Cannulated Screw Fixation For Femoral neck Fractures : A 5-year experience In A Single Institution

Abstract

Cannulated screw fixation is a widely accepted surgical method for management of fractures of the neck of femur especially in patients with poor premorbid conditions, minimally displaced fractures and those from a younger age group. A five year retrospective study was carried out in 53 consecutive patients between 2006 to 2010 to determine the pattern of injuries, management, outcomes and the associated predictive factors.All the patients underwent cannulated screw fixation, with 37 (69.8%) having had surgery within 24 hours and the remaining 16 (30.2%) 24 hours after the initial injury. All patients were followed up to union of fractures and complications thereafter if any. Good outcome was observed in 43 (81.1%) patients leaving only 10 (18.9%) patients with a poor outcome, of whom nine developed avascular necrosis (90%) and one non-union (10%). We found no significant relationship between the incidence of avascular necrosis and age of patient, fracture displacement, numbers of cannulated screws used, fracture reduction acceptability and anatomical location of the fracture. The time interval from injury to surgery and the presence of posterior comminution did seem to influence the rate of avascular necrosis but due to the small number of patients, was not statistically significant.We conclude that cannulated screw fixation is a viable option of treatment for fractures of the neck of femur.Key Wordsfemoral neck fractures, screw fixation

Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis

“…Data on age were available for the meta-analysis from 4 studies [16, 17, 19, 28], and nonsignificant heterogeneity was presented among the studies ( I 2 = 17%, P = 0.31). Therefore, the fixed effect model was applied.…”

Ordinary Cannulated Compression Screws or Headless Cannulated Compression Screws? A Synthetic Bone Biomechanical Research in the Internal Fixation of Vertical Femoral Neck Fracture

“…A 17-item survey showed that for the undisplaced fracture near 80% surgeons prefer using OCCS [ 14 ]. In the retrospective study of 59 patients in a single institution, 4/5 of them treated with OCCS showed good results at last [ 15 ]. However, for the more vertical fracture, the rate of failure and complication has risen obviously because of the increase of shear force [ 16 , 17 ].…”

The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures

“…In the younger population, primary osteosyntheisis is recommended as it is relatively inexpensive and minimally invasive procedure. Also with adequate reduction, maximal bone contact can be achieved which is sufficient for early immobilization and efficiently promote bone healing 1 7 14) . Specially, when the cannulated screw is used as a fixation method, the use of guide wire can accurately determine the size and the position of the screw thereby providing optimal stability even with minimal invasion to the fracture site 4 11) The operation of femoral neck fracture is usually perfromed with the use of fracture table but in the current series, all operations were performed using conventional operation table.…”

“…However, the operation result depends on the experience and proficiency of the operator and the exposure to radiation by the fluoroscopy, risk of fixation failure, nonunion and AVN remains possible complications 1 2 3 4) . When the primary osteosynthesis is attempted in the femoral neck fracture, AVN is reported to occur in 10-45% and nonunion in 10-30% 3 5 6 14 15) . This is consistent with our series as the nonunion occurred in 11% and AVN in 22%.…”