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Caldaria A, Gambuti E, Biagi N, Spadoni E, Saracco A, Massari L, Caruso G. Comparison of femoral neck system versus cannulated cancellous screws for the fixation of femoral neck fracture: a single-center retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3207-3213. [PMID: 39085468 DOI: 10.1007/s00590-024-04051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION The dynamic hip screw (DHS) and cannulated compression screws (CCS) have been the two implants most frequently employed for the fixation of femoral neck fractures. The objective of this study is to compare clinical and radiographic outcomes between patients treated with the FNS and those treated with CCS. MATERIAL AND METHODS We conducted a retrospective analysis of a consecutive series of femoral neck fractures treated with FNS or CCS between May 2019 and June 2022. The study included 144 patients who met the inclusion criteria. Collected data encompassed age, sex, Garden fracture classification, Pauwels classification, duration of surgery, length of hospital stays, Harris Hip Score (HHS), complications, and injured side. RESULTS The FNS group comprised 70 patients, while the CCS group consisted of 74 patients. The operation time was 43.6 ± 12.09 min for the FNS group and 56.47 ± 22.42 min for the CCS group. At the end of the follow-up, the mean HHS was 87.07 ± 11.77 for the FNS group and 76.20 ± 13.64 for the CCS group. The mean reduction in hemoglobin levels from pre- to post-surgery was 1.05 mg/dl in the FNS group and 0.87 mg/dl in the CCS group. The reintervention rate was 8.1% for the CCS group and 2.85% for the FNS group. CONCLUSION The FNS does not demonstrate superiority over CCS regarding femoral neck shortening, complication rate, and reduction in hemoglobin levels. However, FNS does appear superior to CCS in terms HHS, operation time, and reoperation rate.
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Affiliation(s)
- A Caldaria
- Department of Orthopedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, 00189, Rome, Italy
- Faculty of Medicine and Surgery, UniCamillus-Saint Camillus Internation University of Health and Medical Science, 00131, Rome, Italy
| | - E Gambuti
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - N Biagi
- Henley Business School, Business Informatics System and Accounting, Information Research Centre, University of Reading, Reading, UK
| | - E Spadoni
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - A Saracco
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - L Massari
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - G Caruso
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy.
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy.
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Salameh M, Fram B. The synthes femoral neck system (FNS): a technical tip and case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3373-3376. [PMID: 39073600 DOI: 10.1007/s00590-024-04053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
The femoral neck system (FNS) was recently introduced for treatment of femoral neck fractures. A novel feature is an anti-rotation screw with a diverging design from the neck bolt to provide rotational stability. Using the 4 Nm torque limiting screwdriver might cause the incomplete insertion of the screw specifically in dense or sclerotic bone. A nontorque limiting manual screwdriver should be used to complete the insertion and locking of the screw to prevent this error. We present series of seven cases with incomplete insertion of the anti-rotation screw in patient with femoral neck fractures treated with the FNS.
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Affiliation(s)
- Motasem Salameh
- Department of Orthopedics, Yale University School of Medicine, 47 College Street 2nd Floor, New Haven, CT, 06510, USA
| | - Brianna Fram
- Department of Orthopedics, Yale University School of Medicine, 47 College Street 2nd Floor, New Haven, CT, 06510, USA.
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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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Mahapatra B, Pal B. Biomechanical analysis of various internal fracture fixation devices used for treating femoral neck fractures: A comparative finite element analysis. Injury 2024; 55:111717. [PMID: 39002322 DOI: 10.1016/j.injury.2024.111717] [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: 03/22/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Several internal fixation devices are available for treating Pauwels type I, II and III femoral neck fractures. The present study compared various fixation implants for all Pauwels fracture types using a CT-based subject-specific finite element model of the femur and determined the most effective implant for each fracture type. MATERIALS AND METHODS The analysis included four different configurations of cannulated screw models, Femoral Neck System, Dynamic Hip Screw and Dynamic Condylar Screw (with and without anti-rotational screw). Ti-alloy was considered as the implant material. Heterogeneous bone material property was assigned based on CT grey value. Frictional contact was assumed in the contact interfaces. Peak loading corresponding to normal walking and stair-climbing were considered. Equivalent strain in bone, equivalent stress in the implants, femoral head deformation and rotation, micromotion in the contact interfaces, and strain-shielding in bone were evaluated for each implanted model. RESULTS Stresses generated in the implants were within the yield limit of the implant material. In Pauwels I and II, the micromotion predicted at the contact regions in all the implanted models was within 100 µm, which is suitable for bone integration. However, in Pauwels III fracture, most of the implanted models other than DHS with AR-screw model exhibited micromotion of more than 150 µm in the contact regions, which is expected to inhibit bone growth. CONCLUSIONS The DHS with AR-screw implanted model was identified as the most effective in treating Pauwels I and III fractures. However, for Pauwels type II, DCS with an AR-screw implant was deemed superior to the other configurations.
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Affiliation(s)
- Biswajit Mahapatra
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah 711103, West Bengal, India
| | - Bidyut Pal
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah 711103, West Bengal, India.
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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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Obey MR, Falgons CG, Eastman JG, Choo AM, Achor TS, Munz JW, Warner SJ. Low reoperation rate after fixation of displaced femoral neck fractures with the femoral neck system (FNS). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2581-2588. [PMID: 38700518 DOI: 10.1007/s00590-024-03962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/14/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Operative fixation of femoral neck fractures (FNFs) remains challenging. Complications are not infrequent, especially in displaced patterns. Numerous fixation techniques have been previously described in the literature; however, there remains a paucity of data regarding outcomes of these injuries treated with the femoral neck system (FNS). METHODS Patients with a displaced FNF (OTA/AO 31B) treated with the FNS at a single level 1 academic trauma center between 1/1/2019 and 1/1/2023 were identified. Radiographs were reviewed to assess fracture displacement, location, and characteristics. Patient records were further reviewed to assess for complications, reoperations, and osseous union. RESULTS Forty-three patients (65% male) with 44 FNFs were identified with a mean age of 35.0 years (range, 13-61 years). Two patients developed a deep infection requiring surgical debridement, four patients underwent a total hip arthroplasty, and one patient underwent a valgus intertrochanteric osteotomy for nonunion. There were three cases of femoral head AVN. Mean follow-up was 482.5 days among all patients, and 36 fractures had at least 6 months of follow-up or reached bony union. CONCLUSIONS Here, we present a series of patients treated with the FNS for internal fixation and report a 18% reoperation rate. This is lower than the average rate that has been previously reported in similar patient populations in the literature treated with alternative methods of internal fixation. Thus, the FNS appears to be a safe and effective option for treatment of these injuries.
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Affiliation(s)
- Mitchel R Obey
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Washington University in St. Louis, 660 S. Euclid, Campus Box 8233, St. Louis, MO, 63110, USA.
| | - Christian G Falgons
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonathan G Eastman
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Andrew M Choo
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Timothy S Achor
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John W Munz
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephen J Warner
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
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Hernández-Naranjo JM, Campuzano-Bitterling B, Renau-Cerrillo M, Vives-Barquiel M, Camacho-Carrasco MP, Muñoz-Mahamud E. Preliminary clinical and radiological evaluation of osteosynthesis using the Femoral Neck System (FNS) for subcapital fractures of the femur. Sci Rep 2024; 14:14494. [PMID: 38914658 PMCID: PMC11196705 DOI: 10.1038/s41598-024-64955-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] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
Addressing subcapital fractures of the femur poses a substantial clinical challenge, complicated by the diverse range of available osteosynthesis materials. This study is dedicated to a comprehensive analysis of the clinical and radiological implications linked with the implementation of the Femoral Neck System (FNS) in osteosynthesis procedures. A descriptive study was conducted involving patients who underwent osteosynthesis for subcapital fractures of the femur utilizing the FNS during the period from 2019 to 2022. The investigation encompassed various facets, including the classification of fractures according to the Garden and Pauwells classifications, criteria for achieving precise reduction based on the Garden criteria and Tip Apex Distance (TAD). At the one-year follow-up, factors such as fracture consolidation, loss of reduction, fracture collapse, complications, and functional outcomes were evaluated utilizing the Harris Hip Score (HHS) scale. The study cohort included a total of 26 patients, among whom 22 exhibited non-displaced subcapital femur fractures categorized as Garden I and II. Successful reduction was accomplished in 23 cases, in which 24 cases (92.3%) displayed a TAD measurement below 25 mm. According to the HHS, patients achieved an average score of 90.9 (ranging from 63 to 100) following the surgical intervention, with predominantly "excellent" and "good" outcomes. The outcomes derived from our investigation corroborate the viability of the Femoral Neck System (FNS) as a reliable option for osteosynthesis in femoral neck fractures. The results obtained are comparable to those achieved with other available implants, as highlighted by previous studies.
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Affiliation(s)
- Jose Manuel Hernández-Naranjo
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - Borja Campuzano-Bitterling
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Marina Renau-Cerrillo
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Marian Vives-Barquiel
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Pilar Camacho-Carrasco
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ernesto Muñoz-Mahamud
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Zheng S, Lin D, Chen P, Lin C, Chen B, Zheng K, Lin F. Comparison of femoral neck shortening after femoral neck system and cannulated cancellous screw fixation for displaced femoral neck fractures in young adults. Injury 2024; 55:111564. [PMID: 38640596 DOI: 10.1016/j.injury.2024.111564] [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: 09/20/2023] [Revised: 03/04/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The purpose of this study was to compare the outcomes of femoral neck shortening between the femoral neck system (FNS) and the cannulated cancellous screws (CCS) for displaced femoral neck fractures in young adults PATIENTS AND METHODS: In this retrospective analysis, 225 patients aged 18-65 years with displaced femoral neck fracture were divided into two groups according to internal fixation: 135 patients in the FNS group and 90 patients in the CCS group. The length of hospital stay, duration of surgery, intraoperative blood loss, quality of reduction, extent of femoral neck shortening, incidence of femoral neck shortening, femoral neck shortening at each follow-up visit, Harris hip score (HHS), reoperation, and complications were compared between the two groups. RESULTS The median follow-up time was 28.2 (26.0, 31.2) months in the FNS group and 30.2 (26.3, 34.7) months in the CCS group. The follow-up time, age, sex distribution, body mass index (BMI), mechanism of injury, injured side, length of hospital stay, time from injury to surgery, and fracture classification were similar between the groups. Duration of surgery was longer in the FNS group (65.0 (55.0, 87.0) min versus 55.0 (50.0, 65.0) min, P<0.001); intraoperative blood loss was greater in the FNS group (50.0 (20.0, 60.0) ml versus 20.0 (10.0, 35.0) ml, P<0.001). Femoral neck shortening was 2.4 (1.0, 4.5) mm in the FNS group versus 0.6 (0.0, 2.6) mm in the CCS group at 1 month postoperatively (P<0.001); 3.7 (1.8, 6.4) mm in the FNS group versus 1.2 (0.6, 3.8) mm in the CCS group at 3 months (P<0.001); 4.1(2.4, 7.7) mm in the FNS group versus 2.3 (1.1, 4.4) mm in the CCS group at 6 months (P<0.001); 4.2 (2.6, 7.7) mm in the FNS group versus 2.6 (1.3, 4.6) mm in the CCS group at 12 months (P<0.001); and 4.5 (2.8, 8.0) mm in the FNS group versus 2.8 (1.5, 4.8) mm in the CCS group at 18 months (P<0.001). The two groups showed no significant differences in HHS, reoperation, and reduction quality. CONCLUSION Compared to CCS, FNS is deficient in preventing femoral neck shortening. Future research should focus on improving FNS in terms of preventing femoral neck shortening.
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Affiliation(s)
- Shunze Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China
| | - Dongze Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Peisheng Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Chaohui Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Bin Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Ke Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China.
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Nan C, Liu Y, Zhang D, Qin Y, Yu H, Ma Z. Biomechanical changes in the proximal femur before and after removal of femoral neck system. J Orthop Surg Res 2024; 19:290. [PMID: 38735949 PMCID: PMC11089723 DOI: 10.1186/s13018-024-04769-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: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND As an innovative internal fixation system, FNS (femoral neck system) is increasingly being utilized by surgeons for the treatment of femoral neck fractures. At present, there have been numerous finite element analysis experiments studying the immediate stability of FNS and CSS in treating femoral neck fractures. However, there is scarce mechanical analysis available regarding the effects post internal fixation removal. This study aimed to investigate the alterations in mechanical parameters of the proximal femur before and after the removal of FNS (femoral neck system), and to assess potential distinctions in indicators following the extraction of CSS (Cannulated Screws). METHODS A proximal femur model was reconstructed using finite element numerical techniques. The models for CSS and FNS were formulated utilizing characteristics and parametric definitions. The internal fixation was combined with a normal proximal femur model to simulate the healing state after fracture surgery. Within the framework of static analysis, consistent stress burdens were applied across the entirety of the models. The total deformation and equivalent stress of the proximal femur were recorded before and after the removal of internal fixation. RESULTS Under the standing condition, the total deformation of the model before and after removing CSS was 0.99 mm and 1.10 mm, respectively, indicating an increase of 12%. The total deformation of the model before and after removing FNS was 0.65 mm and 0.76 mm, respectively, indicating an increase of 17%. The equivalent stress for CSS and FNS were 55.21 MPa and 250.67 MPa, respectively. The average equivalent stress on the cross-section of the femoral neck before and after removal of CSS was 7.76 MPa and 6.11 MPa, respectively. The average equivalent stress on the cross-section of the femoral neck before and after removal of FNS was 9.89 MPa and 8.79 MPa, respectively. CONCLUSIONS The retention of internal fixation may contribute to improved stability of the proximal femur. However, there still existed risks of stress concentration in internal fixation and stress shielding in the proximal femur. Compared to CSS, the removal of FNS results in larger bone tunnels and insufficient model stability. Further clinical interventions are recommended to address this issue.
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Affiliation(s)
- Chong Nan
- Department of Orthopedic, Baoding No. 1 Central Hospital, Baoding, Hebei Province, 071000, China
| | - Yuxiu Liu
- Department of Orthopedic, Baoding No. 1 Central Hospital, Baoding, Hebei Province, 071000, China
| | - Di Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, China
| | - Yazhuo Qin
- Department of Orthopedic, Baoding No. 1 Central Hospital, Baoding, Hebei Province, 071000, China
| | - Hetong Yu
- Department of Orthopedic, Baoding No. 1 Central Hospital, Baoding, Hebei Province, 071000, China
| | - Zhanbei Ma
- Department of Orthopedic, Baoding No. 1 Central Hospital, Baoding, Hebei Province, 071000, China.
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Lin D, Zhu F, Chen P, Lin C, Chen B, Zheng K, Zheng S, Lin F. Pre-sliding of the femoral neck system to prevent postoperative shortening of femoral neck fractures. Heliyon 2024; 10:e29187. [PMID: 38601698 PMCID: PMC11004876 DOI: 10.1016/j.heliyon.2024.e29187] [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: 10/13/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
Objective The purpose of this study is to evaluate the effect of pre-sliding of the femoral neck system (FNS) in the prevention of postoperative femoral neck shortening in femoral neck fractures. Method This study was designed to retrospectively analyze data from 109 patients with femoral neck fractures who were admitted to a Level I trauma center between April 2020 and June 2022. Of these patients, 90 were followed up for more than 12 months. The study included 52 males and 38 females, with 35 cases of Garden I and II fractures and 55 cases of Garden III and IV fractures. The Harris Hip Score at 12 months postoperatively were recorded. The patients were divided into two groups based on their surgical records and postoperative radiography: the Pre-sliding group and the No-pre-sliding group. The purpose of this study is to analyze the role of pre-sliding in preventing femoral neck shortening, fracture healing time, degree of postoperative shortening, complications, and Harris Hip Score, and to make a comparison between the two groups. Results All 90 patients were followed up for over one year after surgery. A statistically significant difference was observed in the preoperative Garden classification (P < 0.05). At 1 year after the operation, the shortening distance was 6.5 ± 6.4 mm in the No-pre-sliding group and 3.9 ± 3.4 mm in the Pre-sliding group. The Harris Hip Score were 88.7 (79.8, 93.5) in the No-pre-sliding group and 94.8 (87.7, 96.9) in the Pre-sliding group, with a statistically significant difference between the two groups (P < 0.05). Shortening was concentrated at 3 months postoperatively and reached a stable state within 6 months, with less persistent shortening occurring after 6 months. There was no statistically significant difference in the preoperative baseline data. Conclusion Pre-sliding of the FNS prevents postoperative shortening of the femoral neck and improves hip function as measured by the Harris Hip Score.
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Affiliation(s)
| | | | - Peisheng Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Chaohui Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Bin Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Ke Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Shunze Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, Fuzhou Second Hospital of Xiamen University, School of Clinical Medicine of Fujian Medical University, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
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董 一, 骆 聪, 张 宁, 尤 若, 袁 强, 李 无, 张 颖. [Correlation between combined deflection angle classification adduction typing and complications after internal fixation of adduction femoral neck fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:405-411. [PMID: 38632058 PMCID: PMC11024535 DOI: 10.7507/1002-1892.202401063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Objective To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. Methods The clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. Results The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients' CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion ( P>0.05), but correlated with the incidence of osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P>0.05). Conclusion CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.
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Affiliation(s)
- 一平 董
- 河南中医药大学研究生院(郑州 450046)Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China
- 河南省洛阳正骨医院(河南省骨科医院)髋关节外五科(河南洛阳 417002)The Fifth Department of Hip Joint, Luoyang Orthopedic-Traumatological of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P. R. China
| | - 聪聪 骆
- 河南中医药大学研究生院(郑州 450046)Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China
- 河南省洛阳正骨医院(河南省骨科医院)髋关节外五科(河南洛阳 417002)The Fifth Department of Hip Joint, Luoyang Orthopedic-Traumatological of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P. R. China
| | - 宁 张
- 河南中医药大学研究生院(郑州 450046)Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China
- 河南省洛阳正骨医院(河南省骨科医院)髋关节外五科(河南洛阳 417002)The Fifth Department of Hip Joint, Luoyang Orthopedic-Traumatological of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P. R. China
| | - 若楠 尤
- 河南中医药大学研究生院(郑州 450046)Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China
- 河南省洛阳正骨医院(河南省骨科医院)髋关节外五科(河南洛阳 417002)The Fifth Department of Hip Joint, Luoyang Orthopedic-Traumatological of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P. R. China
| | - 强 袁
- 河南中医药大学研究生院(郑州 450046)Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China
| | - 无阴 李
- 河南中医药大学研究生院(郑州 450046)Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China
| | - 颖 张
- 河南中医药大学研究生院(郑州 450046)Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China
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Kale S, Chalak A, Vatkar A, Dey JK, Mehta N, Das S. Limitations and Complications in Treating Femoral Neck Fractures with the Femoral Neck System: A Case Report. J Orthop Case Rep 2024; 14:78-82. [PMID: 38560300 PMCID: PMC10976553 DOI: 10.13107/jocr.2024.v14.i03.4294] [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: 12/01/2023] [Revised: 01/11/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The femoral neck system (FNS) represents an emerging fixation system designed for the management of femoral neck fractures. This innovative system combines the mechanical benefits of compression and anti-rotation properties in internal fixation. Biomechanical studies have demonstrated the superior axial and rotational stability of the FNS implant when compared to traditional cannulated screws and dynamic hip screw. Despite these promising mechanical advantages, there is currently a limited body of literature addressing the factors contributing to FNS failure. A thorough assessment of the safety and outcomes associated with this novel implant is essential. Case Report In this context, we present three cases wherein FNS failure occurred, aiming to elucidate the potential causes behind these failures, and had to undergo either an implant removal or bipolar hemiarthroplasty. Conclusion While considering the femoral neck system as the implant of choice, we should consider the age, injury to surgery time, and the location of the fracture line. However, we cannot conclusively ascertain whether age contributes independently to the risk of failure.
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Affiliation(s)
- Sachin Kale
- Department of Orthopaedics, Dr. DY Patil Medical College and Hospital, Mumbai, Maharashtra, India
| | - Ajit Chalak
- Department of Orthopaedics, Dr. DY Patil Medical College and Hospital, Mumbai, Maharashtra, India
| | - Arvind Vatkar
- Department of Orthopaedics, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Joydeep K Dey
- Department of Orthopaedics, Dr. DY Patil Medical College and Hospital, Mumbai, Maharashtra, India
| | - Nrupam Mehta
- Department of Orthopaedics, Dr. DY Patil Medical College and Hospital, Mumbai, Maharashtra, India
| | - Sonali Das
- Department of Orthopaedics, Dr. DY Patil Medical College and Hospital, Mumbai, Maharashtra, India
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Deng W, Wan J, Wang D, Geng K, Zhang G, Hou R. Experimental analysis of femoral head intraosseous vascular anastomosis in the treatment of porcine subcapital femoral neck fractures. Heliyon 2024; 10:e25211. [PMID: 38327464 PMCID: PMC10847604 DOI: 10.1016/j.heliyon.2024.e25211] [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: 06/04/2023] [Revised: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Femoral neck fractures are challenging injuries associated with a compromised blood supply to the femoral head, leading to a high risk of avascular necrosis and poor clinical outcomes. This study aimed to investigate the efficacy of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. Methods Ten Landrace pigs were used as experimental animal models. The femoral head was completely removed after femoral neck sub-cephalic fracture. It was fixed on the medial side of the knee joint, and the blood supply to the femoral head was reconstructed by anastomosing the femoral head vessels. One week later, blood flow in the femoral head was observed by borehole, digital subtraction angiography examination, and hematoxylin and eosin staining. Further, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling tests were performed to detect pathological changes in the femoral head. Results After one-week, digital subtraction angiography of the femoral head revealed a blood circulation rate of 70 %, and the blood seepage rate of the borehole was 80 %. Hematoxylin and eosin staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling test results showed that necrosis of bone marrow cells in the experimental group was significantly improved compared to that in the control group. Discussion This study highlights the potential benefits of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. Further research and clinical trials are warranted to validate these findings and to explore the translational potential of this technique in human patients.
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Affiliation(s)
- Wei Deng
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Jiaming Wan
- Yangzhou University Medical College, Yangzhou, China
| | - Dingsong Wang
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Kailong Geng
- Suzhou Medical College of Soochow University, Suzhou, China
| | | | - Ruixing Hou
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Ruihua Orthopedic Hospital, Suzhou, China
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Hasegawa K, Takegami Y, Tokutake K, Nakashima H, Mishima K, Kobayashi K, Imagama S. Early versus delayed weight bearing after internal fixation for femoral neck fracture in younger adults: A multicenter retrospective study. Injury 2024; 55:111292. [PMID: 38157758 DOI: 10.1016/j.injury.2023.111292] [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: 09/25/2023] [Revised: 11/26/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Femoral neck fracture (FNF) is among the most common and devastating injuries that orthopedic surgeons encounter. However, the incidence of FNF is lower in younger adults than in elderly individuals. In elderly FNF patients, early weight bearing (EWB) is preferred to prevent loss of function and decreased activity. In younger adults, some surgeons decide on delayed-weight bearing (DWB) after surgery because EWB may cause femoral neck shortening. We aimed to compare the postoperative results (clinical outcome, radiological evaluation, and complications) of EWB and DWB after FNF surgery in younger adults. METHODS The study included 151 younger adults (age: ≤65 years at injury; nondisplaced, n = 100; displaced, n = 51) who underwent internal fixation at 11 university-affiliated hospitals in 2016-2020, and who were followed for ≥1 year. Patients were divided into the EWB (EWB in early postoperative period) and DWB (beginning weight bearing at 4 weeks after surgery) groups. The two groups were matched for age, and nondisplaced (EWB and DWB, both n = 24) and displaced (EWB and DWB, both n = 11) FNF were analyzed. The study items were age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), presence of diabetes, days waiting for surgery, fracture type, Parker mobility score (PMS) at last follow-up examination, pain (Numerical Rating Scale: NRS), radiological evaluation (femoral neck shortening, Canulated Cancellous screws (CCS) backout, and complications (nonunion, femoral head osteonecrosis). RESULTS The patient backgrounds of the nondisplaced and displaced types did not differ. The PMS was significantly higher in the DWB group at the last follow-up examination (nondisplaced: 8.00±2.20 vs. 6.67±2.22, p = 0.005, displaced: 8.67±0.89 vs. 6.91±2.77, p<0.001). NRS and the amount of femoral neck shortening were significantly lower in the DWB group (nondisplaced: 1.65±0.70 mm vs. 3.94±3.03 mm, p<0.001, displaced: 4.26± 2.64 mm vs. 8.91±5.69 mm, p<0.001). CCS backout did not differ between the groups. One case of each of nonunion and femoral head osteonecrosis were observed in the displaced EWB and DWB groups; these differences were not significant. CONCLUSIONS DWB after internal fixation for FNF in younger adults was associated with better outcomes than EWB.
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Affiliation(s)
- Kanta Hasegawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Katsuhiro Tokutake
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Fan X, Zhou Y, Dai S, Lao K, Zhang Q, Yu T. Bio-mechanical effects of femoral neck system versus cannulated screws on treating young patients with Pauwels type III femoral neck fractures: a finite element analysis. BMC Musculoskelet Disord 2024; 25:83. [PMID: 38245678 PMCID: PMC10799488 DOI: 10.1186/s12891-023-07110-5] [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: 10/13/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION As a novel internal fixation for femoral neck fractures, the femoral neck system has some advantages for young Pauwels type III femoral neck fractures without clear biomechanical effects and mechanisms. Thus, the objection of the study is to realize the biomechanical effects and mechanism of FNS cannulated screws on treating young patients with Pauwels type III femoral neck fractures compared to cannulated screws which are commonly used for femoral neck fractures by finite element analysis. METHODS Firstly, the model of young Pauwels type III femoral neck fractures, femoral neck system (FNS), and three cannulated screws (CS) arranged in an inverted triangle were established, and the internal fixations were set up to fix young Pauwels type III femoral neck fractures. Under 2100 N load, the finite element was performed, and the deformation, peak von Mises stress (VMS), and contact at fracture segments were recorded to analyze the biomechanical effects and mechanism of FNS and three-CS fixing young Pauwels type III femoral neck fractures. RESULTS Compared to three-CS, the deformation of the whole model, internal fixation, and fracture segments after FNS fixation were lower, and the peak VMS of the whole model and the internal fixation after FNS were higher with lower peak VMS of the distal femur and the fracture segments. With a sticking contact status, the contact pressure at fracture segments after FNS fixation was lower than that of three-CS. CONCLUSIONS FNS can provide better mechanical effects for young patients with Pauwels type III femoral neck fractures, which may be the mechanical mechanism of the clinical effects of FNS on femoral neck fracture. Although there is high stress on FNS, it is still an effective and safe internal fixation for young patients with Pauwels type III femoral neck fractures.
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Affiliation(s)
- Xiao Fan
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Yimin Zhou
- Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, 100007, China
| | - Shiyou Dai
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Kecheng Lao
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Qiliang Zhang
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China.
| | - Tengbo Yu
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China.
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Lim ZZC, Tan CMP, Antony Xavier RP, Yam MGJ, Chua ITH. Femoral neck system as a safe alternative to cannulated compression screw and dynamic hip screw in femoral neck fractures: an early comparative study. Singapore Med J 2024:00077293-990000000-00072. [PMID: 38421148 DOI: 10.4103/singaporemedj.smj-2022-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/02/2022] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The femoral neck system (FNS) is a safe alternative to cannulated compression screw (CCS) and dynamic hip screw (DHS) in femoral neck fractures. METHODS A dual-centre retrospective cohort study was performed on femoral neck fractures (AO type 31-B) treated with closed reduction and internal fixation using FNS, DHS or CCS between April 2016 and April 2020. Exclusion criteria were as follows: patients aged below 16 years; chronic fractures beyond 7 days; pathological fractures; fracture extension to the intertrochanteric region or ipsilateral neck and shaft fractures; and open fractures. A total of 85 patients were identified: FNS (n = 28), DHS (n = 29) and CCS (n = 28). RESULTS The FNS and CCS groups had a lower Garden and Pauwels classification compared to the DHS group (both P < 0.001). Both FNS and CCS groups were comparable in postoperative orthopaedic complications (10.7% [n = 3] vs. 3.6% [n = 1], adjusted P = 0.321). The DHS group had more postoperative orthopaedic complications than the FNS group, but this was not statistically significant (27.6% [n = 8] vs. 10.7% [n = 3], adjusted P = 0.321). There were no significant differences in median time to radiological union or median femoral neck shortening at union (both P > 0.05) among the three groups. CONCLUSION The new DePuy Synthes FNS is a safe alternative to CCS with comparable complication rates for femoral neck fractures that are less displaced and more stable. The FNS also appears to be a safe alternative to DHS in the fixation of femoral neck fractures for the few cases of high-energy femoral neck fractures.
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刘 亚, 王 照, 徐 陈, 朱 仲, 段 克, 官 建. [Early effectiveness of Ti-Robot assisted femoral neck system for minimally invasive treatment of elderly Garden type Ⅱ and 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 2023; 37:1471-1476. [PMID: 38130189 PMCID: PMC10739661 DOI: 10.7507/1002-1892.202308051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/18/2023] [Indexed: 12/23/2023]
Abstract
Objective To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures. Methods A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up. Results The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488). Conclusion Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.
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Affiliation(s)
- 亚军 刘
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - 照东 王
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - 陈 徐
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - 仲廉 朱
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - 克友 段
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - 建中 官
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
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Chen L, Jiang JB, Ma H, Duan X, Chen JL. Factors associated with early failure of the femoral neck system (FNS) in patients with femoral neck fractures. BMC Musculoskelet Disord 2023; 24:912. [PMID: 38012667 PMCID: PMC10680198 DOI: 10.1186/s12891-023-06994-7] [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: 04/25/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Femoral neck system (FNS) is a new type of internal fixation system which has been widely used for treating femoral neck fractures (FNFs).Compared with other internal fixation methods, FNS is minimally invasive and stable, and often achieves satisfactory short-term efficacy.Early failure of FNS (EFFNS) is not uncommon, however, there are few literatures and reports on factors associated with EFFNS.This study aimed to survey the prevalence and risk factors of EFFNS. METHODS We retrospectively analysed 62 patients with FNFs and underwent FNS fixation between 2019 and 2021. Demographic data, clinical characteristics, radiographic features and treatment process were described. Multifactor logistic regression analysis was used to analyse the different influencing factors. RESULTS Out of the 62 FNFs patients, 10 patients (16.1%) developed EFFNS, including 6 cases of severe femoral neck shortening, 2 cases of screw-out, 1 case of avascular necrosis of the femoral head and 1 case of nonunion. In the failure group, all patients were younger than 65 years old, which was significantly higher than 59.6% in the healing group (P = 0.012). There were no significant differences in sex(P = 0.490), BMI (P = 0.709), injured side (P = 0.312), injury mechanism (P = 0.617), reduction method(P = 0.570),femoral neck-shaft angle(P = 0.545), Pauwels classification (P = 0.564) and Garden classification (P = 0.195). Moreover, we not found that Garden classification (P = 0.464) and age (P = 0.128) were statistically significant risk factors for EFFNS at multivariate analysis. CONCLUSION In this study, sex, BMI, injury side, injury mechanism, reduction method, Pauwels angle, femoral neck-shift angle, Pauwels classification and Garden classification were excluded as EFFNS risk factors. Moreover, our study demonstrated that age and Garden classification were not significant risk factors at multivariate analysis. TRIAL REGISTRATION ChiCTR, ChiCTR2100051360. Registered on 21 September, 2021. https://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- L Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - J B Jiang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - H Ma
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - X Duan
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - J L Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- Trauma Center, West China Hospital, Sichuan University, Chengdu, China.
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de Oliveira MM, Freitas A, Giordano V, Moura CMDC, Ferreira BL, Lucas LDG, Pires RE, Belangero WD. In vitro biomechanical analysis of a locking self-compression screw model applied to Pauwels III and comminuted femoral neck fractures. Injury 2023; 54 Suppl 6:110810. [PMID: 38143133 DOI: 10.1016/j.injury.2023.05.041] [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: 02/28/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 12/26/2023]
Abstract
Femoral neck fractures (FNFs) affect the young adult population and are intimately related to high-energy trauma. Despite innovations in osteosynthesis materials, the rate of complications remains at 10%-59% in Pauwels type III (PIII) fractures. The authors thus propose a fixation model with a novel self-compression screw, comparing it to a sliding hip screw plate associated with a derotation screw in the fixation of a PIII fracture with posterior inferior comminution. The finite element method (FEM) was used in this comparison along with a virtual femur model with structural characteristics similar to those of a healthy young human bone. We formed 4 groups: Group 1 (GC), intact bone; Group 2 (SHS+S), sliding hip screw plate with derotation screw; Group 3 (XS), X-pin + SS (self-compression model with superior positioning screw); Group 4 (XI), X-pin + IS (self-compression model with inferior positioning screw). A 700 N monotonic load was applied to the apex of the femur head towards the ground so that stress was mainly focused on the fracture site and osteosynthesis. Analyses included total displacement and maximum principal stress and were performed for all groups. Fracture displacement, rotation, and von Mises were assessed only in groups that underwent osteosynthesis. Total displacement values in groups with self-compression screws (XS and XI) were closer to those for healthy femurs, with a 38.5% reduction when comparing the XS group with the SHS+S group. Fracture displacement and rotation values presented reductions of over 60% when comparing the XS and XI groups with the SHS+S group. Equivalent Von Mises stress values were similar between XS and XI and presented a reduction of approximately 5.25% when compared with the SHS+S group. Our FEM analyses demonstrated that the self-compression screw model has potential biomechanical advantages over the SHS+S model.
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Affiliation(s)
- Matheus Moreno de Oliveira
- Orthopedic Trauma Service, Hospital Regional do Gama, Área Especial n° 01, St. Central, Gama, 72405901 Brasília, DF, Brazil.
| | - Anderson Freitas
- Orthopedic Trauma Service, Hospital Regional do Gama, Área Especial n° 01, St. Central, Gama, 72405901 Brasília, DF, Brazil; Hospital Ortopédico e Medicina Especializada (HOME), SGAS Quadra 613, Conjunto C, Asa Sul, 70200730 Brasília, DF, Brazil
| | - Vincenzo Giordano
- Orthopedics and Traumatology Service Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, 117, Rio de Janeiro 22430-160, RJ, Brazil
| | - Carlos Magno da Costa Moura
- Orthopedic Trauma Service, Hospital Regional do Gama, Área Especial n° 01, St. Central, Gama, 72405901 Brasília, DF, Brazil
| | - Breno Lima Ferreira
- Orthopedic Trauma Service, Hospital Regional do Gama, Área Especial n° 01, St. Central, Gama, 72405901 Brasília, DF, Brazil
| | - Luan de Góis Lucas
- Orthopedic Trauma Service, Hospital Regional do Gama, Área Especial n° 01, St. Central, Gama, 72405901 Brasília, DF, Brazil
| | - Robinson Esteves Pires
- Department of the Locomotive Apparatus, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627, Belo Horizonte 31270-901, MG, Brazil
| | - William Dias Belangero
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Rua Vital Brasil, 80, Campinas 13083-888, SP, Brazil
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Lin H, Lai C, Zhou Z, Wang C, Yu X. Femoral Neck System vs. four cannulated screws in the treatment of Pauwels III femoral neck fracture. J Orthop Sci 2023; 28:1373-1378. [PMID: 36229352 DOI: 10.1016/j.jos.2022.09.006] [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: 12/15/2021] [Revised: 07/15/2022] [Accepted: 09/04/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of the Femoral Neck System (FNS) vs. four cannulated screws in Pauwels III femoral neck fractures. METHODS This retrospective study included patients with newly occurred type Pauwels III femoral neck fracture treated at author' Hospital of between January 2017 and February 2021. The patients received FNS (n = 27) or four cannulated screws (control group, n = 31). The operation time, blood loss, fracture healing time, incidence of complications (such as short femoral neck, necrosis of femoral head, nonunion of fracture, and failure of internal fixation withdrawal), and hip Harris score at the last follow-up were analyzed. RESULTS The operation time, blood loss, and fracture healing time were not significantly different between the two groups (all P > 0.05). In the FNS group, three and one patients were with femoral neck shortening and femoral head necrosis, respectively, while no fracture nonunion or failure of internal fixation withdrawal occurred. In the control group, seven, two, one, and two patients were with femoral neck shortening, femoral head necrosis, nonunion, and internal fixation failure, respectively. The cumulative complication incidence was 14.8% and 38.7% in the FNS and control groups (P = 0.042). The excellent and good rates of the hip Harris score at the last follow-up were 92.6% and 71.0% in the FNS and control groups, respectively (P = 0.036). CONCLUSION The study suggested that the clinical efficacy of FNS was better than internal fixation using four cannulated screws in treating Pauwels III type femoral neck fracture.
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Affiliation(s)
- Hongkuan Lin
- Department of Orthopedics, Mindong Hospital of Fujian Medical University, Fu'an, Fujian 355000, PR China.
| | - Caosheng Lai
- Department of Orthopedics, Mindong Hospital of Fujian Medical University, Fu'an, Fujian 355000, PR China
| | - Zhiping Zhou
- Department of Orthopedics, Mindong Hospital of Fujian Medical University, Fu'an, Fujian 355000, PR China
| | - Chaoqiang Wang
- Department of Orthopedics, Mindong Hospital of Fujian Medical University, Fu'an, Fujian 355000, PR China
| | - Xinlin Yu
- Department of Orthopedics, Mindong Hospital of Fujian Medical University, Fu'an, Fujian 355000, PR China
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Liang C, Cao Y, Lin Z, Liu G, Zhang C, Hu Y. Open reduction and internal fixation of irreducible displaced femoral neck fracture with femoral Neck System: a preliminary study. BMC Musculoskelet Disord 2023; 24:826. [PMID: 37858123 PMCID: PMC10585802 DOI: 10.1186/s12891-023-06839-3] [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: 05/22/2023] [Accepted: 08/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Most displaced femoral neck fractures can achieve satisfactory anatomical reduction by closed reduction, but there are still some that cannot reset satisfactorily after closed reduction, and open reduction are required. Such fractures that cannot be repositioned successfully by closed reduction are called irreducible displaced femoral neck fractures in this study. The objective of our study was to evaluate the efficacy of direct anterior incision with the Femoral Neck System in the treatment of irreducible displaced femoral fractures. METHODS A total of 16 young and middle-aged patients with irreducible displaced femoral neck fractures involving Garden type III and IV were treated using Femoral Neck System fixation by open reduction through Direct Anterior Approach between January 2020 to September 2021. Functional outcomes and postoperative complications were assessed during follow-up. Clinical outcomes were evaluated by the Hip Harris score. The postoperative reduction was evaluated by the Garden Index. Observe postoperative complications. RESULTS All patients were followed up with a mean follow-up time of 21.1(12-30) months, and according to radiological results, all patients achieved fracture healing, with a mean healing time of 4.25 months. All 16 patients received grade Garden I and II reductions, and there was no significant difference in the anteroposterior Garden reduction index between the first day after surgery (166.13 ± 5.61) and the 12th month after surgery(164.94 ± 4.49) (P>0.05) and no significant difference in lateral Garden index between the first day after surgery(171.06 ± 4.46) and the 12th month after surgery(169.38 ± 3.98) (P<0.05). According to the Hip Harris score scale, 13 patients received excellent and 3 patients received good. The postoperative Hip Harris Score(17.19 ± 4.8) was significantly higher than the preoperative score(92.19 ± 3.4), and the difference was statistically significant (P < 0.05). No or mild femoral neck shortness occurred in 12 (75%) patients, moderate shortening occurred in 3 (18.75%) patients, and severe shortening occurred in 1 (6.25%) patient. None of the patients experienced femoral head necrosis, fracture nonunion, or incision infection. One patient developed deep venous thrombosis of the lower extremity. CONCLUSIONS The Direct Anterior Approach combined with Femoral Neck System is an excellent treatment for irreducible displaced femoral neck fracture and achieved good functional outcomes and anatomical reduction with low complications.
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Affiliation(s)
- Chengzhi Liang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330000, People's Republic of China
| | - Yuan Cao
- Department of Orthopedics, People's Hospital of Rizhao, Rizhao, Shandong, 276800, People's Republic of China
| | - Zhihao Lin
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Guoming Liu
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Chengdong Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Yanling Hu
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266003, People's Republic of China.
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22
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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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23
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Niemann M, Maleitzke T, Jahn M, Salmoukas K, Braun KF, Graef F, Stöckle U, Meller S. Restoration of Hip Geometry after Femoral Neck Fracture: A Comparison of the Femoral Neck System (FNS) and the Dynamic Hip Screw (DHS). Life (Basel) 2023; 13:2073. [PMID: 37895454 PMCID: PMC10608621 DOI: 10.3390/life13102073] [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: 09/14/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The femoral neck system (FNS) was introduced as a minimally invasive fixation device for managing femoral neck fractures. OBJECTIVE To compare radiographic, clinical, and patient-reported outcome measures (PROMs) of femoral neck fracture patients following FNS compared to dynamic hip screw (DHS) implantation combined with an anti-rotational screw. METHODS Patients who underwent closed reduction and internal fixation of a femoral neck fracture between 2020 and 2022 were retrospectively included. We measured leg length, femoral offset, and centrum-collum-diaphyseal (CCD) angle in plain radiographs. Scar length, Harris Hip Score, short-form health survey 36-item score (SF-36), and Numeric Rating Scale (NRS) were assessed during follow-up visits. RESULTS We included 43 patients (22 females) with a median age of 66 (IQR 57, 75). In both groups, leg length differences between the injured and the contralateral side increased, and femoral offset and CCD angle differences were maintained over time. FNS patients had shorter scars and reported fewer emotional problems and more energy. There were no differences between groups regarding the remaining SF-36 sub-scores, Harris Hip Score, and NRS. CONCLUSIONS The FNS allows for a comparable leg length, femoral offset, and CCD angle reconstruction while achieving similarly high functional and global health scores to the DHS.
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Affiliation(s)
- Marcel Niemann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, 13353 Berlin, Germany
| | - Tazio Maleitzke
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, 13353 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Programme, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Markus Jahn
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Katharina Salmoukas
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Department of Trauma Surgery and Orthopaedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, 12683 Berlin, Germany
| | - Karl F. Braun
- Department of Trauma Surgery, University Hospital Rechts der Isar, Technical University of Munich, 81675 München, Germany;
| | - Frank Graef
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Ulrich Stöckle
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Sebastian Meller
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
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Wang X, Zhang Y, Lou L, Xu L, Fei W, Dai J, Wang J. Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study. J Orthop Surg Res 2023; 18:633. [PMID: 37641097 PMCID: PMC10463292 DOI: 10.1186/s13018-023-04070-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Robots are being used in a wide range of surgical procedures. However, in clinical practice, the efficacy of orthopedic robotic-assisted treatment of femoral neck fractures is still poorly reported, particularly in terms of screw placement accuracy, femoral neck fracture healing rates and postoperative functional recovery. Moreover, there is a lack of comparative analysis between robot-assisted surgery and traditional surgical approaches. PURPOSE The purpose of this study was to compare the clinical outcomes of patients with femoral neck fractures treated with TiRobot-assisted hollow screw fixation with those of patients with femoral neck fractures treated with traditional surgical approaches. METHODS This study included 112 patients with femoral neck fracture who were treated from March 2017 to October 2021 with percutaneous hollow screw internal fixation. These included 56 cases in the TiRobot-assisted surgery group and 56 cases in the standard surgery group. After at least 1 year of follow-up, the treatment outcomes of the two groups were compared, including the amount of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, the length of hospital stay, the accuracy rate of screw placement, the final Harris Hip Score, the fracture healing rate, and the rate of femoral head necrosis. Statistical analysis software was used to process and analyze the result. RESULTS The TiRobot-assisted group had a statistically significant improvement over the control group in terms of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, length of hospital stay, accuracy of screw placement and incidence of femoral head necrosis (P < 0.05). There was no statistically significant difference in time to surgery, final Harris hip score and fracture healing rate (P > 0.05). CONCLUSION This study shows that TiRobot-assisted surgery has the advantages of short hospital stay, high safety, minimally invasive, high success rate of nail placement, and can reduce the amount of intraoperative radiation and the incidence of femoral head necrosis, thus achieving satisfactory clinical outcomes, and is worthy of clinical promotion.
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Affiliation(s)
- Xiaofei Wang
- Dalian Medical University, Dalian, 116044, China
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Yaxin Zhang
- Dalian Medical University, Dalian, 116044, China
| | - Linbing Lou
- Dalian Medical University, Dalian, 116044, China
| | - Lei Xu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Wenyong Fei
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
| | - Jihang Dai
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
| | - Jingcheng Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
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Zhong Z, Lan X, Xiang Z, Duan X. Femoral neck system and cannulated compression screws in the treatment of non-anatomical reduction Pauwels type-III femoral neck fractures: A finite element analysis. Clin Biomech (Bristol, Avon) 2023; 108:106060. [PMID: 37536196 DOI: 10.1016/j.clinbiomech.2023.106060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND High shear force is a major factor detrimental to the healing of vertical femoral neck fractures. In addition to firm fixation, reduction quality is crucial for postoperative stability. The present study aimed to compare the biomechanical stability of the newly invented femoral neck system and three inverted-triangle cannulated compression screws treatments for non-anatomical reduction of Pauwels type-III femoral neck fractures. METHODS A total of 18 non-anatomical reduction Pauwels type-III femoral neck fracture finite element models were fabricated and fixed using three inverted-triangle cannulated compression screws or the femoral neck system. A 1950-N force was applied to the femoral head to simulate the physiological load during a single-leg stance. Parameters of the maximum total deformation, the interfragmentary gap, and the maximum von Mises stress of the implants and the proximal femur were analyzed. FINDINGS The results of the maximum total deformation, interfragmentary gap, and maximum von Mises stress of the implants in the negative-negative buttress model fixed by the femoral neck system were the largest among all groups (3.58 mm, 0.252 mm, and 729.68 MPa, respectively). In contrast, the anatomical-anatomical reduction model fixed by three inverted-triangle cannulated compression screws demonstrated the minimum total deformation, interfragmentary gap, and minimum von Mises stress of implants (1.107 mm, 0.09 mm, and 189.83 MPa, respectively). INTERPRETATION Anatomical reduction or positive buttress in femoral neck fractures should be recommended during fracture reduction. The femoral neck system showed weaker biomechanical stability than three inverted-triangle cannulated compression screws in treating Pauwels type-III femoral neck fractures.
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Affiliation(s)
- Zhou Zhong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China
| | - Xuejun Lan
- Department of Health Management Center, General Practice Center, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China
| | - Zhou Xiang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China.
| | - Xin Duan
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China; Department of Orthopedic Surgery, Sichuan Fifth People's Hospital, Chengdu 610000, China.
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Kuang X, Jian G, Xie D, Chen X, Liu H. Choose the appropriate implantation position of the Femoral Neck System in the femoral neck: a finite-element analysis. Eur J Trauma Emerg Surg 2023; 49:1845-1853. [PMID: 36964769 PMCID: PMC10449665 DOI: 10.1007/s00068-023-02253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/19/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE There is no specific literature on the best implantation position of the Femoral Neck System (FNS) for treating Pauwels type III femoral neck fracture in young adults. METHODS Use finite-element analysis to compare the mechanical properties of implantation positions: FNS in the central position, FNS in the low position, and FNS in the low position combined with cannulated screw (CS). The CT data of the femur were imported into the mimics20.0 to obtain the three-dimensional model of the femur; imported into geomagic2017 and SolidWorks 2017 for optimizations; models of FNS and CS are built on the basis of the device manuals. Grouping is as follows: FNS group, FNS-LOW group, and FNS-CS group. Assemble and import them into abaques6.14 for load application. The displacement distribution and von Mises Stress value of them were compared. RESULTS On femoral stability and stress distribution, the FNS-CS group performs best, followed by the FNS-LOW group, and finally FNS group. The FNS-LOW group has an improvement over the FNS group but not by much. CONCLUSION In operations, when the implantation position of the central guide wire is not at the center of the femoral neck but slightly lower, it is recommended not to adjust the wire repeatedly in pursuit of the center position; for femoral neck fractures that are extremely unstable at the fracture end or require revision, the insertion strategy of FNS in the low position combined with CS can be adopted to obtain better fixation effects.
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Affiliation(s)
- Ximu Kuang
- Department of Orthopedics, Chenggong Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Guojian Jian
- Department of Orthopedics, Chenggong Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Desheng Xie
- Department of Orthopedics, Chenggong Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaolin Chen
- Department of Orthopedics, Chenggong Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Haoyuan Liu
- Department of Orthopedics, Chenggong Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Ruangsillapanan N, Rattanakitkoson T, Chanhom N, Chinvattanachot G, Piyapromdee U, Leownorasate M. Reliability of Modified Pauwels Angle in Preoperative Plain X-ray and Intraoperative Fluoroscope in Young Femoral Neck Fracture Fixation. Indian J Orthop 2023; 57:1290-1295. [PMID: 37525742 PMCID: PMC10386982 DOI: 10.1007/s43465-023-00913-7] [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: 08/10/2022] [Accepted: 05/21/2023] [Indexed: 08/02/2023]
Abstract
Purpose This research aims to evaluate the reliability of modified Pauwels angle in preoperative plain X-ray and intraoperative fluoroscope. Method This study included 48 male and 18 female patients with an average age of 36.95 years. Seven observers contributed to this study by measuring the modified Pauwels types and angles on 66 anterior-posterior (AP) views from preoperative radiographs and intraoperative fluorography. Intra-observer and inter-observer reliability was calculated using Fleiss's kappa and intraclass correlation coefficient (ICC). Results The results showed that the intra-observer reliability for the modified Pauwels type using Kappa coefficient in preoperative and intraoperative assessments was 0.584 and 0.823, respectively. The inter-observer reliability for preoperative and intraoperative evaluations was 0.467 and 0.753 for all observers, 0.647 and 0.783 for specialized trauma orthopedists, and 0.41 and 0.752 for the residents. The modified Pauwels angle assessment in intra-observers using ICC was 0.804 preoperatively and 0.943 intraoperatively. The inter-observer for preoperative and intraoperative assessments was 0.675 and 0.834 for all observers, 0.977 and 0.982 for specialized trauma orthopedists, and 0.622 and 0.823 for residents. The difference between preoperative and intraoperative modified Pauwels angles was 9.75 ± 6.76 (p < 0.05). Eleven patients had their modified Pauwels type changed, which altered the implant selection in 8 patients. Conclusion The modified Pauwels angle together with type assessment has excellent reliability for implant selection when implemented intraoperatively, and at least two specialized trauma orthopedists should evaluate the fracture lines.
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Affiliation(s)
- Naruepol Ruangsillapanan
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Tana Rattanakitkoson
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Napaj Chanhom
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Guntarat Chinvattanachot
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Urawit Piyapromdee
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Manoon Leownorasate
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
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Zhou Y, Li Z, Lao K, Wang Z, Zhang L, Dai S, Fan X. Femoral neck system vs. cannulated screws on treating femoral neck fracture: a meta-analysis and system review. Front Surg 2023; 10:1224559. [PMID: 37533744 PMCID: PMC10390772 DOI: 10.3389/fsurg.2023.1224559] [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: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Objective This meta-analysis aimed to compare the relative safety and efficacy of cannulated compression screw (CCS) and femoral neck system (FNS) in treating patients with femoral neck fractures and to provide evidence-based medical evidence for FNS in treating femoral neck fractures. Methods PubMed, Embase, Cochrane, and China National Knowledge Infrastructure databases were searched to collect outcomes related to femoral neck fractures treated with FNS and CCS, including time to fracture healing, incidence of non-union, incidence of osteonecrosis of the femoral head, incidence of failure of internal fixation, rate of femoral neck shortening, Harris hip score, Barthel index, operative time, intraoperative blood loss, fluoroscopy frequency, and complications. A meta-analysis was performed using RevManv5.4 (The Cochrane Collaboration) and Stata v14.0 software. Results This analysis included 21 studies involving 1,347 patients. The results showed that FNS was superior to CCS in terms of fracture healing time [mean difference (MD) = -0.75, 95% CI = (-1.04, -0.46), P < 0.05], incidence of bone non-union [odds ratio (OR) = 0.53, 95% CI = (0.29, 0.98), P = 0.04], incidence of osteonecrosis of the femoral head [OR = 0.49, 95% CI = (0.28, 0.86), P = 0.01], incidence of internal fixation failure [OR = 0.30, 95% CI = (0.18, 0.52), P < 0.05], rate of femoral neck shortening [OR = 0.38, 95% CI = (0.27, 0.54), P > 0.05], Harris hip score [MD = 3.31, 95% CI = (1.99, 4.63), P < 0.001], Barthel index [MD = 4.31, 95% CI = (3.02, 5.61), P < 0.05], intraoperative bleeding [MD = 14.72, 95% CI = (8.52, 20.92), P < 0.05], fluoroscopy frequency [OR = 0.53, 95% CI = (0.29, 0.98), P = 0.04], and complications [OR = 0.31, 95% CI = (0.22, 0.45), P < 0.05]. The difference between FNS and CCS in operative time was not statistically significant [MD = -2.41, 95% CI = (-6.88, 2.05), P = 0.29]. Conclusion FNS treatment of femoral neck fracture can shorten the fracture healing time; reduce the incidence and translucent rate of bone non-union, osteonecrosis of the femoral head, and internal fixation failure; reduce intraoperative blood loss and postoperative complications; and improve hip joint function and activity. We are confident in the findings that FNS, an effective and safe procedure for internal fixation of femoral neck fractures, is superior to CCS.
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Affiliation(s)
- Yimin Zhou
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Zongyang Li
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Kecheng Lao
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Zixiu Wang
- College of Pharmacy, Gannan Medical University, Ganzhou, China
| | - Li Zhang
- Department of Rehabilitation and Health, Fujian Vocational College of Bio-engineering, Fuzhou, China
| | - Shiyou Dai
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xiao Fan
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
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Wang Y, Ma JX, Bai HH, Lu B, Sun L, Jin HZ, Ma XL. Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications. World J Clin Cases 2023; 11:4814-4823. [PMID: 37584003 PMCID: PMC10424033 DOI: 10.12998/wjcc.v11.i20.4814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The femoral neck dynamic intersection system (FNS) is mechanically more stable than other internal fixation techniques. Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations. However, whether the suitability of the FNS's 130° main nail angle design for Asian populations has been thoroughly investigated remains unclear. AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations. METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur. The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles. Afterward, the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software. Subsequently, they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures. RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120° group and 7.416 millimeters in the 125° group; in the 130°, 135°, and 140° FNS fixation groups, the peak displacement was 7.324 millimeters, 8.138 millimeters, and 8.246 millimeters, respectively. In the 120° and 125° FNS fixation groups, the maximum stresses were concentrated at the main nail and the anti-rotation screw, which intersected the fracture line of the femur neck, resulting in peak stresses of 200.7 MPa and 138.8 MPa, respectively. Peak stresses of 208.8 MPa, 219.8 MPa, and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°, 135°, and 140° fixation groups. CONCLUSION FNS has significant stress distribution properties, a minimal proximal femoral displacement, and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130° main nail angle.
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Affiliation(s)
- Ying Wang
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Jian-Xiong Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hao-Hao Bai
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Bin Lu
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Lei Sun
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hong-Zhen Jin
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Xin-Long Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
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Wang Y, Ma JX, Bai HH, Lu B, Sun L, Jin HZ, Ma XL. Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications. World J Clin Cases 2023; 11:4810-4819. [DOI: 10.12998/wjcc.v11.i20.4810] [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: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The femoral neck dynamic intersection system (FNS) is mechanically more stable than other internal fixation techniques. Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations. However, whether the suitability of the FNS's 130° main nail angle design for Asian populations has been thoroughly investigated remains unclear.
AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations.
METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur. The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles. Afterward, the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software. Subsequently, they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures.
RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120° group and 7.416 millimeters in the 125° group; in the 130°, 135°, and 140° FNS fixation groups, the peak displacement was 7.324 millimeters, 8.138 millimeters, and 8.246 millimeters, respectively. In the 120° and 125° FNS fixation groups, the maximum stresses were concentrated at the main nail and the anti-rotation screw, which intersected the fracture line of the femur neck, resulting in peak stresses of 200.7 MPa and 138.8 MPa, respectively. Peak stresses of 208.8 MPa, 219.8 MPa, and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°, 135°, and 140° fixation groups.
CONCLUSION FNS has significant stress distribution properties, a minimal proximal femoral displacement, and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130° main nail angle.
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Affiliation(s)
- Ying Wang
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Jian-Xiong Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hao-Hao Bai
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Bin Lu
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Lei Sun
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hong-Zhen Jin
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Xin-Long Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
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Sun X, Yi G, Ao L, Zhou X, Zhang T, Guan TY. Effect analysis of medial bracing plate combined with cannulated screw in unstable femoral neck fracture assisted by surgical hip dislocation: a retrospective study. J Orthop Surg Res 2023; 18:498. [PMID: 37452375 PMCID: PMC10347755 DOI: 10.1186/s13018-023-03991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Unstable femoral neck fractures have a high likelihood of causing severe disruption to the blood supply. This study aimed to assess the therapeutic effect of surgical hip dislocation using a medial support plate combined with cannulated screw fixation for the treatment of unstable femoral neck fractures in young and middle-aged adults. METHODS We retrospectively analyzed the medical records of 68 young adults who underwent internal fixation of unstable femoral neck fractures. The observation group included 32 patients who had received medial support plate and cannulated screw fixation by the surgical hip dislocation method and 36 patients who had undergone anti-rotation screw composite compression system fixation comprised the comparison group. The amount of intraoperative bleeding, surgery duration, fracture recovery time and complications were recorded. The degree of femoral neck shortening and Garden index were assessed using the Zlowodzki method. Additionally, hip functionality was evaluated using the Harris score at 3 and 6 months and at the last follow-up. RESULTS All 68 patients in both groups were followed up for 12-42 months (mean, 22.4 months). The postoperative incision was well-aligned and no inflation was observed. The intraoperative blood loss and surgery duration in the comparison group were longer than those in the observation. Additionally, the observation group had a significantly shorter fracture recovery time and a higher Garden index than the comparison at 6 months postoperatively; however, there was no significant statistical discrepancy between the two groups at the remaining time points. The observation group had higher Harris scores than the comparison at 3 and 6 months postoperatively. CONCLUSION Surgical hip dislocation applied to the medial support plate combined with cannulated screw fixation has clinical application value in restoring the stability of femoral neck fractures while facilitating the maintenance of blood flow to the femoral head and neck.
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Affiliation(s)
- Xin Sun
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- College Of Integration Of Traditional Chinese And Western Medicine To Southwest Medical University, Luzhou, Sichuan, China
| | - Gang Yi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Liang Ao
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Tao Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Tai-Yuan Guan
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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Peterson DF, Schabel K. Cold Welding of the Synthes Femoral Neck System Encountered at Conversion to Arthroplasty: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00008. [PMID: 37437052 DOI: 10.2106/jbjs.cc.22.00530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
CASE The Synthes Femoral Neck System (FNS) is a relatively new device available to the market in 2019 designed to reduce complication and revision rates after femoral neck fracture stabilization. We present a 77-year-old man with Parkinson disease and avascular necrosis after femoral neck fracture initially managed with the FNS. Subsequent challenges in device removal occurred because of its propensity for bony integration, plate and locking screw welding, and screw head recess destruction. CONCLUSION Surgeons must recognize the need for additional available equipment (e.g., burr or broken screw removal set) for successful extraction when FNS removal is required.
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Affiliation(s)
- Danielle F Peterson
- Department of Orthopaedics, Oregon Health and Science University, Portland, Oregon
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Jiang J, Chen J, Xing F, Liu H, Xiang Z. Comparison of femoral neck system versus cannulated screws for treatment of femoral neck fractures: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:285. [PMID: 37055749 PMCID: PMC10099821 DOI: 10.1186/s12891-023-06378-x] [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: 09/26/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs. METHOD The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants. RESULTS A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P < 0.001; I2 = 0%), fracture healing time (WMD = -1.54; 95% CI, -2.38 to -0.70; P < 0.001; I2 = 92%), length of femoral neck shortening (WMD = -2.01; 95% CI, -3.11 to -0.91; P < 0.001; I2 = 0%), femoral head necrosis (OR = 0.27; 95% CI, 0.08 to 0.83; P = 0.02; I2 = 0%), implant failure/cutout (OR = 0.28; 95% CI, 0.10 to 0.82; P = 0.02; I2 = 0%), and Visual Analog Scale Score (WMD = -1.27; 95% CI, -2.51 to -0.04; P = 0.04; I2 = 91%). And the Harris Score was significantly higher in the FNS group than in the CS group (WMD = 4.15; 95% CI, 1.00 to 7.30; P = 0.01; I2 = 89%). CONCLUSIONS Based on this meta-analysis, FNS shows better clinical efficacy and safety in treating FNFs compared to CS. However, due to the limited quality and number of included studies and the high heterogeneity of the meta-analysis; large samples and multicenter RCTs are needed to confirm this conclusion in the future. LEVEL OF EVIDENCE II, Systematic review and Meta-analysis. TRIAL REGISTRATION PROSPERO CRD42021283646.
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Affiliation(s)
- Jiabao Jiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jialei Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Fei Xing
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zhou Xiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Jiang T, Gao H, Xu B, Lv F, Liu T. The comparison of femoral neck system and cancellous screws internal fixation for femoral neck fracture. Biotechnol Genet Eng Rev 2023:1-12. [PMID: 37043667 DOI: 10.1080/02648725.2023.2197335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND The clinical efficacy of cancellous screws (CS) and femoral neck system (FNS) internal fixation in the treatment of femoral neck fracture (FNF) was compared in this research. METHODS Ninety-six patients with FNF were enrolled in this study. There were 47 cases in FNS group and 49 cases in CS group. The data of operation time, intraoperative bleeding, bed days and complication were recorded. Patients' joint function was evaluated by Harris score. At the last follow-up, the cost-effectiveness analysis of the two methods was analyzed according to the total cost of patients and hip function. RESULTS The intraoperative blood loss of the patients in FNS group was significantly higher than that in the CS group, but the length of hospitalization was significantly lower. There was no significant difference in the incidence of complications between FNS and CS. The joint function of FNS group was significantly better than that of CS group at 3 months after operation. There was no significant difference in Harris score between the two groups at the last follow-up. The overall medical cost of FNS group in 1 year is high. Cost-effectiveness analysis showed that compared with CS group, FNS group needs to pay 5761.1 yuan more for each additional Harris score. CONCLUSION FNS and CS internal fixation can achieve satisfactory clinical results in the treatment of FNF. FNS treatment is helpful to the early functional recovery of patients, but the overall medical cost is high.
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Affiliation(s)
- Tao Jiang
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Han Gao
- Department of Pathology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Bin Xu
- Out Patient Department, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Fuxin Lv
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Tao Liu
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Jäger M, Portegys E, Busch A, Wegner A. [Femoral neck fractures]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:332-346. [PMID: 36867225 DOI: 10.1007/s00132-023-04364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
Femoral neck fractures (FNF) are the most frequent fractures in the older population and are also of high socioeconomic importance due to the high risk of mortality. The diagnostics are based on the clinical examination and imaging procedures. The classification systems used in the routine clinical practice are oriented towards the prognosis and are therefore a valuable aid in making decisions for the selection of the treatment procedure. Early surgery is decisive for the success of treatment. Older patients (> 60 years) with arthritically damaged hips and a high degree of fracture dislocation benefit from prompt hip replacement (bipolar systems, total hip arthroplasty, dual mobility systems). In contrast, joint-preserving surgery by osteosynthesis is indicated in younger patients with a low degree of dislocation. This article summarizes the clinically relevant aspects of FNF and gives an overview of current treatment strategies with inclusion of the scientific literature.
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Affiliation(s)
- M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland.
| | - E Portegys
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
| | - A Busch
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland
| | - A Wegner
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
- Klinik für Unfallchirurgie, Orthopädie, Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland
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Huang S, Zhang Y, Zhang X, Zhou C, Li W, Wang Y, Wang B, Zhu Z. Comparison of femoral neck system and three cannulated cancellous screws in the treatment of vertical femoral neck fractures: clinical observation and finite element analysis. Biomed Eng Online 2023; 22:20. [PMID: 36859241 PMCID: PMC9979525 DOI: 10.1186/s12938-023-01083-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to compare the biomechanical and clinical results of two surgical methods for the treatment of vertical femoral neck fractures: Femoral neck system (FNS) and traditional three cannulated cancellous screws (CCS). METHODS First, we developed three different vertical femoral neck fracture models for the finite element analysis, with angles of 55°, 65°, and 75°, respectively. Two experimental groups were set up: the FNS group and the CCS group. Each fracture group was tested under axial loads of 2100 N to measure the femur's displacement, Von Mises stress (VMS), and its internal fixation components. Secondly, we retrospectively included the cases of vertical femoral neck fractures with FNS and CCS in our hospital from May 2019 to May 2021. In this study, we compared the duration of intraoperative fluoroscopy, operative time, hospital stay, fracture healing time, Hemoglobin loss, Harris score of hip joint function, and postoperative complications among patients undergoing hip joint replacement. RESULTS In terms of finite element analysis, FNS has better anti-displacement stability than CCS at 55°and 65°, while FNS is greater than CCS in Von Mises stress. Clinically, we followed up on 87 patients for an average of 12 months. FNS was superior to traditional CCS in fracture healing time, operation time, fluoroscopy duration, fracture healing time, and Harris hip function score. CONCLUSION FNS is superior to traditional CCS in biomechanical and clinical aspects of treating vertical femoral neck fractures. There is potential for FNS to become a new treatment option for vertical femoral neck fractures.
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Affiliation(s)
- Shaolong Huang
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000 Jiangsu China ,grid.417303.20000 0000 9927 0537Graduate School of Xuzhou Medical University, Xuzhou, 221000 Jiangsu China
| | - Yazhong Zhang
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000 Jiangsu China
| | - Xu Zhang
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000 Jiangsu China ,grid.417303.20000 0000 9927 0537Graduate School of Xuzhou Medical University, Xuzhou, 221000 Jiangsu China
| | - Chengqiang Zhou
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000 Jiangsu China ,grid.417303.20000 0000 9927 0537Graduate School of Xuzhou Medical University, Xuzhou, 221000 Jiangsu China
| | - Wenbo Li
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000 Jiangsu China
| | - Yunqing Wang
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000 Jiangsu China
| | - Bin Wang
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000 Jiangsu China
| | - Ziqiang Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China.
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Cho Y, Shin JU, Kim S. Comparative Study for Osteosynthesis of Femoral Neck Fractures: Cannulated Screws versus Femoral Neck System. Hip Pelvis 2023; 35:47-53. [PMID: 36937213 PMCID: PMC10020727 DOI: 10.5371/hp.2023.35.1.47] [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: 06/10/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 03/18/2023] Open
Abstract
Purpose The purpose of this study is to compare the radiological results of fixation using the femoral neck system (FNS) and cannulated screw (CS) for treatment of femoral neck fractures. Materials and Methods A retrospective study of patients with femoral neck fractures who underwent internal fixation and had follow-up of more than six months from 2010 to 2020 was conducted. A total of 87 patients were enrolled in the study. The FNS group included 20 patients and the CS group included 67 patients. Classification of fractures was performed according to Garden and Pauwels classification. Operation time, intraoperative blood loss, sliding distance of the implant, lateral soft tissue irritation caused by implants, and complications were evaluated. Results The mean operation time was 40.30 minutes in the FNS group and 46.84 minutes in the CS group. The mean intraoperative bleeding volume was 51.25 mL in the FNS group and 72.16 mL in the CS group. Bone union was achieved in 18 patients in the FNS group (90.0%) and in 61 patients in the CS group (91.0%). The mean sliding distance of the implant was 4.06 mm in the FNS group and 3.92 mm in the CS group. No patients in the FNS group and 12 patients in the CS group complained of soft tissue irritation. Conclusion A shorter operative time, less intraoperative bleeding, and less irritation of soft tissue were observed in the FNS group. FNS could be an alternative to CS for fixation of femoral neck fractures.
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Affiliation(s)
- Youngho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jae-uk Shin
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
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Ge Z, Xiong W, Wang D, Tang Y, Fang Q, Wang L, Zhang Z, Lin W, Wang G. Comparison of femoral neck system vs. dynamic hip system blade for the treatment of femoral neck fracture in young patients: A retrospective study. Front Surg 2023; 10:1092786. [PMID: 36816012 PMCID: PMC9935827 DOI: 10.3389/fsurg.2023.1092786] [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: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Femoral neck fracture is a common fracture in orthopedic practice. This study aimed to compare the clinical outcomes between the femoral neck system and dynamic hip system blade for the treatment of femoral neck fracture in young patients. Methods This retrospective study included 43 and 52 patients who underwent treatment for femoral neck fracture with the femoral neck system and dynamic hip system blade, respectively, between August 2019 and August 2020. Operative indexes, including operation duration, blood loss, incision length, postoperative complications (femoral neck shortening, non-union, screw pull-out, femoral head necrosis), and Harris scale scores were recorded and analyzed. Results Compared to that with the dynamic hip system blade, the femoral neck system showed significantly less operation duration (femoral neck system vs. dynamic hip system blade: 47.09 ± 9.19 vs. 52.90 ± 9.64, P = 0.004), less blood loss (48.53 ± 10.69 vs. 65.31 ± 17.91, P < 0.001), and shorter incision length (4.04 ± 0.43 vs. 4.93 ± 0.53, P < 0.001). Femoral neck shortening was significantly lower with the femoral neck system than with the dynamic hip system blade (3.93 ± 2.40, n = 39 vs. 5.22 ± 2.89, n = 44, P = 0.031). No statistical differences were observed between the two groups in nonunion, screw pull-out, and femoral head necrosis. In addition, the latest follow-up Harris scale score was significantly higher with the femoral neck system than with the dynamic hip system blade (92.3 ± 4.5 vs. 89. 9 ± 4.9, P = 0.015). Conclusion The femoral neck system results in less trauma, less femoral neck shortening, and better hip joint function than the dynamic hip system blade for the treatment of femoral neck fracture in young patients.
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Affiliation(s)
- Zilu Ge
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Xiong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yunfeng Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Fang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Limin Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Lin
- WestChina Women's and Children's Hospital, Sichuan University, Chengdu, China,Correspondence: Wei Lin Guanglin Wang
| | - Guanglin Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Wei Lin Guanglin Wang
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Kenmegne GR, Zou C, Fang Y, He X, Lin Y, Yin Y. Femoral neck fractures in non-geriatric patients: femoral neck system versus cannulated cancellous screw. BMC Musculoskelet Disord 2023; 24:70. [PMID: 36703126 PMCID: PMC9878738 DOI: 10.1186/s12891-023-06140-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The fractures of femoral neck account for 50% among hip fractures with around 3%-10% occurring in younger population of below 65 years. The newly introduced FNS as management approach appears to be a potential alternative to the traditional CCS. The aim of this study was to compare the clinical efficacy and outcome of the femoral neck system (FNS) and the cannulated cancellous screw (CCS) in the treatment of femoral neck fractures in adult below 65 years of age. METHODS Data of 114 patients between 18-65 years, admitted in our department for femoral neck fracture from January 2019 to March 2021 were retrospectively studied and ranged into two groups based on the surgical methods: FNS group (56 patients) and CCS group (58 patients). The variables of interest including demographic and clinical variables (age, gender, fracture mechanism, injury side and classification), perioperative parameters(operation time, intraoperative bleeding, incision length and hospitalization time), postoperative outcomes and complications (fracture healing time, nonunion rate, femoral neck avascular necrosis, aseptic screw loosening and the Harris Hip Score), were analyzed and compared between the two groups. RESULTS All 114 patients presented satisfactory reduction and were followed-up for a period of 12 to 36 months (mean 27 ± 2.07 months); there were no significant differences between both groups in terms of age, gender, fracture classification, side of injury, mechanism of injury, the operative time, intraoperative blood loss and the hospital length of stay. However, the fracture healing time between FNS group and CCS group was statistically significant (p < 0.05), respectively 2.86 ± 0.77 and 5.10 ± 0.81 months. The significant differences were also found in terms of numbers of fluoroscopies 8.34 ± 1.38 Vs 17.72 ± 2.19, the HHS 87.80 ± 1.92 Vs 84.28 ± 2.24, postoperative complications 8 (14.28%) Vs 26 (44.82) respectively in FNS and CCS group. CONCLUSION FNS presented satisfactory outcomes had significantly lower complications rate, therefore, can be one of the alternatives for internal implantation devices in treatment of femoral neck fracture in non-geriatric population.
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Affiliation(s)
- Guy Romeo Kenmegne
- grid.412901.f0000 0004 1770 1022Trauma center, West China Hospital of Sichuan University, 610044 Chengdu, People’s Republic of China
| | - Chang Zou
- grid.412901.f0000 0004 1770 1022Trauma center, West China Hospital of Sichuan University, 610044 Chengdu, People’s Republic of China
| | - Yue Fang
- grid.412901.f0000 0004 1770 1022Trauma center, West China Hospital of Sichuan University, 610044 Chengdu, People’s Republic of China
| | - Xuanhong He
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yixiang Lin
- grid.412901.f0000 0004 1770 1022Trauma center, West China Hospital of Sichuan University, 610044 Chengdu, People’s Republic of China
| | - Yijie Yin
- grid.412901.f0000 0004 1770 1022Trauma center, West China Hospital of Sichuan University, 610044 Chengdu, People’s Republic of China
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40
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Wu ZF, Luo ZH, Hu LC, Luo YW. Efficacy of the femoral neck system in femoral neck fracture treatment in adults: A systematic review and meta-analysis. World J Clin Cases 2022; 10:11454-11465. [PMID: 36387785 PMCID: PMC9649536 DOI: 10.12998/wjcc.v10.i31.11454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/19/2022] [Accepted: 10/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Controversy remains around the available choices for the internal fixation of a femoral neck fracture. The femoral neck system (FNS) was developed in 2018 and has been widely applied since then as it can provide rigid fixation stability with less damage to the bone mass around the fracture. However, no systematic reviews and meta-analyses have investigated the efficacy of the FNS in comparison with that of traditional internal fixation in the treatment of femoral fractures.
AIM To assess the efficacy of the FNS in comparison with that of cannulated compression screws (CCS) in the treatment of femoral fractures through systematic review and meta-analysis.
METHODS Five electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang) were searched from the earliest publication date to December 31, 2021. Reference Citation Analysis (https://www.referencecitationanalysis.com/) was used to check the results and further analyze the related articles. Controlled trials were included if the FNS was applied for the femoral neck fracture in adults and if it was compared with CCS for the achievement of internal fixation. The measurement outcomes included the required operation time, observed patient’s blood loss, extent of fracture healing, patient’s Harris Hip score (HHS) at the last follow-up, and records of any complications (such as failure of internal fixation, femoral neck shortness, avascular necrosis of the femoral head, and delayed union or nonunion).
RESULTS Ten retrospective controlled studies (involving 711 participants) were included in this meta-analysis. The meta-analysis showed that compared with CCS, use of the FNS could not decrease the operation time [standardized mean difference (SMD): -0.38, 95% confidence interval (CI): -0.98 to 0.22, P = 0.21, I2 = 93%), but it could increase the intraoperative blood loss (SMD: 0.59, 95%CI: 0.15 to 1.03, P = 0.009, I2 = 81%). The pooled results also showed that compared with CCS, the FNS could better promote fracture healing (SMD: -0.97, 95%CI: -1.65 to -0.30, P = 0.005, I2 = 91%), improve the HHS at the last follow-up (SMD: 0.76, 95%CI: 0.31 to 1.21, P = 0.0009, I2 = 84%), and reduce the chances of developing femoral neck shortness (OR: 0.29, 95%CI: 0.14 to 0.61, P = 0.001, I2 = 0%) and delayed union or nonunion (OR: 0.47, 95%CI: 0.30 to 0.73, P = 0.001; I2 = 0%) in adult patients with femoral neck fractures. However, there was no statistically significant difference between the FNS and CCS in terms of failure of internal fixation (OR: 0.49, 95%CI: 0.23 to 1.06, P = 0.07, I2 = 0%) and avascular necrosis of the femoral head (OR: 0.46, 95%CI: 0.20 to 1.10, P = 0.08, I2 = 0%).
CONCLUSION Compared with CCS, the FNS could decrease the chances of developing femoral neck shortness and delayed union or nonunion in adults with femoral neck fractures. Simultaneously, it could accelerate fracture healing and improve the HHS in these patients.
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Affiliation(s)
- Zhi-Fang Wu
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
| | - Zi-Heng Luo
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
| | - Liu-Chao Hu
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
| | - Yi-Wen Luo
- Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China
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Muacevic A, Adler JR, Mandal S, Rani S, Shekhar S, Halder S, Prasad P, Kumar A, Haque ZU. Comparison of Femoral Neck System Versus Cannulated Cancellous Screws for the Fixation of Femoral Neck Fracture in Young Adults: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e32011. [PMID: 36589187 PMCID: PMC9798663 DOI: 10.7759/cureus.32011] [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] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
A femoral neck fracture is a very common injury in the elderly. However, its incidence is low among young adults, usually presenting as an emergency. In young adults, implant choice is one of the important factors. This systematic review aims to analyze the femoral neck system (FNS) versus cannulated cancellous (CC) screw for the fixation of femoral neck fractures in young adults through well-defined objectives. A comprehensive search from the electronic database (PubMed, Google Scholar, Web of Science, Cochrane Library) was conducted from the beginning till February 18, 2022. The data regarding study type, authors, year of publication, country, union time, Harris hip score, intraoperative blood loss, operating time, neck shortening, and hospital stay were extracted from the selected articles and analyzed using RevMan 5.4.1 software. For continuous data, e.g., healing time, intraoperative blood loss, operation time, Harris hip score, neck shortening, and hospital stay, the mean difference (MD), either weighted mean difference (WMD) or standardized mean difference (SMD), with a 95% confidence interval (CI) was recorded. A p-value less than 0.05 was taken as statistically significant. The Newcastle Ottawa scale was used for the risk of bias assessment. Six retrospective cohort studies including 427 patients were selected for the meta-analysis. There was significantly less healing time (WMD= -1.10, 95% CI: -1.73 to -0.47), shorter operation duration (WMD=7.70, 95% CI: -0.06 to 15.46), and better Harris hip score (WMD=4.79, 95% CI: 2.12-7.46) in the FNS than CC screw fixation method. However, intraoperative blood loss was significantly less in the CC screw system (WMD=21.27, 95% CI: 8.20-34.35). There was no significant difference between the two approaches in-hospital stay duration and femoral neck shortening. This can be concluded that FNS is better than CC screw fixation for treating neck of femur fractures in adults on the outcome basis of union time, less operation time, and better Harris hip score (HHS) with significant heterogeneity.
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Patel S, Kumar V, Baburaj V, Dhillon MS. The use of the femoral neck system (FNS) leads to better outcomes in the surgical management of femoral neck fractures in adults compared to fixation with cannulated screws: A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03407-8. [PMID: 36201031 DOI: 10.1007/s00590-022-03407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intracapsular femoral neck fractures are challenging to treat, with outcomes depending on the quality of reduction, and the stability of fixation. Cannulated cancellous screws (CCS) are the most commonly used implants to fix these fractures, but failure rates are significant. The recently introduced femoral neck system (FNS) may be a better option than CCS fixation and this review attempts to compare the results. METHODS Four electronic databases were searched for eligible articles that had comparative data on the outcomes of fixation of adult femoral neck fractures with FNS and CCS. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% confidence intervals. RESULTS Eight studies with 509 cases having a mean age of 50.8 years were included for final analysis. FNS was found to be associated with significantly reduced complication rates (p < 0.001), decreased incidence of postoperative femoral neck shortening (p < 0.001), quicker time to fracture union (p = 0.002), and better functional outcome scores (p < 0.001) compared to cannulated screws. FNS was also associated with a shorter operating time (mean difference 6.65 min) although not statistically significant (p = 0.24). CCS group had significantly reduced mean blood loss (p < 0.001). CONCLUSION The available literature supports FNS as a better option for adult femoral neck fractures, with a lower complication rate, quicker union, and better clinical outcomes. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Sandeep Patel
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishnu Baburaj
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lin G, Yang D, Sui W. Clinical Effect of Open Reduction and Internal Fixation for Femoral Neck Fracture in Young Adults and Related Factors of Femoral Head Necrosis. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:2974830. [PMID: 36238824 PMCID: PMC9553415 DOI: 10.1155/2022/2974830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/27/2022] [Indexed: 11/18/2022]
Abstract
Objective The purpose of this article is to analyze the clinical effect of open reduction and internal fixation on femoral neck fracture in young adults and to explore the related factors of femoral head necrosis. Methods The subjects were young and middle-aged femoral neck fracture patients admitted to our hospital from July 2019 to July 2021. 90 patients were randomly divided into two groups according to different treatment methods. The control group (n = 45) was treated with open reduction and internal fixation with hollow nails, while the observation group (n = 45) was treated with closed reduction and internal fixation with hollow nails. The clinical effects and adverse reactions of the two groups and the risk factors of avascular necrosis of femoral head were analyzed. Results Compared with the control group, the operation time of the observation group was significantly shortened (P < 0.05), the amount of bleeding during the operation was significantly reduced (P < 0.05), and the incidence of total adverse reactions was significantly reduced (P < 0.05). The HSS score and Harris score of the two groups were significantly decreased after treatment (P < 0.05), but there was no significant difference in the above scores between the two groups before and after treatment (P > 0.05). The related risk factors of necrosis included gender, Garden classification, time from injury to operation, and time of weight bearing after operation (P < 0.05) but not related to age and cause of injury (P > 0.05). Conclusion Open and closed reduction and internal fixation can effectively treat femoral neck fracture in young adults. The risk factors of adverse reactions of osteonecrosis include gender, Garden classification, time from injury to operation, and weight-bearing time after operation.
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Affiliation(s)
- Guanghui Lin
- Department of Orthopaedics, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Sciences, Xiangyang, Hubei 441021, China
| | - Dongliang Yang
- Department of Orthopaedics, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Sciences, Xiangyang, Hubei 441021, China
| | - Wei Sui
- Department of Orthopaedics, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Sciences, Xiangyang, Hubei 441021, China
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Lu Y, Huang Z, Xu Y, Huang Q, Ren C, Li M, Li Z, Sun L, Xue H, Zhang K, Wang Q, Ma T. Femoral neck system versus cannulated screws for fixation of femoral neck fracture in young adults: a systematic review and meta-analysis. Am J Transl Res 2022; 14:5480-5490. [PMID: 36105033 PMCID: PMC9452327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Femoral neck fracture treatment in young adults remains controversial. Cannulated screws (CS) and femoral neck system (FNS) are well-accepted methods for femoral neck fracture treatment; however, these methods are associated with complications. This meta-analysis aimed to evaluate the relative safety and effectiveness of CS and FNS for treating young patients with femoral neck fractures. METHODS We searched the following sources for studies that compared CS and FNS fixation: Cochrane library, Embase, PubMed, Web of Science, Wanfang data, China National Knowledge Infrastructure, China Biology Medicine disc, and Chinese Science and Technology Journals. The outcomes were surgical and prognostic results and complications. RESULTS This meta-analysis included eight studies. The pooled results revealed that the two fixation methods were similar in terms of the operation time, length of hospital stay, healing time, intraoperative blood loss, non-union, femoral head necrosis, and internal fixation cut-out. Compared with CS fixation, FNS fixation required fewer intraoperative fluoroscopies and had better Harris Hip Score, earlier weight-bearing, lower number of total complications, lesser femoral neck shortening, and lesser extent of nail retreat. CONCLUSION FNS fixation outperforms CS fixation in terms of intraoperative fluoroscopies, Harris Hip Score, and morbidity in young patients with femoral neck fractures. Clinicians should consider FNS as a first choice in treating femoral neck fracture in young adults, except where this approach is contraindicated.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Zhilong Huang
- Department of Orthopaedic Surgery, The Nuclear Industry 417 HospitalXi’an 710600, Shaan’xi Province, China
| | - Yibo Xu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
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Lu Y, Canavese F, Nan G, Lin R, Huang Y, Pan N, Chen S. Is Femoral Neck System a Valid Alternative for the Treatment of Displaced Femoral Neck Fractures in Adolescents? A Comparative Study of Femoral Neck System versus Cannulated Compression Screw. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58080999. [PMID: 35893114 PMCID: PMC9332796 DOI: 10.3390/medicina58080999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: The femoral neck system (FNS) is a new minimally invasive internal fixation system for femoral neck fractures (FNFs), but its use has not been reported in adolescents. The aim of this study was to compare the clinical and radiographic outcomes of displaced FNF in adolescents treated with FNS or a cannulated compression screw (CCS). Materials and Methods: A retrospective study of 58 consecutive patients with displaced FNF treated surgically was performed; overall, 28 patients underwent FNS and 30 CCS fixation. Sex, age at injury, type of fracture, associated lesions, duration of surgery, radiation exposure, and blood loss were collected from the hospital database. The clinical and radiographic results, as well as complications, were recorded and compared. Results: The patients were followed up for 16.4 ± 3.1 months on average after index surgery (range, 12 to 24). Consolidation time among patients treated with FNS was significantly lower than those managed by CCS (p = 0.000). The functional scores of patients treated with FNS were significantly higher than those managed by CCS (p = 0.030). Unplanned hardware removal in patients treated with FNS was significantly lower than in those managed by CCS (p = 0.024). Conclusions: FNS has a lower complication rate and better functional outcome than CCS. It may be a good alternative to treat femoral neck fractures in adolescents.
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Affiliation(s)
- Yunan Lu
- Department of Paediatric Orthopaedics, The Third Clinical Medicine College of Fujian Medical University, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, China; (Y.L.); (R.L.); (Y.H.); (N.P.)
| | - Federico Canavese
- Lille University Centre, Department of Paediatric Orthopaedic Surgery, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000 Lille, France;
| | - Guoxin Nan
- Department of Orthopaedics, Children’s Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2 Road 136#, Chongqing 400014, China;
| | - Ran Lin
- Department of Paediatric Orthopaedics, The Third Clinical Medicine College of Fujian Medical University, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, China; (Y.L.); (R.L.); (Y.H.); (N.P.)
| | - Yuling Huang
- Department of Paediatric Orthopaedics, The Third Clinical Medicine College of Fujian Medical University, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, China; (Y.L.); (R.L.); (Y.H.); (N.P.)
| | - Nuoqi Pan
- Department of Paediatric Orthopaedics, The Third Clinical Medicine College of Fujian Medical University, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, China; (Y.L.); (R.L.); (Y.H.); (N.P.)
| | - Shunyou Chen
- Department of Paediatric Orthopaedics, The Third Clinical Medicine College of Fujian Medical University, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, China; (Y.L.); (R.L.); (Y.H.); (N.P.)
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou 350007, China
- Correspondence: ; Tel./Fax: +86-0591-22169176
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Tian P, Kuang L, Li ZJ, Xu GJ, Fu X. Comparison Between Femoral Neck Systems and Cannulated Cancellous Screws in Treating Femoral Neck Fractures: A Meta-Analysis. Geriatr Orthop Surg Rehabil 2022; 13:21514593221113533. [PMID: 35832467 PMCID: PMC9272162 DOI: 10.1177/21514593221113533] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background We performed a meta-analysis to compare the efficacy and safety of the femoral neck system (FNS) with cannulated cancellous screws (CCSs) in treating femoral neck fractures (FNFs) in controlled clinical trials. Methods Eligible scientific articles published prior to September 2021 were retrieved from the PubMed, Web of Science, Springer, ScienceDirect and Cochrane Library databases. The statistical analysis was performed with RevMan 5.1. Results Seven retrospective studies met the inclusion criteria. Meta-analysis showed that there were significant differences in perioperative blood loss, the postoperative Harris score, healing time, fluoroscopy frequency, total complications, femoral head necrosis, femoral neck shortening and screw cutout. No significant differences were found regarding operation time, length of hospital stay or nonunion between the two groups. Conclusion Compared with CCSs, the FNS showed better clinical efficacy and fewer complications in treating FNFs. Due to the limited quality and data of the currently available evidence, more high-quality randomized controlled trials are needed.
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Affiliation(s)
- Peng Tian
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, P.R. China
| | - Lan Kuang
- Department of Orthopedics Emergency, Tianjin Hospital, Tianjin, P.R. China
| | - Zhi-Jun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Gui-Jun Xu
- Department of Orthopedics, Tianjin Hospital, Tianjin, P.R. China
| | - Xin Fu
- Department of Orthopedics, Tianjin Hospital, Tianjin, P.R. China
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Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis. J Orthop 2022; 32:52-59. [DOI: 10.1016/j.jor.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/14/2022] [Accepted: 05/08/2022] [Indexed: 11/18/2022] Open
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Saad A, Patralekh MK, Jain VK, Shrestha S, Botchu R, Iyengar KP. Femoral neck system reduces surgical time and complications in adults with femoral neck fractures: A systematic review and meta-analysis. J Clin Orthop Trauma 2022; 30:101917. [PMID: 35755934 PMCID: PMC9218557 DOI: 10.1016/j.jcot.2022.101917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Femoral neck fractures (FNF) in adults are conventionally managed with surgical options. This paper is aimed to assess the safety, and functional outcomes of the novel Femoral neck system (FNS) for FNF treatment in adult population. METHODS An organized quest of four literature databases (PubMed, Scopus, Web of Science, and Cochrane Library) was performed on March 1, 2022 using the term "femoral neck system". Fixed or random-effect meta-analysis was used to analyse the outcome measures after selecting relevant studies and assessing their quality. Heterogeneity was considered when calculating pooled effect sizes and 95% confidence ranges. RESULTS On comparing FNS with cannulated cancellous screws (CCS) or other methods, in a total of 762 patients (351 FNS and 411 CCS) in the 11 comparative studies considered for meta-analysis, blood loss was pointedly higher overall in the FNS group, mean difference 115.77 ml; 95% CI 3.11 ml, 28.42 ml; test of overall effect: z = 1.68, p = 0.09); with considerable heterogeneity. However, in the FNS group the operative time was substantially lower (Mean difference -7.91 min; 95% CI -15.01, -0.80; test of overall effect: z = 2.18, p = 0.03, with marked heterogeneity). Moreover, complications such as infections, non-union, osteonecrosis, implant cut-out were significantly lower in the FNS group with a Mantel Haenszel Odds ratio of 0.20 (95% CI 0.12, 0.34: Z = 6.01, p < 0.0001). CONCLUSION Keeping in mind the heterogenicity of the studies, -management of adult patients with FNF with FNS can provide results comparable to traditional fixation methods with significantly lower rate of complications.
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Affiliation(s)
- Ahmed Saad
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Mohit Kumar Patralekh
- Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee institute of medical sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
| | - Sagaurav Shrestha
- Foundation Year 2 Doctor in Surgery, Northampton General Hospital, Northampton, NN1 5BD, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review. INTERNATIONAL ORTHOPAEDICS 2022; 46:2105-2115. [PMID: 35538322 PMCID: PMC9372123 DOI: 10.1007/s00264-022-05414-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022]
Abstract
Introduction The recently developed femoral neck system (FNS) for treatment of femoral neck fractures (FNF), comprises theoretical biomechanical advantages compared to other implants. The aim of this study was to validate the safety and to report outcomes of patients treated with the FNS. Method A retrospective multicentric analysis of patients treated by FNS with a minimum of three months of follow-up. Details analysed from three medical centres were operative duration, estimated blood loss, initial hospitalisation duration, fixation quality as well as complications and reoperation rate. Patients who had revision surgery were compared to all other patients to identify risk factors for failure. In addition, a literature review was performed to analyse data on FNS clinical implementation and patient’s outcomes. The two data sets were combined and analysed. Results One-hundred and two patients were included in this study cohort with an average follow-up of seven months (range 3–27). Ten papers were included in the literature review, reporting data on 278 patients. Overall, 380 patients were analysed. Average age was 62.6 years, 52% of the fractures were classified as Gardens 1–2. Overall, the revision rate was 9.2% (14 patients diagnosed with cut-out of implant, 10 with AVN, 8 with non-union and 8 with hardware removal). For the 102 patients in the cohort risk factors for reoperation included patients age, surgeon seniority and inadequate placement of the implant. Conclusion This study shows that FNS is a safe treatment option for FNF. Intra-operative parameters and failure rates are comparable to previously reported rates for this implant and other frequently used implants.
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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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