Objective To compare the curative effect of dynamic hi p screw (DHS) combined with anti-rotation screw and cannulated screw in treating patients with Pauwels type II or III femoral neck fracture and to provide the basis for the choice of surgical procedure. Methods Between March 2008 and September 2009, 51 patients with fresh Pauwels type II or III femoral neck fracture were treated with DHS combined with anti-rotation screw (DHS group) and three cannulated screws (cannulated screw group). The DHS group included 23 patients, 13 males and 10 females, aging 27-59 years (mean, 43.2 years); fracture was caused by fall ing in 1 case, by traffic accident in 17, by fall ing from height in 5 with a mean time of 27 hoursfrom injury to hospital ization (range, 12-70 hours); and 23 fractures included 9 Pauwels type II and 14 Pauwels type III femoral neck fracture. The cannulated screw group included 28 patients, 12 males and 16 females, aging 20-60 years (mean, 40.7 years); fracture was caused by fall ing in 1 case, by traffic accident in 22, by fall ing from height in 5 with a mean time of 25 hours from injury to hospital ization (range, 9-38 hours); and 28 fractures included 12 Pauwels type II and 16 Pauwels type III femoral neck fracture. There was no significant difference in the basel ine characteristics between 2 groups (P gt; 0.05). Results The incision heal ing of both groups by first intention was achieved. There were significant differences in operation time, incision size, operation blood loss, the cases of blood transfusion, the amount of blood transfusion, C reaction protein level on the 2nd postoperative day, and hospital ization days between 2 groups (P lt; 0.05). In DHS group, anatomic reduction was observed in 20 cases (86.96%) and satisfactory reduction in 3 cases (13.04%), while in cannulated screw group, anatomic reduction was observed in 25 cases (89.29%) and satisfactory reduction in 3 cases (10.71%) ; there was no significant difference (χ2=0.660, P=1.000). The patients were followed up 12-30 months with an average of 14.8 months. There was no significant difference (P gt; 0.05) in the rate of nonunion (10.71% vs. 0), the implant failure (3.57% vs. 0), and avascular necrosis of the femoral head (10.71% vs. 0) between the DHS group and the cannulated screw group. The union time was (94.5 ± 2.0) days in the DHS group and (106.0 ± 33.5) days in the cannulated screw group, showing no significant difference (t=—1.641, P=0.107). The re-opereation rates and the overall success rates were 25% and 75% in the cannulated group and were 0 and 100% in the DHS group, showing significant differences (χ2=6.650, P=0.012). At last follow-up, there was no significant difference in Harris hip score and visualanalogue scale (VAS) score between DHS group and cannulated screw group (P gt; 0.05). Conclusion The optimal treatment of young adults Pauwels type II or III femoral neck fracture is DHS combined with anti-rotation screw with an high overall success and less compl ications.
Objective To evaluate the effectiveness of unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft. MethodsThe clinical data of 18 patients with unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft between July 2016 and March 2020 were retrospectively analyzed. The age ranged from 22 to 64 years, with a median age of 43 years. The causes of injury included 11 cases of falling injury, 3 cases of traffic accident injury, and 4 cases of fall from height injury. According to Garden classification, the femoral neck fracture was classified as type Ⅲ in 3 cases, type Ⅳ in 15 cases, and all patients were type Ⅲ according to Pauwels classification. The time from injury to operation was 1-5 days, with an average of 2.3 days. The fracture healing time and complications were recorded. The quality of fracture reduction was evaluated by Garden index immediately after operation; at last follow-up, the degree of femoral neck shortening was determined by Zlowodzki method, Harris score was used to evaluate hip function. Results The operation time was 62-98 minutes (mean, 75 minutes); intraoperative blood loss was 101-220 mL (mean, 153 mL). Cannulated screws guide wire was inserted 3-5 times (mean, 4 times). Intraoperative fluoroscopy was performed 9-21 times (mean, 15 times). The hospital stay was 5-11 days (mean, 7.2 days). All the patients were followed up 12-40 months with an average of 17.3 months. There was no postoperative complication such as accumulated pneumonia, lower extremity deep venous thrombosis, nail cutting, nail withdrawal, internal fixation fracture, and so on. There was no fracture nonunion and osteonecrosis of the femoral head during the follow-up; the fracture healing time was 7-15 weeks, with an average of 12.1 weeks. The quality of fracture reduction was evaluated immediately after operation, the results were grade Ⅰ in 15 cases and grade Ⅱ in 3 cases. At last follow-up, there were 2 cases with femoral neck shortening less than 5 mm and 1 case with 5-10 mm. The incidence of femoral neck shortening was 16.7%. The Harris score of hip joint was 73-97, with an average of 93.5; among them, 12 cases were rated as excellent, 3 cases as good, and 3 cases as fair, with an excellent and good rate of 83.3%. ConclusionFor the treatment of unstable femoral neck fracture with posteromedial comminutations, cannulated screws and medial bracing plate combined with bone allograft are dramatically effective due to earlier weight bearing, faster fracture healing, and better hip function recovery.
Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.
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. MethodsThe 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.
Objective To design a new type of three-dimensional honeycomb guide for percutaneous cannulated screw placement in femoral neck fracture and evaluate its effectiveness. Methods The clinical data of 40 patients with femoral neck fracture who met the selection criteria between June 2019 and December 2020 were retrospectively analyzed. According to different intraoperative positioning methods, they were divided into control group (20 cases, free hand positioning screws) and study group (20 cases, new guide assisted positioning screws). There was no significant difference in gender, age, side, cause of injury, Garden classification, and time from injury to operation between the two groups (P>0.05). The operation time, fluoroscopy times, guide needle puncture times, and fracture healing time of the two groups were recorded. The hip function was evaluated by Harris score at last follow-up. At immediate after operation, the following imaging indexes were used to evaluate the accuracy of screw implantation distribution: screw spacing, screw coverage area, distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation. Results All operations were successfully completed, and the guide needle did not penetrate the femoral neck cortex. There was no significant difference in operation time and fluoroscopy times between the two groups (P>0.05); the guide needle puncture times in the study group was significantly less than that in the control group (t=8.209, P=0.000). Imaging detection at immediate after operation showed that the screw spacing and screw coverage area in the study group were significantly greater than those in the control group (P<0.05); the distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation were significantly smaller than those in the control group (P<0.05). All patients were followed up 7-25 months, with an average of 19.3 months. There was no significant difference in follow-up time between the two groups (t=−0.349, P=0.729). There were 2 cases of fracture nonunion in the control group and 1 case in the study group, and the other fractures completely healed. One case of osteonecrosis of the femoral head occurred in the control group. During the follow-up, there was no complication such as vascular and nerve injury, venous thrombosis, screw penetration, withdrawal, breakage, and refracture, etc. There was no significant difference in fracture healing time and Harris score at last follow-up between the two groups (P>0.05). ConclusionThe new three-dimensional honeycomb guide has the advantages of simple structure and convenient use. It can reduce the puncture times of the guide needle and effectively improve the accuracy distribution of cannulated screw implantation.
ObjectiveTo summarize the patterns and research progress of the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter, and to provide a common language among orthopedic surgeons for scientific exchange.MethodsAccording to related literature and authors own experiences concerning the anatomic border between femoral neck and trochanter region, the intertrochanteric line (or intertrochanteric belt) and its capsularligament attachment footprint, fracture patterns, and treatment strategies were reviewed and analyzed.ResultsWith the rapid growing of geriatric hip fractures, an increased incidence was noted in recent years regarding the proximal femoral comminuted fractures that involving ipsilateral intracapsular neck and extracapsular trochanter regions simultaneously. But the concept of femoral neck combined with trochanter fractures was ambiguous. Based on the anatomic type of femoral neck fracture, the location of fracture center, and the ability to achieve direct inferior calcar or anteromedial cortex-to-cortex apposition and buttress, we classified these complex fractures into 3 sub-types: ① Segmental femoral neck fractures (two separate fracture centers at subcapital and trochanteric region respectively); ② Femoral neck fracture (trans-cervical) with extension to the supero-lateral trochanteric region (fracture center in femoral neck); ③ Trochanteric fracture with extension to the medio-inferior femoral neck region (fracture center in trochanter, comminuted basicervical fracture, or variant type of comminuted trochanter fracture). For treatment strategy, surgeons should consider the unique characteristics of femoral neck and trochanter, usually with combined fixation techniques, or arthroplasty supplemented with fixation.ConclusionCurrently there is no consensus on diagnosis and terminology regarding the concomitant ipsilateral fractures of femoral neck and trochanter. Further studies are needed.
ObjectiveTo explore the changes of bone and risk of micro-fracture in femoral head after removal of cannulated screws following femoral neck fracture healing under the impact force of daily stress.MethodsA total of 42 specimens of normal hip joint were collected from 21 adult fresh cadaveric pelvic specimens. Wiberg central-edge (CE) angle, bone mineral density, diameter of femoral head, neck-shaft angle, and anteversion angle of femoral neck were measured. Then, the 3 cannulated screws were implanted according to the AO recommended method and removed to simulate the complete anatomical union of femoral neck fracture. The morphology of screw canal in the femoral head was observed by CT. Finally, the specimens were immobilized vertically within the impact device in an upside-down manner, and the femoral heads were impacted vertically. Every specimen was impacted at 200, 600, and 1 980 N for 20 times with the impacting device. After impact, every specimen was scanned by CT to observe the morphology changes of screw canal in the femoral head. Micro-fractures in the femoral head could be confirmed when there was change in the morphology of screw canal, and statistical software was used to analyze the risk factors associated with micro-fractures.ResultsAfter impact at 200 and 600 N, CT showed that the morphology of screw canal of all specimens did not change significantly compared with the original. After impact at 1 980 N, there were protrusion and narrowing in the screw canal of the 22 femoral head specimens (11 pelvic specimens), showing obvious changes compared with the original screw canal, indicating that there were micro-fractures in the femoral head. The incidence of micro-fracture was 52.38% (11/21). logistic regression results showed that there was correlation between micro-fracture and bone mineral density (P= 0.039), but no correlation was found with CE angle, diameter of femoral head, neck-shaft angle, and anteversion angle (P>0.05).ConclusionThe micro-fractures in the femoral head may occur when the femoral head is impacted by daily activities after removal of cannulated screws for femoral neck fractures, and such micro-fractures are associated with decreased bone density of the femoral head.
ObjectiveTo summarize the characteristics and biomechanical research progress of common internal fixation for femoral neck fractures in recent years, so as to provide reference to clinical treatment of femoral neck fracture. Methods The domestic and foreign relevant literature on biomechanics of internal fixation of femoral neck fracture in recent years was reviewed, and the biomechanical research progress was summarized. Results Among the internal fixations currently used in the treatment of femoral neck fractures, three cannulated screws can provide sliding compression at the end of the fracture, but the shear resistance is weak, and the risk of long-term internal fixation failure is high; dynamic hip screw and proximal femoral locking plate have excellent angle stability and overall strength; medial buttress plate can transform vertical shear force into compressive stress to promote fracture healing and produce a certain anti-rotation effect; femoral neck system can support the fracture in multi-axial direction, with excellent anti-rotation and anti-shortening properties; and cephalomedullary nails have high overall strength and failure load. Different internal fixations have their own indications due to differences in structure and biomechanics. ConclusionAt present, there is no detailed standard guidance of internal fixation selection. Clinically, the appropriate treatment should be selected according to the fracture types of patients.
ObjectiveTo summarize the research progress of femoral neck system (FNS) in the treatment of femoral neck fracture in young and middle-aged patients. Methods The literature on FNS at home and abroad in recent years was extensively reviewed, and the results of mechanical and clinical studies on FNS were summarized based on clinical experience. Results FNS has good mechanical stability, which can reduce complications such as femoral neck shortening, internal fixation failure, and varus caused by mechanical instability. At present, FNS is mainly selected for comparison with cannulated compression screws and dynamic hip screws in clinical research. The results show that FNS has the advantages of minimally invasive, short operation time, less intraoperative fluoroscopy, earlier postoperative weight-bearing and fracture healing, and better hip function recovery. Conclusion As a new internal fixator, FNS has achieved satisfactory results in the current research. FNS has good mechanical advantages, which is beneficial to fracture healing and the recovery of hip joint function after operation. However, whether FNS can reduce the incidence of nonunion and osteonecrosis of the femoral head remains to be further clarified.
Objective To investigate the effects of dexmedetomidine combined with subanesthetic doses of ketamine on cognitive function after surgery for elderly patients with femoral neck fractures. Methods A total of 78 elderly patients with femoral neck fracture who were admitted to hospital between January 2015 and June 2016 were divided into the control group (n=38) and the study group (n=40) according to the admitting time. The cases in the control group were treated with dexmedetomidine given anesthesia and the cases in the study group received dexmedetomidine combined with subanesthetic dose of ketamine. The incidences of postoperative cognitive dysfunction (POCD) and the scores of Mini-mental State Examination (MMSE) and Ramsay scores were compaired, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected. Results There was no difference in operation time, blood loss, blood pressure and oxygen partial pressure between the two groups (P>0.05). The 1-, 3-day postoperative incidences of POCD in the study group were significantly lower than those in the control group (P<0.05). The 1-, 3-, 7-day postoperative MMSE scores and Ramsay sedation scores 1 hour, 3 and 6 hours after stopping anaesthetic drugs in the study group were significantly higher than those in the control group (P<0.05). The 1-, 3-day postoperative serum levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group (P<0.05). Conclusion For elderly patients with femoral neck fracture after surgery, taking dexmedetomidine flax composite drunk dose of ketamine anesthesia method helps to reduce the incidence of postoperative cognitive dysfunction.