Treatment of femoral neck fractures with closed reduction assisted by joystick technique and cannulated screw fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Lei ¹ , ZHANG Jianfeng ¹ , LIU Xin ² , WU Zhixin ¹ , WU Aimin ¹

1. The Fourth Department of Trauma Orthopaedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;
2. Department of Rehabilitation Medicine, Tangshan Workers’ Hospital, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

WANG Lei, Email: wanglei2003814@163.com

Keywords：

Femoral neck fracture; internal fixation; joystick technique; closed reduction; femoral neck shortening; score of fracture reduction

DOI：

10.7507/1002-1892.202303044

Video：

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Objective To investigate the effectiveness of joystick technique assisted closed reduction and cannulated screw fixation in the treatment of femoral neck fracture. Methods Seventy-four patients with fresh femoral neck fractures who met the selection criteria between April 2017 and December 2018 were selected and divided into observation group (36 cases with closed reduction assisted by joystick technique) and control group (38 cases with closed manual reduction). There was no significant difference in gender, age, fracture side, cause of injury, Garden classification, Pauwels classification, time from injury to operation, and complications (except for hypertension) between the two groups (P>0.05). The operation time, intraoperative infusion volume, complications, and femoral neck shortening were recorded and compared between the two groups. Garden reduction index was used to evaluate the effect of fracture reduction, and score of fracture reduction (SFR) was designed and was used to evaluate the subtle reduction effect of joystick technique. Results The operation was successfully completed in both groups. There was no significant difference in operation time and intraoperative infusion volume between the two groups (P>0.05). All patients were followed up 17-38 months, with an average of 27.7 months. Two patients in the observation group received joint replacement due to failure of internal fixation during the follow-up, and the other patients had fracture healing. Within 1 week after operation, the Garden reduxtion index of the observation group was better than the control group; the SFR score of the observation group was also higher than that of the control group; the proportion of femoral neck shortening within 1 week after operation and at 1 year after operation in the observation group were lower than those in the control group. The differences of the above indexes between the two groups were significant (P<0.05). Conclusion The joystick technique can improve the effectiveness of closed reduction of femoral neck fractures and reduce the incidence of femoral neck shortening. The designed SFR score can directly and objectively evaluate the reduction effect of femoral neck fracture.

Citation： WANG Lei, ZHANG Jianfeng, LIU Xin, WU Zhixin, WU Aimin. Treatment of femoral neck fractures with closed reduction assisted by joystick technique and cannulated screw fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 681-687. doi: 10.7507/1002-1892.202303044 Copy

1.	Jiang D, Zhan S, Wang L, et al. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res, 2021, 39(8): 1669-1680.
2.	Su Y, Chen W, Zhang Q, et al. An irreducible variant of femoral neck fracture: a minimally traumatic reduction technique. Injury, 2011, 42(2): 140-145.
3.	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.
4.	Molnar RB, Routt ML. Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure. J Orthop Trauma, 2007, 21(7): 490-494.
5.	Kang JS, Moon KH, Shin JS, et al. Clinical results of internal fixation of subcapital femoral neck fractures. Clin Orthop Surg, 2016, 8(2): 146-152.
6.	Strömqvist B, Hansson LI, Palmer J, et al. Scintimetric evaluation of nailed femoral neck fractures with special reference to type of osteosynthesis. Acta Orthop Scand, 1983, 54(3): 340-347.
7.	Madsen F, Linde F, Andersen E, et al. Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws. Acta Orthop Scand, 1987, 58(3): 212-216.
8.	Kaplan T, Akesen B, Demirağ B, et al. Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures. Ulus Travma Acil Cerrahi Derg, 2012, 18(1): 65-70.
9.	Bout CA, Cannegieter DM, Juttmann JW. Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle. Injury, 1997, 28(2): 135-139.
10.	Pförringer W, Rosemeyer B. Fractures of the hip in children and adolescents. Acta Orthop Scand, 1980, 51(1): 91-108.
11.	Rau FD, Manoli A, Morawa LG. Treatment of femoral neck fractures with the sliding compression screw. Clin Orthop Relat Res, 1982, (163): 137-140.
12.	Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-e259.
13.	Uhthoff HK. Current concepts of internal fixation of fractures. Can J Surg, 1980, 23(3): 213-214.
14.	Charles MN, Bourne RB, Davey JR, et al. Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr Course Lect, 2005, 54: 131-141.
15.	Gupta M, Arya RK, Kumar S, et al. Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults. Chin J Traumatol, 2016, 19(4): 209-212.
16.	Heetveld MJ, Raaymakers EL, van Eck-Smit BL, et al. Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome? J Bone Joint Surg (Br), 2005, 87(3): 367-373.
17.	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.
18.	Costa P, Carretti P, Giancecchi F, et al. The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia. Ital J Orthop Traumatol, 1988, 14(4): 475-482.
19.	Vécsei V, Häupl J. The value of dynamic adjustment in locking intramedullary nailing. Aktuelle Traumatol, 1989, 19(4): 162-168.
20.	Wu CC, Shih CH. Effect of dynamization of a static interlocking nail on fracture healing. Can J Surg, 1993, 36(4): 302-306.
21.	Lindequist S, Törnkvist H. Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma, 1995, 9(3): 215-221.
22.	Kofoed H. Femoral neck fractures in young adults. Injury, 1982, 14(2): 146-150.
23.	Graham J. Early or delayed weight-bearing after internal fixation of transcervical fracture of the femur. A clinical trial. J Bone Joint Surg (Br), 1968, 50(3): 562-569.
24.	Loizou CL, Parker MJ. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Injury, 2009, 40(11): 1143-1146.
25.	Shih C H, Wang K C, Femoral neck fractures. 121 cases treated by Knowles pinning. Clin Orthop Relat Res, 1991, (271): 195-200.
26.	Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg (Br), 1953, 35-B(3): 442-461.
27.	Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg (Br), 1965, 47: 560-573.
28.	Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. Clin Orthop Relat Res, 1980, (152): 10-16.
29.	Lucie RS, Fuller S, Burdick DC, et al. Early prediction of avascular necrosis of the femoral head following femoral neck fractures. Clin Orthop Relat Res, 1981, (161): 207-214.

1. Jiang D, Zhan S, Wang L, et al. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res, 2021, 39(8): 1669-1680.
2. Su Y, Chen W, Zhang Q, et al. An irreducible variant of femoral neck fracture: a minimally traumatic reduction technique. Injury, 2011, 42(2): 140-145.
3. 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.
4. Molnar RB, Routt ML. Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure. J Orthop Trauma, 2007, 21(7): 490-494.
5. Kang JS, Moon KH, Shin JS, et al. Clinical results of internal fixation of subcapital femoral neck fractures. Clin Orthop Surg, 2016, 8(2): 146-152.
6. Strömqvist B, Hansson LI, Palmer J, et al. Scintimetric evaluation of nailed femoral neck fractures with special reference to type of osteosynthesis. Acta Orthop Scand, 1983, 54(3): 340-347.
7. Madsen F, Linde F, Andersen E, et al. Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws. Acta Orthop Scand, 1987, 58(3): 212-216.
8. Kaplan T, Akesen B, Demirağ B, et al. Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures. Ulus Travma Acil Cerrahi Derg, 2012, 18(1): 65-70.
9. Bout CA, Cannegieter DM, Juttmann JW. Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle. Injury, 1997, 28(2): 135-139.
10. Pförringer W, Rosemeyer B. Fractures of the hip in children and adolescents. Acta Orthop Scand, 1980, 51(1): 91-108.
11. Rau FD, Manoli A, Morawa LG. Treatment of femoral neck fractures with the sliding compression screw. Clin Orthop Relat Res, 1982, (163): 137-140.
12. Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-e259.
13. Uhthoff HK. Current concepts of internal fixation of fractures. Can J Surg, 1980, 23(3): 213-214.
14. Charles MN, Bourne RB, Davey JR, et al. Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr Course Lect, 2005, 54: 131-141.
15. Gupta M, Arya RK, Kumar S, et al. Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults. Chin J Traumatol, 2016, 19(4): 209-212.
16. Heetveld MJ, Raaymakers EL, van Eck-Smit BL, et al. Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome? J Bone Joint Surg (Br), 2005, 87(3): 367-373.
17. 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.
18. Costa P, Carretti P, Giancecchi F, et al. The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia. Ital J Orthop Traumatol, 1988, 14(4): 475-482.
19. Vécsei V, Häupl J. The value of dynamic adjustment in locking intramedullary nailing. Aktuelle Traumatol, 1989, 19(4): 162-168.
20. Wu CC, Shih CH. Effect of dynamization of a static interlocking nail on fracture healing. Can J Surg, 1993, 36(4): 302-306.
21. Lindequist S, Törnkvist H. Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma, 1995, 9(3): 215-221.
22. Kofoed H. Femoral neck fractures in young adults. Injury, 1982, 14(2): 146-150.
23. Graham J. Early or delayed weight-bearing after internal fixation of transcervical fracture of the femur. A clinical trial. J Bone Joint Surg (Br), 1968, 50(3): 562-569.
24. Loizou CL, Parker MJ. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Injury, 2009, 40(11): 1143-1146.
25. Shih C H, Wang K C, Femoral neck fractures. 121 cases treated by Knowles pinning. Clin Orthop Relat Res, 1991, (271): 195-200.
26. Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg (Br), 1953, 35-B(3): 442-461.
27. Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg (Br), 1965, 47: 560-573.
28. Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. Clin Orthop Relat Res, 1980, (152): 10-16.
29. Lucie RS, Fuller S, Burdick DC, et al. Early prediction of avascular necrosis of the femoral head following femoral neck fractures. Clin Orthop Relat Res, 1981, (161): 207-214.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of femoral neck fractures with closed reduction assisted by joystick technique and cannulated screw fixation

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