Should full threaded compression screws be used in adult femoral neck fractures?

Okçu, Güvenir; Özkayın, Nadir; Erkan, Serkan; Tosyalı, Hakan Koray; Aktuğlu, Kemal

doi:10.1016/j.injury.2015.05.028

Cited by 30 publications

(32 citation statements)

References 26 publications

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“…The sliding compression device allowed the controlled fracture impaction across parallel placed screws to eliminate the fracture gap and increase the stability of fracture which was favorable to the fracture union [7, 19]. Nevertheless, the “controlled” impaction would be out of control and the ultimate stability was hardly achieved by sliding pressure when the posteromedial buttressing effect was lost.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple cannulated cancellous screws are used widely due to the advantages including less tissue invasive, less blood loss, and shorter operation time which made it a very common choice for surgeons to treat with FNF [3]. Moreover, the configuration of three parallel partially thread screws (PTSs) can be utilized to compress the fracture fragments and eliminate a potential fracture gap which can enhance fracture healing [4–7]. The use of multiple compressive screws has been advocated for Garden types 1 and 2 to promote healing [1, 8].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Evaluation of the Modified Cannulated Screws Fixation of Unstable Femoral Neck Fracture with Comminuted Posteromedial Cortex

Zhang

Yin

et al. 2019

BioMed Research International

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Purpose. To verify the biomechanical importance with respect to the integrity of posteromedial cortex of femoral neck fracture (FNF) and demonstrate whether the modified fixation of cannulated screws (CSs) could increase the biomechanical strength. Methods. A total of 24 left artificial femurs were randomly divided into three groups. The osteotomy was made in the center of the femoral neck at a 20° angle to the shaft axial. The posteromedial cortices of femoral neck were removed in groups B and C. In group A, 8 femurs with intact posteromedial cortex were fixed with three parallel partial thread screws (PTSs), forming a standard triangle. In group B, the femurs were stabilized with the same fixation of CSs like group A. In group C, two inferior PTSs were replaced by two fully thread screws (FTSs). Results. The lower A-P and axial stiffness and load to failure along with higher axial displacement were found in group B compared with group A (p≤0.001 for all). Between groups B and C, the modified fixation of CSs increased A-P and axial stiffness and load to failure and reduced the axial displacement (p≤0.001 for all). Conclusions. We verified that the comminuted posteromedial cortex affected the biomechanical strength adversely and resulted in higher displacement. The modified fixation of CSs characterized by two inferior FTSs could improve the biomechanical performance and buttress the femoral head fragment better.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation of the Modified Cannulated Screws Fixation of Unstable Femoral Neck Fracture with Comminuted Posteromedial Cortex

Zhang

Yin

et al. 2019

BioMed Research International

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“…1). Die Schrauben sollten parallel zueinander eingebracht werden und die Gewinde müssen jenseits der Fraktur liegen, um ein Einstauchen der Fragmente und damit eine gute Frakturkompression zu gewährleisten (8). Die Schrauben sollten nahe der Kortikalis, also so weit wie möglich auseinander liegen, um eine möglichst hohe Stabilität zu erzielen.…”

Section: Therapie Der Medialen Schenkelhalsfrakturunclassified

Operative Therapie medialer Oberschenkelhalsbrüche

Gaulke¹

2016

Arthritis und Rheuma

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ZusammenfassungDie mediale Schenkelhalsfraktur hat eine mit dem Lebensalter steigende Inzidenz. Da das Kopffragment bei dieser intrakapsulären Fraktur von der Durchblutung abgeschnitten werden kann, ist die Femurkopfnekrose- und Pseudarthroserate hoch. Sie steigt mit zunehmendem Lebensalter, dem Dislokationsgrad der Fraktur und dem Intervall bis zur operativen Stabilisierung. Bei jungen Patienten bis 60 Jahren sollte bei varisch eingestauchten und undislozierten Frakturen eine Osteosynthese in situ erfolgen und mit Teilbelastung behandelt werden. Bei älteren Patienten sollte bei dislozierten Frakturen primär eine endoprothetische Versorgung erfolgen, da die Komplikationsrate geringer ist und die Mobilisation unter Vollbelastung erfolgen kann. Bei sehr alten Patienten mit sehr schlechter Knochenqualität, die nicht in der Lage sind, eine Teilbelastung durchzuführen, ist selbst bei undislozierten Frakturen eine Prothese zu erwägen.

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“…When compared to PTS, FTHCS have been shown to minimize femoral neck shortening [13,14]. Recent clinical studies have evaluated the potential of FTHCS to reduce other complications of FNF xation, such as xation failure and nonunion [10,15,16]. Unfortunately, a limited number of these clinical studies have led to uncertain conclusions due to small sample sizes and varying demographic patterns [10,[13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Decreased Complications but a Distinctive Fixation Loosening Mechanism of Fully Threaded Headless Cannulated Screw Fixation for Femoral Neck Fractures in Young Adults.

Sun

Shu

Sherrier

et al. 2021

Preprint

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Background: Despite being a commonly encountered injury in orthopaedic practice, controversy surrounds the methods of optimal internal fixation for femoral neck fractures (FNF) in young patients. The objective of the present study is to compare complication rates and failure mechanisms for surgical fixation of FNF using fully threaded headless cannulated screws (FTHCS) versus partial threaded cannulated screws (PTS) in young adults.Methods: A total of 75 patients (18-65 years old) with FNF were prospectively treated with close reduction and internal fixation using three parallel FTHCS and compared to a historical control case-matched group (75 patients) with FNF treated by PTS fixation. After two years follow-up, rates of fixation failure (including varus collapse, fracture displacement, and femoral neck shortening), nonunion, and avascular necrosis of the femoral head (ANFH) were compared between the two cohorts. The demographic, follow-up information, and radiological images were assessed by independent blinded investigators. Results: Patient demographics and fracture patterns were similar in the two patient groups. The overall fixation failure rates were 8% (6/75) in the FTHCS cohort, which was significantly lower than the 25.3% (19/75) seen in the PTS group. Rates of nonunion and ANFH were significantly lower in the FTHCS group when compared to the PTS control group. When stratified by injury severity (high-energy versus low-energy fractures), the rate of fixation failure was significant lower with the use of FTHCS when compared with PTS for high-energy fractures while there was no difference in the rates of nonunion or ANFH for high or low-energy fracture patterns. Unique to the FTHCS cohort was an atypical screw migration pattern with varus collapse (6/75, 8%). Conclusions: The results show that FTHCS fixation could significantly reduce the complication rate of young patients with FNF, especially in high-energy fracture patterns (Garden III-IV, Pauwels III or vertical of the neck axis (VN) angle ≥ 15°). There was also confirmation that the modes of fixation loosening in the FTCHS group, including screw “medial migration” and superior cutout, were different from the screw withdrawal pattern seen in the PTS cohort. Trial registration: The study was retrospectively registered at www.Chictr.org.cn (ChiCTR-IPR-1900025851) on September 11, 2019.

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Should full threaded compression screws be used in adult femoral neck fractures?

Cited by 30 publications

References 26 publications

Biomechanical Evaluation of the Modified Cannulated Screws Fixation of Unstable Femoral Neck Fracture with Comminuted Posteromedial Cortex

Biomechanical Evaluation of the Modified Cannulated Screws Fixation of Unstable Femoral Neck Fracture with Comminuted Posteromedial Cortex

Operative Therapie medialer Oberschenkelhalsbrüche

Decreased Complications but a Distinctive Fixation Loosening Mechanism of Fully Threaded Headless Cannulated Screw Fixation for Femoral Neck Fractures in Young Adults.

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