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Comparative Study for Osteosynthesis of Femoral Neck Fractures: Cannulated Screws versus Femoral Neck System

  • Youngho Cho (Department of Orthopaedic Surgery, Daegu Fatima Hospital) ;
  • Jae-uk Shin (Department of Orthopaedic Surgery, Daegu Fatima Hospital) ;
  • Sangwoo Kim (Department of Orthopaedic Surgery, Daegu Fatima Hospital)
  • 투고 : 2022.06.10
  • 심사 : 2022.10.29
  • 발행 : 2023.03.31

초록

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.

키워드

참고문헌

  1. Gjertsen JE, Vinje T, Engesaeter LB, et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am. 2010;92:619-28. https://doi.org/10.2106/JBJS.H.01750
  2. Grosso MG, Danoff JR, Padgett DE, Iorio R, Macaulay WB. The cemented unipolar prosthesis for the management of displaced femoral neck fractures in the dependent osteopenic elderly. J Arthroplasty. 2016;31:1040-6. https://doi.org/10.1016/j.arth.2015.11.029
  3. Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ. 2010;340:c2332. https://doi.org/10.1136/bmj.c2332
  4. Stromqvist B, Nilsson LT, Thorngren KG. Femoral neck fracture fixation with hook-pins. 2-year results and learning curve in 626 prospective cases. Acta Orthop Scand. 1992;63:282-7. https://doi.org/10.3109/17453679209154783
  5. Stappaerts KH, Broos PL. Internal fixation of femoral neck fractures. A follow-up study of 118 cases. Acta Chir Belg. 1987;87:247-51.
  6. Phillips JE, Christie J. Undisplaced fracture of the neck of the femur: results of treatment of 100 patients treated by single Watson-Jones nail fixation. Injury. 1988;19:93-6. https://doi.org/10.1016/0020-1383(88)90081-2
  7. Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures: a comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma. 2017;31:131-7. https://doi.org/10.1097/BOT.0000000000000739
  8. Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43-B:647-63. https://doi.org/10.1302/0301-620X.43B4.647
  9. Bartonicek J. Pauwels' classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma. 2001;15:358-60. https://doi.org/10.1097/00005131-200106000-00009
  10. World Health Organization (WHO). Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]. Geneva: WHO; 1994. 843. https://apps.who.int/iris/handle/10665/39142
  11. Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Joint Surg Br. 2006;88:1053-9. https://doi.org/10.1302/0301-620X.88B8.17534
  12. Corrales LA, Morshed S, Bhandari M, Miclau T 3rd. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008;90:1862-8. https://doi.org/10.2106/JBJS.G.01580
  13. Stockton DJ, Lefaivre KA, Deakin DE, et al. Incidence, magnitude, and predictors of shortening in young femoral neck fractures. J Orthop Trauma. 2015;29:e293-8. https://doi.org/10.1097/BOT.0000000000000351
  14. Bishop JA, Behn AW, Castillo TN. The biomechanical significance of washer use with screw fixation. J Orthop Trauma. 2014;28:114-7. https://doi.org/10.1097/BOT.0b013e31829f9805
  15. Zlowodzki MP, Wijdicks CA, Armitage BM, Cole PA. Value of washers in internal fixation of femoral neck fractures with cancellous screws: a biomechanical evaluation. J Orthop Trauma. 2015;29:e69-72. https://doi.org/10.1097/BOT.0000000000000172
  16. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am. 2008;90:2254-66.
  17. Madsen F, Linde F, Andersen E, Birke H, Hvass I, Poulsen TD. Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws. Acta Orthop Scand. 1987;58:212-6. https://doi.org/10.3109/17453678709146468
  18. Kaplan T, Akesen B, Demirag˘ B, Bilgen S, Durak K.Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures. Ulus Travma Acil Cerrahi Derg. 2012;18:65-70. https://doi.org/10.5505/tjtes.2011.33427
  19. Gupta M, Arya RK, Kumar S, Jain VK, Sinha S, Naik AK. Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults. Chin J Traumatol. 2016;19:209-12. https://doi.org/10.1016/j.cjtee.2015.11.021
  20. Baitner AC, Maurer SG, Hickey DG, et al. Vertical shear fractures of the femoral neck. A biomechanical study. Clin Orthop Relat Res. 1999;(367):300-5. https://doi.org/10.1097/00003086-199910000-00037
  21. Blair B, Koval KJ, Kummer F, Zuckerman JD. Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques. Clin Orthop Relat Res. 1994;(306):256-63.
  22. Liporace F, Gaines R, Collinge C, Haidukewych GJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008;90:1654-9. https://doi.org/10.2106/JBJS.G.01353
  23. Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle "vertical" femoral neck fractures in young adult patients. J Orthop Trauma. 2014;28:270-5. https://doi.org/10.1097/BOT.0000000000000014
  24. Hsu MR, Shu HT, Luksameearunothai K, at al. Is there an increased risk for subtrochanteric stress fracture with the Femoral Neck System versus multiple cannulated screws fixation? J Orthop. 2022;30:127-33. https://doi.org/10.1016/j.jor.2022.02.016
  25. Crump EK, Quacinella M, Deafenbaugh BK. Does screw location affect the risk of subtrochanteric femur fracture after femoral neck fixation? A biomechanical study. Clin Orthop Relat Res. 2020;478:770-6. https://doi.org/10.1097/CORR.0000000000000945
  26. Stiasny J, Dragan S, Kulej M, Martynkiewicz J, Plochowski J, Dragan S£. Comparison analysis of the operative treatment results of the femoral neck fractures using side-plate and compression screw and cannulated AO screws. Ortop Traumatol Rehabil. 2008;10:350-61.
  27. Nibe Y, Matsumura T, Takahashi T, Kubo T, Matsumoto Y, Takeshita K. A comparison between the femoral neck system and other implants for elderly patients with femoral neck fracture: a preliminary report of a newly developed implant. J Orthop Sci. 2022;27:876-80. https://doi.org/10.1016/j.jos.2021.04.016
  28. Hu H, Cheng J, Feng M, Gao Z, Wu J, Lu S. Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. J Orthop Surg Res. 2021;16:370. https://doi.org/10.1186/s13018-021-02517-z
  29. Pei F, Zhao R, Li F, Chen X, Guo K, Zhu L. Osteonecrosis of femoral head in young patients with femoral neck fracture: a retrospective study of 250 patients followed for average of 7.5 years. J Orthop Surg Res. 2020;15:238. https://doi.org/10.1186/s13018-020-01724-4
  30. Min BW, Kim SJ. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture. Orthopedics. 2011;34:349. https://doi.org/10.3928/01477447-20110317-13