Antirotation Screw Research Articles

Dual-construct fixation is recommended in ipsilateral femoral neck fractures with infra-isthmus shaft fracture: A STROBE compliant study.

The aim of this study was to evaluate the risk factors related to osteosynthesis failure in patients with concomitant ipsilateral femoral neck and shaft fractures, including old age; smoking habit; comminuted fragments; infra-isthmus fracture; angular malreduction; unsatisfactory reduction (fracture gap >5 mm); and treatment with single construct.Patients over the age of 20 with concomitant ipsilateral femoral neck and shaft fractures diagnosed at a level one medical center between 2003 and 2019 were included. Treatment modalities included single construct with/without an antirotational screw for the neck and dual constructs. Radiographic outcomes were assessed from anteroposterior and lateral hip radiographs at follow-up. Fisher exact test was used to analyze categorical variables. The presence of avascular necrosis of the femoral head, delayed union, atrophic or hypertrophic nonunion of the femoral shaft fracture, and loss of reduction were identified as factors related to treatment failure.A total of 22 patients were included in this study. The average age was 58.5 years, and the majority was male (68.2%). The minimum radiographic follow-up duration was 12 months, and the median follow-up time was 12 (interquartile range 12–24) months.Femoral neck osteosynthesis failed in 3 patients, whereas femoral shaft osteosynthesis failed in 12 patients. Fisher exact test demonstrated the failure of femoral shaft osteosynthesis was significantly more frequent in the single-construct cohort in 16 infra-isthmus femoral fracture cases (P = .034).In ipsilateral femoral neck and infra-isthmus shaft fractures, it is better to treat the neck and shaft fractures with separate implants (dual constructs).In a dual-construct cohort, separate plate fixation of the femoral shaft achieved a better result in terms of bone union than retrograde nailing of the shaft (bone union rate: 4/8 vs 0/2).

Optimal fracture site compression of trochanteric region fracture managed with proximal femoral nailing at the time of surgery: Analysis of clinico-radiological and functional outcome

Objectives: Proximal Femoral Nail (PFN) with dual cephalic screw configuration is now widely used for management of trochanteric region fracture. Good fracture reduction and intraoperative achievement of optimal fracture site compression are very important surgical steps of proximal femoral nailing. There is very limited information available in literature regarding trochanteric region fracture site compression while fixation by PFN with dual cephalic screws (lag and anti-rotation screws). We are practicing a technique of intraoperative compression of fracture site by alternate tightening of lag and anti-rotation screws of PFN. Aim of this study is to evaluate the clinico-radiological and functional outcome of trochanteric region fracture management by PFN with intraoperative adequate fracture site compression achieved by this method. Materials and Methods: Total 47 patients, who underwent PFN fixation for trochanteric region fractures during September 2017 to October 2019 with 12 months follow up period, were included in this prospective study. Fractures were classified according to the AO/OTA system; the most common fracture type 31A2 (n = 28), followed by 31A1 (n = 18) and 31A3 (n = 1). At the time of PFN fixation, fracture site compression was performed by combination of two surgical steps - 1) by giving firm manual pressure towards medial direction with the help of PFN Jig after nail insertion into medullary canal, maintaining this pressure till fixation of both lag and anti-rotation screws and 2) alternate tightening of the anti-rotation and lag screws till final sitting of both screws was achieved. Clinical and radiological parameters including quality of reduction, tip-apex distance (TAD), lateral slide of lag screw, length of both cephalic screws as well as complications were measured. Functional outcome was assessed using Harris Hip Score (HHS). Results: Good reduction was achieved in 89.4% cases. Mean TAD AP (anteroposterior) was 11.6 mm, mean TAD LAT (lateral) was 11.1 mm and mean TAD Total was 22.7 mm. Overall mean lateral slide was 3.2 mm and it was more in unstable 31A2fracture. The HHS at 12 months postoperatively was excellent in 20 (42.6%), good in 16 (34.0%), fair in 5 (10.6%), and poor in 6 patients (12.8%). Conclusion: Intraoperative fracture site compression achieved by alternate tightening of the anti-rotation and lag screws of PFN shows excellent to good results in the management of trochanteric region fractures and a low incidence of complications.

Single lag screw and reverse distal femur locking compression plate for concurrent cervicotrochanteric and shaft fractures of the femur: biomechanical study validated with a clinical series.

The optimal surgical management of concurrent cervicotrochanteric and shaft fractures of the femur has not been consensual. The authors investigated the reliability of combined single lag screw and reverse distal femur locking compression plate (LCP-DF) by finite element (FE) study and retrospectively described the present technique for these dual fractures. Intact femurs were derived from CT data, and the implant models were created by using CAD software. The fractured femur and implant models were virtually aligned based on the surgical techniques before converting to the FE model. In the FE model, applied boundary conditions included body weight, muscle forces, and constraint of the joints. Regarding clinical series, three patients with these dual fractures of the femur and 2 with cervicotrochanteric fractures with subtrochanteric extension were operated on by the proposed technique. The collected data include operative time, postoperative complications, union times, and clinical outcomes. Equivalent von Mises stress exhibited on dynamic hip screws with an anti-rotational screw was higher than the other techniques, close to the yield stress of the material. Multiple screw fixation produced better stability for transcervical fractures whereas the proposed technique of combined single lag screw and reverse LCP-DF provided better stability for intertrochanteric fractures. No significant difference in cortical bone stress was found between multiple screw construct and the proposed technique. The proposed technique presented a lower risk of secondary fractures, as the strain energy density (SED) in cancellous bone was lower than multiple screw construct. Regarding clinical series, all fractures were united with a mean union time of-16.1weeks (range 12-20). There were no any postoperative complications. Regarding the Harris score, 1 was determined to be excellent value, and 4 to be good. By the FE results, a combination of a single lag screw and reverse LCP-DF is an effective technique for fixation of cervicotrochanteric fractures. Empowered by the clinical results, this proposed technique could be an alternative for concurrent cervicotrochanteric and shaft fractures of the femur especially when either single-system or dual-system devices seem not to be suitable.

Clinical Results of Dual SC Screw: A Mini-Sliding Hip Screw with an Anti-rotating Screw for Femoral Neck Fractures.

BackgroudDual SC screw (DSCS) is a unique concept internal fixation device consisting of a sliding screw and barrel assembly that enables compression force to be applied to the femoral neck fracture side. There are two types of barrels: a thread barrel and a plate barrel that has a one-holed side plate to prevent varus deformity. We report clinical results of the application of a DSCS with combined use of a thread barrel screw as an anti-rotational screw and a plate barrel screw as a compression hip screw.MethodsWe used DSCS for femoral neck fractures in 196 hip joints of 190 patients between November 2005 and June 2017. Among them, 70 hips in 66 patients (13 men and 53 women; mean age, 73.2 years) were followed up for at least 24 months. There were 53 nondisplaced fractures (Garden's classification stage 1 or 2) and 17 displaced fractures (stage 3 or 4). We evaluated the postoperative walking ability of the patients who were followed up for at least 24 months and examined details of all complications.ResultsThe mean follow-up period was 37.4 months (range, 24–144 months). Forty-two (64%) out of the 66 patients who were followed up for at least 2 years were able to walk independently with or without a cane. The incidence of complications was 11.5% in nondisplaced fractures and 17.5% in displaced fractures, and arthroplasty was required in 5.8% and 5.0%, respectively. The most frequent complication was secondary displacement including cutout and shortening of the femoral neck, but no implants showed varus displacement.ConclusionsThe application of DSCS for the treatment of femoral neck fractures had satisfactory results. The complication rate was low, and there was no postoperative varus displacement of DSCS in either displaced or nondisplaced fractures. We suggest DSCS is a reliable option for both displaced and nondisplaced femoral neck fractures.

Clinical analysis of internal fixation femoral neck fractures with two or three cannulated screws

Introduction/Objective. Angular stability and dynamic fixation are key factors to successful healing of femoral neck fractures. The objective was to evaluate the efficacy of internal fixation of femoral neck fractures with two parallel self-tapping antirotation screws (SAF) compared to standard, three cannulated cancellous screws (CCS) fixation. Methods. In total 100 fractures were retrospectively analyzed, divided in two groups in which two SAF screws were used in parallel (n = 50) or three standard screws in an inverted triangle configuration (n = 50). The groups were compared with operation time, time of consolidation, femoral neck shortening, Harris hip score and reoperation rates. Results. SAF parallel fixation group of patients achieved consolidation rate of 86% compared to 74% in CCS fixation group, without statistically significant difference between the examined groups (p > 0,05). Dynamization of implants was significantly positively correlated with the fracture healing time in both examined groups (SAF: r = 0.324, p = 0.025; CCS: r = 0.572, p = 0.001), with significantly shorter healing time in SAF patients ? on average 15 weeks (15.02 ? 1.44) in relation to the CCS group of patients ? 19 weeks (19.81 ? 2.94) (?2/z = 7.048, p < 0.001). There was no statistically significant difference in the Harris hip score and reoperation rate among the study groups (?2 = 2.44, p = 0.487; ?2 = 0.500, p = 0.696). Conclusion. Our results suggested that dual parallel fixation is simpler, less invasive and it demands less performance time. It is not inferior to fixation with three screws, from the point of biomechanics, possible complications, healing and functional recovery.

Comparative study of PFN vs PFNA 2 in intertrochanteric fractures: A randomised control trial

Introduction: As the life expectancy increases due to improved medical facilities, it leads to increased incidence of intertrochamteric fracture. The intertrochanteric fractures can be managed by conservative methods or by surgery. PFN comprise of an intramedullary nail with two screws of which one is the lag screw settling the fracture as it collapses and other is antirotation screw giving the rotational stability. PFN comprise of an intramedullary nail with two screws of which one is the lag screw settling the fracture as it collapses and other is antirotation screw giving the rotational stability. Aim of our study is to analyze both the intramedullary devices as functional outcome and implant related complications. Material and Method: A prospective, randomized, comparative study of 60 patients. This study was conducted in Patna Medical College and Hospital, Patna, Bihar, between June 2017- June 2019 for two Years. Conclusion: From the study we concluded that the PFNA2 reduces the surgery time, blood loss, and image shots number as compared to PFN. As the union rate is more with PFNA2, the functional outcome is significantly better with PFNA2 than PFN. Implant related late complication is more with PFN which was markedly reduced with PFNA2.

In vitro biomechanical comparison of various implants in Pauwels type 3 fracture neck femur

<p class="abstract"><strong>Background:</strong> The objective of this study was to find out the correlation among type of implant, type of fracture and quality of bone in a cadaveric model of unstable fracture neck of femur (Pauwels type 3) fixed with either; proximal femoral nail (PFN), dynamic hip screw (DHS), dynamic hip screw with an anti-rotation screw (DHS and ARS) or cannulated cancellous screws (CCS).</p><p class="abstract"><strong>Methods:</strong> This study was conducted on 24 cadaveric bones (6 in each group) in which unstable fracture neck of femur (Pauwels type 3) were created and fractures in each group were fixed with different implants after creating a comparable group using DEXA scan. These were tested on a cyclic physiological loading machine at 2 cycles per second with a load of 200kg. The test was observed for 10,000 loading cycles or till failure whichever occurred earlier. Subsidence was measured and analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Five specimens in the PFN group, 3 specimens in the DHS and ARS and DHS group completed 10,000 cycles while all the specimens in CCS group failed before 10000 cycles. Mean subsidence of the PFN group was significantly lower than the other groups.</p><p class="abstract"><strong>Conclusions:</strong> PFN constructs were stronger than the other constructs. However, these data must be interpreted as strictly biomechanical, representing only part of the scenario at work in vivo. Nonetheless, the significant findings of increased strength of fixation over the DHS, DHS with ARS and CCS certainly appear to support the use of PFN clinically.</p><p class="abstract"> </p>

Modified Short Proximal Femoral Nail for Intertrochanteric Fractures of Femur in Indian Patients - our Experience.

Introduction:Proximal femoral nail (PFN) is a commonly used implant for intertrochanteric fractures which is designed according to western femoral measurements. However, anthropometry of proximal femur in Indian and in general, Asian, are smaller. So a modified short PFN with smaller dimensions was developed. This study analyses the radiological and functional outcome of treatment of intertrochanteric fractures with modified short PFN.Materials and Methods:A retrospective study analysed 120 adult patients operated between 2014-2017 using modified short PFN for intertrochanteric fractures, having a minimum follow-up of 12 months. Clinical and radiological parameters including tip-apex distance (TAD), position of tip of lag screw in femoral head, lateral slide of lag screw as well as length of anti-rotation screw were measured. Final functional outcome was assessed using Barthel’s index and Kyle’s criteria.Results:Good reduction was achieved in 90.83% cases and 79.16% had ideal placement of lag screw in femoral head. Intra-operative difficulties were encountered in 13.33% (n=16). Mean TAD AP (anteroposterior) was 11.8mm, TAD LAT (lateral) was 11.0mm and mean TAD TOT was 22.8mm. Overall mean lateral slide was 3.20mm and it was more in unstable fracture. We had five mechanical failures, one patient with screw breakage without loss of reduction and two peri-implant fractures after union. 81.66% returned to pre-injury levels of activity with 88.33% good to excellent outcome as per Kyle’s criteria.Conclusion:Although, not devoid of complications, modified short PFN results in good functional recovery of patients with intertrochanteric fractures of femur.

Comparison of dynamic hip screw and antirotation screw with cannulated screw in the treatment of transcervical collum femoris fractures.

Objectives This study aims to compare the results of internal fixation with dynamic hip screw (DHS)/antirotation screw and conventional cannulated screw (CS) for femoral neck fracture.Patients and methods This retrospective study included a total of 78 patients (57 males, 21 females) with collum femoris fractures treated with internal fixation between January 2015 and January 2019. Group 1 comprised 41 patients with a mean age of 45.7 years (range, 19 to 62 years) treated with DHSs/antirotation screws, while group 2 comprised 37 patients with a mean age of 41.9 years (range, 17 to 75 years) treated with CSs. The patients were evaluated for union, avascular necrosis (AVN), femoral neck shortness, operation time, duration of fluoroscopy exposure, and functional outcomes.Results Age, gender, and Garden classification stages were similar in both groups. No significant difference was found between the groups in respect of AVN and non-union rates. The non-union rate was 12.2% in group 1 and 21.6% in group 2 (p>0.05). The duration of fluoroscopy exposure was statistically significantly higher in group 2 (p=0.001) and the operation time was statistically significantly longer in group 1 (p=0.001). In group 2, femoral neck shortness stature was significantly higher (p=0.007). At the final follow-up examination, the Harris hip score was statistically significantly higher in group 1 (p=0.04).ConclusionDynamic hip screw/antirotation screw was a more relevant treatment method for transcervical femoral neck fractures compared to CS with more favorable functional outcomes and less fluoroscopy exposure.

Evaluation of Outcome of Fracture Neck of Femur Treated with Dynamic Hip Screw and Antirotation Screw for Early Mobilisation in Young Adults

Evaluation of Outcome of Fracture Neck of Femur Treated with Dynamic Hip Screw and Antirotation Screw for Early Mobilisation in Young Adults

A Comparison of Bipolar Hemiarthroplasty versus Dynamic Hip Screw Fixation of Basicervical Femoral Neck Fractures

Background: Surgical treatment of basicervical femoral neck fractures, which are biomechanically similar to intertrochanteric fractures, is an internal fixation by dynamic hip screw (DHS) and anti-rotation screw. Since one of the remarkable complications of this surgical procedure is device failure, we aimed to make a comparison between bipolar hemiarthroplasty and the DHS plate fixation in elderly patients with basicervical femoral neck fracture. Methods: In this randomized controlled clinical trial study, 60 patients with femoral neck fractures were randomly divided into two groups of DHS fixation (control group, n = 30) and bipolar hemiarthroplasty (intervention group, n = 30). Harris Hip Score (HHS) questionnaire and the Visual Analogue Scale (VAS) for pain assessment were used for functional evaluations. Postoperative complications were evaluated at 6 months and one year postoperatively. Results: The mean age was 73.95 ± 9.85 years in the hemiarthroplasty group and 74.22 ± 7.85 years in the internal fixation group. Three patients in the internal fixation group and 6 patients in the hemiarthroplasty group were excluded. HHS in 6 months and one year after surgery in the intervention group was dramatically higher than the control group. There were no noticeable changes in VAS scores between the two groups. Two cases of device failure happened in the control group. Conclusions: It seems that bipolar hemiarthroplasty is more effective than internal fixation by DHS plate in improving the patient’s quality of life, considering higher HHS scores, earlier patient mobilization, shorter hospital stay, lower device failure rate, and lower revision rate

Biomechanical study of different internal fixations in Pauwels type III femoral neck fracture - A finite elements analysis

ObjectiveTo evaluate biomechanical behavior of different internal fixation methods for the treatment of Pauwels Type III femoral neck fractures. MethodsThree internal fixators were developed to treat Pauwels Type III femoral neck fracture using finite elements: dynamic hip screw (DHS); DHS combined with anti-rotation screw; three cannulated screws in an inverted triangular configuration (ASNIS). Under the same conditions, vertical fracture displacement, and maximum and minimum principal, and Von Mises stresses were evaluated. ResultsThe vertical displacements evaluated were: 5.43 mm, 5.33 mm and 6.22 mm, rotational displacements values were 1.1 mm, 0.4 mm and 1.3 mm; maximum principle stress values obtained for the upper region of the femoral neck were 3.26 hPa, 2.77 hPa, and 4.5 hPa, minimum principal stress values obtained for the inferior region of the femoral neck were −1.97 hPa, −1.8 hPa and t −3.15 hPa; Von Mises peak stress values were 340.0 MPa, 315.5 MPa and 326.1 Mpa, for DHS, DHS with anti-rotation device, and ASNIS, respectively. Conclusion: The DHS combined with anti-rotation screw yielded better results in terms of rotational and vertical displacements, traction and compression distributions on fractures, and Von Mises stress, demonstrating mechanical superiority for Pauwels Type III fracture.

Biomechanical evaluation of locked plating fixation for unstable femoral neck fractures.

AimsEvaluate if treating an unstable femoral neck fracture with a locking plate and spring-loaded telescoping screw system would improve construct stability compared to gold standard treatment methods.MethodsA 31B2 Pauwels’ type III osteotomy with additional posterior wedge was cut into 30 fresh-frozen femur cadavers implanted with either: three cannulated screws in an inverted triangle configuration (CS), a sliding hip screw and anti-rotation screw (SHS), or a locking plate system with spring-loaded telescoping screws (LP). Dynamic cyclic compressive testing representative of walking with increasing weight-bearing was applied until failure was observed. Loss of fracture reduction was recorded using a high-resolution optical motion tracking system.ResultsLP constructs demonstrated the highest mean values for initial stiffness and failure load. LP and SHS constructs survived on mean over 50% more cycles and to loads 450 N higher than CS. During the early stages of cyclic loading, mean varus collapse of the femoral head was 0.5° (SD 0.8°) for LP, 0.7° (SD 0.7°) for SHS, and 1.9° (SD 2.3°) for CS (p = 0.071). At 30,000 cycles (1,050 N) mean femoral neck shortening was 1.8 mm (SD 1.9) for LP, 2.0 mm (SD 0.9) for SHS, and 3.2 mm (SD 2.5) for CS (p = 0.262). Mean leg shortening at construct failure was 4.9 mm (SD 2.7) for LP, 8.9 mm (SD 3.2) for SHS, and 7.0 mm (SD 4.3) for CS (p = 0.046).ConclusionUse of the LP system provided similar (hip screw) or better (cannulated screws) biomechanical performance as the current gold standard methods suggesting that the LP system could be a promising alternative for the treatment of unstable fractures of the femoral neck.Cite this article: Bone Joint Res 2020;9(6):314–321.

Posterior Inferior Comminution Significantly Influences Torque to Failure in Vertically Oriented Femoral Neck Fractures: A Biomechanical Study.

To evaluate axial fracture obliquity and posterior inferior comminution in vertically oriented femoral neck fractures (FNFs) in the physiologically young patient. A biomechanical investigation was designed to evaluate the impact of these fracture elements on torque to failure using cannulated screw (CS) and sliding hip screw fixation. Four Pauwels III FNF models were established in synthetic femurs: (1) vertically oriented in the coronal plane (COR), (2) coronal plane with axial obliquity (AX), (3) coronal plane with posterior inferior comminution (CCOM), and (4) coronal plane with axial obliquity and posterior inferior comminution (ACOM). In each group (n = 10), specimens were fixed using either 3 CSs or a sliding hip screw with supplemental antirotation screw (SHS). Quasistatic cyclic ramp-loading to failure was performed using a custom testing jig combining axial preloading and torsional ramp-loading. The primary outcome was torque to failure, defined as angular displacement ≥5 degrees. In the CS group, torque to failure was 40.2 ± 2.6 Nm, 35.0 ± 1.4 Nm, 29.8 ± 1.5 Nm, and 31.8 ± 2.2 Nm for the COR, AX, CCOM, and ACOM fracture groups, respectively (P < 0.05). In the SHS group, torque to failure was 28.6 ± 1.3 Nm, 24.2 ± 1.4 Nm, 21.4 ± 1.2 Nm, and 21.0 ± 0.9 Nm for the COR, AX, CCOM, and ACOM fracture groups, respectively (P < 0.05). In both constructs, groups with posterior inferior comminution demonstrated significantly lower torque to failure compared to the COR group (P < 0.05). The CS construct demonstrated higher torque to failure in all groups when compared to the SHS construct (P < 0.01). Posterior inferior comminution significantly affects torque to failure in vertically oriented FNFs. Three peripherally placed CSs may resist combined axial and torsional loading better than a sliding hip screw construct.

Increased stability by a novel femoral neck interlocking plate compared to conventional fixation methods. A biomechanical study in synthetic bone

BackgroundStable fixation promotes union in the common femoral neck fractures, but high non-union rates due to fixation failure remain with traditional fixations. To enhance stability, a plate interlocking pins, but without further fixation to femur has been developed. To our knowledge, no comparison to other conventional fixation methods has been performed. We tested the hypothesis that the novel implant biomechanically leads to a more stable femoral neck fixation. MethodsFifty synthetic femurs with a cervical wedge osteotomy were allocated to intervention with three hook-pins interlocked in a plate (Hansson Pinloc® System) or standard fixations with a two-hole Dynamic Hip Screw® plate with an anti-rotational screw, three cannulated screws (ASNIS® III) or two screws (Olmed® or Cannulated Hip Screws®). Quasi-static non-destructive torsion around the neck, anteroposterior bending and vertical compression were tested to detect stiffness. The specimen's deformation was evaluated after cyclic compression simulating weight-bearing. Local deformation of implant channels was measured. Fixation failure was defined by fissure formation. FindingsCompared to the conventional implants all together, the interlocked pins enhanced mean stiffness 130% in torsion and 33% in bending (P < 0.001), while compressive stability was increased by a reduced deformation of 62% in average of the global test specimen and 95% decreased local implant channel deformation after cycling (P < 0.001). In comparisons with each of the standard fixations the interlocking pins revealed no signs of adverse effects. InterpretationThe novel femoral neck interlocking plate allowed dynamic compression and improved multi-directional stability compared to the traditional fixations.

Analysis of risk factors for necrosis of femoral head after internal fixation surgery in young and mid-aged patients with femoral neck fracture

To retrospectively analyze the risk factors of avascular necrosis of femoral head (ANFH) after internal fixation in young and mid-aged adults. From January 2007 to December 2017, femoral neck fracture patients (18-60 years old) treated by reduction and internal fixation were retrospectively studied in Peking University Third Hospital. We recorded their gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) grade, reason of injury, fracture side, interval between injury and surgery, location of fracture line, Garden classification, Pauwels classification, reduction method (open or closed), internal fixation and reduction quality. The diagnosis of ANFH was confirmed based on X-ray and MRI images during the follow-up. The internal fixation method included cannulated compression screw (CCS) or dynamic hip screw (DHS, with or without anti-rotation screw). χ2 test and Logistic regression analysis were used to analyze the relationship between the various factors and postoperative ANFH. A total of 113 patients were included in this study, including 63 males and 50 females with an average age of (43.17 ± 12.34) years. They were followed up by (25.08 ± 16.17) months. ASA grade included grade I (21 cases), grade II (55 cases) and grade III (37 cases). The reasons of injury included low-energy trauma (76 cases) and high-energy (37 cases). The fracture line included subcapital type (37 cases), transverse type (74 cases) and basal type (2 cases). Garden classification included type I (3 cases), type II (46 cases), type III (39 cases) and type IV (25 cases). Pauwels classification included type I (21 cases), type II (55 cases) and type III (37 cases). Interval between injury and surgery was (3.88 ± 3.66) days, 108 patients and 5 patients performed closed and open reduction respectively. 63 patients performed CCS, and 50 patients performed DHS. The reduction quality included grade A (91 cases), grade B (18 cases) and grade C (4 cases). 18 patients developed ANFH after surgery, the incidence rate was 15.93% (18/113). The result of χ2 test showed the reason of injury (OR=0.19, P < 0.01), Garden classification (OR=0.13, P < 0.01), Pauwels classification (OR=0.12, P = 0.02), internal fixation method (OR=3.29, P = 0.04) and reduction quality (OR=0.33, P < 0.01) were significantly associated with ANFH. These five factors were further included into the Logistic regression analysis, and its results showed that the reason of injury (OR=4.11, P = 0.03) and Garden classification (OR=4.85, P = 0.04) were statistically significant. The reason of injury, Garden classification, Pauwels classification, internal fixation and reduction quality may increase the risk of ANFH after surgery, and the reason of injury and Garden classification were much more significant.

Osteosynthesis of Fracture Neck Femur in the Sixth and Seventh Decades of Life

AIM: Fracture neck of femur is common in elderly people due to osteoporosis or osteomalacia. The aim of this study is to assess the results of internal fixation of fracture neck femur in the sixth and seventh decades of life by dynamic hip screw (DHS) and antirotation screw. MATERIALS AND METHODS: 38 patients with displaced fracture neck femur were included in this study. The ages ranged from 50 to 69 years with an average of 61 years. 22 patients were males and 16 were females. All patients were treated by closed reduction and internal fixation by DHS and antirotation screw. RESULTS: Bone union was achieved in all patients except four. The time to bone union ranged from 3 to 8 months with an average of 5 months. The time to full weight bearing ranged from 2 to 7 months with an average of 4 months. The complications included superficial wound infection in 3 cases, nonunion in 4 cases and osteonecrosis in 3 cases. CONCLUSION: Internal fixation by DHS and antirotation screw is a good method for treatment of fracture neck femur in the sixth and early seventh decades of life. It provides sufficient stability that allows for early weight bearing and increases the chances of bone union.

Osteosynthesis of Fracture Neck Femur in the Sixth and Seventh Decades of Life

AIM: Fracture neck of femur is common in elderly people due to osteoporosis or osteomalacia. The aim of this study is to assess the results of internal fixation of fracture neck femur in the sixth and seventh decades of life by dynamic hip screw (DHS) and antirotation screw. MATERIALS AND METHODS: 38 patients with displaced fracture neck femur were included in this study. The ages ranged from 50 to 69 years with an average of 61 years. 22 patients were males and 16 were females. All patients were treated by closed reduction and internal fixation by DHS and antirotation screw. RESULTS: Bone union was achieved in all patients except four. The time to bone union ranged from 3 to 8 months with an average of 5 months. The time to full weight bearing ranged from 2 to 7 months with an average of 4 months. The complications included superficial wound infection in 3 cases, nonunion in 4 cases and osteonecrosis in 3 cases. CONCLUSION: Internal fixation by DHS and antirotation screw is a good method for treatment of fracture neck femur in the sixth and early seventh decades of life. It provides sufficient stability that allows for early weight bearing and increases the chances of bone union.

经皮撬拨复位联合PNFA治疗与DHS治疗老年股骨转子间骨折临床疗效比较

经皮撬拨复位联合PNFA治疗与DHS治疗老年股骨转子间骨折临床疗效比较

PFNA and DHS for AO/OTA 31-A2 fractures: radiographic measurements, morbidity and mortality.

For this retrospective cohort study, we assessed pertrochanteric fracture types AO/OTA 31-A2. PFNA and DHS were the devices used. We determined both devices in relation to peri-operative variables, postoperative radiographic measurements, implant-related complications and mortality up to 2years. The null hypothesis was no effect between the two devices. This single-centre study was conducted based on our computerized data. The treatment period ranged from 2006 to 2015. Only patients with type AO/OTA 31-A2 fractures and an age ≥ 65years were included. Apart from descriptive variables, the following measurements were assessed: (1) duration of surgery, (2) blood loss, (3) transfusion, (4) hospitalization, (5) tip-apex distance (TAD), (6) fracture reduction, (7) screw position, (8) implant-related complications, and (9) mortality. The follow-up was 2years for each living patient. Missing data were evaluated by telephone call. A total of 375 consecutive patients were enrolled into three groups: (1) 75 patients treated with DHS and antirotation screw (ARS); (2); 100 patients treated with DHS + ARS + TSP (trochanteric stabilization plate); and (3) 200 patients treated with PFNA. Apart from dementia, the descriptive data (e.g., age and BMI) demonstrated no effects between the three groups. Compared to PFNA, DHS with or without TSP was adversely affected by a longer operation time, higher blood loss, increase in transfusion, and more implant-related complications including cut-out, infection and failure. The rate of cut-out was significantly higher in TAD ≥ 25mm (p = 0.005), and PFNA demonstrated significantly better TAD measurements (p = 0.001), better fracture reduction (0.002), more central-central screw positions (p = 0.014), and less poor screw placement (p = 0.001). The mortality rate was without effect between the three groups (log rank 0.698). DHS with or without TSP was associated with significantly higher rates of implant-related complications based on inferior radiographic measurements. Therefore, we only recommend PFNA for the treatment of proximal type AO/OTA 31-A2 femoral fractures. Therapeutic level III.