Abstract:Femoral neck fracture stability can be substantially increased applying BDSF due to better cortical screw support and screw orientation. Having two calcar-buttressed screws oriented in different inclinations, BDSF can enhance constant stability during various patient activities. The more unstable the situation, the better BDSF stability is in comparison to CFIX.
“…Further to the results reported in our recently published biomechanical comparative study, the current clinical study reconfirms that the better outcomes following BDSF treatment are due to its high fixation strength [10]. …”
Section: Discussionsupporting
confidence: 83%
“…The recently introduced novel method of biplane double-supported screw fixation (BDSF; Filipov’s method) provides improved cortical screw support and increased fixation strength [8–10]. The concept of biplane positioning makes it feasible to place three cannulated screws at steeper angles to the diaphyseal axis with entry points located much more distally within the thicker cortex of the proximal diaphysis, thus improving their beam function and cortical support.…”
IntroductionOsteosynthesis of femoral neck fractures is related up to 46% rate of complications. The novel method of biplane double-supported screw fixation (BDSF; Filipov’s method) offers better stability using three medially diverging cannulated screws with two of them buttressed on the calcar. Biomechanically, the most effective component is the distal screw placed at steeper angle and supported on a large area along the distal and posterior cortex of the femoral neck following its spiral anterior curve. Thereby, BDSF achieves the strongest possible distal-posterior cortical support for the fixation construct, which allows for immediate full weight-bearing. The aim of this study was to evaluate the outcomes from the first 5-year period of BDSF clinical application.Materials and methodsSubject of this retrospective study were 207 patients with displaced Garden III–IV femoral neck fractures treated with BDSF. Three 7.3-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex.ResultsThe outcomes in 207 patients were analysed in 29.6 ± 16.8 months follow-up. Bone union occurred in 96.6% of the cases (males 97.6%, females 96.4%, P = 0.99). Rate of nonunion was 3.4%, including fixation failure (2.4%), pseudoarthrosis (0.5%) and nonunion with AVN (0.5%). Rate of AVN was 12.1% (males 4.8%, females 13.9%, P = 0.12). Modified Harris hip score was 86.2 ± 18.9 (range 10–100), with no significant difference between genders, P = 0.07. Older patients were admitted with significantly more comorbidities (P = 0.001), and on follow-up they were significantly less mobile (P = 0.005) and had significantly more difficulties to put socks and shoes on (P < 0.001).ConclusionsBy providing additional cortical support, the novel BDSF method enhances femoral neck fracture fixation strength.
“…Further to the results reported in our recently published biomechanical comparative study, the current clinical study reconfirms that the better outcomes following BDSF treatment are due to its high fixation strength [10]. …”
Section: Discussionsupporting
confidence: 83%
“…The recently introduced novel method of biplane double-supported screw fixation (BDSF; Filipov’s method) provides improved cortical screw support and increased fixation strength [8–10]. The concept of biplane positioning makes it feasible to place three cannulated screws at steeper angles to the diaphyseal axis with entry points located much more distally within the thicker cortex of the proximal diaphysis, thus improving their beam function and cortical support.…”
IntroductionOsteosynthesis of femoral neck fractures is related up to 46% rate of complications. The novel method of biplane double-supported screw fixation (BDSF; Filipov’s method) offers better stability using three medially diverging cannulated screws with two of them buttressed on the calcar. Biomechanically, the most effective component is the distal screw placed at steeper angle and supported on a large area along the distal and posterior cortex of the femoral neck following its spiral anterior curve. Thereby, BDSF achieves the strongest possible distal-posterior cortical support for the fixation construct, which allows for immediate full weight-bearing. The aim of this study was to evaluate the outcomes from the first 5-year period of BDSF clinical application.Materials and methodsSubject of this retrospective study were 207 patients with displaced Garden III–IV femoral neck fractures treated with BDSF. Three 7.3-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex.ResultsThe outcomes in 207 patients were analysed in 29.6 ± 16.8 months follow-up. Bone union occurred in 96.6% of the cases (males 97.6%, females 96.4%, P = 0.99). Rate of nonunion was 3.4%, including fixation failure (2.4%), pseudoarthrosis (0.5%) and nonunion with AVN (0.5%). Rate of AVN was 12.1% (males 4.8%, females 13.9%, P = 0.12). Modified Harris hip score was 86.2 ± 18.9 (range 10–100), with no significant difference between genders, P = 0.07. Older patients were admitted with significantly more comorbidities (P = 0.001), and on follow-up they were significantly less mobile (P = 0.005) and had significantly more difficulties to put socks and shoes on (P < 0.001).ConclusionsBy providing additional cortical support, the novel BDSF method enhances femoral neck fracture fixation strength.
“…Orlin Filipov and Boyko Gueorguiev did a biomechanical cadaveric study in 8 fresh frozen and 6 embalmed human femoral pairs in 2014 and proved that this method of fixation is biomechanically stable fixation than conventional method of fixation for femoral neck fractures. 16 The period defined in the literature for occurrence of bone union after osteosynthesis of femoral neck fractures is usually within 3 months following surgery. 17,18 Going through the literature regarding the occurrence of complications, we assumed a minimal follow-up period of 12 months as sufficient to demonstrate occurrence of bone union and other associated complications.…”
<p class="abstract"><strong>Background:</strong> The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture<strong> </strong>as far as treatment and results are concerned. There are different views regarding the optimal method of internal fixation in femoral neck fractures. Biomechanical data from literature suggest that calcar fixation is superior to central screws placement. This study aims to analyse the functional and radiological outcome of femoral neck fractures treated by calcar buttressed screw fixation described by Filipov as biplane double supported screw fixation.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted in our institution from May 2015 to May 2018.The study included 43 patients (31 male, 12 female) with femoral neck fracture. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Patients were followed up for average period of 2 years. Functional outcome was evaluated using Harris Hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Bone union occurred in 40 patients (93%) with average period of 3-4 months.<strong> </strong>51.2% of cases had<strong> </strong>excellent outcome. 23.2% of cases had good and 16.3% of cases had fair outcome. 9.3% of cases ended with poor outcome. Non union was reported in 3 patients (7%) and AVN in one patient. Various factors like age, Garden and Pauwel fracture types, time of presentation and time of surgery were statistically significant to the final functional outcome in our study.</p><p><strong>Conclusions:</strong> By providing additional calcar buttress compared to conventional method, this technique of screw fixation enhances femoral neck fracture fixation strength and reduces the fixation failure. </p>
“…Actually, such a biomechanical study comparing the novel BDSF method to the traditional inverted triangle parallel screw fixation (CFIX) with the use of human cadaveric femora has been published [1]. It demonstrated about 44% higher axial fixation strength for BDSF in 7° varus inclination compared to conventional parallel screw fixation (initial axial stiffness instrumented, BDSF 0.93 ± 0.10 kN/mm vs. CFIX 0.53 ± 0.06 kN/mm); 15% higher secondary axial stiffness; and 20% higher failure load, and with similar strength in 16° varus inclination.…”
Section: Biomechanical Testing and Biomechanics Of The Methods Of Bdsfmentioning
confidence: 99%
“…Schematic representation of the middle and distal BDSF screws; the proximal BDSF screw is not shownFig. 2Biomechanical testing [1]. The applied load is vertical and the femoral shaft is inclined at 7° varus inclination to resemble the physiological resultant force inclination of 7° to the vertical when standing on one leg, according to Bergmann et al [2].…”
Section: Biomechanical Testing and Biomechanics Of The Methods Of Bdsfmentioning
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