Modified dynamic hip screw loaded with autologous bone graft for treating Pauwels type-3 vertical femoral neck fractures

Luo, Dingcun; Zou, Weitao; He, Yijiao; Xian, Hua; Wang, Lei; Shen, Jiazuo; Lian, Kun; Lin, Dasheng

doi:10.1016/j.injury.2017.05.031

Cited by 18 publications

(10 citation statements)

References 20 publications

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“…We identified a treatment failure rate of 45% in this large multicenter study of 492 young adult patients with FNFs managed with operative repair at 26 North American trauma centers. Forty-two percent of all injured hips ultimately underwent at least one additional surgery after initial repair, 4,10,[25][26][27][28] have shown improved but still broadly variable results for fixation in the young adult population. More than a decade ago, Damany et al 29 reported overall rates of nonunion at 8.9% and osteonecrosis at 23.0% for FNFs in 15-to 50year-old patients in a meta-analysis, including 18 studies and 564 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Nonunion and osteonecrosis occurred in 59% and 86% of these hips, respectively. Subsequent results with protocolized, contemporary treatments 4,10,25–28 have shown improved but still broadly variable results for fixation in the young adult population. More than a decade ago, Damany et al 29 reported overall rates of nonunion at 8.9% and osteonecrosis at 23.0% for FNFs in 15- to 50-year-old patients in a meta-analysis, including 18 studies and 564 patients.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers

Collinge

Finlay

Rodriguez-Buitrago

et al. 2022

Journal of Orthopaedic Trauma

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Objectives:To assess the operative results of femoral neck fractures (FNFs) in young adults in a large multicenter series, specifically focusing on risk factors for treatment failure.Design:Large multicenter retrospective cohort series.Setting:Twenty-six North American Level 1 trauma centers.Patients:Skeletally mature patients younger than 50 years with displaced and nondisplaced FNFs treated between 2005 and 2017.Intervention:Operative repair of FNF.Main outcome measurements:The main outcome measure is treatment failure: nonunion and/or failed fixation, osteonecrosis, malunion, and need for subsequent major reconstructive surgery (arthroplasty or proximal femoral osteotomy). Logistic regression models were conducted to examine factors associated with treatment failure.Results:Of 492 patients with FNFs studied, a major complication and/or subsequent major reconstructive surgery occurred in 45% (52% of 377 displaced fractures and 21% of 115 nondisplaced fractures). Overall, 23% of patients had nonunion/failure of fixation, 12% osteonecrosis type 2b or worse, 15% malunion (>10 mm), and 32% required major reconstructive surgery. Odds of failure were increased with fair-to-poor reduction [odds ratio (OR) = 5.29, 95% confidence interval (CI) = 2.41–13.31], chronic alcohol misuse (OR = 3.08, 95% CI = 1.59–6.38), comminution (OR = 2.63, 95% CI = 1.69–4.13), multiple screw constructs (vs. fixed-angle devices, OR = 1.95, 95% CI = 1.30–2.95), metabolic bone disease (OR = 1.77, 95% CI = 1.17–2.67), and increasing age (OR = 1.03, 95% CI = 1.01–1.06). Women (OR = 0.57, 95% CI = 0.37–0.88), Pauwels angle ≤50 degrees (type 1 or 2; OR = 0.64, 95% CI = 0.41–0.98), or associated femoral shaft fracture (OR = 0.19, 95% CI = 0.10–0.33) had lower odds of failure.Conclusions:FNFs in adults <50 years old remain a difficult clinical and surgical problem, with 45% of patients experiencing major complications and 32% undergoing subsequent major reconstructive surgery. Risk factors for complications after treatment of displaced FNFs were numerous.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers

Collinge

Finlay

Rodriguez-Buitrago

et al. 2022

Journal of Orthopaedic Trauma

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“…The former is conducive to postoperative early rehabilitation and weight-loading of patients, while the latter is conducive to fracture healing. 7 , 17 , 18 Although DHS also has dynamic compression ability, its anti-rotation stability is poor since there is only one sliding screw. PCCP has two thicker screws in the neck-head (φ7.5 mm) and an angular locking connection between the screw and plate.…”

Section: Discussionmentioning

confidence: 99%

Imaging observation of percutaneous compression plate use in promoting femoral neck fracture healing

Yong

Dai

et al. 2021

J Int Med Res

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Objective To examine the imaging evidence of the use of percutaneous compression plate (PCCP) in promoting femoral neck fracture healing compared with cannulated screws (CS). Methods This retrospective study enrolled patients with femoral neck fractures undergoing internal fixation procedures. The patients were divided into a PCCP group and a CS group with imaging as the primary outcome and Harris hip score (HHS) as the secondary outcome. Results This study included 162 patients: 80 in the PCCP group and 82 in the CS group. There were no significant differences between the patients in their preoperative baseline characteristics. Patient follow-up ranged from 24–56 months (mean 30.7 months). Differences in reduction quality, screw slipping, neck shortening and avascular necrosis (AVN) were not significant between the two groups. There were significant differences between the treatment groups in bone absorption, nonunion, healing time, screw withdrawal and fixation failure in favour of the PCCP group. Postoperative HHS at 6 and 12 months were significantly better for the PCCP group than the CS group, but the differences were not significant at 24 months and last follow-up. Conclusion Stable internal fixation with dynamic compression was the key to PCCP promoting femoral neck fracture healing.

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“…Femoral neck fracture (FNF) tends to extend in a vertical fashion secondary to high-energy trauma in the young [ 1 , 2 ]. According to the widely used Pauwels classification described in 1935, FNF line > 50 ° from the horizontal plane is Pauwels type III [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Modified F configuration in the treatment of Pauwels type III femoral neck fracture: a finite element analysis

Lin

Shang

Xing

et al. 2021

BMC Musculoskelet Disord

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Background The optimal treatment of Pauwels type III femoral neck fracture (FNF) in young patients remains a worldwide challenge in orthopedic surgery. Methods Finite element models of four internal fixations were developed to treat Pauwels type III FNF: a: the traditional inverted triangular parallel cannulated screw (PCS) model, b: the F-technique cannulated screw model, c: the modified F-technique cannulated screw model using a fully threaded screw instead of a partially threaded distally, d: the dynamic hip screw coupled with derotational screw (DHS + DS) model. Under the same conditions, finite element analyses were carried out to compare the displacement and von Mises stress distribution of four internal fixations and femurs, the maximum crack distances of the fracture surfaces, Z axis displacements of four models as well as the stress distribution in the subtrochanteric region. Results The modified F-technique configuration resulted in a more stable fixation as compared to the other three configurations, with respect to the maximum displacement and stress peaks of femur and internal fixations, the maximum crack distances of the fracture surfaces, Z axis displacements of four configurations as well as the stress distribution in the subtrochanteric region. Conclusions Our results suggested that modified F-technique configuration show a better performance in resisting shearing and rotational forces in treating Pauwels type III FNF compared to those using traditional inverted triangular PCS, the F-technique configuration or DHS + DS, providing a new choice for the treatment of FNFs.

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Modified dynamic hip screw loaded with autologous bone graft for treating Pauwels type-3 vertical femoral neck fractures

Cited by 18 publications

References 20 publications

Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers

Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers

Imaging observation of percutaneous compression plate use in promoting femoral neck fracture healing

Modified F configuration in the treatment of Pauwels type III femoral neck fracture: a finite element analysis

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