Effectiveness analysis of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Hai , YE Junjian , CHEN Chunyong , WU Gui , CHEN Yaoqing ,  XIE Yun

Department of Orthopedic Trauma & Ankle Surgery, Fujian Trauma Medical Center, First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350004, P. R. China;

Corresponding author：

XIE Yun, Email: xyxlr@126.com

Keywords：

Femoral neck fracture; young adult; internal fixation; sartorius pedicled iliac flap; osteonecrosis of the femoral head

DOI：

10.7507/1002-1892.202108093

Video：

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Objective To evaluate the effectiveness of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults. Methods The clinical data of 11 young adult patients with femoral neck fractures between February 2013 and February 2019 were analyzed retrospectively. There were 7 males and 4 females with a mean age of 45 years (range, 32-58 years). Fractures were caused by falling from height in 6 cases, by traffic accident in 4 cases, and by sports injury in 1 case. There were 7 cases in the left hip and 4 cases in the right hip. The mean Pauwels angle was 64° (range, 55°-75°). All patients were treated by medial buttress plate augmented hollow lag screws fixation and sartorius pedicled iliac flap. The X-ray film of pelvis, lateral X-ray film of hip joint, CT scan and three-dimensional reconstruction of hip joint were taken after operation to assess fracture healing and position of the internal fixators. The postoperative hip function was evaluated according to the Harris score. Results All the incisions healed by first intention, and no complication such as incision infection and lateral femoral cutaneous nerve injury happened. Re-examination on the second day after operation showed that reduction and fixation of fractures was good. All patients were followed up 18-36 months (mean, 29 months). All fractures achieved bony union. The time of bony union was 16-23 weeks, with an average of 18.2 weeks. One patient (9.1%) got osteonecrosis of the femoral head (ONFH) at 30 months after operation. At last follow-up, Harris score was used to evaluate hip joint function, 9 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 90.9%. Conclusion Medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults has the advantage of strong biomechanical stability and can effectively improve the blood supply of femoral head and neck, which subsequently reduce the incidence of ONFH. However, the surgical indication should be fully considered.

Citation： WANG Hai, YE Junjian, CHEN Chunyong, WU Gui, CHEN Yaoqing, XIE Yun. Effectiveness analysis of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 163-169. doi: 10.7507/1002-1892.202108093 Copy

1.	Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg (Am), 2004, 86(8): 1711-1716.
2.	Willert HG, Buchhorn GH, Fayyazi A, et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg (Am), 2005, 87(1): 28-36.
3.	勘武生, 郑琼, 胡家朗, 等. 切开复位与闭合复位治疗移位型股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2011, 13(5): 401-405.
4.	Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
5.	张长青, 侯春林, 顾立强, 等. 青壮年股骨颈骨折的显微外科治疗专家共识. 中华显微外科杂志, 2016, 39(3): 209-212.
6.	中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
7.	Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
8.	Aminian A, Gao F, Fedoriw WW, et al. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma, 2007, 21(8): 544-548.
9.	谭志伟, 郑佐慧, 莫建福, 等. 带旋髂深血管髂骨瓣结合空心加压螺钉内固定治疗青壮年股骨颈骨折. 中华显微外科杂志, 2012, 35(4): 332-334.
10.	Siavashi B, Aalirezaei A, Moosavi M, et al. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop, 2015, 39(10): 2069-2071.
11.	Hoshino CM, Christian MW, O’Toole RV, et al. Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws? Injury, 2016, 47(8): 1676-1684.
12.	Berkes MB, Little MT, Lazaro LE, et al. Catastrophic failure after open reduction internal fixation of femoral neck fractures with a novel locking plate implant. J Orthop Trauma, 2012, 26(10): e170-e176.
13.	Zderic I, Oh JK, Stoffel K, et al. Biomechanical analysis of the proximal femoral locking compression plate: Do quality of reduction and screw orientation influence construct stability? J Orthop Trauma, 2018, 32(2): 67-74.
14.	Duffin M, Pilson HT. Technologies for young femoral neck fracture fixation. J Orthop Trauma, 2019, 33 Suppl 1: S20-S26.
15.	Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
16.	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.
17.	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.
18.	Stacey SC, Renninger CH, Hak D, et al. Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol, 2016, 26(4): 355-363.
19.	耿大伟, 陈思春, 江龙海, 等. 直接前侧入路切开复位空心螺钉联合内侧支撑钢板固定治疗Pauwels Ⅲ型股骨颈骨折的疗效观察. 中华解剖与临床杂志, 2020, 25(5): 503-507.
20.	沈点红, 周高尚, 查兴胜, 等. 空心螺钉结合内侧支撑钢板治疗Pauwels 3型股骨颈骨折的近期疗效观察. 中国医师杂志, 2019, 21(5): 144-147.
21.	Zhuang L, Wang L, Xu D, et al. Anteromedial femoral neck plate with cannulated screws for the treatment of irreducible displaced femoral neck fracture in young patients: a preliminary study. Eur J Trauma Emerg Surg, 2019, 45(6): 995-1002.
22.	庄乐彬, 廖华, 胡稷杰. 自体骨瓣移植在青壮年股骨颈骨折治疗中的应用进展. 中国临床解剖学杂志, 2019, 37(6): 729-731.
23.	龚渭波, 段祥林, 姚正国, 等. 缝匠肌蒂髂骨瓣及加压螺钉在中青年股骨颈骨折中的应用. 中国修复重建外科杂志, 2007, 21(12): 1386-1387.
24.	陈家禄, 李家元. 缝匠肌蒂骨瓣植骨治疗45例青壮年股骨颈骨折. 中华创伤杂志, 1995, 11(4): 209-210.
25.	Mei J, Quan K, Wang H, et al. Total cross-sectional area of the femoral neck nutrient foramina measured to assess arterial vascular beds in the femoral head. J Orthop Surg Res, 2019, 14(1): 439. doi: 10.1186/s13018-019-1480-7. doi: 10.1186/s13018-019-1480-7.
26.	Putnam SM, Collinge CA, Gardner MJ, et al. Vascular anatomy of the medial femoral neck and implications for surface plate fixation. J Orthop Traum, 2019, 33(3): 111-115.
27.	Marchand LS, Karns M, Higgins TF, et al. Femoral neck fracture fixation with a medial buttress plate that led to impingement with hip flexion: A case report. JBJS Case Connect, 2019, 9(1): e21. doi: 10.2106/JBJS.CC.18.00135.
28.	倪明, 孙万驹, 叶晔. 内侧支撑钢板辅助固定治疗青壮年股骨颈骨折的研究进展. 中国修复重建外科杂志, 2020, 34(11): 1454-1457.

1. Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg (Am), 2004, 86(8): 1711-1716.
2. Willert HG, Buchhorn GH, Fayyazi A, et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg (Am), 2005, 87(1): 28-36.
3. 勘武生, 郑琼, 胡家朗, 等. 切开复位与闭合复位治疗移位型股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2011, 13(5): 401-405.
4. Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
5. 张长青, 侯春林, 顾立强, 等. 青壮年股骨颈骨折的显微外科治疗专家共识. 中华显微外科杂志, 2016, 39(3): 209-212.
6. 中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
7. Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
8. Aminian A, Gao F, Fedoriw WW, et al. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma, 2007, 21(8): 544-548.
9. 谭志伟, 郑佐慧, 莫建福, 等. 带旋髂深血管髂骨瓣结合空心加压螺钉内固定治疗青壮年股骨颈骨折. 中华显微外科杂志, 2012, 35(4): 332-334.
10. Siavashi B, Aalirezaei A, Moosavi M, et al. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop, 2015, 39(10): 2069-2071.
11. Hoshino CM, Christian MW, O’Toole RV, et al. Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws? Injury, 2016, 47(8): 1676-1684.
12. Berkes MB, Little MT, Lazaro LE, et al. Catastrophic failure after open reduction internal fixation of femoral neck fractures with a novel locking plate implant. J Orthop Trauma, 2012, 26(10): e170-e176.
13. Zderic I, Oh JK, Stoffel K, et al. Biomechanical analysis of the proximal femoral locking compression plate: Do quality of reduction and screw orientation influence construct stability? J Orthop Trauma, 2018, 32(2): 67-74.
14. Duffin M, Pilson HT. Technologies for young femoral neck fracture fixation. J Orthop Trauma, 2019, 33 Suppl 1: S20-S26.
15. Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
16. 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.
17. 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.
18. Stacey SC, Renninger CH, Hak D, et al. Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol, 2016, 26(4): 355-363.
19. 耿大伟, 陈思春, 江龙海, 等. 直接前侧入路切开复位空心螺钉联合内侧支撑钢板固定治疗Pauwels Ⅲ型股骨颈骨折的疗效观察. 中华解剖与临床杂志, 2020, 25(5): 503-507.
20. 沈点红, 周高尚, 查兴胜, 等. 空心螺钉结合内侧支撑钢板治疗Pauwels 3型股骨颈骨折的近期疗效观察. 中国医师杂志, 2019, 21(5): 144-147.
21. Zhuang L, Wang L, Xu D, et al. Anteromedial femoral neck plate with cannulated screws for the treatment of irreducible displaced femoral neck fracture in young patients: a preliminary study. Eur J Trauma Emerg Surg, 2019, 45(6): 995-1002.
22. 庄乐彬, 廖华, 胡稷杰. 自体骨瓣移植在青壮年股骨颈骨折治疗中的应用进展. 中国临床解剖学杂志, 2019, 37(6): 729-731.
23. 龚渭波, 段祥林, 姚正国, 等. 缝匠肌蒂髂骨瓣及加压螺钉在中青年股骨颈骨折中的应用. 中国修复重建外科杂志, 2007, 21(12): 1386-1387.
24. 陈家禄, 李家元. 缝匠肌蒂骨瓣植骨治疗45例青壮年股骨颈骨折. 中华创伤杂志, 1995, 11(4): 209-210.
25. Mei J, Quan K, Wang H, et al. Total cross-sectional area of the femoral neck nutrient foramina measured to assess arterial vascular beds in the femoral head. J Orthop Surg Res, 2019, 14(1): 439. doi: 10.1186/s13018-019-1480-7. doi: 10.1186/s13018-019-1480-7.
26. Putnam SM, Collinge CA, Gardner MJ, et al. Vascular anatomy of the medial femoral neck and implications for surface plate fixation. J Orthop Traum, 2019, 33(3): 111-115.
27. Marchand LS, Karns M, Higgins TF, et al. Femoral neck fracture fixation with a medial buttress plate that led to impingement with hip flexion: A case report. JBJS Case Connect, 2019, 9(1): e21. doi: 10.2106/JBJS.CC.18.00135.
28. 倪明, 孙万驹, 叶晔. 内侧支撑钢板辅助固定治疗青壮年股骨颈骨折的研究进展. 中国修复重建外科杂志, 2020, 34(11): 1454-1457.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults

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