Meta-analysis of the efficacy of platelet-rich plasma combined with cannulated screw fixation for the treatment of femoral neck fracture / 中国组织工程研究

BACKGROUND: Numerous studies have reported the effectiveness of platelet-rich plasma in promoting and improving bone healing. However, due to the limitations of methods, follow-up and study design, many orthopedicians still doubt the clinical effect of platelet-rich plasma combined with cannulated screw fixation in the treatment of fracture and nonunion. OBJECTIVE: To evaluate the difference in efficacy between platelet-rich plasma combined with cannulated screw fixation and simple cannulated screw fixation in the treatment of femoral neck fracture using meta-analysis system. METHODS: The Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search and collect clinical randomized controlled trials of platelet-rich plasma combined with cannulated screw fixation and cannulated screw fixation for the treatment of femoral neck fractures. Two reviewers independently evaluated the quality of the included studies, extracted data and checked each other. Meta-analysis was utilized to analyze the collected data with RevMan 5. 3 software. RESULTS AND CONCLUSION: (1) Seven clinical randomized controlled trials were selected for meta-analysis, totally 760 patients. There were 380 cases undergoing platelet-rich plasma combined with cannulated screw fixation and 380 cases undergoing cannulated screw fixation. (2) The meta-analysis showed that compared with the cannulated screw fixation group, fracture healing time was shorter [MD=-1. 86, 95%CI(-2. 97, -0. 75), P=0. 001]; healing rate was higher [OR=6. 51, 95%CI(3. 36, 12. 62), P < 0. 000 01]; necrosis rate was lower [OR=0. 25, 95%CI(0. 15, 0. 44), P < 0. 000 01]; Harris scores at 1, 3, 6, 9, and 12 months postoperatively were higher [MD=4. 95, 95%CI(4. 12, 5. 77), P < 0. 000 01; MD=19. 78, 95%CI(18. 45, 21. 11), P < 0. 000 01; MD=17. 16, 95%CI(10. 39, 23. 92), P < 0. 000 01; MD=12. 66, 95%CI(10. 60, 14. 71), P < 0. 000 01; MD=10. 17, 95%CI(5. 98, 14. 36), P < 0. 000 01] in the platelet-rich plasma combined with cannulated screw fixation group. (3) Platelet-rich plasma combined with cannulated screw fixation for femoral neck fracture is more effective than that of cannulated screw fixation alone. Combined treatment can accelerate the fracture healing of patients, improve the healing rate, reduce necrosis rate, and promote the recovery of postoperative hip joint function.

Computational Simulation of Multiple Cannulated Screw Fixation for Femoral Neck Fractures and the Anatomic Features for Clinical Applications

PURPOSE: To identify the anatomic features for clinical applications through a computational simulation of the fixation of three cannulated screws for a femoral neck fracture. MATERIALS AND METHODS: Thirty cadaveric femurs underwent computed tomography and the images were transferred to the Mimics® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the 7.0 mm cannulated screw was performed to enable computerized virtual fixation of multiple cannulated screws for femoral neck fractures. After positioning the screws definitively for cortical support, the intraosseous position of the cannulated screws was evaluated in the anteroposterior image and axial image direction. RESULTS: Three cannulated screws located at the each ideal site showed an array of tilted triangles with anterior screw attachment and the shortest spacing between posterior and central screws. The central screw located at the lower side was placed in the mid-height of the lesser trochanter and slightly posterior, and directed toward the junction of femoral head and neck to achieve medial cortical support. All the posterior screws were limited in height by the trochanteric fossa and were located below the vastus ridge, but the anterior screws were located higher than the vastus ridge in 10 cases. To obtain the maximum spacing of the anterior and posterior screws on the axial plane, they should be positioned parallel to the cervical region nearest the cortical bone at a height not exceeding the vastus ridge. CONCLUSION: The position of cannulated screws for cortical support were irregular triangular arrangements with the anterosuperior apex. The position of the ideal central screw in the anteroposterior view was at the mid-height of the lesser trochanter toward the junction of the femoral head and neck, and the anterior and posterior screws were parallel to the neck with a maximal spread just inferior to the vastus ridge.

Clinical observation of closed reduction and percutaneous cannulated screw fixation in treatment of femoral neck fracture in adolescents / 吉林大学学报(医学版)

Objective:To analyze the clinical effect and influencing factors of closed reduction and percutaneous cannulated screw fixation in the treatment of femoral neck fracture in the adolescents, and to provide evidence for surgical treatment of femoral neck fracture in the adolescents. Methods:The clinical effect and influencing factors of 36 cases of femoral neck fracture treated by closed reduction and percutaneous cannulated screw fixation were analyzed. The time of operation, the time of fracture healing evaluated with X-ray image, the evaluation on the function after operation by Harris score of hip joint,and the occurrence of complications of the patients were observed.Results:All the cases were followed up for 6-24 months, average 16 months. One case of all patients had avascular necrosis of the femoral head, and accounted for 2.78% of all the patients;2 cases of all fractures were nonunion, and 5.56%.The remaining 33 cases were completely healed.The HHS-harris hip score results showed that 26 were excellent, 6 cases were good, and 2 cases were poor;the excellent and good rate was 88.89%.Conclusion:Closed reduction and percutaneous cannulated screw fixation in the treatment of adolescent femoral neck fracture is an effective program of operation;timing of operation, good reduction, and rigid internal fixation can decrease the femoral head necrosis and the incidence of complications.

Two-Year Follow-up Results of Anteroposterior Cannulated Screw Fixation of Posterior Malleolar Fragment in the Trimalleolar Fracture / 대한족부족관절학회지

PURPOSE: The purpose of this study was to assess the 2-year follow-up results of patients with a trimalleolar fracture, who had undergone an anterior incision cannulated screw fixation of the posterior malleolar fragment, which had more than 25% of articular involvement or had no cortical continuity with the distal tibia. MATERIALS AND METHODS: Among 28 patients with a trimalleolar fracture who had undergone fixation of the posterior malleolar fragment between February 2005 and February 2010, 14 patients, who underwent an anterior incision cannulated screw fixation of posterior malleolar fragment and were followed-up for more than 2 years, were selected. The postoperative clinical and radiological findings immediately and at the 1- and 2-year follow-up were compared. The clinical findings were evaluated as American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological assessment was evaluated as the maintenance of reduction, period to bone union, and the presence of nonunion, malunion, and complications. RESULTS: The clinical outcome by mean AOFAS score revealed 83.0 points in the group with preoperative displacement below 2 mm and 80.7 points in the group with preoperative displacement above 2 mm postoperatively. The mean AOFAS score was 91.7 and 93.1 points in the group with preoperative displacement below 2 mm on 1- and 2-year follow-up, respectively, and 89.8 and 91.7 points in group with the preoperative displacement above 2 mm on 1- and 2-year follow-up, respectively. After a 2-year follow-up among 14 cases selected for this study, 13 cases showed an excellent reduction state and only 1 case (7.1%) showed a displacement of more than 2 mm. No complication were encountered in the group with preoperative displacement below 2 mm. On the other hand, among 8 patients in the group with preoperative displacement above 2 mm, there were 3 with limitations of the range of motion of the ankle joint (37.5%) and 1 post-traumatic arthritis (12.5%) at the 2-year follow-up. CONCLUSION: Anterior incision cannulated screw fixation of the posterior malleolar fragment could be a valuable method for the treatment of trimalleolar fractures that provides satisfactory results.

Tibio-talo-calcaneal Arthrodesis with Multiple Cannulated Screw Fixation / 대한족부족관절학회지

PURPOSE: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. MATERIALS AND METHODS: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. RESULTS: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. CONCLUSION: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.

Migration of Multiple Cannulated Screws in the Treatment of Femur Neck Fractures

PURPOSE: We wanted to assess the characteristics and clinical significance of screw migration after surgical treatment of femoral neck fractures. MATERIALS AND METHODS: We reviewed 44 hips (22 males, 22 females) that were treated with closed reduction and multiple cannulated screws between February 1998 and May 2005. The medical records and radiographs were analyzed retrospectively at a minimum of 18 months after surgery. 3 mm migration was arbitrarily chosen as the differentiating measure between the migration (27cases) and the nonmigration (17 cases) groups. The anatomical location of the fracture, Garden's classification, comminution, the screw position in the femoral head and the complications were statistically compared between the migration and nonmigration groups. The time sequence of events after surgery and the distance of migration were evaluated in the migration group. RESULTS: No significant differences between the two groups were noted in regard to complications, the screw position in the femoral head, the degree of displacement of fractures with using Garden's classification and the anatomic location of the fracture. There was a statistically significant difference between the two groups with regard to comminution (p=.001). In the migration group, the screws started migrating from 1 month after the operation and this was remarkable at 3~6 months. The average migration was 6.51 mm with 4.23 mm migration occurring in the first 3 months. CONCLUSION: For comminuted femur neck fractures that are treated with multiple cannulated screws, screw migration and shortening of the femoral neck can be anticipated to happen at 3 months after surgery.

Transverse Fracture through Screw Site after Cannulated Screw Fixation in Vertical Patella Fracture: A Case Report

Many complications after operative treatment of patella including redisplacement of fracture, refracture, weakness of extensor muscles, patellofemoral joint arthritis, metal failure, malunion, infection, avascular necrosis were reported. We report a case of transverse fracture of patella through the cannulated screw fixation site used to fix previous vertical patella fracture with a review of the literatures.