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Chan CX, Lim JI, Singh A, Murphy D, Chen Y. Two-year outcomes of internal fixation with femoral neck system in patients with femoral neck fracture in an Asian population. J Orthop 2024; 57:98-103. [PMID: 39006207 PMCID: PMC11245931 DOI: 10.1016/j.jor.2024.06.010] [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: 04/10/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Abstract
Background Femoral neck fractures (FNF) are one of the most common fractures, with a projected increase in incidence with population growth and ageing. The Femoral Neck System (FNS) launched in 2019 was developed specifically for fixation of FNF with the purported advantages of providing both angular and rotational stability. We report our experience with the FNS and evaluate its effectiveness and associated complications. Methods A retrospective case series of 50 patients who underwent surgical fixation for FNF from August 2020 to October 2021 using the FNS in two Singapore tertiary institutions with at least 2 years follow-up were included. Clinical data (patients' demographics, fracture classification, intra-operative and post-operative complications) were reviewed. Radiological analysis assessed the pre- and immediate post-operative garden alignment index (GAI) and presence of femoral neck shortening at 3 months. Results The mean age was 63.5 years (SD 16.9, range 26-92). Five (10 %), 34 (68 %) and 11 (22 %) were ASA 1, 2 and 3 respectively. Twenty-four (48 %), 16 (32 %), 4 (8 %), and 6 (12 %) patients sustained Garden's 1, 2, 3 and 4 FNF respectively. The mean operative duration was 66.2 min (SD 20.5) and length of stay was 6.9 days (SD 4.6).The post-operative improvement in garden alignment index (GAI) was a mean of 9.1° (p < 0.001) on lateral view. The mean femoral neck shortening was 1.97 mm (SD 5.3) at 3 months. There were no intra-operative complications. Post-operatively, 1 (2 %) patient required blood transfusion, 1 (2 %) patient had implant cut-out and non-union managed non-operatively, 2 (4 %) patients developed avascular necrosis and required revision to total hip replacements. There were two (4 %) cases of 1-year mortality. Conclusion The FNS achieved good outcomes with low rates of complications. The promising results justify its continued use and further evaluation in comparison to other devices.
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Affiliation(s)
- Chloe Xiaoyun Chan
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
| | - Joshua Ian Lim
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
| | - Amritpal Singh
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
| | - Diarmuid Murphy
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - Yongsheng Chen
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
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Shen W, Xue Y, Shi J, Deng X, Pu Z, Gao Q. Eleven internal fixations for young vertical femoral neck fractures: A protocol for systematic review and network meta-analysis. PLoS One 2024; 19:e0310971. [PMID: 39316560 PMCID: PMC11421801 DOI: 10.1371/journal.pone.0310971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/10/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Vertical femoral neck fractures (VFNFs) in young patients lead to significant biomechanical instability. Multitudinous internal fixation devices have been developed and utilized in clinical interventions. However, there has yet to be a consensus expert opinion regarding the optimal internal fixation configurations. This study aims to conduct a network meta-analysis to evaluate the safety and efficacy of all currently recognized internal fixation procedures for the treatment of VFNFs in young individuals. METHODS Comprehensive literature searches will be performed in China National Knowledge Infrastructure, the Cochrane Library, PubMed, Web of Science, Embase, the Wanfang Database, and the Chinese Biomedical Literature Database, covering the entire database history up until May 21, 2024. Individual papers will be evaluated for possible bias using RoB 2.0, the most recent version of the randomized trial Cochrane risk-of-bias approach. Pairwise meta-analysis and network meta-analysis (NMA) will be conducted for data analysis using STATA 15.0 and R 4.1.3. Inconsistency tests, subgroup analyses, sensitivity analyses, and assessments of publication bias will also be performed. CONCLUSION The study will provide evidence-based recommendations for the optimal internal fixation methods in treating young patients with VFNFs. TRIAL REGISTRATION INPLASY202460017.
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Affiliation(s)
- Weiwei Shen
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province, China
| | - Yun Xue
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province, China
| | - Jie Shi
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province, China
| | - Xiaowen Deng
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province, China
| | - Zhongshu Pu
- Department of Infection Control, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province, China
| | - Qiuming Gao
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province, China
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Xu Z, Sun J, Li J, Huang F, Zhao J, Shao Y, Fang S, Wang Z, Gong Y, Zhou H, Tian S. Comparative analysis of the femoral neck system (FNS) vs. cannulated cancellous screws (CCS) in the treatment of Middle-aged and elderly patients with femoral neck fractures: clinical outcomes and biomechanical insights. BMC Musculoskelet Disord 2024; 25:735. [PMID: 39277709 PMCID: PMC11401286 DOI: 10.1186/s12891-024-07863-7] [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: 05/10/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024] Open
Abstract
PURPOSE This study aimed to compare the clinical outcomes and differences in biomechanical characteristics between the femoral neck system (FNS) and cannulated cancellous screws (CCSs) in the treatment of femoral neck fractures. METHODS This study retrospectively analysed a cohort of 38 registered cases of femoral neck fractures treated surgically with either the FNS (n = 17) or CCSs (n = 21) between January 2020 and December 2023. Indicators such as fluoroscopy frequency, length of hospital stay, and fracture healing time were compared between the two groups. Functional status was evaluated via the Harris hip score (HHS) and visual analogue scale (VAS), whereas prognosis was assessed based on changes in the neck shaft angle and femoral neck shortening. Additionally, six sets of femoral neck fracture models were developed based on Pauwels angles of 30°, 40°, 50°, 60°, 70°, and 80°. Two experimental groups, FNS and CCS, were established, and a joint reaction force of 1800 N was applied to the proximal femur. The displacement, stress, and stiffness of the components of interest in the different models were tested and compared. RESULTS The distributions of all the baseline characteristics were similar between the two groups (p > 0.05). The FNS group presented significantly shorter fluoroscopy frequency, length of hospital stay, and fracture healing time (p < 0.05). Harris and VAS scores were higher in the FNS group than in the CCS group (p < 0.05). Postoperative changes in the neck shaft angle and femoral neck shortening were significantly lower in the FNS group than in the CCS group (p < 0.05). The results of the finite element analysis indicated that the maximum stress on the femoral head and varus angle were generally lower in the FNS group than in the CCS group and that the maximum displacement of the femoral head and FNS was generally lower in the FNS group than in the CCS group. However, the superiority of FNS over CCS decreased with increasing Pauwels angle. Additionally, the effectiveness of FNS in limiting displacement of the femoral neck upper wall was not as favourable as that of CCS. CONCLUSIONS The treatment of femoral neck fractures with FNS is superior and contributes to improved hip joint function. Biomechanical research has confirmed its structural stability and advantages in resisting femoral head varus. However, challenges to its fixation efficacy persist, particularly at higher Pauwels angles.
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Affiliation(s)
- Zhi Xu
- Department of Orthopedic, Zhangjiagang fifth People's Hospital, No.120 Lefeng Road,, Zhangjiagang, 215600, Jiangsu province, China
| | - Jun Sun
- Department of Orthopedic, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Junjie Li
- Department of Orthopedics, Ningxia Chinese Medicine Research Center, Ningxia Autonomous Region, Yinchuan, 750021, China
| | - Feng Huang
- Department of Orthopedic, Zhangjiagang fifth People's Hospital, No.120 Lefeng Road,, Zhangjiagang, 215600, Jiangsu province, China
| | - Jinxiang Zhao
- Research and Development Department, Shanghai SIEG Machinery Co., Ltd, Shanghai, 200000, China
| | - Yiping Shao
- Research and Development Department, Shanghai SIEG Machinery Co., Ltd, Shanghai, 200000, China
| | - Shuping Fang
- Research and Development Department, Shanghai SIEG Machinery Co., Ltd, Shanghai, 200000, China
| | - Ziru Wang
- Department of Orthopedic, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui province, China
| | - Yu Gong
- Department of Orthopedic, Zhangjiagang fifth People's Hospital, No.120 Lefeng Road,, Zhangjiagang, 215600, Jiangsu province, China
| | - Hao Zhou
- Department of Orthopedic, Zhangjiagang fifth People's Hospital, No.120 Lefeng Road,, Zhangjiagang, 215600, Jiangsu province, China.
| | - Shoujin Tian
- Department of Orthopedic, Zhangjiagang First People's Hospital, No.68 Jiyang West Road Zhangjiagang 215600, Zhangjiagang, 215600, Jiangsu province, China.
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Zhang X, Zheng C, Huang J, Chen H, Lei J, Huang C. Comparison of three different internal fixation methods in the treatment of femoral neck fracture. Heliyon 2024; 10:e34582. [PMID: 39149078 PMCID: PMC11325052 DOI: 10.1016/j.heliyon.2024.e34582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/26/2024] [Accepted: 07/11/2024] [Indexed: 08/17/2024] Open
Abstract
Objective This study aimed to assess the efficacy of three different fixation methods in treating femoral neck fractures in young patients. Methods A retrospective analysis was conducted on 35 young patients with femoral neck fractures who underwent surgical treatment. Among them, 16, 12, and 7 patients underwent fixation with three cannulated compression screws (3CS), the femoral neck system (FNS), and the compound compression system (CCS), respectively. Data, including fracture classification, injury-to-surgery time, surgery duration, intraoperative blood loss, fluoroscopy instances, fracture healing time, complications, and Harris score at the final follow-up, were collected and analyzed to compare clinical outcomes among the three fixation methods. Results All patients were followed for at least 6 months, exhibiting no significant differences in age, gender, injury side, fracture type, or injury-to-operation time among the three groups (P > 0.05). The FNS and CCS groups exhibited shorter operation durations and fewer intraoperative fluoroscopy instances compared to the 3CS group (P < 0.01). Despite the minimally invasive nature of 3CS, the FNS and CCS groups experienced higher intraoperative blood loss (P < 0.01). During follow-up, only one patient with 3CS fixation developed nonunion. Additionally, patients treated with 3CS demonstrated a higher incidence of femoral head necrosis and severe femoral neck shortening than the FNS and CCS groups. Excluding patients with combined nonunion, no significant difference in mean fracture healing time was observed among the three groups (P > 0.05). At the last follow-up, the FNS and CCS groups showed higher Harris scores (P < 0.05). Conclusions Both FNS and CCS are effective internal fixation systems for the treatment of femoral neck fractures in young patients, yielding more satisfactory clinical functional outcomes than 3CS. Comparatively, the CCS system presents a higher risk of iatrogenic rotation of the proximal fracture segment. Therefore, we advocate the insertion of two to three 2.5 mm Kirschner wires from the upper edge of the femoral neck along the axial direction before CCS lag screw insertion to resist iatrogenic rotational stress.
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Affiliation(s)
- Xinzhao Zhang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Changling Zheng
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Jin Huang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Hui Chen
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Jie Lei
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Cong Huang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
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Yeoh SC, Wu WT, Peng CH, Yao TK, Chang CM, Liu KL, Yu TC, Chen IH, Wang JH, Yeh KT. Femoral neck system versus multiple cannulated screws for the fixation of Pauwels classification type II femoral neck fractures in older female patients with low bone mass. BMC Musculoskelet Disord 2024; 25:62. [PMID: 38218794 PMCID: PMC10787435 DOI: 10.1186/s12891-024-07179-6] [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: 10/23/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Femoral neck fractures in older adult patients are a major concern and often necessitate surgical intervention. This study compared the clinical outcomes of 2 surgical techniques: the femoral neck system (FNS) and cannulated compression screws (CCSs). METHODS A total of 40 female patients (mean age 73.50 ± 11.55 years) with femoral neck fractures of Pauwels classification type II and receiving surgical fixation between 2020 and 2022 were enrolled. The patients were categorized into an FNS group (n = 12) or a CCS group (n = 28), and surgical duration, intraoperative blood loss, length of hospital stay, and incidence of postoperative adverse events were analyzed. RESULTS No significant intergroup differences in demographic characteristics were discovered. The mean surgical duration for all patients was 52.88 ± 22.19 min, with no significant difference between the groups. However, the FNS group experienced significantly higher intraoperative blood loss (P = 0.002) and longer hospital stay (P = 0.023) than did the CCS group. The incidence of osteonecrosis was higher in the CCS group, whereas the incidence of nonunion or malunion was higher in the FNS group. The surgical method did not appear to be a significant risk factor. The main risk factor for revision surgery was longer duration until the first adverse event (P = 0.015). CONCLUSION The FNS does not appear to provide superior surgical outcomes compared with CCSs in older adult women with Pauwels classification type II femoral neck fractures. A longer duration between surgical fixation and the first adverse event before stabilization of the fracture site may be a risk factor for revision surgery.
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Affiliation(s)
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Cheng-Huan Peng
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Ting-Kuo Yao
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Chia-Ming Chang
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Kuan-Lin Liu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Tzai-Chiu Yu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Ing-Ho Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan.
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien, Taiwan.
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