Comparison of effectiveness of two cannulated screw configurations in the treatment of femoral neck fractures in young adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhaodong ,  GUAN Jianzhong , WU Min , ZHU Zhonglian , ZHOU Pinghui , LIU Yajun , XU Chen , ZHAO Yupeng

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China;

Corresponding author：

GUAN Jianzhong, Email: jzguan2002@163.com

Keywords：

Young adults; femoral neck fracture; cannulated screw; inverted triangle; rhomboid

DOI：

10.7507/1002-1892.202009103

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Objective To investigate and analyze the effectiveness of internal fixation with the two different cannulated screw implanting methods of rhomboid and inverted triangle in the treatment of femoral neck fracture in young adults.Methods The clinical data of 38 young adults with femoral neck fracture who met the selection criteria between January 2018 and August 2019 were retrospectively analyzed. According to the different methods of cannulated screw implanting, the patients were divided into two groups, 19 cases in each group. The trial group was treated with closed reduction and cannulated screw rhombic distribution internal fixation, while the control group was treated with closed reduction and cannulated screw inverted triangular distribution internal fixation. There was no significant differences in patients’ gender, age, cause of injury, Garden classification of fracture, and time from injury to operation between the two groups (P>0.05). The fracture healing time, the incidence of nonunion, femoral neck shortening, and femoral head necrosis were recorded and compared between the two groups; the effectiveness was evaluated by Harris score and visual analogue scale (VAS) score at last follow-up.Results The incisions of the two groups healed by first intention. All patients were followed up 12-24 months with an average of 15.5 months. There were 1 case of fracture nonunion and 2 cases of shortening of femoral neck in the trial group; while there were 2 cases of fracture nonunion, 1 case of necrosis of femoral head, and 6 cases of femoral neck shortening in the control group; the difference in the incidence of complications (15.8% vs. 47.4%) between the two groups was significant (χ²=4.385, P=0.036). The remaining 18 cases in the trial group and 17 cases in the control group all achieved osteonal union, and the healing time was (14.8±1.6) weeks and (15.9±1.3) weeks, respectively, showing no significant difference between the two groups (t=1.265, P=0.214). At last follow-up, Harris score and VAS score of the trial group were 88.9±4.3 and 1.1±0.7, respectively, while those of the control group were 86.9±5.9 and 1.3±0.9, respectively, showing no significant difference (t=0.603, P=0.550; t=1.152, P=0.257). Hip function was evaluated in accordance with Harris score, the results were excellent in 12 cases, good in 6 cases, and fair in 1 case in the trial group, the excellent and good rate was 94.74%; the results were excellent in 10 cases, good in 7 cases, and fair in 2 cases in the control group, the excellent and good rate was 89.47%; there was no significant difference in the excellent and good rate between the two groups (χ²=0.368, P=0.544).Conclusion The short-term effectiveness of the two kinds of cannulated screw implanting methods is clear, rhomboid fixation of 4 screws has strong stability with stress distribution, which can effectively reduce the incidence of femoral neck shortening, fracture nonunion, femoral head necrosis, and other complications.

Citation： WANG Zhaodong, GUAN Jianzhong, WU Min, ZHU Zhonglian, ZHOU Pinghui, LIU Yajun, XU Chen, ZHAO Yupeng. Comparison of effectiveness of two cannulated screw configurations in the treatment of femoral neck fractures in young adults. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 318-322. doi: 10.7507/1002-1892.202009103 Copy

1.	Wani IH, Sharma S, Latoo I, et al. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa- and septuagenarians. J Orthop Traumatol, 2014, 15(3): 209-214.
2.	王秀萍, 孙瑞波, 刘又文, 等. 空心钉内固定治疗股骨颈骨折: 关节功能恢复的影响因素分析. 中国组织工程研究, 2017, 21(19): 2999-3004.
3.	Filipov O, Stoffel K, Gueorguiev B, et al. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg, 2017, 137(6): 779-788.
4.	王建, 冉建, 刘修信, 等. 空心钉“F”技术与倒三角形方式布钉治疗股骨颈骨折的疗效比较. 中国矫形外科杂志, 2016, 24(24): 2243-2246.
5.	张成宝, 马信龙, 马剑雄, 等. 股骨颈骨折空间移位程度与内固定术后股骨头缺血性死的相关性研究. 中华创伤骨科杂志, 2016, 18(2): 133-137.
6.	任栋, 程培焱, 宋朝晖, 等. 不同数量和空间构型的空心拉力螺钉治疗股骨颈骨折的有限元分析. 中华创伤杂志, 2017, 33(9): 815-822.
7.	远东涛, 张绍安, 吴广良, 等. 富血小板血浆联合中空螺钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2020, 22(3): 263-267.
8.	中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
9.	Elgeidi A, El Negery A, Abdellatif MS, et al. Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution. Arch Orthop Trauma Surg, 2017, 137(10): 1363-1369.
10.	刘儒. Pauwels Ⅲ型股骨颈骨折的手术方式选择及近期疗效比较. 广州医科大学学报, 2017, 45(1): 49-52.
11.	胡家朗, 李绍刚, 陈明, 等. 动力加压锁定钉板系统与空心拉力螺钉固定 Pauwels Ⅲ型股骨颈骨折的生物力学比较. 中华骨科杂志, 2018, 38(21): 1322-1329.
12.	Halawi MJ, Brigati D, McBride JM, et al. Surgical hip dislocation through a direct lateral approach: A cadaveric study of vascular danger zones. J Clin Orthop Trauma, 2017, 8(3): 281-284.
13.	Ghijselings SG, Driesen R, Simon JP, et al. Distal extension of the direct anterior approach to the hip: A cadaveric feasibility study. J Arthroplasty, 2017, 32(1): 300-303.
14.	魏志辉, 马坤龙, 张铭华. 4 枚空心钉与动力髋螺钉结合防旋螺钉内固定治疗股骨颈骨折的疗效比较. 中国骨与关节损伤杂志, 2017, 32(2): 187-188.
15.	龙亚周, 张树明, 王奎友, 等. 股骨颈骨折空心钉固定闭合复位治疗策略. 中国修复重建外科杂志, 2016, 30(7): 809-814.
16.	虎伟山, 李山珠, 袁锋. 三枚和四枚空心钉内固定治疗股骨颈骨折的比较研究. 中国骨与关节损伤杂志, 2013, 28(4): 307-309.
17.	吴乾, 袁振, 郝跃峰, 等. 按骨折线倾斜角分型Ⅲ型青壮年股骨颈骨折的治疗进展. 中华关节外科杂志 (电子版), 2018, 12(6): 42-45.
18.	张浩, 史雪峰, 杨春宝, 等. 三枚与四枚螺钉置入治疗 Pauwels Ⅲ型股骨颈骨折的有限元分析. 中国组织工程研究, 2016, 20(26): 3897-3902.
19.	吕金柱, 朱求亮, 罗建民, 等. 4 枚空心钉与锁定钢板内固定治疗粉碎性股骨颈骨折临床疗效分析. 中国骨与关节损伤杂志, 2017, 32(12): 1283-1284.
20.	Kauffman JI, Simon JA, Kummer FJ, et al. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study. J Orthop Trauma, 1999, 13(3): 155-159.
21.	Rajnish RK, Haq RU, Aggarwal AN, et al. Four screws diamond configuration fixation for displaced, comminuted intracapsular fracture neck femur in young adults. Indian J Orthop, 2019, 53(1): 70-76.
22.	Pathrot D, Ul Haq R, Aggarwal AN, et al. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects. Indian J Orthop, 2016, 50(3): 269-276.

1. Wani IH, Sharma S, Latoo I, et al. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa- and septuagenarians. J Orthop Traumatol, 2014, 15(3): 209-214.
2. 王秀萍, 孙瑞波, 刘又文, 等. 空心钉内固定治疗股骨颈骨折: 关节功能恢复的影响因素分析. 中国组织工程研究, 2017, 21(19): 2999-3004.
3. Filipov O, Stoffel K, Gueorguiev B, et al. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg, 2017, 137(6): 779-788.
4. 王建, 冉建, 刘修信, 等. 空心钉“F”技术与倒三角形方式布钉治疗股骨颈骨折的疗效比较. 中国矫形外科杂志, 2016, 24(24): 2243-2246.
5. 张成宝, 马信龙, 马剑雄, 等. 股骨颈骨折空间移位程度与内固定术后股骨头缺血性死的相关性研究. 中华创伤骨科杂志, 2016, 18(2): 133-137.
6. 任栋, 程培焱, 宋朝晖, 等. 不同数量和空间构型的空心拉力螺钉治疗股骨颈骨折的有限元分析. 中华创伤杂志, 2017, 33(9): 815-822.
7. 远东涛, 张绍安, 吴广良, 等. 富血小板血浆联合中空螺钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2020, 22(3): 263-267.
8. 中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
9. Elgeidi A, El Negery A, Abdellatif MS, et al. Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution. Arch Orthop Trauma Surg, 2017, 137(10): 1363-1369.
10. 刘儒. Pauwels Ⅲ型股骨颈骨折的手术方式选择及近期疗效比较. 广州医科大学学报, 2017, 45(1): 49-52.
11. 胡家朗, 李绍刚, 陈明, 等. 动力加压锁定钉板系统与空心拉力螺钉固定 Pauwels Ⅲ型股骨颈骨折的生物力学比较. 中华骨科杂志, 2018, 38(21): 1322-1329.
12. Halawi MJ, Brigati D, McBride JM, et al. Surgical hip dislocation through a direct lateral approach: A cadaveric study of vascular danger zones. J Clin Orthop Trauma, 2017, 8(3): 281-284.
13. Ghijselings SG, Driesen R, Simon JP, et al. Distal extension of the direct anterior approach to the hip: A cadaveric feasibility study. J Arthroplasty, 2017, 32(1): 300-303.
14. 魏志辉, 马坤龙, 张铭华. 4 枚空心钉与动力髋螺钉结合防旋螺钉内固定治疗股骨颈骨折的疗效比较. 中国骨与关节损伤杂志, 2017, 32(2): 187-188.
15. 龙亚周, 张树明, 王奎友, 等. 股骨颈骨折空心钉固定闭合复位治疗策略. 中国修复重建外科杂志, 2016, 30(7): 809-814.
16. 虎伟山, 李山珠, 袁锋. 三枚和四枚空心钉内固定治疗股骨颈骨折的比较研究. 中国骨与关节损伤杂志, 2013, 28(4): 307-309.
17. 吴乾, 袁振, 郝跃峰, 等. 按骨折线倾斜角分型Ⅲ型青壮年股骨颈骨折的治疗进展. 中华关节外科杂志 (电子版), 2018, 12(6): 42-45.
18. 张浩, 史雪峰, 杨春宝, 等. 三枚与四枚螺钉置入治疗 Pauwels Ⅲ型股骨颈骨折的有限元分析. 中国组织工程研究, 2016, 20(26): 3897-3902.
19. 吕金柱, 朱求亮, 罗建民, 等. 4 枚空心钉与锁定钢板内固定治疗粉碎性股骨颈骨折临床疗效分析. 中国骨与关节损伤杂志, 2017, 32(12): 1283-1284.
20. Kauffman JI, Simon JA, Kummer FJ, et al. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study. J Orthop Trauma, 1999, 13(3): 155-159.
21. Rajnish RK, Haq RU, Aggarwal AN, et al. Four screws diamond configuration fixation for displaced, comminuted intracapsular fracture neck femur in young adults. Indian J Orthop, 2019, 53(1): 70-76.
22. Pathrot D, Ul Haq R, Aggarwal AN, et al. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects. Indian J Orthop, 2016, 50(3): 269-276.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of effectiveness of two cannulated screw configurations in the treatment of femoral neck fractures in young adults

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