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Chen Z, Chen F, Xu X, Li X, Cui H, Zhang W, Jiang D, Zhang F, Chen Y, Zhou S, Lyu S. Biomechanical analysis of a new cannulated screw for unstable femoral neck fractures. Front Bioeng Biotechnol 2024; 12:1382845. [PMID: 38803846 PMCID: PMC11128572 DOI: 10.3389/fbioe.2024.1382845] [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: 02/06/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
Background The treatment of unstable femoral neck fractures (FNFs) remains a challenge. In this study, a new cannulated screw for unstable FNFs was designed to provide a new approach for the clinical treatment of these injuries, and its biomechanical stability was analyzed using finite element analysis and mechanical tests. Methods An unstable FNF model was established. An internal fixation model with parallel inverted triangular cannulated screws (CSs) and a configuration with two superior cannulated screws and one inferior new cannulated screw (NCS) were used. The biomechanical properties of the two fixation methods were compared and analyzed by using finite element analysis and mechanical tests. Results The NCS model outperformed the CSs model in terms of strain and stress distribution in computer-simulated reconstruction of the inverted triangular cannulated screw fixation model for unstable FNFs. In the biomechanical test, the NCS group showed significantly smaller average femoral deformation (1.08 ± 0.15 mm vs. 1.50 ± 0.37 mm) and fracture line displacement (1.43 ± 0.30 mm vs. 2.01 ± 0.47 mm). In the NCS group, the mean stiffness was significantly higher than that in the CSs group (729.37 ± 82.20 N/mm vs. 544.83 ± 116.07 N/mm), and the mean compression distance was significantly lower than that in the CSs group (2.87 ± 0.30 mm vs. 4.04 ± 1.09 mm). Conclusion The NCS combined with two ordinary cannulated screws in an inverted triangle structure to fix unstable FNFs can provide better biomechanical stability than CSs and exhibit a length- and angle-stable construct to prevent significant femoral neck shortening.
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Affiliation(s)
- Zhigang Chen
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
- Department of Orthopaedics, Affiliated Hai’an Hospital of Nantong University, Hai’an, Jiangsu, China
| | - Feiyang Chen
- Medical School, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xinbao Xu
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Xin Li
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Haidong Cui
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Wen Zhang
- Institute of Orthopaedics, Soochow University, Suzhou, Jiangsu, China
| | - Dong Jiang
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Feixiang Zhang
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Yinbing Chen
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Shiran Zhou
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Shujun Lyu
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
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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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Jiang D, Zhan S, Hai H, Wang L, Zhao J, Zhu Z, Wang T, Jia W. What makes vertical femoral neck fracture with posterior inferior comminution different? An analysis of biomechanical features and optimal internal fixation strategy. Injury 2023:110842. [PMID: 37296009 DOI: 10.1016/j.injury.2023.110842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Fracture comminution occurs in 83.9%-94% of vertical femoral neck fractures (VFNFs), the majority of which were located in posterior-inferior region, and poses a clinical challenge in fixation stability. We conducted a subject-specific finite element analysis to determine the biomechanical features and optimal fixation selection for treating VFNF with posterior-inferior comminution. PATIENTS AND METHODS Eighteen models with three fracture types (VFNF without comminution [NCOM], with comminution [COM], with comminution + osteoporosis [COMOP]) and six internal fixation types (alpha [G-ALP], buttress [G-BUT], rhomboid [G-RHO], dynamic hip screw [G-DHS], invert triangle [G-ITR], femoral neck system (G-FNS)) were created based on the computed tomography data. By using the subject-specific finite element analysis method, stiffness, implant stress, yielding rate (YR) were compared. Additionally, in order to elucidate distinct biomechanical characters of different fracture types and fixation strategies, we calculated interfragmentary movement (IFM), detached interfragmentary movement (DIM), shear interfragmentary movement (SIM) of all fracture surface nodes. RESULTS Generally, in comparison with NCOM, COM showed a 30.6% reduction of stiffness and 1.46-times higher mean interfragmentary movement. Besides, COM had a 4.66-times (p = 0.002) higher DIM at the superior-middle position, but similar SIM across fracture line, which presented as varus deformation. In COM and COMOP, among all six fixation strategies, G-ALP had significantly the lowest IFM (p<0.001) and SIM (p<0.001). Although G-FNS had significantly highest IFM and SIM (p<0.001), it had the highest stiffness and lowest DIM (p<0.001). In COMOP, YR was the lowest in G-FNS (2.67%). CONCLUSIONS Posterior-inferior comminution primarily increases superior-middle detached interfragmentary movement in VFNF, which results in varus deformation. For comminuted VFNF with or without osteoporosis, alpha fixation has the best interfragmentary stability and anti-shear property among six current mainstream fixation strategies, but a relatively weaker stiffness and anti-varus property compared to fixed-angle devices. FNS is advantageous owing to stiffness, anti-varus property and bone yielding rate in osteoporosis cases, but is insufficient in anti-shear property.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Hu Hai
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Lingtian Wang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Jinhui Zhao
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Ziyang Zhu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Tao Wang
- Department of emergency trauma center, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weitao Jia
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China.
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What makes fixation of femoral neck fractures fail? A systematic review and meta-analysis of risk factors. Injury 2023; 54:652-660. [PMID: 36437167 DOI: 10.1016/j.injury.2022.11.042] [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: 10/02/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This systematic review aims to provide an overview of predictors for failure of treatment of displaced femoral neck fracture (dFNF) with internal fixation and quantify their risk of fixation failure in a meta-analysis. PATIENTS AND METHODS PubMed, Embase, Web of Science, Cochrane Library, and EMCare were searched for original studies published from January 2000, including adult patients with an internally fixated dFNF, that reported data on predictors for fixation failure defined as revision surgery due to non-union, avascular femoral head necrosis or cut-out of implant. RevMan version 5 software was used to pool univariable Odds Ratio's (OR) for predictors of fixation failure by means of a random effects model. RESULTS This review included 16 articles (15 articles cohort studies and one randomised trial). Twenty-four predictors for fixation failure were identified and analysed, 16 of which were evaluated in just one study. Data of 7 predictors were pooled in a meta-analysis. Female sex (OR 1.78, 95% confidence interval [CI] 1.26-2.52), smoking (OR 3.64, 95% CI 1.68-7.91), age >50 years (OR 3.64, 95% CI 1.68-7.91), inadequate fracture reduction (OR 2.28, 95% CI 1.62-3.22), fixation with cannulated screws (CS) or pins compared to fixed angle devices (OR 2.16, 95% CI 1.03-4.54) were identified as significant predictors for fixation failure. CONCLUSION This study can help surgeons to choose the preferred treatment for patients with a dFNF and substantiate future algorithms and guidelines for treatment of FNF.
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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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Zhu XZ, Han CX, Ai ZS, Wang W, Wu SH, Zhao KY, Liao P, Mei J. A quantitative study of bone defects in displaced femoral neck fractures based on virtual reduction techniques. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 222:106958. [PMID: 35738093 DOI: 10.1016/j.cmpb.2022.106958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/11/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bone defects in femoral neck fractures are strongly associated with the prognosis after internal fixation. However, qualitative analysis of bone defects in femoral neck fractures has already been performed, quantitative studies have not been reported. In this study, we aimed to systematically analyse the morphological characteristics of bone defects in patients with femoral neck fractures using computed tomography (CT) images combined with computer image analysis techniques. METHODS Four hundred and sixty-nine patients with femoral neck fractures from January 2014 to December 2018 at two grade A tertiary hospitals were included. Models were created in Mimics software based on CT images collected within 1 week after injury and then imported into 3-matic software for virtual reduction. The volume of the bone defect (VBD), maximum defect thickness (MDT), extent of the bone defect region (EBDR) , main defect quadrant (MDQ), collapse type and fracture classification were calculated and recorded. RESULTS The EBDR, collapse type and MDT all had a significant positive effect on the VBD (P <0.05), with a more significant effect at higher quantiles. Age also had a significant positive effect on the VBD (P < 0.05), but its effect was more pronounced at lower quantiles. Compared to non-subcapital fractures, subcapital fractures had a positive effect on the VBD only at the 50 and 75% quantiles (P < 0.01). The female sex had a significant negative effect on the VBD compared to the male sex (P < 0.05). CONCLUSION This study established a reliable computer image processing method for quantitative analysis of the VBD in femoral neck fractures and revealed that all patients with femoral neck fractures had bone defects, which can occur at any part of the femoral neck. The EBDR, MDT, collapse type, and patient age and sex were all important risk factors for the extent of the defect and should be taken into account in surgical planning.
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Affiliation(s)
- Xiao-Zhong Zhu
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Chun-Xia Han
- Department of Medical Statistic, Tongji University School of Medicine, Shanghai, China
| | - Zi-Sheng Ai
- Department of Medical Statistic, Tongji University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sheng-Hui Wu
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ke-Yang Zhao
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Peng Liao
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jiong Mei
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
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Multiple cannulated screw fixation of femoral neck fractures with comminution in young- and middle-aged patients. J Orthop Surg Res 2022; 17:280. [PMID: 35585631 PMCID: PMC9118618 DOI: 10.1186/s13018-022-03157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the distribution and influence of comminution in femoral neck fracture (FNF) patients after cannulated screw fixation (CSF). Methods From January 2019 to June 2020, a total of 473 patients aged 23–65 years with FNF treated by CSF were included in the present study. Based on location of the cortical comminution, FNF patients were assigned to two groups: the comminution group (anterior comminution, posterior comminution, superior comminution, inferior comminution, multiple comminutions) or the without comminution group. The incidence of postoperative complications, quality of life and functional outcomes was recorded at 1-year follow-up. Results Comminution was more likely to appear in displaced FNF patients (86.8%) compared with non-displaced FNF patients (8.9%), and the rate of comminution was closely associated with Pauwels classification (3.2% vs 53.5% vs 83.9%, P < 0.05). The incidence of osteonecrosis of the femoral head (ONFH, 11.3% vs 2.9%, P < 0.05), nonunion (7.5% vs 1.7%, P < 0.05), femoral neck shortening (21.6% vs 13.4%, P < 0.05) and internal fixation failure (11.8% vs 2.9%, P < 0.05) was significantly higher in FNF patients with comminutions, especially with multiple comminutions, than those without. Furthermore, there was a significant difference in the Harris hip score (HHS, 85.6 ± 15.6 vs 91.3 ± 10.8, P < 0.05) and EuroQol five dimensions questionnaire (EQ-5D, 0.85 ± 0.17 vs 0.91 ± 0.18, P < 0.05) between FNF patients with comminution and those without. There was no significant difference in Visual analogue scale scores (VAS, 1.46 ± 2.49 vs 1.13 ± 1.80, P > 0.05) between two groups at 1 year post-surgery. Conclusion Comminution is a risk factor for postoperative complications in young- and middle-aged patients with displaced and Pauwels type III FNF who undergo CSF. This can influence the recovery of hip function, thereby impacting quality of life. Further evaluation with a more comprehensive study design, larger sample and long-term follow-up is needed.
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Terhune EB, Polce EM, Williams JC. A Novel Fluoroscopic View for Improved Assessment of the Safety of the Posterosuperior Screw in Femoral Neck Fracture Fixation. J Bone Joint Surg Am 2022; 104:889-895. [PMID: 35583544 DOI: 10.2106/jbjs.21.00959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present study was to determine specific fluoroscopic views of the femoral neck to accurately identify partially extraosseous ("in-out-in"; IOI) placement of the posterosuperior screw for fixation of femoral neck fractures. METHODS A 3.2-mm guide pin was placed in the posterosuperior aspect of 2 synthetic femur models: 1 entirely intraosseous and 1 IOI. Sequential fluoroscopic images were made at 5° intervals in order to identify which fluoroscopic projections identified IOI guide pin placement. These images were utilized to inform screw placement and assessment in the second phase of the study, which involved the use of cadaveric specimens. In Phase II, the posterosuperior screw of the inverted triangle was placed in 10 cadaveric specimens with use of a standard posteroanterior fluoroscopic view and 1 of 2 lateral views, either (1) neck in line with the shaft, i.e., 0° lateral; or (2) a -15° rollunder view. The final fluoroscopic views (i.e., the posteroanterior and multiple lateral and oblique views) were randomized and blinded for review by 10 orthopaedic residents and 5 attending orthopaedic traumatologists. Specimens were stripped of soft tissue and inspected for screw perforation. RESULTS Overall accuracy of respondents was 68.8%, with no difference between the attending traumatologists (71.8%) and resident surgeons (67.4%; p = 0.173). Interobserver reliability was moderate (κ = 0.496). Dissection identified that 4 (40%) of 10 screws were extraosseous. All of the extraosseous screws were placed with use of the 0° lateral view. The -15° rollunder lateral view was the most sensitive (81.7%) and specific (92.2%) view for identifying IOI screw placement. CONCLUSIONS Surgeons often utilize the standard posteroanterior and 0° lateral fluoroscopic views to safely place screws; however, many of these screws are IOI. The addition of a -15° rollunder lateral view significantly improved identification of IOI screws in the posterosuperior femoral neck. Unidentified IOI screw placement may result in damage to the blood supply of the femoral head.
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Affiliation(s)
- E Bailey Terhune
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Evan M Polce
- School of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Joel C Williams
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Jiang D, Zhan S, Hu H, Zhu H, Zhang C, Jia W. The Effect of Vertical and Oblique Inclinations on Fracture Stability and Reoperation Risks in Femoral-Neck Fractures of Nongeriatric Patient. Front Bioeng Biotechnol 2021; 9:782001. [PMID: 34805128 PMCID: PMC8595327 DOI: 10.3389/fbioe.2021.782001] [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] [Received: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background: For nongeriatric patients with femoral neck fractures (FNFs), preoperative evaluation of fracture three-dimensional inclination is essential to identify fracture stability, select appropriate fixation strategies, and improved clinical prognoses. However, there is lack of evaluation system which takes into account both vertical and oblique inclinations. The purpose of this study was to comprehensively investigate the effect of vertical and oblique inclinations on fracture stability and reoperation risks. Methods: We retrospectively reviewed the medical records of 755 FNFs patients with over 2 years follow-up. The 3-D inclination angle in vertical (α) and oblique plane (β) were measured based on CT images. The optimal threshold for unstable 3-D inclination were identified by seeking the highest Youden Index in predicting reoperation and validated in the biomechanical test. According to the cut-off value proposed in the diagnostic analysis, forty-two bone models were divided into seven groups, and were all fixed with traditional three parallel screws. Interfragmentary motion (IFM) was used for comparison among seven groups. The association between reoperation outcome and 3-D inclination was analysed with a multivariate model. Results and Conclusion: The overall reoperation rate was 13.2%. Unstable 3-D inclination angles with an optimally determined Youden index (0.39) included vertical (α > 70°) and oblique (50°<α < 70° and β > 20°/β < −20°) types. Biomechanical validation showed these fractures had significantly greater (p < 0.05) interfragmentary motion (1.374–2.387 mm vs. 0.330–0.681 mm). The reoperation rate in 3-D unstable group (32.7%) is significantly (p < 0.001) higher than that in 3-D stable group (7.9%). Multivariate analysis demonstrated that 3-D inclination angle was significantly (OR = 4.699, p < 0.001) associated with reoperation. FNFs with α > 70°; 50°<α < 70° and β > 20°/β < −20° are real unstable types with significantly worse interfragmentary stability and higher reoperation risks. Fracture inclination in vertical and oblique planes is closely related to reoperation outcomes and may be a useful complement to the way FNFs are currently evaluated.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai Hu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyi Zhu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weitao Jia
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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