Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw

Guimarães, João Antônio Matheus; Rocha, Leonardo Rosa; Rocha, Tito Henrique; Bonfim, Danielle Cabral; Sartore, Rafaela C.; Cavalcanti, Amanda dos Santos; Roesler, Carlos Rodrigo de Mello; Machado, Jamila Alessandra Perini; Aguiar, Diego Pinheiro; Duarte, Maria Eugênia Leite

doi:10.1016/s0020-1383(17)30769-6

Cited by 35 publications

(40 citation statements)

References 25 publications

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“…Figure 7 illustrated that the triangular screws construct provided the greatest stability to the fracture fragment since the minimum displacement of the fragment gap was achieved in the triangular configuration under the increasing loads. As to unstable femoral neck fractures, with higher shear angle and greater shear force, postoperative complications like fixation failure, nonunion, and avascular necrosis were with high incidence [ 22 , 23 ]. Heightened stability could improve femoral head blood flow leading to a decrease in avascular necrosis and union complications and was the better option in the treatment of the displaced femoral neck fractures [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures

Wang

et al. 2018

J Orthop Surg Res

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BackgroundIn the present study, we evaluated the mechanical outcome of different configurations formed by fully threaded screws and partially threaded screws in the treatment of unstable femoral neck fracture.MethodsThe Pauwels type III unstable femoral fracture and the models of the fully threaded screw and partially threaded screw were constructed in 3-matic software and UG-NX software respectively. We then assembled the different screw configurations to the fracture model separately to form the fixation models. After meshing the models’ elements, we used Abaqus software to perform the finite element analysis. Parameters of von Mises stress distribution on the screws, peak stress, displacement between fracture fragments, and model principal strains in cancellous bone were reported.ResultsOur results indicated that the peak von Mises stresses of screws was concentrated in the middle surface of the screw near the fracture line in each group. Peak stress value of the implants was highest in the model of triangle with posterior single screw. And the lowest stress values were observed in the triangular model. Fully threaded screw in each group underwent the most stress while partially threaded screw underwent a little bit of stress. Lowest displacement was observed in the triangular model. The volume of bone susceptible to yielding in the femoral neck region was the lowest for triangular configuration.ConclusionsFor unstable femoral neck fractures, superior results were obtained by stabilizing the fracture with triangular configuration formed by one superior partially threaded screw and two inferior fully threaded screws. This study will require clinical confirmation as to its practicality in the management of unstable femoral fractures.

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Section: Discussionmentioning

confidence: 99%

Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures

Wang

et al. 2018

J Orthop Surg Res

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“…For more vertical femoral neck fractures that are axial and rotationally unstable, strong shear forces across the hip frequently led to fixation failure, with overall complication rates ranging from 20-86% [9,15,16]. No standard internal fixation has been clinically proven to be superior for vertical fractures, although the addition of a cross screw or combination of a sliding hip screw and an additional anti-rotation screw has been recommended [17], but higher nonunion and AVN rates was reported by Parker [18]. In addition, a medial buttress plate was proposed to augment the fixation of ordinary cannulated screws, which still need longer follow-up and larger sample size [3].…”

Section: Discussionmentioning

confidence: 99%

A comparative study of partial-threaded cannulated screws and double-threaded cannulated screws in the fixation of vertical femoral neck fractures

Zhang

Gang

Zhang

2020

Preprint

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Background This study purposed to compare the partial- threaded cannulated screws (PTCS) and the double-threaded cannulated screws (DTCS) in vertical shear femoral neck fractures both clinically and biomechanically. Methods Clinally, the radiographs of 81 patients with Pauwels Ⅲ femoral neck fractures, including 54 fractures fixed with PTCS and 27 fractures fixed with DTCS were analyzed. Complications consist of fixation failure (nail withdrawal, obvious fracture displacement, varus deformity or femoral neck shortening), bony nonunion and avascular necrosis (AVN) were determined. Biomechanically, twenty femur synthetic bones were equally divided and made to a vertical femoral neck fracture model, then fixed with three parallel PTCSs or DTCSs respectively. All specimens were tested for axial stiffness and a maximum load to failure with a loading rate of 2 mm/min. Results Clinically , 22 fractures in the PTCS group experienced fixation failure, including 19 nail withdrawal, 18 femoral neck shortening, 14 varus deformity and 8 obvious fracture displacement; while only 5 fractures showed up with fixation failure in the DTCS group, including 3 nail withdrawal, 4 femoral neck shortening, 4 varus deformity and 1 obvious fracture displacement. Additionally, 11 fractures in the PTCS group had nonunion while only 3 in the DTCS group and 9 fractures with AVN in the PTCS group while only 2 in the DTCS group. Biomechanically, The axial stiffness of DTCS was 152.89±22.74 N/mm, greater than PTCS (134.68±26.61), moreover, the failure load in DTCS was significantly greater than PTCS (1148.11±124.80 vs 795.88±162.50). Conclusion DTCS may exert more advantages than PTCS for vertical femoral neck fractures, including stronger fixation stability, lower rate of fixation failure and nonunion.

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“…24 Femoral neck fractures, in particular, are challenging as they are at an increased risk of complications, such as fixation failure, malunion, nonunion, and avascular necrosis of the femoral head. 23,25 They may occur due to either low-or high-energy trauma, or because of a sport injury, and can be classified using the Garden or Pauwels classification system (Tables 2 and 3). 5,[25][26][27] Femoral neck fractures are a leading cause of disability and morbidity in the elderly, and, in the United States, yearly incidence rates for this injury have ranged from 146 to 242 per 100 000 adults.…”

Section: Background On Femoral Neck Fracturesmentioning

confidence: 99%

Closed Limb Fractures With Compromised Vascularization: A Narrative Review

Vannabouathong¹,

Schemitsch

Petrisor

et al. 2019

Clin Med�Insights�Arthritis�Musculoskelet Disord

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Vascular compromised fractures typically result in a high rate of healing complications, such as avascular necrosis, nonunion, delayed union, and arthritis, which severely affect a patient’s function and quality of life. The purpose of this review was to identify and describe the epidemiology and available treatment options for the most well-known vascular compromised closed fractures. The injuries discussed in detail in this review were scaphoid, lunate, femoral neck, and talar fractures. Current evidence suggests that optimal treatment for vascular compromised fractures is dependent on the degree of fracture displacement and comminution, and the patient’s post-injury functional demands, age, and bone quality. Conservative efforts generally include casting or splinting with a period of immobilization. Surgery is indicated for substantially displaced fractures, patients who require higher functional demands and an earlier return to activity, or if complications occur following nonoperative treatment; however, operative intervention is typically performed for femoral neck fractures regardless of the amount of displacement. Various surgical techniques exist, though internal fixation with screws is a common procedure among these injuries and can be used in combination with other implants, such as plating or Kirschner wires (k-wires), when needed. Severe fracture comminution, poor bone quality, or arthritis can contraindicate the use of screws and more invasive intervention will be required. Bone grafting is done in some cases to enhance vascularity. Salvage procedures exist for patients who develop severe complications, but these will permanently alter the anatomy of the injured area and should be considered a last resort.

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Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw

Cited by 35 publications

References 25 publications

Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures

Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures

A comparative study of partial-threaded cannulated screws and double-threaded cannulated screws in the fixation of vertical femoral neck fractures

Closed Limb Fractures With Compromised Vascularization: A Narrative Review

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