Objective To compare the clinical effects of traditional manual and robot-assisted implantation of cannulated screws in the treatment of femoral neck fracture. Methods The medical records of patients with femoral neck fracture in Department of Orthopaedics, People’s Hospital of Deyang City were analyzed retrospectively. The patients were divided into two groups, including the traditional manual implantation group from January to December 2018 and the robot-assisted implantation group from May 2019 to May 2020. The clinical therapeutic efficacy of the two groups were compared. Harris hip function score was used to evaluate hip function. Results A total of 85 patients were included. All patients had closed fractures. There were 45 cases in the traditional manual implantation group and 40 cases in the robot-assisted implantation group. There was no significant difference between the two groups in preoperative waiting time, operation time, hospitalization time, fracture healing time, complications within one year after operation, or Harris hip function score one year after operation (P>0.05). The placement nail time [(11.1±2.0) vs. (23.8±2.3) min; t=27.142, P<0.001], frequency of guide pin insertion [(4.7±1.2) vs. (11.4±1.7) times; t=20.640, P<0.001], frequency of intraoperative fluoroscopy [(10.8±1.7) vs. (21.0±1.8) times; t=26.990, P<0.001] and intraoperative blood loss [(8.1±2.0) vs. (12.0±1.7) mL; t=9.711, P<0.001] in the robot-assisted implantation group were less than those in the traditional manual implantation group. No wound infection or neurovascular injury was found in the two groups. Conclusion Robot-assisted implantation of cannulated screws in the treatment of femoral neck fracture has the advantages of less fluoroscopy, fewer guide pin insertion, less blood loss, more accurate screw placement than the traditional manual implantation of cannulated screws.
Objective To evaluate the effectiveness of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults. MethodsThe clinical data of 11 young adult patients with femoral neck fractures between February 2013 and February 2019 were analyzed retrospectively. There were 7 males and 4 females with a mean age of 45 years (range, 32-58 years). Fractures were caused by falling from height in 6 cases, by traffic accident in 4 cases, and by sports injury in 1 case. There were 7 cases in the left hip and 4 cases in the right hip. The mean Pauwels angle was 64° (range, 55°-75°). All patients were treated by medial buttress plate augmented hollow lag screws fixation and sartorius pedicled iliac flap. The X-ray film of pelvis, lateral X-ray film of hip joint, CT scan and three-dimensional reconstruction of hip joint were taken after operation to assess fracture healing and position of the internal fixators. The postoperative hip function was evaluated according to the Harris score. Results All the incisions healed by first intention, and no complication such as incision infection and lateral femoral cutaneous nerve injury happened. Re-examination on the second day after operation showed that reduction and fixation of fractures was good. All patients were followed up 18-36 months (mean, 29 months). All fractures achieved bony union. The time of bony union was 16-23 weeks, with an average of 18.2 weeks. One patient (9.1%) got osteonecrosis of the femoral head (ONFH) at 30 months after operation. At last follow-up, Harris score was used to evaluate hip joint function, 9 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 90.9%. Conclusion Medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults has the advantage of strong biomechanical stability and can effectively improve the blood supply of femoral head and neck, which subsequently reduce the incidence of ONFH. However, the surgical indication should be fully considered.
Objective To investigate the effectiveness and the advantage of fixation with percutaneous cannulated screws assisted by robot navigation in the treatment of femoral neck fractures by comparing with the conventional surgery. Methods Between January 2013 and December 2014, 20 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation (navigation group), another 18 patients undergoing conventional surgery with manual positioning were chosen as the control group. There was no significant difference in gender, age, cause of injury, the injury side, time from injury to operation, and the classification of fractures between 2 groups (P > 0.05). The operation time, X-ray fluoroscopy time, blood loss, frequency of guide pin insertion, and healing time were recorded. At 1 week after operation, the parallel degree of screws was measured on the anteroposterior and lateral X-ray films; the Harris score was used to evaluate the hip function. Results All incisions of 2?groups healed by first intention after operation. There was no significant difference in operation time between 2?groups (t= -1.139, P=0.262). The blood loss, frequency of guide pin insertion, and X-ray fluoroscopy time of navigation group were significantly less than those of control group (P < 0.05). There were 2 screws penetrating into the joint cavity in control group. The patients were followed up 12-24 months with an average of 18 months. The navigation group got significantly better parallel degree of screws than control group on the anteroposterior and lateral X-ray films (t=25.021, P=0.000; t=18.659, P=0.000). Fractures healed in all patients of navigation group (100%), and the healing time was (21.8±2.8) weeks; fracture healed in 16 patients of control group (88.9%), and the healing time was (24.0 ± 3.7) weeks. There was no significant difference in healing rate and healing time between 2 groups (χ2=2.346, P=0.126; t=1.990, P=0.055). The Harris score of navigation group (87.1±3.7) was significantly higher than that of control group (79.3±4.7) at last follow-up (t= -5.689, P=0.000). Conclusion Cannulated screw fixation assisted by robot navigation is a good method to treat femoral neck fractures, which has the advantages of more accurate positioning, better hip function recovery, less surgical trauma, and shorter X-ray exposure time.
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.
Objective To compare the effectiveness of full thread compression cannulated screw and partial thread cannulated screw in the treatment of femoral neck fracture. Methods A retrospective analysis was made on 152 patients with femoral neck fractures, who met the selection criteria, between April 2013 and February 2021. The fractures were fixed with the full thread compression cannulated screws in 74 cases (trial group) and the partial thread cannulated screws in 78 cases (control group). There was no significant difference in general data such as age, gender, body mass index, cause of injury, time from injury to operation, and the side, Garden typing, Pauwels typing of fracture between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, follow-up time, and Harris score were recorded in both groups. X-ray films were performed to evaluate the quality of fracture reduction and bone healing, the changes of neck-shaft angle, the changes of femoral neck, as well as the occurrence of internal fixation failure, screw back-out, and osteonecrosis of the femoral head. Results There was no significant difference in operation time and hospital stay between the two groups (P>0.05). However, the intraoperative blood loss in the trial group was significantly lower than that in the control group (P<0.05). Patients in both groups were followed up, with the follow-up time of (24.11±4.04) months in the trial group and (24.10±4.42) months in the control group, and the difference was not significant (P>0.05). Postoperative X-ray films showed that there was no significant difference in fracture reduction grading between the two groups (P>0.05). Six cases in the trial group developed bone nonunion and 7 cases in the control group, the fractures of the other patients healed, and the healing time was significantly shorter in the trial group than in the control group (P<0.05). There was no significant difference in the incidence of bone nonunion between the two groups (P>0.05). During follow-up, 2 cases in the trial group and 5 cases in the control group had osteonecrosis of the femoral head, the difference was not significant (P>0.05), and the patients with osteonecrosis of the femoral head were treated with secondary operation. The screw back-out occurred in 3 cases of the trial group and in 9 cases of the control group, showing no significant difference (P>0.05). But the screw back-out distance was significantly shorter in the trial group than in the control group (P<0.05). The incidence of internal fixation failure in the trial group (4 cases) was significantly lower than that in the control group (14 cases) (P<0.05). The incidence of femoral neck shortening and the change of neck-shaft angle at 1 year after operation were significantly lower in the trial group than in the control group (P<0.05). The Harris score at last follow-up was significantly higher in the trial group than in the control group (P<0.05). Conclusion Compared with the partial threaded cannulated screws, the full threaded cannulated compression screws can effectively maintain fracture reduction, avoid femoral neck shortening, and internal fixation failure. It is a better choice for femoral neck fracture.
Objective To compare the efficiency of secondary total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after failed internal fixation of femoral neck fracture and the primary THA for non-traumatic ONFH and to evaluate if the two groups have significant difference. Methods From June 2004 to July 2007, 203 cases of ONFH were treated by THA. In group A, 83 patients (83 hips) with ONFH after failed internal fixation included 56 males (56 hips) and 27 females (27 hips) with an average age of 58.3 years (range 45-75 years). According to Ficat classification, there were 61 cases atstage III and 22 cases at stage IV. The Harris score was 37.6 ± 2.0. The disease course was 1-6 years with an average of 2.6 years. In group B, 120 patients (167 hips) with non-traumatic ONFH included 67 males (94 hips) and 53 females (73 hips) with an average age of 52.6 years (range 41-67 years). According to Ficat classification, there were 56 cases (83 hips) at stage III and 64 cases (84 hips) at stage IV. The Harris score was 38.2±1.0. The disease course was 1.5-5.0 years with an average of 2.6 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All 203 cases were followed up for 2 to 5 years (average 3.4 years). There were no significant differences in the operation time of single-hip, the blood loss, the blood transfusion between two groups (P gt; 0.05). Intraoperative fractures occurred in 4 hips (4.8%) of group A and 2 hips (1.2%) of group B, showing significant difference (P lt; 0.05). There were no significant differences (P gt; 0.05) in the incidence of dislocation [3 hips (3.6%) in group A and 1 hip (0.6%) in group B], continuous femoral pain [2 hips (2.4%) in group A and 1 hip (0.6%) in group B] and infection [1 hip (0.6%) in group B] between two groups. There were no significant differences (P gt; 0.05) in acetabular abduction, anteversion, femoral anteversion, and combined anteversion angles as well as the recovery rate of acetabular rotational center between two groups. The Harris scores of groups A and B after 2 years were 79.4 ± 2.1 and 84.2 ± 3.5.There was no significant difference between two groups (P gt; 0.05). The Harris score postoperation had significant differences compared with preoperation (P lt; 0.05). Conclusion Compared to the primary THA to non-traumatic ONFH, secondary THA to ONFH after failed internal fixation has no significant increase in operative difficulty, the postoperative hip function isgood, but the incidence of intraoperative fracture is higher.
Objective To investigate the specific variables and influence factors of Harris scores in follow-up data of patients with internal fixation of femoral neck fracture. Methods From May 1999 to May 2004, 99 cases of femoral neck fracture receiving close reduction with cannulated screw and having complete follow-up data were evaluated in terms of age, sex, type of bone fracture (Garden classification), reduction time, reduction qual ity (Garden indicators), time of full weight-loading, removal of internal fixation, traction before operation, side of bone fracture, necrosis of femoral head, duration of follow-up and Harris score during follow-up period. Univariate and multivariate were analyzed by SPSS14.0 and SAS8.2. Results P-P probabil ity plot and normal test revealed the Harris scores were non-normal distribution (W=0.757 09, P=0.000 1). By nonparametric test in univatiate analysis, the following variables in Harris scores were of statistic significance: the time of reduction (U=— 2.289, P=0.022), the Garden classifaction (H=16.943, P=0.001), the time of full weight-bearing (U=— 3.069, P=0.002), the qual ity of reduction (U=— 3.448, P=0.001) and the necrosis of femoral head (U=— 4.723, P=0.000).By the analysis of correlation, the following variables in Harris scores were of statistic significance: Garden classification(rs=— 0.412, P=0.000), the time of reduction (rs=— 0.231, P=0.021), the qual ity of reduction (rs=— 0.348, P=0.000), the time of full weight-bearing (rs=— 0.310, P=0.002), and the necrosis of femoral head (rs=— 0.477, P=0.000). By the univariate logistic regression analysis, the following variables in Harris scores were of statistic significance: Garden classification (P=0.000 1), the time of reduction (P=0.012 6), the qual ity of reduction (P=0.000 3), the time of full weight-bearing (P=0.003 2), the traction before operation (P=0.049 2) and the necrosis of femoral head (P=0.000 1). By the multivariate logistic regression analysis, the influence factors of Harris scores rank included the necrosis of femoral head (P=0.000 1), the time of reduction (P=0.028 2), and Garden classification (P=0.000 7). Conclusion Harris scores is of non-normal distribution, and the necrosis of femoral head is the most important factor influencing the function after applying internal fixation with cannulated screws to femoral neck fracture.
Objective To investigate whether the biomechanical effect of mushroom shaped surface prosthesis on femoral neck is in the scope of safety after the replacement. Methods Four donated fresh-adult specimens of upper femur under the age of 55 years old were used. The strains of detecting points A (lateral) and B (medial) on the narrow place of femoral neck in the standing position were simulated for three stages before or after the prosthesis replacement, namely the pre-replacement, the initial stage during which the interspace of the prosthesis was filled with cancellous bone, and laterstage during which the interspace of the prosthesis was filled with bone cement. Then they were compared by using l inear regression analysis in Excel and rel iabil ity analysis. Results The regression analysis showed that the values of correlation coefficient r were all more than 99% at the different stages, indicating the strain of femoral neck’s cortical bone was proportional to the load and there was no occurrence of the plastic deformation of the femoral neck. For point A, the slope of the trend l ine of strain was 0.671 9 at the pre-replacement stage. The value of the initial stage after replacement was 0.619 2 and its change rate was —7.8%; while corresponding value was 0.662 7 and —1.4% at the later stage after replacement. For point B, the slope of the trend l ine of strain was —1.056 1 at the pre-replacement stage. The value of the initial stage after replacement was — 1.129 2 and its change rate was 6.9%; while corresponding value was —1.085 1 and 2.7% at the later stage after replacement. Conclusion The mechanical strength of femoral neck is in the scope of safety after surface replacement of the femoral head. The change rate of strain at the later stage is smaller than the initial stage.
Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.
Objective To compare the effects of arthroplasty with that of intenal fixation for displaced femoral neck fractures in the elderly. Methods We searched for all randomized controlled trials and quasi-randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching MEDLINE( 1966 to September, 2006),EMbase(1966 to September, 2006), Cochrane Library( Issue 4 2006), CBM( up to September, 2006) and CNKI (September, 2006) and handsearching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2.8 software. The quality of the trials was assessed. And meta-analysis was conducted by using RevMan4.2.8 software. Results A total of 228 papers were retrieved, but only 15 published randomized controlled trials involving a total of 2 254 patients were suitable for inclusion in the review. Based on the meta-analyses, hip arthroplasty showed obvious advantages over internal fixation in terms of the incidences of major complications after 2 years (RR 0.15 ; 95%CI 0.09 to 0.23) and after 5 years (RR 0.18 ; 95%CI 0.11 to 0.30) as well as re-operation rate (RR0.12 ; 95%CI 0.08 to 0.18) after 2 years, and after 5 years (RR0.11 ; 95%CI 0.06 to 0.22), there was an advantage to performing hip asthroplasty. After one year, the mortality was the same in both groups with RR 1.05 and 95%CI 0.89 to 1.23. Conclusion There is an evidence base to support arthroplasty as a treatment for displaced femoral neck fractures in the elderly. Arthroplasty can not only decrease the rate of re-operation, but can also reduce the incidence of complications, with similar one-year mortality when compared to internal fixation.