Oblique and non-oblique cannulated screwing for senile femoral neck fractures: a comparative study / 中华创伤骨科杂志

ABSTRACT

Objective To compare the clinical outcomes between oblique and non-oblique fixation with cannulated screws for femoral neck fractures in the elderly patients.Methods Totally 189 patients of over 65 years old were treated for femoral neck fracture from June 2007 to October 2013 at our department.Oblique fixation with cannulated screws was used in 130 cases.They were 43 males aud 87 females with an average age of 77.8 ± 7.5 years.According to Garden classification,40 cases were of Garden types Ⅰ and Ⅱ (undisplaced fractures),and 90 of Garden types Ⅲ and Ⅳ (displaced fractures).Of them 26 were Pauwells type Ⅲ.Non-oblique fixation with cannulated screws was conducted in 59 cases.They were 24 males and 35 females with an average age of 75.5 ± 8.2 years.According to Garden classification,12 cases were of Garden types Ⅰ and Ⅱ (undisplaced fractures),and 47 of Garden types Ⅲ and Ⅳ (displaced fractures).Of them,15 were Pauwells type Ⅲ.The fracture union,postoperative complications,rate of reoperation and Harris scores at the last follow-up were compared between the 2 groups.Results All the 189 patients were followed up for 10 to 38 months (average,17.4 months).The oblique fixation led to a union rate of 99.2％ (129/130),a fixation failure rate of 3.1％ (4/130) and a femoral head necrosis rate of 2.3％ (3/130),which were not significantly different from those resulted from the non-oblique fixation [98.3％ (58/59),10.2％ (6/59) and 5.1％ (3/59) respectively] (P ＞ 0.05).However,the rate of femoral neck shortening [35.4％ (46/130)] and the reoperation rate [3.1％ (4/130)] in the oblique fixation group were significantly lower than those in the non-oblique fixation group [50.8％ (30/59) and 15.3％ (9/59) respectively] (P ＜ 0.05).The mean Harris hip score at the last follow-up for the oblique fixation(75.7 ± 14.3) was significantly higher than that for the non-oblique fixation (70.8 ± 16.7) (P ＜ 0.05).Conclusion As oblique cannulated screwing can reduce the rates of femoral neck shortening and reoperation to some extent,it may be a better fixation choice than the non-oblique cannulated screwing for femoral neck fracture in elderly patients.