Early Results of Internal Fixation with Femoral Neck System in Young Patients with Femoral Neck Fracture.

BACKGROUND: Femoral neck fractures are intracapsular hip fractures. There are several surgical implants that have been used to treat femoral neck fractures. Depuy Synthes Products and the lower extremity expert group have developed an innovative femoral neck system (FNS) for fixing femoral neck fractures. With minimally invasive procedures, FNS can provide angular stability. MATERIALS AND METHODS: A non-randomized single centre prospective study was conducted in 30 patients of less than 60 years of age at Maharishi Markandeshwar Institute of Medical Sciences and Research between August 2020 to May 2022. All patients underwent internal fixation with FNS within 48 hours of presentation. RESULTS: Although blood loss and operative time in our operated group was more than that in conventional fixation by cannulated screws, our group had better VAS scores, better Harris scores and lower complication rates. CONCLUSIONS: 1. The Femoral Neck System resulted in better biomechanical properties and good early results in femoral neck fractures. FNS gives both angular stability and rotational stability. The last follow-up in our study showed Harris score to be significantly higher, and the incidence of complications were lower. 2. The combination of FNS bolts with anti-rotation screws avoids the "Z" effect and improves the overall stability and anti-rotation effect. 3. In addition, the novel sliding compression mechanism of FNS allows the fracture ends to come in close contact with each other, benefitting fracture healing.

Fixation of Fresh Femoral Neck Fractures Using Fibular Strut Graft Along with Cannulated Screws.

BACKGROUND: Intracapsular femoral neck fractures can result from trivial trauma in the elderly or high-energy trauma in younger age-groups. In younger patients aged <60 years, the femoral head should be conserved to avoid the long-term complications of replacement arthroplasty. The options of osteosynthesis include closed/ open reduction and internal fixation with/without bone grafting. Internal fixation alone does not provide rigid fixation, owing to cavities in the posterior part of the femoral head and neck. Fibular grafts augment union and provide strength to the posterior cortex during reconstruction of the femoral neck. We evaluated the use of fibular grafting for fresh femoral neck fractures with posterior comminution. MATERIAL AND METHODS: Between November 2019 and March 2022, 20 women and 12 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=19) and IV (n=13) femoral neck fractures. Clinical and radiological outcomes were evaluated. RESULTS: Patients were followed up for a period of 15 months. According to the Harris hip score, outcome was good to excellent in 23, fair in 7, and poor in 2. 30 of the 32 patients achieved bone union after a mean of 4.5 (range 3.5-5.5) months. In 2 patients, the bone was united with a mean of 10º of varus collapse. Two patients had non-union. Other complications included screw migration in the joint space (n=1) and screw pullout (n=2). No patient had avascular necrosis of the femoral head. CONCLUSION: Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.

Early Results of Bridge Plating of Humerus Diaphyseal Fractures by MIPO Technique.

BACKGROUND: Anterior bridge plating with minimally invasive technique in humeral shaft fractures is reported as an acceptable, less traumatic and reproducible procedure by several authors. We have evaluated the clini-cal, radiological, and functional outcome of such fractures in eleven patients, all of which were managed with dynamic compression plates over an average follow-up period of 22 months. MATERIAL AND METHODS: Forty patients with humerus shaft fractures managed by anterior bridge plating using the MIPO technique between 2014 and 2016 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The UCLA shoulder and Mayo elbow performance scores were used for assessing shoulder and elbow function. RESULTS: Of the forty patients followed up for a minimum of 18 months in the study, 26 were males and 14 were females. The mean age was 34.3 years (range 20 to 53 years). 24 out of the forty patients (60%) had the dominant side fractured. The mean surgical time was 72.5 minutes (range: 45-100 minutes) and mean radiation exposure was 160 seconds (range: 100-220 seconds). The mean radiological fracture union time was 13 weeks (range: 8-18 weeks). Shoulder function based on the UCLA score was excellent to good in 33 cases (82.5%), fair in 6 cases (15%) and one patient (2.5%) developed infection for which the plate was removed prematurely at the 4th month and the wound was meticulously debrided and then managed conservatively. Road traffic accident (RTA) was the most common mode of injury, found in 27 cases; 12 patients sustained blunt trauma due to a fall; one patient sustained an injury following a direct blow by stick. CONCLUSIONS: 1. The mini-incision anterior bridge technique for humeral shaft fractures gives good functional results and should be considered an effective, cosmetically advanced surgical option in the treatment of humeral shaft fractures. 2. The mini-incision anterior bridge technique is a safe and less method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.

Early Clinical Results of Short Same-Segment Posterior Fixation in Thoracolumbar Burst Fractures.

BACKGROUND: We did a prospective study to study the efficiency of Short Segment Posterior Instrumentation using a Universal Spine System with incorporation of the fractured vertebra in post-traumatic thoracic and lumbar spine fractures. MATERIAL AND METHODS: 25 cases in the age group of I5-50 years with thoracic and lumbar spine fractures were included in the study. The operative decision was made on the basis of instability of spine fractures with or without neurological deficit. Patients were followed up for an average period of twelve months, reporting for assessment at 3-monthly intervals. The final result was analyzed on the basis of neurological recovery as per Frankel's Grading, spine stability as per kyphotic angle by Cobb's method, vertebral body height and complications. RESULTS: Post-operatively at the final follow-up visit, 36% patients had Frankel's grade E neurological status. The mean sagittal plane kyphosis pre-operatively was 31.16°, which reduced to 21.52° post-operatively, which represents 30.93% reduction. Mean anterior body compression was 38.6°, which decreased to 23.4° post-operatively, corresponding to 15% increase. CONCLUSIONS: 1. Although conventional short segment posterior fixation (SSPF) has become an increasingly popular method of treatment of thoracolumbar burst fractures, providing the advantage of incorporating fewer motion segments in the fixation, a review of literature demonstrated that SSPF led to 9-55% incidence of implant failure and long term loss of kyphosis correction. 2. Short segment posterior fixation with pedicle fixation at the level of the fractured vertebra (short same-segment fixation) provides more biomechanical stability than traditional SSPF.