Risk of micro-fracture in femoral head after removal of cannulated screws for femoral neck fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHU Kai , ZHANG Xinglin , LU Xing ,  CHEN Xu

Department of Orthopaedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China;

Corresponding author：

CHEN Xu, Email: chenvt2005@126.com

Keywords：

Femoral neck fracture; internal fixation; cannulated screw; micro-fracture

DOI：

10.7507/1002-1892.202001076

Video：

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Objective To explore the changes of bone and risk of micro-fracture in femoral head after removal of cannulated screws following femoral neck fracture healing under the impact force of daily stress.Methods A total of 42 specimens of normal hip joint were collected from 21 adult fresh cadaveric pelvic specimens. Wiberg central-edge (CE) angle, bone mineral density, diameter of femoral head, neck-shaft angle, and anteversion angle of femoral neck were measured. Then, the 3 cannulated screws were implanted according to the AO recommended method and removed to simulate the complete anatomical union of femoral neck fracture. The morphology of screw canal in the femoral head was observed by CT. Finally, the specimens were immobilized vertically within the impact device in an upside-down manner, and the femoral heads were impacted vertically. Every specimen was impacted at 200, 600, and 1 980 N for 20 times with the impacting device. After impact, every specimen was scanned by CT to observe the morphology changes of screw canal in the femoral head. Micro-fractures in the femoral head could be confirmed when there was change in the morphology of screw canal, and statistical software was used to analyze the risk factors associated with micro-fractures.Results After impact at 200 and 600 N, CT showed that the morphology of screw canal of all specimens did not change significantly compared with the original. After impact at 1 980 N, there were protrusion and narrowing in the screw canal of the 22 femoral head specimens (11 pelvic specimens), showing obvious changes compared with the original screw canal, indicating that there were micro-fractures in the femoral head. The incidence of micro-fracture was 52.38% (11/21). logistic regression results showed that there was correlation between micro-fracture and bone mineral density (P= 0.039), but no correlation was found with CE angle, diameter of femoral head, neck-shaft angle, and anteversion angle (P>0.05).Conclusion The micro-fractures in the femoral head may occur when the femoral head is impacted by daily activities after removal of cannulated screws for femoral neck fractures, and such micro-fractures are associated with decreased bone density of the femoral head.

Citation： CHU Kai, ZHANG Xinglin, LU Xing, CHEN Xu. Risk of micro-fracture in femoral head after removal of cannulated screws for femoral neck fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1091-1095. doi: 10.7507/1002-1892.202001076 Copy

1.	丁涛, 张保焜, 田少奇, 等. 老年髋部骨折手术方法的选择原则及应用现状. 中国修复重建外科杂志, 2018, 32(11): 1435-1440.
2.	中华老年骨科与康复电子杂志编辑委员会. 股骨头坏死保髋治疗指南 (2016 版). 中华老年骨科与康复电子杂志, 2016, 2(2): 65-70.
3.	吴伟, 喻爱喜, 漆白文, 等. 股骨颈断端愈合去除空心钉后的有限元分析. 中华实验外科杂志, 2015, 32(7): 1590-1592.
4.	Van Houcke J, Schouten A, Steenackers G, et al. Computer-based estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations. Appl Ergon, 2017, 63(9): 99-105.
5.	王亦璁, 刘沂, 姜保国. 骨与关节损伤. 北京: 人民卫生出版社, 2007: 1155-1156.
6.	Munemoto M, Kido A, Sakamoto Y, et al. Analysis of trabecular bone microstructure in osteoporotic femoral heads in human patients: in vivo study using multidetector row computed tomography. BMC Musculoskelet Disord, 2016, 17(1): 13.
7.	樊向利, 郭征, 宫赫, 等. 正常人股骨近端生物力学性能的区域性分析. 中国骨与关节损伤杂志, 2011, 26(7): 601-603.
8.	文良元, 黄公怡, 申剑. 股骨颈骨折后股骨头坏死的病理学特点观察. 中国骨伤, 2003, 16(1): 47-49.
9.	Lv H, Zhang L, Yang F, et al. Comparison of microstructural and mechanical properties of trabeculae in femoral head from osteoporosis patients with and without cartilage lesions: a case-control study. BMC Musculoskelet Disord, 2015, 16(1): 72.
10.	Majernicek M, Dungl P, Kolman J, et al. Osteosynthesis of intracapsular femoral neck fractures by dynamic hip screw (DHS) fixation. Acta Chir Orthop Traumatol Cech, 2009, 76(4): 319-325.
11.	Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury, 2005, 36(1): 131-141.
12.	Ai ZS, Gao YS, Sun Y, et al. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci, 2013, 18(2): 271-276.
13.	孙欣, 曾荣, 胡资兵, 等. 空心螺钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析. 中华创伤骨科杂志, 2012, 14(6): 477-479.
14.	张永飞, 张义修. 股骨颈骨折术后股骨头坏死的力学因素. 中国骨与关节损伤杂志, 2001, 16(4): 270-272.
15.	Kim YM, Lee SH, Lee FY, et al. Morphological and biomechanical study of avascular necrosis of the femoral head. Orthopedics, 1991, 14(10): 1111-1116.
16.	Brown TD, Way ME, Ferguson AB. Mechanical characteristics of bone in femoral capital aseptic necrosis. Clin Orthop Relat Res, 1981, (156): 240-247.
17.	Felson DT, Anderson JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet, 1987, (8538): 902-906.

1. 丁涛, 张保焜, 田少奇, 等. 老年髋部骨折手术方法的选择原则及应用现状. 中国修复重建外科杂志, 2018, 32(11): 1435-1440.
2. 中华老年骨科与康复电子杂志编辑委员会. 股骨头坏死保髋治疗指南 (2016 版). 中华老年骨科与康复电子杂志, 2016, 2(2): 65-70.
3. 吴伟, 喻爱喜, 漆白文, 等. 股骨颈断端愈合去除空心钉后的有限元分析. 中华实验外科杂志, 2015, 32(7): 1590-1592.
4. Van Houcke J, Schouten A, Steenackers G, et al. Computer-based estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations. Appl Ergon, 2017, 63(9): 99-105.
5. 王亦璁, 刘沂, 姜保国. 骨与关节损伤. 北京: 人民卫生出版社, 2007: 1155-1156.
6. Munemoto M, Kido A, Sakamoto Y, et al. Analysis of trabecular bone microstructure in osteoporotic femoral heads in human patients: in vivo study using multidetector row computed tomography. BMC Musculoskelet Disord, 2016, 17(1): 13.
7. 樊向利, 郭征, 宫赫, 等. 正常人股骨近端生物力学性能的区域性分析. 中国骨与关节损伤杂志, 2011, 26(7): 601-603.
8. 文良元, 黄公怡, 申剑. 股骨颈骨折后股骨头坏死的病理学特点观察. 中国骨伤, 2003, 16(1): 47-49.
9. Lv H, Zhang L, Yang F, et al. Comparison of microstructural and mechanical properties of trabeculae in femoral head from osteoporosis patients with and without cartilage lesions: a case-control study. BMC Musculoskelet Disord, 2015, 16(1): 72.
10. Majernicek M, Dungl P, Kolman J, et al. Osteosynthesis of intracapsular femoral neck fractures by dynamic hip screw (DHS) fixation. Acta Chir Orthop Traumatol Cech, 2009, 76(4): 319-325.
11. Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury, 2005, 36(1): 131-141.
12. Ai ZS, Gao YS, Sun Y, et al. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci, 2013, 18(2): 271-276.
13. 孙欣, 曾荣, 胡资兵, 等. 空心螺钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析. 中华创伤骨科杂志, 2012, 14(6): 477-479.
14. 张永飞, 张义修. 股骨颈骨折术后股骨头坏死的力学因素. 中国骨与关节损伤杂志, 2001, 16(4): 270-272.
15. Kim YM, Lee SH, Lee FY, et al. Morphological and biomechanical study of avascular necrosis of the femoral head. Orthopedics, 1991, 14(10): 1111-1116.
16. Brown TD, Way ME, Ferguson AB. Mechanical characteristics of bone in femoral capital aseptic necrosis. Clin Orthop Relat Res, 1981, (156): 240-247.
17. Felson DT, Anderson JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet, 1987, (8538): 902-906.

Chinese Journal of Reparative and Reconstructive Surgery

Risk of micro-fracture in femoral head after removal of cannulated screws for femoral neck fracture

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