Multiple Cancellous Screws Research Articles

Comparison of dynamic compression system versus multiple cancellous screws in the treatment of femoral neck fractures in young adults

IntroductionFemoral neck fractures have posed a significant global healthcare challenge and had notable impacts on the quality of life. Current treatment strategies for femoral neck fractures in young individuals have varied, emphasizing the need for optimal fixation methods. This study compared the clinical and radiological outcomes of the dynamic compression system (DCS) and multiple cancellous screws (MCS) methods.MethodsThis retrospective study included a total of 275 young adults with fresh femoral neck fractures treated with DCS and MCS. A matching analysis with a 1:1 ratio based on age, gender, fracture classification, and reduction quality was conducted. Demographic data were recorded, and comparisons were made according to follow-up time (FUT), hospitalization period, operation duration, femoral neck shortening, caput-collum-diaphysis (CCD) angle, Harris Hip Score (HHS), and post-operative complications.ResultsA total of 42 fractures were matched with a median age of 42 years (range, 22–48). In the DCS group, vertical neck shortening (median 1.92) was significantly lower than that in the MCS group (median 4.53) (P < 0.05). In the DCS group, horizontal femoral neck shortening, resultant femoral neck shortening, the amount of change in CCD angle, and HHS were 0.57 mm (0.43, 4.74 mm), 1.82 mm (0.40, 3.53 mm), 0.13° (-0.78°, 1.80°), and 91 (85–93), respectively. They were all non-significant than 1.00 mm (0.56, 6.23 mm), 2.74 mm (1.59, 6.71 mm), -0.18° (-1.11°,1.85°), and 91 (75, 93) in the MCS group, respectively (P > 0.05). There was no statistical difference in FUT, hospitalization period, operation time, and post-operative complications at the latest follow-up (P > 0.05). There were no complications such as pulmonary embolism, deep vein thrombosis, and incision infection reported.ConclusionDCS and MCS demonstrated effectiveness in treating femoral neck fractures in young adults. The DCS implant provides additional stability in the vertical axis. A prospective randomized controlled study with a large sample size was needed to validate these findings.

Comparison of young femoral neck fractures treated by femoral neck system, multiple cancellous screws and dynamic hip screws: a retrospectively comparison study

BackgroundImplant choice for the fixation of femoral neck fracture is one of the most important management controversies. This study aims to evaluate and compare the short-term outcomes associated with the use of the Femoral Neck System (FNS), Multiple Cancellous Screws (MCS), and Dynamic Hip Screws (DHS) in treating femoral neck fractures in a young patient population.MethodsFrom June 2018 to June 2021, a total of 120 surgeries for a primary femoral neck fracture were retrospectively analyzed. This review encompassed demographic details of the patients and the mechanisms behind the injuries. Key surgical parameters such as operation duration, intraoperative blood loss, fluoroscopy duration, and hospital stay were meticulously documented. The employed surgical technique was described. All patients were followed up at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Avascular necrosis of the femoral head (AVN), nonunion, malreduction, implant failure or other complications were noted. The functional status at the last follow-up was assessed using the Harris functional scoring criteria.ResultsThere were 90 males and 30 females, with a mean age of 40.4 years. As to patient characteristics, there were no significant differences between the three groups. DHS group showed longer operation time(52.15 ± 4.80 min), more blood loss(59.05 ± 5.87 ml) and longer time of hospitalization(7.6 ± 0.90 d) than FNS group (39.65 ± 2.84 min, 45.33 ± 9.63 ml and 4.87 ± 0.48 d) and MCS group (39.45 ± 3.10 min, 48.15 ± 7.88 ml and 5.04 ± 0.49 d) (p < 0.05). In addition, the time of fluoroscopy in FNS group (15.45 ± 3.67) was less than that in MCS group (26.3 ± 4.76) and DHS group (27.1 ± 5.67) (p < 0.05). The cost of FNS group(44.51 ± 2.99 thousand RMB) was significantly higher than the MCS and DHS groups. The FNS, MCS and DHS groups showed a similar mean length of femoral neck shortening (LFNS) and Harris score. The FNS, MCS and DHS groups showed a similar mean rate of AVN and internal fixation failure.ConclusionsFollowing successful fracture reduction, FNS, MCS, and DHS are effective for in the young femoral neck fractures. No difference was found in complications between the three groups. However, the reduced fluoroscopy time associated with FNS contributes to shorter operation durations. The adoption of minimally invasive techniques correlates with decreased blood loss and shorter hospital stays. Nevertheless, these advantages may be offset by the potential economic burden they impose.

Dynamic Locking Plate versus Multiple Cancellous Screws for the Fixation of Intracapsular Femoral Neck Fractures: Long-Term Results and Quality-Of-Life Assessment Based on Patient-Reported Outcome Measures.

The purpose of this study was to compare the long-term clinical outcomes and quality-of-life measures for two fixation methods in the setting of displaced femoral neck fractures. The two groups included fixation with multiple cancellous screws (group 1) and telescopic femoral neck screws and a small locking plate device (Targon FN) (group 2). Patients underwent reduction and internal fixation with either multiple cancellous screws or the Targon FN device from March 2000 to January 2012. Failure endpoints included nonunion, osteonecrosis of the femoral head, and revision surgery. Patient-reported outcome measures included chronic pain, ability to ambulate, and the use of ambulation assistive devices. Statistical analysis demonstrated a statistically significant lower rate of non-union and overall complication in the Targon FN group (p value < 0.001 and p value = 0.005, respectively). Logistic regression analysis showed that operative fixation with the Targon FN device decreased the odds ratio for overall complication by a factor of 0.34 (p = 0.02). There were no statistically significant differences between groups 1 and 2 in patient-reported outcomes (chronic pain (p = 0.21), ability to ambulate (p = 0.07), and the use of an ambulation assistive device (p = 0.07)). When compared to traditional cancellous screw fixation of femoral neck fractures, the Targon FN device has significantly lower complication rates and equivalent patient-reported outcomes.

EARLY RESULTS OF THE FEMORAL NECK SYSTEM IN FIXATION OF FEMORAL NECK FRACTURES

The Femoral Neck System (FNS) was introduced as an alternative device for the fixation of neck of femur fractures (NOFFs). The purported advantages include superior angular and rotatory stability compared to multiple cancellous screws, via a minimally invasive instrumentation that is simpler than conventional fixed angle devices. There were limited clinical studies regarding the utility of this device. We aimed to study the outcomes of NOFFs fixed with the FNS.This was a single-institution, retrospective review of all undisplaced elderly (≥60 years old) undisplaced young, and displaced young NOFFs fixed with the FNS. Demographics, surgical parameters, radiographic parameters, and clinical outcomes including complications were reviewed.Thirty-six subjects with a median age of 75 [44,89] years old, had NOFF fixation using the FNS. Thirty-one (86.1%) had undisplaced fractures. There were 6 (16.7%), 26 (72.2%), and 4 (11.1%) subjects with Pauwels types 1, 2, and 3 respectively. Thirty-two (88.9%) had posterior tilt of &lt;20º. The mean duration of surgery was 71±18 minutes. Excluding 4 patients whom required revision surgery, 2 patients whom demised, and 10 patients whom defaulted reviews, the mean follow-up duration was 55±13 weeks. Four complications were recorded, namely implant cut out at the femoral head at week 8, breaking of the locking screw at the run-off region at week 22, avascular necrosis at week 25, and a refracture following near fall, causing the fracture to fail in varus at week 7 postoperation.While reasonably fast to instrument, failures still occur and it is likely multifactorial. However, the rate of reoperation is lower than what has been reported for NOFFs fixed with the a fixed-angle device or 3 cancellous screws. In conclusion, the FNS is a reasonably safe instrument to use. Surgeons’ discretion is still needed in patient selection, keeping in mind the need for satisfactory radiological parameters.

Structure-mechanical analysis of various fixation constructs for basicervical fractures of the proximal femur and clinical implications; finite element analysis

ObjectiveThis present study was conducted to determine the structural-mechanical stability of various fixation constructs through finite element (FE) analysis following simulation of a basicervical fracture and to introduce the clinical implications. Materials and MethodsWe simulated fracture models by using a right synthetic femur (SAWBONES®). We imported the implant models into ANSYS® for placement in an optimal position. Five assembly models were constructed: (1) multiple cancellous screws (MCS), (2) FNS (femoral neck system®), (3) dynamic hip screw (DHS), (4) DHS with anti-rotation 7.0 screw (DHS + screw), and PFNA-II (Proximal Femoral Nail Antirotation-II®). The femur model's distal end was completely fixed and 7° abducted. We set the force vector at a 3° angle laterally and 15° posteriorly from the vertical ground. Analysis was done using Ansys® software with von Mises stress (VMS) in megapascals (MPa) and displacement (mm) ResultsThe displacements of the proximal femur were 10.25 mm for MCS, 9.66 mm for DHS, 9.44 mm for DHS + screw, 9.86 mm for FNS, and 9.31 mm for PFNA-II. The maximum implant VMS was 148.94 MPa for MCS, 414.66 MPa for DHS, 385.59 MPa for DSH + screw, 464.07 MPa for FNS, and 505.07 MPa for PFNA-II. The maximum VMS at the fracture site was 621.13 MPa for MCS, 464.14 MPa for DHS, 64.51 MPa for DHS + screw, 344.54 MPa for FNS, and 647.49 MPa for PFNA-II. The maximum VMS at the fracture site was in the superior area with the high point around the posterior screw in the MCS, anterosuperior corner in the DHS, the posteroinferior site of the FNS, and posterosuperior site around the entry point in the PFNA-II. In the DHS + screw, the stresses were distributed evenly and disappeared at the maximum VMS fracture site. ConclusionBased on the fracture site and implant's stress distribution, the model receiving the optimal load was a DHS + screw construct, and the FNS implant could be applied to anatomically reduced fractures without comminution. Considering the high-stress concentration around the entry point, a PFNA-II fixation has a high probability of head-neck fragment rotational instability.

Comparison of femoral neck system to multiple cancellous screws and dynamic hip screws in the treatment of femoral neck fractures

ObjectiveTo compare the short-term outcomes of the femoral neck system (FNS) with multiple cancellous screws (MCS) and dynamic hip screws (DHS) in the treatment of femoral neck fractures. MethodsA retrospective analysis was performed on 157 patients with fresh femoral neck fractures treated with FNS (from September 2019 to October 2020), MCS, and DHS (from January 2018 to October 2020). According to internal fixation methods, all patients were divided into the FNS group (54 cases), MCS group (51 cases), and DHS group (52 cases). Demographic data were also collected, recorded, and compared, including the follow-up time, days of hospitalization, operation time, blood loss, intraoperative fluoroscopy times (IFT), weight-bearing time (WBT), length of femoral neck shortening (LFNS), Harris hip score, and complications (such as internal fixation failure, bone nonunion, and avascular necrosis of the femoral head) between the three groups. ResultsOverall, 157 patients with a mean age of 61.8 (range, 18–89) years were analyzed. In the FNS group, IFT (median 10.5) was significantly lower than that in the MCS group (median 21) and DHS group (median 20.5) (P<0.05), and WBT was significantly earlier than that of the MCS group (P<0.05). In the FNS group, the median hospitalization time, operation time, and blood loss were 2 (2, 4) days, 45 (40–59) min, and 30 (20, 50) ml, respectively. They were all significantly less than 3.5 (3, 6) days, 72 (55–88.75) min, and 50 (30, 50) ml in the DHS group, respectively (P < 0.05). There was no statistical difference in LFNS, quality of reduction, internal fixation failure rate, and Harris hip score at the latest follow-up (P>0.05). No surgical complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in any of the three groups. ConclusionFNS, MCS, and DHS are all effective for femoral neck fractures. However, a lower IFT of FNS shortens the operation time. Compared to MCS, FNS has the advantages of being a simple operation, with early WBT; compared to DHS, a minimally invasive operation is the main advantage of FNS.

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

Objective To compare the clinical effect of proximal femoral locking plate (PFLP) versus multiple cancellous screw (MCS) for FNF. Methods FNF patients were treated with the PFLP implant or multiple cancellous screws (MCSs). Patient has been followed up for at least 12 months after surgery nonunion, and the occurrence of complications, femoral neck shortening, fracture healing time, and Harris hip score were recorded and compared. Results 77 FNF patients were treated with the PFLP (36 patients) or MCS (41 patients). The sex, age, side of the injured limb, type of Garden fracture, time from injury to surgery, and fracture healing time of two groups patients were comparable. The operation time and intraoperative blood loss in the PFLP group were worse than those in the MCS group. Two patients with the PFLP (5%) and nine patients (21%) with the MCS experienced cut out of the lag screw or avascular necrosis of the femoral head or nonunion and received hip replacement. However, the number of fluoroscopies in the PFLP group was significantly lower than that in the MCS group. Additionally, the femoral neck shortening and Harris hip score were all strongly better in the PFLP group than in the MCS group. Conclusions Compared with the MCS, PFLP treatment for FNF in young adults can decrease the fluoroscopy times, improve hip functional recovery, and reduce the complications rate and femoral neck shortening.

Treatment of Valgus-Impacted and Nondisplaced Femoral Neck Fragility Fractures in the Elderly.

As the life expectancy of the worldwide population increases, the number of hip fractures in the elderly cohort is expected to grow. It is important for surgeons to critically analyze available treatment options for these injuries, with the goal of optimizing outcomes and minimizing complications. Femoral neck fractures make up approximately half of all hip fractures. Nonoperative treatment of valgus-impacted and nondisplaced (Garden I and II) femoral neck fractures has high rates of secondary displacement, osteonecrosis, and nonunion; only patients with notable risk for perioperative complications are treated nonoperatively. Surgical intervention is the standard of care, with options including internal fixation (IF) with multiple cancellous screws or a sliding hip screw, hemiarthroplasty, or total hip arthroplasty. Patients with a posterior tilt of greater than 20° have a high rate of revision surgery when treated with IF and may benefit from primary arthroplasty. Furthermore, primary arthroplasty has demonstrated lower revision surgery rates and equivalent postoperative mortality when compared with IF. Surgeons should be aware of the functional outcomes, complications, revision surgery rates, and mortality rates associated with each treatment modality to make a patient-specific decision regarding their care.

Fracture patella: Fixation with cancellous screws and anterior cerclage wiring

Patella is the largest sesamoid bone. It is a triangular bone that lies within quadriceps tendon. Fractures of patella constitute approximately 1% of all skeletal injuries and occur in all age groups. There is always a need to salvage the fracture as it is an important functional structure in extensor mechanism of knee. Its report to evaluate the effectiveness and safety of anterior cerclage wire/tension band wiring technique using two or more cannulated cancellous screws in patients with transverse or transverse with comminuted patellar fractures. Material and Methods: This is a prospective study of 28 patients with transverse or transverse with comminuted fractures. All patients were treated with open reduction and internal fixation using multiple cancellous screws (more than two) and 18G stainless steel wire except two cases with TBW with k wire as per tension band principle. Result-There were 28 patients, 24(85.71%) males and 4(14.28%) females. The age group ranged from 22-60 years with mean age 38 years. The mode of injury was either direct or indirect trauma, fall (74%) followed by RTA (18%) and violent quadriceps contraction (8%). Transverse fractures were present in 60% patients and transverse fracture with comminution in 40% patients. Mean time to achieve union was 10.7 weeks (Range 8-12 weeks). Cases were followed up for 3 months, then at 6 months, thereafter 6 monthly and assessed for recovery of knee function. Study continued up to 12 months to 18 months. Mean ROM at the end of 3 months was 113.8° (90-130) and at final follow up this movement improved up to 125.4° (ROM 100-150). There was loss of reduction in one case, one case of infection and one case of nonunion. No case of implant failure was observed. The study was conducted in Department of Orthopaedics, Hi Tech Medical College, Rourkela and SB Medical College, Hazaribag. The results were graded according to the criteria given by Gaur et al. IJO May 1997. Conclusion: The criteria for surgery, open reduction and internal fixation with multiple cannulated cancellous screws with anterior cerclage was if ˃ 3mm displacement and ˃ 2mm articular step off was present. The screws provide rotation control of fragment and anchorage of cerclage wire. It provides additional compression across the fracture site. Open reduction and internal fixation with cannulated cancellous screws with anterior cerclage /TBW is a safe, reliable and reproducible method in the management of transverse or transverse with comminuted fractures, with less chances of implant failure and less soft tissue irritation.

Free fibular graft augmentation in delayed fixation of fracture neck of femur in young adults

Introduction: This clinical study was conducted to assess the long-term follow-up results of using free fibular graft to augment fracture fixation with cannulated cancellous screw (CCS) or dynamic hip screw (DHS) as a treatment option for femoral neck fractures in young adults who presented after 24 h of injury but within 3 weeks. Methodology: A prospective study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws or DHS with fibular graft. Patients aged between 15 and 50 years and having Garden Type III or IV fracture with duration of injury >3 weeks were included in the study. They were assessed for radiological outcome and functional outcome using modified Harris hip score. Results: Twenty-two cases were operated between day 2 and day 21 after sustaining injury. The mean time of union was 3.4 months. Nineteen fractures united uneventfully. Two fractures went in for nonunion and one developed avascular necrosis (AVN) of the femoral head. According to Harris hip score, 14 patients scored “excellent,” three patients scored “good,” three scored “fair,” and “poor” score was recorded in two patients. Conclusions: Delay in surgery as a contributing factor for the development of complications in fracture neck of femur cannot be ruled out with the present literature available. Using a free fibular graft as an adjunct to implant construct helps in reducing the rates of nonunion and AVN. However, this cannot be a substitute for proper surgical precision that is required in the treatment of fracture neck of femur. Further prospective studies involving large sample size are required.

Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study.

To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). Retrospective cohort study. Secondary data analysis of 2 multinational randomized controlled trials. Patients aged 50 years or older with a FNF. Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF. The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life. The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01). Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fractured neck of femur: a review of three seminal papers and their implications to clinical management

It is unusual, if not unique, for three major research papers concerned with the management of the fractured neck of femur (FNOF) to be published in a short period of time, each describing large prospective randomized clinical trials. These studies were conducted in up to 17 countries worldwide, involving up to 80 surgical centers and include large numbers of patients (up to 2,900) with FNOF. Each article investigated common clinical dilemmas; the first paper comparing total hip arthroplasty versus hemiarthroplasty for FNOF, the second as to whether ‘fast track’ care offers improved clinical outcomes and the third, compares sliding hip with multiple cancellous hip screws. Each paper has been deemed of sufficient quality and importance to warrant publication in The Lancet or the New England Journal of Medicine. Although ‘premier’ journals, they only occationally contain orthopaedic studies and thus may not be routinely read by the busy orthopaedic/surgical clinician of any grade. It is therefore our intention with this present article to accurately summarize and combine the results of all three papers, presenting, in our opinion, the most important clinically relevant facts. Cite this article: Bone Joint Open 2020;1-6:198–202.

Fractured neck of femur: a review of three seminal papers and their implications to clinical management.

It is unusual, if not unique, for three major research papers concerned with the management of the fractured neck of femur (FNOF) to be published in a short period of time, each describing large prospective randomized clinical trials. These studies were conducted in up to 17 countries worldwide, involving up to 80 surgical centers and include large numbers of patients (up to 2,900) with FNOF. Each article investigated common clinical dilemmas; the first paper comparing total hip arthroplasty versus hemiarthroplasty for FNOF, the second as to whether ‘fast track’ care offers improved clinical outcomes and the third, compares sliding hip with multiple cancellous hip screws. Each paper has been deemed of sufficient quality and importance to warrant publication in The Lancet or the New England Journal of Medicine. Although ‘premier’ journals, they only occationally contain orthopaedic studies and thus may not be routinely read by the busy orthopaedic/surgical clinician of any grade. It is therefore our intention with this present article to accurately summarize and combine the results of all three papers, presenting, in our opinion, the most important clinically relevant facts.Cite this article: Bone Joint Open 2020;1-6:198–202.

English

English

Fixation using alternative implants for the treatment of hip fractures (FAITH-2): design and rationale for a pilot multi-centre 2\u2009\xd7\u20092 factorial randomized controlled trial in young femoral neck fracture patients

BackgroundFemoral neck fractures in patients ≤ 60 years of age are often very different injuries compared to low-energy, hip fractures in elderly patients and are difficult to manage because of inherent problems associated with high-energy trauma mechanisms and increased functional demands for recovery. Internal fixation, with multiple cancellous screws or a sliding hip screw (SHS), is the most common treatment for this injury in young patients. However, there is no clinical consensus regarding which surgical technique is optimal. Additionally, there is compelling rationale to use vitamin D supplementation to nutritionally optimize bone healing in young patients. This pilot trial will determine feasibility and provide preliminary clinical data for a larger definitive trial.MethodsWe will conduct a multicenter, concealed randomized controlled pilot study, using a 2 × 2 factorial design in 60 patients aged 18–60 years with a femoral neck fracture. Eligible patients will be randomized in equal proportions to one of four groups: 1) SHS and vitamin D supplementation (4000 international units (IU) daily dose) for 6 months, 2) cancellous screws and vitamin D supplementation (4000 IU daily dose) for 6 months, 3) SHS and placebo, and 4) cancellous screws and placebo. Participants will be followed for 12 months post-fracture. Feasibility outcomes include initiation of clinical sites, recruitment, follow-up, data quality, and protocol adherence. Clinical outcomes, for both the pilot and planned definitive trials, include a composite of patient-important outcomes (re-operation, femoral head osteonecrosis, severe femoral neck malunion, and nonunion), health-related quality of life and patient-reported function, fracture healing complications, and radiographic fracture healing. A priori success criteria have been established. If the pilot study is deemed successful, study participants will be included in the definitive trial and clinical outcomes for the pilot will not be analyzed. If the pilot study is not deemed successful, clinical outcome data will be analyzed.DiscussionResults of this study will inform the feasibility of a definitive trial. If clinical outcome data are analyzed, they will be disseminated through a publication and presentations.Trial registrationThe FAITH-2 trial, described as a definitive trial, was registered at ClinicalTrials.gov (NCT01908751) prior to enrollment of the first participant.

Failure Patterns of Femoral Neck Fracture Fixation in Young Patients.

The primary purpose of this study was to describe the failure patterns of femoral neck fracture fixation in young patients. The secondary purpose was to determine if pattern of failure varies by type of implant. Adult patients (age range, 18-55 years) who experienced a "fixation failure" following internal fixation of a femoral neck fracture were identified from 5 level 1 trauma centers. Failure was defined by screw cutout, implant breakage, varus collapse (<120° neck-shaft angle), or severe fracture shortening (≥1 cm). When multiple complications were identified, mechanical failures were preferentially noted for the analysis. Failure patterns were compared between patients who received multiple cancellous screws and patients who received a sliding hip screw plus a derotation screw. Severe fracture shortening was the most common complication identified (61%). No differences in the incidence of severe shortening (P=.750) or implant breakage (P=1.000) were detected between the fixation groups. However, among the failures with a sliding hip screw plus a derotation screw construct, a greater portion were related to screw cutout (38% for a sliding hip screw plus a derotation screw vs 7% for screws, P=.019). Failures with multiple screws were associated with varus collapse (25% for screws vs 0% for a sliding hip screw plus a derotation screw, P=.037). Severe shortening was the most common fixation failure. Sliding hip screw plus derotation screw implants were associated with screw cutout. Multiple cancellous screw implants failed by varus collapse. Selecting a surgical implant based on its likely failure pattern may allow surgeons to minimize the severity of failure or the need for secondary conversion to hip arthroplasty. [Orthopedics. 2019; 42(4):e376-e380.].

Novel Treatment Options for the Surgical Management of Young Femoral Neck Fractures.

In physiologically young patients with displaced femoral neck fractures, surgical treatment is aimed at achieving fracture union while preserving native hip anatomy and biomechanics. The intracapsular environment, tenuous vascular supply, and unfavorable hip biomechanics contribute to the high complication rates seen after osteosynthesis of these fractures. Conventional fixation methods for osteosynthesis of femoral neck fractures include multiple cancellous screws, fixed-angle dynamic implants, and fixed-angle length-stable constructs. Despite several biomechanical and clinical studies evaluating various surgical options, the optimal fixation construct to allow healing and prevent nonunion of displaced femoral neck fractures is not known. This article will review the clinical data regarding conventional fixation constructs and describe the technique and rationale behind 2 novel alternative treatment options for these challenging fractures. The surgical technique and clinical examples for constructs involving multiple cannulated screws/Pauwels screw augmented with a fibular strut graft, as well as a novel fixed-angle locking plate with controlled dynamic compression, are presented.

Comparison of early complications between the use of a cannulated screw locking plate and multiple cancellous screws in the treatment of displaced intracapsular hip fractures in young adults: a randomized controlled clinical trial

BackgroundThe incidence of early postoperative complications of displaced intracapsular hip fractures is high. The purpose of this study was to compare the early postoperative complications and assess the incidence of femoral neck shortening on using a newly designed proximal femoral cannulated screw locking plate (CSLP) versus multiple cancellous screws (MCS) in the treatment of displaced intracapsular hip fractures in young adults.MethodsSixty-eight young adult patients with displaced intracapsular hip fractures were randomly assigned to either the CSLP group or the MCS group and treated routinely by internal fixation with either the CSLP or the MCS. Harris Hip Score, nonunion, failure of fixation, overall complications, and femoral neck shortening were recorded and compared.ResultsTwo patients (5.88%) in the CSLP group and eight (23.53%) in the MCS group had postoperative nonunion (P < 0.05). There was one case (2.94%) of fixation failure in the CSLP group and three cases (8.82%) in the MCS group (P > 0.05). Three patients (8.82%) in the CSLP group and 11 (32.35%) in the MCS group had overall complications (P < 0.05). Mean femoral neck shortening was 5.10 mm in the vertical plane and 5.11 mm in the horizontal plane in the CSLP group and 11.14 mm in the vertical plane and 10.51 mm in the horizontal plane in the MCS group. Severe femoral neck shortening (≥ 10 mm) did not occur in either the vertical or the horizontal plane in any patient of the CSLP group but occurred in 10 patients (28.57%) in the vertical plane and in 8 (22.86%) patients in the horizontal plane in the MCS group.ConclusionsCompared with MCS, the use of CSLP in the treatment of displaced intracapsular hip fractures in young adults can reduce the rates of postoperative nonunion and overall complications and minimize femoral neck shortening.Trial registrationChiCTR1800016032. Registered 8 May 2018. Retrospectively registered.

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

BACKGROUND: Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. METHODS: For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. FINDINGS: Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63-1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06-3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). INTERPRETATION: In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. FUNDING: National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.

Incidence of and Factors Influencing Femoral Neck Shortening in Elderly Patients After Fracture Fixation with Multiple Cancellous Screws.

BackgroundTo study the incidence of and factors influencing “neck shortening” in elderly patients treated for femoral neck fractures using multiple cancellous screws.Material/MethodsOf the 197 femoral neck fracture cases treated via closed reduction and cancellous screws fixation from January 2006 to February 2010, 110 were followed up. Patient age, gender, operative time, implantation method, reduction quality, fracture type, bone mineral density, loading time, length of hospital stay, and Harris hip score 12 months after operation were recorded. The patients were divided into two groups (shortening and non-shortening) based on their X-ray performance during follow-up. The healing rates and Harris hip scores of the two groups were compared, and the influencing factors of femoral neck shortening were analyzed.ResultsOf the 110 cases followed up, 94.5% (104/110) were healed and neck shortening occurred in 41.8% (46/110) within 12.5 months (mean) after treatment. The Harris hip score of the shortening group was lower than that of the non-shortening group (78±17 vs. 86±23, p=0.048). The fracture healing rates of the two groups were not significantly different (p=0.068). The factors influencing neck shortening were significantly correlated with bone mineral density, patient age, gender, and type of fracture.ConclusionsThe incidence of neck shortening in elderly patients treated for femoral neck fracture using cancellous screws was high. Bone mineral density, patient age, gender, and type of fracture were the influencing factors of neck shortening.