Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xiaopan ,  WU Min , CHEN Xiaotian , YE Longfei , DAI Xiusong

Department of Orthopaedics, Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China;

Corresponding author：

WU Min, Email: 464550501@qq.com

Keywords：

Valgus-impacted femoral neck fracture; screwdrive rod; femoral neck system; closed reduction; internal fixation

DOI：

10.7507/1002-1892.202212043

Video：

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Objective To evaluate the feasibility and effectiveness of percutaneous screwdriver rod-assisted closed reduction in the treatment of valgus-impacted femoral neck fractures. Methods Between January 2021 and May 2022, 12 patients with the valgus-impacted femoral neck fractures were treated with percutaneous screwdriver rod-assisted closed reduction and femoral neck system (FNS) internal fixation. There were 6 males and 6 females with a median age of 52.5 years (range, 21-63 years). The fractures were caused by traffic accident in 2 cases, falling in 9 cases, and falling from height place in 1 case. All were unilateral closed femoral neck fractures, including 7 on the left side and 5 on the right side. The time from injury to operation was 1-11 days, with an average of 5.5 days. The fracture healing time and postoperative complications were recorded. The quality of fracture reduction was evaluated by Garden index. At last follow-up, Harris score was used to evaluate the hip joint function, also the shortening of femoral neck was measured. Results All the operations were successfully completed. After operation, the incision fat liquefaction occurred in 1 case, which healed after enhanced dressing change, and the other patients’ incisions healed by first intention. All patients were followed up 6-18 months, with an average of 11.7 months. The X-ray film reexamination showed that the quality of fracture reduction was grade Ⅰ in 10 cases and grade Ⅱ in 2 cases according to the Garden index. All fractures reached bony union, and the healing time was 3-6 months, with an average of 4.8 months. At last follow-up, the femoral neck was shortened by 1-4 mm, with an average of 2.1 mm. No internal fixation failure or osteonecrosis of the femoral head occurred during follow-up. At last follow-up, the hip Harris score was 85-96, with an average of 92.4; 10 cases were rated as excellent and 2 were good. Conclusion The percutaneous screwdriver rod-assisted closed reduction can effectively reduce the valgus-impacted femoral neck fracture. It has the advantages of simple operation, effective, and less impact on blood supply.

Citation： WANG Xiaopan, WU Min, CHEN Xiaotian, YE Longfei, DAI Xiusong. Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(3): 272-276. doi: 10.7507/1002-1892.202212043 Copy

1.	Nyholm AM, Palm H, Sandholdt H, et al. Osteosynthesis with parallel implants in the treatment of femoral neck fractures: Minimal effect of implant position on risk of reoperation. J Bone Joint Surg (Am), 2018, 100(19): 1682-1690.
2.	王朝晖, 曹书杰, 杨杰, 等. 空心钉原位内固定治疗后倾角<20°外展嵌插型股骨颈骨折. 医学理论与实践, 2021, 34(21): 3752-3754.
3.	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.
4.	Biz C, Tagliapietra J, Zonta F, et al. Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures. Aging Clin Exp Res, 2020, 32(3): 505-513.
5.	Raaymakers EL, Marti RK. Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg (Br), 1991, 73(6): 950-954.
6.	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.
7.	Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury, 2016, 47(12): 2743-2748.
8.	Song HK, Lee JJ, Oh HC, et al. Clinical implication of subgrouping in valgus femoral neck fractures: comparison of 31-B1.1 with 31-B1.2 fractures using the OTA/AO classification. J Orthop Trauma, 2013, 27(12): 677-682.
9.	梁慕天, 张英琪, 蔡倩莹, 等. 外展嵌插型股骨颈骨折对屈髋活动度影响的三维模拟研究. 中华创伤骨科杂志, 2021, 23(10): 841-849.
10.	Strehl A, Ganz R. Anterior femoroacetabular impingement after healed femoral neck fractures. Unfallchirurg, 2005, 108(4): 263-273.
11.	Schaefer TK, Spross C, Stoffel KK, et al. Biomechanical properties of a posterior fully threaded positioning screw for cannulated screw fixation of displaced neck of femur fractures. Injury, 2015, 46(11): 2130-2133.
12.	Dai Y, Ni M, Dou B, et al. Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture. Comput Methods Biomech Biomed Engin, 2022, 25: 1-8.
13.	Aepli M, Rüdiger HA, Leunig M. Ligamentum teres impingement in valgus impacted femoral neck fracture: A case for hip arthroscopy. JBJS Case Connect, 2020, 10(4): e2000284. doi: 10.2106/JBJS.CC.20.00284.
14.	王富洋, 刘宇宸, 程亮亮, 等. 股骨颈骨折常用内固定方式的生物力学研究进展. 中国修复重建外科杂志, 2022, 36(7): 896-901.
15.	Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
16.	冀家琛, 杨博, 王敏, 等. 股骨颈动力交叉钉系统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, 2022, 36(11): 1434-1439.
17.	杨家赵, 周雪锋, 李黎, 等. 股骨颈动力交叉钉系统和倒三角空心钉治疗Pauwels Ⅲ型股骨颈骨折疗效比较. 中国修复重建外科杂志, 2021, 35(9): 1111-1118.
18.	朱求亮, 颜茂华, 许斌, 等. 闭合复位技术治疗外展嵌插型股骨颈骨折. 中国骨伤, 2022, 35(4): 357-360.
19.	Yoon BH, Kim YS, Koo KH. A simple percutaneous technique to reduce valgus-impacted femoral neck fractures. Clin Orthop Surg, 2020, 12(2): 258-262.

1. Nyholm AM, Palm H, Sandholdt H, et al. Osteosynthesis with parallel implants in the treatment of femoral neck fractures: Minimal effect of implant position on risk of reoperation. J Bone Joint Surg (Am), 2018, 100(19): 1682-1690.
2. 王朝晖, 曹书杰, 杨杰, 等. 空心钉原位内固定治疗后倾角<20°外展嵌插型股骨颈骨折. 医学理论与实践, 2021, 34(21): 3752-3754.
3. 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.
4. Biz C, Tagliapietra J, Zonta F, et al. Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures. Aging Clin Exp Res, 2020, 32(3): 505-513.
5. Raaymakers EL, Marti RK. Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg (Br), 1991, 73(6): 950-954.
6. 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.
7. Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury, 2016, 47(12): 2743-2748.
8. Song HK, Lee JJ, Oh HC, et al. Clinical implication of subgrouping in valgus femoral neck fractures: comparison of 31-B1.1 with 31-B1.2 fractures using the OTA/AO classification. J Orthop Trauma, 2013, 27(12): 677-682.
9. 梁慕天, 张英琪, 蔡倩莹, 等. 外展嵌插型股骨颈骨折对屈髋活动度影响的三维模拟研究. 中华创伤骨科杂志, 2021, 23(10): 841-849.
10. Strehl A, Ganz R. Anterior femoroacetabular impingement after healed femoral neck fractures. Unfallchirurg, 2005, 108(4): 263-273.
11. Schaefer TK, Spross C, Stoffel KK, et al. Biomechanical properties of a posterior fully threaded positioning screw for cannulated screw fixation of displaced neck of femur fractures. Injury, 2015, 46(11): 2130-2133.
12. Dai Y, Ni M, Dou B, et al. Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture. Comput Methods Biomech Biomed Engin, 2022, 25: 1-8.
13. Aepli M, Rüdiger HA, Leunig M. Ligamentum teres impingement in valgus impacted femoral neck fracture: A case for hip arthroscopy. JBJS Case Connect, 2020, 10(4): e2000284. doi: 10.2106/JBJS.CC.20.00284.
14. 王富洋, 刘宇宸, 程亮亮, 等. 股骨颈骨折常用内固定方式的生物力学研究进展. 中国修复重建外科杂志, 2022, 36(7): 896-901.
15. Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
16. 冀家琛, 杨博, 王敏, 等. 股骨颈动力交叉钉系统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, 2022, 36(11): 1434-1439.
17. 杨家赵, 周雪锋, 李黎, 等. 股骨颈动力交叉钉系统和倒三角空心钉治疗Pauwels Ⅲ型股骨颈骨折疗效比较. 中国修复重建外科杂志, 2021, 35(9): 1111-1118.
18. 朱求亮, 颜茂华, 许斌, 等. 闭合复位技术治疗外展嵌插型股骨颈骨折. 中国骨伤, 2022, 35(4): 357-360.
19. Yoon BH, Kim YS, Koo KH. A simple percutaneous technique to reduce valgus-impacted femoral neck fractures. Clin Orthop Surg, 2020, 12(2): 258-262.

Chinese Journal of Reparative and Reconstructive Surgery

Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures

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