Treatment of unstable femoral neck fracture with posteromedial comminutations by cannulated screws and medial bracing plate combined with bone allograft_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SU Yuhui , WANG Bowen , CHEN Ruisong , CHEN Xiaolin , WANG Guangze , HUANG Yanpeng , HUANG Jianming , LIU Haoyuan ,  HUANG Zheyuan

Department of Orthopedics, Hospital of the 73rd Group Army (Key Orthopaedic Specialties Specialties of Xiamen City 2015347), Xiamen Fujian, 361000, P.R.China;

Corresponding author：

HUANG Zheyuan, Email: aoplate@qq.com

Keywords：

Femoral neck fracture; unstable fracture; internal fixation; bone graft; plate

DOI：

10.7507/1002-1892.202105101

Video：

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Objective To evaluate the effectiveness of unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft. Methods The clinical data of 18 patients with unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft between July 2016 and March 2020 were retrospectively analyzed. The age ranged from 22 to 64 years, with a median age of 43 years. The causes of injury included 11 cases of falling injury, 3 cases of traffic accident injury, and 4 cases of fall from height injury. According to Garden classification, the femoral neck fracture was classified as type Ⅲ in 3 cases, type Ⅳ in 15 cases, and all patients were type Ⅲ according to Pauwels classification. The time from injury to operation was 1-5 days, with an average of 2.3 days. The fracture healing time and complications were recorded. The quality of fracture reduction was evaluated by Garden index immediately after operation; at last follow-up, the degree of femoral neck shortening was determined by Zlowodzki method, Harris score was used to evaluate hip function. Results The operation time was 62-98 minutes (mean, 75 minutes); intraoperative blood loss was 101-220 mL (mean, 153 mL). Cannulated screws guide wire was inserted 3-5 times (mean, 4 times). Intraoperative fluoroscopy was performed 9-21 times (mean, 15 times). The hospital stay was 5-11 days (mean, 7.2 days). All the patients were followed up 12-40 months with an average of 17.3 months. There was no postoperative complication such as accumulated pneumonia, lower extremity deep venous thrombosis, nail cutting, nail withdrawal, internal fixation fracture, and so on. There was no fracture nonunion and osteonecrosis of the femoral head during the follow-up; the fracture healing time was 7-15 weeks, with an average of 12.1 weeks. The quality of fracture reduction was evaluated immediately after operation, the results were grade Ⅰ in 15 cases and grade Ⅱ in 3 cases. At last follow-up, there were 2 cases with femoral neck shortening less than 5 mm and 1 case with 5-10 mm. The incidence of femoral neck shortening was 16.7%. The Harris score of hip joint was 73-97, with an average of 93.5; among them, 12 cases were rated as excellent, 3 cases as good, and 3 cases as fair, with an excellent and good rate of 83.3%. Conclusion For the treatment of unstable femoral neck fracture with posteromedial comminutations, cannulated screws and medial bracing plate combined with bone allograft are dramatically effective due to earlier weight bearing, faster fracture healing, and better hip function recovery.

Citation： SU Yuhui, WANG Bowen, CHEN Ruisong, CHEN Xiaolin, WANG Guangze, HUANG Yanpeng, HUANG Jianming, LIU Haoyuan, HUANG Zheyuan. Treatment of unstable femoral neck fracture with posteromedial comminutations by cannulated screws and medial bracing plate combined with bone allograft. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(11): 1434-1439. doi: 10.7507/1002-1892.202105101 Copy

1.	Lifeso R, Younge D. The neglected hip fracture. J Orthop Trauma, 1990, 4(3): 287-292.
2.	Leung PC, Shen WY. Fracture of the femoral neck in younger adults. A new method of treatment for delayed and nonunions. Clin Orthop Relat Res, 1993, (295): 156-160.
3.	Robinson CM, Court-Brown CM, McQueen MM, et al. Hip fractures in adults younger than 50 years of age. Epidemiology and results. Clin Orthop Relat Res, 1995, (312): 238-246.
4.	Dedrick DK, Mackenzie JR, Burney RE. Complications of femoral neck fracture in young adults. J Trauma, 1986, 26(10): 932-937.
5.	Swiontkowski MF, Winquist RA, Hansen ST. Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg (Am), 1984, 66(6): 837-846.
6.	Protzman RR, Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg (Am), 1976, 58(5): 689-695.
7.	林绪超, 何文, 郑竑, 等. 经皮空心钉联合DAA入路微创支撑钢板内固定治疗青壮年Pauwels Ⅲ型股骨颈骨折的近期疗效. 中国骨与关节损伤杂志, 2019, 34(6): 593-595.
8.	Ye Y, Chen K, Tian K, et al. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results. Injury, 2017, 48(10): 2189-2193.
9.	Mir H, Collinge C. Application of a medial buttress plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults. Med Hypotheses, 2015, 84(5): 429-433.
10.	Zlowodzki M, Ayeni O, Petrisor BA, et al. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma, 2008, 64(1): 163-169.
11.	Skála-Rosenbaum J, Dzupa V, Bartonícek J, et al. Osteosynthesis of intracapsular femoral neck fractures. Rozhl Chir, 2005, 84(6): 291-298.
12.	Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res, 2007, 458: 175-179.
13.	Liu J, Zhang B, Yin B, et al. Biomechanical evaluation of the modified cannulated screws fixation of unstable femoral neck fracture with comminuted posteromedial cortex. Biomed Res Int, 2019, 2019: 2584151. doi: 10.1155/2019/2584151.
14.	Rajnish RK, Haq RU, Aggarwal AN, et al. Four screws diamond configuration fixation for displaced, comminuted intracapsular fracture neck femur in young adults. Indian J Orthop, 2019, 53(1): 70-76.
15.	林焱斌, 余光书, 钟志辉, 等. 新构型四枚空心钉固定极不稳定型股骨颈骨折生物力学分析. 中华创伤骨科杂志, 2019, 21(2): 160-165.
16.	Jaiswal A, Pruthi KK, Goyal RK, et al. Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures. J Clin Orthop Trauma, 2013, 4(2): 58-69.
17.	Zahid M, Bin Sabir A, Asif N, et al. Fixation using cannulated screws and fibular strut grafts for fresh femoral neck fractures with posterior comminution. J Orthop Surg (Hong Kong), 2012, 20(2): 191-195.
18.	Ye Y, Hao J, Mauffrey C, et al. Optimizing stability in femoral neck fracture fixation. Orthopedics, 2015, 38(10): 625-630.
19.	许步伟, 朱文峰, 裴介成, 等. 中青年股骨颈粉碎性骨折行内固定加股方肌肌骨瓣移植治疗19例. 南通医学院学报, 2009, 29(6): 514-515.
20.	杨友全, 江涛, 林成君, 等. 短板Richrd钉内固定股方肌骨瓣转位术治疗青壮年股骨颈粉碎性骨折. 中国煤炭工业医学杂志, 2001, 4(1): 27-28.
21.	Lazaro LE, Birnbaum JF, Farshad-Amacker NA, et al. Endosteal biologic augmentation for surgical fixation of displaced femoral neck fractures. J Orthop Trauma, 2016, 30(2): 81-88.
22.	Giordano V, Alves DD, Paes RP, et al. The role of the medial plate for Pauwels type Ⅲ femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws. J Exp Orthop, 2019, 6(1): 18. doi: 10.1186/s40634-019-0187-3.
23.	Kunapuli SC, Schramski MJ, Lee AS, et al. Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma, 2015, 29(3): 144-150.
24.	Putnam SM, Collinge CA, Gardner MJ, et al. Vascular anatomy of the medial femoral neck and implications for surface plate fixation. J Orthop Trauma, 2019, 33(3): 111-115.

1. Lifeso R, Younge D. The neglected hip fracture. J Orthop Trauma, 1990, 4(3): 287-292.
2. Leung PC, Shen WY. Fracture of the femoral neck in younger adults. A new method of treatment for delayed and nonunions. Clin Orthop Relat Res, 1993, (295): 156-160.
3. Robinson CM, Court-Brown CM, McQueen MM, et al. Hip fractures in adults younger than 50 years of age. Epidemiology and results. Clin Orthop Relat Res, 1995, (312): 238-246.
4. Dedrick DK, Mackenzie JR, Burney RE. Complications of femoral neck fracture in young adults. J Trauma, 1986, 26(10): 932-937.
5. Swiontkowski MF, Winquist RA, Hansen ST. Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg (Am), 1984, 66(6): 837-846.
6. Protzman RR, Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg (Am), 1976, 58(5): 689-695.
7. 林绪超, 何文, 郑竑, 等. 经皮空心钉联合DAA入路微创支撑钢板内固定治疗青壮年Pauwels Ⅲ型股骨颈骨折的近期疗效. 中国骨与关节损伤杂志, 2019, 34(6): 593-595.
8. Ye Y, Chen K, Tian K, et al. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results. Injury, 2017, 48(10): 2189-2193.
9. Mir H, Collinge C. Application of a medial buttress plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults. Med Hypotheses, 2015, 84(5): 429-433.
10. Zlowodzki M, Ayeni O, Petrisor BA, et al. Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma, 2008, 64(1): 163-169.
11. Skála-Rosenbaum J, Dzupa V, Bartonícek J, et al. Osteosynthesis of intracapsular femoral neck fractures. Rozhl Chir, 2005, 84(6): 291-298.
12. Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res, 2007, 458: 175-179.
13. Liu J, Zhang B, Yin B, et al. Biomechanical evaluation of the modified cannulated screws fixation of unstable femoral neck fracture with comminuted posteromedial cortex. Biomed Res Int, 2019, 2019: 2584151. doi: 10.1155/2019/2584151.
14. Rajnish RK, Haq RU, Aggarwal AN, et al. Four screws diamond configuration fixation for displaced, comminuted intracapsular fracture neck femur in young adults. Indian J Orthop, 2019, 53(1): 70-76.
15. 林焱斌, 余光书, 钟志辉, 等. 新构型四枚空心钉固定极不稳定型股骨颈骨折生物力学分析. 中华创伤骨科杂志, 2019, 21(2): 160-165.
16. Jaiswal A, Pruthi KK, Goyal RK, et al. Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures. J Clin Orthop Trauma, 2013, 4(2): 58-69.
17. Zahid M, Bin Sabir A, Asif N, et al. Fixation using cannulated screws and fibular strut grafts for fresh femoral neck fractures with posterior comminution. J Orthop Surg (Hong Kong), 2012, 20(2): 191-195.
18. Ye Y, Hao J, Mauffrey C, et al. Optimizing stability in femoral neck fracture fixation. Orthopedics, 2015, 38(10): 625-630.
19. 许步伟, 朱文峰, 裴介成, 等. 中青年股骨颈粉碎性骨折行内固定加股方肌肌骨瓣移植治疗19例. 南通医学院学报, 2009, 29(6): 514-515.
20. 杨友全, 江涛, 林成君, 等. 短板Richrd钉内固定股方肌骨瓣转位术治疗青壮年股骨颈粉碎性骨折. 中国煤炭工业医学杂志, 2001, 4(1): 27-28.
21. Lazaro LE, Birnbaum JF, Farshad-Amacker NA, et al. Endosteal biologic augmentation for surgical fixation of displaced femoral neck fractures. J Orthop Trauma, 2016, 30(2): 81-88.
22. Giordano V, Alves DD, Paes RP, et al. The role of the medial plate for Pauwels type Ⅲ femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws. J Exp Orthop, 2019, 6(1): 18. doi: 10.1186/s40634-019-0187-3.
23. Kunapuli SC, Schramski MJ, Lee AS, et al. Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma, 2015, 29(3): 144-150.
24. Putnam SM, Collinge CA, Gardner MJ, et al. Vascular anatomy of the medial femoral neck and implications for surface plate fixation. J Orthop Trauma, 2019, 33(3): 111-115.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of unstable femoral neck fracture with posteromedial comminutations by cannulated screws and medial bracing plate combined with bone allograft

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