Research progress of femoral neck system in treatment of femoral neck fracture in young and middle-aged patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JI Jiachen ^1,2 , YANG Bo ^1,2 , WANG Min ² , DONG Liang ² ,  HUANG Xiaoqiang ³

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China;
2. Department of Orthopedics, Honghui Hospital Affiliated to Medicine College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;
3. Department of Orthopedics, Xi’an Fifth Hospital, Xi’an Shaanxi, 710082, P. R. China;

Corresponding?author：

HUANG Xiaoqiang, Email: huangxq73@163.com

Keywords：

Femoral neck system; femoral neck fracture; internal fixation; young and middle-aged adults

DOI：

10.7507/1002-1892.202205092

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the research progress of femoral neck system (FNS) in the treatment of femoral neck fracture in young and middle-aged patients. Methods The literature on FNS at home and abroad in recent years was extensively reviewed, and the results of mechanical and clinical studies on FNS were summarized based on clinical experience. Results FNS has good mechanical stability, which can reduce complications such as femoral neck shortening, internal fixation failure, and varus caused by mechanical instability. At present, FNS is mainly selected for comparison with cannulated compression screws and dynamic hip screws in clinical research. The results show that FNS has the advantages of minimally invasive, short operation time, less intraoperative fluoroscopy, earlier postoperative weight-bearing and fracture healing, and better hip function recovery. Conclusion As a new internal fixator, FNS has achieved satisfactory results in the current research. FNS has good mechanical advantages, which is beneficial to fracture healing and the recovery of hip joint function after operation. However, whether FNS can reduce the incidence of nonunion and osteonecrosis of the femoral head remains to be further clarified.

Citation： JI Jiachen, YANG Bo, WANG Min, DONG Liang, HUANG Xiaoqiang. Research progress of femoral neck system in treatment of femoral neck fracture in young and middle-aged patients. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1434-1439. doi: 10.7507/1002-1892.202205092 Copy

1.	中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
2.	Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
3.	Enocson A, Lapidus LJ. The vertical hip fracture-a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskelet Disord, 2012, 13: 171. doi: 10.1186/1471-2474-13-171.
4.	Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet, 2017, 389(10078): 1519-1527.
5.	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.
6.	Xia Y, Zhang W, Zhang Z, et al. Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis. J Orthop Surg Res, 2021, 16(1): 54. doi: 10.1186/s13018-020-02189-1.
7.	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.
8.	張長青, 張偉. 股骨頸骨折內固定治療的挑戰與應對. 中華創傷骨科雜志, 2021, 23(6): 467-469.
9.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
10.	Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res, 2017, 475(8): 2011-2023.
11.	王子華, 趙德偉. 基于顯微灌注和三維數字成像的股骨頭血供解剖學研究為青壯年股骨頸骨折治療策略帶來的新啟示. 中華顯微外科雜志, 2017, 40(5): 417-418.
12.	Basso T, Klaksvik J, Syversen U, et al. Biomechanical femoral neck fracture experiments—a narrative review. Injury, 2012, 43(10): 1633-1639.
13.	Li J, Wang M, Li L, et al. Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures. J Orthop Surg Res, 2018, 13(1): 272.
14.	楊通池, 胡居正, 王仁崇, 等. 股骨頸系統治療成人Pauwels Ⅲ型股骨頸骨折的有限元分析. 中國組織工程研究, 2022, 26(36): 5775-5780.
15.	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.
16.	杜兵, 馬騰, 路遙, 等. 新型股骨頸內固定系統與3枚空心釘加內側鋼板固定青壯年Pauwels Ⅲ型股骨頸骨折的有限元分析. 中華老年骨科與康復電子雜志, 2021, 7(6): 333-338.
17.	Jung CH, Cha Y, Yoon HS, et al. Mechanical effects of surgical variations in the femoral neck system on Pauwels type Ⅲ femoral neck fracture: a finite element analysis. Bone Joint Res, 2022, 11(2): 102-111.
18.	Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
19.	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.
20.	Moon JK, Lee JI, Hwang KT, et al. Biomechanical comparison of the femoral neck system and the dynamic hip screw in basicervical femoral neck fractures. Sci Rep, 2022, 12(1): 7915. doi: 10.1038/s41598-022-11914-1.
21.	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.
22.	任程, 馬騰, 李明, 等. 股骨頸動力交叉釘系統固定治療中青年股骨頸骨折的近期療效評價. 中華創傷骨科雜志, 2021, 23(9): 769-774.
23.	熊巍, 易敏, 龍成, 等. 股骨頸動力交叉釘系統與倒三角形空心螺釘固定治療成人股骨頸骨折的療效比較. 中華創傷骨科雜志, 2021, 23(9): 748-753.
24.	楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療Pauwels Ⅲ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
25.	嚴才平, 王星寬, 向超, 等. 股骨頸動力交叉釘系統與空心加壓螺釘治療中青年股骨頸骨折的療效比較. 中國修復重建外科雜志, 2021, 35(10): 1286-1292.
26.	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.
27.	He C, Lu Y, Wang Q, et al. Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults. BMC Musculoskelet Disord, 2021, 22(1): 994. doi: 10.1186/s12891-021-04888-0.
28.	Zhou XQ, Li ZQ, Xu RJ, et al. Comparison of early clinical results for femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures. Orthop Surg, 2021, 13(6): 1802-1809.
29.	Hu H, Cheng J, Feng M, et al. Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. J Orthop Surg Res, 2021, 16(1): 370. doi: 10.1186/s13018-021-02517-z.
30.	Tang Y, Zhang Z, Wang L, et al. Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: a preliminary comparative study. J Orthop Surg Res, 2021, 16(1): 504. doi: 10.1186/s13018-021-02659-0.
31.	Zhang YZ, Lin Y, Li C, et al. A comparative analysis of femoral neck system and three cannulated screws fixation in the treatment of femoral neck fractures: A six-month follow-up. Orthop Surg, 2022, 14(4): 686-693.
32.	Kubiak EN, Beebe MJ, North K, et al. Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg, 2013, 21(12): 727-738.
33.	Haider T, Schnabel J, Hochp?chler J, et al. Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients. Arch Orthop Trauma Surg, 2018, 138(11): 1511-1517.
34.	Yin H, Pan Z, Jiang H. Is dynamic locking plate (Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis. Int J Surg, 2018, 52: 30-34. doi: 10.1016/j.ijsu.2018.01.044.
35.	楊家趙, 周雪鋒, 朱萬博, 等. 股骨頸動力交叉釘系統與空心螺釘固定治療青壯年股骨頸骨折的近期療效比較. 中華創傷骨科雜志, 2021, 23(9): 761-768.
36.	Lamb JN, Holton C, O’Connor P, et al. Avascular necrosis of the hip. BMJ, 2019, 365: l2178. doi: 10.1136/bmj.l2178.
37.	Wang W, Wei J, Xu Z, et al. Retraction note: Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis. BMC Musculoskelet Disord, 2015, 16: 70. doi: 10.1186/s12891-015-0528-z.
38.	Sung YB, Jung EY, Kim KI, et al. Risk factors for neck shortening in patients with valgus impacted femoral neck fractures treated with three parallel screws: Is bone density an affecting factor? Hip Pelvis, 2017, 29(4): 277-285.
39.	胡家朗, 李紹剛, 陳明, 等. 新型股骨頸動力加壓鎖定釘板系統治療股骨頸骨折. 中華創傷骨科雜志, 2019, 21(11): 939-944.
40.	Chen H, Li J, Chang Z, et al. Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach. J Orthop Translat, 2019, 19: 126-132.

1. 中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
2. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
3. Enocson A, Lapidus LJ. The vertical hip fracture-a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskelet Disord, 2012, 13: 171. doi: 10.1186/1471-2474-13-171.
4. Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet, 2017, 389(10078): 1519-1527.
5. 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.
6. Xia Y, Zhang W, Zhang Z, et al. Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis. J Orthop Surg Res, 2021, 16(1): 54. doi: 10.1186/s13018-020-02189-1.
7. 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.
8. 張長青, 張偉. 股骨頸骨折內固定治療的挑戰與應對. 中華創傷骨科雜志, 2021, 23(6): 467-469.
9. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
10. Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res, 2017, 475(8): 2011-2023.
11. 王子華, 趙德偉. 基于顯微灌注和三維數字成像的股骨頭血供解剖學研究為青壯年股骨頸骨折治療策略帶來的新啟示. 中華顯微外科雜志, 2017, 40(5): 417-418.
12. Basso T, Klaksvik J, Syversen U, et al. Biomechanical femoral neck fracture experiments—a narrative review. Injury, 2012, 43(10): 1633-1639.
13. Li J, Wang M, Li L, et al. Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures. J Orthop Surg Res, 2018, 13(1): 272.
14. 楊通池, 胡居正, 王仁崇, 等. 股骨頸系統治療成人Pauwels Ⅲ型股骨頸骨折的有限元分析. 中國組織工程研究, 2022, 26(36): 5775-5780.
15. 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.
16. 杜兵, 馬騰, 路遙, 等. 新型股骨頸內固定系統與3枚空心釘加內側鋼板固定青壯年Pauwels Ⅲ型股骨頸骨折的有限元分析. 中華老年骨科與康復電子雜志, 2021, 7(6): 333-338.
17. Jung CH, Cha Y, Yoon HS, et al. Mechanical effects of surgical variations in the femoral neck system on Pauwels type Ⅲ femoral neck fracture: a finite element analysis. Bone Joint Res, 2022, 11(2): 102-111.
18. Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
19. 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.
20. Moon JK, Lee JI, Hwang KT, et al. Biomechanical comparison of the femoral neck system and the dynamic hip screw in basicervical femoral neck fractures. Sci Rep, 2022, 12(1): 7915. doi: 10.1038/s41598-022-11914-1.
21. 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.
22. 任程, 馬騰, 李明, 等. 股骨頸動力交叉釘系統固定治療中青年股骨頸骨折的近期療效評價. 中華創傷骨科雜志, 2021, 23(9): 769-774.
23. 熊巍, 易敏, 龍成, 等. 股骨頸動力交叉釘系統與倒三角形空心螺釘固定治療成人股骨頸骨折的療效比較. 中華創傷骨科雜志, 2021, 23(9): 748-753.
24. 楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療Pauwels Ⅲ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
25. 嚴才平, 王星寬, 向超, 等. 股骨頸動力交叉釘系統與空心加壓螺釘治療中青年股骨頸骨折的療效比較. 中國修復重建外科雜志, 2021, 35(10): 1286-1292.
26. 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.
27. He C, Lu Y, Wang Q, et al. Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults. BMC Musculoskelet Disord, 2021, 22(1): 994. doi: 10.1186/s12891-021-04888-0.
28. Zhou XQ, Li ZQ, Xu RJ, et al. Comparison of early clinical results for femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures. Orthop Surg, 2021, 13(6): 1802-1809.
29. Hu H, Cheng J, Feng M, et al. Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. J Orthop Surg Res, 2021, 16(1): 370. doi: 10.1186/s13018-021-02517-z.
30. Tang Y, Zhang Z, Wang L, et al. Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: a preliminary comparative study. J Orthop Surg Res, 2021, 16(1): 504. doi: 10.1186/s13018-021-02659-0.
31. Zhang YZ, Lin Y, Li C, et al. A comparative analysis of femoral neck system and three cannulated screws fixation in the treatment of femoral neck fractures: A six-month follow-up. Orthop Surg, 2022, 14(4): 686-693.
32. Kubiak EN, Beebe MJ, North K, et al. Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg, 2013, 21(12): 727-738.
33. Haider T, Schnabel J, Hochp?chler J, et al. Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients. Arch Orthop Trauma Surg, 2018, 138(11): 1511-1517.
34. Yin H, Pan Z, Jiang H. Is dynamic locking plate (Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis. Int J Surg, 2018, 52: 30-34. doi: 10.1016/j.ijsu.2018.01.044.
35. 楊家趙, 周雪鋒, 朱萬博, 等. 股骨頸動力交叉釘系統與空心螺釘固定治療青壯年股骨頸骨折的近期療效比較. 中華創傷骨科雜志, 2021, 23(9): 761-768.
36. Lamb JN, Holton C, O’Connor P, et al. Avascular necrosis of the hip. BMJ, 2019, 365: l2178. doi: 10.1136/bmj.l2178.
37. Wang W, Wei J, Xu Z, et al. Retraction note: Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis. BMC Musculoskelet Disord, 2015, 16: 70. doi: 10.1186/s12891-015-0528-z.
38. Sung YB, Jung EY, Kim KI, et al. Risk factors for neck shortening in patients with valgus impacted femoral neck fractures treated with three parallel screws: Is bone density an affecting factor? Hip Pelvis, 2017, 29(4): 277-285.
39. 胡家朗, 李紹剛, 陳明, 等. 新型股骨頸動力加壓鎖定釘板系統治療股骨頸骨折. 中華創傷骨科雜志, 2019, 21(11): 939-944.
40. Chen H, Li J, Chang Z, et al. Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach. J Orthop Translat, 2019, 19: 126-132.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of femoral neck system in treatment of femoral neck fracture in young and middle-aged patients

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