Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures

Abstract

Objective Unstable femoral neck fractures are typically high-angled shear fractures caused by high-energy trauma. Internal fixation of femoral neck fractures with placement of parallel cannulated screws in an inverted triangle configuration is commonly performed in the clinical setting. This study was performed to investigate the primary results of intramedullary nailing with cannulated screws for the treatment of unstable femoral neck fractures in young and middle-aged patients. Methods In total, 96 consecutive patients with no history of hip surgery using inverted triangular cannulated compression screws or construction nails with cannulated screws were reviewed. Their demographic and radiological data were retrospectively collected from our institutional database. Results Inverted cannulated screws had an excellent effect on decreasing the blood loss volume and incision size, but intramedullary nails exhibited superior advantages in decreasing screw exit and shortening the hospital stays. The Harris hip scores were comparable between the two groups. Conclusions Intramedullary fixation with cannulated screws has advantages in treating complicated femoral neck fractures. Besides cannulated screws, intramedullary fixation with cannulated screws might be another method to treat unstable femoral neck fractures in young and middle-aged patients. The study was registered in ClinicalTrials.gov. Unique Protocol ID: 11156458. The ClinicalTrial number is NCT03550079.

Definition of ideal configuration for femoral neck screw fixation in older people

“…The plate augmentation does not increase the rate of avascular necrosis. In our previous research, we found that cannulated screw augmented with intramedullary nail was another choice in treating vertical ones 4 . After a comprehensive understanding of the anatomy and fracture pattern, it was beneficial to choose optimal internal fixation and decrease complications after femoral neck fractures.…”

“…Numerous methods have been proposed for the stabilization of femoral neck fractures 3 . Dynamic hip screws, cannulated screws and so on are commonly used implants 4 . However, in patients who are not fit for arthroplasty, especially young ones, inverted triangle parallel cannulated screws remain a feasible and effective choice 5,6 .…”

Fractura de cadera en el adulto mayor: epidemiología y costos de la atención

“…2,30 El número de procedimientos realizados fue en promedio de 1,544 al año, la reducción abierta con fi jación interna de fémur se efectuó en más de 50%, lo cual es congruente con la literatura, ya que para los pacientes en quienes la artroplastía no es la primera opción de tratamiento, la fi jación interna con la colocación de tres tornillos www.medigraphic.org.mx canulados en confi guración de triángulo invertido es una opción de tratamiento para las fracturas de cuello femoral; éstas representaron 77.16% de las fracturas totales en el estudio. 31 No tenemos la evolución de estos casos, lo que sería importante para defi nir una mejor estrategia terapéutica al respecto.…”

The ‘Unsolved’ Fracture Neck of Femur– A Comprehensive Review

“…It was also noted that the helical blade has enhanced purchase in the femoral head as it conserves the bone which is otherwise lost during drilling and insertion of Richard's screw [20,23,36].…”