Internal fixation of fragility fractures of the femoral neck

Translation of nanotechnology-based implants for orthopedic applications: current barriers and future perspective

The objective of bioimplant engineering is to develop biologically compatible materials for restoring, preserving, or altering damaged tissues and/or organ functions. The variety of substances used for orthopedic implant applications has been substantially influenced by modern material technology. Therefore, nanomaterials can mimic the surface properties of normal tissues, including surface chemistry, topography, energy, and wettability. Moreover, the new characteristics of nanomaterials promote their application in sustaining the progression of many tissues. The current review establishes a basis for nanotechnology-driven biomaterials by demonstrating the fundamental design problems that influence the success or failure of an orthopedic graft, cell adhesion, proliferation, antimicrobial/antibacterial activity, and differentiation. In this context, extensive research has been conducted on the nano-functionalization of biomaterial surfaces to enhance cell adhesion, differentiation, propagation, and implant population with potent antimicrobial activity. The possible nanomaterials applications (in terms of a functional nanocoating or a nanostructured surface) may resolve a variety of issues (such as bacterial adhesion and corrosion) associated with conventional metallic or non-metallic grafts, primarily for optimizing implant procedures. Future developments in orthopedic biomaterials, such as smart biomaterials, porous structures, and 3D implants, show promise for achieving the necessary characteristics and shape of a stimuli-responsive implant. Ultimately, the major barriers to the commercialization of nanotechnology-derived biomaterials are addressed to help overcome the limitations of current orthopedic biomaterials in terms of critical fundamental factors including cost of therapy, quality, pain relief, and implant life. Despite the recent success of nanotechnology, there are significant hurdles that must be overcome before nanomedicine may be applied to orthopedics. The objective of this review was to provide a thorough examination of recent advancements, their commercialization prospects, as well as the challenges and potential perspectives associated with them. This review aims to assist healthcare providers and researchers in extracting relevant data to develop translational research within the field. In addition, it will assist the readers in comprehending the scope and gaps of nanomedicine's applicability in the orthopedics field.

Dynamic compression locking system versus multiple cannulated compression screw for the treatment of femoral neck fractures: a comparative study

BACKGROUND

Femoral neck fractures are one of the problems in clinical treatment. The prognosis is uncertain. Currently, No internal fixation method is superior to other internal fixation methods in the treatment of femoral neck fractures. Therefore, the internal fixation system needs to be further explored. The aim of this study was to compare clinical outcomes of femoral neck dynamic compression locking system (DCLS) and multiple cannulated compression screws(MCCS) in the treatment of femoral neck fractures.

METHODS

A prospective analysis of 54 cases of femoral neck fractures treated with either a DCLS (n = 28) or MCCS (n = 26) was conducted between December 2015 and November 2017 in authors' hospitals. The perioperative and postoperative parameters of the two groups were recorded and evaluated.

RESULTS

Fifty-four patients were followed up for 24-47 months. The etiology was caused by a fall. There was no significant difference in follow-up time, operation time, incision length, surgical blood loss, the incidence of perioperative and postoperative healing complications, and mobility in the two groups (all P > 0.05). The Harris score, fracture healing time, femoral neck shortening, partial weight-bearing time and complete weight-bearing time were significantly better in the DCLS group than in the MCCS group (all P < 0.05). The fracture healing rate in the DCLS group was higher than that in the MCCS group.

CONCLUSIONS

The DCLS and MCCS might be equally effective in terms of operation time, incision length, surgical blood loss, the incidence of perioperative and postoperative healing complications, and mobility in the treatment of femoral neck fractures. However, the DCLS is superior to the MCCS in Harris score, fracture healing time, femoral neck shortening, weight-bearing time and fracture healing rate. So, DCLS deserves further study.

Minimally invasive open reduction combined with proximal femoral hollow locking plate in the treatment of Pauwels type III femoral neck fracture

Objective

This study was performed to investigate the clinical effects of minimally invasive open reduction and internal fixation with a proximal femoral hollow locking plate on Pauwels type III femoral neck fractures.

Methods

The clinical data of 45 patients aged 32.0 ± 8.1 years (range, 19–45 years) with Pauwels type III femoral neck fractures treated from March 2012 to August 2016 were retrospectively analyzed. All patients underwent anterolateral minimally invasive open reduction and proximal femoral hollow locking plate fixation of the hip joint. Garden’s index was used to evaluate the quality of fracture reduction. Complications and fracture healing were recorded in all patients. At the last follow-up, the functional outcome was recorded using the Harris hip score.

Results

No complications such as femoral neck shortening, internal fixation loosening, or refracture occurred. However, three patients required reoperation (one with nonunion and two with femoral head necrosis). At the last follow-up, the mean Harris hip score was 92.1 ± 4.5 (range, 76–98). The rate of excellent and good Harris hip scores was 93.3%.

Conclusion

The herein-described strategy for Pauwels type III femoral neck fractures is advantageous in terms of high reduction quality, firm fixation, and prevention of neck shortening.

Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

We examined the feasibility of radiostereometric analysis (RSA) in the assessment of the initial stability of internally fixed femoral neck fractures. The study included 16 patients (mean age 73 years). During surgery, multiple RSA-beads were inserted on both sides of the fracture. Radiographs for RSA were taken in the supine position within the first 3 days and 6, 12, 24, and 52 weeks after surgery. To detect any inducible motion at the fracture-site, radiographs for RSA were taken with the patient resting or applying a load through the fracture. Fracture loading was achieved by the patient pressing the ipsilateral foot as much as tolerated on a force plate while providing a counterforce through both hands. Micromotion exceeding the precision values of RSA (≥0.3 mm for the translation vector and/or ≥1.2 degrees for the rotation vector) was considered significant. Permanent three-dimensional fracture-site displacement was also recorded. Voluntary loading induced fracture-site micromotion, which exhibited a dichotomous distribution. In patients with uncomplicated fracture union, inducible micromotion was detectable only at baseline-if at all. Conversely, fractures that developed a nonunion were characterized by the continuation of inducible micromotion beyond baseline. Permanent fracture-site displacement was, on average, nearly an order of magnitude greater than the inducible micromotion. Fracture unions were characterized by the cessation of permanent fracture-site displacement by 12 weeks. Nonunions presented as outliers in permanent fracture-site displacement. Large-scale studies are warranted to evaluate whether the detection of inducible micromotion beyond baseline could serve as an indicator of insufficient fixation stability. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.

The clinical application of a novel method of internal fixation for femoral neck fractures-dynamic locking compression system

Background

Femoral neck fractures are the commonly encountered injury in orthopedic practice and result in significant morbidity and mortality. Currently, how to treat femoral neck fractures safely and effectively is still a challenge. The objective of this study is to evaluate the efficiency of dynamic compression locking system for femoral neck fractures.

Methods

This is a retrospective study conducted from May 2015 to October 2016. The study included 36 patients suffering from femoral neck fractures who underwent closed reduction and were fixed using dynamic compression locking system. All surgeries were performed by the same surgeon. The study was conducted by telephone and on-site follow-up. The Garden classification and anatomical site classification were categorized for all patients. We assessed radiographic outcomes of union, femoral neck shortening, screw back-out, and femoral head avascular necrosis. We also evaluated functional outcome using the Harris hip score. Other outcomes included the length of surgery, duration of hospital stay, injury to surgery time, intraoperative hemorrhage, time to clinical bone union, and other fracture complications.

Results

All patients were followed up 12 to 29 months with an average of 21.58 ± 5.41 months. All cases were caused by falls including 17 males and 19 females with an average age of 65.33 ± 9.30 years old ranging from 53 to 82 years old. Among them, injury to surgery time ranged between 1 and 4 days with an average of 2.58 ± 1.05 days. Duration of hospital stay was 8 to 21 days with an average of 15.33 ± 3.71 days. Intraoperative hemorrhage was 40 to 80 ml with an average of 61.67 ± 12.31 ml. Operation time was from 35 to 80 min with average of 50.25 ± 11.77 min. According to Garden classification, 9 cases (25%) were type II and 27 cases (75%) were type III. According to the anatomical site classification, 8 cases (22.2%) were subcapital femoral neck fractures, 19 cases (52.8%) trans-cervical, and 9 cases (25%) basi-cervical. At present, the follow-up has not found the fracture complications of femoral head avascular necrosis, fracture nonunion, and re-fracture. All patients achieved solid bone union. The mean time of clinical bone union was 3 to 4 months. Among all patients, there were only 3 cases of femoral neck shortening < 5 mm and 1 case of screw back-out = 4 mm. For Harris scoring, average Harris scale at the end of the follow-up was 93.42 ± 3.95 ranging from 85 to 98. There were 32 cases of excellent function scores on the Harris scale and 4 cases of good function scores on the Harris scale. Therefore, the excellent and good rate of Harris hip scores was 100%.

Conclusions

Femoral neck dynamic compression locking system for femoral neck fractures in elderly patients can provide effective stability and reduce complications and revision rates.