Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xiaopan ,  WU Min , CHEN Xiaotian , YE Longfei , DAI Xiusong

Department of Orthopaedics, Anhui Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China;

Corresponding?author：

WU Min, Email: 464550501@qq.com

Keywords：

Valgus-impacted femoral neck fracture; screwdrive rod; femoral neck system; closed reduction; internal fixation

DOI：

10.7507/1002-1892.202212043

Video：

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Objective To evaluate the feasibility and effectiveness of percutaneous screwdriver rod-assisted closed reduction in the treatment of valgus-impacted femoral neck fractures. Methods Between January 2021 and May 2022, 12 patients with the valgus-impacted femoral neck fractures were treated with percutaneous screwdriver rod-assisted closed reduction and femoral neck system (FNS) internal fixation. There were 6 males and 6 females with a median age of 52.5 years (range, 21-63 years). The fractures were caused by traffic accident in 2 cases, falling in 9 cases, and falling from height place in 1 case. All were unilateral closed femoral neck fractures, including 7 on the left side and 5 on the right side. The time from injury to operation was 1-11 days, with an average of 5.5 days. The fracture healing time and postoperative complications were recorded. The quality of fracture reduction was evaluated by Garden index. At last follow-up, Harris score was used to evaluate the hip joint function, also the shortening of femoral neck was measured. Results All the operations were successfully completed. After operation, the incision fat liquefaction occurred in 1 case, which healed after enhanced dressing change, and the other patients’ incisions healed by first intention. All patients were followed up 6-18 months, with an average of 11.7 months. The X-ray film reexamination showed that the quality of fracture reduction was grade Ⅰ in 10 cases and grade Ⅱ in 2 cases according to the Garden index. All fractures reached bony union, and the healing time was 3-6 months, with an average of 4.8 months. At last follow-up, the femoral neck was shortened by 1-4 mm, with an average of 2.1 mm. No internal fixation failure or osteonecrosis of the femoral head occurred during follow-up. At last follow-up, the hip Harris score was 85-96, with an average of 92.4; 10 cases were rated as excellent and 2 were good. Conclusion The percutaneous screwdriver rod-assisted closed reduction can effectively reduce the valgus-impacted femoral neck fracture. It has the advantages of simple operation, effective, and less impact on blood supply.

Citation： WANG Xiaopan, WU Min, CHEN Xiaotian, YE Longfei, DAI Xiusong. Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(3): 272-276. doi: 10.7507/1002-1892.202212043 Copy

1.	Nyholm AM, Palm H, Sandholdt H, et al. Osteosynthesis with parallel implants in the treatment of femoral neck fractures: Minimal effect of implant position on risk of reoperation. J Bone Joint Surg (Am), 2018, 100(19): 1682-1690.
2.	王朝暉, 曹書杰, 楊杰, 等. 空心釘原位內固定治療后傾角<20°外展嵌插型股骨頸骨折. 醫學理論與實踐, 2021, 34(21): 3752-3754.
3.	Nanty L, Canovas F, Rodriguez T, et al. Femoral neck shortening after internal fixation of Garden Ⅰ fractures increases the risk of femoral head collapse. Orthop Traumatol Surg Res, 2019, 105(5): 999-1004.
4.	Biz C, Tagliapietra J, Zonta F, et al. Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures. Aging Clin Exp Res, 2020, 32(3): 505-513.
5.	Raaymakers EL, Marti RK. Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg (Br), 1991, 73(6): 950-954.
6.	Park YC, Um KS, Kim DJ, et al. Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures. Injury, 2021, 52(3): 569-574.
7.	Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury, 2016, 47(12): 2743-2748.
8.	Song HK, Lee JJ, Oh HC, et al. Clinical implication of subgrouping in valgus femoral neck fractures: comparison of 31-B1.1 with 31-B1.2 fractures using the OTA/AO classification. J Orthop Trauma, 2013, 27(12): 677-682.
9.	梁慕天, 張英琪, 蔡倩瑩, 等. 外展嵌插型股骨頸骨折對屈髖活動度影響的三維模擬研究. 中華創傷骨科雜志, 2021, 23(10): 841-849.
10.	Strehl A, Ganz R. Anterior femoroacetabular impingement after healed femoral neck fractures. Unfallchirurg, 2005, 108(4): 263-273.
11.	Schaefer TK, Spross C, Stoffel KK, et al. Biomechanical properties of a posterior fully threaded positioning screw for cannulated screw fixation of displaced neck of femur fractures. Injury, 2015, 46(11): 2130-2133.
12.	Dai Y, Ni M, Dou B, et al. Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture. Comput Methods Biomech Biomed Engin, 2022, 25: 1-8.
13.	Aepli M, Rüdiger HA, Leunig M. Ligamentum teres impingement in valgus impacted femoral neck fracture: A case for hip arthroscopy. JBJS Case Connect, 2020, 10(4): e2000284. doi: 10.2106/JBJS.CC.20.00284.
14.	王富洋, 劉宇宸, 程亮亮, 等. 股骨頸骨折常用內固定方式的生物力學研究進展. 中國修復重建外科雜志, 2022, 36(7): 896-901.
15.	Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
16.	冀家琛, 楊博, 王敏, 等. 股骨頸動力交叉釘系統治療青壯年股骨頸骨折的研究進展. 中國修復重建外科雜志, 2022, 36(11): 1434-1439.
17.	楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療Pauwels Ⅲ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
18.	朱求亮, 顏茂華, 許斌, 等. 閉合復位技術治療外展嵌插型股骨頸骨折. 中國骨傷, 2022, 35(4): 357-360.
19.	Yoon BH, Kim YS, Koo KH. A simple percutaneous technique to reduce valgus-impacted femoral neck fractures. Clin Orthop Surg, 2020, 12(2): 258-262.

1. Nyholm AM, Palm H, Sandholdt H, et al. Osteosynthesis with parallel implants in the treatment of femoral neck fractures: Minimal effect of implant position on risk of reoperation. J Bone Joint Surg (Am), 2018, 100(19): 1682-1690.
2. 王朝暉, 曹書杰, 楊杰, 等. 空心釘原位內固定治療后傾角<20°外展嵌插型股骨頸骨折. 醫學理論與實踐, 2021, 34(21): 3752-3754.
3. Nanty L, Canovas F, Rodriguez T, et al. Femoral neck shortening after internal fixation of Garden Ⅰ fractures increases the risk of femoral head collapse. Orthop Traumatol Surg Res, 2019, 105(5): 999-1004.
4. Biz C, Tagliapietra J, Zonta F, et al. Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures. Aging Clin Exp Res, 2020, 32(3): 505-513.
5. Raaymakers EL, Marti RK. Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg (Br), 1991, 73(6): 950-954.
6. Park YC, Um KS, Kim DJ, et al. Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures. Injury, 2021, 52(3): 569-574.
7. Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury, 2016, 47(12): 2743-2748.
8. Song HK, Lee JJ, Oh HC, et al. Clinical implication of subgrouping in valgus femoral neck fractures: comparison of 31-B1.1 with 31-B1.2 fractures using the OTA/AO classification. J Orthop Trauma, 2013, 27(12): 677-682.
9. 梁慕天, 張英琪, 蔡倩瑩, 等. 外展嵌插型股骨頸骨折對屈髖活動度影響的三維模擬研究. 中華創傷骨科雜志, 2021, 23(10): 841-849.
10. Strehl A, Ganz R. Anterior femoroacetabular impingement after healed femoral neck fractures. Unfallchirurg, 2005, 108(4): 263-273.
11. Schaefer TK, Spross C, Stoffel KK, et al. Biomechanical properties of a posterior fully threaded positioning screw for cannulated screw fixation of displaced neck of femur fractures. Injury, 2015, 46(11): 2130-2133.
12. Dai Y, Ni M, Dou B, et al. Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture. Comput Methods Biomech Biomed Engin, 2022, 25: 1-8.
13. Aepli M, Rüdiger HA, Leunig M. Ligamentum teres impingement in valgus impacted femoral neck fracture: A case for hip arthroscopy. JBJS Case Connect, 2020, 10(4): e2000284. doi: 10.2106/JBJS.CC.20.00284.
14. 王富洋, 劉宇宸, 程亮亮, 等. 股骨頸骨折常用內固定方式的生物力學研究進展. 中國修復重建外科雜志, 2022, 36(7): 896-901.
15. Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
16. 冀家琛, 楊博, 王敏, 等. 股骨頸動力交叉釘系統治療青壯年股骨頸骨折的研究進展. 中國修復重建外科雜志, 2022, 36(11): 1434-1439.
17. 楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療Pauwels Ⅲ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
18. 朱求亮, 顏茂華, 許斌, 等. 閉合復位技術治療外展嵌插型股骨頸骨折. 中國骨傷, 2022, 35(4): 357-360.
19. Yoon BH, Kim YS, Koo KH. A simple percutaneous technique to reduce valgus-impacted femoral neck fractures. Clin Orthop Surg, 2020, 12(2): 258-262.

Chinese Journal of Reparative and Reconstructive Surgery

Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures

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