Risk of micro-fracture in femoral head after removal of cannulated screws for femoral neck fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHU Kai , ZHANG Xinglin , LU Xing ,  CHEN Xu

Department of Orthopaedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China;

Corresponding?author：

CHEN Xu, Email: chenvt2005@126.com

Keywords：

Femoral neck fracture; internal fixation; cannulated screw; micro-fracture

DOI：

10.7507/1002-1892.202001076

Video：

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Objective To explore the changes of bone and risk of micro-fracture in femoral head after removal of cannulated screws following femoral neck fracture healing under the impact force of daily stress.Methods A total of 42 specimens of normal hip joint were collected from 21 adult fresh cadaveric pelvic specimens. Wiberg central-edge (CE) angle, bone mineral density, diameter of femoral head, neck-shaft angle, and anteversion angle of femoral neck were measured. Then, the 3 cannulated screws were implanted according to the AO recommended method and removed to simulate the complete anatomical union of femoral neck fracture. The morphology of screw canal in the femoral head was observed by CT. Finally, the specimens were immobilized vertically within the impact device in an upside-down manner, and the femoral heads were impacted vertically. Every specimen was impacted at 200, 600, and 1 980 N for 20 times with the impacting device. After impact, every specimen was scanned by CT to observe the morphology changes of screw canal in the femoral head. Micro-fractures in the femoral head could be confirmed when there was change in the morphology of screw canal, and statistical software was used to analyze the risk factors associated with micro-fractures.Results After impact at 200 and 600 N, CT showed that the morphology of screw canal of all specimens did not change significantly compared with the original. After impact at 1 980 N, there were protrusion and narrowing in the screw canal of the 22 femoral head specimens (11 pelvic specimens), showing obvious changes compared with the original screw canal, indicating that there were micro-fractures in the femoral head. The incidence of micro-fracture was 52.38% (11/21). logistic regression results showed that there was correlation between micro-fracture and bone mineral density (P= 0.039), but no correlation was found with CE angle, diameter of femoral head, neck-shaft angle, and anteversion angle (P>0.05).Conclusion The micro-fractures in the femoral head may occur when the femoral head is impacted by daily activities after removal of cannulated screws for femoral neck fractures, and such micro-fractures are associated with decreased bone density of the femoral head.

Citation： CHU Kai, ZHANG Xinglin, LU Xing, CHEN Xu. Risk of micro-fracture in femoral head after removal of cannulated screws for femoral neck fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1091-1095. doi: 10.7507/1002-1892.202001076 Copy

1.	丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
2.	中華老年骨科與康復電子雜志編輯委員會. 股骨頭壞死保髖治療指南 (2016 版). 中華老年骨科與康復電子雜志, 2016, 2(2): 65-70.
3.	吳偉, 喻愛喜, 漆白文, 等. 股骨頸斷端愈合去除空心釘后的有限元分析. 中華實驗外科雜志, 2015, 32(7): 1590-1592.
4.	Van Houcke J, Schouten A, Steenackers G, et al. Computer-based estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations. Appl Ergon, 2017, 63(9): 99-105.
5.	王亦璁, 劉沂, 姜保國. 骨與關節損傷. 北京: 人民衛生出版社, 2007: 1155-1156.
6.	Munemoto M, Kido A, Sakamoto Y, et al. Analysis of trabecular bone microstructure in osteoporotic femoral heads in human patients: in vivo study using multidetector row computed tomography. BMC Musculoskelet Disord, 2016, 17(1): 13.
7.	樊向利, 郭征, 宮赫, 等. 正常人股骨近端生物力學性能的區域性分析. 中國骨與關節損傷雜志, 2011, 26(7): 601-603.
8.	文良元, 黃公怡, 申劍. 股骨頸骨折后股骨頭壞死的病理學特點觀察. 中國骨傷, 2003, 16(1): 47-49.
9.	Lv H, Zhang L, Yang F, et al. Comparison of microstructural and mechanical properties of trabeculae in femoral head from osteoporosis patients with and without cartilage lesions: a case-control study. BMC Musculoskelet Disord, 2015, 16(1): 72.
10.	Majernicek M, Dungl P, Kolman J, et al. Osteosynthesis of intracapsular femoral neck fractures by dynamic hip screw (DHS) fixation. Acta Chir Orthop Traumatol Cech, 2009, 76(4): 319-325.
11.	Damany DS, 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.
12.	Ai ZS, Gao YS, Sun Y, et al. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci, 2013, 18(2): 271-276.
13.	孫欣, 曾榮, 胡資兵, 等. 空心螺釘內固定治療股骨頸骨折術后股骨頭壞死的影響因素分析. 中華創傷骨科雜志, 2012, 14(6): 477-479.
14.	張永飛, 張義修. 股骨頸骨折術后股骨頭壞死的力學因素. 中國骨與關節損傷雜志, 2001, 16(4): 270-272.
15.	Kim YM, Lee SH, Lee FY, et al. Morphological and biomechanical study of avascular necrosis of the femoral head. Orthopedics, 1991, 14(10): 1111-1116.
16.	Brown TD, Way ME, Ferguson AB. Mechanical characteristics of bone in femoral capital aseptic necrosis. Clin Orthop Relat Res, 1981, (156): 240-247.
17.	Felson DT, Anderson JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet, 1987, (8538): 902-906.

1. 丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
2. 中華老年骨科與康復電子雜志編輯委員會. 股骨頭壞死保髖治療指南 (2016 版). 中華老年骨科與康復電子雜志, 2016, 2(2): 65-70.
3. 吳偉, 喻愛喜, 漆白文, 等. 股骨頸斷端愈合去除空心釘后的有限元分析. 中華實驗外科雜志, 2015, 32(7): 1590-1592.
4. Van Houcke J, Schouten A, Steenackers G, et al. Computer-based estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations. Appl Ergon, 2017, 63(9): 99-105.
5. 王亦璁, 劉沂, 姜保國. 骨與關節損傷. 北京: 人民衛生出版社, 2007: 1155-1156.
6. Munemoto M, Kido A, Sakamoto Y, et al. Analysis of trabecular bone microstructure in osteoporotic femoral heads in human patients: in vivo study using multidetector row computed tomography. BMC Musculoskelet Disord, 2016, 17(1): 13.
7. 樊向利, 郭征, 宮赫, 等. 正常人股骨近端生物力學性能的區域性分析. 中國骨與關節損傷雜志, 2011, 26(7): 601-603.
8. 文良元, 黃公怡, 申劍. 股骨頸骨折后股骨頭壞死的病理學特點觀察. 中國骨傷, 2003, 16(1): 47-49.
9. Lv H, Zhang L, Yang F, et al. Comparison of microstructural and mechanical properties of trabeculae in femoral head from osteoporosis patients with and without cartilage lesions: a case-control study. BMC Musculoskelet Disord, 2015, 16(1): 72.
10. Majernicek M, Dungl P, Kolman J, et al. Osteosynthesis of intracapsular femoral neck fractures by dynamic hip screw (DHS) fixation. Acta Chir Orthop Traumatol Cech, 2009, 76(4): 319-325.
11. Damany DS, 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.
12. Ai ZS, Gao YS, Sun Y, et al. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci, 2013, 18(2): 271-276.
13. 孫欣, 曾榮, 胡資兵, 等. 空心螺釘內固定治療股骨頸骨折術后股骨頭壞死的影響因素分析. 中華創傷骨科雜志, 2012, 14(6): 477-479.
14. 張永飛, 張義修. 股骨頸骨折術后股骨頭壞死的力學因素. 中國骨與關節損傷雜志, 2001, 16(4): 270-272.
15. Kim YM, Lee SH, Lee FY, et al. Morphological and biomechanical study of avascular necrosis of the femoral head. Orthopedics, 1991, 14(10): 1111-1116.
16. Brown TD, Way ME, Ferguson AB. Mechanical characteristics of bone in femoral capital aseptic necrosis. Clin Orthop Relat Res, 1981, (156): 240-247.
17. Felson DT, Anderson JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet, 1987, (8538): 902-906.

Chinese Journal of Reparative and Reconstructive Surgery

Risk of micro-fracture in femoral head after removal of cannulated screws for femoral neck fracture

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