Neck Fractures In Young Patients Research Articles

Nonanatomical reduction of femoral neck fractures in young patients with different Pauwels classifications: a retrospective study and finite element analysis

BackgroundPrevious studies have reported that positive buttress is as effective as anatomical reduction in treating young femoral neck fractures, but whether this effect is related to the Pauwels classification remains unclear. The purpose of this study was to retrospectively analyze the clinical prognosis of positive buttress in young femoral neck fractures with different Pauwels classifications, as well as to assess its biomechanical properties.MethodsA total of 170 young patients with femoral neck fractures who were treated with three cannulated screws were included in this study. Patients were divided into three groups based on their preoperative Pauwels classification. Each group was divided into three subgroups based on the reduction quality: positive buttress, negative buttress and anatomical reduction. The femoral neck shortening, the incidence of necrosis of the femoral head (AVN) and the Harris hip scores at the last follow-up were compared across the three reduction quality within each Pauwels classification. Subsequently, a volunteer was recruited, CT data of the hip was obtained, and finite element models representing different reduction quality under varying Pauwels classifications were established. The biomechanical properties of each model were then evaluated following the application of strains.ResultsIn Pauwels type I, there were no significant differences in postoperative femoral neck shortening, incidence of AVN, or Harris score among the three types of reduction quality (P > 0.05). However, positive buttress provided superior biomechanical stability compared to negative buttress and anatomical reduction. In Pauwels type II, the incidence of AVN was similar between the positive buttress and the anatomical reduction groups, and both were significantly lower than that in the negative buttress (P < 0.05). The Harris score of the positive buttress was higher than that of the negative buttress, and there was no significant difference in the occurrence of femoral neck shortening between the three groups (P > 0.05). Finite element analysis showed that the biomechanical stability of positive buttress was equivalent to anatomical reduction, and both were better than negative buttress. In Pauwels type III, the incidence of AVN in the anatomical reduction group was lower than that in both the positive buttress and negative buttress (P < 0.05). There was no significant difference in the occurrence of AVN or femoral neck shortening between positive buttress and negative buttress (P > 0.05). There was also no difference in postoperative Harris scores between the three reduction qualities (P > 0.05). Both positive buttress and negative buttress exhibited identical biomechanical qualities and were inferior to anatomical reduction.ConclusionsThe biomechanical and clinical dominance of positive buttress correlates with Pauwels type. Specifically, Positive buttress is biomechanically stable in Pauwels types I and II. In Pauwels type III, positive buttress is not advantageous. As the Pauwels angle increases, the biomechanical benefit of the positive buttress is lost. Therefore, regardless of the Pauwels classification, negative buttress should be avoided after reduction of femoral neck fractures in young patients.

Comparison of three different internal fixation methods in the treatment of femoral neck fracture

ObjectiveThis study aimed to assess the efficacy of three different fixation methods in treating femoral neck fractures in young patients. MethodsA retrospective analysis was conducted on 35 young patients with femoral neck fractures who underwent surgical treatment. Among them, 16, 12, and 7 patients underwent fixation with three cannulated compression screws (3CS), the femoral neck system (FNS), and the compound compression system (CCS), respectively. Data, including fracture classification, injury-to-surgery time, surgery duration, intraoperative blood loss, fluoroscopy instances, fracture healing time, complications, and Harris score at the final follow-up, were collected and analyzed to compare clinical outcomes among the three fixation methods. ResultsAll patients were followed for at least 6 months, exhibiting no significant differences in age, gender, injury side, fracture type, or injury-to-operation time among the three groups (P > 0.05). The FNS and CCS groups exhibited shorter operation durations and fewer intraoperative fluoroscopy instances compared to the 3CS group (P < 0.01). Despite the minimally invasive nature of 3CS, the FNS and CCS groups experienced higher intraoperative blood loss (P < 0.01). During follow-up, only one patient with 3CS fixation developed nonunion. Additionally, patients treated with 3CS demonstrated a higher incidence of femoral head necrosis and severe femoral neck shortening than the FNS and CCS groups. Excluding patients with combined nonunion, no significant difference in mean fracture healing time was observed among the three groups (P > 0.05). At the last follow-up, the FNS and CCS groups showed higher Harris scores (P < 0.05). ConclusionsBoth FNS and CCS are effective internal fixation systems for the treatment of femoral neck fractures in young patients, yielding more satisfactory clinical functional outcomes than 3CS. Comparatively, the CCS system presents a higher risk of iatrogenic rotation of the proximal fracture segment. Therefore, we advocate the insertion of two to three 2.5 mm Kirschner wires from the upper edge of the femoral neck along the axial direction before CCS lag screw insertion to resist iatrogenic rotational stress.

Treatment of Pauwels III femoral neck fracture in young patients using biplane double support screw internal fixation technology based on X-ray image

Traditional treatment methods have certain limitations. In recent years, the technique of internal fixation with double-plane double-supported screws based on X-ray images has been proposed to improve the therapeutic effect. The main objective of this research was to examine the effectiveness of the X-ray image-based bi-planar double-braced screw internal fixation technique . During surgery, the procedure was determined based on X-ray images, followed by an open reduction procedure at the fracture site, and finally internal fixation using bi-planar double-support screws. All patients were successfully treated with X-ray image-based bi-planar double support screw fixation. After surgery, X-ray images showed a good reduction of the fracture site without significant loosening or failure of the internal fixation. At the postoperative follow-up, the patient's pain symptoms were significantly relieved, and no significant complications occurred during recovery.

Medial Locking Plate Can Increase the Fixation Stability of Vertical Femoral Neck Fracture in Young Adults?

Introduction: Vertical femoral neck fractures in young adults are usually caused by high-energy trauma. These injuries are difficult to stabilize due to significant shear forces acting on the fracture site. Their treatment is challenging and with high risks of complications, such as fixation failure, malunion, nonunion, and avascular necrosis of the femoral head. Material and Methods: It compared the biomechanical stability provided by 3 different fixation methods: (1) dynamic hip screw with derotation screw, (2) cannulated screws with a conventional medial bone plate, and (3) cannulated screws with a locked medial bone plate. These fixation structures were applied on fourth-generation medium-sized synthetic bones, with a 17 pound per cubic foot cellular foam core and cervico-diaphyseal angle of 120 degrees were used. The comparison was performed through biomechanical tests under cyclic loading followed by an ultimate load. The interfragmentary movement at the fracture site was the main variable for the cyclical phase. Results: The biomechanical comparison showed no statistical differences (P &gt; 0.05) in stiffness, micromovement level, and mechanical resistance among the fixation techniques evaluated. Discussion: To stabilize the vertical femoral neck fracture in young patients, the use of a medial bone plate associated with cannulated screws on a “tie-rod” assembly is an option that supports the mechanical demand until the fracture healing. The locked medial plate did not provide an advantage compared with the conventional bone plate.

Prediction of hip joint function and analysis of risk factors for internal fixation failure after Femoral Neck System (FNS)

ObjectiveAnalysis of the risk factors affecting hip function and complications after femoral neck system (FNS) surgery for femoral neck fractures is of great significance for improving the procedure’s efficacy.MethodsThe data of patients with femoral neck fractures who underwent FNS surgery in our hospital between October 2019 and October 2020 were retrospectively analyzed. Age, gender, time from injury to operation, fracture classification, operation time, fracture reduction, and postoperative weight-bearing time information were set as potential factors that may affect the results. Hip Harris scores were performed at 12 months postoperatively, and postoperative complication data (e.g., femoral head necrosis, nonunion, and femoral neck shortness) were collected. The risk factors affecting hip function and complications after FNS surgery were predicted using linear and logistic regression analyses.ResultsA total of 69 cases of femoral neck fracture were included, with an average age of 56.09 ± 11.50 years. The linear analysis demonstrated that the age and fracture type of the patients were the risk factors affecting the Harris score of the hip joint after FNS surgery. Older patients with displaced femoral neck fractures had an inferior postoperative hip function. In addition, fracture type, reduction of the femoral neck, and postoperative weight-bearing significantly impacted postoperative complications. Displaced fractures, negative fixation, and premature weight-bearing (< 6 weeks) were risk factors for postoperative complications. The Harris score of patients with a shortened femoral neck in the included cases was not significantly different from that of patients without shortening (P = 0.25).ConclusionsAdvanced age and fracture type are important evaluation indicators of the Harris score after FNS internal fixation of femoral neck fractures in young patients. Fracture type, fracture reduction, and postoperative weight-bearing time are risk factors for complications after FNS.

Nonanatomical reduction of femoral neck fractures in young patients treated with femoral neck system: a retrospective cohort study

PurposeNegative buttress reduction should be avoided in the treatment of femoral neck fractures (FNFs) using conventional fixation. As the femoral neck system (FNS) has been recently developed and utilized widely to treat FNFs, the association of reduction quality with postoperative complications and clinical function has not been clarified. The purpose of this study was to evaluate the clinical effect of nonanatomical reduction in young patients with FNFs treated with FNS.MethodsThis multicenter, retrospective cohort study included 58 patients with FNFs treated with FNS between September 2019 and December 2021. According to the reduction quality immediately following surgery, patients were classified into positive, anatomical, and negative buttress reduction groups. Postoperative complications were assessed with 12 months of follow-up. The logistic regression model was used to identify risk factors for postoperative complications. The postoperative hip function was assessed using the Harris hip scores (HHS) system.ResultsAt a follow-up of 12 months, a total of eight patients (8/58, 13.8%) had postoperative complications in three groups. Compared with the anatomical reduction group, negative buttress reduction was significantly associated with a higher complication rate (OR = 2.99, 95%CI 1.10–8.10, P = 0.03). No significant associations were found between positive buttress reduction and the incidence of postoperative complications (OR = 1.21, 95%CI 0.35–4.14, P = 0.76). The difference was not statistically significant in Harris hip scores.ConclusionNegative buttress reduction should be avoided in young patients with FNFs treated with FNS.

Effects of Technical Errors on the Outcomes of Operatively Managed Femoral Neck Fractures in Adults Less than 50 Years of Age.

To evaluate the effect of technical errors (TEs) on the outcomes after repair of femoral neck fractures in young adults. Multicenter retrospective clinical study. 26 North American Level 1 Trauma Centers. Skeletally mature patients younger than 50 years of age with 492 femoral neck fractures treated between 2005 and 2017. Operative repair of femoral neck fracture. The association between TE (malreduction and deviation from optimal technique) and treatment failure (fixation failure, nonunion, malunion, osteonecrosis, malunion, and revision surgery) were examined using logistic regression analysis. Overall, a TE was observed in 50% (n = 245/492) of operatively managed femoral neck fractures in young patients. Two or more TEs were observed in 10% of displaced fractures. Treatment failure in displaced fractures occurred in 27% of cases without a TE, 56% of cases with 1 TE, and 86% of cases with 2 or more TEs. TEs were encountered less frequently in treatment of nondisplaced fractures compared with displaced fractures (39% vs. 53%, P < 0.001). Although TE(s) in nondisplaced fractures increased the risk of treatment failure and/or major reconstructive surgery (22% vs. 9%, P < 0.001), they were less frequently associated with treatment failure when compared with displaced fractures with a TE (22% vs. 69% P < 0.001). TEs were found in half of all femoral neck fractures in young adults undergoing operative repair. Both the occurrence and number of TEs were associated with an increased risk for failure of treatment. Preoperative planning for thoughtful and well-executed reduction and fixation techniques should lead to improved outcomes for young patients with femoral neck fractures. This study should also highlight the need for educational forums to address this subject. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Assessing osteonecrosis of the femoral head after internal fixation of femoral neck fractures in young patients with fixation implants in situ: the value of MARS MRI in relation to conventional radiography and patient-reported outcomes

Little is known on the use of metal artifact reduction sequence (MARS) MRI to diagnose osteonecrosis of the femoral head (ONFH) after fixation of femoral neck fractures (FNF) with conventional metal implants present. We compared MARS MRI with radiography in diagnosing ONFH. Secondarily, we determined whether signs of ONFH on MARS MRI correlate with patient-reported outcomes (PROs) via Oxford Hip Score (OHS) and pain (VAS). 30 adults under 60 years treated with internal fixation after FNF were prospectively included (2015-2018) at 2 hospitals. They were followed up with radiography and PROs at 4, 12, and 24 months and MARS MRI at 4 and 12 months. OHS < 34 or VAS pain > 20 was considered significant. At 12 months, 14 patients had a pathological MRI. 3 of 14 had ONFH on radiographs at 12 months, increasing to 5 at 24 months, and 4 had unfavorable PROs. 2 of 5 patients with ONFH signs on both MRI and radiography had unfavorable PROs. 1 of 10 patients with normal MRI and radiography had unfavorable 2-year PROs. 4 patients had inconsistent MRI results, of which 1 developed ONFH. 1 patient dropped out. Information from a pathological MRI was not useful, as a majority remained free from symptoms and ONFH signs on radiographs. Furthermore, PROs did not correlate with imaging results. MARS MRI findings must be better understood before being taken into clinical practice. However, a normal MARS MRI seems to be a good prognostic finding.

Comparison of femoral neck system vs. dynamic hip system blade for the treatment of femoral neck fracture in young patients: A retrospective study.

Femoral neck fracture is a common fracture in orthopedic practice. This study aimed to compare the clinical outcomes between the femoral neck system and dynamic hip system blade for the treatment of femoral neck fracture in young patients. This retrospective study included 43 and 52 patients who underwent treatment for femoral neck fracture with the femoral neck system and dynamic hip system blade, respectively, between August 2019 and August 2020. Operative indexes, including operation duration, blood loss, incision length, postoperative complications (femoral neck shortening, non-union, screw pull-out, femoral head necrosis), and Harris scale scores were recorded and analyzed. Compared to that with the dynamic hip system blade, the femoral neck system showed significantly less operation duration (femoral neck system vs. dynamic hip system blade: 47.09 ± 9.19 vs. 52.90 ± 9.64, P = 0.004), less blood loss (48.53 ± 10.69 vs. 65.31 ± 17.91, P < 0.001), and shorter incision length (4.04 ± 0.43 vs. 4.93 ± 0.53, P < 0.001). Femoral neck shortening was significantly lower with the femoral neck system than with the dynamic hip system blade (3.93 ± 2.40, n = 39 vs. 5.22 ± 2.89, n = 44, P = 0.031). No statistical differences were observed between the two groups in nonunion, screw pull-out, and femoral head necrosis. In addition, the latest follow-up Harris scale score was significantly higher with the femoral neck system than with the dynamic hip system blade (92.3 ± 4.5 vs. 89. 9 ± 4.9, P = 0.015). The femoral neck system results in less trauma, less femoral neck shortening, and better hip joint function than the dynamic hip system blade for the treatment of femoral neck fracture in young patients.

Age-related Comparison of Hip Joint Morphology in Isolated Femur Neck Fractures

Objective: Femoral neck fractures mostly occurs due to high-energy trauma in young population and management differs compared to elderly. Different geometric parameters in the hip joint can play a role in fracture morphology regarding to the age. Present study aims to compare hip morphology between young and elderly population Materials and methods: 45 patients with isolated femoral neck fracture included to the study. Patients were divided into two regarding to the age; group 1 (younger than 60 yr.) and group 2 (older than 60 yr.). Garden and Pauwels classifications, Sharp angle (acetabular index-AI), acetabular depth (AD), Hip-axis length (HLA), Neck-shaft angle (NSA), Center-edge angle (CE), Singh indexes and femur head extrusion indexes were compared between groups. Results: The mean age of group 1 (22 patients) was 48 ± 10.4 while the mean age of group 2 (23 patients) was 77 ± 6.3. Significant differences found in 3 parameters; the mean HLA (13.4 ± 1.4 cm vs 12 ± 1.1 cm) (p: 0,034), the Sharp angle (37.9° ± 5° vs 40.3° ± 3°) (p: 0.047) and the CE (38.1° ± 6.2° vs 34.8° ± 4.5°) (p: 0.48) between group 1 and 2 respectively. No statistically significant difference was found in terms of AD, NSA, Singh index and extrusion index. Conclusions: Our study shows influence of proximal femoral and acetabular morphology on femoral neck fracture in young patients and may help future studies to reveal the relevance between hip morphology and fractures type.

Functional outcome of displaced femoral neck fractures in young patients treated by dynamic hip screw with CC screws

Background: Although femoral neck fractures are common in elderly individuals, it is an uncommon occurrence in young patients. It is crucial to achieve anatomical reduction as well as stable fixation so as to avoid complications in young individuals who are expected to have considerable functional demand in post-surgical period. Dynamic hip screws are commonly used for internal fixation of these fractures. Although satisfactory functional outcomes have been reported in the patients treated by DHS, complications such as malunion and osteonecrosis remain an area of concern. Aims and Objectives: The aims of the study were to study the functional outcome of young patients with femoral neck fractures treated by DHS with CC screws and to study the complications in young patients with femoral neck fractures treated by DHS with CC screws. Materials and Methods: This was a prospective cohort study in which 80 young adults (below the age of 45 years) having femoral neck fractures and treated by DHS with 2CC screws were included in this study on the basis of a predefined inclusion and exclusion criteria. Gender and distribution, nature of injury, type of fracture, functional outcome, and complications were studied in studied cases. Open reduction and internal fixation was done using dynamic hip screw. The functional outcome was assessed using modified Harris hip score. All patients were assessed for complications such as non-union, malunion, and osteonecrosis. Statistical analysis was done using SSPS 21.0 software and P&lt;0.05 was taken as statistically significant. Results: Out of 80 studied cases having femoral neck fractures, there were 54 (67.50%) males and 26 (32.50%) females with an M: F ratio of 1:0.48. The mean age of male and female patients was found to be 38.37±4.62 and 38.80±4.97 years, respectively. The most frequent cause of fracture was fall from height (48 cases) followed by road traffic accident (31 cases). Forty-six patients had complete fracture with partial displacement (Type III) and remaining 34 patients had complete fracture with total displacement (Type IV). Associated injuries were seen in 9 (11.25%) patients. Nine (11.25%) cases of avascular necrosis of femoral head were seen in our study. Surgery more than 48 h after injury and complete fracture with total displacement were associated with increased risk of avascular necrosis of femoral head (P&lt;0.05). Conclusion: Femoral neck fractures in young patients treated by dynamic hip screws with CC screws have found to have excellent functional results in majority of cases. The complications such as osteonecrosis of femoral head can be minimized by decreased time duration between fracture and surgical intervention.

Medial Locking Plate Can Increase the Fixation Stability of Vertical Femoral Neck Fracture in Young Adults?

Vertical femoral neck fractures in young adults are usually caused by a high-energy trauma. These injuries are difficult to stabilize due to significant shear forces acting on the fracture site. Their treatment is challenging and has a high risk of complications, such as fixation failure, malunion, nonunion and avascular necrosis of the femoral head. In recent years, several studies have focused on the use of direct reduction of vertical femoral neck fractures in young adult patients. This technique allows for anatomical reduction as well as the placement of an intra-articular implant to avoid shear forces at the fracture site. The aim of this study was to evaluate, based on in vitro experimental tests, the biomechanical stability provided by three different fixation methods: (i) dynamic hip screw with derotation screw, (ii) cannulated screws with a conventional medial bone plate and (iii) cannulated screws with a locked medial bone plate. For the biomechanical tests, these techniques were applied to reduce the vertical osteotomy performed on synthetic bones for later verification of the mechanical behavior under axial cyclic loading and destructive axial loading. There were no statistical differences in stiffness, micromovement displacement and mechanical strength during the biomechanical comparison of the fixation methods. Therefore, we conclude that the use of a conventional medial bone plate associated with cannulated screws, with a transverse trochanteric screw, supports the mechanical demand while the fracture is healing and this option can be used to stabilize vertical femoral neck fractures in young patients.

Biomechanical Comparative Study for Osteosynthesis of Pauwels Type III Femoral Neck Fractures: Conventional Devices versus Novel Fixed Angle Devices.

PurposeOsteosynthesis has been recommended for treatment of Pauwels type III femoral neck fractures in young patients. However, no implant of choice has been reported so far. This study was conducted in order to compare the fixation stability of two conventional fixation methods with three different novel fixed angle devices in this type of fracture.Materials and MethodsA total of 25 composite femurs (4th Generation Saw bone; Pacific Research Laboratories, USA) corresponding to human bone were used. Pauwels type III fracture type was uniformly reproduced. Specimens were fixed with a cannulated screw, cannulated screw with cable, and Intertan nail, dynamic hip screw, and IKEY nail. Measurement of failure loads and the rotational change of the femoral head fragment was performed for evaluation of fixation stability.ResultsAll implants were compared with cannulated screw and dynmaic hip screw. No meaningful improvement was observed for the cannulated screw with cable compared with the cannulated screw and dynamic hip screw. Meaningful improvement in load-to-failure and y-rotation and z-rotation was observed for both the Intertan nail and IKEY nail compared with the cannulated screw. However, compared with the dynamic hip screw, only the IKEY nail showed improvement in the same profile but the Intertan nail did not.ConclusionAmong novel fixed angle devices, meaningful improvement was observed for the IKEY nail compared with conventional implants. Strengths of this implant include biomechanical stability and simplicity of surgical technique, indicating that it may be another good option for osteosynthesis of Pauwels type III femoral neck fractures.

Mapping of Vertical Femoral Neck Fractures in Young Patients Using Advanced 2 and 3-Dimensional Computed Tomography.

To better describe the pathoanatomy of young patients' femoral neck fractures with the goal of improving surgeons' decisions for treatment including reduction and fixation. This is a retrospective study of patient records, plain radiographs, and the modern computed tomography scans to study the pathoanatomy of Pauwels II and III femoral neck fractures (coronal angle >30 degrees) in young adults. One American College of Surgeons Level 1 trauma center. All patients 18-49 years of age with a surgically repaired Pauwels' II and III (>30 degrees) femoral neck fracture between 2013 and 2017. Fifty-six adult patients younger than 50 years were identified with a femoral neck fracture in the study period, of whom 30 met study criteria. We evaluated plain radiography and computed tomography data including fracture orientation, characteristics of fracture morphology including size, shape, and dimensions, comminution, displacement, and deformity. Fracture morphology typically included a wide-based caudal head-neck segment (80%) that ends at a variable location along the medial calcar, sometimes as caudal as the lesser trochanter. Comminution was present in 90% of cases mostly located in the inferior quadrant, but anterior or posterior to the void left by the head-neck's caudal segment. The fractures orientations and deformities were reported by means and ranges. We investigated and reported on the pathoanatomy of high-energy femoral neck fractures in young adults with the goal of increasing understanding of the injury and improving surgeons' ability to provide for improved treatment decisions and quality fracture repair. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Outcomes of Femoral Neck Fractures in Young Patients and the Factors Associated With Complications: A Multicenter Study From Malaysia.

Background and objectiveFemoral neck fractures are relatively rare in young adults, but they result in prolonged loss of function in these patients, thereby placing a huge burden on a country’s healthcare and economy. Femoral neck fractures in young adults are normally treated with head salvage surgery. However, primary head replacement surgeries have been gaining traction recently to expedite the recovery of these patients. In this study, we aimed to investigate the outcomes in young patients with femoral neck fractures and factors associated with their complications.Patients and methodsPatients with femoral neck fractures who underwent surgery in three tertiary hospitals [Hospital Tengku Ampuan Afzan (HTAA), Hospital Sultan Haji Ahmad Shah (HOSHAS), and Hospital Kuala Lipis] in Pahang state in Malaysia were reviewed and included in this study. The demographic profile of the patients, injury patterns, intervention details, functional outcomes, and complications were analyzed. The comparison between the sociodemographics, clinical assessment, and complication outcomes was analyzed using statistical software.ResultsThe complications were associated with the mechanism of injury, capsulotomy, and type of fixation. A total of 46 patients were included in the study. Most of the patients were found to have severe displacement based on Garden and Pauwels classification. The majority of the patients underwent femoral head salvage surgeries. Almost half of the patients sustained complications and were unable to achieve weight-bearing status at six months postoperatively.ConclusionDespite a relatively short follow-up period in our study, femoral neck fractures in young adults were found to be associated with a high rate of complications. Primary head replacement surgeries should be considered in high-risk patients with femoral neck fractures.

Analysis on risk factors for neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients

BackgroundFemoral neck shortening can occur in young patients receiving internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws (FPTCS) for Pauwels type II femoral neck fracture in relatively young patients.MethodsClinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. And the Chi-squared test or Fisher’s exact test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis.ResultsStatistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening.ConclusionFracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after internal fixation with FPTCS for Pauwels type II femoral neck fracture in young patients. BMD and BMI may be also risk factors.

Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Exploratory Health-Related Quality of Life and Patient-Reported Functional Outcomes of a Multi-Centre 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients

PurposeFemoral neck fractures in young patients are typically managed with internal fixation using either cancellous screws or a sliding hip screw (SHS). Although fixation preserves the hip joint, patients are still at risk of complications and poor clinical outcomes which lead to diminished function and health related quality of life (HRQL). The Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH-2) pilot randomized controlled factorial trial evaluated the effect of surgical fixation (cancellous screws vs. SHS) and vitamin D supplementation vs. placebo on patient-reported function and HRQL. MethodsPatients between the ages of 18-60 years with a femoral neck fracture requiring surgical fixation were eligible. Eligible patients were randomized to receive either a sliding hip screw or cancellous screws for fracture fixation AND vitamin D3 4,000 IU or placebo daily for 6 months. Patient-reported function (Hip Outcome Score) and HRQL (Short Form-12) were assessed at standardized time points in the 12 months following their fixation surgery. Patient-reported function and HRQL were summarized using means, SD, and 95% confidence intervals (CIs), or percentages and counts. Longitudinal data analysis with mixed models was used to explore the effect of treatment group and time on the patient-reported function and HRQL. Results86 of the 91 patients randomized into the FAITH-2 pilot study were deemed eligible. There were no significant differences in patient-reported function or HRQL between the treatment groups at 12 months post-fracture. At the 6- and 9-month assessments, a potential benefit in hip function was seen in the cancellous screw group. In all treatment groups, participants reported lower function and HRQL at 12 months post-fracture as compared to their pre-injury assessment. ConclusionsFew differences were found in function and HRQL among the treatment groups in the FAITH-2 pilot study. Despite modern implants and vitamin D supplementation, neither function nor HRQL returns to baseline in this population. Additional efforts to improve the outcomes of these challenging injuries are still needed. Level of EvidenceTherapeutic Level II

Nonanatomical Reduction of Femoral Neck Fractures in Young Patients (≤65 Years Old) with Internal Fixation Using Three Parallel Cannulated Screws.

Purpose The study is aimed at investigating the association between different reduction classifications (anatomic reduction, positive buttress position reduction, and negative buttress position reduction) and two end points (complications and reoperations). Methods The study retrospectively analyzed 110 patients undergoing internal fixation with three parallel cannulated screws from January 2012 to January 2019 in Huashan Hospital. Based on the principles of the “Gotfried reduction,” all enrolled patients were divided into three groups: anatomic reduction, positive buttress position reduction, and negative buttress position reduction intraoperatively or immediately after surgery. Clinical characteristics including age, sex, side, Garden classification, Pauwels classification, fracture level, reduction classification, Garden alignment index angles, cortical thickness index (CTI), tip-caput distance (TCD), angle of the inferior screw, and the two ending points (complications and reoperations) were included in the statistical analysis. The Mann-Whitney U-test, the chi-square test, Fisher's exact test, and multiple logistic regression analysis were used in the study. Results Of the 110 patients included in our study, the mean ± standard deviation (SD) of age was 51.4 ± 10.4 years; 41 patients showed anatomic reduction, 35 patients showed positive buttress position reduction, and 34 patients showed negative buttress position reduction. For the outcomes, 24 patients (anatomic reduction: 6 [14.6%]; positive buttress position reduction: 5 [14.3%]; negative buttress position reduction: 13 [38.2%]) had complications, while 18 patients (anatomic reduction: 5 [12.2%]; positive buttress position reduction: 3 [8.6%]; negative buttress position reduction: 10 [29.4%]) underwent reoperations after surgery. In the multivariate logistic regression analysis of complications, negative buttress position reduction (negative buttress position reduction vs. anatomic reduction, OR = 4.309, 95%CI = 1.137 to 16.322, and p = 0.032) was found to be correlated with higher risk of complications. The same variable (negative buttress position reduction vs. anatomic reduction, OR = 5.744, 95%CI = 1.177 to 28.042, and p = 0.031) was also identified as risk factor in the multivariate logistic regression analysis of reoperations. However, no significant difference between positive reduction and anatomical reduction was investigated in the analysis of risk factors for complications, not reoperations. Conclusion Positive buttress position reduction of femoral neck fractures in young patients showed a similar incidence of complications and reoperations compared with those of anatomic reduction. For irreversible femoral neck fractures, if positive buttress position reduction has been achieved intraoperatively, it is not necessary to pursue anatomical reduction; however, negative reduction needs to be avoided.

Assessing the effect of Gotfried reduction with positive buttress pattern in the young femoral neck fracture

BackgroundAlthough many available surgical procedures for displaced femoral neck fractures in young patients, there are still many challenges to achieve satisfactory results. The incidence of avascular necrosis and nonunion rates remains relatively high despite the progress in our understanding and surgical technique. The purpose of this study was to evaluate the clinical efficacy of Gotfried reduction and cannulated screw fixation in the treatment of femoral neck fracture for young adults.MethodsA retrospective analysis was made on 67 cases from May 2013 to March 2019. They were divided into three groups according to the first postoperative anteroposterior view of hip X-ray: Anatomic reduction (group A), Gotfried positive buttress reduction (group B), and Gotfried negative buttress reduction (group C). The incidence of avascular osteonecrosis of the femoral head (AVN) and the Harris scores of hip joints were compared in three groups at the last follow-up.ResultsThe mean follow-up period after surgery was 22.5 ± 11.3 (range, 11–34) months. There were 21 cases (mean age, 49.7 ± 11.6) in group A, 24 cases (mean age, 48.6 ± 11.3) in group B, 22 cases (mean age, 48.3 ± 12.4) in group C. No significant difference in general preoperative demographics (P > 0.05). The incidence of avascular necrosis of femoral head in group A, B, and C was 19.05%, 20.83%, and 22.73%, respectively, showing no significant difference between groups (P = 0.156). The mean Harris hip scores at the final follow-up for groups A (85.6 ± 6.7) and B (84.5 ± 6.2) were significantly higher than group C (74.3 ± 8.3), and the difference was statistically significant (P = 0.043). The incidence of femoral neck shortening in group A and group B was significantly lower than that in group C in postoperative 1 year, and the difference was statistically significant (P < 0.05).ConclusionsGotfried positive buttress reduction and fixation for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better than Gotfried negative buttress reduction. For the patients of femoral neck fracture with severe displacement and difficulty reduction, it is not necessary to pursue anatomical reduction. Achieving positive valgus reduction can also obtain satisfactory clinical results, and should try to avoid negative buttress.

Results of femoral neck screw fixation in 112 under 65-years-old at a minimum 2 years’ follow-up

IntroductionFailure rates for screw fixation in femoral neck fracture in young patients are often high, with risk of aseptic femoral head osteonecrosis and non-consolidation. The present study sought to identify factors for success or failure of internal fixation according to: 1) initial treatment; 2) initial reduction quality; and 3) population characteristics. HypothesisThe study hypothesis was that population, fracture type, initial treatment and reduction quality can predict survival. Material and methodsA retrospective study included all cases of femoral neck fracture in under 65-years-old treated by screwing in our center: i.e., 112 patients. Patient characteristics, time to surgery were collated; surviving patients were followed up at a minimum 24 months. Reduction quality was assessed on X-rays in 3 dimensions and cervico-diaphyseal angle. ResultsMean follow-up was 5.3±3.0 years [range, 2.0–13.6 years]. At 2 years, 23 of the 112 patients (20.5%) had developed complications: 10 osteonecroses (8.9%) and 13 non-unions (11.6%). Known hip osteonecrosis risk factors showed no significant association with survival. Failure rates were significantly higher in unstable (Garden≥3) than stable (Garden≤2) fracture: HR=2.77 [95%CI: 1.09–7.02]; p=0.025. There was no significant association with time to treatment (≤6 hours): HR=1.08 [95%CI: 0.46–2.54]; p=0.86. On 2-year radiographs, mean shortening on the z-axis was 12.3±4.8mm [−0.7 to 26.2], 8.5±5.0mm [−6.8 to 23.9] on the x-axis, and 6.4±6.1mm [−6.3 to 25.3] on the y-axis. There was a significant negative correlation between z shortening and HOOS pain component (r=−0.38; p=0.005), a non-significant negative correlation with quality of life (r=−0.20; p=0.16), and a significant negative correlation with sports activity (r=−0.28; p=0.039). ConclusionThe present series showed lower rates of complications and of arthroplasty than in the literature. Internal fixation seemed to be indicated even at an interval of 6 hours or more. Level of evidenceIV, retrospective study.