Internal fixation using fully threaded cannulated compression screws for fresh femoral neck fractures in adults

Kai-Xuan Yuan,Chen-Yi Jiang,Kai Fu,Dao-Yu Zhu,Peng-Bo Luo,Ze-Hao Wang,Dong-Xu Jin,You-Shui Gao,Xiao-Yuan Peng,Fan Yang

doi:10.1186/s13018-022-03005-8

Kai-Xuan Yuan, Chen-Yi Jiang + Show 8 more

Open Access

https://doi.org/10.1186/s13018-022-03005-8

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Abstract

ObjectivesInternal fixation with multiple cannulated compression screws is an optional treatment for femoral neck fracture. Recently, fully threaded cannulated compression screws (FTCCS) have been introduced to fix fresh femoral neck fractures (FNF). The purpose of this study was to investigate the effectiveness of FTCCS.Patients and methodsPatients with FNF fixed by multiple FTCCS from February 1st, 2014 to August 31st, 2017 were included in this study. They were followed for at least 12 months postoperatively. Nonunion, osteonecrosis of the femoral head (ONFH), fixation failure, reoperation, and femoral neck shortening (FNS) were used to evaluate the outcomes. Risk factors including age, sex, fracture side, fracture displacement, fracture stability, fixation configuration, and screw numbers were analyzed.ResultsA total of 113 patients including 67 males and 46 females with an average age of 48.4 ± 13.4 years were included. The mean duration of follow-up was 27.1 months (range: 12–51 months). The incidence of nonunion, ONFH, fixation failure, and reoperation was 15.9%, 22.1%, 8.8%, and 24.8%, respectively. The rates of nonunion and reoperation were significantly higher in displaced fractures and unstable fractures. And patients with an unstable fracture had a higher risk of internal fixation failure. The median length of FNS was 2.9 mm (interquartile range: 0.9–6.5 mm, range: 0–17.5 mm). Age was a significant risk factor for FNS.ConclusionsThe screw fixation method with FTCCS provided encouraging clinical results which may be a rational choice for the treatment of fresh FNF. Displaced fractures and unstable fractures were attributed to the higher incidence of complications.Trial registration: ChiCTR, ChiCTR1800017200. Registered 17 July 2018-Retrospectively registered, http: www.chictr.org.cn/showprojen.aspx?proj=29182.

Highlights

Femoral neck fractures (FNF) are a dangerous type of musculoskeletal injury and result in significant morbidity and mortality, accounting for 3.6% of all fractures and 53–56% of hip fractures [1]
The screw fixation method with fully threaded cannulated compression screws (FTCCS) provided encouraging clinical results which may be a rational choice for the treatment of fresh FNF
Displaced fractures and unstable fractures were attributed to the higher inci‐ dence of complications

Summary

Introduction

Femoral neck fractures (FNF) are a dangerous type of musculoskeletal injury and result in significant morbidity and mortality, accounting for 3.6% of all fractures and 53–56% of hip fractures [1]. Numerous surgical techniques and implants have been developed and used for the treatment of FNF. Internal fixation using multiple partially threaded cannulated compression screws (PTCCS) remains a standard method for FNF management [7, 8]. These implants hasten to heal through dynamic fracture compression caused by axial loading during weight bearing. Loss of fixation after closed reduction with three PTCCS is reported to be up to 39% within the first three postoperative months [9], and the subsequent complications including femoral neck shortening (FNS), nonunion, avascular necrosis, and malunion were believed to limit physical function [10]

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