Strategies of closed reduction in treatment of femoral neck fracture using cannulated screw fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LONGYazhou , ZHANGShuming , WANGKuiyou , LIUChunsheng , ZHOUMi , WANGXiaoyu , ZHANGWei ,  QIAOLin

Department of Orthopedics, the Rocket Army General Hospital of Chinese PLA, Beijing, 100088, P. R. China;

Corresponding?author：

QIAOLin, Email: qiaolindoc@sohu.com

Keywords：

Femoral neck fracture; Cannulated screw; Internal fixation; Closed reduction

DOI：

10.7507/1002-1892.20160166

Video：

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Objective To study intraoperative reduction strategy in treatment of femoral neck fracture using cannulated screw fixation and the relationship between excellent and good rate of reduction and postoperative effectiveness. Methods A retrospective analysis was made on the clinical data of 174 cases of femoral neck fracture treated between August 2005 and March 2015. There were 78 males and 96 females with an average age of 53.8 years (range, 23-75 years). The injury causes were falling in 85 cases, traffic accident in 61 cases, and falling from height in 28 cases. According to Garden typing, there were 35 cases of type I, 56 cases of typeⅡ, 47 cases of typeⅢ, and 36 cases of typeⅣ. The time from injury to operation was 1-7 days (mean, 2.74 days). Based on reduction strategy, closed 3 hollow compression screws were used; evaluating standards for fracture reduction effect were also established. Harris score was used for effectiveness evaluation. Results All the cases received follow-up of 12-42 months (mean, 36.5 months). Bone healing was obtained in 152 cases at 6-12 months (mean, 9 months). Non-union and internal fixation failure occurred in 9 and 3 patients respectively, who underwent hemiarthroplasty; femoral head necrosis occurred in 6 patients after removing internal fixator at 15-26 months (mean, 18.5 months) after operation, who underwent total hip arthroplasty; 4 patients with non-union received vascular pedicle iliac flap transplantation. No other serious complications were observed. At last follow-up, the excellent and good rate of reduction was 94.29% for Garden type I, 91.07% for typeⅡ, 87.23% for typeⅢ, and 75.00% for typeⅣ, with a total excellent and good rate of 87.36%; the excellent and good rate of Harris score was 97.14% for Garden type I, 78.57% for typeⅡ, 68.09% for typeⅢ, and 50.00% for typeⅣ, with a total excellent and good rate of 73.56%. Conclusion To obtain high Harris score in fixation of femoral neck fractures by using hollow screws, surgeons not only need reasonable technology, but also follow correct and good reduction strategy and assessment, fracture complexity is inversely proportional to excellent and good rate of reduction. Higher excellent and good reduction rate of complexity fracture should be obtained as much as possible in order to achieve good prognosis.

Citation： LONGYazhou, ZHANGShuming, WANGKuiyou, LIUChunsheng, ZHOUMi, WANGXiaoyu, ZHANGWei, QIAOLin. Strategies of closed reduction in treatment of femoral neck fracture using cannulated screw fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 809-814. doi: 10.7507/1002-1892.20160166 Copy

1.	劉清華, 馬曉文, 張堃.創傷性股骨頸骨折后股骨頭血運的早期評估及風險預測.中國骨與關節損傷雜志, 2014, 29(2): 204-206.
2.	楊秀軍, 肖湘生.牽引、內旋位對股骨頸骨折早期股骨頭血運影響的超選擇DSA研究.中華放射學雜志, 2005, 39(8): 812-816.
3.	Wang SH, Yang JJ, Shen HC, et al. Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients. Injury, 2015, 46(10): 1969-1974.
4.	危杰, 周力, 王滿宜.股骨頸骨折術后股骨頭缺血性壞死的發生及轉歸.中華骨科雜志, 2005, 25(1): 1-6.
5.	Gregersen M, Krogshede A, Brink O, et al. Prediction of reoperation of femoral neck fractures treated with cannulated screws in elderly patients. Geriatr Orthop Surg Rehabil, 2015, 6(4): 322-327.
6.	Yuenyongviwat V, Tuntarattanapong P, Tangtrakulwanich B. A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study. BMC Musculoskelet Disord, 2016, 17: 8.
7.	Stone JD, Hill MK, Pan Z, et al. Open reduction of pediatric femoral neck fractures reduces osteonecrosis risk. Orthopedics, 2015, 38(11): e983-990.
8.	Cao L, Wang B, Li M, et al. Closed reduction and internal fixation versus total hip arthroplasty for displaced femoral neck fracture. Chin J Traumatol, 2014, 17(2): 63-68.
9.	龍亞周, 張樹明, 王奎友.空心加壓螺釘內固定治療老年股骨頸骨折.中國骨與關節損傷雜志, 2015, 30(10): 1088-1089.
10.	Jeno Manninger, Ulrich Bosch. Internal fixation of femoral neck fractures. New York: Springer Wien New York, 2007: 8-9.
11.	Araujo TP, Guimaraes TM, Andrade-Silva FB, et al. Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws. Injury, 2014, 45 Suppl 5: S36-39.
12.	林志紅, 孫勇飛, 吳小山, 等.早期切開復位與閉合復位治療移位的兒童股骨頸骨折的療效比較.中國骨傷, 2012, 25(7): 546-548.
13.	田維, 崔壯, 闞世廉.不同時間和復位方法空心釘內固定治療移位股骨頸骨折術后骨折愈合的比較.中國修復重建外科雜志, 2009, 23(4): 440-443.
14.	Liu C, Liu MT, Li P, et al. Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction. Chin Med J (Engl), 2015, 128(4): 483-488.
15.	Leadbetter GW. A treatment for fracture of the neck of the femur. Reprinted from J Bone Joint Surg 20:108-113, 1938. Clin Orthop Relat Res, 2002, (399): 4-8.
16.	Javdan M, Bahadori M, Hosseini A. Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011. Adv Biomed Res, 2013, 2: 14.
17.	CLAFFEY TJ. Avascular necrosis of the femoral head. An anatomical study. J Bone Joint Surg (Br), 1960, 42-B: 802-809.
18.	Popelka O, Skála-Rosenbaum J, Barto?ka R, et al. Fracture type and injury-to-surgery interval as risk factors for avascular necrosis of the femoral head after internal fixation of intracapsular femoral neck. Acta Chir Orthop Traumatol Cech, 2015, 82(4): 282-287.
19.	吳敏, 官建中, 肖玉周, 等.帶旋髂深血管蒂骨膜瓣植入治療未成年股骨頸骨折術后股骨頭缺血性壞死.中國修復重建外科雜志, 2015, 29(3): 275-279.
20.	Yang JJ, Lin LC, Chao KH, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg (Am), 2013, 95(1): 61-69.
21.	Ikemura S, Hara T, Nakamura T, et al. Subchondral insufficiency fracture of the femoral head: a report of two cases with a history of internal fixation of a femoral neck fracture. Skeletal Radiol, 2013, 42(6): 849-851.

1. 劉清華, 馬曉文, 張堃.創傷性股骨頸骨折后股骨頭血運的早期評估及風險預測.中國骨與關節損傷雜志, 2014, 29(2): 204-206.
2. 楊秀軍, 肖湘生.牽引、內旋位對股骨頸骨折早期股骨頭血運影響的超選擇DSA研究.中華放射學雜志, 2005, 39(8): 812-816.
3. Wang SH, Yang JJ, Shen HC, et al. Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients. Injury, 2015, 46(10): 1969-1974.
4. 危杰, 周力, 王滿宜.股骨頸骨折術后股骨頭缺血性壞死的發生及轉歸.中華骨科雜志, 2005, 25(1): 1-6.
5. Gregersen M, Krogshede A, Brink O, et al. Prediction of reoperation of femoral neck fractures treated with cannulated screws in elderly patients. Geriatr Orthop Surg Rehabil, 2015, 6(4): 322-327.
6. Yuenyongviwat V, Tuntarattanapong P, Tangtrakulwanich B. A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study. BMC Musculoskelet Disord, 2016, 17: 8.
7. Stone JD, Hill MK, Pan Z, et al. Open reduction of pediatric femoral neck fractures reduces osteonecrosis risk. Orthopedics, 2015, 38(11): e983-990.
8. Cao L, Wang B, Li M, et al. Closed reduction and internal fixation versus total hip arthroplasty for displaced femoral neck fracture. Chin J Traumatol, 2014, 17(2): 63-68.
9. 龍亞周, 張樹明, 王奎友.空心加壓螺釘內固定治療老年股骨頸骨折.中國骨與關節損傷雜志, 2015, 30(10): 1088-1089.
10. Jeno Manninger, Ulrich Bosch. Internal fixation of femoral neck fractures. New York: Springer Wien New York, 2007: 8-9.
11. Araujo TP, Guimaraes TM, Andrade-Silva FB, et al. Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws. Injury, 2014, 45 Suppl 5: S36-39.
12. 林志紅, 孫勇飛, 吳小山, 等.早期切開復位與閉合復位治療移位的兒童股骨頸骨折的療效比較.中國骨傷, 2012, 25(7): 546-548.
13. 田維, 崔壯, 闞世廉.不同時間和復位方法空心釘內固定治療移位股骨頸骨折術后骨折愈合的比較.中國修復重建外科雜志, 2009, 23(4): 440-443.
14. Liu C, Liu MT, Li P, et al. Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction. Chin Med J (Engl), 2015, 128(4): 483-488.
15. Leadbetter GW. A treatment for fracture of the neck of the femur. Reprinted from J Bone Joint Surg 20:108-113, 1938. Clin Orthop Relat Res, 2002, (399): 4-8.
16. Javdan M, Bahadori M, Hosseini A. Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011. Adv Biomed Res, 2013, 2: 14.
17. CLAFFEY TJ. Avascular necrosis of the femoral head. An anatomical study. J Bone Joint Surg (Br), 1960, 42-B: 802-809.
18. Popelka O, Skála-Rosenbaum J, Barto?ka R, et al. Fracture type and injury-to-surgery interval as risk factors for avascular necrosis of the femoral head after internal fixation of intracapsular femoral neck. Acta Chir Orthop Traumatol Cech, 2015, 82(4): 282-287.
19. 吳敏, 官建中, 肖玉周, 等.帶旋髂深血管蒂骨膜瓣植入治療未成年股骨頸骨折術后股骨頭缺血性壞死.中國修復重建外科雜志, 2015, 29(3): 275-279.
20. Yang JJ, Lin LC, Chao KH, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg (Am), 2013, 95(1): 61-69.
21. Ikemura S, Hara T, Nakamura T, et al. Subchondral insufficiency fracture of the femoral head: a report of two cases with a history of internal fixation of a femoral neck fracture. Skeletal Radiol, 2013, 42(6): 849-851.

Chinese Journal of Reparative and Reconstructive Surgery

Strategies of closed reduction in treatment of femoral neck fracture using cannulated screw fixation

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