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Journal of Long-Term Effects of Medical Implants

Published 4 issues per year

ISSN Print: 1050-6934

ISSN Online: 1940-4379

SJR: 0.184 SNIP: 0.485 CiteScore™:: 1.1 H-Index: 39

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Fixation of Femoral Neck Fractures Using Divergent Versus Parallel Cannulated Screws

Volume 21, Issue 1, 2011, pp. 63-69
DOI: 10.1615/JLongTermEffMedImplants.v21.i1.50
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ABSTRACT

Controversy exists regarding the optimal method of internal fixation in femoral neck fractures. Biomechanical data suggest that calcar fixation is superior to central screws placement. We propose a divergent technique for placing 3 cannulated stainless steel screws engaging the calcar femorale. Fifty two patients admitted to our institution for a femoral neck fracture were treated with the divergent screw technique, over a 7-year period. Four patients were deceased and 4 were lost to follow-up. Of the remaining 44 patients there were 10 males and 34 females, aged from 33 to 78 years (mean, 58 years). All patients were operated on by the same surgeon and were followed-up for a minimum of 2 years (mean: 33.6 months, range: 2−6 years). Twenty four patients sustained a non-displaced fracture (Garden I-II) and 20 sustained a displaced fracture (Garden III-IV) of the femoral neck. Mean Harris hip score (HHS) was 89.6 points. Avascular necrosis was evident in 4 patients (9%) with displaced fractures. Non-unions or failed internal fixations were not encountered. There was a significant difference in the HHS, in favor of the divergent group (P = 0.006), while more complications were encountered in the parallel group including 6 cases with non-union. In conclusion, parallel screw placement is not critical for an excellent clinical outcome. Our proposed fixation method using 3 screws that diverge and lie in different coronal planes (1 engaging the calcar femorale) with a free-hand technique may offer enhanced fixation. Biomechanical data along with larger clinical studies are needed to establish our proposed method.

CITED BY
  1. Ehlinger M., Adam P., Bonnomet F., Fractura del extremo superior del fémur del adulto, EMC - Aparato Locomotor, 47, 3, 2014. Crossref

  2. Florschutz Anthony V., Langford Joshua R., Haidukewych George J., Koval Kenneth J., Femoral Neck Fractures, Journal of Orthopaedic Trauma, 29, 3, 2015. Crossref

  3. Stacey Stephen C., Renninger Christopher H., Hak David, Mauffrey Cyril, Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient, European Journal of Orthopaedic Surgery & Traumatology, 26, 4, 2016. Crossref

  4. Sung Yerl-Bo, Jung Eui-Yub, Kim Kyung-Il, Kim Soo-Yeon, Risk Factors for Neck Shortening in Patients with Valgus Impacted Femoral Neck Fractures Treated with Three Parallel Screws: Is Bone Density an Affecting Factor?, Hip & Pelvis, 29, 4, 2017. Crossref

  5. Galal Sherif, Nagy Mohamed, Non-parallel screw fixation for femoral neck fractures in young adults, Journal of Clinical Orthopaedics and Trauma, 8, 3, 2017. Crossref

  6. Fitzpatrick Ellen P., Geriatric Hip Fractures, in Geriatric Trauma and Acute Care Surgery, 2018. Crossref

  7. Wu Yueh, Leu Tsai-Hsueh, Chuang Tai-Yuan, Ho Wei-Pin, Chen Yu-Pin, Lin Chung-Ying, Screw trajectory affects screw cut-out risk after fixation for nondisplaced femoral neck fracture in elderly patients, Journal of Orthopaedic Surgery, 27, 2, 2019. Crossref

  8. Lim Eic Ju, Kim Beom-Su, Kim Chul-Ho, Parallel and non-parallel cannulated screw fixation complications in femoral neck fractures: A systematic review and meta-analysis, Orthopaedics & Traumatology: Surgery & Research, 107, 6, 2021. Crossref

  9. Zazirnyi I.M., Kostrub O.O., Current Management of Femoral Neck Fractures (Literature Review), Visnyk Ortopedii Travmatologii Protezuvannia, 1(108), 2021. Crossref

  10. Polat Abdulkadir, Misir Abdulhamit, Buyukkuscu Mehmet Ozbey, Basilgan Seckin, Basar Hakan, Factors Associated with Femoral Neck Shortening After Closed or Open Reduction and Screw Fixation, Indian Journal of Orthopaedics, 56, 2, 2022. Crossref

  11. Xia Guangming, Liu Wei, Bai He, Xue Yuan, Dai Yu, Lei Ping, Zhang Jianxun, Surgical Tool Handle Vibration‐Based Drilling State Recognition During Hip Fracture Fixation, Orthopaedic Surgery, 2022. Crossref

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