Abstract
ObjectiveTo compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures.MethodsA retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type‐3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age, and similar body mass index (BMI). A total of 30 pairs were successfully matched at a 1:1 ratio, including 12 males and 18 females. The average age of the patients in the FNS group was 54.53 ± 6.71 years. In the cannulated screw group, the average age of the patients was 53.14 ± 7.19 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analog scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate, and complication rate were compared between the groups.ResultsPostoperative re‐examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10–22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow‐up, and lower complication rates (P < 0.05). VAS scores were lower in the FNS group (3.13 ± 1.07 scores) than in the cannulated screw group (3.77 ± 1.04 scores) (P = 0.018). Patients in the FNS group (5.23 ± 1.33 months) recovered to walking without crutches earlier than did those in the cannulated screw group (6.03 ± 1.45 months) (P<0.001). In addition, a statistically higher postoperative Harris score was detected in the FNS group (86.16 ± 7.26) than in the cannulated screw group (82.37 ± 7.52) (P = 0.039). Overall, a higher incidence of complications was observed in the cannulated screw group (9/30) than in the FNS group (2/30) (P = 0.042). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P < 0.05). Intraoperative blood loss was greater in the FNS group (99.73 ± 4.69) than in the cannulated screw group (30.27 ± 9.04) (P<0.001). In addition, patients in the FNS group (46976 ± 2270 ¥) spent more on hospitalization costs than did those in the cannulated screw group (15626 ± 1732 ¥) (P<0.001). No statistically significant difference in operation time, hospital stay, or femoral head necrosis rate was observed between the two groups (P > 0.05).ConclusionFor patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive.
Highlights
Femoral neck fractures are often caused by high-energy trauma in young adults
Intraoperative blood loss was greater in the femoral neck system (FNS) group (99.73±4.69) than in the cannulated screw group (30.27±9.04) (P
No significant differences in operation time or hospital stay were detected between the FNS group and the cannulated screw group (P>0.05, Table 1)
Summary
Femoral neck fractures are often caused by high-energy trauma in young adults. For patients with femoral neck fracture who are younger than 65 years old, internal fixation with femoral head preservation is considered to be the first choice[1]. Current opinion remains inconsistent with regard to the selection of internal fixation approaches to achieve better outcomes of fracture end stability, bone union, decreasing incidences of femoral head necrosis and complications[2]. By compressing the fracture end, fixation with three cannulated screws contributes to anatomical reduction, rigid internal fixation and union of femoral neck fractures[3]. Some problems in the fixation of partially unstable femoral neck fractures with three cannulated screws remain[4, 5]
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