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.
ObjectiveTo investigate the clinical e cacy of hip arthroplasty in treating intracapsular femoral neck fracture in elderly patients. MethodsFrom January 2010 to December 2012, 198 patients with intracapsular femoral neck fractures (Garden Ⅲ and Ⅳ ), aged between 65 and 85 years old were selected to be treated with hip arthroplasty. Clinical evaluation including Harris hip score, Barthel index, postoperative complications and activities of daily living were performed. ResultsThe patients were followed up for an average time of 15.6 months. At the follow-up time of 12 months, the Harris scores were 85-98, averaging 94.5; the Barthel indexes were 86-97, averaging 94.0. The main postoperative complications were subcutaneous fat necrosis (3 cases), deep venous thrombosis of lower limbs (2 cases), bedsores (2 cases), pulmonary infection (4 cases), dislocation (2 cases) and pain (4 cases). More than 95% of the patients had a satisfactory treatment and recovered activities of daily living. ConclusionHip arthroplasty reduces postoperative complications caused by prolonged bed rest and helps the patients get back to normal activities of daily living early, so it is an effective method to treat intracapsular femoral neck fractures and is suitable for widespread clinical application.
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.
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 evaluate the feasibility and short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in the middle-aged and elderly patients. Methods A retrospective analysis was made on the clinical data of 13 patients with femoral neck fracture undergoing fixation with polyaxial locking plates between September 2013 and June 2015 (group A) and 13 patients with femoral neck fracture undergoing fixation with three cannulated screws in the same period (group B). There was no significant difference in gender, age, side, cause of injury, Garden type, type of fracture position, type of Pauwels angle, Singh index, time between injury and operation, and preoperative complications between 2 groups (P>0.05). The femoral neck shortening at 1 year postoperatively, and fracture nonunion, femoral head necrosis, and Harris hip score at last follow-up were compared between 2 groups. Results The follow-up time was (19.23±3.98) months in group A and (18.00±3.61) months in group B, showing no significant difference between 2 groups (t=2.063,P=0.417). No femoral head necrosis occurred in group A, but head necrosis occurred in 1 case of group B, and hemiarthroplasty was performed. There was no significant difference in the rate of femoral head necrosis between 2 groups (χ2=0.000,P=1.000). Bone union was obtained in the other patients of 2 groups. The Harris hip score of group A (85.23±2.95) was significantly higher than that of group B (81.92±3.64) at last follow-up (t=2.064,P=0.018). No infection or internal fixation failure occurred in 2 groups. One case had pain at the outer thigh at 1 month after operation in group A, but pain relief was achieved at 3 months after operation. At 1 year after operation, no femoral neck shortening occurred in group A, but degree I, II, and III femoral neck shortening was observed in 3, 2, and 8 cases of group B, respectively, showing significant difference between 2 groups (Z=–4.714,P=0.000). Conclusion Although fixation with polyaxial locking plate for femoral neck fracture in the middle-aged and elderly patients has similar femoral head necrosis rate to fixation with cannulated screws, it has advantages in preventing neck shortening and improving hip joint function after operation.
Objective To study the application and the curative effect of compressed screw and sartorius bone flap in treating femoral neck fractures in youth or middle age. Methods From February 1996 to December 2004, 86 patients with femoral neck fracture were treated by open reduction compressed screw and sartorius bone flap, aging from 21 to 49 years. Fracture was caused by traffic accident in 35 cases, fall from height in 27 cases and fall in 24 cases. Accoding to Garden classification, 23 cases were type Ⅱ, 25 cases were type Ⅲ, and 15 cases were type Ⅳ. We analyzed fracture healing and evaluate function by observation of the postoperative X-ray films. Results Of the 86 patients, 62 were followed up 6 months to 7 years (2 years and 5 months on average). According to Weijie’s criterion for nonunion and necrosis offemoral head, nonunion occurred in 4 cases; the healing rate of fracture was 93.5%. In healed patients, necrosis of femoral head occurred in 7 cases (11.3%) after 3 years. The results of hip joint function evaluation were excellent in 44 cases, good in 8 cases, fair in 6 cases and poor in 4 cases; and the excellent and good rate was 83.9%. Conclusion Compressed screw and sartorius bone flap was simple and effective for femoral neck fractures in youth or middle age.
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.
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.
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.
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.