Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures

Jialiang Guo, Weichong Dong, Bing Yin, Lin Jin, Zhe Lin, Zhiyong Hou, Yingze Zhang, Jialiang Guo, Weichong Dong, Bing Yin, Lin Jin, Zhe Lin, Zhiyong Hou, Yingze Zhang

Abstract

Objective: Unstable femoral neck fractures are typically high-angled shear fractures caused by high-energy trauma. Internal fixation of femoral neck fractures with placement of parallel cannulated screws in an inverted triangle configuration is commonly performed in the clinical setting. This study was performed to investigate the primary results of intramedullary nailing with cannulated screws for the treatment of unstable femoral neck fractures in young and middle-aged patients.

Methods: In total, 96 consecutive patients with no history of hip surgery using inverted triangular cannulated compression screws or construction nails with cannulated screws were reviewed. Their demographic and radiological data were retrospectively collected from our institutional database.

Results: Inverted cannulated screws had an excellent effect on decreasing the blood loss volume and incision size, but intramedullary nails exhibited superior advantages in decreasing screw exit and shortening the hospital stays. The Harris hip scores were comparable between the two groups.

Conclusions: Intramedullary fixation with cannulated screws has advantages in treating complicated femoral neck fractures. Besides cannulated screws, intramedullary fixation with cannulated screws might be another method to treat unstable femoral neck fractures in young and middle-aged patients. The study was registered in ClinicalTrials.gov. Unique Protocol ID: 11156458. The ClinicalTrial number is NCT03550079.

Keywords: Femoral neck fracture; Harris hip score; cannulated screws; intramedullary fixation; inverted triangle; retrospective study.

Figures

Figure 1.
Figure 1.
Radiograph of an unstable femoral neck fracture. Preoperative anteroposterior radiograph with a Garden IV, Pauwels III femoral neck fracture.
Figure 2.
Figure 2.
Preoperative and postoperative radiograph of a 58-year-old man with a Garden III, Pauwels III femoral neck fracture treated with inverted triangular configurations. (a) Preoperative anteroposterior (AP) radiograph (b) Preoperative lateral radiograph (c) Postoperative AP radiograph (d) Postoperative lateral radiograph (e) On the AP radiograph at 13 months, the screws exhibited exit-out (f) Lateral radiograph at 13 months (g) AP radiograph showing revision arthroplasty after internal fixation failure (h) AP radiograph after arthroplasty (before follow-up).
Figure 3.
Figure 3.
Preoperative and postoperative radiographs of a 58-year-old woman with a Garden IV, Pauwels III femoral neck fracture treated with an intramedullary nail. (a) Preoperative anteroposterior (AP) radiograph (b) Postoperative AP radiograph (c) Postoperative lateral radiograph (d) AP radiograph before finishing follow-up (e) Lateral radiograph before finishing follow-up.
Figure 4.
Figure 4.
Preoperative and postoperative radiographs of a 42-year-old man with a femoral neck fracture combined with a femoral shaft fracture treated with an intramedullary nail. The femoral neck fracture was healed with no complications at 2 years postoperatively. (a) Preoperative anteroposterior (AP) radiograph (b) Postoperative AP radiograph (c) Postoperative lateral radiograph (d) AP radiograph at 2 years postoperatively.

References

    1. Broderick JM, Bruce-Brand R, Stanley E, et al. Osteoporotic hip fractures: the burden of fixation failure. ScientificWorldJournal 2013; 2013: 515197. 2013/03/12. DOI: 10.1155/2013/515197.
    1. Wilk R, Skrzypek M, Kowalska M, et al. Standardized incidence and trend of osteoporotic hip fracture in Polish women and men: a nine year observation. Maturitas 2014; 77: 59–63. 2013/10/05. DOI: 10.1016/j.maturitas.2013.09.004.
    1. Estrada LS, Volgas DA, Stannard JP, et al. Fixation failure in femoral neck fractures. Clin Orthop Relat Res 2002; 399: 110–118. 2002/05/16.
    1. Miller BJ, Lu X, Cram P. The trends in treatment of femoral neck fractures in the Medicare population from 1991 to 2008. J Bone Joint Surg Am 2013; 95: e132. 2013/09/21. DOI: 10.2106/jbjs.l.01163.
    1. Parker MJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am 2009; 91: 490–491; author reply 491. 2009/02/03.
    1. Filipov O, Gueorguiev B. Unique stability of femoral neck fractures treated with the novel biplane double-supported screw fixation method: a biomechanical cadaver study. Injury 2015; 46: 218–226. 2014/12/21. DOI: 10.1016/j.injury.2014.11.013.
    1. 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-A: 1711–1716. 2004/08/05.
    1. 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: 155–159. 1999/04/17.
    1. Blomfeldt R, Tornkvist H, Ponzer S, et al. Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment. J Bone Joint Surg Br 2005; 87: 523–529. 2005/03/30. DOI: 10.1302/0301-620x.87b4.15764.
    1. Yih-Shiunn L, Chien-Rae H, Wen-Yun L. Surgical treatment of undisplaced femoral neck fractures in the elderly. Int Orthop 2007; 31: 677–682. 2006/10/13. DOI: 10.1007/s00264-006-0243-3.
    1. Kunapuli SC, Schramski MJ, Lee AS, et al. Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma 2015; 29: 144–150. 2014/07/30. DOI: 10.1097/bot.0000000000000205.
    1. Roderer G, Moll S, Gebhard F, et al. Side plate fixation vs. intramedullary nailing in an unstable medial femoral neck fracture model: A comparative biomechanical study. Clin Biomech (Bristol, Avon) 2011; 26: 141–146. 2010/10/19. DOI: 10.1016/j.clinbiomech.2010.09.020.
    1. Boraiah S, Paul O, Hammoud S, et al. Predictable healing of femoral neck fractures treated with intraoperative compression and length-stable implants. J Orthop Trauma 2010; 69: 142–147. 2009/12/17. DOI: 10.1097/TA.0b013e3181bba236.
    1. Zlowodzki M, Jonsson A, Paulke R, et al. Shortening after femoral neck fracture fixation: is there a solution? Clin Orthop Relat Res 2007; 461: 213–218. 2007/04/07. DOI: 10.1097/BLO.0b013e31805b7ec4.
    1. Harris WH. 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 Joint Surg Am 1969; 51: 737–755. 1969/06/01.
    1. Marchetti P, Binazzi R, Vaccari V, et al. Long-term results with cementless Fitek (or Fitmore) cups. J Arthroplasty 2005; 20: 730–737. 2005/09/06. DOI: 10.1016/j.arth.2004.11.019.
    1. Satish BR, Ranganadham AV, Ramalingam K, et al. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients. Indian J Orthop 2013; 47:174–181. DOI: 10.4103/0019-5413.108912.
    1. 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: 779–788. 2017/04/10. DOI: 10.1007/s00402-017-2689-8.
    1. Hoskinson S, Morison Z, Shahrokhi S, et al. Managing AVN following internal fixation: treatment options and clinical results. Injury 2015; 46: 497–506. 2014/12/31. DOI: 10.1016/j.injury.2014.11.016.
    1. Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury 2015; 46: 445–452. 2015/01/20. DOI: 10.1016/j.injury.2014.12.031.
    1. Schwartsmann CR, Lammerhirt HM, Spinelli LF, et al. Treatment of displaced femoral neck fractures in young patients with DHS and its association to osteonecrosis. Rev Bras Ortop 2018; 53: 82–87. 2018/01/26. DOI: 10.1016/j.rboe.2017.03.003.
    1. Swiontkowski MF, Harrington RM, Keller TS, et al. Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density. J Orthop Res 1987; 5: 433–444. 1987/01/01. DOI: 10.1002/jor.1100050316.
    1. Penzkofer J, Mendel T, Bauer C, et al. [Treatment results of pertrochanteric and subtrochanteric femoral fractures: a retrospective comparison of PFN and PFNA]. Der Unfallchirurg 2009; 112: 699–705. 2009/07/15. DOI: 10.1007/s00113-009-1642-x.
    1. Zhuang L, Wang L, Xu D, et al. Anteromedial femoral neck plate with cannulated screws for the treatment of irreducible displaced femoral neck fracture in young patients: a preliminary study. Eur J Trauma Emerg Surg 2018. [Epub ahead of print]. DOI: 10.1007/s00068-018-0972-1.
    1. Ye Y, Chen K, Tian K, et al. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results. Injury 2017; 48: 2189–2193. 2017/08/19. DOI: 10.1016/j.injury.2017.08.017.
    1. Nowotarski PJ, Ervin B, Weatherby B, et al. Biomechanical analysis of a novel femoral neck locking plate for treatment of vertical shear Pauwel's type C femoral neck fractures. Injury 2012; 43: 802–806. 2011/10/25. DOI: 10.1016/j.injury.2011.09.012.

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