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Wang T, Yin H, Zhao X, Ma C. Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study. Arch Orthop Trauma Surg 2023; 143:7063-7071. [PMID: 37668661 DOI: 10.1007/s00402-023-05029-z] [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: 02/14/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The optimal internal fixation for non-displaced femoral neck fractures remains controversial. This study aimed to compare the clinical results of the percutaneous compression plate (PCCP) with parallel screws (PS) in treating femoral neck fractures in elderly patients. MATERIALS AND METHODS A total of 218 patients who underwent internal fixation were randomized to receive either a percutaneous compression plate (PCCP group) or parallel screws (PS group) using a computerized random sequence generator which was used to assign the order of randomization. Patients were assessed by the operating time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stay, the time to full weight-bearing, reduction quality, fracture healing time, Harris hip score, and postoperative complications. RESULTS There was no significant difference between PCCP and PS groups regarding operative time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stays, reduction quality, and Harris hip score (p > 0.05). The time to full weight-bearing and the fracture healing time in the PCCP group were shorter than those in the PS group (p < 0.05). The overall complication rates were slightly lower in the PCCP compared to the PS patients, but there was no significant difference (p > 0.05). However, the implant failure rate was significantly higher in the PS group compared to the PCCP group (p < 0.05). CONCLUSIONS The present study suggests that the PCCP is superior to the parallel screws fixation in the treatment of non-displaced elderly femoral neck fractures in terms of earlier full weight-bearing, shorter fracture healing time, and lower implant failure rate. Therefore, it may be a better therapeutic strategy for non-displaced femoral neck fractures in elderly patients.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Shanghai, 200080, People's Republic of China
| | - Haibo Yin
- Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, People's Republic of China
| | - Xijiang Zhao
- Department of Orthopaedics, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214122, People's Republic of China.
| | - Chunhui Ma
- Department of Orthopaedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Shanghai, 200080, People's Republic of China.
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Jin ZY, Gu C, Yang HL, Xu M. Outcome of percutaneous compression plate for treatment of femoral neck fractures: mean follow-up of 4.4 years. INTERNATIONAL ORTHOPAEDICS 2022; 46:1891-1898. [DOI: 10.1007/s00264-022-05405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/08/2022] [Indexed: 12/01/2022]
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Chen Y, Li H, Dai L, Yin Q, Li D, Wang X. Imaging observation of percutaneous compression plate use in promoting femoral neck fracture healing. J Int Med Res 2021; 49:3000605211033501. [PMID: 34407688 PMCID: PMC8381436 DOI: 10.1177/03000605211033501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To examine the imaging evidence of the use of percutaneous compression plate
(PCCP) in promoting femoral neck fracture healing compared with cannulated
screws (CS). Methods This retrospective study enrolled patients with femoral neck fractures
undergoing internal fixation procedures. The patients were divided into a
PCCP group and a CS group with imaging as the primary outcome and Harris hip
score (HHS) as the secondary outcome. Results This study included 162 patients: 80 in the PCCP group and 82 in the CS
group. There were no significant differences between the patients in their
preoperative baseline characteristics. Patient follow-up ranged from 24–56
months (mean 30.7 months). Differences in reduction quality, screw slipping,
neck shortening and avascular necrosis (AVN) were not significant between
the two groups. There were significant differences between the treatment
groups in bone absorption, nonunion, healing time, screw withdrawal and
fixation failure in favour of the PCCP group. Postoperative HHS at 6 and 12
months were significantly better for the PCCP group than the CS group, but
the differences were not significant at 24 months and last follow-up. Conclusion Stable internal fixation with dynamic compression was the key to PCCP
promoting femoral neck fracture healing.
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Affiliation(s)
- Yong Chen
- Department of Radiology, Liyang People's Hospital Affiliated to Nantong University, Changzhou, Jiangsu Province, China
| | - Haifeng Li
- Department of Orthopaedics, 12582Soochow University, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu Province, China
| | - Liansheng Dai
- Department of Orthopaedics, Jiangnan University Affiliated Hospital, Wuxi, Jiangsu Province, China
| | - Qudong Yin
- Department of Orthopaedics, 12582Soochow University, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu Province, China
| | - Dong Li
- Department of Radiology, Liyang People's Hospital Affiliated to Nantong University, Changzhou, Jiangsu Province, China
| | - Xinming Wang
- Department of Radiology, Liyang People's Hospital Affiliated to Nantong University, Changzhou, Jiangsu Province, China
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Bao H, Li H, Gu S, Zhang W. [Short- and medium-term effectiveness of percutaneous compression plate internal fixation in the treatment of femoral neck fractures in the elderly]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:961-966. [PMID: 34387422 DOI: 10.7507/1002-1892.202102091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the short- and medium-term effectiveness of percutaneous compression plate (PCCP) internal fixation for femoral neck fractures in the elderly. Methods The clinical data of 32 elderly patients with femoral neck fracture treated with PCCP internal fixation between January 2012 and January 2019 were retrospectively analyzed. All of them were traumatic fractures. The causes of injury were falling in 20 cases, traffic accident in 7 cases, and falling from height in 5 cases. According to Garden classification, there were 7 cases of type Ⅱ, 15 cases of type Ⅲ, and 10 cases of type Ⅳ; there were 12 cases with Singh index level Ⅳ, 14 cases with level Ⅴ, and 6 cases with level Ⅵ; the bone mineral density of femoral neck was 0.610-0.860 g/cm 2 (mean, 0.713 g/cm 2). The time from injury to operation was 3-14 days, with an average of 5.8 days. Patients began to weight-bear gradually within 3 days postoperatively. The operation time, intraoperative blood loss, hospitalization stay, fracture reduction (Garden alignment index), fracture healing, failure of internal fixation, femoral neck shortening, and osteonecrosis of the femoral head were observed; hip function recovery was evaluated by Harris score. Results The operation time was 35-135 minutes (mean, 73.4 minutes), the intraoperative blood loss was 75-385 mL (mean, 116.4 mL), the hospitalization stay was 3-15 days (mean, 8.3 days). At 1 week after operation, the Garden alignment index of fracture reduction was grade Ⅰ in 25 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 1 case. One case of superficial infection of the incision occurred after operation, and no early complications such as deep vein thrombosis in the lower extremities, pulmonary embolism, or bedsores occurred. All the patients were followed up 2.1-4.0 years, with an average of 2.7 years. Except for 2 cases of delayed union (displaced trans-neck and subhead fractures), no nonunion of fracture and failure of internal fixation occurred, the fracture healing time was 4-8 months, with an average of 4.9 months. Femoral neck shortening occurred in 12 cases (37.5%); osteonecrosis of the femoral head occurred in 3 cases (9.4%), all of which were displaced trans-neck and subhead fractures, of which 2 cases received total hip arthroplasty and the other received conservative treatment. The Harris scores of the hip joint at 3 months, 2 years after operation and at last follow-up were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between each time point after operation ( P>0.05). At last follow-up, the hip joint function was evaluated according to Harris score, the results were excellent in 15 cases, good in 12 cases, and fair in 5 cases, with an excellent and good rate of 84.4%. There was no significant difference in postoperative hip function composition among patients with different ages, Garden classification, Singh index, and Garden alignment index ( P>0.05). Conclusion For elderly patients with femoral neck fractures without severe osteoporosis and with relatively good physical conditions, PCCP internal fixation can achieve satisfactory short- and medium-term effectiveness, but there is a certain risk of osteonecrosis of the femoral head.
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Affiliation(s)
- Huanxiang Bao
- Department of Orthopaedics,Yancheng No.1 People's Hospital, Yancheng Jiangsu, 224300, P.R.China
| | | | - Sanjun Gu
- Department of Orthopaedics, Wuxi No.9 People's Hospital, Wuxi Jiangsu, 214062, P.R.China
| | - Weiya Zhang
- Department of Orthopaedics,Yancheng No.1 People's Hospital, Yancheng Jiangsu, 224300, P.R.China
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Xu K, Liu Y, Wang J, Yan S, Liu X, Li H, Gu S. [Effectiveness of percutaneous compression plate fixation for femoral neck fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1364-1368. [PMID: 33191691 DOI: 10.7507/1002-1892.202002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of percutaneous compression plate (PCCP) fixation for femoral neck fracture. Methods A clinical data of 100 patients with femoral neck fractures who were treated with internal fixation were analyzed retrospectively. The fractures were fixed with the cannulated screws (CS) in 55 patients (CS group) and with the PCCP in 45 patients (PCCP group). There was no significant difference in gender, age, the cause of injury, the fracture type, complications, and disease duration between the two groups ( P>0.05). The quality of fracture reduction, bone resorption, screw slipping, femoral neck shortening, complications (nonunion, failure of fixation, and osteonecrosis of femoral head), and functional recovery of hip (Harris score) were compared between the two groups. Results All incisions healed by first intention. All patients were followed up 24-56 months, with an average of 30.7 months. The quality of fracture reduction was excellent in 26 cases, good in 18 cases, fair in 9 cases, and poor in 2 cases in CS group and excellent in 21 cases, good in 17 cases, fair in 4 cases, and poor in 3 cases in PCCP group, showing no significant difference between the two groups ( Z=-0.283, P=0.773). The incidence of nonunion in PCCP group was significantly lower than that in CS group ( P=0.046), and the fracture healing time in PCCP group was shorter than that in CS group ( t=2.155, P=0.034). There was no significant difference in the incidences of bone resorption, screw slipping, femoral neck shortening, failure of fixation, and osteonecrosis of femoral head between the two groups ( P>0.05). The overall complication rates were 27.27% (15/55) in CS group and 8.89% (4/45) in PCCP group, showing significant difference ( χ 2=5.435, P=0.020). The Harris score in PCCP group at 6 months after operation was significantly higher than that in CS group ( t=-2.073, P=0.041). However, there was no significant difference in the Harris score at 12, 18, and 24 months after operation between the two groups ( P>0.05). Conclusion Stable sliding compression of PCCP is benefit for the femoral neck fracture healing, especially shortening union.
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Affiliation(s)
- Kelin Xu
- Department of Orthopedics and Traumatology, Wuxi Traditional Chinese Medicine Hospital, Wuxi Jiangsu, 214000, P.R.China
| | | | - Jianwei Wang
- Department of Orthopedics and Traumatology, Wuxi Traditional Chinese Medicine Hospital, Wuxi Jiangsu, 214000, P.R.China
| | - Songhe Yan
- Department of Orthopedics and Traumatology, Wuxi Traditional Chinese Medicine Hospital, Wuxi Jiangsu, 214000, P.R.China
| | - Xiaofeng Liu
- Department of Orthopedics and Traumatology, Wuxi Traditional Chinese Medicine Hospital, Wuxi Jiangsu, 214000, P.R.China
| | - Haifeng Li
- Department of Orthopedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Sanjun Gu
- Department of Orthopedics, the 9th People's Hospital of Wuxi (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
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Schemitsch EH, Miclau T, Karachalios T, Nowak LL, Sancheti P, Poolman RW, Caminis J, Daizadeh N, Dent-Acosta RE, Egbuna O, Chines A, Maddox J, Grauer A, Bhandari M. A Randomized, Placebo-Controlled Study of Romosozumab for the Treatment of Hip Fractures. J Bone Joint Surg Am 2020; 102:693-702. [PMID: 31977817 PMCID: PMC7508283 DOI: 10.2106/jbjs.19.00790] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Romosozumab is a bone-forming antibody that increases bone formation and decreases bone resorption. We conducted a double-blinded, randomized, phase-2, dose-finding trial to evaluate the effect of romosozumab on the clinical outcomes of open reduction and internal fixation of intertrochanteric or femoral neck hip fractures. METHODS Patients (55 to 94 years old) were randomized 2:3:3:3 to receive 3 subcutaneous injections of romosozumab (70, 140, or 210 mg) or a placebo postoperatively on day 1 and weeks 2, 6, and 12. The primary end point was the difference in the mean timed "Up & Go" (TUG) score over weeks 6 to 20 for romosozumab versus placebo. Additional end points included the time to radiographic evidence of healing and the score on the Radiographic Union Scale for Hip (RUSH). RESULTS A total of 332 patients were randomized: 243 to receive romosozumab (70 mg, n = 60; 140 mg, n = 93; and 210 mg, n = 90) and 89 to receive a placebo. Although TUG scores improved during the study, they did not differ significantly between the romosozumab and placebo groups over weeks 6 to 20 (p = 0.198). The median time to radiographic evidence of healing was 16.4 to 16.9 weeks across treatment groups. The RUSH scores improved over time across treatment groups but did not differ significantly between the romosozumab and placebo groups. The overall safety and tolerability profile of romosozumab was comparable with that of the placebo. CONCLUSIONS Romosozumab did not improve the fracture-healing-related clinical and radiographic outcomes in the study population. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Emil H. Schemitsch
- Department of Surgery, University of Western Ontario, London, Ontario, Canada,Email address for E.H. Schemitsch:
| | - Theodore Miclau
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California,Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Theofilos Karachalios
- Orthopaedic Department UGHL, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Lauren L. Nowak
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Parag Sancheti
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
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Wang G, Tang Y, Wu X, Yang H. Finite element analysis of a new plate for Pauwels type III femoral neck fractures. J Int Med Res 2020; 48:300060520903669. [PMID: 32054346 PMCID: PMC7111023 DOI: 10.1177/0300060520903669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Method Result Conclusion
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Affiliation(s)
- Gang Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Department of Orthopaedics, 72nd Group Army Hospital of the PLA, Huzhou, Zhejiang, China
| | - Yong Tang
- Department of Orthopaedics, 72nd Group Army Hospital of the PLA, Huzhou, Zhejiang, China.,Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xuhua Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Ordinary Cannulated Compression Screws or Headless Cannulated Compression Screws? A Synthetic Bone Biomechanical Research in the Internal Fixation of Vertical Femoral Neck Fracture. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4898301. [PMID: 29850523 PMCID: PMC5925079 DOI: 10.1155/2018/4898301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/23/2018] [Accepted: 02/27/2018] [Indexed: 11/25/2022]
Abstract
Purpose The purpose of this study is to verify whether the headless cannulated compression screw (HCCS) has higher biomechanical stability than the ordinary cannulated compression screw (OCCS) in the treatment of vertical femoral neck fractures. Materials and Methods 30 synthetic femur models were equally divided into 2 groups, with 50°, 60°, and 70° Pauwels angle of femoral neck fracture, under 3D printed guiding plates and C-arm fluoroscopic guidance. The femur molds were fixed with three parallel OCCSs as OCCS group and three parallel HCCSs as HCCS group. All specimens were tested for compressive strength and maximum load to failure with a loading rate of 2 mm/min. Results The result showed that there was no significant difference with the compressive strength in the Pauwels angle of 50° and 60°. However, we observed that the maximum load to failure with the Pauwels angle of 50°, 60°, and 70° and the compressive strength with 70° of HCCS group showed better performance than the OCCS group. Conclusion HCCS performs with better biomechanical stability than OCCS in the treatment of vertical femoral neck fracture, especially with the Pauwels angle of 70°.
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