Clinical application of new three-dimensional honeycomb guide in percutaneous cannulated screw fixation of femoral neck fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Feng ,  WU Xiaofeng , XU Feng , QIAN Pingkang , YIN Zifei , GAO Xueqin

Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan Jiangsu, 215300, P. R. China;

Corresponding author：

WU Xiaofeng, Email: loveyouwxf @126.com

Keywords：

Femoral neck fracture; new three-dimensional honeycomb guide; internal fixation; cannulated screw

DOI：

10.7507/1002-1892.202107106

Video：

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Objective To design a new type of three-dimensional honeycomb guide for percutaneous cannulated screw placement in femoral neck fracture and evaluate its effectiveness. Methods The clinical data of 40 patients with femoral neck fracture who met the selection criteria between June 2019 and December 2020 were retrospectively analyzed. According to different intraoperative positioning methods, they were divided into control group (20 cases, free hand positioning screws) and study group (20 cases, new guide assisted positioning screws). There was no significant difference in gender, age, side, cause of injury, Garden classification, and time from injury to operation between the two groups (P>0.05). The operation time, fluoroscopy times, guide needle puncture times, and fracture healing time of the two groups were recorded. The hip function was evaluated by Harris score at last follow-up. At immediate after operation, the following imaging indexes were used to evaluate the accuracy of screw implantation distribution: screw spacing, screw coverage area, distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation. Results All operations were successfully completed, and the guide needle did not penetrate the femoral neck cortex. There was no significant difference in operation time and fluoroscopy times between the two groups (P>0.05); the guide needle puncture times in the study group was significantly less than that in the control group (t=8.209, P=0.000). Imaging detection at immediate after operation showed that the screw spacing and screw coverage area in the study group were significantly greater than those in the control group (P<0.05); the distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation were significantly smaller than those in the control group (P<0.05). All patients were followed up 7-25 months, with an average of 19.3 months. There was no significant difference in follow-up time between the two groups (t=−0.349, P=0.729). There were 2 cases of fracture nonunion in the control group and 1 case in the study group, and the other fractures completely healed. One case of osteonecrosis of the femoral head occurred in the control group. During the follow-up, there was no complication such as vascular and nerve injury, venous thrombosis, screw penetration, withdrawal, breakage, and refracture, etc. There was no significant difference in fracture healing time and Harris score at last follow-up between the two groups (P>0.05). Conclusion The new three-dimensional honeycomb guide has the advantages of simple structure and convenient use. It can reduce the puncture times of the guide needle and effectively improve the accuracy distribution of cannulated screw implantation.

Citation： GAO Feng, WU Xiaofeng, XU Feng, QIAN Pingkang, YIN Zifei, GAO Xueqin. Clinical application of new three-dimensional honeycomb guide in percutaneous cannulated screw fixation of femoral neck fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(1): 65-70. doi: 10.7507/1002-1892.202107106 Copy

1.	Chang CH, Tsai SW, Wu PK, et al. Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients. Hip Int, 2020, 30(4): 474-480.
2.	Wang Z, Yin Y, Li Q, et al. Comparison of early complications between the use of a cannulated screw locking plate and multiple cancellous screws in the treatment of displaced intracapsular hip fractures in young adults: a randomized controlled clinical trial. J Orthop Surg Res, 2018, 13(1): 201. doi: 10.1186/s13018-018-0901-3.
3.	Cui S, Wang D, Wang X, et al. The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis. J Orthop Surg Res, 2020, 15(1): 433. doi: 10.1186/s13018-020-01958-2.
4.	Erivan R, Fassot G, Villatte G, et al. Results of femoral neck screw fixation in 112 under 65-years-old at a minimum 2 years’ follow-up. Orthop Traumatol Surg Res, 2020, 106(7): 1425-1431.
5.	Zhao G, Liu M, Li B, et al. Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality. J Orthop Surg Res, 2021, 16(1): 450. doi: 10.1186/s13018-021-02580-6.
6.	Zhu ZD, Xiao CW, Tan B, et al. TiRobot-assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures: A minimum 2-year follow-up of 50 patients. Orthop Surg, 2021, 13(1): 244-252.
7.	Zhang RY, Su XY, Zhao JX, et al. Three-dimensional morphological analysis of the femoral neck torsion angle-an anatomical study. J Orthop Surg Res, 2020, 15(1): 192. doi: 10.1186/s13018-020-01712-8.
8.	Selvan VT, Oakley MJ, Rangan A, et al. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury, 2004, 35(2): 136-141.
9.	Ye Y, Hao J, Mauffrey C, et al. Optimizing stability in femoral neck fracture fixation. Orthopedics, 2015, 38(10): 625-630.
10.	Cui H, Wei W, Shao Y, et al. Finite element analysis of fixation effect for femoral neck fracture under different fixation configurations. Comput Methods Biomech Biomed Engin, 2021: 1-8.
11.	何晓君, 徐红伟, 季康, 等. 股骨颈骨折2枚空心螺钉内固定的力学稳定性研究. 中国骨伤, 2016, 29(11): 994-1000.
12.	Sadic S, Custovic S, Jasarevuc M, et al. Proximal femoral nail antirotation in treatment of intertrochanteric hip fractures: a retrospective study in 113 patients. Med Arch, 2015, 69(6): 352-356.
13.	阮哲, 朱勇, 林涨源, 等. 正三角和倒三角排列空心螺钉治疗股骨颈骨折的系统评价. 中国组织工程研究, 2020, 24(6): 924-930.
14.	Vitalkar S, Manglunia AS, Kulkarni A, et al. Compression type stress fracture of femoral neck with equivocal X-ray features diagnosed on (99m)Tc-MDP SPECT/CT in a case of trivial hip pain. Indian J Nucl Med, 2016, 31(3): 225-228.
15.	Zhu Q, Shi B, Xu B, et al. Obtuse triangle screw configuration for optimal internal fixation of femoral neck fracture: an anatomical analysis. Hip Int, 2019, 29(1): 72-76.

1. Chang CH, Tsai SW, Wu PK, et al. Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients. Hip Int, 2020, 30(4): 474-480.
2. Wang Z, Yin Y, Li Q, et al. Comparison of early complications between the use of a cannulated screw locking plate and multiple cancellous screws in the treatment of displaced intracapsular hip fractures in young adults: a randomized controlled clinical trial. J Orthop Surg Res, 2018, 13(1): 201. doi: 10.1186/s13018-018-0901-3.
3. Cui S, Wang D, Wang X, et al. The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis. J Orthop Surg Res, 2020, 15(1): 433. doi: 10.1186/s13018-020-01958-2.
4. Erivan R, Fassot G, Villatte G, et al. Results of femoral neck screw fixation in 112 under 65-years-old at a minimum 2 years’ follow-up. Orthop Traumatol Surg Res, 2020, 106(7): 1425-1431.
5. Zhao G, Liu M, Li B, et al. Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality. J Orthop Surg Res, 2021, 16(1): 450. doi: 10.1186/s13018-021-02580-6.
6. Zhu ZD, Xiao CW, Tan B, et al. TiRobot-assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures: A minimum 2-year follow-up of 50 patients. Orthop Surg, 2021, 13(1): 244-252.
7. Zhang RY, Su XY, Zhao JX, et al. Three-dimensional morphological analysis of the femoral neck torsion angle-an anatomical study. J Orthop Surg Res, 2020, 15(1): 192. doi: 10.1186/s13018-020-01712-8.
8. Selvan VT, Oakley MJ, Rangan A, et al. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury, 2004, 35(2): 136-141.
9. Ye Y, Hao J, Mauffrey C, et al. Optimizing stability in femoral neck fracture fixation. Orthopedics, 2015, 38(10): 625-630.
10. Cui H, Wei W, Shao Y, et al. Finite element analysis of fixation effect for femoral neck fracture under different fixation configurations. Comput Methods Biomech Biomed Engin, 2021: 1-8.
11. 何晓君, 徐红伟, 季康, 等. 股骨颈骨折2枚空心螺钉内固定的力学稳定性研究. 中国骨伤, 2016, 29(11): 994-1000.
12. Sadic S, Custovic S, Jasarevuc M, et al. Proximal femoral nail antirotation in treatment of intertrochanteric hip fractures: a retrospective study in 113 patients. Med Arch, 2015, 69(6): 352-356.
13. 阮哲, 朱勇, 林涨源, 等. 正三角和倒三角排列空心螺钉治疗股骨颈骨折的系统评价. 中国组织工程研究, 2020, 24(6): 924-930.
14. Vitalkar S, Manglunia AS, Kulkarni A, et al. Compression type stress fracture of femoral neck with equivocal X-ray features diagnosed on (99m)Tc-MDP SPECT/CT in a case of trivial hip pain. Indian J Nucl Med, 2016, 31(3): 225-228.
15. Zhu Q, Shi B, Xu B, et al. Obtuse triangle screw configuration for optimal internal fixation of femoral neck fracture: an anatomical analysis. Hip Int, 2019, 29(1): 72-76.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of new three-dimensional honeycomb guide in percutaneous cannulated screw fixation of femoral neck fracture

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