Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture in young and middle-aged patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAN Caiping , WANG Xingkuan , XIANG Chao ,  JIANG Ke , LI Yuling , CHEN Qian , DENG Changgong ,  CHEN Lu

Department of Orthopedics, Affiliated Hospital of North Sichuan Medical College, Nanchong Sichuan, 637000, P.R.China;

Corresponding?author：

JIANG Ke, Email: 20359251@qq.com; CHEN Lu, Email: 18057819@qq.com

Keywords：

Femoral neck system; cannulate compression screw; femoral neck fracture; internal fixation

DOI：

10.7507/1002-1892.202103099

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Objective To 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. Methods The 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. Results The 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). Conclusion FNS 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.

Citation： YAN Caiping, WANG Xingkuan, XIANG Chao, JIANG Ke, LI Yuling, CHEN Qian, DENG Changgong, CHEN Lu. Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture in young and middle-aged patients. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1286-1292. doi: 10.7507/1002-1892.202103099 Copy

1.	林振恩, 鄭竑, 陳學生, 等. 改良閉合復位技術治療股骨頸骨折療效分析. 中國骨傷, 2018, 31(2): 115-119.
2.	張學全, 樊仕才, 黎惠金, 等. 帶旋髂深血管髂骨瓣和股方肌骨瓣移植治療青壯年GardenⅢ-Ⅳ型股骨頸骨折的比較. 中國骨傷, 2015, 28(9): 802-807.
3.	桂景雄, 王小平, 鄧志成, 等. 閉合復位經皮微創加壓空心螺釘內固定治療股骨頸骨折的臨床觀察. 創傷外科雜志, 2015, 15(4): 367-368.
4.	曾劍文, 張華亮, 謝建軍, 等. 青壯年股骨頸骨折股骨近端空心釘鎖定鋼板固定效果評價. 武警醫學, 2016, 27(1): 20-22.
5.	Slobogean GP, Sprague SA, Scott T, et al. Management of young femoral neck fractures: is there a consensus? Injury, 2015, 46(3): 435-440.
6.	Pauyo T, Drager J, Albers A, et al. Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop, 2014, 5(3): 204-217.
7.	彭方成, 王賢月, 王鵬, 等. 股骨近端空心釘鎖定板內固定治療成人股骨頸骨折. 中國骨與關節損傷雜志, 2015, 30(12): 1305-1306.
8.	Yang JJ, Lin LC, Chao KH, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg (Am), 2013, 95(1): 61-69.
9.	Kain MS, Marcantonio AJ, Iorio R. Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res, 2014, 472(12): 4010-4014.
10.	Han SK, Song HS, Kim R, et al. Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old. Eur J Trauma Emerg Surg, 2016, 42(2): 191-196.
11.	Zielinski SM, Keijsers NL, Praet SF, et al. Femoral neck shortening after internal fixation of a femoral neck fracture. Orthopedics, 2013, 36(7): e849-858.
12.	Zlowodzki M, Ayeni O, Petrisor BA, et al. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma, 2008, 64(1): 163-169.
13.	Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable Pauwels Ⅲ femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma, 2017, 31(3): 131-137.
14.	Schopper C, Zderic I, Menze J, et al. Higher stability and more predictive fixation with the femoral neck system versus Hansson pins in femoral neck fractures Pauwels Ⅱ. J Orthop Translat, 2020, 24: 88-95.
15.	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(4): 737-755.
16.	Dhar SA, Gani NU, Butt MF, et al. Delayed union of an operated fracture of the femoral neck. J Orthop Traumatol, 2008, 9(2): 97-99.
17.	Slobogean GP, Stockton DJ, Zeng B, et al. Femoral neck fractures in adults treated with internal fixation: A prospective multicenter Chinese cohort. J Am Acad Orthop Surg, 2017, 25(4): 297-303.
18.	Stacey SC, Renninger CH, Hak D, et al. Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol, 2016, 26(4): 355-363.
19.	Kim JW, Byun SE, Chang JS. The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg, 2014, 134(7): 941-946.
20.	Jain R, Koo M, Kreder HJ, et al. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg (Am), 2002, 84(9): 1605-1612.
21.	Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ, 2010, 182(15): 1609-1616.
22.	趙勇, 秦偉凱. 重視股骨頸骨折的評估與內固定治療的若干問題. 中國骨傷, 2021, 34(3): 195-199.
23.	Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
24.	Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg (Am), 2008, 90(8): 1654-1659.
25.	王青, 姜達君, 賈偉濤. Pauwels三型股骨頸骨折不同內固定方式的meta分析. 上海交通大學學報 (醫學版), 2018, 38(9): 1045-1052.
26.	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(3): 144-150.
27.	Mei J, Liu S, Jia G, et al. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury, 2014, 45(12): 2045-2050.
28.	Kloen P, Rubel IF, Lyden JP, et al. Subtrochanteric fracture after cannulated screw fixation of femoral neck fractures: a report of four cases. J Orthop Trauma, 2003, 17(3): 225-229.
29.	Li J, Wang M, Zhou J, et al. Optimum configuration of cannulated compression screws for the fixation of unstable femoral neck fractures: Finite element analysis evaluation. BioMed research international, 2018, 9: 1271762. doi: 10.1155/2018/1271762.
30.	范智榮, 蘇海濤, 周霖, 等. 新型股骨頸內固定系統治療不穩定性股骨頸骨折的有限元分析. 中國組織工程研究, 2021, 25(15): 2321-2328.
31.	劉智. 應重視股骨頸骨折的內固定手術治療. 中國骨傷, 2021, 34(3): 200-202.
32.	楊亞軍, 馬濤, 張小鈺, 等. 股骨頸動力交叉釘系統治療股骨頸骨折近期療效. 中國修復重建外科雜志, 2021, 35(5): 539-543.
33.	許新忠, 常菁, 余水生, 等. 股骨頸系統固定治療股骨頸骨折的近期療效分析. 中華創傷骨科雜志, 2020, 22(7): 624-627.

1. 林振恩, 鄭竑, 陳學生, 等. 改良閉合復位技術治療股骨頸骨折療效分析. 中國骨傷, 2018, 31(2): 115-119.
2. 張學全, 樊仕才, 黎惠金, 等. 帶旋髂深血管髂骨瓣和股方肌骨瓣移植治療青壯年GardenⅢ-Ⅳ型股骨頸骨折的比較. 中國骨傷, 2015, 28(9): 802-807.
3. 桂景雄, 王小平, 鄧志成, 等. 閉合復位經皮微創加壓空心螺釘內固定治療股骨頸骨折的臨床觀察. 創傷外科雜志, 2015, 15(4): 367-368.
4. 曾劍文, 張華亮, 謝建軍, 等. 青壯年股骨頸骨折股骨近端空心釘鎖定鋼板固定效果評價. 武警醫學, 2016, 27(1): 20-22.
5. Slobogean GP, Sprague SA, Scott T, et al. Management of young femoral neck fractures: is there a consensus? Injury, 2015, 46(3): 435-440.
6. Pauyo T, Drager J, Albers A, et al. Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop, 2014, 5(3): 204-217.
7. 彭方成, 王賢月, 王鵬, 等. 股骨近端空心釘鎖定板內固定治療成人股骨頸骨折. 中國骨與關節損傷雜志, 2015, 30(12): 1305-1306.
8. Yang JJ, Lin LC, Chao KH, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg (Am), 2013, 95(1): 61-69.
9. Kain MS, Marcantonio AJ, Iorio R. Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res, 2014, 472(12): 4010-4014.
10. Han SK, Song HS, Kim R, et al. Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old. Eur J Trauma Emerg Surg, 2016, 42(2): 191-196.
11. Zielinski SM, Keijsers NL, Praet SF, et al. Femoral neck shortening after internal fixation of a femoral neck fracture. Orthopedics, 2013, 36(7): e849-858.
12. Zlowodzki M, Ayeni O, Petrisor BA, et al. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma, 2008, 64(1): 163-169.
13. Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable Pauwels Ⅲ femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma, 2017, 31(3): 131-137.
14. Schopper C, Zderic I, Menze J, et al. Higher stability and more predictive fixation with the femoral neck system versus Hansson pins in femoral neck fractures Pauwels Ⅱ. J Orthop Translat, 2020, 24: 88-95.
15. 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(4): 737-755.
16. Dhar SA, Gani NU, Butt MF, et al. Delayed union of an operated fracture of the femoral neck. J Orthop Traumatol, 2008, 9(2): 97-99.
17. Slobogean GP, Stockton DJ, Zeng B, et al. Femoral neck fractures in adults treated with internal fixation: A prospective multicenter Chinese cohort. J Am Acad Orthop Surg, 2017, 25(4): 297-303.
18. Stacey SC, Renninger CH, Hak D, et al. Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol, 2016, 26(4): 355-363.
19. Kim JW, Byun SE, Chang JS. The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg, 2014, 134(7): 941-946.
20. Jain R, Koo M, Kreder HJ, et al. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg (Am), 2002, 84(9): 1605-1612.
21. Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ, 2010, 182(15): 1609-1616.
22. 趙勇, 秦偉凱. 重視股骨頸骨折的評估與內固定治療的若干問題. 中國骨傷, 2021, 34(3): 195-199.
23. Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
24. Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg (Am), 2008, 90(8): 1654-1659.
25. 王青, 姜達君, 賈偉濤. Pauwels三型股骨頸骨折不同內固定方式的meta分析. 上海交通大學學報 (醫學版), 2018, 38(9): 1045-1052.
26. 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(3): 144-150.
27. Mei J, Liu S, Jia G, et al. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury, 2014, 45(12): 2045-2050.
28. Kloen P, Rubel IF, Lyden JP, et al. Subtrochanteric fracture after cannulated screw fixation of femoral neck fractures: a report of four cases. J Orthop Trauma, 2003, 17(3): 225-229.
29. Li J, Wang M, Zhou J, et al. Optimum configuration of cannulated compression screws for the fixation of unstable femoral neck fractures: Finite element analysis evaluation. BioMed research international, 2018, 9: 1271762. doi: 10.1155/2018/1271762.
30. 范智榮, 蘇海濤, 周霖, 等. 新型股骨頸內固定系統治療不穩定性股骨頸骨折的有限元分析. 中國組織工程研究, 2021, 25(15): 2321-2328.
31. 劉智. 應重視股骨頸骨折的內固定手術治療. 中國骨傷, 2021, 34(3): 200-202.
32. 楊亞軍, 馬濤, 張小鈺, 等. 股骨頸動力交叉釘系統治療股骨頸骨折近期療效. 中國修復重建外科雜志, 2021, 35(5): 539-543.
33. 許新忠, 常菁, 余水生, 等. 股骨頸系統固定治療股骨頸骨折的近期療效分析. 中華創傷骨科雜志, 2020, 22(7): 624-627.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture in young and middle-aged patients

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