Midterm effectiveness of percutaneous compression plate for femoral neck fractures in young and middle-aged patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Tianhao , LI Rongqun , ZHOU Jun , XU Ming , GENG Dechun ,  XU Yaozeng ,  ZHU Feng

Department of Orthopedics, the First Affiliated Hospital, Soochow University, Suzhou Jiangsu, 215008, P. R. China;

Corresponding author：

XU Yaozeng, Email: xuyaozeng@163.com; ZHU Feng, Email: 925521767@qq.com

Keywords：

Femoral neck fracture; percutaneous compression plate; internal fixation; young and middle-aged

DOI：

10.7507/1002-1892.202202053

Video：

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Objective To analyze midterm effectiveness of percutaneous compression plate (PCCP) for femoral neck fractures in young and middle-aged patients. Methods The clinical data of 173 young and middle-aged patients with femoral neck fractures who met the selection criteria and were treated with PCCP internal fixation between January 2011 and March 2019 were retrospectively analyzed. Among them, there were 102 males and 71 females; the age ranged from 18 to 59 years, with an average age of 44.9 years. The injury causes included falling in 112 cases, traffic accident in 32 cases, falling from height in 21 cases, struck in 7 cases, and sprain in 1 case. According to Garden classification, there were 90 cases without displacement (51 cases of type Ⅰ and 39 cases of type Ⅱ) and 83 cases with displacement (51 cases of type Ⅲ and 39 cases of type Ⅳ). According to Pauwels classification, there were 10 cases of type Ⅰ, 88 cases of type Ⅱ, and 75 cases of type Ⅲ. The time from injury to operation was 1-14 days, with an average of 4.5 days. The operation time, intraoperative blood loss, perioperative blood transfusion, and hospitalization stay were recorded; the fracture reduction was evaluated by Garden alignment index at 1 day after operation; fracture healing and complications were observed, and Harris score was used to evaluate the effectiveness at last follow-up. Results The operation time was 34-130 minutes (mean, 78.6 minutes); the intraoperative blood loss was 10-250 mL (mean, 93.2 mL); 171 cases did not receive blood transfusion during perioperative period, 2 patients received blood transfusion of 400 mL and 800 mL respectively; the hospitalization stay was 3-19 days (mean, 11.3 days). All 173 cases were followed up 11-103 months, with an average of 42.6 months. Postoperative reduction quality was satisfactory in 170 cases and unsatisfactory in 3 cases. There were 13 cases of osteonecrosis of femoral head, 1 case of screw cutting out, 2 cases of screw withdrawal, 5 cases of femoral neck shortening, and no deep vein thrombosis in the lower extremity requiring surgical intervention. Fractures healed in 172 patients, and the healing time ranged from 3.0 to 7.5 months, with an average of 3.6 months; 1 case of nonunion occurred. Internal fixation was removed after fracture healing in 51 patients. At last follow-up, Harris score was excellent in 156 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 96.5%. Conclusion The treatment of femoral neck fractures with PCCP has advantages of rigid fixation, immediate weight-bearing, and sliding compression, reducing the incidences of osteonecrosis of femoral head and nonunion.

Citation： WANG Tianhao, LI Rongqun, ZHOU Jun, XU Ming, GENG Dechun, XU Yaozeng, ZHU Feng. Midterm effectiveness of percutaneous compression plate for femoral neck fractures in young and middle-aged patients. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 708-713. doi: 10.7507/1002-1892.202202053 Copy

1.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
2.	Gotfried Y. Percutaneous compression plating of intertrochanteric hip fractures. J Orthop Trauma, 2000, 14(7): 490-495.
3.	Brandt SE. A new and stable implant in the treatment of the intracapsular hip fracture: A case report. Injury Extra, 2008, 39(4): 137-139.
4.	Mukherjee P, Ashworth MJ. A new device to treat intra-capsular fracture neck of femur non-union. Strategies Trauma Limb Reconstr, 2010, 5(3): 159-162.
5.	Brandt E, Verdonschot N, van Vugt A, et al. Biomechanical analysis of the percutaneous compression plate and sliding hip screw in intracapsular hip fractures: experimental assessment using synthetic and cadaver bones. Injury, 2006, 37(10): 979-983.
6.	朱锋, 徐耀增, 耿德春, 等. 经皮加压钢板治疗股骨颈骨折的早期疗效. 中华创伤杂志, 2014, 30(9): 909-912.
7.	Chiang MH, Wang CL, Fu SH, et al. Does fully-threaded Headless Compression Screw provide a length-stable fixation in undisplaced femoral neck fractures? Asian J Surg, 2019, 42(1): 320-325.
8.	Nanty L, Canovas F, Rodriguez T, et al. Femoral neck shortening after internal fixation of Garden Ⅰ fractures increases the risk of femoral head collapse. Orthop Traumatol Surg Res, 2019, 105(5): 999-1004.
9.	Robinson CM, Court-Brown CM, McQueen MM, et al. Hip fractures in adults younger than 50 years of age. Epidemiology and results. Clin Orthop Relat Res, 1995, (312): 238-246.
10.	张长青, 侯春林, 顾立强, 等. 青壮年股骨颈骨折的显微外科治疗专家共识. 中华显微外科杂志, 2016, 39(3): 209-212.
11.	徐可林, 刘宇, 王建伟, 等. 经皮加压钢板固定治疗股骨颈骨折的疗效研究. 中国修复重建外科杂志, 2020, 34(11): 1364-1368.
12.	Ramadanov N, Toma I, Herkner H, et al. Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation. Sci Rep, 2020, 10(1): 758. doi: 10.1038/s41598-020-57696-2.
13.	DamanyDS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury, 2005, 36(1): 131-141.
14.	Claes L. Improvement of clinical fracture healing-What can be learned from mechano-biological research? J Biomech, 2021, 115: 110148. doi: 10.1016/j.jbiomech.2020.110148.
15.	Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
16.	Conn KS, Parker MJ. Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res, 2004, (421): 249-254.
17.	Lu-Yao GL, Keller RB, Littenberg B, et al. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg (Am), 1994, 76(1): 15-25.
18.	Wu K, Huang J, Wang Q. The use of superselective arteriography in the evaluation of the influence of intracapsular hip joint pressure on the blood flow of the femoral head. Med Princ Pract, 2016, 25(2): 123-129.
19.	Maruenda JI, Barrios C, Gomar-Sancho F. Intracapsular hip pressure after femoral neck fracture. Clin Orthop Relat Res, 1997, (340): 172-180.
20.	Papakostidis C, Panagiotopoulos A, Piccioli A, et al. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome. Injury, 2015, 46(3): 459-466.
21.	孙欣, 曾荣, 胡资兵, 等. 空心螺钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析. 中华创伤骨科杂志, 2012, 14(6): 477-479.
22.	西尔买买提·艾哈提, 艾克热木江·阿尔肯, 丁舒晨, 等. 动力髋螺钉联合防旋钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析. 中华创伤杂志, 2017, 33(9): 801-807.
23.	Wang T, Sun JY, Zha GC, et al. Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures. Orthopedics, 2014, 37(12): e1117-e1123.

1. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
2. Gotfried Y. Percutaneous compression plating of intertrochanteric hip fractures. J Orthop Trauma, 2000, 14(7): 490-495.
3. Brandt SE. A new and stable implant in the treatment of the intracapsular hip fracture: A case report. Injury Extra, 2008, 39(4): 137-139.
4. Mukherjee P, Ashworth MJ. A new device to treat intra-capsular fracture neck of femur non-union. Strategies Trauma Limb Reconstr, 2010, 5(3): 159-162.
5. Brandt E, Verdonschot N, van Vugt A, et al. Biomechanical analysis of the percutaneous compression plate and sliding hip screw in intracapsular hip fractures: experimental assessment using synthetic and cadaver bones. Injury, 2006, 37(10): 979-983.
6. 朱锋, 徐耀增, 耿德春, 等. 经皮加压钢板治疗股骨颈骨折的早期疗效. 中华创伤杂志, 2014, 30(9): 909-912.
7. Chiang MH, Wang CL, Fu SH, et al. Does fully-threaded Headless Compression Screw provide a length-stable fixation in undisplaced femoral neck fractures? Asian J Surg, 2019, 42(1): 320-325.
8. Nanty L, Canovas F, Rodriguez T, et al. Femoral neck shortening after internal fixation of Garden Ⅰ fractures increases the risk of femoral head collapse. Orthop Traumatol Surg Res, 2019, 105(5): 999-1004.
9. Robinson CM, Court-Brown CM, McQueen MM, et al. Hip fractures in adults younger than 50 years of age. Epidemiology and results. Clin Orthop Relat Res, 1995, (312): 238-246.
10. 张长青, 侯春林, 顾立强, 等. 青壮年股骨颈骨折的显微外科治疗专家共识. 中华显微外科杂志, 2016, 39(3): 209-212.
11. 徐可林, 刘宇, 王建伟, 等. 经皮加压钢板固定治疗股骨颈骨折的疗效研究. 中国修复重建外科杂志, 2020, 34(11): 1364-1368.
12. Ramadanov N, Toma I, Herkner H, et al. Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation. Sci Rep, 2020, 10(1): 758. doi: 10.1038/s41598-020-57696-2.
13. DamanyDS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury, 2005, 36(1): 131-141.
14. Claes L. Improvement of clinical fracture healing-What can be learned from mechano-biological research? J Biomech, 2021, 115: 110148. doi: 10.1016/j.jbiomech.2020.110148.
15. Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
16. Conn KS, Parker MJ. Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res, 2004, (421): 249-254.
17. Lu-Yao GL, Keller RB, Littenberg B, et al. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg (Am), 1994, 76(1): 15-25.
18. Wu K, Huang J, Wang Q. The use of superselective arteriography in the evaluation of the influence of intracapsular hip joint pressure on the blood flow of the femoral head. Med Princ Pract, 2016, 25(2): 123-129.
19. Maruenda JI, Barrios C, Gomar-Sancho F. Intracapsular hip pressure after femoral neck fracture. Clin Orthop Relat Res, 1997, (340): 172-180.
20. Papakostidis C, Panagiotopoulos A, Piccioli A, et al. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome. Injury, 2015, 46(3): 459-466.
21. 孙欣, 曾荣, 胡资兵, 等. 空心螺钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析. 中华创伤骨科杂志, 2012, 14(6): 477-479.
22. 西尔买买提·艾哈提, 艾克热木江·阿尔肯, 丁舒晨, 等. 动力髋螺钉联合防旋钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析. 中华创伤杂志, 2017, 33(9): 801-807.
23. Wang T, Sun JY, Zha GC, et al. Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures. Orthopedics, 2014, 37(12): e1117-e1123.

Chinese Journal of Reparative and Reconstructive Surgery

Midterm effectiveness of percutaneous compression plate for femoral neck fractures in young and middle-aged patients

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