Comparison of effectiveness of two cannulated screw configurations in the treatment of femoral neck fractures in young adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhaodong ,  GUAN Jianzhong , WU Min , ZHU Zhonglian , ZHOU Pinghui , LIU Yajun , XU Chen , ZHAO Yupeng

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China;

Corresponding?author：

GUAN Jianzhong, Email: jzguan2002@163.com

Keywords：

Young adults; femoral neck fracture; cannulated screw; inverted triangle; rhomboid

DOI：

10.7507/1002-1892.202009103

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate and analyze the effectiveness of internal fixation with the two different cannulated screw implanting methods of rhomboid and inverted triangle in the treatment of femoral neck fracture in young adults.Methods The clinical data of 38 young adults with femoral neck fracture who met the selection criteria between January 2018 and August 2019 were retrospectively analyzed. According to the different methods of cannulated screw implanting, the patients were divided into two groups, 19 cases in each group. The trial group was treated with closed reduction and cannulated screw rhombic distribution internal fixation, while the control group was treated with closed reduction and cannulated screw inverted triangular distribution internal fixation. There was no significant differences in patients’ gender, age, cause of injury, Garden classification of fracture, and time from injury to operation between the two groups (P>0.05). The fracture healing time, the incidence of nonunion, femoral neck shortening, and femoral head necrosis were recorded and compared between the two groups; the effectiveness was evaluated by Harris score and visual analogue scale (VAS) score at last follow-up.Results The incisions of the two groups healed by first intention. All patients were followed up 12-24 months with an average of 15.5 months. There were 1 case of fracture nonunion and 2 cases of shortening of femoral neck in the trial group; while there were 2 cases of fracture nonunion, 1 case of necrosis of femoral head, and 6 cases of femoral neck shortening in the control group; the difference in the incidence of complications (15.8% vs. 47.4%) between the two groups was significant (χ²=4.385, P=0.036). The remaining 18 cases in the trial group and 17 cases in the control group all achieved osteonal union, and the healing time was (14.8±1.6) weeks and (15.9±1.3) weeks, respectively, showing no significant difference between the two groups (t=1.265, P=0.214). At last follow-up, Harris score and VAS score of the trial group were 88.9±4.3 and 1.1±0.7, respectively, while those of the control group were 86.9±5.9 and 1.3±0.9, respectively, showing no significant difference (t=0.603, P=0.550; t=1.152, P=0.257). Hip function was evaluated in accordance with Harris score, the results were excellent in 12 cases, good in 6 cases, and fair in 1 case in the trial group, the excellent and good rate was 94.74%; the results were excellent in 10 cases, good in 7 cases, and fair in 2 cases in the control group, the excellent and good rate was 89.47%; there was no significant difference in the excellent and good rate between the two groups (χ²=0.368, P=0.544).Conclusion The short-term effectiveness of the two kinds of cannulated screw implanting methods is clear, rhomboid fixation of 4 screws has strong stability with stress distribution, which can effectively reduce the incidence of femoral neck shortening, fracture nonunion, femoral head necrosis, and other complications.

Citation： WANG Zhaodong, GUAN Jianzhong, WU Min, ZHU Zhonglian, ZHOU Pinghui, LIU Yajun, XU Chen, ZHAO Yupeng. Comparison of effectiveness of two cannulated screw configurations in the treatment of femoral neck fractures in young adults. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 318-322. doi: 10.7507/1002-1892.202009103 Copy

1.	Wani IH, Sharma S, Latoo I, et al. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa- and septuagenarians. J Orthop Traumatol, 2014, 15(3): 209-214.
2.	王秀萍, 孫瑞波, 劉又文, 等. 空心釘內固定治療股骨頸骨折: 關節功能恢復的影響因素分析. 中國組織工程研究, 2017, 21(19): 2999-3004.
3.	Filipov O, Stoffel K, Gueorguiev B, et al. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg, 2017, 137(6): 779-788.
4.	王建, 冉建, 劉修信, 等. 空心釘“F”技術與倒三角形方式布釘治療股骨頸骨折的療效比較. 中國矯形外科雜志, 2016, 24(24): 2243-2246.
5.	張成寶, 馬信龍, 馬劍雄, 等. 股骨頸骨折空間移位程度與內固定術后股骨頭缺血性死的相關性研究. 中華創傷骨科雜志, 2016, 18(2): 133-137.
6.	任棟, 程培焱, 宋朝暉, 等. 不同數量和空間構型的空心拉力螺釘治療股骨頸骨折的有限元分析. 中華創傷雜志, 2017, 33(9): 815-822.
7.	遠東濤, 張紹安, 吳廣良, 等. 富血小板血漿聯合中空螺釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2020, 22(3): 263-267.
8.	中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
9.	Elgeidi A, El Negery A, Abdellatif MS, et al. Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution. Arch Orthop Trauma Surg, 2017, 137(10): 1363-1369.
10.	劉儒. Pauwels Ⅲ型股骨頸骨折的手術方式選擇及近期療效比較. 廣州醫科大學學報, 2017, 45(1): 49-52.
11.	胡家朗, 李紹剛, 陳明, 等. 動力加壓鎖定釘板系統與空心拉力螺釘固定 Pauwels Ⅲ型股骨頸骨折的生物力學比較. 中華骨科雜志, 2018, 38(21): 1322-1329.
12.	Halawi MJ, Brigati D, McBride JM, et al. Surgical hip dislocation through a direct lateral approach: A cadaveric study of vascular danger zones. J Clin Orthop Trauma, 2017, 8(3): 281-284.
13.	Ghijselings SG, Driesen R, Simon JP, et al. Distal extension of the direct anterior approach to the hip: A cadaveric feasibility study. J Arthroplasty, 2017, 32(1): 300-303.
14.	魏志輝, 馬坤龍, 張銘華. 4 枚空心釘與動力髖螺釘結合防旋螺釘內固定治療股骨頸骨折的療效比較. 中國骨與關節損傷雜志, 2017, 32(2): 187-188.
15.	龍亞周, 張樹明, 王奎友, 等. 股骨頸骨折空心釘固定閉合復位治療策略. 中國修復重建外科雜志, 2016, 30(7): 809-814.
16.	虎偉山, 李山珠, 袁鋒. 三枚和四枚空心釘內固定治療股骨頸骨折的比較研究. 中國骨與關節損傷雜志, 2013, 28(4): 307-309.
17.	吳乾, 袁振, 郝躍峰, 等. 按骨折線傾斜角分型Ⅲ型青壯年股骨頸骨折的治療進展. 中華關節外科雜志 (電子版), 2018, 12(6): 42-45.
18.	張浩, 史雪峰, 楊春寶, 等. 三枚與四枚螺釘置入治療 Pauwels Ⅲ型股骨頸骨折的有限元分析. 中國組織工程研究, 2016, 20(26): 3897-3902.
19.	呂金柱, 朱求亮, 羅建民, 等. 4 枚空心釘與鎖定鋼板內固定治療粉碎性股骨頸骨折臨床療效分析. 中國骨與關節損傷雜志, 2017, 32(12): 1283-1284.
20.	Kauffman JI, Simon JA, Kummer FJ, et al. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study. J Orthop Trauma, 1999, 13(3): 155-159.
21.	Rajnish RK, Haq RU, Aggarwal AN, et al. Four screws diamond configuration fixation for displaced, comminuted intracapsular fracture neck femur in young adults. Indian J Orthop, 2019, 53(1): 70-76.
22.	Pathrot D, Ul Haq R, Aggarwal AN, et al. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects. Indian J Orthop, 2016, 50(3): 269-276.

1. Wani IH, Sharma S, Latoo I, et al. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa- and septuagenarians. J Orthop Traumatol, 2014, 15(3): 209-214.
2. 王秀萍, 孫瑞波, 劉又文, 等. 空心釘內固定治療股骨頸骨折: 關節功能恢復的影響因素分析. 中國組織工程研究, 2017, 21(19): 2999-3004.
3. Filipov O, Stoffel K, Gueorguiev B, et al. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg, 2017, 137(6): 779-788.
4. 王建, 冉建, 劉修信, 等. 空心釘“F”技術與倒三角形方式布釘治療股骨頸骨折的療效比較. 中國矯形外科雜志, 2016, 24(24): 2243-2246.
5. 張成寶, 馬信龍, 馬劍雄, 等. 股骨頸骨折空間移位程度與內固定術后股骨頭缺血性死的相關性研究. 中華創傷骨科雜志, 2016, 18(2): 133-137.
6. 任棟, 程培焱, 宋朝暉, 等. 不同數量和空間構型的空心拉力螺釘治療股骨頸骨折的有限元分析. 中華創傷雜志, 2017, 33(9): 815-822.
7. 遠東濤, 張紹安, 吳廣良, 等. 富血小板血漿聯合中空螺釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2020, 22(3): 263-267.
8. 中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
9. Elgeidi A, El Negery A, Abdellatif MS, et al. Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution. Arch Orthop Trauma Surg, 2017, 137(10): 1363-1369.
10. 劉儒. Pauwels Ⅲ型股骨頸骨折的手術方式選擇及近期療效比較. 廣州醫科大學學報, 2017, 45(1): 49-52.
11. 胡家朗, 李紹剛, 陳明, 等. 動力加壓鎖定釘板系統與空心拉力螺釘固定 Pauwels Ⅲ型股骨頸骨折的生物力學比較. 中華骨科雜志, 2018, 38(21): 1322-1329.
12. Halawi MJ, Brigati D, McBride JM, et al. Surgical hip dislocation through a direct lateral approach: A cadaveric study of vascular danger zones. J Clin Orthop Trauma, 2017, 8(3): 281-284.
13. Ghijselings SG, Driesen R, Simon JP, et al. Distal extension of the direct anterior approach to the hip: A cadaveric feasibility study. J Arthroplasty, 2017, 32(1): 300-303.
14. 魏志輝, 馬坤龍, 張銘華. 4 枚空心釘與動力髖螺釘結合防旋螺釘內固定治療股骨頸骨折的療效比較. 中國骨與關節損傷雜志, 2017, 32(2): 187-188.
15. 龍亞周, 張樹明, 王奎友, 等. 股骨頸骨折空心釘固定閉合復位治療策略. 中國修復重建外科雜志, 2016, 30(7): 809-814.
16. 虎偉山, 李山珠, 袁鋒. 三枚和四枚空心釘內固定治療股骨頸骨折的比較研究. 中國骨與關節損傷雜志, 2013, 28(4): 307-309.
17. 吳乾, 袁振, 郝躍峰, 等. 按骨折線傾斜角分型Ⅲ型青壯年股骨頸骨折的治療進展. 中華關節外科雜志 (電子版), 2018, 12(6): 42-45.
18. 張浩, 史雪峰, 楊春寶, 等. 三枚與四枚螺釘置入治療 Pauwels Ⅲ型股骨頸骨折的有限元分析. 中國組織工程研究, 2016, 20(26): 3897-3902.
19. 呂金柱, 朱求亮, 羅建民, 等. 4 枚空心釘與鎖定鋼板內固定治療粉碎性股骨頸骨折臨床療效分析. 中國骨與關節損傷雜志, 2017, 32(12): 1283-1284.
20. Kauffman JI, Simon JA, Kummer FJ, et al. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study. J Orthop Trauma, 1999, 13(3): 155-159.
21. Rajnish RK, Haq RU, Aggarwal AN, et al. Four screws diamond configuration fixation for displaced, comminuted intracapsular fracture neck femur in young adults. Indian J Orthop, 2019, 53(1): 70-76.
22. Pathrot D, Ul Haq R, Aggarwal AN, et al. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects. Indian J Orthop, 2016, 50(3): 269-276.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of effectiveness of two cannulated screw configurations in the treatment of femoral neck fractures in young adults

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content