Osteosynthesis Of Femoral Neck Fractures Research Articles

Femoral neck osteosynthesis using interfragmentary compression or position screw in synthetic bones. What are the mechanical differences?

We aim to compare interfragmentary compression with the position osteosynthesis in the fixation of different femoral neck fractures (FN)in synthetic bones subjected to vertical load. Forty-two synthetic femurs were subjected to neck fractures and separated into 3 groups according to the Pauwels classification: Pauwels I had 6 units (PI); Pauwels II, 24 units, with and without comminution (PII); and Pauwels III, 12 units, with and without comminution (PIII). After, they were fixed with 2 different ways: three 7, 0mm cannulated lag screws (CSs) versus three 6, 5mm solid fully threaded screws (SSs). Screws positioning was oriented by the Pauwels classification: inverted triangle or crossed screws. All specimens were submitted to vertical loading until failure. The average force was 79.4 ± 22.6Kgf. The greatest one was recorded in model 1 (135.6Kgf), and the lowest in model 41 (39.6Kgf). CSs and SSs had similar resistance until failure (p = 0.2). PI showed heightened resistance and PIII showed a worse response (p < 0,01). CSs had better performance in PIII (p = 0.048). Comminution and screws orientation caused no difference on peak force (p = 0.918 and p = 0.340, respectively). In synthetic bones, the resistance of a femoral neck fracture osteosynthesis using a 7, 0mm cannulated lag screw or 6, 5mm solid fully threaded screw are similar. There was no loss of efficiency with comminution in the femoral neck. Osteosynthesis resistance decreased with the verticalization of the fracture line and, in the more vertical ones, interfragmentary compression with CSs was more resistant than positional osteosynthesis with SSs.

Surgical Residents´ Results Seem to be Non-Inferior Comparing to More Experienced Surgeons in Femoral Neck Fracture Osteosynthesis

Purpose of the StudyFemoral neck fracture osteosynthesis is usually performed by using dynamic hip screw (DHS) or multiple parallel cannulated screws (MCS). In orthopedic surgery training, certain hip fractures are one of the most common operations performed by residents. It has been questioned, whether residents can provide as safe treatment and patient outcomes as those of more experienced surgeons. The aim of this study was to evaluate the effect of surgical experience on risk of complications by comparing the surgical performance and clinical outcomes in femoral neck osteosyntheses between surgical residents and orthopaedic surgeons.MethodsAll patients with femoral neck fracture admitted to Helsinki and Uusimaa Hospital District (HUS) Hyvinkää Hospital from 2011 to 2016 were collected as research material. 88 hip fractures (87 patients) treated with DHS or MCS osteosyntheses were included in this study. The patients were divided into 2 groups, based on the surgeon’s experience: an orthopedic surgeon group (n = 68) and a surgical resident group (n = 20). All data from complications, reoperations, and the duration of operations were collected.ResultsThere was no significant difference in characteristics of operated patients between orthopaedics and residents group. There was no significant difference in complications or re-operations between groups (p = 0.4, p = 0.2). Surgical residents had statistically longer surgical time (mean 76 min, 95% CI 62.92 min, mean 46 min, 95% Cl 42.51 min; p-value < 0.001). Still surgical time was not a risk factor for complication (p-value 0.5).ConclusionOur results show that surgical residents´ outcomes in femoral neck fracture osteosynthesis seem to be as favorable as those of orthopedic surgeons; the operations just last slightly longer.

A PROSPECTIVE STUDY OF “FUNCTIONAL AND RADIOLOGICAL OUTCOME OF NECK OF FEMUR FRACTURE TREATED BY BIPLANE DOUBLE SUPPORTED SCREW FIXATION METHOD”

Introduction: Osteosynthesis of femoral neck fractures is related up to 46% rate of complications. The novel method of biplane double-supported screw xation (BDSF; Filipov's method) offers better stability using three medially diverging cannulated screws with two of them buttressed on the calcar. Biomechanically, the most effective component is the distal screw placed at steeper angle and supported on a large area along the distal and posterior cortex of the femoral neck following its spiral anterior curve. Thereby, BDSF achieves the strongest possible distal-posterior cortical support for the xation construct, which allows for immediate full weight-bearing. The Aim: aim of this study was to evaluate the functional and radiological outcome of femoral neck fractures treated by biplane double supported screw xation method. Materials And Methods: Subject of this study were 22 patients with displaced Garden III–IV femoral neck fractures treated with BDSF. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Results: The outcomes in 22 patients were analysed for minimum 6 months, maximum up to 24 months follow-up. Bone union occurred in 90% of the cases (18 patients). Rate of non-union was 10%. Rate of AVN was 12.1% (males 4.8%, females 13.9%, P = 0.12). Modied Harris hip score was 90.13 (range 10–100) Conclusion: By providing additional cortical support, the novel BDSF method enhances femoral neck fracture xation strength.

Comparative Study for Osteosynthesis of Femoral Neck Fractures: Cannulated Screws versus Femoral Neck System.

The purpose of this study is to compare the radiological results of fixation using the femoral neck system (FNS) and cannulated screw (CS) for treatment of femoral neck fractures. A retrospective study of patients with femoral neck fractures who underwent internal fixation and had follow-up of more than six months from 2010 to 2020 was conducted. A total of 87 patients were enrolled in the study. The FNS group included 20 patients and the CS group included 67 patients. Classification of fractures was performed according to Garden and Pauwels classification. Operation time, intraoperative blood loss, sliding distance of the implant, lateral soft tissue irritation caused by implants, and complications were evaluated. The mean operation time was 40.30 minutes in the FNS group and 46.84 minutes in the CS group. The mean intraoperative bleeding volume was 51.25 mL in the FNS group and 72.16 mL in the CS group. Bone union was achieved in 18 patients in the FNS group (90.0%) and in 61 patients in the CS group (91.0%). The mean sliding distance of the implant was 4.06 mm in the FNS group and 3.92 mm in the CS group. No patients in the FNS group and 12 patients in the CS group complained of soft tissue irritation. A shorter operative time, less intraoperative bleeding, and less irritation of soft tissue were observed in the FNS group. FNS could be an alternative to CS for fixation of femoral neck fractures.

Femoral neck fracture osteosynthesis: comparative study between biplan double support screw fixation method and inverted triangle conventional method

Femoral neck fracture osteosynthesis: comparative study between biplan double support screw fixation method and inverted triangle conventional method

Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational case series

IntroductionOsteosynthesis of femoral neck fractures (FNFs) is an important treatment option, especially for younger patients. We aimed to assess the rate of early implant-related complications in FNF osteosynthesis using the Femoral Neck System (FNS).Patients and methodsConsecutive patients diagnosed with displaced or nondisplaced FNFs were treated with FNS in this prospective, observational, multicenter investigation. Patients were followed up for minimally 3 months and up to 12 months if radiologic bone union and no pain was not achieved beforehand. Predefined treatment-related adverse events (AEs, defined as implant failure, loss of reduction, iatrogenic fractures, deep infection, and surgical revision), radiologic bone union, and patient-reported Harris hip score (HHS) and EQ-5D-5L index score were assessed.ResultsOne hundred and twenty-five patients were included in the study. Thirty-eight (30.4%) fractures were displaced (Garden III and IV), and 37 (29.6%) were vertical fractures (Pauwels type III). Predefined treatment-related AE rate at 3 months was 8 patients, 6.4% (95% CI, 2.8–12.2), and at 12 months, 11 patients, 8.8% (95% CI, 4.5–15.2). Cumulative incidences of bone union were 68% at 3 months, 90% at 6 months, and 98% at 12 months. The mean changes of HHS and EQ-5D-5L index score between preinjury and at 12 months were -7.5 (95% CI, [ – 21.1] to [6.2]) and – 0.03 (95% CI, [ – 0.21] to [0.15]), respectively; neither were statistically significant.ConclusionThe current study on osteosynthesis of FNFs with the FNS resulted in treatment-related complication rates of 6.4% (95% CI, 2.8–12.2) at 3 months and 8.8% (95% CI, 4.5–15.2) at 12 months. On average, patients returned to preinjury function and quality of life. The current study may also indicate that the conventional wisdom of treating stable FNF in patients aged between 60 and 80 years with osteosynthesis may need to be reconsidered.RegistrationThe study is registered with ClinicalTrials.gov (registration number: NCT02422355).

Biomechanical evaluation of femoral neck fracture osteosynthesis

Bone geometry, density, and thickness of the cortical layer of the femoral neck (FN) contribute to the mechanical strength in osteosythesis of femoral neck fractures (FNF) in young adults. The available techniques for fracture fixation of the FN are reviewed with respect to the biomechanical stability.A biomechanical study of the osteosynthesis stability of the FNF with three cannulated screws was carried out using synthetic models of the proximal part of the femoral bone (FB). The experimental models were divided into 4 groups. Each group related to the configuration of screws in the FN. The vertical and horizontal FNF stability was assessed using two series of load. In series I, models were loaded with forces in the longitudinal axis to the FB and in series II, forces acted in the perpendicular direction to the FB axis. The loading forces were evaluated when the displacement of 2 mm fragments was achieved. The highest stability strengths were obtained in group I in the both series ‒ 1898 N with a vertical load and 1046 N with a horizontal load. Further, in decreasing order, the results of stability were obtained in groups II, III and IV.In this study, it was found that the consideration of the position of screws according to architectonics of the FN is crucial for fragment stability. The triangular position of screws with three points of contact with the compact bone ensures the maximum stability of the construct in osteosynthesis of the FN fractures, which is comparable to the normal walking load conditions.We hypothesize that osteosynthesis of FN fractures with three screws in a triangular manner could provide a better stability when inserted into the dense tissues of the proximal FB with relation to bone architectonics. To ensure a maximum stability, each screw should have three points of contact with the compact bone – the lateral cortical wall of the subtrochanteric region of the FB, the inner wall of the FN, and the compact part of the FB head. New triangular configuration of screws’ placement could have a better neutralization of share forces in FN fractures.

To Compare the Frequency of Fracture Consolidation in Two Versus Three Cannulated Screws Osteosynthesis of Femoral Neck Fractures

Background: When it happens in a child or adolescent, an intracapsular femoral neck fracture can be very challenging to heal. Hip fractures are expected to rise from 1.26 million in 1990 to 2.6 million in 2025 and 4.5 million by the middle of this century, according to the latest estimates. 1 After a fixation, problems might occur for a number of various reasons, including those listed above. The initial displacement and the time and accuracy of the reduction are the most essential factors in determining the final output. Objective: To compare the frequency of fracture consolidation in two versus three cannulated screws for osteosynthesis of femoral neck fractures. Subjects and Method: In Karachi, the Al Mumtaz hospital complex hosted a total of eighty patients who met the study's eligibility criteria and agreed to participate. After being informed of the technique, patients agreed to participate. Each patient's name, age, gender, address, and phone number were entered into a database. utilizing a lottery technique, each patient was placed in one of two groups, A or B. 80 chits (40 for group A and 40 for group B) sealed in opaque envelope was put in a jar and patient was asked to pick one chit from jar and that patient was assigned to that particular group written on that chit. In group A, 40 patients were undergo osteosynthesis by using two cannulated screws, while in group B, 40 patients were undergo osteosynthesis by using three cannulated screws. All procedures were done under general anesthesia and by same surgeon’s team having minimum 5 years post qualification surgical experience. After surgery, patients were shifted to ward and was discharged. Then patients were followed-up in OPD for 3 months after surgery for assessment of fracture consolidation. Final assessment was made at 3rd month. Data was entered and analyzed through SPSS version 20. Results: In total, there were eighty people that took part in this research. Two cannulated screws were inserted into forty patients, whereas another forty patients received three screws. Patients with ages ranging from 18 to 55 were included in the study. Patients in Group 1 were on average 32.4 years old plus 8.13 years, while patients in Group 2 were on average 35.9 years old plus 9.01 years. Patients who were treated with two cannulated screws achieved fracture consolidation in 35 (87.5% of cases), but patients who were treated with three cannulated screws only experienced fracture consolidation in 20 (50%) of their instances, which is a significant difference. Conclusion: In conclusion, fracture consolidation with two cannulated screws is an effective approach for the treatment of osteosynthesis of femoral neck fractures. Keywords: Femoral neck fractures, Osteosynthesis, two cannulated screws, three cannulated screws.

Calculation and application of a safe range of load on the limb in patients after osteosynthesis of the femoral neck

BackgroundFractures of the femoral neck occupy a leading place in the total injury rate in the Russian Federation. Despite significant advances in the field of osteosynthesis of femoral neck fractures, there is still a high percentage of unsatisfactory treatment outcomes, including the cases when functional load is applied in the early activation of patients. Therefore, it is very important to find ways to dose the load on the operated limb in the postoperative period in patients with fractures of the femoral neck. The aim of the study is to demonstrate the successful experience of calculating and applying a safe range of load on the limb in patients after osteosynthesis of the femoral neck and substantiate its effectiveness using a universal personalized method of evaluating the results of treatment. MethodsThe study involved 80 patients with fractures of the femoral neck, who had undergone osteosynthesis with various metal structures. A safe range of load on the limb was applied using a method determined by us. The postoperative period results of the selected patients, who formed a comparison group and a study group, were then analyzed using a universal method of personalized evaluation of treatment results. A prospective study was applied. ResultsIt was shown that in the study group of 40 patients, using the method developed by us for dosing the load on the limb, 12 months after surgery, 20.5% more excellent and good treatment results were obtained than in the comparison group. ConclusionsPatients can have a better postoperative outcome owing to the possibility of determining the optimal range of load on the operated limb, which makes it possible to draw up an individual plan for dosing the load from the first day of the postoperative period to the onset of consolidation.

Non-traumatic subtrochanteric fracture after osteosynthesis of femoral neck fracture; A case report

Non-traumatic subtrochanteric fracture after osteosynthesis of femoral neck fracture; A case report

Femoral Neck Fracture Osteosynthesis is Safe in the Hands of Surgical Residents

Femoral Neck Fracture Osteosynthesis is Safe in the Hands of Surgical Residents

非転位型大腿骨頚部骨折骨接合術後の予後予測におけるcombined tilting angleの有用性

非転位型大腿骨頚部骨折骨接合術後の予後予測におけるcombined tilting angleの有用性

Отдаленные результаты накостно-чрескостного остеосинтеза внутрисуставных переломов проксимального отдела бедренной кости

We analyze the condition of 28 patients who underwent internal-and-transosseous metal osteosynthesis of the femoral neck. We use clinical, radiological and functional research methods for the examination. In clinical research methods, the main attention was paid to the patient's gait, pain syndrome, which was evaluated both during physical exertion and at rest. The radiological methods of the study assessed the signs of consolidation of bone fragments, the presence of bone trabeculae, which, without interruption, pass from the neck to the femoral head. In case of pain in the hip joint, a computed tomography was performed with the measurement of the length of the hip neck, which was compared with the length of the hip neck of the healthy side. The congruence of the articular surfaces and the articular gap of the hip joint were studied. Functional studies were carried out using the systems for assessing the state of the hip joint of Luboshitz–Mattis–Schwarzberg and W.H. Harris. The follow-up period ranged from 1 to 7 years. The obtained studies allowed an objective assessment of the long-term results of metal osteosynthesis of femoral neck fractures with an original fixator. A positive assessment of the long-term results of osteosynthesis of the femoral neck allows us to recommend using this fixator in clinical practice.

Efficiency of an implant: new criterion of objective assessment of implants for osteosynthesis of femoral neck fracture.

In line with several designs for osteosynthesis of femoral neck fracture (FNF), their effectiveness is still estimated by the results of biomechanical and clinical trials, finite element method (FE). But surgeons require the criteria which would define their properties in advance and allow improve the results of treatment. When new implant (NI) is being designed, we developed such criterion - index efficiency of an implant (IEI) - and performed mathematical comparative researches of properties of NI with the known designs. We analyzed the results of comparative clinical trials on treatment of FNF with various implants considering their IEI. Analysis showed that results of comparative clinical trials with the use of various implants for osteosynthesis FNF completely correlated to their IEI; IEI of the NI two to three times exceeds IEI of all known designs, and the destruction percentage of a bone tissue is two to three times less when it is applied. The offered IEI can be used for designing new implants and allows improving the results of treatment of patients with FNF by optimizing the choice of implant for osteosynthesis.

A comparative study of rate of fracture union in femur neck fractures- operated within 24 hours and after 24 hours and within 7 days, effect of tamponade on rate of union in cases fixed with cannulated cancellous screws

Background: Osteosynthesis of femoral neck fractures is particularly indicated in patients aged under 60years. A prolonged interval between the fracture and surgical fixation has been associated with avascular necrosis (AVN) of the femoral head. The primary objective of this study was to evaluate the association between the time to surgery and the rate of union in femur neck fractures.Methods: Patients with displaced fractures of the femoral neck (Garden III or IV) who underwent fixation with cannulated screws from August 2016 to August 2018 were evaluated retrospectively for the rate of union in femoral neck fractures.Patients were divided into two groups according to the time to surgery (within 24 hours and within 7days after 24 hours). Union rates were compared between the two groups.Results: 50 patients were included in the study; the duration of follow-up ranged from 12 to 24 months. The time from fracture to surgery ranged from 24 hours to 7 days. Fourty nine patients underwent surgery within 24 hours, and fourty eight patients underwent surgery within 7 days. There were two cases of femoral head necrosis. One patient had an associated infection. There were no statistically significant differences in the overall rate of union between the groups (p=0.999). None of the preoperative parameters or fracture characteristics were predictive factors for union. The only factor which affects the rate of union is inadequate reduction/fixation(odds ratio [OR]= 35.50, 95% confidence interval [CI]= 2.56 to 548.36, p=0.008).Conclusions: The interval between the occurrence of the injury and surgical fixation is not associated with rate of union in fractures of the femoral neck. Inadequate fracture reduction is a predictive factor in rate of union in femur neck fractures fixed with CC screws.

Result for osteosynthesis of femoral neck fractures using new implant with angle stability and anti-rotational function

Result for osteosynthesis of femoral neck fractures using new implant with angle stability and anti-rotational function

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.

Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes.

Osteosynthesis of femoral neck fractures is still associated with high complication rates. The novel method of biplane double-supported screw fixation offers better osteosynthesis stability by buttressing two of three medially diverging cannulated screws on the inferior neck cortex. Biomechanically, the most effective component of this fixation is the third, inferior obtuse screw, supported along considerable distance on both the inferior and posterior cortices of the femoral neck following its spiral anterior curve. Thus, biplane double-supported screw fixation achieves greater inferoposterior cortical support of the implants, allowing immediate full weight bearing for patients older than 55 years. Although the method has been recently communicated, some important surgical aspects still remain to be discussed. This report aims at describing a detailed and modified surgical technique and providing criteria and recommendations for its successful application according to the clinical experience over more than 9 years.Level of Evidence:Level V, expert evidence

Is bone-cement augmentation of screw-anchor fixation systems superior in unstable femoral neck fractures? A biomechanical cadaveric study

ObjectivesImproved fixation techniques with optional use of bone cements for implant augmentation have been developed to enhance stability and reduce complication rates after osteosynthesis of femoral neck fractures. This biomechanical study aimed to evaluate the effect of cement augmentation on implant anchorage and overall performance of screw-anchor fixation systems in unstable femoral neck fractures. MethodsTen pairs of human cadaveric femora were used to create standardized femoral neck fractures (Pauwels type 3 fractures; AO/OTA 31-B2) with comminution and were fixed by means of a rotationally stable screw-anchor (RoSA) system. The specimens were assigned pairwise to two groups and either augmented with PMMA-based cement (Group 1, augmented) or left without such augmentation (Group 2, control).Biomechanical testing, simulating physiological loading at four distinct load levels, was performed over 10.000 cycles for each level with the use of a multidimensional force-transducer system. Data was analysed by means of motion tracking. ResultsStiffness, femoral head rotation, implant migration, femoral neck shortening, and failure load did not differ significantly between the two groups (p ≥ .10). For both groups, the main failure type was dislocation in the frontal plane with consecutive varus collapse). In the cement-augmented specimens, implant migration and femoral neck shortening were significantly dependent on bone mineral density (BMD), with higher values in osteoporotic bones. There was a correlation between failure load and BMD in cement-augmented specimens. ConclusionIn screw-anchor fixation of unstable femoral neck fractures, bone-cement augmentation seems to show no additional advantages in regard to stiffness, rotational stability, implant migration, resistance to fracture displacement, femoral neck shortening or failure load.

Stress Distribution of a New Type of Perforated Implants in Femur Neck Fracture: Finite Element Model

Osteosynthesis of femoral neck fractures (FNF) is accompanied by a large percentage of various complications. The aim of this research was to study biomechanical implications arising from the stress and strain distributions by use of new device –perforated H-beam implant. A reference 3D femur model has been developed using digital femur geometry. The stress and deformity characteristics after the application of force were determined by ANSYS, which entails the finite element analysis (FEA) method. This method was used for both the perforated and non-perforated implant models and compared the application of constant strength. Three types of FNF were realized according to the Pauwell classification system.We concluded that, the perforations in the implants make the distribution of strength and pressure homogenous along the whole implant functioning as wave breaker to reduce the pressure on the bone. This contributes to implant stability and the minimization of bone destruction.