Medial Buttress Plate and Allograft Bone‐Assisted Cannulated Screw Fixation for Unstable Femoral Neck Fracture with Posteromedial Comminution: A Retrospective Controlled Study

Huang, Zhongdong; Su, Yiwei; Huang, Zhiping; Wang, Yi-Bei; Du, Gui-Cheng; Huang, Yanpeng; Chen, Gang; Xu, Chun; Zhu, Qingan

doi:10.1111/os.13273

Cited by 10 publications

(6 citation statements)

References 36 publications

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“…Fixation failure occurred in 22 patients, including 19 cases of screw loosening, 18 cases of shortening of the femoral neck, 14 cases of inversion deformity, and 8 cases of signi cant fracture displacement. Some scholars suggested adding medial buttress plate to the medial femoral neck through a modi ed anterior hip approach to enhance the strength of internal xation of unstable femoral neck fractures [5,11] , which achieved good clinical results. The effectiveness of this xation was also veri ed by nite element analysis.…”

Section: Discussionmentioning

confidence: 99%

Reverse obliquity femoral neck fracture: two cases report and review of the literature

Huang,

Fu,

Chen

et al. 2024

Preprint

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Background:The literature defines a femoral neck fracture with a Pauwels angle of more than 70° as a vertical femoral neck fracture, which is one of the refractory fracture types. Clinically, there is a class of femoral neck fractures with a Pauwels angle ≥ 90° and a fracture line alignment that does not allow for Gotfried-positive support. we classified and named it as reverse obliquity femoral neck fracture（ROFNF）and report the treatment of two cases. Case presentation: The first case was a 56-year-old female admitted with a right femoral neck fracture (Pauwels III-type, Pauwels angle 95°) caused by a slip and fall while playing table tennis. The second case was a 45-year-old male admitted with a right femoral neck fracture (Pauwels III-type, Pauwels angle 90°) due to a rollover accident while driving an electric car. The patients were supine on a fluoroscopic operating table and offered lumbar epidural anesthesia. After failure of closed anatomical repositioning under fluoroscopy, both patients were treated with incisional repositioning via an anterior hip approach and internal fixation with three 7.3 mm cannulated screws in combination with a medial femoral neck buttressplate. The follow‑up radiographs at 9 months showed complete union of the bone fractures. Conclusions: This is the first reported of reverse obliquity femoral neck fracture with Pauwels angle≥ 90°. The course of treatment in our case showed that closed reduction and firm fixation of this rare type of femoral neck fracture were difficult, and open reduction via anterior hip approach and combined fixation were the optional treatment.

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Section: Discussionmentioning

confidence: 99%

Reverse obliquity femoral neck fracture: two cases report and review of the literature

Huang,

Fu,

Chen

et al. 2024

Preprint

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“…However, some surgeons lack experience, and the accuracy varies owing to different personal experiences and inconsistencies in operations. If the posteromedial nail is placed completely into the cancellous bone, it will not provide sufficient stability and is predisposed to the collapse of the femoral neck and fixation failure 19 . Moreover, a deviated nail can damage the surrounding vessels, such as the lateral epiphyseal artery, which can lead to femoral head necrosis.…”

Section: Introductionmentioning

confidence: 99%

Surgical Tool Handle Vibration‐Based Drilling State Recognition During Hip Fracture Fixation

Xia¹,

Liu

Bai

et al. 2022

Orthopaedic Surgery

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Objectives Traditional manual drilling during hip fracture fixation can easily lead to unstable fixation and vascular damage. This study aimed to investigate a safe and easy‐to‐use robot‐assisted method to automatically drill bone and distinguish critical bone drilling states with high accuracy in real‐time for the bone hole‐making process during hip fracture fixation. Methods A bone‐drilling robotic system was designed to automatically create holes in the femoral neck. Four fresh pig femurs were drilled at the posterosuperior femoral neck using three modes: “all‐in” (AI), “in‐out‐in” (IOI), and “percutaneous fixation” (PF). A high‐frequency accelerometer captured the generated vibrations of the drill handle, which were then transferred to a personal computer using a data acquisition card. Five bone drilling states are defined, including: “drill idling,” “initial drilling,” “in the cancellous bone,” “out the femoral neck,” and “in the cortical bone.” The harmonic distribution of the vibration signal was extracted by fast Fourier transform (FFT) and used as a critical feature to identify different drilling states. To prove the difference in the harmonic distribution at different drilling states, an independent sample t‐test was used to compare the percentage of the first harmonic amplitude in the first 10 harmonics at each drilling state. A neural network classifier was trained with the frequency spectrum as the input and the drilled state as the output to distinguish the critical bone drilling states with high accuracy in real‐time. The classifier was trained and tested on four specimens to ensure that the surgical robot could accurately identify the five drilling states. Results In each specimen, the harmonic distributions of the drilling vibration at different drilling modes were significantly different (p < 0.05). The average recognition accuracies of the drilling state for the four specimens were all higher than 84%. The three defined modes were distinguished with extremely high accuracies. The recognition accuracies of “in the cancellous bone” for specimens 1 to 4 were 83.2%, 84.8%, 92.9%, and 84.7%. The recognition accuracies of “in out the femoral neck” from specimens 1 to 4 are 98.2%, 88.4%, 95.8%, and 88.8%. The recognition accuracies of “in the cortical bone” for specimens 1 to 4 were 94.6%, 80.8%, 95.5%, and 85.8%. Conclusions The proposed robot‐assisted method can automatically distinguish five critical bone‐drilling states with high accuracy in real‐time to avoid weak fixation and damage to the lateral epiphyseal artery.

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“…Reducing a fracture usually depends on its pattern, and unstable types of fracture may create difficulties in fracture reduction ( 5 ). Bone defect or comminution is an important factor for unstable fracture and fixation instability in patients with FNFs ( 6 ). Additionally, malreduction and fixation instability may prevent normal fracture healing ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

Wu¹,

Zhu²,

Wei³

et al. 2022

Ann Transl Med

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Background: This study aimed to define the distribution and frequency of fracture lines and bone defects in displaced femoral neck fractures (DFNFs) using a three-dimensional (3D) mapping technique, and to investigate the factors associated with the area of bone defects in patients with DFNFs. Methods:The data of 256 adult patients with DFNFs were retrospectively reviewed. Multiplanar reconstructions of the DFNFs were made using computed tomography (CT) images, and the DFNF fragments were virtually reduced to match a 3D model of the femoral neck. Subsequently, 3D mapping was performed by graphically superimposing all of the fracture lines and bone defects onto a femoral neck template. The 3D mappings were independently examined by two orthopedic surgeons, and the interobserver agreement was analyzed. For intraobserver analysis, one of the surgeons measured the mappings twice more, and the intraclass correlation coefficients (ICCs) were calculated. A linear regression analysis was conducted to explore bone defect area-related factors. Results:The cohort comprised 141 (55%) patients with left hip injuries and 115 (45%) patients with right hip injuries. On the 3D maps, the dense zones of the fracture lines were largely observed from the superior to the posterior part of the femoral neck, while the dense zone of the bone defect was primarily concentrated in the posterior part of the femoral neck. Only a few dense zones were located in the anterior and inferior parts of the femoral neck. An overlapping region between the fracture line and the bone defect was located in the 2.5th to 4.5th (5th) part of the 1/10 of the superior (posterior) femoral neck length. Both the fracture line and bone defect mapping techniques had good intra-and inter-observer reliability, with ICCs of 0.879 (0.977) and 0.780 (0.974), respectively. Garden type and age were positively correlated with bone defects, while simplified AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification was negatively associated with bone defects. Conclusions:The fracture lines and bone defects of the DFNFs were mainly located in the superior and posterior parts of the femoral neck, while an overlapping region was observed in the subcapital area of the femoral neck. 3D mapping is a reliable method for searching for DFNF features, and separately studying fracture lines and bone defects can further elucidate the morphology of these fractures. Bone defects in patients with DFNFs were associated with Garden type, simplified AO/OTA classification, and age.

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Medial Buttress Plate and Allograft Bone‐Assisted Cannulated Screw Fixation for Unstable Femoral Neck Fracture with Posteromedial Comminution: A Retrospective Controlled Study

Cited by 10 publications

References 36 publications

Reverse obliquity femoral neck fracture: two cases report and review of the literature

Reverse obliquity femoral neck fracture: two cases report and review of the literature

Surgical Tool Handle Vibration‐Based Drilling State Recognition During Hip Fracture Fixation

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

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