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A femoral neck fracture is currently one of the most common types of fracture in clinical practice. The incidence continues to increase due to traffic accidents, trauma, and osteoporosis. This research includes a biomechanical study and a clinical retrospective study. In the biomechanical studies, three groups’ effects (Control Group: 3CCS, DHS gro...
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Citations
... In clinical practice, FNF in young and middle-aged adults was relatively uncommon compared to the elder [10] , leading to limited experience for doctors in managing these populations, and the optimal timing and approach for surgery became challenging to be decided. Previous studies tended to reduce complication rates by focusing on optimizing internal xation materials or surgical methods [11][12][13] , while limited existing studies on the relationship between surgical delays and postoperative complications such as IFLB and ONFH, could be found. In this study, an increasing risk of developing IFLB with longer surgical delays in FNF patients was observed. ...
Background
Femoral neck fractures (FNF) in young and middle-aged adults are primarily caused by high-energy injuries in traffic accidents. Surgical delays often occur due to transportation issues, preoperative evaluations, and economic burdens.
Methods
A retrospective analysis was conducted on young and middle-aged FNF patients undergoing reduction and internal fixation surgeries from 2010 to 2019 with the use of the National Inpatient Sample database. Logistic regression analysis was used to assess the relationship between surgical delays and complications, and the independent risk factors contributing to delays. Categorical variables were investigated via a chi-square test, while continuous variables including Elixhauser Comorbidity Index (ECI) scores, length of hospital stay (LOS), and total medical costs were analyzed via t-test or rank-sum test.
Results
9,204 patients undergoing reduction and internal fixation surgeries were included. In the delayed group, patients had higher ECI scores, longer hospital stays, higher expenses, and increased inpatient mortality (1.61% vs. 0.28%, P < 0.0001). Longer surgical delays were associated with higher risks of complications, including femoral head osteonecrosis, internal fixation loosening and breakage, and respiratory complications. Fluid and electrolyte disorders, metastatic cancer, pulmonary circulation disorders, and weight loss were identified as independent risk factors for surgical delays. Except for anemia (OR = 2.37, P < 0.0001), no significant differences in early postoperative complications were found between open-reduction and closed-reduction internal fixation (ORIF/CRIF) surgeries.
Conclusion
Early surgical intervention, within a 2-days period after injury, seems to be crucial for young adults with FNF. If CRIF is challenging in some cases, ORIF can be another choice.
Level of evidence:
... Precision in reduction and formidable internal xation aim to stabilize the fracture with the prospective preservation or restoration of GM functionality; however, suboptimal surgical outcomes can precipitate biomechanical alterations and an augmented in ammatory response. [12][13][14][15] These deleterious entities, in tandem with pain, can compromise muscular function, instigate muscular atrophy, and ultimately permeate into compromised gait and functionality. Consequently, alterations observed in the GM muscle can serve as an indirect metric for assessing the therapeutic management of femoral neck fractures. ...
Background
The femoral neck system (FNS) shows promise as an effective alternative for treating femoral neck fractures, particularly Pauwels type III fractures. However, limited literature exists on comparative studies investigating the effects of FNS versus cannulated compression screws (CCS) on the gluteus medius (GM) muscle. This study aims to compare the impact of FNS and CCS interventions on the GM in Pauwels type III femoral neck fracture treatment.
Methods
This study included 103 patients diagnosed with Pauwels type III femoral neck fractures, treated between January 2019 and September 2021. Among them, 54 patients underwent FNS treatment (FNS group), while 49 patients received CCS fixation (CCS group). Changes in GM area were assessed through ultrasound at 3 and 6 months postoperatively, and hip function was assessed by Harris hip score.
Results
At 3-, and 6-months post-surgery, the GM area was notably reduced on the operated side in the CCS group compared to the healthy side (p < 0.0001), while no significant disparity was observed in the FNS group (p = 0.402 at 3 months, p = 0.989 at 6 months). The Harris hip score, reflecting postoperative recovery, was significantly superior in the FNS group compared to the CCS group both in March (84.5 ± 3.9 vs. 82.7 ± 4.4, P = 0.029) and June (91.4 ± 4.4 vs. 89.7 ± 4.0, P = 0.037).
Conclusion
FNS internal fixation for Pauwels type III femoral neck fractures minimally impacts the GM compared to compression screws, suggesting its potential to improve hip function, facilitate gait, and enhance overall hip joint rehabilitation.
... The elderly are mainly suffering from low-energy failing and osteoporosis, and the young people are prone to high-energy torsion and violence. In clinical treatment, Pauwels type III femoral neck fracture can be cured using different treatment strategies [10][11][12][13][14]. In this paper, the artificial model specimens for Pauwels type III femoral neck fracture were investigated and found that the crossed fixation configurations with two FTSs and one PTS are effective to treat Pauwels type III femoral neck fracture. ...
Objectives
The purpose of this study is to evaluate the value of full thread screw and different fixation configurations in Pauwels type III femoral neck fracture.
Methods
A total of 40 artificial femoral model specimens were chosen, and Pauwels type III femoral neck fracture was simulated upon osteotomy at 80°. According to random number table, models were divided into four groups (10 cases in each group): Group A received the paralleled fixation with three partial thread screws (PTSs), group B received the crossed fixation with three PTSs, group C received the paralleled fixation with two full thread screws (FTSs) and one PTS, and group D received the crossed fixation with two FTSs and one PTS. Changes including the model rigidity, axial displacement in fatigue test and limit loads for Pauwels type III femoral neck fracture models were analyzed through MTS 858 Mini Bionix Ⅱ test system.
Results
Among four groups, the model rigidity, axial displacement in fatigue test and limit loads were the highest in group D, and they were the lowest in group A. However, the model rigidity, axial displacement in fatigue test and limit loads between group B and group C showed no statistically significant difference (P＞0.05). Eventually, all the specimens were displaced along the fracture lines while the femoral head was split at varying degrees. After splits, the removal rate of fixation screws in group A (60.0 %) and group C (40.0 %) was significantly higher than that of group B (10.0 %) and group D (0 %) (P＜0.05), but it showed no statistically significant difference between group A and group C, and between group B and group D (P＞0.05).
Conclusions
The crossed fixation configuration with two FTSs and one PTS in group D is proven to be more effective, which can go against the shear stress, tension and introversion in Pauwels type III femoral neck fracture models.
... Femoral neck fractures occur in approximately 3.6% of total body fractures and 57% of hip fractures and are the leading cause of hospitalization in elderly patients [1]. Young adults with femoral neck fractures are considered for hospitalization if they are younger than 65-70 years and they tend to have fewer femoral neck fractures than elderly with osteoporosis. ...
Locking plates nowadays represent an important treatment in bone trauma and bone healing due to its strong biomechanical properties. The purpose of this study was to both computationally and experimentally validate a novel screw locking system by comparing it to another locking system from state-of-the-art and to apply it in an environment of a fractured mandible. FEA was used to test both systems prior to experimental tests. The systems were locked in the plate holes at 0°, 10°, 15°, and 20°. Cyclic bending tests and push-out tests were performed in order to determine the stiffness and push-out forces of both locking systems. Finally, newly designed locking system was implemented in mandibular angle fracture. Control locking system was biomechanically superior in push-out test, but with no greater significance. In contrast, the new locking system showed greater stiffness by 17.3% at the deflection angle of 20° in cyclic tests, with lower values for other deflection angles. Similar values were displayed in fractured mandible angle environment. Greater stiffness of the new locking system in cyclic loading tests, together with polyaxiallity of the new locking screw, could lead to easier application and improved biomechanical stability of the mandible angle fractures.
... [38] Medial support screws and femoral plates have been identified as valuable options for high-shear Pauwels type III femoral neck fractures. [41,42] The effectiveness of different surgical approaches on fracture healing may be attributed to the provision of adequate support and the restoration of blood supply after surgery. Further investigations could look at the biomechanical and biological factors that influence fracture healing and avascular necrosis after bone screw fixation and how they can be optimized by surgical technique or implant design. ...
Background:
This study endeavors to scrutinize the hotspots and trends in the literature concerning the internal fixation of femoral neck fractures (INFNF) through a comprehensive bibliometric analysis. Notably, this analytical process encompasses both qualitative and quantitative components.
Methods:
The present study has utilized the Science Citation Index-Expanded from the Web of Science Core Collection to extract datasets ranging from January 1, 2010, to August 31, 2022. Quantitative analysis was carried out using sophisticated analytical tools such as the Bibliographic Item Co-Occurrence Matrix Builder, the Online Analysis Platform of Literature Metrology, and CiteSpace software. Further, the major Medical Subject Headings terms and their subheading counterparts associated with INFNF were extracted from the PubMed2XL website using the corresponding PMIDs. These Medical Subject Headings terms were employed in conducting a co-word clustering analysis. Ultimately, the Graphical CLUstering TOolkit program was utilized to execute a co-word biclustering analysis to discern the prevailing hotspots in this domain.
Results:
Between January 1, 2010, and August 31, 2022, a total of 463 publications were issued on INFNF. The INJURY-INTERNAL JOURNAL OF THE CARE OF THE INJURED stood out as the most extensively perused journal in this area. Notably, China emerged as the foremost contributor to publishing articles within the last 12 years, followed by the United States and Canada. McMaster University was identified as the leading institution in INFNF research, while Bhandari M emerged as the most prolific author in this field. Moreover, the study identified five notable research hotspots within the domain of INFNF.
Conclusions:
This study has identified five critical areas of research in the field of INFNF. It suggests that the primary focus of future research is likely to center on advancing internal fixation methods and robot-assisted instrumentation for femoral neck fractures. As such, this study provides valuable insights into future research directions and ideas for those working in this field.
... Femoral neck fractures occur in approximately 3.6% of total body fractures and 57% of hip fractures and are the leading cause of hospitalization in elderly patients [1]. Young adults with femoral neck fractures are considered for hospitalization if they are younger than 65-70 years and they tend to have fewer femoral neck fractures than elderly with osteoporosis. ...
Verticality of transcervical hip fractures in young patients is usually connected with typically high-energy fractures which are known as Pauwels type III. Artificial femoral head replacement surgery is mostly not considered for treating femoral neck fractures in such patients. The commonly used devices for the fixation of vertical femoral neck fractures are multiple screws or a sliding hip screw with or without an antirotation screw. Size, location and length of the screws are the most effective parameters in terms of the structural performance of internal fixation implants, but the optimal configuration of the screws is necessary to be investigated to direct the clinical practice. The aim of this study is to compare the biomechanical stability of the standard inverted triangle configuration with the various newly proposed x-crossed screw configurations. FEA simulations carried out in this study demonstrated that using an x-crossed-right assembly in treating Pauwels type III femoral neck fractures satisfies the biomechanical stability in terms of maximum von Mises stresses and maximum femoral head displacement. However, in terms of maximum relative neck fracture displacement, the x-crossed-right assembly would not entirely suffice the desired biomechanical stability. Therefore, using an x-crossed screw assembly in treating femoral neck fractures would provide the needed biomechanical stability.Graphical Abstract
... As the angle of the fracture line increases (Pauwel 1 towards Pauwel 3), the fracture is subjected to more shear forces, necessitating optimal fixation which can resist these forces and also add to rotational stability. 16 The CCS have been shown to offer adequate stability for fractures with lesser angles with 3 or more screws configurations. However, with Pauwel 3 fractures they become prone to increased cut outs and failures. ...
Background
Management of neck of femur fractures depend upon the age of presentation and it ranges from internal fixation to arthroplasty. In a relatively young population, anatomical reduction with stable internal fixation is the preferred treatment modality; the choice of implants available are multiple cannulated cancellous screws, dynamic hip screws, and the newly devised femoral neck system. The fracture configuration and pattern dictate the ideal implant to be utilized, with the femoral neck system documented to be apt for all the fracture types, while the cannulated screws are deemed better for stable fractures.
Methods
A primary electronic search was conducted on databases of Medline, Scopus, Scopus, Cochrane Library, and Embase, to look for articles published between 1st January 2010 to 22nd November 2021. Studies including adults with femoral neck fractures treated with internal fixation with femoral neck system and comparing them with internal fixation with cannulated cancellous screws in terms of variables like mean surgical duration, loss of blood, length of incision, fluoroscopy time, duration of hospital stay and outcomes like union time, complications, functional outcomes, Visual Analogue Score, and femoral neck shortening, were included.
Results
6 retrospective studies with 371 patients (224 males,147 females) (164: FNS; 207: CCS) were included. Our analysis demonstrated no statistically significant difference in terms of duration of surgery, incision length, and length of hospital stay, there was more blood loss in FNS, but less fluoroscopy time. The fracture union time was lesser for the FNS group and also the femoral shortening was lesser in it. There was no difference in terms of complications, pain relief, and functional outcomes.
Conclusion
Femoral neck system is a new and effective implant for femoral neck fractures in the young with faster union rates and lesser neck shortening through an incision similar to the conventional multiple cancellous screws. It has additional advantages of lesser fluoroscopy exposure to the patient and the OT personnel. However, the rates of complications like implant failure, non-unions, and avascular necrosis are similar to the cannulated screws and either of the implants do not offer any advantage in the final functional status and pain relief to the patient over each other.
... Moreover, it is also in line with the concept of preserving hip joint advocated by some scholars 6 . However, due to blood supply and special morphological anatomy of the femoral head, as well as the above characteristics of femoral neck fracture in young people, the overall incidence rate of post-operative complications and secondary operation rate are relatively high 7 , seriously affecting the quality of life and aggravating the burden of the family. Therefore, how to improve the curative effect for the treatment of femoral neck fractures, University: SL-LC2020-001). ...
Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.
Background:
High shear force is a major factor detrimental to the healing of vertical femoral neck fractures. In addition to firm fixation, reduction quality is crucial for postoperative stability. The present study aimed to compare the biomechanical stability of the newly invented femoral neck system and three inverted-triangle cannulated compression screws treatments for non-anatomical reduction of Pauwels type-III femoral neck fractures.
Methods:
A total of 18 non-anatomical reduction Pauwels type-III femoral neck fracture finite element models were fabricated and fixed using three inverted-triangle cannulated compression screws or the femoral neck system. A 1950-N force was applied to the femoral head to simulate the physiological load during a single-leg stance. Parameters of the maximum total deformation, the interfragmentary gap, and the maximum von Mises stress of the implants and the proximal femur were analyzed.
Findings:
The results of the maximum total deformation, interfragmentary gap, and maximum von Mises stress of the implants in the negative-negative buttress model fixed by the femoral neck system were the largest among all groups (3.58 mm, 0.252 mm, and 729.68 MPa, respectively). In contrast, the anatomical-anatomical reduction model fixed by three inverted-triangle cannulated compression screws demonstrated the minimum total deformation, interfragmentary gap, and minimum von Mises stress of implants (1.107 mm, 0.09 mm, and 189.83 MPa, respectively).
Interpretation:
Anatomical reduction or positive buttress in femoral neck fractures should be recommended during fracture reduction. The femoral neck system showed weaker biomechanical stability than three inverted-triangle cannulated compression screws in treating Pauwels type-III femoral neck fractures.
Background: To improve the performance of cannulated screws (CSs) in the treatment of femoral neck fractures (FNF), a number of new screw configurations have been proposed. However, most of the studies have only analyzed the biomechanical performance of different screw configurations under static conditions. This study aimed to investigate the biomechanical performance of three cannulated screws configurations under different loadings through finite element analysis.
Methods: A computed tomography scan of the proximal femur was performed to make a Three-dimensional (3D) model, and a fracture line was simulated in the femoral neck. The Pauwels I, II, III fracture model was fixed by three inverted triangular parallel cannulated screws (TCS), four non-parallel cannulated screws (FCS) and biplane double-supported screw fixation (BDSF) respectively. The maximum principal strain (MPS) on the proximal femur and the von Mises stress on the screws were compared for different models.
Results: In Pauwels I and II fractures, FCS had the lowest peak MPS on the proximal femur and the BDSF had highest peak MPS value. In Pauwels III fractures, BDSF performance in MPS is improved and better than FCS under partial loading conditions. FCS exhibits the lowest von Mises stress in all load conditions for all fracture types, demonstrating minimal risk of screws breakage.
Conclusions: FCS is an ideal screw configuration for the treatment of FNF. And BDSF has shown potential in the treatment of Pauwels type III FNF.
