Fixation Of Femoral Neck Fractures Research Articles

Early results of the femoral neck system in fixation of femoral neck fractures.

Early results of the femoral neck system in fixation of femoral neck fractures.

Retracted: A Comparative Study between Proximal Femoral Locking Plate and Multiple Cannulated Screws for Fixation of Femoral Neck Fractures in Young Adults.

[This retracts the article DOI: 10.1155/2022/1286419.].

Clinico-radiological evaluation of results of biplane double supported screw fixation (BDSF) in femoral neck fractures

Clinico-radiological evaluation of results of biplane double supported screw fixation (BDSF) in femoral neck fractures

Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications

Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications

Optimal position and apex-subchondral bone distance of cannulated screws for internal fixation of femoral neck fracture: A radiological study.

To determine the optimal position of three cannulated screws in an inverted triangle pattern for internal fixation of femoral neck fractures, including the apex-subchondral bone distance, computed tomography (CT) images of the hip were processed using the MIMICS (Materialize Interactive Medical Image Control System) Research software. Points adjacent to the inferior, anterosuperior, and posterior cortex of the femoral neck were selected on the axial view. Subsequently, the positions of these points were adjusted to maximize the area between them, and splines were drawn in the coronal and sagittal planes to represent the cannulated screws. Finally, the virtual anteroposterior and lateral fluoroscopy images of the proximal femur and splines were created and the parameters calculated. Finite element analysis showed this fixation scheme provides stronger fracture support and stability. Twenty patients with femoral neck fractures (Modified group), with the area and perimeter of the triangle formed on axial postoperative CT images, including the shortest distance from the tip of the screw to the subchondral bone was compared with 23 matched patients for whom the conventional inverted isosceles triangle configuration of screws for internal fixation was used (Conventional group). The area and perimeter of the stabilization screws were larger, with a shorter apex-subchondral bone distance for the Modified group. There was no incidence of screw penetration in the femoral neck or head in either group, and all fractures healed within a follow-up period of 10 months. The modified screw placement method is simple and safe and provides greater fracture stability than the conventional empirical method of fixation.

The Influence of Femoral Fixation on Mortality and Revision After Hip Arthroplasty in Femoral Neck Fractures in Patients Older Than 65 Years. A Matched Cohort Analysis From the American Joint Replacement Registry.

In the United States, most hip arthroplasties for femoral neck fractures are done with a noncemented stem despite worldwide registry data suggesting that cemented fixation has improved long-term survivorship in patients older than 65 years. We, therefore, evaluated the effect of femoral fixation on the risk of revision, revision for periprosthetic fracture (PPFx), and mortality in patients undergoing hip arthroplasty for femoral neck fractures. Seventeen thousand one hundred thirty-eight cases of cemented femoral stems were exactly matched to noncemented fixation cases in a 1:1 fashion based on age, sex, and Charlson Comorbidity Index as reported in the American Joint Replacement Registry. Outcome variables included revision for PPFx, all-cause revision within 1 year and 90 days, and in-hospital mortality at 90 days and 1 year. The primary independent variable was femoral fixation (cemented and noncemented), and covariates included race (black, white, and others), ethnicity (Hispanic and non-Hispanic), hospital teaching status (minor, major, and nonteaching), and hospital size (number of beds: 1 to 99, 100 to 399, and ≥400). Chi square tests and multivariable logistic regression models were used for statistical analysis. Hip arthroplasty with a cemented stem was associated with a 30% reduction in all-cause revision at 90 days (odds ratio [OR]:0.692, confidence interval [CI]:0.558 to 0.86), a 29% reduction in revision at 1 year (OR:0.709, CI:0.589 to 0.854), and an 86% reduction in revision for PPFx (OR:0.144, CI:0.07 to 0.294). However, cemented stem fixation was associated with increased odds of in-hospital (OR: 2.232 CI: 1.644 to 3.3031), 90-day, and 1-year (OR:1.23, CI:1.135 to 1.339; and OR:1.168, CI:1.091 to 1.25, respectively) mortality. In this exact match study, cemented stem fixation for femoral neck fracture was associated with a markedly reduced risk of revision for PPFx and for all-cause revision. This must be weighed against the associated increased risk in mortality, which warrants additional investigation.

The incidence of focal osteonecrosis of the femoral head and its impact on conversion hip arthroplasty after screw fixation of femoral neck fractures: a multicenter retrospective study based on postoperative magnetic resonance imaging.

Osteonecrosis of the femoral head (ONFH) and subsequent head collapse is a major concern after internal fixation of femoral neck fracture (FNF). Previous studies focused on ONFH incidence using plain radiography; postoperative magnetic resonance imaging (MRI) was rarely performed. We performed a multicenter retrospective study to investigate the incidence of ONFH and the need for conversion hip arthroplasty after FNF screw fixation. We reviewed 195 patients who underwent screw fixation during closed FNF reduction between 2012 and 2017 at three institutions. Except for patients who did not consent to MRI, all patients underwent postoperative MRI either 1-3years after screw fixation. The occurrence of ONFH was investigated through plain radiography and MRI. Thirty patients were diagnosed with ONFH through plain radiography, and an additional 33 patients were diagnosed with MRI, resulting in a total of 63 patients (32.3%) diagnosed with ONFH. The mean time to ONFH diagnosis was 18.9months and the conversion rate to hip arthroplasty was 10.2%. Of the 33 patients who were normal on hip radiography but exhibited ONFH on MRI, all had small focal lesions not associated with head collapse at the last follow-up. The ONFH group diagnosed through plain radiography had more unstable FNFs than the group diagnosed through MRI. Although postoperative MRI revealed a higher incidence of ONFH after FNF screw fixation than reported previously, the small focal MRI lesions were not associated with increased risks of femoral head collapse or conversion to arthroplasty.

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.

Reoperation rate and implants’ position variation features of displaced femoral neck fractures with sliding compression or length-stable fixation in young and middle-aged population

IntroductionSliding compression fixation and length-stable fixation are two basic internal fixation concepts in the treatment of displaced femoral neck fractures. In this study, we aimed to compare the reoperation rates for different methodologies of internal fixation for femoral neck fractures in young and middle-aged population.Materials and methodsThis a retrospective study. A total of 215 patients with displaced femoral neck fractures treated with cannulated screw fixation were enrolled and divided into the sliding compression and length-stable groups according to the fixation pattern. The occurrence of and reason for revision surgery within one year were recorded. Forty-five patients with complete CT data (including CT scanning on the first postoperative day and at the last follow up) were selected from the total sample. A newly established computerized image processing method was used to evaluate variations in the spatial location of screws.ResultsThe reoperation rate was significantly higher in the length-stable group (23.8%) than in the sliding compression group (7.3%). The rate of revision surgery due to nonunion was also higher in the length-stable group (11.4%) than in the sliding compression group (1.8%). However, no significant difference was observed in terms of joint penetration or soft tissue irritation. The sliding compression group (6.58 ± 3.18 mm) showed higher femoral neck shortening than length-stable group (4.16 ± 3.65 mm). When analyzing the spatial variations, a significantly greater screw withdrawal distance was observed in the sliding compression group than in the length-stable group, but with a smaller rotation angle.ConclusionLength-stable internal fixation of displaced femoral neck fractures may lead to an increased reoperation rate in young and middle-aged population.Trial registrationName of the registry: Chinese Clinical Trial Registry.Trial registration number: ChiCTR2000032327.Trial registration date: 2020–4-26.

What makes fixation of femoral neck fractures fail? A systematic review and meta-analysis of risk factors

IntroductionThis systematic review aims to provide an overview of predictors for failure of treatment of displaced femoral neck fracture (dFNF) with internal fixation and quantify their risk of fixation failure in a meta-analysis. Patients and methodsPubMed, Embase, Web of Science, Cochrane Library, and EMCare were searched for original studies published from January 2000, including adult patients with an internally fixated dFNF, that reported data on predictors for fixation failure defined as revision surgery due to non-union, avascular femoral head necrosis or cut-out of implant. RevMan version 5 software was used to pool univariable Odds Ratio's (OR) for predictors of fixation failure by means of a random effects model. ResultsThis review included 16 articles (15 articles cohort studies and one randomised trial). Twenty-four predictors for fixation failure were identified and analysed, 16 of which were evaluated in just one study. Data of 7 predictors were pooled in a meta-analysis. Female sex (OR 1.78, 95% confidence interval [CI] 1.26–2.52), smoking (OR 3.64, 95% CI 1.68–7.91), age >50 years (OR 3.64, 95% CI 1.68–7.91), inadequate fracture reduction (OR 2.28, 95% CI 1.62–3.22), fixation with cannulated screws (CS) or pins compared to fixed angle devices (OR 2.16, 95% CI 1.03–4.54) were identified as significant predictors for fixation failure. ConclusionThis study can help surgeons to choose the preferred treatment for patients with a dFNF and substantiate future algorithms and guidelines for treatment of FNF.

Quick and Accurate Placement of Cannulated Screws to Internal Fixation of Femoral Neck Fractures Using a Novel Guide Device.

Fixation of femoral neck fractures with cannulated screws is an accepted method. This study aimed to compare a novel guide device and conventional technique with regard to the accuracy, operation time, fluoroscopy numbers, and drilling attempts during the insertion of cannulated screws to internal fixation of femoral neck fractures. This retrospective study included 60 patients with intracapsular femoral neck fractures who were treated with cannulated screws from January 2020 to June 2021. Three screws were inserted into the femoral neck by conventional technique or using the novel guide device. The operative time, total drilling attempts, and fluoroscopy numbers were evaluated. The precision of implant placement was evaluated by screw parallelism and spread. The patients were followed for 12-24months. The fluoroscopy numbers and operation time of the guide-device-assisted group were shorter than for the conventional group (p < 0.05). The total drilling attempts were significantly lower with the guide device than in the conventional group (p < 0.05). The guide-device-assisted group had better screw parallelism and greater spread than the conventional group (p < 0.05). The novel guide device may be an effective assistant instrument for internal fixation of femoral neck fracture with cannulated screws.

A retrospective study on internal fixation of femoral neck fractures with Hansson Pins® in Switzerland

Background: Hansson Pins® (The Swemac Group, Linköping, Sweden) are devices for the internal fixation of femoral neck fractures that are widely used in Scandinavia. The authors hypothesized that the pins could be used with satisfactory results outside of Scandinavia, that they were a valid alternative to cancellous screws and the dynamic hip screw, and that they also could be used in elderly patients. Methods: Sixty-five consecutive patients with femoral neck fractures who received internal fixation with Hansson Pins between January 2007 and December 2016 at the Oberengadin Hospital in Switzerland were included in this retrospective study. The hospital’s electronic database was searched for information, and questionnaires were sent to the patients. Results: After internal fixation with Hansson Pins, 22% of the patients needed a hip prosthesis. For patients 70 yr and older, this rate was 33%. For 60% of the patients who needed a hip prosthesis, the reason for arthroplasty was nonunion. For 20%, the reason was avascular necrosis of the femoral head, and for another 20% of the patients symptomatic coxarthrosis was the cause. Conclusions: The rate of salvage arthroplasties in this study was similar to the rates in the literature of Hansson Pins (mostly from studies performed in Scandinavia), cancellous screws and dynamic hip screws. The findings suggested that Hansson pins could be used with good results outside of Scandinavia and that they were a reasonable alternative to cancellous screws and the dynamic hip screw. The pins also could be used with satisfactory outcomes in elderly patients, but the rate of salvage arthroplasties would be higher. Level of Evidence: Level IV.

Subtle hip joint subluxation after femoral neck fracture fixation: an ominous sign in a report of two cases

Bhatia, Nishant MS Ortho; Khan, Yasim MS Ortho, DNB Ortho; Garhia, Saurabh MBBS; Maini, Lalit MS Ortho Author Information

Fixation of Fresh Femoral Neck Fractures Using Fibular Strut Graft Along with Cannulated Screws

Intracapsular femoral neck fractures can result from trivial trauma in the elderly or high-energy trauma in younger age-groups. In younger patients aged &lt;60 years, the femoral head should be conserved to avoid the long-term complications of replacement arthroplasty. The options of osteosynthesis include closed/ open reduction and internal fixation with/without bone grafting. Internal fixation alone does not provide rigid fixation, owing to cavities in the posterior part of the femoral head and neck. Fibular grafts augment union and provide strength to the posterior cortex during reconstruction of the femoral neck. We evaluated the use of fibular grafting for fresh femoral neck fractures with posterior comminution. Between November 2019 and March 2022, 20 women and 12 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=19) and IV (n=13) femoral neck fractures. Clinical and radiological outcomes were evaluated. Patients were followed up for a period of 15 months. According to the Harris hip score, outcome was good to excellent in 23, fair in 7, and poor in 2. 30 of the 32 patients achieved bone union after a mean of 4.5 (range 3.5-5.5) months. In 2 patients, the bone was united with a mean of 10º of varus collapse. Two patients had non-union. Other complications included screw migration in the joint space (n=1) and screw pullout (n=2). No patient had avascular necrosis of the femoral head. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.

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.

122 Outcomes in Young Adult Patients with Intracapsular Femoral Neck Fractures

Abstract Aim The aim was to evaluate short- and long-term outcomes for young adult patients undergoing fixation for an intracapsular femoral neck fracture. Method From 2008–2018, we retrospectively identified 112 consecutive patients (mean age 48yrs [20–60], 54% male). Complication details were determined from medical records and radiographs. Long-term patient-reported outcomes – including Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D)/Visual Analogue Scale (EQ-VAS) and UCLA Activity Scale – were obtained via telephone survey. Results Union occurred in 77% (n=86/112) at a mean of nine months (3–87). Complications occurred in 23% (n=26/112), including fixation failure (5.4%, n=6/112), nonunion (4.5%, n=5/112) and AVN (14.3%, n=16/112). Alcohol excess (p=0.04), time to surgery &amp;gt;24hrs (p=0.023) and fracture malreduction (p=0.002) were associated with complications. Overall, 35% required further surgery, including metalwork removal (18.8%, n=21/112), total hip replacement (18.8%, n=21/112) and excision arthroplasty (1.8%, 2/112). Long-term outcomes were obtained for 72% (n=81/112) at a mean of 6.9yrs (2.8–12.8). The mean OHS was 41.4 (4–48), FJS 63.3 (0–100), EQ-5D 0.823 (-0.59–1.0) and EQ-VAS 79.5 (5–100). Mean EQ-5D was significantly lower than population controls (p=0.005). The mean UCLA score fell from 6.8 pre-injury to 6.0 post-injury (p&amp;lt;0.001). Patients with complications had significantly lower OHS (p&amp;lt;0.001), EQ-5D (p=0.001), EQ-VAS (p=0.01) and UCLA scores (p=0.001) compared with those who united uneventfully. Conclusions Most young adult patients united following fixation of their fracture. However, one in four experienced a complication, resulting in inferior long-term function and health-related quality of life. Time to surgery and fracture reduction were significantly associated with complications.

Biplane double supported screw fixation for femoral neck fracture in young adults: A prospective cohort study

IntroductionAchieving accurate anatomic reduction and stable internal fixation is mandatory in the management of femoral neck fractures (FNF) in adults. The spatial configuration and direction of the screws have been reported to provide stability to the fracture. The study's goal is to analyse the clinico-radiological outcome of the newer biplane double-supported screw fixation (BDSF) technique in the Indian cohort. Materials and methodsPatients with isolated FNFs underwent osteo-synthesis by BDSF technique. Radiological outcome was evaluated by time to union and fracture healing on plain radiographs. Clinical outcome was measured using the Harris hip score (HHS) at 1, 3, 6, and 12 months after surgery. The pain reduction was measured using the VAS score. ResultsTwenty-seven patients with a mean age of 37.33 ± 9.84 years (24–55 years) were followed up for at least 12 months (12–31 months). The mean HHS at 12 months was 94.81 ± 8.18 (range: 68–100). Twenty-five patients were able to achieve radiological union within a mean time of 14.60 ± 4.69 weeks (range: 8–28). The overall complication rate was found to be 18.51% (5 out of 27 patients). Individual complications were non-union (2 patients; 7.4%), AVN (3 patients; 11.11%), and screw back out with femoral neck shortening (4 patients; 14.81%). ConclusionScrew configuration using the BDSF technique provides a good union rate with minimum complications. The majority of patients resulted in a good (HHS >80) to excellent functional outcome. Based on the clinico-radiological outcome obtained, we conclude that this technique is effective in the fixation of FNF in adults. Level of studyLevel II.

The application of the 150° oblique tangential fluoroscopic view to detect the posterosuperior femoral neck screw in–out–in intraoperatively

This study investigates the application of the 150° tangential fluoroscopic projection as a novel fluoroscopic view to detect the posterosuperior screw in–out–in (IOI) in the cannulated screws fixation of femoral neck fractures. A retrospective analysis was conducted including 33 patients with femoral neck fractures enrolled from April to November 2021. All patients underwent closed reduction and internal fixation with cannulated screws under intra-operative C-arm fluoroscopy. The posterosuperior femoral neck screw position (whether in–out–in and the distance to the femoral neck cortex) was evaluated from the standard anteroposterior (AP), lateral view, and tangential view images. Postoperative computed tomography (CT) scan results are considered the gold standard for detecting the femoral neck screw locations. Of 33 patients, no femoral neck screws were found to be placed IOI under the standard AP and lateral views. The tangential view revealed the posterosuperior screw was IOI in 8 patients, whereas the average distance between the posterosuperior screw and the posterior femoral neck cortex was 2.73 ± 1.06 mm under the standard lateral view. Postoperative CT verified that posterosuperior screw was placed IOI in these 8 patients. In the other 25 patients with the tangential view showed the posterosuperior screw completely contained in the femoral neck, the average distance between the posterosuperior screw and the posterior femoral neck cortex was 5.48 ± 1.26 mm under the standard lateral view and 2.76 ± 1.08 mm under the tangential view, with a statistically significant difference between the two groups (p < 0.05). Post-operative CT demonstrated that the femoral neck screws were completely contained in the femoral neck in these 25 patients. Intra-operative tangential view of 150° can effectively identify the posterosuperior screw IOI in the cannulated screws fixation of femoral neck fractures. Based on our study, we highly recommend the tangential view as a routine intraoperative fluoroscopic angle to detect the posterosuperior screw IOI.

The accuracy of hip fracture data entered into the national surgical quality improvement program (NSQIP) database.

Internal validation studies of National Surgical Quality Improvement Program (NSQIP) registry data have reported potential inaccuracies. The purpose of this study was to determine the accuracy of hip fracture CPT codes and complications entered into NSQIP for a single participating center. A retrospective study identified patients with a hip fracture CPT code from NSQIP data at a single institution over a two-year period. CPT codes included 27235 (percutaneous fixation of femoral neck fracture (Perc FNFX)), 27236 (open treatment of femoral neck fracture, internal fixation/prosthetic replacement (Open FNFX)), 27244 (open treatment of inter/peri/subtrochanteric femoral fracture with plate (Plate ITFX)), 27245 (treatment of inter/peri/subtrochanteric femoral fracture, with intramedullary implant (IMN ITFX)), and 27125 (hemiarthroplasty (HA)). The institutional medical record was reviewed to determine the accuracy of CPT code and 30-day complication data entered into the registry. 12.8% (n = 20/156) of patients had an inaccurate CPT code. The proportion of inaccurate CPT codes varied significantly by procedure: Plate ITFX (76.9%), Open FNFX (13.8%), IMN ITFX (7.0%), and HA (0%) (p < 0.0001). A total of 82 complications were identified in 66 patients via the medical record. 43.9% (n = 36/82) of these complications were not documented in the NSQIP data. The proportion of missing complications varied significantly by type: renal (100%), UTI (53.8%), infection (50%), bleeding (30%), death (25%), respiratory (25%), cardiac (0%), stroke (0%), and VTE (0%) (p < 0.0001). Hip fracture CPT codes and 30-day complication data entered into the NSQIP registry were frequently inaccurate. Studies incorporating NSQIP data should acknowledge these potential limitations of the registry, and future research to validate NSQIP orthopedic data across procedures and institutions is necessary. LEVEL III: Diagnostic study.

Research progress in biomechanics of common internal fixation for femoral neck fracture

To summarize the characteristics and biomechanical research progress of common internal fixation for femoral neck fractures in recent years, so as to provide reference to clinical treatment of femoral neck fracture. The domestic and foreign relevant literature on biomechanics of internal fixation of femoral neck fracture in recent years was reviewed, and the biomechanical research progress was summarized. Among the internal fixations currently used in the treatment of femoral neck fractures, three cannulated screws can provide sliding compression at the end of the fracture, but the shear resistance is weak, and the risk of long-term internal fixation failure is high; dynamic hip screw and proximal femoral locking plate have excellent angle stability and overall strength; medial buttress plate can transform vertical shear force into compressive stress to promote fracture healing and produce a certain anti-rotation effect; femoral neck system can support the fracture in multi-axial direction, with excellent anti-rotation and anti-shortening properties; and cephalomedullary nails have high overall strength and failure load. Different internal fixations have their own indications due to differences in structure and biomechanics. At present, there is no detailed standard guidance of internal fixation selection. Clinically, the appropriate treatment should be selected according to the fracture types of patients.