Treatment of femoral neck fractures with closed reduction assisted by joystick technique and cannulated screw fixation / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of joystick technique assisted closed reduction and cannulated screw fixation in the treatment of femoral neck fracture.@*METHODS@#Seventy-four patients with fresh femoral neck fractures who met the selection criteria between April 2017 and December 2018 were selected and divided into observation group (36 cases with closed reduction assisted by joystick technique) and control group (38 cases with closed manual reduction). There was no significant difference in gender, age, fracture side, cause of injury, Garden classification, Pauwels classification, time from injury to operation, and complications (except for hypertension) between the two groups ( P>0.05). The operation time, intraoperative infusion volume, complications, and femoral neck shortening were recorded and compared between the two groups. Garden reduction index was used to evaluate the effect of fracture reduction, and score of fracture reduction (SFR) was designed and was used to evaluate the subtle reduction effect of joystick technique.@*RESULTS@#The operation was successfully completed in both groups. There was no significant difference in operation time and intraoperative infusion volume between the two groups ( P>0.05). All patients were followed up 17-38 months, with an average of 27.7 months. Two patients in the observation group received joint replacement due to failure of internal fixation during the follow-up, and the other patients had fracture healing. Within 1 week after operation, the Garden reduxtion index of the observation group was better than the control group; the SFR score of the observation group was also higher than that of the control group; the proportion of femoral neck shortening within 1 week after operation and at 1 year after operation in the observation group were lower than those in the control group. The differences of the above indexes between the two groups were significant ( P<0.05).@*CONCLUSION@#The joystick technique can improve the effectiveness of closed reduction of femoral neck fractures and reduce the incidence of femoral neck shortening. The designed SFR score can directly and objectively evaluate the reduction effect of femoral neck fracture.

Effect of degree of initial deformity of impacted femoral neck fractures under 65 years of age on femoral neck shortening / 中国组织工程研究

BACKGROUND: Non-surgical treatment for impacted femoral neck fractures is a strategy rarely used at present. Hollow screw internal fixation is the main treatment for impacted femoral neck fractures. Studies on impacted femoral neck fractures so far have focused on treatment patterns and risk factors affecting internal fixation failure, but the effect of initial degree of deformity of impacted femoral neck fractures on postoperative femoral neck shortening was not studied. OBJECTIVE: To analyze the relationship between the degree of shortening and initial deformity of impacted femoral neck fractures after hollow screw fixation in patients under 65 years of age and the effect of femoral neck shortening on hip function. METHODS: Fifty-three impacted femoral neck fractures patients with complete medical records were included, and treated with three hollow screws for internal fixation. The patients were followed up for 12-24 months. Hip Harris score was used to evaluate the recovery of function. The posterior inclination angle, valgus angle, and Pauwels angle of the affected femoral head were measured by X-ray examination of pelvis and hip joint before treatment. X-ray films of pelvis were taken at the last follow-up to calculate the percentage of joint-coarsal distance decrease representing the degree of femoral neck shortening. Not less than 30% is significantly shortened (SFNS) and less than 30% is not significantly shortened (NSFNS). The related factors of neck shortening and the effect on hip function were analyzed. RESULTS AND CONCLUSION: (1) All 53 patients healed without adverse events such as femoral head necrosis. Seven cases (13.2%) had obvious neck shortening. (2) Independent-sample t-test found that neck shortening was associated with valgus angle (P=0.000), posterior dip angle (P=0.001) and body mass index (P=0.001). Logistic regression analysis found that valgus angle was a significant predictor of neck shortening (P=0.041). (3) The hip Harris score decreased with the increase of femoral neck shortening. The hip Harris scores were (82.57±5.12) and (94.15±4.03) in the SFNS group and NSFNS group, respectively, with significant difference. (4) It is indicated that the degree of valgus deformity is an independent risk factor for neck shortening in impacted femoral neck fractures, and femoral neck shortening is associated with hip function.

Incidence of femoral neck shortening after internal fixation of femoral neck fracture and prognostic factors / 中国组织工程研究

BACKGROUND: Internal fixation with cannulated screws is the most commonly used treatment for femoral neck fracture, but some patients may have the phenomenon of femoral neck shortening after surgery, and even cause the occurrence of postoperative dysfunction of the hip joint. OBJECTIVE: To investigate the incidence, clinical features, prognosis and influencing factors of femoral neck shortening after internal fixation of femoral neck fracture. METHODS: One hundred and eleven cases of femoral neck fracture treated by cannulated screw internal fixation at three orthopedic hospitals in Chengdu from January 2012 to March 2017 were retrospectively analyzed. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. Femoral neck shortening was as the prognostic indicator. The incidence, occurrence time and main clinical characteristics of femoral neck shortening after surgery were recorded. Univariate chi-square test was used to analyze the correlation between sex, age, Garden type, Garden index, bone mineral density T value, Singh index, time from injury to operation, weight-bearing time and the femoral neck shortening after surgery. Statistically significant factors were included in the multivariate Logistic regression model. RESULTS AND CONCLUSION: (1) The incidence of femoral neck shortening was 48.6% (54/111), with 31.5% (35/111) of 10-19 mm shortening and 5.4% (6/111) of ≥ 20 mm shortening. (2) The occurrence time of femoral neck shortening was mainly within 6 months after surgery, accounting for 76%. (3) The clinical manifestations of the femoral neck shortening mainly included pain during weight-bearing, dysfunction of hip movement and claudication. The analysis results showed that the moderate pain (67%) was dominant in the shortening group, and no pain/mild pain (86%) was dominant in the non-shortening group; the incidence of hip motion limitation in the shortening group was higher than that in the non-shortening group (68% vs. 21%); and the incidence of claudication in the shortening group was higher than that in the non-shortening group (61% vs. 18%); the differences were significant (all P < 0.05). (4) Univariate and multivariate Logistic regression analysis showed that Garden classification of fracture was type III and IV, Garden index was grade III and IV, bone mineral density T value ≤ -2.5, weight-bearing time ≤ 2 months were independent risk factors for femoral neck shortening after reduction and internal fixation of femoral neck fracture. Therefore, there is a high risk of femoral neck shortening after internal fixation with cannulated nails for femoral neck fractures, which mainly occurs within 6 months after surgery.

Risk Factors for Neck Shortening in Patients with Valgus Impacted Femoral Neck Fractures Treated with Three Parallel Screws: Is Bone Density an Affecting Factor? / 대한고관절학회지

PURPOSE: The purpose of this study is to analyze the relationship between significant femoral neck shortening (SFNS) and bone density after three parallel screw fixation in valgus impacted femoral neck fracture, and to analyze the risk factors for SFNS. MATERIALS AND METHODS: This is retrospective study of 83 patients. We performed univariate analysis for patient information, bone density, fracture configuration and screw position divided into SFNS group (n=13) and non-SFNS group (n=70) and performed multivariate analysis using logistic regression model. We also analyzed the relationship between SFNS and complications such as osteonecrosis of femoral head and nonunion. RESULTS: There was a significant difference in age, screw non-parallelism and bone mineral density of intertrochanteric and total hip area in the univariate analysis between the two groups (P < 0.05). In multivariate analysis, old age (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03-1.21) and screw non-parallelism (OR, 2.95; 95% CI, 1.44-6.59) were significant risk factors for SFNS. The incidence of SFNS was significantly higher in the complication group (P=0.027). CONCLUSION: Bone density did not significantly affect SFNS in valgus impacted femoral neck fractures treated with three parallel screws. The risk factors of SFNS were old age and screw non-parallelism. Therefore, we recommend using other fixation method to prevent SFNS in older ages and making the screw position as parallel as possible when performing screw fixation in valgus impacted femoral neck fracture.

Presence of a Nail in the Medullary Canal; Is It Enough to Prevent Femoral Neck Shortening in Trochanteric Fracture?

PURPOSE: Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. MATERIALS AND METHODS: We observed 95 patients (mean age, 75+/-2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. RESULTS: Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, p<0.001), medullary canal diameter (p<0.001), and COR (p<0.001). Multiple regression analyses revealed that FNS was strongly correlated with fracture type (p<0.001) and COR (p<0.001). CONCLUSION: Presence of a CMN in the medullary canal could not effectively prevent FNS in patients with low COR and in A3 type fracture.