Osteochondral allografts for the treatment of shoulder instability.

Aims: To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability. Methods: This systematic review, following PRISMA guidelines and registered in PROSPERO, involved a comprehensive literature search using PubMed, Embase, Web of Science, and Scopus. Key search terms included "allograft", "shoulder", "humerus", and "glenoid". The review encompassed 37 studies with 456 patients, focusing on primary outcomes like failure rates and secondary outcomes such as PROMs and functional test results. Results: A meta-analysis of primary outcomes across 17 studies revealed a dislocation rate of 5.1% and an increase in reoperation rates from 9.3% to 13.7% post-publication bias adjustment. There was also a noted rise in conversion to total shoulder arthroplasty and incidence of osteoarthritis/osteonecrosis over longer follow-up periods. Patient-reported outcomes and functional tests generally showed improvement, albeit with notable variability across studies. A concerning observation was the consistent presence of allograft resorption, with rates ranging from 33% to 80%. Comparative studies highlighted similar efficacy between distal tibial allografts and Latarjet procedures in most respects, with some differences in specific tests. Conclusion: OCA transplantation presents a promising treatment option for shoulder instability, effectively addressing both glenoid and humeral head defects with favourable patient-reported outcomes. These findings advocate for the inclusion of OCA transplantation in treatment protocols for shoulder instability, while also emphasizing the need for further high-quality, long-term research to better understand the procedure's efficacy profile.

Treatment of Simultaneous Femoral Supracondylar Nonunion and Tibial Plateau Malunion along with Stiff Knee in a Young Patient: A Case Report.

A 41-year-old man underwent Total Knee Arthroplasty with NexGen Legacy Constrained Condylar Knee (LCCK) system to treat his nonunion of distal femur, stiff knee, and malunion of tibia plateau. The treatment involved femoral and tibial stems and PS polyethylene. As a result, his knee range of motion improved, and he no longer experienced pain. After two years, he resumed work without any signs of loosening or stiffness.

Comparison of Combined Intraarticular and Intravenous Administration of Tranexamic Acid with Intraarticular and Intravenous Alone in Patients Undergoing Total Knee Arthroplasty without Drainage Catheter: A Clinical Trial Study.

Objectives: We aimed to assess the most effective route for Tranexamic acid (TXA) administration among Intraarticular (IA), Intravenous (IV), and combined IA/IV for Total Knee Arthroplasty (TKA) surgeries. Methods: A double-blinded clinical trial was run on 147 TKA candidates. Blood loss and hemoglobin (Hb) drop were evaluated using the Gross and Nadler formula in three matched case groups administered TXA during the TKA through IV, IA, or combined IA/IV route. Tourniquet was used on all operations for controlling intraoperative blood loss. No drainage catheter was used for the cases. Results: The combined group showed an average blood loss of 630±252 ml, which was significantly lower than that in the IV group (878±268 ml, P<0.01) and the IA group (774±288 ml, P=0.03). Furthermore, the mean Hb and hematocrit drop were significantly lower in the combined group, compared to the other two groups, 48 and 72 h postoperatively (P<0.05). Conclusion: The combined IA/IV route had a 28% and 19% reduction of blood loss, compared to the IV or IA methods, respectively. Therefore, using TXA via the combined IA/IV route may be more effective for reducing perioperative blood loss following TKA surgery using a tourniquet without drain placement.

Orthopedic oncology residency education, how broad and how deep?

Orthopedic residency training has long been an area of active research and discussion, and as the knowledge and concepts in subspecialties evolve, it is crucial to investigate the implications of these advancements in the musculoskeletal oncology field. It is important to note that the acquisition of surgical skills and scientific knowledge from orthopedic texts alone is not sufficient in this area. Orthopedic residents must also acquire multidisciplinary communication and leadership skills, as well as the mental capacity to make sound clinical decisions. Therefore, this commentary highlights the importance of assessing whether the current curriculum provides adequate preparation for residents' future careers, despite the fact that the expansion of subspecialties in orthopedic education has undoubtedly enhanced the depth of knowledge and concepts in the field. In addition, orthopedic residents must adopt an open-minded and scientific approach toward orthopedic oncology, which has unique principles. Moreover, it is crucial that general orthopedic surgeons have the necessary skills to manage patients and know when to refer them. By exploring these issues, we hope to continually contribute to ongoing discussions about how to improve orthopedic residency education.

Gorham-Stout syndrome, the challenge in diagnosis and unique in treatment: a case report.

BACKGROUND: Gorham-Stout disease is a rare condition with fewer than 400 reported cases in the literature. The presentation of Gorham-Stout disease varies on the basis of location, extent, fracture, and accompanying symptoms. It lacks a specific histopathological appearance but is characterized by vascular changes and the absence of cellular atypia. CASE PRESENTATION: This article presents a case study of a 16-year-old Persian boy with an entire femur with Gorham-Stout disease, highlighting the difficulties in managing this condition. The lack of a clear diagnosis resulted in prolonged procedures, delayed medical treatments, and ultimately required total femoral replacement with an endoprosthesis. CONCLUSION: It is important to note that raising awareness of this disease and its potential complications can facilitate timely and appropriate treatment for patients presenting in the early stages of the disease.

Early versus late physiotherapy following arthroscopic repair of small and medium size rotator cuff tear: a randomized clinical trial.

PURPOSE: We compared early and late physiotherapy for patients with small and medium size rotator cuff tears following arthroscopic repair. METHODS: A single-centre, single-blinded, prospective parallel RCT was performed with two arms: early physiotherapy (start within the first week) versus late physiotherapy (start 4 weeks after surgery). Patients with small- to medium-sized isolated full-thickness superior rotator cuff tears were included and followed for 12 months. The primary outcome measures were shoulder function and range of motion (ROM) measured by the Constant-Murley score (CMS) at three months, six months, and 12 months. The other outcomes were the visual analog scale (VAS) pain and the rotator cuff ultrasound (US) evaluation by the Sugaya classification. RESULTS: In three and six month follow-ups, CMS was significantly superior in the intervention group compared to controls (P < 0.05). However, only at the three month follow-up between-group difference met the minimal clinically important difference (MCID) (MCID = 10.4) (59.8 vs. 48.9). The intervention group experienced less pain than controls in the first six months (P < 0.001), and only the three month follow-up was clinically meaningful based on MCID (MCID = 1.4). Moreover, in the first six months, the shoulder ROM favoured the intervention group (P < 0.05). US grading of the supraspinatus and infraspinatus was similar between groups (P = 0.07). One retear occurred in the intervention group and another in the controls, detected by examination and US evaluation. CONCLUSION: Following the arthroscopic repair of a small- to medium-sized rotator cuff tear, early physiotherapy showed promising results for pain, function, and range of motion. LEVEL OF EVIDENCE: Level I therapeutic.

Arthroscopic rotator cuff repair: Is healing enough?

HYPOTHESIS/BACKGROUND: Arthroscopic rotator cuff repair most commonly results in good clinical outcomes, however understanding of predictive factors influencing the final clinical outcome is limited. AIM: The purpose of our study was to evaluate clinical outcomes of patients with healed supraspinatus tendon after arthroscopic rotator cuff repair and to identify its pre- and peri-operative predictive factors of good clinical results. METHODS: A multi-center prospective study followed up 188 patients, who had a healed tendon after an arthroscopic repair of isolated supraspinatus tear. Inclusion criteria were: age under 70 years old, isolated supraspinatus tear, stage 0 or I of fatty infiltration, healed supraspinatus tendon at one year postoperatively and the same arthroscopic double row rotator cuff repair used in all patients. Clinical assessment used Constant Murley Score (CMS) and Subjective Shoulder Value (SSV) preoperatively and at one year postoperatively. Ultrasound (US) control checked tendon repair quality based on Sugaya classification. Types I-II-III were considered as healed. RESULTS: The average age of our cohort was 57.57 (range; 41 to 70) years and the female to male ratio was 1.14 (range; 100 to 87). The average preoperative CMS was 53.75±13.50 (mean±SD; range; 16 to 83). At final follow up, the average postoperative CMS was 79.95±12.05 (mean±SD; range; 28 to 100). 12.22% (23/188) of patients, who had a CMS score below 70, had a clinically significant difference compared to the average CMS, due to the fact that the minimal clinically significant difference (MCID) in CMS is 10. A statistical analysis has shown that in patients with lower scores there was only a significant dominance of females (p-value=0.001). No difference was found in regards to age, preoperative CMS, fatty degeneration and other factors. CONCLUSION: Our study showed that despite all patients had a healed repair of supraspinatus, not all of them experienced a good final clinical outcome. The only factor negatively influencing the final clinical outcome was a female gender. No other structural factors seemed to influence the final clinical results. Futures studies should focus more on analyzing which personality traits and other psychosocial factors play an important role in determining the final outcome after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: III; retrospective cohort study.

Posterior hemivertebra resection and short-segment fusion with lateral mass screws in congenital scoliosis: a novel strategy for the resource-limited setting.

BACKGROUND: Posterior hemivertebra resection and short-segment fusion with pedicle screws are an established treatment in congenital scoliosis, which require pediatric-specific instrumentation. The purpose of this study was to report the results of utilizing cervical lateral mass screws instead of pedicle screws in the treatment of congenital scoliosis in children younger than 5 years old. METHODS: In an IRB-approved retrospective chart review study, patients <5 years old with congenital scoliosis who underwent posterior hemivertebra resection and fusion with lateral mass screws from 2013 to 2017 were included. Demographic information, pre- and post-operative radiographs, complications, and outcomes were extracted from the charts. RESULTS: Twenty-three patients were included in the final analysis with a mean age of 40 months, of which 14 were female. Patients were followed for a mean of 51.3±13.2 months. The mean blood loss was 210ml, and patients were hospitalized for a mean of 4 days post-operatively. The correction rate of the main coronal curve, compensatory cranial curve, compensatory caudal curve, and segmental sagittal curve was 74.8%, 68%, 65.2%, and 68.9%, respectively. Three complications were observed: one intra-operative pedicle fracture, one case of implant failure, and one deep surgical-site infection, all of which were successfully managed. CONCLUSIONS: Our findings suggest that adult lateral mass screws can be used for transpedicular fixation of the thoracic and lumbar vertebrae in low-resource settings where pediatric-specific pedicle instruments are not readily available. The correction rate, outcomes, and complications are similar and comparable to pediatric-specific pedicle screws, in addition to being low-profile and less bulky compared to adult implants.

Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Sternoclavicular joint dislocation accounts for 1 percent of the human joint dislocations. Sternoclavicular joint dislocation most commonly occurs in anterior or posterior dislocation. To the best of the authors knowledge, only six cases of superior sternoclavicular joint dislocation are reported in the literature. The injury is commonly missed. CASE PRESENTATION: We present a 28-year-old athlete with upper chest pain and right shoulder range of motion limitation. On imaging, it was revealed that he had a superior sternoclavicular dislocation. He was managed with arm sling, analgesics and physiotherapy. After 3 months, he was asymptomatic and returned to his sport activity successfully. CLINICAL DISCUSSION: We searched the published related studies and summarized the signs and symptoms of patients presented with sternoclavicular dislocation. Chest pain is one of the most common symptom while sternoclavicular tenderness and restriction of shoulder movement are among the most common signs of sternoclavicular dislocations. Conservative, close reduction, and open reduction and internal fixation with fiber wire have been applied for cases with superior sternoclavicular dislocation with acceptable results. CONCLUSION: A high index of suspicion is needed in order not to miss sternoclavicular dislocation. In cases with no evidence of mediastinal structure compression it may be managed conservatively successfully. However, some degree of cosmetic deformity may remain at the sternoclavicular joint in those treated with conservative therapy.

An exceptional case of posterior shoulder fracture dislocation in patient with recurrent anterior dislocation forming "Mirror Hill-Sachs lesion".

A posterior dislocation should be always kept in mind in a painful shoulder especially after trauma or seizure. Even in the presence of recurrent dislocation, the direction may be different from one episode to another.

Prevalence of Carpal Tunnel Release as a Risk Factor of Trigger Finger.

BACKGROUND: Carpal tunnel release (CTR) is acknowledged as a predisposing factor for the development of the trigger finger. However, the incidence of new-onset trigger finger after CTR surgery has been inconsistently reported. In this study, we aimed to evaluate the prevalence of CTR as a risk factor of the development of the trigger finger. METHODS: In a retrospective study, 57 consecutive patients who underwent surgery for the treatment of trigger finger were included. The severity of carpal tunnel syndrome (CTS) was determined using the electromyogram test and nerve conduction study. The clinical and demographic characteristics of the patients were extracted from their medical profiles and compared between patients who did and did not develop a trigger finger after CTR. RESULTS: Post-CTR trigger finger was detected in 15 (26.3%) patients. The trigger finger occurred approximately six months after CTR surgery. The thumb and ring fingers were the most commonly involved fingers. Ten out of 15 (66.7%) patients who developed a post-CTR trigger finger had mild-to-moderate CTS, and five (33.3%) patients had severe CTS. No significant difference was found between the patients who did and did not develop a trigger finger after CTR. CONCLUSION: The rate of developing a post-CTR trigger finger was remarkable in our study. Therefore, the potential sequelae should be discussed with patients, preoperatively.

Prospective study of tendon healing and functional gain after arthroscopic repair of isolated supraspinatus tear.

INTRODUCTION: In case of failure of non-operative treatment of isolated supraspinatus tear, tendon surgery can improve shoulder function and alleviate pain. The present study hypothesis was that isolated supraspinatus repair shows good healing, with improved clinical results. MATERIALS AND METHODS: A prospective multicentre study followed up 199 patients (mean age, 57 years) for one year. Inclusion criteria comprised: isolated full-thickness supraspinatus tear, retraction grade<3, with the same double-row arthroscopic technique. Clinical assessment used Constant score at 6 weeks and 3, 6 and 12 months. Ultrasound control checked tendon repair quality on the Sugaya criteria, types I-II-III being considered as healed. RESULTS: At one year, mean Constant score had increased by 26 points (p<0.001). Healing rate was 94% (n=187): Sugaya type I, 46% (n=92); type II, 41% (n=81); type III, 7% (n=14). Mean Constant score was significantly higher in case of healing: 81 vs. 70 points (p=0.002). Constant score progression was identical in both healing groups throughout follow-up. Univariate analysis showed no correlation between epidemiological or tear-related factors and tendon healing. CONCLUSION: Arthroscopic repair of isolated small supraspinatus tear provided 94% healing. Clinical results were better when healing was achieved. LEVEL OF EVIDENCE: I, prospective cohort study.

Total Knee Arthroplasty in Patients with Hemophilia: What Do We Know?

Total knee arthroplasty is considered as the treatment of choice for those with end stage hemophilic arthropathy. Compared to other patients undergoing TKA, these patients have specific features such as bleeding tendency, younger age, pre-operative restricted range of motion (ROM), altered anatomy, and increased complications. This narrative review of literature is going to investigate several issues regarding the TKA in hemophilic patients including indications, perioperative factor replacement, surgical challenges, postoperative rehabilitation, outcomes, and complications.

Fixation of distal tibia fracture through plating, nailing, and nailing with Poller screws: A comparative biomechanical-based experimental and numerical investigation.

The goal of this study was to investigate two commonly used methods of fixation of distal metaphyseal tibia fractures, plating and nailing as well as the less frequently employed nailing with Poller screws, from a biomechanical perspective. Despite numerous studies, the best method to repair fractures of tibia the remains up for of debate. This study includes an in vitro experimental phase on human cadaveric tibias followed by a finite element analysis. In the experimental phase, under partial weight-bearing axial loading, the axial stiffness of the bone-implant construct and interfragmentary movements for each of the fixation methods, bone-plate, bone-nail, and bone-nail-Poller screw, were measured and compared with each other. Shear interfragmentary movement and stress distribution in the bone-implant construct for the three mentioned fixation methods were also determined from FE models and compared with each other. Results of in vitro experiments, i.e., the exertion of axial loading on the tibia-plate, tibia-nail, and tibia-nail-Poller screw, showed that utilization of tibia-nail and tibia-nail-Poller screw led to a stiffer bone-implant construct, and consequently, lower interfragmentary movement, compared to the tibia-plate construct (p values for tibia-nail and tibia-nail-Poller screw, and for both axial stiffness and interfragmentary movement, compared to those of tibia-plate construct, were less than 0.05). Numerical analyses showed that nailing produced less undesirable shear interfragmentary movement, compared to the plating, and application of a Poller screw decreased the shear movements, compared to tibia-nail. Furthermore, using the finite element analysis, maximum von Mises stress of adding a screw in tibia-nail, tibia-plate, and tibia-nail-Poller screw, was found to be: 51.5, 78.6, and 60.5 MPa, respectively. The results of this study suggested that from a biomechanical standpoint, nailing both with and without a Poller screw is superior to plating for the treatment of distal tibia fractures.

Closed Antegrade/Retrograde intramedullary fixation of central metatarsal fractures: Surgical technique and clinical outcomes.

BACKGROUND: Intramedullary fixation with k-wires is a surgical option in the management of fractures of the shaft and neck of central metatarsals. The current study aimed at investigating the clinical outcomes of closed antegrade/retrograde intramedullary pinning technique. PATIENTS AND METHODS: A total of 34 patients (26 males and eight females) with 58 metatarsal neck and shaft fractures (28 shaft and 26 neck fractures) were operated using the antegrade/retrograde intramedullary fixation technique. At the final follow-up visit, pain intensity was assessed using the visual analog scale (VAS) and foot function was evaluated by the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system. RESULTS: Mean follow-up period was 18 months, ranged 12 to 34. Mean time to clinical fracture healing was 6.5 weeks, ranged 5 to 9. Bony union was occurred in all the cases. No surgical site infection was noted. Mean VAS score at the final follow-up visit was 0.28, ranged 0 to 3. At the final follow-up, the mean AOFAS score was 95.2, ranged 81 to 100. CONCLUSION: Closed antegrade/retrograde intramedullary pinning is a minimally invasive technique to manage central metatarsal fractures. Using this technique, metatarsal alignment can be restored and good clinical outcome is achieved.

Evaluation of the Inter and Intra-Observer Reliability of the AO Classification of Intertrochanteric Fractures and the Device Choice (DHS, PFNA, and DCS) of Fixations.

BACKGROUND: ArbeitsgemeinschaftfürOsteosynthesefragen (AO) classification is the most frequently used tool to classify intertrochanteric fractures. However, there is limited evidence regarding its reliability. Therefore, this study was designed to evaluate inter-observer and intra-observer reliability of the AO-2018 intertrochanteric fracture classification. METHOD: A retrospective study was conducted in Imam Khomeini Hospital Complex, on radiography of patients who came with intertrochanteric fractures from March 21, 2018, to March 19, 2019. Four orthopedic trauma surgeons assessed 96 anteroposterior pelvic radiographs of intertrochanteric fractures and classified using an AO intertrochanteric fracture classification of 2018. The reading and review of radiography were performed in 2 separate occasions in a 1-month interval. The inter-observer and intra-observer reliability was assessed using kappa statistics. RESULT: The level of both mean inter-observer (K =0.322; 95%CI: 0.321-0.323) and intra-observer agreement (K =0.317; 95%CI: 0.314-0.320) in AO intertrochanteric fracture classification subgrouping were not satisfactory. The inter-observer (K =0.61; 95%CI: 0.608-0.611) and intra-observers' (K=0.560; 95%CI: 0.544-0.566) reliability in AO main groupings showed moderate agreement. CONCLUSION: The AO classification does not show adequate and acceptable inter-observer and intra-observer reliability and reproducibility. Therefore, it will be hard to base on the AO classification for treatment protocols.

A rare case of floating fifth metacarpal and review of literature.

BACKGROUND: Floating metacarpal is a rare concurrent bipolar dislocation of metacarpal at both ends. Isolated dislocations of Carpo-metacarpal (CMC) or Metacarpo-phalangeal (MCP) have been previously reported, simultaneous dislocations of both joints is scarcely reported in literature and bares high chance of diagnosis being missed on presentation. PATIENT: A 29-year-old male presented with pain, swelling in left hand and loss of movement in fifth and fourth finger following a motorcycle fall injury. Radiography showed floating metacarpal of fifth ray along with fracture dislocation of at base of fourth metacarpal. DIAGNOSIS: The patient was diagnosed with floating fifth metacarpal along with fracture dislocation at base of fourth metacarpal. INTERVENTION: Open reduction and K-wire fixation was performed across CMC for fifth and fourth metacarpal along with MCP fixation for fifth metacarpal joint. OUTCOMES: The patient had excellent outcome after one year with normal Range of motion and grip. LESSONS: Early recognition and prompt management of these injuries are considered as hallmark of prognosis. Ideal treatment for such dislocation is controversial. However, we have noted from earlier case reports that with acute dislocation and minimal swelling closed reduction and cast immobilization could be sufficient. In case of delayed presentation or swelling along with fracture, open reduction is favorable choice of treatment.

The Outcome of Salter Innominate Osteotomy for Developmental Hip Dysplasia before and after 3 Years Old.

BACKGROUND: Developmental dysplasia of the hip (DDH) is one of the most important and challenging conditions in the field of pediatric orthopedics; if not diagnosed and treated in time, it would lead to remarkable morbidity. Methods of treatment based on the patient's age can vary. The aim of this study is to compare the outcomes of Salter osteotomy surgery in two groups of patients under and over three years old. METHODS: In this retrospective study, medical records of patients who had undergone innominate Salter osteotomy, within the past ten years, due to non-pathological DDH were collected. Mean follow up of all patients is 70.28 months (min=25, max=118). RESULTS: eventy patients were selected including 85 operated hips. Radiological satisfaction based on modified Severin score system rate was 86% and 85% for lower three years old group and second group, respectively. In clinical assessment, it was found that results in 82% of the patients under 3 years old and 82.9% of patients older than three years old were satisfactory. There was no statistically significant difference between the two groups based on Modified MacKay criterion. CONCLUSION: Results in both groups of patients under and over 3 years old were found satisfactory. Difference in patient satisfaction rates based on clinical and radiological outcomes was not statistically significant between the two groups. It should also be noted that complications such as redislocation and deep wound infection would cause poor clinical and radiological outcomes.

Ponseti Casting Method in Idiopathic Congenital Clubfoot and Its Correlation with Radiographic Features Abstract.

BACKGROUND: The aim of this study was to evaluate the idiopathic congenital clubfoot deformity treated by Ponseti method to determine the different factors such as radiological investigations that may have relations with the risk of failure and recurrence in mid-term follow-up of the patients. METHODS: Since 2006 to 2011, 226 feet from 149 patients with idiopathic congenital clubfoot were treated with weekly castings by Ponseti method. Anteroposterior and lateral foot radiographies were performed at the final follow-up visit and the data from clinical and radiological outcomes were analysed. RESULTS: In our patients, 191(84.9%) feet required percutaneous tenotomy. The successful correction rate was 92% indication no need for further surgical correction. No significant correlation was found between the remained deformity rate and the severity of the deformity and compliance of using the brace (P=0.108 and 0.207 respectively). The remained deformity rate had an inverse association with the beginning age of treatment (P=0.049). No significant correlation was found between the percutaneous tetonomy and passive dorsiflexion range (P=0.356). CONCLUSION: According to our results treatment with the Ponseti method resulted in poor or no correlation. The diagnosis of clubfoot is a clinical judgment; therefore, the outcome of the treatment must only be clinically evaluated. Although the Ponseti method can retrieve the normal shape of the foot, it fails to treat the bone deformities and eventually leads to remained radiologic deformity. Further studiesare suggested to define a different modification that can address the abnormal angles between the foot and ankle bones to minimize the risk of recurrence.

Interfragmentary motion assessment for three different fixation techniques of femoral neck fractures in young adults.

BACKGROUND: Vertical femoral neck fractures in the youth could be happened in high-energy accidents, and because of dominant shearing forces, this fracture is considered as a troublesome injury with a controversy regarding selection of the best fixation method. OBJECTIVE: The long term goal of this quasi-experimental study was to find the more stable fixation method among cannulated screws (CSs), proximal femoral locking plate (PFLP), and dynamic hip screw with derotational screw (DHS+DS) for this kind of fracture. METHODS: Twelve fresh-frozen cadaveric femurs were assigned to three groups that were matched for mean bone mineral density and stiffness of intact bone. Vertical fractures were artificially mimicked in the specimens and fixed using three different implants, i.e. CSs, PFLP, and DHS+DS. Then, the samples were tested under incremental, cyclic, and failure loading phases. RESULTS: The differences in all biomechanical parameters were statistically significant among tested groups (p<0.05). All biomechanical parameters for the DHS+DS method of fixation are significantly different from those corresponding to CSs (p<0.05). There were no significant differences in failure load and failure energy between the PFLP and CSs techniques (p>0.05). Also, there were no significant differences in relative stiffness and femoral head displacement between the PFLP and DHS+DS groups (p>0.05). CONCLUSIONS: Based on the clinical assumption that restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the results of this study suggest that the priority order of selection for the stable fixation implant of vertical femoral neck fracture in young patients is DHS+DS, then PFLP, and finally CSs.