial aspects, and provide suggestions for future research. METHODS We have reviewed the literature on paediatric proximal femur fractures and have provided an evidence-based guide to the diagnosis and management of these injuries. Common complications have been elaborated and options for their prevention and/or management discussed. CONCLUSION There is universal agreement that anatomic reduction and stable internal fixation, supplemented by spica immobilization in younger children, are essential to obtain good outcomes. The role of capsular decompression, choice and configuration of implant, and appropriate timing of surgery are aspects that continue to be debated. Multicenter prospective studies are necessary to standardize treatment of these challenging injuries.
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Dynamic limited axial compression yields favorable functional outcomes in the fixation of Pauwels type-3 femoral neck fractures: A retrospective cohort study. Injury 2020; 51:1851-1857. [PMID: 32527503 DOI: 10.1016/j.injury.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 05/02/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Pauwels type-3 femoral neck fractures are challenging injuries to manage with high rates of complications after internal fixation and no consensus has been reached regarding the optimal fixation construct. The current study aims to evaluate the effect of dynamic limited axial compression in parallel screws combined with medial buttress plate (SMBP) or lateral compression plate (LCP) fixation of Pauwels type-3 femoral neck fractures. METHODS We performed a retrospective analysis of 51 cases of Pauwels type-3 femoral neck fractures who were fixed by SMBP or LCP. Specifically, the screw fixing the femoral head in the buttress plate was omitted. Postoperative complications and functional outcomes were mainly studied. RESULTS With a mean follow-up of 19.9 months, the rate of neck shortening was higher in the LCP group than that in SMBP group (32.1% vs. 8.7%, p = 0.04). Neither nonunion nor avascular necrosis was observed in both groups. Good-to-excellent Harris hip score accounts for 95.2% in SMBP group and 89.3% in LCP group (p = 0.40). Moreover, older age, fracture comminution and compression plate fixation predispose to neck shortening. CONCLUSION Dynamic limited axial compression by SMBP or LCP fixation was effective to improve the functional outcome of patients with Pauwels type-3 femoral neck fractures.
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Liu GZ, Chen C, Kong N, Tian R, Li YY, Li Z, Wang KZ, Yang P. Identification of potential miRNA biomarkers for traumatic osteonecrosis of femoral head. J Cell Physiol 2020; 235:8129-8140. [PMID: 31951022 DOI: 10.1002/jcp.29467] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
Traumatic osteonecrosis of femoral head (TONFH) is a common orthopedic disease caused by physical injury in hip. However, the unclear pathogenesis mechanism of TONFH and lacking of simple noninvasive early diagnosis method cause the necessity of hip replacement for most patients with TONFH. In this study, we aimed to identify circulating microRNAs (miRNAs) by integrated bioinformatics analyses as potential biomarker of TONFH. mRNA expression profiles were downloaded from the Gene Expression Omnibus database. Then we combined two miRNA screen methods: Weighted gene co-expression network analysis and fold change based differentially expressed miRNAs analysis. As a result, we identified 14 key miRNAs as potential biomarkers for TONFH. Besides, 302 target genes of these miRNAs were obtained and the miRNA-mRNA interaction network was constructed. Furthermore, the results of Kyoto Encyclopedia of Gene and Genome pathway analysis, Gene Ontology function analysis, protein-protein interaction (PPI) network analysis and PPI network module analysis showed close correlation between these 14 key miRNAs and TONFH. Then we established receiver operating characteristic curves and identified 6-miRNA signature with highly diagnosis value including miR-93-5p (area under the curve [AUC] = 0.93), miR-1324 (AUC = 0.92), miR-4666a-3p (AUC = 0.92), miR-5011-3p (AUC = 0.92), and miR-320a (AUC = 0.89), miR-185-5p (AUC = 0.89). Finally, the results of quantitative real-time polymerase chain reaction confirmed the significantly higher expression of miR-93-5p and miR-320a in the serum of patients with ONFH. These circulating miRNAs could serve as candidate early diagnosis markers and potential treatment targets of TONFH.
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Affiliation(s)
- Guan-Zhi Liu
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chen Chen
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ning Kong
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Run Tian
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi-Yang Li
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhe Li
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kun-Zheng Wang
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pei Yang
- Bone and Joint Surgery Center, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Liu T, Hua X, Yu W, Lin J, Zhao M, Liu J, Zeng X. Long-term follow-up outcomes for patients undergoing primary total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up. J Orthop Surg Res 2019; 14:371. [PMID: 31730476 PMCID: PMC6858652 DOI: 10.1186/s13018-019-1415-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/14/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This retrospective analysis compared the long-term outcomes for patients with a femoral neck fracture (AO/OTA type 31B) treated with a primary unilateral total hip arthroplasty with uncemented or cemented femoral components (UTHA or CTHA, respectively). METHODS We conducted a retrospective cohort study using the South China Hip Arthroplasty Database. We identified 422 patients with femoral neck fracture (AO/OTA type 31B) who were previously treated with primary unilateral UTHA or CTHA between 2007 and 2015, with follow-up until 2019. Follow-up occurred 1, 3, 6 and 12 months postoperatively and yearly thereafter. The primary outcome was the Harris hip score (HHS). The secondary outcome was the orthopaedic complication rate. RESULTS In total, 324 patients (UTHA n = 160, mean age 68.61 ± 7.49 years; CTHA n = 164, mean age 68.75 ± 7.04 years) were evaluated for study eligibility. The median follow-up was 73.3 months (range, 11.6-89.2 months). At the final follow-up, HHS was 74.09 ± 6.23 vs 79.01 ± 10.21 (UTHA vs CTHA, p = 0.012). Significant differences were detected in the incidence of prosthetic revision, loosening, and periprosthetic fracture between the UTHA and CTHA groups (7.5% for UTHA vs 1.8% for CTHA, p = 0.015; 17.5% for UTHA vs 8.5% for CTHA, p = 0.016; 11.9% for UTHA vs 4.9% for CTHA, p = 0.021, respectively). CONCLUSION In this setting, CTHA demonstrated superiority to UTHA by improving functional outcomes and decreasing complication rates.
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Affiliation(s)
- Tiejian Liu
- Department of Neurosurgery, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan avenue west, Tianhe District, Guangzhou, 510630, China
| | - Xiaoxiao Hua
- Department of Anesthesiology, The Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, No. 56, Lingyuan West Road, Guangzhou, 510055, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Jinluan Lin
- Department of Orthopaedics, The Affiliated Hospital of Fujian Medical University, Chazhong Road No. 20, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, 201508, China.
| | - Jun Liu
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Shehata MSA, Aboelnas MM, Abdulkarim AN, Abdallah AR, Ahmed H, Holton J, Consigliere P, Narvani AA, Sallam AA, Wimhurst JA, Imam MA. Sliding hip screws versus cancellous screws for femoral neck fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1383-1393. [PMID: 31165917 DOI: 10.1007/s00590-019-02460-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/29/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Both sliding hip screws (SHS) and cancellous screws are used in the surgical management of intracapsular femoral neck fracture. However, there is paucity of information as to which is the superior treatment modality. We performed this systematic review and meta-analysis study to compare the clinical outcomes of SHS and cancellous screws for the treatment of femoral neck fractures in adult patients. METHODS We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL, up to December 2017. Randomized controlled trials (RCTs) directly comparing the clinical outcomes of SHS and cancellous screws for femoral neck fractures were retrieved with no language or publication year restrictions. Data retrieved included operative details, nonunion rate, avascular necrosis, reoperation, infection and mortality, hip pain, functional hip scores, and medical complications. These were pooled as risk ratio or mean difference (MD) with their corresponding 95% confidence interval (CI). Heterogeneity was assessed by Chi-square test. RESULTS Ten RCTs involving 1934 patients were included in the final analysis. The pooled estimate showed that the SHS group was associated with more intraoperative blood loss (MD = 110.01 ml, 95% CI [52.42, 167.60], p = 0.00002) than the cancellous screws. There was no significant difference in terms of operative time, postoperative hip function, nonunion, avascular necrosis, reoperation rate, infection, fracture healing, hip pain, medical complications, and mortality rate. CONCLUSION Based on our study, the cancellous screws group was associated with less intraoperative blood loss in comparison with the SHS group. No other significant differences were found between the two interventions.
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Affiliation(s)
| | | | | | | | - Hussien Ahmed
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Ali A Narvani
- Rowley Bristow Orthopaedic Center, St Peter's Hospital, Chertsey, UK
| | - Asser A Sallam
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt.
| | - James A Wimhurst
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, UK
| | - Mohamed A Imam
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt.,Norfolk and Norwich University Hospital, University of East Anglia, Norwich, UK
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