Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures: A retrospective study

Chao Chen, Li Yu, Xin Tang, Mo-Zhen Liu, Li-Zhong Sun, Changjian Liu, Zhen Zhang, Chang-Zhou Li, Chao Chen, Li Yu, Xin Tang, Mo-Zhen Liu, Li-Zhong Sun, Changjian Liu, Zhen Zhang, Chang-Zhou Li

Abstract

Objective: The aim of this study was to compare clinical outcomes of patients with femoral neck fractures treated with the dynamic hip system blade (DHS-BLADE) or cannulated compression screws.

Methods: Eighty-six patients with femoral neck fractures were treated by closed reduction internal fixation with a DHS-BLADE (n = 42; 18 males and 24 females; mean age: 56.3 years (37-87)) or cannulated compression screws (n = 44; 20 males and 24 females; mean age: 53.8 years (26-83)) between March 2011 and August 2013. The groups were compared with Harris hip score, operation time, surgical blood loss, incision size, hospital stay, and related complications.

Results: The average follow-up time was 27 months (range, 24-36 months). There was no significant difference for the operation time, incision size, hospital stay, and Harris hip score between the groups. Also, no statistically significant differences in the rates of nonunion (4.5% vs. 0) and avascular necrosis of the femoral head (9.1% vs. 7.1%) were observed. However, the screw group experienced significantly less surgical blood loss (32.4 ± 24.7 ml) than the blade group (87.2 ± 46.6 ml; P = 0.041). The incidence of femoral neck shortening above 10 mm in the screw group was significantly higher than that in the blade group (15.9% vs. 2.4%, P = 0.031). The blade group had a significantly lower incidence of screw migration than the screw group (4.8% vs. 22.7%, P = 0.016).

Conclusion: The DHS-BLADE and cannulated compression screws might be equally effective in terms of postoperative fracture union. However, the DHS-BLADE has advantages over cannulated compression screws for preventing femoral neck shortening, screw migration, and cut-out.

Level of evidence: Level III, Therapeutic study.

Keywords: Cannulated screw; Dynamic hip system blade; Femoral neck fracture; Internal fixation.

Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
A line was drawn from the rotation center of the femoral head through the center of the femoral neck. The distance from the femoral head cartilage to the greater trochanter cortex was measured. Any difference between the injured and the uninjured side was considered indicative of femoral neck shortening.
Fig. 2
Fig. 2
A 41-year-old man with a Garden III fracture fixed with DHS-BLADE. (A) Preoperative anterioposterior radiograph. (B) Preoperative lateral radiograph. (C) Preoperative CT image. (D) Preoperative three-dimensional CT reconstruction. (E) Postoperative anterioposterior radiograph. (F) Postoperative lateral radiograph. (G) Postoperative anterioposterior radiograph at 1 year. (H) Postoperative lateral radiograph at 1 year.
Fig. 3
Fig. 3
A 56-year-old woman with a Garden III fracture fixed with a cannulated compression screw. (A) Preoperative anterioposterior radiograph. (B) Preoperative lateral radiograph. (C) Preoperative CT image. (D) Preoperative three-dimensional CT reconstruction. (E) Postoperative anterioposterior radiograph. (F) Postoperative lateral radiograph. (G) Postoperative anterioposterior radiograph at 2 years. (H) Postoperative lateral radiograph at 2 years.

References

    1. Broderick J.M., Bruce-Brand R., Stanley E. Osteoporotic hip fractures: the burden of fixation failure. Sci World J. 2013;2013:515197.
    1. Wilk R., Skrzypek M., Kowalska M. Standardized incidence and trend of osteoporotic hip fracture in Polish women and men: a nine year observation. Maturitas. 2014;77:59–63.
    1. Parker M.J. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Jt Surg Am. 2009;91:490–491.
    1. Sommers M.B., Roth C., Hall H. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma. 2004;18:361–368.
    1. Simmermacher R.K., Ljungqvist J., Bail H. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury. 2008;39:932–939.
    1. Strauss E., Frank J., Lee J. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury. 2006;37:984–989.
    1. Windolf M., Muths R., Braunstein V. Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance. Clin Biomech (Bristol, Avon) 2009;24:53–58.
    1. Windolf M., Braunstein V., Dutoit C. Is a helical shaped implant a superior alternative to the Dynamic Hip Screw for unstable femoral neck fractures? A biomechanical investigation. Clin Biomech (Bristol, Avon) 2009;24:59–64.
    1. Leung F., Gudushauri P., Yuen G. Dynamic hip screw blade fixation for intertrochanteric hip fractures. J Orthop Surg. 2013:132–133.
    1. Zhao W.B., Liu L. Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis. Chin J Traumatol. 2014;17:275–278.
    1. Neilipovitz D.T., Murto K., Hall L., Barrowman N.J., Splinter W.M. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001;93:82–87.
    1. Wong J., Hossam E., Suntheralingam Y., Rampersaud R., Chung F. Tranexamic acid reduces blood loss and transfusion in adult patients having spinal fusion surgery. Can J Anesth. 2006;53(suppl 1):26385.
    1. Boraiah S., Paul O., Hammoud S., Gardner M.J., Helfet D.L., Lorich D.G. Predictable healing of femoral neck fractures treated with intraoperative compression and length-stable implants. J Trauma. 2010;69:142–147.
    1. Zlowodzki M., Jönsson A., Paulke R. Shortening after femoral neck fracture fixation: is there a solution? Clin Orthop Relat Res. 2007;461:213–218.
    1. Harris W.H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Jt Surg Am. 1969;51:737–755.
    1. Marchetti P., Binazzi R., Vaccari V. Long-term results with cementless Fitek (or Fitmore) Cups. J Arthroplasty. 2005;20:730–737.
    1. Estrada L.S., Volgas D.A., Stannard J.P., Alonso J.E. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002;399:110–118.
    1. Kold S., Bechtold J.E., Mouzin O., Elmengaard B., Chen X., Søballe K. Fixation of revision implants is improved by a surgical technique to crack the sclerotic bone rim. Clin Orthop Relat Res. 2005;432:160–166.
    1. O'Neill F., Condon F., McGloughlin T., Lenehan B., Coffey J.C., Walsh M. Dynamic hip screw versus DHS blade: a biomechanical comparison of the fixation achieved by each implant in bone. J Bone Jt Surg Br. 2011;935:616–621.
    1. Zhang Pei-xun, Dang Yu, Xue Feng. Clinical analysis of obvious and hidden blood loss during treatment of intertrochanter fracture with proximal femoral nail anti-rotation. Chin J Trauma. 2011;27:785–788.
    1. Bhandari M., Rd T.P., Hanson B. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? J Orthop Trauma. 2009;23:403–407.
    1. Angelini M., Mckee M.D., Waddell J.P. Salvage of failed hip fracture fixation. J Orthop Trauma. 2009;23:471.
    1. Rogmark C., Flensburg L., Fredin H. Undisplaced femoral neck fractures–no problems? A consecutive study of 224 patients treated with internal fixation. Injury. 2009;40:274–276.
    1. Haidukewych G.J., Rothwell W.S., Jacofsky D.J. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Jt Surg Am. 2004;86-A:1711–1716.
    1. Bosch U., Schreiber T., Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res. 2002;399:59–71.
    1. Kold S., Bechtold J.E., Mouzin O. Fixation of revision implants is improved by a surgical technique to crack the sclerotic bone rim. Clin Orthop Relat Res. 2005;432:160–166.
    1. Su Y., Chen W., Zhang Q. An irreducible variant of femoral neck fracture: a minimally traumatic reduction technique. Injury. 2011;42:140–145.
    1. Zlowodzki M., Brink O., Switzer J. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Jt Surg Br. 2008;90:1487–1494.
    1. Nüchtern J.V., Ruecker A.H., Sellenschloh K. Malpositioning of the lag-screws by one- or two-screw nailing systems for pertrochanteric femoral fractures: a biomechanical comparison of Gamma3 and Intertan. J Orthop Trauma. 2014;28:276–282.
    1. Nikoloski A.N., Osbrough A.L., Yates P.J. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8:35.

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