Comparative study of fresh femoral neck fractures managed by multiple cancellous screws with and without fibular graft in young adults

Kumar, Snajay; Bharti, Ajay; Rawat, Ashok; Kumar, Vikesh; Avasthi, Sachin

doi:10.1016/j.jcot.2014.12.008

Cited by 13 publications

(11 citation statements)

References 31 publications

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“…13 Kumar et al reported 40 cases of femoral neck fracture treated with multiple cannulated screws in younger patients with union in 31 patients. 8 The osseous union, in our study was achieved at 16±8 weeks in group A and 16±8 weeks in group B. In our series all fractures were displaced, Garden type III, 73.33% in group A, 78.57% in group B and Garden IV, 26.66% in group A and 21.4% in group B.…”

Section: Discussionsupporting

confidence: 54%

“…A cancellous screw with a single fibular graft has been reported with excellent results in patients below the age of 50 years. 8 Free fibular grafting has been widely studied as a method to introduce both structural support and a graft framework due to osteoconductive and osteo-inductive properties, in a femoral neck fracture. 10,11 Harris hip score of 4 patients in group A and patients in group B had excellent results and 2 patients in group A and group B had good results.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover it is technically easy to harvest the graft. 8 We conducted a retrospective study of patients with femoral neck fractures in our centre treated with multiple cancellous screws with or without fibular graft.…”

Section: Introductionmentioning

confidence: 99%

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Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Wisesa¹,

Dusak²

2020

Int J Res Med Sci

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Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16±8 weeks in both groups. There is no complication such as non-union, avascular necrosis of femoral head and/or broken fibular graft in both the groups occurrences. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost effective and technically less demanding and associated with good outcomes. There is no added advantage of non-vascularized fibular grafting with multiple hip screw fixation in fresh femoral neck fractures in young adults over multiple hip screw fixation alone.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Wisesa¹,

Dusak²

2020

Int J Res Med Sci

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“…33,34 More recently, this concept has been introduced to other fractures that are prone to subsidence, loss of reduction, or poor bony fixation including tibial plateau fractures 35,36 and femoral neck fractures. 37–39 One technique using a fibular strut allograft, described by Lorich et al in 2013 was developed with the benefits of fixed-angle, length stable fixation in mind. 40 The technique also seeks to capitalize on the biomechanical benefits (increased stiffness and decreased fracture displacement) of widely spread inverted triangle cannulated screw constructs with a Pauwel screw placed perpendicular to the fracture.…”

Section: Introductionmentioning

confidence: 99%

Novel Treatment Options for the Surgical Management of Young Femoral Neck Fractures

Levack

Gausden

Dvorzhinskiy

et al. 2019

Journal of Orthopaedic Trauma

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In physiologically young patients with displaced femoral neck fractures, surgical treatment is aimed at achieving fracture union while preserving native hip anatomy and biomechanics. The intra-capsular environment, tenuous vascular supply, and unfavorable hip biomechanics contribute to the high complication rates seen following osteosynthesis of these fractures. Conventional fixation methods for osteosynthesis of femoral neck fractures include multiple cancellous screws, fixed-angle dynamic implants, and fixed-angle length-stable constructs. Despite several biomechanical and clinical studies evaluating various surgical options, the optimal fixation construct to allow healing and prevent non-union of displaced femoral neck fractures is not known. This article will review the clinical data regarding conventional fixation constructs and describe the technique and rationale behind two novel alternative treatment options for these challenging fractures. The surgical technique and clinical examples for constructs involving multiple cannulated screws/Pauwels screw augmented with a fibular strut graft as well as a novel fixed-angle locking plate with controlled dynamic compression are presented.

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“…Reported incidence of nonunion after three-cannulated-screw fixation ranged from 13.3% to 21.8% and many risk factors including impropriate crew fixation configuration, displaced fracture, and poor reduction have been revealed [1–3]. …”

Section: Introductionmentioning

confidence: 99%

Metformin Prevents Nonunion after Three-Cannulated-Screw Fixation in Displaced Femoral Neck Fractures: A Retrospective Study

Zhu

Zheng

2016

BioMed Research International

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Patients aged from 40 to 60 with displaced fractures of the femoral neck (Garden III or IV) who received fixation with three cannulated screws from January 2005 to December 2012 were evaluated retrospectively for the development of nonunion. Plasma HbA1C, a marker for long-term plasma glucose level, anti-T2DM medication, and other potential risk factors were recorded for the purpose of this study. There were no differences between the union and nonunion groups with respect to age, gender, Garden classification, Pauwel's angle, reduction quality, and T2DM presence. There were significant differences in reduction quality and preoperative plasma HbA1C level between patients with and those without union. The odds ratio (OR) for fracture nonunion was 2.659 (95% confidence interval [CI], 1.530–4.620) in subjects with anatomical reduction compared with those without anatomical reduction, 4.797 (95% CI, 1.371–16.778), in subjects with poor blood glucose control (HbA1C > 10%). The metformin usage showed a preventive effect on nonunion development (OR: 0.193 and CI: 0.060–0.616). The nonunion rate of metformin group (6.7%, 6/89) was even much lower than that of patients without T2DM (17.4%, 80/460).

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Comparative study of fresh femoral neck fractures managed by multiple cancellous screws with and without fibular graft in young adults

Abstract: Fresh femoral neck fracture in young adults managed with multiple cancellous screws fixation with fibular graft has no added advantage over multiple cancellous screws fixation alone.

Cited by 13 publications

References 31 publications

Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Novel Treatment Options for the Surgical Management of Young Femoral Neck Fractures

Metformin Prevents Nonunion after Three-Cannulated-Screw Fixation in Displaced Femoral Neck Fractures: A Retrospective Study

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