Cannulated Cancellous Screw Research Articles

Mechanical analysis of modified femoral neck system in the treatment of osteoporotic femoral neck fractures

BackgroundDespite the explicit biomechanical advantages associated with FNS, it is currently inconclusive, based on the existing literature, whether Femoral Neck System (FNS) outperforms Cannulated cancellous screws (CSS) in all aspects. Due to variances in bone morphology and bone density between the elderly and young cohorts, additional research is warranted to ascertain whether the benefits of FNS remain applicable to elderly osteoporosis patients. This study aimed to investigate the biomechanical properties of FNS in osteoporotic femoral neck fractures and propose optimization strategies including additional anti-rotation screw.MethodsThe Pauwels type III femoral neck fracture models were reconstructed using finite element numerical techniques. The CSS, FNS, and modified FNS (M-FNS) models were created based on features and parameterization. The various internal fixations were individually assembled with the assigned normal and osteoporotic models. In the static analysis mode, uniform stress loads were imposed on all models. The deformation and stress variations of the femur and internal fixation models were recorded. Simultaneously, descriptions of shear stress and strain energy were also incorporated into the figures.ResultsFollowing bone mass reduction, deformations in CSS, FNS, and M-FNS increased by 47%, 52%, and 40%, respectively. The equivalent stress increments for CSS, FNS, and M-FNS were 3%, 43%, 17%, respectively. Meanwhile, variations in strain energy and shear stress were observed. The strain energy increments for CSS, FNS, and M-FNS were 4%, 76%, and 5%, respectively. The shear stress increments for CSS, FNS, and M-FNS were 4%, 65% and 44%, respectively. Within the osteoporotic model, M-FNS demonstrated the lowest total displacement, shear stress, and strain energy.ConclusionModified FNS showed better stability in the osteoporotic model (OM). Using FNS alone may not exhibit immediate shear resistance advantages in OM. Concurrently, the addition of one anti-rotation screw can be regarded as a potential optimization choice, ensuring a harmonious alignment with the structural characteristics of FNS.

Comparative analysis of the femoral neck system (FNS) vs. cannulated cancellous screws (CCS) in the treatment of Middle-aged and elderly patients with femoral neck fractures: clinical outcomes and biomechanical insights

PurposeThis study aimed to compare the clinical outcomes and differences in biomechanical characteristics between the femoral neck system (FNS) and cannulated cancellous screws (CCSs) in the treatment of femoral neck fractures.MethodsThis study retrospectively analysed a cohort of 38 registered cases of femoral neck fractures treated surgically with either the FNS (n = 17) or CCSs (n = 21) between January 2020 and December 2023. Indicators such as fluoroscopy frequency, length of hospital stay, and fracture healing time were compared between the two groups. Functional status was evaluated via the Harris hip score (HHS) and visual analogue scale (VAS), whereas prognosis was assessed based on changes in the neck shaft angle and femoral neck shortening. Additionally, six sets of femoral neck fracture models were developed based on Pauwels angles of 30°, 40°, 50°, 60°, 70°, and 80°. Two experimental groups, FNS and CCS, were established, and a joint reaction force of 1800 N was applied to the proximal femur. The displacement, stress, and stiffness of the components of interest in the different models were tested and compared.ResultsThe distributions of all the baseline characteristics were similar between the two groups (p > 0.05). The FNS group presented significantly shorter fluoroscopy frequency, length of hospital stay, and fracture healing time (p < 0.05). Harris and VAS scores were higher in the FNS group than in the CCS group (p < 0.05). Postoperative changes in the neck shaft angle and femoral neck shortening were significantly lower in the FNS group than in the CCS group (p < 0.05). The results of the finite element analysis indicated that the maximum stress on the femoral head and varus angle were generally lower in the FNS group than in the CCS group and that the maximum displacement of the femoral head and FNS was generally lower in the FNS group than in the CCS group. However, the superiority of FNS over CCS decreased with increasing Pauwels angle. Additionally, the effectiveness of FNS in limiting displacement of the femoral neck upper wall was not as favourable as that of CCS.ConclusionsThe treatment of femoral neck fractures with FNS is superior and contributes to improved hip joint function. Biomechanical research has confirmed its structural stability and advantages in resisting femoral head varus. However, challenges to its fixation efficacy persist, particularly at higher Pauwels angles.

Retro - Prospective Comparative Study of Internal Fixation of Intra Capsular Neck of Femur Fracture by Dynamic Hip Screw Plate and Cannulated Cancellous Screw

Retro - Prospective Comparative Study of Internal Fixation of Intra Capsular Neck of Femur Fracture by Dynamic Hip Screw Plate and Cannulated Cancellous Screw

Analysis of Calcaneal Avulsion Fractures Treated Surgically and Nonsurgically: A Retrospective Multicenter Study.

Calcaneal avulsion fractures (CAvFs) at the Achilles tendon insertion are among the more challenging fractures to treat. Although rare, they often require reoperation. The optimal treatment, including nonsurgical procedures and better implants for surgical procedures in the treatment of CAvFs, remains to be established. Therefore, our study aimed to (1) perform a descriptive evaluation of CAvFs, including cases managed nonsurgically, and (2) assess surgical procedures, including the incidence of complications and reoperation for surgically treated CAvFs. In this multicenter retrospective study, we collected data of patients with CAvFs treated at 9 hospitals from 2012 to 2022. We performed a descriptive study of CAvFs and compared postoperative complications and reoperation rates for multiple surgical techniques and implants. The size of the bone fragments was quantified. The data of 70 patients with CAvFs were analyzed; 20 patients were treated nonsurgically, and 50 were treated surgically. The mean age of patients was 68.5 years; 67% of the patients were female. Nineteen percent of the patients had diabetes, and 19% had osteoporosis. The incidence of postoperative complications was 30%, with infection in 14%, necrosis in 26%, and loss of reduction in 18%. The reoperation rate was 22%. Surgical techniques with use of cannulated cancellous screws were performed in 80% of the surgical cases. Cannulated cancellous screw (CCS) fixation alone resulted in a reoperation rate of 35%, whereas additional augmentation, including washers with CCS fixation, resulted in a reoperation rate of 10%. CCS fixation was successfully performed, although suture anchors were used in some cases with smaller fragments. CAvFs occurred more frequently in older women and had a high rate of postoperative complications. A combination of CCS with augmentation was more effective at reducing postoperative complications than CCS fixation alone, even when the bone fragment size was small. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial

BackgroundThe incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent. MethodsThis randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients’ hip function using Harris Hip Score (HHS). ResultsFifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001). ConclusionFixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.

Comparison of the Outcomes of Plating, Screw Fixation, and Pinning in Sanders Type II Fractures: A Multicenter (TRON) Retrospective Study

Calcaneus fractures Sanders type II have been historically treated with various modalities. However, few studies compared these procedures directly. The multicenter (TRON group) retrospective study compared the radiographic and clinical outcomes of operative procedures using Kirschner wires (K-wires), cannulated cancellous screws (CCSs) and plates. Between 2014 and 2020, 121 patients with Sanders type II calcaneus fractures were surgically treated in our group using K-wire (Group K: n = 31), CCS (Group C: n = 60) or plate (Group p: n = 30) fixation. We assessed the American Orthopedic Foot and Ankle Society (AOFAS) score and infection after operation as clinical outcomes and Böhler's and Preiss’ angles as radiographic outcomes. The AOFAS scores of the 3 groups showed a significant difference, with Group P showing significantly inferior scores to Group C at 6 months postoperatively and at the final follow-up examination (p = .015 and p < .001, respectively). The rate of infection did not differ to a statistically significant extent, but the incidence in Group P tended to be higher in comparison to the other groups. Among the three groups, Böhler's angle did not differ to a statistically significant extent immediately after the operation (p = .113) or at the final follow-up examination (p = .383). Postoperatively, Preiss’ angle did not differ to a statistically significant extent (p = .251) but was significantly smaller in the Group C at the final follow-up examination (p = .0331). In Sanders type II calcaneus fracture, CCS fixation may obtain the best functional outcomes.

To Evaluate Functional Outcomes of Dynamic Hip Screw with Derotation Screw versus Cannulated Cancellous Screw in Basicervical Fracture Neck of Femur in Adults

To Evaluate Functional Outcomes of Dynamic Hip Screw with Derotation Screw versus Cannulated Cancellous Screw in Basicervical Fracture Neck of Femur in Adults

COMPARATIVE ANALYSIS BETWEEN DYNAMIC HIP SCREW AND CANCELLOUS CANNULATED SCREW FIXATION IN FRACTURE OF NECK OF FEMUR

Introduction: Fractures of the femoral neck are common injuries. Even though numerous studies have evaluated dynamic hip screw (DHS) vs multiple cannulated cancellous screw (CCS) xation for fractured neck of femur, no consensus has been reached. We sought to compare DHS and CCS xation for femoral neck fractures. Total 60 patients who Methodology: received DHS/CCS xation for a femoral neck fracture at our hospital were enrolled in this prospective study. All patients were randomly and equally divided patients into group A (DHS, n=30) and group B (CCS, n=30) and a conventional NOF protocol was administered. All patients were followed for one year. No signicant differences in clinic-demographic fact Results: ors were observed across groups. Both groups reported a comparable length of union. More complications were observed in group B than in group A. The mean Harris hip score in group A was signicantly greater than in group B (p=0.0124*). Most patients in group A scored excellent, whereas group B scored good (p=0.0298*). Conclusion: In our study, dynamic hip screw (DHS) xation of femoral neck fracture appeared to be better than the multiple cannulated cancellous screw (CCS) xations

Comparison of femoral neck system and three cannulated cancellous screws in the treatment of vertical femoral neck fractures: clinical observation and finite element analysis

ObjectiveThe purpose of this study was to compare the biomechanical and clinical results of two surgical methods for the treatment of vertical femoral neck fractures: Femoral neck system (FNS) and traditional three cannulated cancellous screws (CCS).MethodsFirst, we developed three different vertical femoral neck fracture models for the finite element analysis, with angles of 55°, 65°, and 75°, respectively. Two experimental groups were set up: the FNS group and the CCS group. Each fracture group was tested under axial loads of 2100 N to measure the femur's displacement, Von Mises stress (VMS), and its internal fixation components. Secondly, we retrospectively included the cases of vertical femoral neck fractures with FNS and CCS in our hospital from May 2019 to May 2021. In this study, we compared the duration of intraoperative fluoroscopy, operative time, hospital stay, fracture healing time, Hemoglobin loss, Harris score of hip joint function, and postoperative complications among patients undergoing hip joint replacement.ResultsIn terms of finite element analysis, FNS has better anti-displacement stability than CCS at 55°and 65°, while FNS is greater than CCS in Von Mises stress. Clinically, we followed up on 87 patients for an average of 12 months. FNS was superior to traditional CCS in fracture healing time, operation time, fluoroscopy duration, fracture healing time, and Harris hip function score.ConclusionFNS is superior to traditional CCS in biomechanical and clinical aspects of treating vertical femoral neck fractures. There is potential for FNS to become a new treatment option for vertical femoral neck fractures.

Femoral neck fractures in non-geriatric patients: femoral neck system versus cannulated cancellous screw

BackgroundThe fractures of femoral neck account for 50% among hip fractures with around 3%-10% occurring in younger population of below 65 years. The newly introduced FNS as management approach appears to be a potential alternative to the traditional CCS. The aim of this study was to compare the clinical efficacy and outcome of the femoral neck system (FNS) and the cannulated cancellous screw (CCS) in the treatment of femoral neck fractures in adult below 65 years of age.MethodsData of 114 patients between 18–65 years, admitted in our department for femoral neck fracture from January 2019 to March 2021 were retrospectively studied and ranged into two groups based on the surgical methods: FNS group (56 patients) and CCS group (58 patients). The variables of interest including demographic and clinical variables (age, gender, fracture mechanism, injury side and classification), perioperative parameters(operation time, intraoperative bleeding, incision length and hospitalization time), postoperative outcomes and complications (fracture healing time, nonunion rate, femoral neck avascular necrosis, aseptic screw loosening and the Harris Hip Score), were analyzed and compared between the two groups.ResultsAll 114 patients presented satisfactory reduction and were followed-up for a period of 12 to 36 months (mean 27 ± 2.07 months); there were no significant differences between both groups in terms of age, gender, fracture classification, side of injury, mechanism of injury, the operative time, intraoperative blood loss and the hospital length of stay. However, the fracture healing time between FNS group and CCS group was statistically significant (p < 0.05), respectively 2.86 ± 0.77 and 5.10 ± 0.81 months. The significant differences were also found in terms of numbers of fluoroscopies 8.34 ± 1.38 Vs 17.72 ± 2.19, the HHS 87.80 ± 1.92 Vs 84.28 ± 2.24, postoperative complications 8 (14.28%) Vs 26 (44.82) respectively in FNS and CCS group.ConclusionFNS presented satisfactory outcomes had significantly lower complications rate, therefore, can be one of the alternatives for internal implantation devices in treatment of femoral neck fracture in non-geriatric population.

Does the Method of Fixation Affect the Risk of Complications in Patients with Pauwels Type 3, Displaced Intracapsular Femoral Fractures

Background: Patients with Pauwels type III displaced intracapsular femoral fractures (DICFF) are at a high risk of developing avascular necrosis (AVN) and non-union following closed reduction and internal fixation (CRIF). We compared the complications between the Targon femoral neck (TFN) plate and the cannulated cancellous screws (CCS). Methods: This retrospective study reviewed the records of 34 patients younger than 65 years of age who underwent CRIF of Pauwels type III DICFF from January 2007 to January 2018. Patients were evaluated for demographic data as well as the fixation method. Subsequent postoperative radiographs were obtained to assess the incidence of AVN and nonunion. Results: 34 patients were included in the study, of which, 18 (53%) and 16 (47%) were treated using TFN and CCS, respectively There were no significant differences observed between the CCS and TFN cohorts in terms of age (p = 0.90), gender (p = 0.27), time to surgery (p = 0.36), and duration of surgery (p = 0.99). The incidence of AVN and non-union did not significantly differ between the groups, with rates of 38.9% and 43.8%, respectively (p = 0.083) Conclusions: The type of fixation utilized, whether CCS or TFN, did not have a significant impact on the incidence of treatment failure in patients with Pauwels type III fractures treated via CRIF

Functional Outcome of Arthrodesis by Cannulated Cancellous Screws in Malunited Fractures around Ankle Joint

Functional Outcome of Arthrodesis by Cannulated Cancellous Screws in Malunited Fractures around Ankle Joint

Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room

BackgroundThe prognosis of conservative treatment for fragility fracture of the pelvis (FFP) in the older patients remains poor. Percutaneous pelvic screw placement (PPSP), which aids in the treatment of FFP, can be challenging to perform using fluoroscopy alone because of the proximity of blood vessels and neuroforamina. Hence, this study aimed to investigate the accuracy and clinical outcomes of PPSP using real-time 3D fluoroscopic navigation for FFP in the hybrid operating room.MethodsThis study included 41 patients with FFP who underwent PPSP in a hybrid operating room between April 2016 and December 2020. Intraoperative C-arm cone-beam CT was performed under general anesthesia. Guidewire trajectory was planned using a needle guidance system. The guidewire was inserted along the overlaid trajectory using 3D fluoroscopic navigation, and a 6.5 mm cannulated cancellous screw (CCS) was placed. The clinical outcomes and accuracy of the screw placement were then investigated.ResultsA total of 121 screws were placed. The mean operative time was 84 ± 38.7 minutes, and the mean blood loss was 7.6 ± 3.8 g. The mean time to wheelchair transfer was 2 days postoperatively. Pain was relieved in 35 patients. Gait ability from preoperative and latest follow-up after surgery was maintained in 30 (73%) patients. All 41 patients achieved bone union. Of the 121 screws, 119 were grade 0 with no misplacement; only 2 patients had grade 1 perforations.ConclusionPPSP using real-time 3D fluoroscopic navigation in a hybrid operating room was accurate and useful for early mobilization and pain relief among older patients with FFP with an already-installed needle biopsy application.

Comparison of Femoral Neck System Versus Cannulated Cancellous Screws for the Fixation of Femoral Neck Fracture in Young Adults: A Systematic Review and Meta-Analysis.

A femoral neck fracture is a very common injury in the elderly. However, its incidence is low among young adults, usually presenting as an emergency. In young adults, implant choice is one of the important factors. This systematic review aims to analyze the femoral neck system (FNS) versus cannulated cancellous (CC) screw for the fixation of femoral neck fractures in young adults through well-defined objectives. A comprehensive search from the electronic database (PubMed, Google Scholar, Web of Science, Cochrane Library) was conducted from the beginning till February 18, 2022. The data regarding study type, authors, year of publication, country, union time, Harris hip score, intraoperative blood loss, operating time, neck shortening, and hospital stay were extracted from the selected articles and analyzed using RevMan 5.4.1 software. For continuous data, e.g., healing time, intraoperative blood loss, operation time, Harris hip score, neck shortening, and hospital stay, the mean difference (MD), either weighted mean difference (WMD) or standardized mean difference (SMD), with a 95% confidence interval (CI) was recorded. A p-value less than 0.05 was taken as statistically significant. The Newcastle Ottawa scale was used for the risk of bias assessment. Six retrospective cohort studies including 427 patients were selected for the meta-analysis. There was significantly less healing time (WMD= -1.10, 95% CI: -1.73 to -0.47), shorter operation duration (WMD=7.70, 95% CI: -0.06 to 15.46), and better Harris hip score (WMD=4.79, 95% CI: 2.12-7.46) in the FNS than CC screw fixation method. However, intraoperative blood loss was significantly less in the CC screw system (WMD=21.27, 95% CI: 8.20-34.35). There was no significant difference between the two approaches in-hospital stay duration and femoral neck shortening. This can be concluded that FNS is better than CC screw fixation for treating neck of femur fractures in adults on the outcome basis of union time, less operation time, and better Harris hip score (HHS) with significant heterogeneity.

A Comparative Study of Dynamic Hip Screw Versus Multiple Cannulated Compression Screw Fixation in Undisplaced Intracapsular Neck of Femur Fractures.

Background Femoral neck fractures are common injuries. Although many studies have compared two-hole dynamic hip screw (DHS) versus multiple cannulated cancellous screw (CCS) fixation for undisplaced intracapsular fractured neck of femurs (NOF), there is no consensus on which surgical technique results in better outcomes. The aim of our study was to compare DHS and CCS for undisplaced NOFs. The primary outcomes were reoperation and mortality rates at one year postoperatively. Methodology A retrospective analysis was performed involving all patients who underwent fixation with DHS/CCS for an undisplaced intracapsular NOF at our hospital between January 2016 and December 2020. All patients had a minimum follow-up time greater than one year. All patients underwent a standardised NOF protocol. Patients either underwent DHS or CCS fixation according to surgeon preference, and there was no randomisation to either group. Results A total of 41 patients underwent fixation with DHS compared to 32 who underwent CCS. The reoperation rate at one year was 9.8% in the DHS group compared to 6.3% in the CCS group. This difference was not statistically significant (p = 0.588). The one-year mortality rate was similar between groups at 22.0% and 21.9% in the DHS group and the CCS group, respectively (p = 0.994). Registrar-level surgeons performed 80.5% of DHScompared to 59.4% of CCS, and consultant surgeons performed 4.9% of DHS compared to 25% of CCS. Conclusions There was no significant difference in revision rates or complications seen between CCS and DHS. A significantly higher percentage of CCS fixations were performed by consultant-grade surgeons at our hospital compared to DHS. This study provides further data on the choice of fixation method for intracapsular fractures. It also reports on the grade of the operating surgeon at our unit, which may be a factor in the quality of fixation and ultimately reoperation rates.

The use of the femoral neck system (FNS) leads to better outcomes in the surgical management of femoral neck fractures in adults compared to fixation with cannulated screws: A systematic review and meta-analysis.

Intracapsular femoral neck fractures are challenging to treat, with outcomes depending on the quality of reduction, and the stability of fixation. Cannulated cancellous screws (CCS) are the most commonly used implants to fix these fractures, but failure rates are significant. The recently introduced femoral neck system (FNS) may be a better option than CCS fixation and this review attempts to compare the results. Four electronic databases were searched for eligible articles that had comparative data on the outcomes of fixation of adult femoral neck fractures with FNS and CCS. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% confidence intervals. Eight studies with 509 cases having a mean age of 50.8years were included for final analysis. FNS was found to be associated with significantly reduced complication rates (p < 0.001), decreased incidence of postoperative femoral neck shortening (p < 0.001), quicker time to fracture union (p = 0.002), and better functional outcome scores (p < 0.001) compared to cannulated screws. FNS was also associated with a shorter operating time (mean difference 6.65min) although not statistically significant (p = 0.24). CCS group had significantly reduced mean blood loss (p < 0.001). The available literature supports FNS as a better option for adult femoral neck fractures, with a lower complication rate, quicker union, and better clinical outcomes. Level 3.

Reoperation for sliding hip screws vs cannulated cancellous screws in femoral neck fractures: A study from the Danish Fracture Database Collaborators

IntroductionIt is still debated whether to use cannulated cancellous screw (CCS) or sliding hip screw (SHS) implants for femoral neck fracture (FNF) patients but there are no studies large enough to evaluate on smaller differences. The aim were to compare the reoperation and mortality rates of a large cohort of FNF patients above 60 years of age with internal fixation using CCS and SHS implants, with stratification by fracture classification. MethodsThis register study employed prospectively collected data from 2014 to 2018 from the Danish Fracture Database, including 2-year follow-up and data on age, sex, surgery, comorbidity and fracture classification. Reoperation data was retrieved from the Danish National Patient Register. The primary outcome was major reoperation, defined as re-osteosynthesis, conversion to arthroplasty, non-union surgery, Girdlestone procedure or deep infection 1-year post-surgery. Relative risk (RR) for the CCS group compared with the SHS group was estimated using Cox proportional hazards modelling, adjusted for age, sex and comorbidity (including 95% confidence intervals). ResultsA total of 2,598 FNFs were included, 1,731 with CCS (67%) and 867 with SHS (33%). The overall 1-year major reoperation rate was 15% with CCS and 13% with SHS, yielding an adjusted RR of 1.10 (0.88; 1.37) for CCS compared to SHS. The adjusted RR was 1.15 (0.77; 1.69) for undisplaced FNF, 1.09 (0.68; 1.75) for displaced FNF and 1.35 (0.94; 1.94) for transcervical FNF, which increased to 1.42 (1.01; 2.00) after 2 years. The minor reoperation rate was higher for CCS (3%) than SHS (1%), yielding an adjusted RR of 2.28 (1.14; 4.51). The adjusted RR for CCS compared to SHS was 0.83 (0.62; 1.12) for 30-day mortality and 0.96 (0.82; 1.14) for 1-year mortality. ConclusionsWe found no difference between CCS and SHS in major reoperation rates; however, for transcervical FNF, CCS was associated with higher reoperation rates. Furthermore, CCS was associated with a higher risk of minor reoperation than SHS. There were no differences in mortality rates.

Is Percutaneous Screw Fixation with 6.5 mm Cannulated Cancellous Screws a Viable Option in Pelvic Ring Fractures?

Background Historically, internal fixation in pelvic ring fractures has been proven to be better in outcome than both external fixation and conservative management. In an attempt to overcome the morbidity of extensile surgical approaches, percutaneous fixation of the pelvis has been receiving increasing attention. The aim of the study was to assess the functional outcome in patients with pelvic ring fractures treated with percutaneous screw fixation. Methods The study included 12 patients of pelvic ring fracture admitted at NSCB medical college, Jabalpur (Madhya Pradesh) from December 2019 to October 2021, all treated percutaneously with cannulated cancellous screw fixation. Four patients had Tiles type C1 injury, 4 patients with type C2, 2 with type B1 and 2 with type A2 injury. Functional assessment was done using the Majeed Scoring system at preoperative, at 3 weeks, 6 weeks, and 3 months postoperatively. Results Functional outcome score at 3-month follow-up was poor in 8% patients, fair in 8% patients, good in 33.3% patients, and excellent in 50% patients. Pain was the most frequent complaint on follow-up. Conclusion Fixation of acute pelvic ring injuries with 6.5 mm cc screws using percutaneous technique offers favorable functional outcome and can be performed in hemodynamically unstable patients.

Comparison Between Femoral Neck Systems and Cannulated Cancellous Screws in Treating Femoral Neck Fractures: A Meta-Analysis.

BackgroundWe performed a meta-analysis to compare the efficacy and safety of the femoral neck system (FNS) with cannulated cancellous screws (CCSs) in treating femoral neck fractures (FNFs) in controlled clinical trials.MethodsEligible scientific articles published prior to September 2021 were retrieved from the PubMed, Web of Science, Springer, ScienceDirect and Cochrane Library databases. The statistical analysis was performed with RevMan 5.1.ResultsSeven retrospective studies met the inclusion criteria. Meta-analysis showed that there were significant differences in perioperative blood loss, the postoperative Harris score, healing time, fluoroscopy frequency, total complications, femoral head necrosis, femoral neck shortening and screw cutout. No significant differences were found regarding operation time, length of hospital stay or nonunion between the two groups.ConclusionCompared with CCSs, the FNS showed better clinical efficacy and fewer complications in treating FNFs. Due to the limited quality and data of the currently available evidence, more high-quality randomized controlled trials are needed.

Femoral neck system reduces surgical time and complications in adults with femoral neck fractures: A systematic review and meta-analysis

PurposeFemoral neck fractures (FNF) in adults are conventionally managed with surgical options. This paper is aimed to assess the safety, and functional outcomes of the novel Femoral neck system (FNS) for FNF treatment in adult population. MethodsAn organized quest of four literature databases (PubMed, Scopus, Web of Science, and Cochrane Library) was performed on March 1, 2022 using the term “femoral neck system”. Fixed or random-effect meta-analysis was used to analyse the outcome measures after selecting relevant studies and assessing their quality. Heterogeneity was considered when calculating pooled effect sizes and 95% confidence ranges. ResultsOn comparing FNS with cannulated cancellous screws (CCS) or other methods, in a total of 762 patients (351 FNS and 411 CCS) in the 11 comparative studies considered for meta-analysis, blood loss was pointedly higher overall in the FNS group, mean difference 115.77 ml; 95% CI 3.11 ml, 28.42 ml; test of overall effect: z = 1.68, p = 0.09); with considerable heterogeneity. However, in the FNS group the operative time was substantially lower (Mean difference −7.91 min; 95% CI -15.01, −0.80; test of overall effect: z = 2.18, p = 0.03, with marked heterogeneity). Moreover, complications such as infections, non-union, osteonecrosis, implant cut-out were significantly lower in the FNS group with a Mantel Haenszel Odds ratio of 0.20 (95% CI 0.12, 0.34: Z = 6.01, p < 0.0001). ConclusionKeeping in mind the heterogenicity of the studies, -management of adult patients with FNF with FNS can provide results comparable to traditional fixation methods with significantly lower rate of complications.