Characteristics of femoral neck fractures in young and middle-aged adults based on fracture mapping technology_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yongqin ^1,2 , XU Zihuan ^1,2 , LI Pengfei ^1,2 , ZHANG Yingqi ³ , SU Zhihao ^1,2 ,  NI Ming ^2,4

1. School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, P. R. China;
2. Department of Orthopedics, Shanghai Pudong New Area People’s Hospital, Shanghai, 201299, P. R. China;
3. Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, Shanghai, 200065, P. R. China;
4. Department of Science Development, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, P. R. China;

Corresponding?author：

NI Ming, Email: gendianqing@163.com

Keywords：

Femoral neck fracture; young and middle-aged adults; fracture characteristics; fracture map; three-dimensional reconstruction

DOI：

10.7507/1002-1892.202204035

Video：

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Objective To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment. Methods A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels’ angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution. Results According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels’ angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from –39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar. Conclusion The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.

Citation： WANG Yongqin, XU Zihuan, LI Pengfei, ZHANG Yingqi, SU Zhihao, NI Ming. Characteristics of femoral neck fractures in young and middle-aged adults based on fracture mapping technology. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(9): 1078-1083. doi: 10.7507/1002-1892.202204035 Copy

1.	Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg (Am), 2008, 90(10): 2254-2266.
2.	Xu DF, Bi FG, Ma CY, et al. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res, 2017, 12(1): 28. doi: 10.1186/s13018-017-0528-9.
3.	Jaya Raj J, Kow RY, Ganthel Annamalai K, et al. Outcomes of femoral neck fractures in young patients and the factors associated with complications: A multicenter study from malaysia. Cureus, 2021, 13(9): e18110. doi: 10.7759/cureus.18110.
4.	Armitage BM, Wijdicks CA, Tarkin IS, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg (Am), 2009, 91(9): 2222-2228.
5.	張英琪, 張世民, 熊文峰, 等. 股骨近端外側壁的骨折特征地圖研究. 中國臨床解剖學雜志, 2017, 35(2): 121-125.
6.	Ni M, Lv ML, Sun W, et al. Fracture mapping of complex intra-articular calcaneal fractures. Ann Transl Med, 2021, 9(4): 333. doi: 10.21037/atm-20-7824.
7.	Nissen FI, Andreasen C, Borgen TT, et al. Cortical bone structure of the proximal femur and incident fractures. Bone, 2022, 155: 116284. doi: 10.1016/j.bone.2021.116284.
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9.	Ly TV, Swiontkowski MF. Management of femoral neck fractures in young adults. Indian J Orthop, 2008, 42(1): 3-12.
10.	Davidovitch RI, Jordan CJ, Egol KA, et al. Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma, 2010, 68(1): 236-242.
11.	Stockton DJ, Lefaivre KA, Deakin DE, et al. Incidence, magnitude, and predictors of shortening in young femoral neck fractures. J Orthop Trauma, 2015, 29(9): e293-e298.
12.	Sarfani S, Beltran MJ, Benvenuti M, et al. Mapping of vertical femoral neck fractures in young patients using advanced 2 and 3-dimensional computed tomography. J Orthop Trauma, 2021, 35(12): e445-e450.
13.	Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
14.	Zhu XZ, Han CX, Ai ZS, et al. A quantitative study of bone defects in displaced femoral neck fractures based on virtual reduction techniques. Comput Methods Programs Biomed, 2022, 222: 106958. doi: 10.1016/j.cmpb.2022.106958.
15.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
16.	王華, 梅炯. 股骨頭頸部血供的三維全景圖制作及臨床意義. 同濟大學學報(醫學版), 2017, 38(6): 46-51.
17.	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.
18.	李海波, 許圣茜, 湯雪霞, 等. 術前牽引對股骨頸骨折術后發生股骨頭缺血性壞死的影響研究. 中國修復重建外科雜志, 2019, 33(6): 671-675.
19.	倪明, 孫萬駒, 葉曄. 內側支撐鋼板輔助固定治療青壯年股骨頸骨折的研究進展. 中國修復重建外科雜志, 2020, 34(11): 1454-1457.
20.	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(10): 2189-2193.

1. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg (Am), 2008, 90(10): 2254-2266.
2. Xu DF, Bi FG, Ma CY, et al. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res, 2017, 12(1): 28. doi: 10.1186/s13018-017-0528-9.
3. Jaya Raj J, Kow RY, Ganthel Annamalai K, et al. Outcomes of femoral neck fractures in young patients and the factors associated with complications: A multicenter study from malaysia. Cureus, 2021, 13(9): e18110. doi: 10.7759/cureus.18110.
4. Armitage BM, Wijdicks CA, Tarkin IS, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg (Am), 2009, 91(9): 2222-2228.
5. 張英琪, 張世民, 熊文峰, 等. 股骨近端外側壁的骨折特征地圖研究. 中國臨床解剖學雜志, 2017, 35(2): 121-125.
6. Ni M, Lv ML, Sun W, et al. Fracture mapping of complex intra-articular calcaneal fractures. Ann Transl Med, 2021, 9(4): 333. doi: 10.21037/atm-20-7824.
7. Nissen FI, Andreasen C, Borgen TT, et al. Cortical bone structure of the proximal femur and incident fractures. Bone, 2022, 155: 116284. doi: 10.1016/j.bone.2021.116284.
8. Rogalski M. A protocol for physiological mechanical testing of cortical bone using digital volume correlation [S/OL]. 2021. [2022-07-25] https://www.ideals.illinois.edu/items/123290.
9. Ly TV, Swiontkowski MF. Management of femoral neck fractures in young adults. Indian J Orthop, 2008, 42(1): 3-12.
10. Davidovitch RI, Jordan CJ, Egol KA, et al. Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma, 2010, 68(1): 236-242.
11. Stockton DJ, Lefaivre KA, Deakin DE, et al. Incidence, magnitude, and predictors of shortening in young femoral neck fractures. J Orthop Trauma, 2015, 29(9): e293-e298.
12. Sarfani S, Beltran MJ, Benvenuti M, et al. Mapping of vertical femoral neck fractures in young patients using advanced 2 and 3-dimensional computed tomography. J Orthop Trauma, 2021, 35(12): e445-e450.
13. Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
14. Zhu XZ, Han CX, Ai ZS, et al. A quantitative study of bone defects in displaced femoral neck fractures based on virtual reduction techniques. Comput Methods Programs Biomed, 2022, 222: 106958. doi: 10.1016/j.cmpb.2022.106958.
15. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
16. 王華, 梅炯. 股骨頭頸部血供的三維全景圖制作及臨床意義. 同濟大學學報(醫學版), 2017, 38(6): 46-51.
17. 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.
18. 李海波, 許圣茜, 湯雪霞, 等. 術前牽引對股骨頸骨折術后發生股骨頭缺血性壞死的影響研究. 中國修復重建外科雜志, 2019, 33(6): 671-675.
19. 倪明, 孫萬駒, 葉曄. 內側支撐鋼板輔助固定治療青壯年股骨頸骨折的研究進展. 中國修復重建外科雜志, 2020, 34(11): 1454-1457.
20. 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(10): 2189-2193.

Chinese Journal of Reparative and Reconstructive Surgery

Characteristics of femoral neck fractures in young and middle-aged adults based on fracture mapping technology

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