Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle <b>Ⅲ</b> femoral neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Jiazhao ¹ , ZHOU Xuefeng ¹ , LI Li ¹ , XU Lei ¹ , ZHU Wanbo ¹ , XU Wei ¹ , XIA Rui ¹ , WANG Xujin ¹ , WANG Gang ² , HUA Xingyi ² , XU Xinzhong ³ ,  FANG Shiyuan ¹

1. Department of Orthopedics and Traumatology, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei Anhui, 230001, P.R.China;
2. Department of Orthopedics and Traumatology, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China;
3. Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230601, P.R.China;

Corresponding author：

FANG Shiyuan, Email: fangshiyuan2008@126.com

Keywords：

Femoral neck fracture; femoral neck system; inverted triangle cannulated screws; internal fixation; reduction

DOI：

10.7507/1002-1892.202102046

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Objective To compare the effectiveness of the femoral neck system (FNS) and inverted triangle cannulated screws (ITCS) for the treatment of Pauwels type Ⅲ femoral neck fractures.Methods The clinical data of 59 patients with Pauwels type Ⅲ femoral neck fractures treated between May 2019 and November 2020 were retrospectively analysed. The patients were divided into FNS group (28 cases) and ITCS group (31 cases) according to the different internal fixation. There was no significant difference in gender, age, affected side, body mass index, cause of injury, smoking history, alcohol abuse history, Pauwels angle, Garden classification, AO/Orthopaedic Trauma Association (AO/OTA) classification, and time from injury to operation between the two groups (P>0.05). The operation time, incision length, intraoperative blood loss, extra assisted reduction procedures (Kirschner wire prying reduction or open reduction), hospitalization stay, and early complications were recorded and compared between the two groups. Garden index and Haidukewych score were used to evaluate fracture reduction. Fracture healing time, lateral thigh irritation, time of partial or total weight-bearing postoperatively, shortening length and degree of femoral neck, change of caput-collum-diaphysis (CCD) angle (the difference of CCD angle between immediate after operation and last follow-up), incidence of osteonecrosis of femoral head and revision surgery were recorded and compared between the two groups. Hip joint function were evaluated by Harris score.Results The operation time of FNS group was significantly shorter than ITCS group, and the incision length was significantly longer than ITCS group (P<0.05). There was no significant difference in intraoperative blood loss, assisted reduction, Garden index, Haidukewych score, and hospitalization stay between the two groups (P>0.05). All the incisions healed by first intention. There were 2 deep vein thrombosis in the FNS group and 1 pulmonary infection and 1 deep vein thrombosis in the ITCS group. No significant difference was found in the incidence of early postoperative complications (7.1% vs. 6.5%) between the two groups (P=1.000). Patients in both groups were followed up 3-14 months, and there was no significant difference in follow-up time between the two groups (t=–0.553, P=0.582). The fracture healing time, Harris score, and the partial weight-bearing time after operation of the FNS group were significantly better than those of the ITCS group (P<0.05). However, there was no significant difference in total weight-bearing time between the two groups (Z=–1.298, P=0.194). No lateral thigh irritation was found in the FNS group, while 10 patients in the ITCS group had lateral thigh irritation, and the incidence between the two groups (0 vs. 32.3%) was significant (P=0.001). At last follow-up, the shortening length and degree of femoral neck and the change of CCD angle in FNS group were significantly less than those in ITCS group (P<0.05). There was no patient with osteonecrosis of femoral head or reoperation in the FNS group, while 4 patients in the ITCS group underwent reoperation (including 2 cases of osteonecrosis of the femoral head). However, the incidences (0 vs. 6.5%; 0 vs. 12.9%) between the two groups were not significant (P=0.493; P=0.114).Conclusion Using FNS to treat Pauwels type Ⅲ femoral neck fracture is simple as well as able to reduce the shortening of the femoral neck and the change of the CCD angle. Also, FNS is conducive to the recovery of hip joint function, which should be considered as a new choice for the treatment of young femoral neck fracture patients.

Citation： YANG Jiazhao, ZHOU Xuefeng, LI Li, XU Lei, ZHU Wanbo, XU Wei, XIA Rui, WANG Xujin, WANG Gang, HUA Xingyi, XU Xinzhong, FANG Shiyuan. Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle Ⅲ femoral neck fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1111-1118. doi: 10.7507/1002-1892.202102046 Copy

1.	Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
2.	倪明, 孙万驹, 叶晔. 内侧支撑钢板辅助固定治疗青壮年股骨颈骨折的研究进展. 中国修复重建外科杂志, 2020, 34(11): 1454-1457.
3.	Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
4.	Zhang LL, Zhang Y, Ma X, et al. Multiple cannulated screws vs. dynamic hip screws for femoral neck fractures: A meta-analysis. Orthopade, 2017, 46(11): 954-962.
5.	FAITH-2 Investigators, Slobogean GP, Sprague S, et al. Fixation using alternative implants for the treatment of hip fractures (FAITH-2): design and rationale for a pilot multi-centre 2×2 factorial randomized controlled trial in young femoral neck fracture patients. Pilot Feasibility Stud, 2019, 5: 70. doi: 10.1186/s40814-019-0458-x.
6.	胡家朗, 李绍刚, 陈明, 等. 新型股骨颈动力加压锁定钉板系统治疗股骨颈骨折. 中华创伤骨科杂志, 2019, 21(11): 939-944.
7.	Matar HE, Chandran P. Outcomes of internal fixation of intracapsular hip fractures using dynamic locking plate system (Targon® FN). J Orthop, 2018, 15(3): 829-831.
8.	Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable pauwels Ⅲ femoral neck fractures: A comparison with the dynamic hip screw and cannulated acrews. J Orthop Trauma, 2017, 31(3): 131-137.
9.	Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg (Am), 2004, 86(8): 1711-1716.
10.	Sepehri A, Martinson J, Marchand LS, et al. Measuring lateral screw protuberance is a clinically accurate method for quantifying femoral neck shortening. J Orthop Trauma, 2020, 34(11): 600-605.
11.	Park YC, Um KS, Kim DJ, et al. Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures. Injury, 2021, 52(3): 569-574.
12.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
13.	徐凯航, 纪方. 青壮年股骨颈骨折的治疗进展. 中华创伤骨科杂志, 2020, 22(6): 549-552.
14.	刘敬文, 张伟. 青壮年垂直型股骨颈骨折手术治疗进展. 国际骨科学杂志, 2018, 39(6): 335-339.
15.	Stockton DJ, Dua K, O’Brien PJ, et al. Failure patterns of femoral neck fracture fixation in young patients. Orthopedics, 2019, 42(4): e376-e380.
16.	Xia Y, Zhang W, Zhang Z, et al. Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis. J Orthop Surg Res, 2021, 16(1): 54. doi: 10.1186/s13018-020-02189-1.
17.	Ma JX, Kuang MJ, Xing F, et al. Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: A systematic review. Int J Surg, 2018, 52: 89-97.
18.	Bliven E, Sandriesser S, Augat P, et al. Biomechanical evaluation of locked plating fixation for unstable femoral neck fractures. Bone Joint Res, 2020, 9(6): 314-321.
19.	You DD, Paik KY, Park IY, et al. Randomized controlled study of the effect of octreotide on pancreatic exocrine secretion and pancreatic fistula after pancreatoduodenectomy. Asian J Surg, 2019, 42(2): 458-463.
20.	Haider T, Schnabel J, Hochpöchler J, et al. Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients. Arch Orthop Trauma Surg, 2018, 138(11): 1511-1517.
21.	许新忠, 常菁, 余水生, 等. 股骨颈系统固定治疗股骨颈骨折的近期疗效分析. 中华创伤骨科杂志, 2020, 22(7): 624-627.
22.	柘植峻, 吉岡裕, 宮坂和良, 等. 当院における Femoral Neck System の短期治療成績. 中部整災誌, 2019, 62: 977-978.
23.	李智勇, 张奇, 陈伟, 等. 难复位性股骨颈骨折的概念提出与治疗. 中华创伤骨科杂志, 2011, 13(11): 1020-1023.
24.	李伟龙, 余霄, 庞清江. 股骨颈骨折内固定术后股骨颈短缩的相关研究进展. 中华骨科杂志, 2016, 36(6): 378-384.
25.	Zlowodzki M, Ayeni O, Petrisor BA, et al. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma, 2008, 64(1): 163-169.
26.	Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: Results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
27.	Enocson A, Lapidus LJ. The vertical hip fracture-a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskelet Disord, 2012, 13: 171. doi: 10.1186/1471-2474-13-171.
28.	Murphy DK, Randell T, Brennan KL, et al. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res, 2013, 471(8): 2691-2702.
29.	Schopper C, Zderic I, Menze J, et al. Higher stability and more predictive fixation with the Femoral Neck System versus Hansson Pins in femoral neck fractures Pauwels Ⅱ. J Orthop Translat, 2020, 24: 88-95.
30.	范智荣, 苏海涛, 周霖, 等. 新型股骨颈内固定系统治疗不稳定性股骨颈骨折的有限元分析. 中国组织工程研究, 2021, 25(15): 2321-2328.
31.	Kubiak EN, Beebe MJ, North K, et al. Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg, 2013, 21(12): 727-738.

1. Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
2. 倪明, 孙万驹, 叶晔. 内侧支撑钢板辅助固定治疗青壮年股骨颈骨折的研究进展. 中国修复重建外科杂志, 2020, 34(11): 1454-1457.
3. Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
4. Zhang LL, Zhang Y, Ma X, et al. Multiple cannulated screws vs. dynamic hip screws for femoral neck fractures: A meta-analysis. Orthopade, 2017, 46(11): 954-962.
5. FAITH-2 Investigators, Slobogean GP, Sprague S, et al. Fixation using alternative implants for the treatment of hip fractures (FAITH-2): design and rationale for a pilot multi-centre 2×2 factorial randomized controlled trial in young femoral neck fracture patients. Pilot Feasibility Stud, 2019, 5: 70. doi: 10.1186/s40814-019-0458-x.
6. 胡家朗, 李绍刚, 陈明, 等. 新型股骨颈动力加压锁定钉板系统治疗股骨颈骨折. 中华创伤骨科杂志, 2019, 21(11): 939-944.
7. Matar HE, Chandran P. Outcomes of internal fixation of intracapsular hip fractures using dynamic locking plate system (Targon® FN). J Orthop, 2018, 15(3): 829-831.
8. Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable pauwels Ⅲ femoral neck fractures: A comparison with the dynamic hip screw and cannulated acrews. J Orthop Trauma, 2017, 31(3): 131-137.
9. Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg (Am), 2004, 86(8): 1711-1716.
10. Sepehri A, Martinson J, Marchand LS, et al. Measuring lateral screw protuberance is a clinically accurate method for quantifying femoral neck shortening. J Orthop Trauma, 2020, 34(11): 600-605.
11. Park YC, Um KS, Kim DJ, et al. Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures. Injury, 2021, 52(3): 569-574.
12. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
13. 徐凯航, 纪方. 青壮年股骨颈骨折的治疗进展. 中华创伤骨科杂志, 2020, 22(6): 549-552.
14. 刘敬文, 张伟. 青壮年垂直型股骨颈骨折手术治疗进展. 国际骨科学杂志, 2018, 39(6): 335-339.
15. Stockton DJ, Dua K, O’Brien PJ, et al. Failure patterns of femoral neck fracture fixation in young patients. Orthopedics, 2019, 42(4): e376-e380.
16. Xia Y, Zhang W, Zhang Z, et al. Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis. J Orthop Surg Res, 2021, 16(1): 54. doi: 10.1186/s13018-020-02189-1.
17. Ma JX, Kuang MJ, Xing F, et al. Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: A systematic review. Int J Surg, 2018, 52: 89-97.
18. Bliven E, Sandriesser S, Augat P, et al. Biomechanical evaluation of locked plating fixation for unstable femoral neck fractures. Bone Joint Res, 2020, 9(6): 314-321.
19. You DD, Paik KY, Park IY, et al. Randomized controlled study of the effect of octreotide on pancreatic exocrine secretion and pancreatic fistula after pancreatoduodenectomy. Asian J Surg, 2019, 42(2): 458-463.
20. Haider T, Schnabel J, Hochpöchler J, et al. Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients. Arch Orthop Trauma Surg, 2018, 138(11): 1511-1517.
21. 许新忠, 常菁, 余水生, 等. 股骨颈系统固定治疗股骨颈骨折的近期疗效分析. 中华创伤骨科杂志, 2020, 22(7): 624-627.
22. 柘植峻, 吉岡裕, 宮坂和良, 等. 当院における Femoral Neck System の短期治療成績. 中部整災誌, 2019, 62: 977-978.
23. 李智勇, 张奇, 陈伟, 等. 难复位性股骨颈骨折的概念提出与治疗. 中华创伤骨科杂志, 2011, 13(11): 1020-1023.
24. 李伟龙, 余霄, 庞清江. 股骨颈骨折内固定术后股骨颈短缩的相关研究进展. 中华骨科杂志, 2016, 36(6): 378-384.
25. Zlowodzki M, Ayeni O, Petrisor BA, et al. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma, 2008, 64(1): 163-169.
26. Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: Results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
27. Enocson A, Lapidus LJ. The vertical hip fracture-a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskelet Disord, 2012, 13: 171. doi: 10.1186/1471-2474-13-171.
28. Murphy DK, Randell T, Brennan KL, et al. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res, 2013, 471(8): 2691-2702.
29. Schopper C, Zderic I, Menze J, et al. Higher stability and more predictive fixation with the Femoral Neck System versus Hansson Pins in femoral neck fractures Pauwels Ⅱ. J Orthop Translat, 2020, 24: 88-95.
30. 范智荣, 苏海涛, 周霖, 等. 新型股骨颈内固定系统治疗不稳定性股骨颈骨折的有限元分析. 中国组织工程研究, 2021, 25(15): 2321-2328.
31. Kubiak EN, Beebe MJ, North K, et al. Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg, 2013, 21(12): 727-738.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle Ⅲ femoral neck fractures

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