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 compare the effectiveness of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients. Methods The clinical data of 55 young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture between June 2021 and December 2022 was retrospectively analyzed. All patients were treated with closed reduction and internal fixation with hollow screws, 25 cases were treated with biplanar vertical fixation (study group), 30 cases with inverted triangle fixation (control group). There was no significant difference in gender, age, affected side, cause of injury, underlying diseases, and time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, guide needle puncture times, starting time of weight bearing, time of full weight bearing, time of fracture healing, and complications were recorded and compared between the two groups. The hip joint function was evaluated by Harris score at 1 day, 6 months, 12 months after operation, and at last follow-up, and the pain relief was evaluated by visual analogue scale (VAS) score. The femoral neck shortening was measured on the X-ray film at last follow-up. Results All patients were followed up 12-31 months (mean, 22.0 months), and there was no significant difference in follow-up time between the two groups (P>0.05). The operation time, intraoperative blood loss, and fluoroscopy times in the study group were higher than those in the control group, but the difference was not significant (P>0.05). The guide needle puncture times in the study group was more than that in the control group, and the time of starting weight bearing and the time of full weight bearing in the study group were shorter than those in the control group, the differences were significant (P<0.05). Bony healing was achieved in both groups, and there was no significant difference in fracture healing time between the two groups (P>0.05). No osteonecrosis of the femoral head and incision-related complication was found in the two groups during follow-up, and the femoral neck shortening length in the study group was significantly shorter than that in the control group at last follow-up (P<0.05). There was no significant difference in Harris score between the two groups at 1 day after operation (P>0.05), and the Harris score of the study group was significantly better than that of the control group at other time points (P<0.05); there was no significant difference in VAS score between the two groups at each time point after operation (P>0.05). Conclusion Compared with the inverted triangle fixation, the treatment of Pauwels type Ⅲ femoral neck fracture with biplanar vertical fixation can effectively reduce femoral neck shortening without affecting fracture healing, and improve hip joint function in early stage.
ObjectiveTo investigate the safety and efficacy of sequential use of tranexamic acid (TXA) in the perioperative period of half hip replacement for femoral neck fracture in the elderly.MethodsPatients who underwent hemiarthroplasty due to femoral neck fracture in Meishan Traditional Chinese Medicine Hospital from January 2016 to October 2018 were retrospectively included. According to the use of TXA during the perioperative period, the patients were divided into group A (no use of TXA), group B (TXA use on the day of surgery), and group C (sequential therapy). The perioperative blood loss, blood transfusion rate and incidence of deep vein thrombosis (DVT) in the 3 groups were recorded and counted.ResultsA total of 113 patients were included, and 99 patients were finally included (31 in group A, 36 in group B, and 32 in group C). There were no statistically significant difference in age, sex, body mass index, hemoglobin (Hb) at admission, hematocrit at admission, blood volume, or blood transfusion among the three groups. The differences in total blood loss (F=43.613, P<0.001), preoperative blood loss (F=4.746, P=0.011), preoperative Hb (F=6.220, P=0.003), maximum Hb change (F=18.913, P<0.001), and postoperative length of hospital stay (F=43.511, P<0.001) among the three groups were statistically significant. There was no DVT of the lower extremities or pulmonary embolism found in the three groups. The differences in preoperative blood loss and preoperative Hb were not statistically significant between group A and group B. The difference in postoperative length of hospital stay was not statistically significant between group B and group C. The differences in other indexes between all the pairs of the three groups were statistically significant (P<0.05).ConclusionUsing TXA early after femoral neck fracture and sequentially to the day of surgery can reduce perioperative blood loss, including hidden blood loss before surgery and blood loss during and after the operation, which is beneficial to patients’ postoperative recovery without increasing the risk of DVT.
ObjectiveTo investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. ResultsUnivariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
Objective To estimate clinical effect ofspin iliac deep vascular pedicled periosteum flap in repairing traumatic femoral neck of theca inside fracture in young and middleaged. Methods From April 1993 to September 2001, 12 cases of traumatic femoral neck fracture were given diaplastic operation with fixation of 3 centre hollow pressed bolt and were conducted under os traction bed and "C" arm X-ray machine. Spin iliac deep vascular pedicled periosteum flap wasstripped off, and transferred to the front of femoral neck fundus，then transplanted to the narrow inside of fracture through outer open door of articular capsule.Results All patients were followed up for 17 years. All fracture healedwithout femoral head necrosis, but mild arthritis appeared in 7 cases.Conclusion Vascular pedicled periosteum flap transfer of young and middle-aged femoral neck fracture, by decompression of femoral neck and reconstruction of blood circulation, can promote the fracture healing and decrease the wound and blood circulation destroy.
Objective To investigate the effectiveness of Holosight robotic navigation-assisted percutaneous cannulated screw fixation for femoral neck fractures. Methods A retrospective analysis was conducted on 65 patients with femoral neck fractures treated with cannulated screw fixation between January 2022 and February 2024. Among them, 31 patients underwent robotic navigation-assisted screw placement (navigation group), while 34 underwent conventional freehand percutaneous screw fixation (freehand group). Baseline characteristics, including age, gender, fracture side, injury mechanism, Garden classification, Pauwels classification, and time from injury to operation, showed no significant differences between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency, fracture healing time, and complications were recorded and compared, and hip function was evaluated by Harris score at last follow-up. Postoperative anteroposterior and lateral hip X-ray films were taken to assess screw distribution accuracy, including deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex. Results No significant difference was observed in operation time between the two groups (P>0.05). However, the navigation group demonstrated superior outcomes in intraoperative blood loss, fluoroscopy frequency, deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex (P<0.05). No incision infections or deep vein thrombosis occurred. All patients were followed up 12-18 months (mean, 16 months). In the freehand group, 1 case suffered from cannulated screw dislodgement and nonunion secondary to osteonecrosis of femoral head at 1 year after operation, 1 case suffered from screw penetration secondary to osteonecrosis of femoral head at 5 months after operation; and 1 case suffered from nonunion secondary to osteonecrosis of femoral head at 6 months after operation in the navigation group. All the 3 patients underwent internal fixators removal and total hip arthroplasty. There was no significant difference in the incidence of complications between the two groups (P>0.05). The fracture healing time and hip Harris score at last follow-up in the navigation group were significantly better than those in the freehand group (P<0.05). ConclusionCompared to freehand percutaneous screw fixation, Holosight robotic navigation-assisted cannulated screw fixation for femoral neck fractures achieves higher precision, reduced intraoperative radiation exposure, smaller incisions, and superior postoperative hip function recovery.
Objective To investigate the effectiveness and the advantage of fixation with percutaneous cannulated screws assisted by robot navigation in the treatment of femoral neck fractures by comparing with the conventional surgery. Methods Between January 2013 and December 2014, 20 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation (navigation group), another 18 patients undergoing conventional surgery with manual positioning were chosen as the control group. There was no significant difference in gender, age, cause of injury, the injury side, time from injury to operation, and the classification of fractures between 2 groups (P > 0.05). The operation time, X-ray fluoroscopy time, blood loss, frequency of guide pin insertion, and healing time were recorded. At 1 week after operation, the parallel degree of screws was measured on the anteroposterior and lateral X-ray films; the Harris score was used to evaluate the hip function. Results All incisions of 2 groups healed by first intention after operation. There was no significant difference in operation time between 2 groups (t= -1.139, P=0.262). The blood loss, frequency of guide pin insertion, and X-ray fluoroscopy time of navigation group were significantly less than those of control group (P < 0.05). There were 2 screws penetrating into the joint cavity in control group. The patients were followed up 12-24 months with an average of 18 months. The navigation group got significantly better parallel degree of screws than control group on the anteroposterior and lateral X-ray films (t=25.021, P=0.000; t=18.659, P=0.000). Fractures healed in all patients of navigation group (100%), and the healing time was (21.8±2.8) weeks; fracture healed in 16 patients of control group (88.9%), and the healing time was (24.0 ± 3.7) weeks. There was no significant difference in healing rate and healing time between 2 groups (χ2=2.346, P=0.126; t=1.990, P=0.055). The Harris score of navigation group (87.1±3.7) was significantly higher than that of control group (79.3±4.7) at last follow-up (t= -5.689, P=0.000). Conclusion Cannulated screw fixation assisted by robot navigation is a good method to treat femoral neck fractures, which has the advantages of more accurate positioning, better hip function recovery, less surgical trauma, and shorter X-ray exposure time.
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.
Objective To investigate whether the biomechanical effect of mushroom shaped surface prosthesis on femoral neck is in the scope of safety after the replacement. Methods Four donated fresh-adult specimens of upper femur under the age of 55 years old were used. The strains of detecting points A (lateral) and B (medial) on the narrow place of femoral neck in the standing position were simulated for three stages before or after the prosthesis replacement, namely the pre-replacement, the initial stage during which the interspace of the prosthesis was filled with cancellous bone, and laterstage during which the interspace of the prosthesis was filled with bone cement. Then they were compared by using l inear regression analysis in Excel and rel iabil ity analysis. Results The regression analysis showed that the values of correlation coefficient r were all more than 99% at the different stages, indicating the strain of femoral neck’s cortical bone was proportional to the load and there was no occurrence of the plastic deformation of the femoral neck. For point A, the slope of the trend l ine of strain was 0.671 9 at the pre-replacement stage. The value of the initial stage after replacement was 0.619 2 and its change rate was —7.8%; while corresponding value was 0.662 7 and —1.4% at the later stage after replacement. For point B, the slope of the trend l ine of strain was —1.056 1 at the pre-replacement stage. The value of the initial stage after replacement was — 1.129 2 and its change rate was 6.9%; while corresponding value was —1.085 1 and 2.7% at the later stage after replacement. Conclusion The mechanical strength of femoral neck is in the scope of safety after surface replacement of the femoral head. The change rate of strain at the later stage is smaller than the initial stage.
Objective To compare the efficacy and safety of dynamic hip screw (DHS) + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults. Methods PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, SinoMed, Wanfang, and Chongqing VIP database were searched for the literature related to the comparison between DHS + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults from the establishment of databases to 2022. RevMan 5.3 software was used for meta-analysis. Results Finally, 25 clinical studies were included, including 8 randomized controlled trials and 17 observational studies, 5 in English and 20 in Chinese. There were a total of 2099 patients, including 989 in the DHS + anti-rotation screw group and 1110 in the cannulated screw group. The meta-analysis results showed that the incidence of bone nonunion [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.17, 0.48)], incidence of femoral head necrosis [OR=0.48, 95% CI (0.27, 0.88)], failure rate of internal fixation [OR=0.28, 95% CI (0.15, 0.51)] in the DHS + anti-rotation screw group were lower than those in the cannulated screw group (P<0.05). The surgical duration [mean difference (MD)=9.91, 95% CI (6.78, 13.05)], incision length [MD=1.25, 95% CI (0.15, 2.35)], and Harris score [MD=6.77, 95% CI (4.66, 8.88)] in the DHS + anti-rotation screw group were higher than those in the cannulated screw group (P<0.05). There was no statistically significant difference in intraoperative bleeding volume, Visual Analogue Scale score, hospital stay, and fracture healing time between the two groups (P>0.05). The incidence of bone nonunion in the DHS + anti-rotation screw group after Pauwels type Ⅲ fracture [OR=0.16, 95% CI (0.05, 0.50)] was lower than that in the cannulated screw group (P<0.05), and there was no statistically significant difference in the incidence of femoral head necrosis between the two groups (P>0.05). Conclusions For femoral neck fracture in adults, DHS + anti-rotation screw can reduce the incidence of bone nonunion, femoral head necrosis, and internal fixation failure compared with cannulated screw alone, and has a higher Harris score, but the surgical duration and incision are longer. Overall, DHS + anti-rotation screw are better at reducing the incidence of complications than cannulated screws alone.