Objective To compare the therapeutic effect of cannulated screws fixation at different time points through different reduction methods on the heal ing of displaced femoral neck fractures. Methods From January 1997 to September 2007, 240 patients with displaced femoral neck fracture were treated, including 121 males and 119 females aged 22-79 years old (average 56 years old). All cases were fresh and close fractures. According to the fractured part, there were 133cases of subcapital fracture, 64 of transcervical fracture and 43 of basal fracture. According to Garden classification, there were 105 cases of type III and 135 of type IV. Cannulated screws fixation was performed on all the patients, and the time from injury to operation was 6 hours to 7 days. Fifty-five cases received closed reduction and 59 cases received l imited open reduction as emergency treatment, while 65 cases received closed reduction and 61 cases received l imited open reduction as selective operation. Different groups were compared in terms of the heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation. Results There was no significant difference between the closed reduction and the l imited open reduction in terms of operation time and bleeding volume (P gt; 0.05). Postoperatively, all wounds healed by first intention, no infection was observed, avascular necrosis of femoral head occurred in 44 cases, and the rate of avascular necrosis of femoral head in the l imited open reduction at emergency group was less than that of other 3 groups (P lt; 0.01). All the patients were followed up for 12-72 months (average 38 months), 193 cases got fracture heal ing at 10-23 months after operation (average 14 months). For the closed reduction as emergency operation group, the l imited open reduction as emergency operation group, the closed reduction as selective operation group, and the l imited open reduction as selective operation group, the heal ing rate of fracture was 74.55%, 91.53%, 69.23% and 86.89%, respectively; the excellent and good rate of reduction was 73.73%, 94.92%,70.77% and 91.80%, respectively; the excellent and good rate of fixation was 76.36%, 93.22%, 73.85% and 88.52%, respectively. The heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation in the l imited open groups were higher than that of the closed reduction groups (Plt; 0.01), and there was no significant difference between the emergency operation groups and the selective operational groups (Pgt; 0.05). Conclusion The reduction methods have significant influences on the heal ing of fractures after cannulated screws fixation of the displaced femoral neck fracture, and the operation time has no obvious effect on fracture heal ing.
Objective To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional (3D) printed guide plate with mortise-tenon joint structure (mortise-tenon joint plate) for the treatment of Pauwels type Ⅲ femoral neck fractures. Methods A clinical data of 78 patients with Pauwels type Ⅲ femoral neck fractures, who were admitted between August 2022 and August 2023 and met the selection criteria, was retrospectively analyzed. The operations were assisted with mortise-tenon joint plates in 26 cases (mortise-tenon joint plate group) and traditional guide plates in 28 cases (traditional plate group), and without guide plates in 24 cases (control group). There was no significant difference in the baseline data of gender, age, body mass index, cause of injury, and fracture side between groups (P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, incision length, incidence of postoperative deep vein thrombosis of lower extremity, pain visual analogue scale (VAS) score at 1 week after operation, and Harris score of hip joint at 3 months after operation were recorded and compared. X-ray re-examination was taken to check the quality of fracture reduction, fracture healing, and the shortening length of the femoral neck at 3 months after operation, and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation. Results Compared with the control group, the operation time, intraoperative blood loss, and frequency of intraoperative fluoroscopy reduced in the two plate groups, and the quality of fracture reduction was better, but the incision was longer, and the differences were significant (P<0.05). The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group (P<0.05), the incision was significantly longer (P<0.05); and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not significant between two plate groups (P>0.05). There was 1 case of deep vein thrombosis of lower extremity in the traditional plate group and 1 case in the control group, while there was no thrombosis in the mortise-tenon joint plate group. There was no significant difference in the incidence between groups (P>0.05). All patients were followed up 12-15 months (mean, 13 months). There was no significant difference in VAS score at 1 week and Harris score at 3 months between groups (P>0.05). Compared with the control group, the fracture healing time and the length of femoral neck shortening at 3 months after operation were significantly shorter in the two plate groups (P<0.05). There was no significant difference between the two plate groups (P>0.05). There was no significant difference in the incidences of non-union fractures, osteonecrosis of the femoral head, or internal fixation failure between groups (P>0.05). Conclusion For Pauwels type Ⅲ femoral neck fractures, the use of 3D printed guide plate assisted reduction and fixation can shorten the fracture healing time, reduce the incidence of postoperative complications, and be more conducive to the early functional exercise of the affected limb. Compared with the traditional guide plate, the mortise-tenon joint plate can reduce the intraoperative bleeding and shorten the operation time.
【Abstract】 Objective To evaluate the cl inical outcome of free vascularized fibular associated with il iac graft intreatment of old femoral neck fracture. Methods From January 1994 to January 1997, 76 cases of old femoral neck fracture were treated with free vascularized fibular associated with il iac graft, including 54 males and 22 females, aging from 24 to 48 years with an average of 31.5 years. All of these fractures resulted from injury. There were 20 cases of Garden II, 41 of Garden III and 15 of Garden IV. Based on the location of fracture, there was 26 cases of subcapital, 42 cases of transcervical and 8 cases of basal. Sixty-five cases were treated with internal fixation, 7 cases with skin traction and 4 just with staying in bed. Their Harris score were from 52 to 72 with an average of 65.6. The time from injury to operation was 2-24 months. The size of free vascularized fibular was 6-8 cm and il iac graft was 3.0 cm×2.0 cm×1.5 cm. Results In 76 cases, 68 were followed up and all fractures healed within 4 to 6 months with an average of 5.2 months. The increased density in femoral head was observed 1 year after operation. After 10 years of operation, normal hip function was achieved in 63 cases（followed up 10.1 -12.4 years with theaverage as 10.5 years); the Harris score was 87.5 (84 to 94). The structure of femoral head was normal and the grafted fibular and il iac bone healed with the femoral, no elapse or cyst occurred. Five cases had been compl ied with total hip replacement for femoral head necrosis or other. Conclusion Free vascularized fibular associated with il iac graft is a good method to treat old femoral neck fracture.
ObjectiveTo compare the effectiveness of femoral neck system (FNS) and cannulate compression screw (CCS) in the treatment of femoral neck fractures in young and middle-aged patients. MethodsThe clinical data of 82 young and middle-aged patients with femoral neck fracture treated between January 2018 and September 2020 were retrospectively analyzed. They were divided into FNS group (24 cases) and CCS group (58 cases) according to different surgical methods. There was no significant difference between the two groups (P>0.05) in general data such as gender, age, height, body mass, cause of injury, complications, fracture location, and fracture classification (Garden classification and Pauwells classification). The operation time, intraoperative blood loss, complications (nonunion, osteonecrosis of the femoral head, shortening of femoral neck, etc.), visual analogue scale (VAS) score at 2 days after operation, clinical healing time of fracture, and Harris score of hip joint after operation were recorded and compared between the two groups. ResultsThe operation time and VAS score at 2 days after operation in FNS group were significantly lower than those in CCS group (P<0.05); there was no significant difference in intraoperative blood loss between the two groups (t=0.263, P=0.796). The patients in CCS group were followed up 6-18 months, with an average of 13.6 months; and the follow-up time in FNS group was 3-12 months, with an average of 7.3 months. There was no complication of internal fixator loosening in both groups. There were 2 cases of osteonecrosis of the femoral head, 1 case of bone nonunion, and 13 cases of femoral neck shortening in CCS group and only 2 cases of femoral neck shortening in FNS group. The difference in the incidence of complications between the two groups (27.6% vs. 8.3%) was significant (χ2=36.670, P=0.015). In CCS group, 3 cases underwent secondary artificial hip arthroplasty due to bone nonunion and osteonecrosis of the femoral head, and the remaining 55 cases achieved clinical healing; in FNS group, 6 patients excluded in the statistics because the follow-up time was less than 6 months, and the remaining 18 fractures healed clinically; there was significant difference in fracture healing time between the two groups (t=4.481, P=0.000). The difference of Harris score of hip joint between 9 months and 6 months after operation in FNS group was significantly higher than that in CCS group (P<0.05), and the Harris score at 9 months after operation was significantly higher than that at 6 months after operation in both groups (P<0.05). ConclusionFNS can accelerate the healing of femoral neck fractures in young and middle-aged patients, so that patients can start functional exercise as soon as possible, thereby reducing the incidence of related complications.
Objective To investigate the clinical efficacy of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. Methods A retrospective analysis was made on the clinical data of 20 femoral neck fracture patients treated by computer-assisted cannulated screw internal fixation system based on error correction method between January 2014 and October 2015 (trial group), and 36 femoral neck fracture patients undergoing traditional manual surgery with closed reduction by cannulated screw fixation in the same period (the control group). There was no significant difference in gender, age, injury cause, side of fracture, types of fracture, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion, fracture healing time, fracture healing rate, and Harris hip score were compared between 2 groups. Results All incisions healed by first intention after operation, and no complication of blood vessel and nerve injury occurred. The operation time of trial group was significantly longer than that of control group (t=2.290,P=0.026), however, the intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion of trial group were significantly less than those of control group (t=–10.650,P=0.000;t=18.320,P=0.000;t=–16.625,P=0.000). All patients were followed up 12-18 months (mean, 14.7 months). X-ray films showed that fracture healing was obtained in 2 groups, showing no significant difference in fracture healing time between 2 groups (t=0.208,P=0.836). No complication of ischemic necrosis of femoral head occurred during follow-up period. At last follow-up, the Harris hip score was 87.05±3.12 in trial group and was 86.78±2.83 in control group, showing no significant difference (t=0.333,P=0.741). Conclusion Computer-assisted cannulated screw internal fixation surgery based on error correction method for femoral neck fractures is better than traditional manual surgery in decreasing intraoperative radiation and surgical trauma during operation.
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
ObjectiveTo investigate the short-term effectiveness and advantages of the orthopedic robot-assisted femoral neck system (FNS) fixation in the treatment of fresh femoral neck fractures compared with the traditional manual operation. Methods A clinical data of 74 patients with fresh femoral neck fractures, who had undergone internal fixation with FNS between April 2020 and September 2021, was retrospectively analyzed. Among them, there were 31 cases of TiRobot-assisted operation (trial group) and 43 cases of traditional manual operation (control group). There was no significant difference between groups (P>0.05) in terms of gender, age, cause of injury, time from injury to operation, fracture side and type. The fracture fixation time (intraoperative fracture reduction to the end of suture), invasive fixation time (incision of internal fixation to the end of suture), the number of placing key-guide needle, incision length, intraoperative blood loss, fracture healing, and Harris score of hip function were recorded and compared. Results All operations were performed with no neurovascular injury or incision complications. The invasive fixation time, intraoperative blood loss, the number of placing key-guide needle, and the incision length in the trial group were superior to the control group (P<0.05), and there was no significant difference in fracture fixation time between groups (P>0.05). All patients were followed up 4-16 months (mean, 7 months). The fracture did not heal in 1 patient of trial group, and the other fractures healed in 2 groups; the fracture healing time was (17.6±1.9) weeks in trial group and (18.2±1.9) weeks in control group, and there was no significant difference between groups (t=0.957, P=0.345). At last follow-up, the Harris score of the trial group was 82.4±5.8, which was higher than that of the control group (79.0±7.7), but the difference was not significant (t=–1.483, P=0.147). Conclusion Orthopedic robot-assisted FNS fixation in the treatment of fresh femoral neck fractures has the similar short-term effectiveness as the traditional method, but the former has advantages in terms of operation time, intraoperative blood loss, and the number of placing key-guide needle, making the operation more minimally invasive and quicker, and more suitable for older patients.
ObjectiveTo explore the risk factors for osteonecrosis of the femoral head (ONFH) after treatment of femoral neck fractures with femoral neck system (FNS). MethodsBetween January 2020 and February 2021, 179 patients (182 hips) with femoral neck fractures treated by FNS fixation were selected for retrospective analysis. There were 96 males and 83 females with an average age of 53.7 years (range, 20-59 years). There were 106 cases of low-energy-induced injury and 73 cases of high-energy-induced injury. The fractures were classified as type Ⅱ in 40 hips, type Ⅲ in 78 hips, and type Ⅳ in 64 hips according to Garden classification standard, and as typeⅠin 23 hips, type Ⅱ in 66 hips, and type Ⅲ in 93 hips according to Pauwels classification standard. There were 21 patients with diabetes. Patients were divided into ONFH group and non-ONFH group according to whether ONFH occurred at last follow-up. The data of the patients were collected, including age, gender, body mass index (BMI), trauma mechanism, bone mineral density, having diabetes or not, Garden classification and Pauwels classification of fractures, fracture reduction quality, femoral head retroversion angle, and removal of internal fixator or not. The above factors were analyzed by univariate analysis, and then multivariate logistic regression analysis was used to identify risk factors. Results Total 179 patients (182 hips) were followed up 20-34 months (mean, 26.5 months). Of these, 30 cases (30 hips) developed ONFH at 9-30 months after operation (ONFH group), and the incidence of ONFH was 16.48%. And 149 cases (152 hips) had no ONFH at last follow-up (non-ONFH group). The univariate analysis showed that there were significant differences between groups in bone mineral density, having diabetes or not, Garden classification, femoral head retroversion angle, and fracture reduction quality (P<0.05). The multivariate logistic regression analysis showed that the Garden type Ⅳ fracture, reduction quality of grading Ⅲ, femoral head retroversion angle >15°, complicated with diabetes were the risk factors for ONFH after FNS fixation (P<0.05). ConclusionFor the patients with Garden type Ⅳ fracture, poor quality of fracture reduction, femoral head retroversion angle >15°, and diabetes, the risk of ONFH after FNS fixation increases.
Objective To compare the effectiveness of three surgical methods in the treatment of Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients, in order to provide reference for clinical selection of appropriate surgical methods. Methods The clinical data of 103 patients with Pauwels type Ⅲ femoral neck fracture who met the selection criteria between June 2018 and December 2021 were retrospectively analyzed. The fractures were fixed with hollow screws in an inverted triangular shape (37 cases, hollow screw group), hollow screws in an inverted triangular shape combined with eccentric shaft screw (34 cases, eccentric shaft screw group), and hollow screws in an inverted triangular shape combined with medial support plate (32 cases, support plate group). There was no significant difference in age, gender, cause of injury, body mass index, time from injury to operation, side of the fracture, and Garden classification, whether they were in traction preoperatively, and other baseline data between groups (P>0.05). The operation time, intraoperative blood loss, the number of fluoroscopy, the length of hospital stay, early postoperative complication and postoperative weight-bearing time of the three groups were recorded. Harris score was used to evaluate joint function at 6 and 12 months after operation, and the difference between the two time points (change value) was calculated for comparison between groups. X-ray films were reviewed to evaluate the quality of fracture reduction (Garden index) and healing, as well as the occurrence of internal fixation failure and femoral head necrosis. Results The patients of the three groups were successfully completed. Compared with the hollow screw group and the eccentric shaft screw group, the operation time and intraoperative blood loss of the support plate group significantly increased, the number of fluoroscopy reduced, and the quality of fracture reduction was better, the differences were significant (P<0.05 ). The operation time, intraoperative blood loss, and the number of fluoroscopy of the hollow screw group were less than those of the eccentric shaft screw group, the differences were significant (P<0.05). There was no significant difference in the length of hospital stay between groups (P>0.05). All patients in the three groups were followed up 21-52 months, with an average follow-up time of 36.0 months, and there was no significant difference between groups (P>0.05). The incisions of all patients healed by first intention. Imaging reexamination showed that there was no significant difference in the incidence of fracture nonunion between groups (P>0.05). The fracture healing, partial weight-bearing, and full weight-bearing were significantly earlier in the eccentric shaft screw group and the support plate group than in the hollow screw group (P<0.05). There was no significant difference in change value of Harris score, the incidence of postoperative deep venous thrombosis and femoral head necrosis between groups (P>0.05); however, the incidence of internal fixation failure in the support plate group and the eccentric shaft screw group was significantly lower than that in the hollow screw group (P<0.05). The incidence of postoperative lateral thigh irritation in the support plate group was significantly lower than that in the hollow screw group (P<0.05); there was no significant difference between the eccentric shaft screw group and the other two groups (P>0.05). The overall incidences of postoperative complications in the eccentric shaft screw group and the support plate group were significantly lower than that in the hollow screw group (P<0.05). Conclusion For young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture, compared with simple hollow screw fixation in an inverted triangular shape, combined with medial support plate or eccentric shaft screw internal fixation can shorten the fracture healing time, reduce the incidences of postoperative complication, more conducive to early functional exercise of the affected limb; at the same time, the operation time and blood loss of combined eccentric shaft screw internal fixation are less than those of combined medial support plate internal fixation, so the hollow screw in an inverted triangular shape combined with eccentric shaft screw fixation may be a better choice.
ObjectiveTo investigate and analyze the effectiveness of internal fixation with the two different cannulated screw implanting methods of rhomboid and inverted triangle in the treatment of femoral neck fracture in young adults.MethodsThe clinical data of 38 young adults with femoral neck fracture who met the selection criteria between January 2018 and August 2019 were retrospectively analyzed. According to the different methods of cannulated screw implanting, the patients were divided into two groups, 19 cases in each group. The trial group was treated with closed reduction and cannulated screw rhombic distribution internal fixation, while the control group was treated with closed reduction and cannulated screw inverted triangular distribution internal fixation. There was no significant differences in patients’ gender, age, cause of injury, Garden classification of fracture, and time from injury to operation between the two groups (P>0.05). The fracture healing time, the incidence of nonunion, femoral neck shortening, and femoral head necrosis were recorded and compared between the two groups; the effectiveness was evaluated by Harris score and visual analogue scale (VAS) score at last follow-up.ResultsThe incisions of the two groups healed by first intention. All patients were followed up 12-24 months with an average of 15.5 months. There were 1 case of fracture nonunion and 2 cases of shortening of femoral neck in the trial group; while there were 2 cases of fracture nonunion, 1 case of necrosis of femoral head, and 6 cases of femoral neck shortening in the control group; the difference in the incidence of complications (15.8% vs. 47.4%) between the two groups was significant (χ2=4.385, P=0.036). The remaining 18 cases in the trial group and 17 cases in the control group all achieved osteonal union, and the healing time was (14.8±1.6) weeks and (15.9±1.3) weeks, respectively, showing no significant difference between the two groups (t=1.265, P=0.214). At last follow-up, Harris score and VAS score of the trial group were 88.9±4.3 and 1.1±0.7, respectively, while those of the control group were 86.9±5.9 and 1.3±0.9, respectively, showing no significant difference (t=0.603, P=0.550; t=1.152, P=0.257). Hip function was evaluated in accordance with Harris score, the results were excellent in 12 cases, good in 6 cases, and fair in 1 case in the trial group, the excellent and good rate was 94.74%; the results were excellent in 10 cases, good in 7 cases, and fair in 2 cases in the control group, the excellent and good rate was 89.47%; there was no significant difference in the excellent and good rate between the two groups (χ2=0.368, P=0.544).ConclusionThe short-term effectiveness of the two kinds of cannulated screw implanting methods is clear, rhomboid fixation of 4 screws has strong stability with stress distribution, which can effectively reduce the incidence of femoral neck shortening, fracture nonunion, femoral head necrosis, and other complications.