Effectiveness analysis of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Yonghui ^1,2 , LI Lei ¹ , LI Chong ¹ , LI Meng ¹ , LI Li ¹ , XU Lei ¹ , YAO Gang ¹ , XU Wei ¹ ,  FANG Shiyuan ¹

1. Department of Trauma Orthopedics, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Heifei Anhui, 230001, P. R. China;
2. Graduate School, Wannan Medical College, Wuhu Anhui, 241002, P. R. China;

Corresponding?author：

FANG Shiyuan, Email: Fangshiyuan2008@163.com

Keywords：

Femoral neck fracture; internal fixation; hollow screw; biplanar vertical fixation; inverted triangle fixation; young and middle-aged

DOI：

10.7507/1002-1892.202404070

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Objective To compare the effectiveness of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients. Methods The clinical data of 55 young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture between June 2021 and December 2022 was retrospectively analyzed. All patients were treated with closed reduction and internal fixation with hollow screws, 25 cases were treated with biplanar vertical fixation (study group), 30 cases with inverted triangle fixation (control group). There was no significant difference in gender, age, affected side, cause of injury, underlying diseases, and time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, guide needle puncture times, starting time of weight bearing, time of full weight bearing, time of fracture healing, and complications were recorded and compared between the two groups. The hip joint function was evaluated by Harris score at 1 day, 6 months, 12 months after operation, and at last follow-up, and the pain relief was evaluated by visual analogue scale (VAS) score. The femoral neck shortening was measured on the X-ray film at last follow-up. Results All patients were followed up 12-31 months (mean, 22.0 months), and there was no significant difference in follow-up time between the two groups (P>0.05). The operation time, intraoperative blood loss, and fluoroscopy times in the study group were higher than those in the control group, but the difference was not significant (P>0.05). The guide needle puncture times in the study group was more than that in the control group, and the time of starting weight bearing and the time of full weight bearing in the study group were shorter than those in the control group, the differences were significant (P<0.05). Bony healing was achieved in both groups, and there was no significant difference in fracture healing time between the two groups (P>0.05). No osteonecrosis of the femoral head and incision-related complication was found in the two groups during follow-up, and the femoral neck shortening length in the study group was significantly shorter than that in the control group at last follow-up (P<0.05). There was no significant difference in Harris score between the two groups at 1 day after operation (P>0.05), and the Harris score of the study group was significantly better than that of the control group at other time points (P<0.05); there was no significant difference in VAS score between the two groups at each time point after operation (P>0.05). Conclusion Compared with the inverted triangle fixation, the treatment of Pauwels type Ⅲ femoral neck fracture with biplanar vertical fixation can effectively reduce femoral neck shortening without affecting fracture healing, and improve hip joint function in early stage.

Citation： ZHOU Yonghui, LI Lei, LI Chong, LI Meng, LI Li, XU Lei, YAO Gang, XU Wei, FANG Shiyuan. Effectiveness analysis of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 961-967. doi: 10.7507/1002-1892.202404070 Copy

1.	Wang K, Ni M, Liao P, et al. Fracture morphology and biomechanical characteristics of Pauwels Ⅲ femoral neck fractures in young adults. Injury, 2021, 52(11): 3227-3238.
2.	Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg (Am), 2008, 90(8): 1654-1659.
3.	Hamburger E, Cohen N, Rosenthal Y, et al. Femoral neck shortening as a sequela of internal fixation for femoral neck fractures and its effect on the coronal alignment of the limb: a pilot study. Arch Orthop Trauma Surg, 2024, 144(2): 723-729.
4.	Wang K, Lin D, Chen P, et al. Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system. J Orthop Surg Res, 2023, 18(1): 317. doi: 10.1186/s13018-023-03787-5.
5.	程培焱. 不同數量和排列方式的空心拉力螺釘治療股骨頸骨折的有限元分析. 石家莊: 河北醫科大學, 2017.
6.	劉英科, 馬文龍, 田可為, 等. 三種手術方式治療中青年PauwelsⅢ型股骨頸骨折的療效比較. 中國修復重建外科雜志, 2024, 38(4): 412-421.
7.	段強民, 李光磊, 張冰, 等. 4枚與3枚空心釘固定PauwelsⅢ型股骨頸骨折比較. 中國矯形外科雜志, 2022, 30(2): 113-118.
8.	張偉, 陳宇浩, 吳沼鋒, 等. 不同內固定方式治療PauwelsⅢ型股骨頸骨折術后并發癥發生率的網狀Meta分析. 現代醫學, 2024, 52(3): 369-378.
9.	中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
10.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
11.	Liu Y, Liang H, Zhou X, et al. Micro-computed tomography analysis of femoral head necrosis after long-term internal fixation for femoral neck fracture. Orthop Surg, 2022, 14(6): 1186-1192.
12.	Rajfer RA, Carlson BA, Johnson JP. High-energy femoral neck fractures in young patients. J Am Acad Orthop Surg, 2024, 32(7): e302-e312.
13.	李磊, 朱晨, 方詩元, 等. 股骨頸骨折空心釘內固定術后長期療效分析. 中華關節外科雜志 (電子版), 2018, 12(3): 310-316.
14.	Yu X, Rong PZ, Pang QJ, et al. The effect on the fracture healing following femoral neck shortening after osteoporotic femoral neck fracture treated with internal fixation: Finite element analysis. Biomed Res Int, 2021, 2021: 3490881. doi: 10.1155/2021/3490881.
15.	Yan SG, Cui Y, Li D, et al. Femoral neck system versus three cannulated screws for fixation of femoral neck fractures in younger patients: A retrospective cohort study. J Invest Surg, 2023, 36(1): 2266752. doi: 10.1080/08941939.2023.2266752.
16.	Huang ZY, Su YH, Huang ZP, et al. Medial buttress plate and allograft bone-assisted cannulated screw fixation for unstable femoral neck fracture with posteromedial comminution: A retrospective controlled study. Orthop Surg, 2022, 14(5): 911-918.
17.	蘇郁暉, 王博文, 陳瑞松, 等. 空心螺釘加內側支撐鋼板結合同種異體骨植骨治療伴后內側粉碎的不穩定性股骨頸骨折. 中國修復重建外科雜志, 2021, 35(11): 1434-1439.
18.	潘林華, 汪金平, 胡斌, 等. 橫行拉力螺釘在后內側皮質粉碎的股骨頸骨折中的應用效果觀察. 中國骨與關節損傷雜志, 2024, 39(2): 179-181.
19.	Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: Results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
20.	Jiang D, Zhan S, Cai Q, et al. Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury, 2021, 52(11): 3408-3414.
21.	Cuellar DO, Garcia Velez DA, Bledsoe G, et al. Hybrid screw fixation for femoral neck fractures: Does it prevent mechanical failure? Injury, 2022, 53(8): 2839-2845.
22.	Dong Q, Han Z, Zhang YG, et al. Comparison of transverse cancellous lag screw and ordinary cannulated screw fixations in treatment of vertical femoral neck fractures. Orthop Surg, 2019, 11(4): 595-603.
23.	Jiang D, Zhan S, Wang L, et al. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res, 2021, 39(8): 1669-1680.
24.	Ding K, Zhu Y, Li J, et al. Age-related changes with the trabecular bone of ward’s triangle and neck-shaft angle in the proximal femur: A radiographic study. Orthop Surg, 2023, 15(12): 3279-3287.
25.	Al-Naseem AO, Gonnah AR, Al-Ali H, et al. Robot-assisted versus conventional freehand fluoroscopy-guided percutaneous screw fixation in femoral neck fractures: A systematic review and meta-analysis. Cureus, 2022, 14(4): e24258. doi: 10.7759/cureus.24258.
26.	Wan L, Zhang X, Wu D, et al. Application of robot positioning for cannulated screw internal fixation in the treatment of femoral neck fracture: Retrospective study. JMIR Med Inform, 2021, 9(1): e24164. doi: 10.2196/24164.
27.	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.

1. Wang K, Ni M, Liao P, et al. Fracture morphology and biomechanical characteristics of Pauwels Ⅲ femoral neck fractures in young adults. Injury, 2021, 52(11): 3227-3238.
2. Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg (Am), 2008, 90(8): 1654-1659.
3. Hamburger E, Cohen N, Rosenthal Y, et al. Femoral neck shortening as a sequela of internal fixation for femoral neck fractures and its effect on the coronal alignment of the limb: a pilot study. Arch Orthop Trauma Surg, 2024, 144(2): 723-729.
4. Wang K, Lin D, Chen P, et al. Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system. J Orthop Surg Res, 2023, 18(1): 317. doi: 10.1186/s13018-023-03787-5.
5. 程培焱. 不同數量和排列方式的空心拉力螺釘治療股骨頸骨折的有限元分析. 石家莊: 河北醫科大學, 2017.
6. 劉英科, 馬文龍, 田可為, 等. 三種手術方式治療中青年PauwelsⅢ型股骨頸骨折的療效比較. 中國修復重建外科雜志, 2024, 38(4): 412-421.
7. 段強民, 李光磊, 張冰, 等. 4枚與3枚空心釘固定PauwelsⅢ型股骨頸骨折比較. 中國矯形外科雜志, 2022, 30(2): 113-118.
8. 張偉, 陳宇浩, 吳沼鋒, 等. 不同內固定方式治療PauwelsⅢ型股骨頸骨折術后并發癥發生率的網狀Meta分析. 現代醫學, 2024, 52(3): 369-378.
9. 中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
10. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
11. Liu Y, Liang H, Zhou X, et al. Micro-computed tomography analysis of femoral head necrosis after long-term internal fixation for femoral neck fracture. Orthop Surg, 2022, 14(6): 1186-1192.
12. Rajfer RA, Carlson BA, Johnson JP. High-energy femoral neck fractures in young patients. J Am Acad Orthop Surg, 2024, 32(7): e302-e312.
13. 李磊, 朱晨, 方詩元, 等. 股骨頸骨折空心釘內固定術后長期療效分析. 中華關節外科雜志 (電子版), 2018, 12(3): 310-316.
14. Yu X, Rong PZ, Pang QJ, et al. The effect on the fracture healing following femoral neck shortening after osteoporotic femoral neck fracture treated with internal fixation: Finite element analysis. Biomed Res Int, 2021, 2021: 3490881. doi: 10.1155/2021/3490881.
15. Yan SG, Cui Y, Li D, et al. Femoral neck system versus three cannulated screws for fixation of femoral neck fractures in younger patients: A retrospective cohort study. J Invest Surg, 2023, 36(1): 2266752. doi: 10.1080/08941939.2023.2266752.
16. Huang ZY, Su YH, Huang ZP, et al. Medial buttress plate and allograft bone-assisted cannulated screw fixation for unstable femoral neck fracture with posteromedial comminution: A retrospective controlled study. Orthop Surg, 2022, 14(5): 911-918.
17. 蘇郁暉, 王博文, 陳瑞松, 等. 空心螺釘加內側支撐鋼板結合同種異體骨植骨治療伴后內側粉碎的不穩定性股骨頸骨折. 中國修復重建外科雜志, 2021, 35(11): 1434-1439.
18. 潘林華, 汪金平, 胡斌, 等. 橫行拉力螺釘在后內側皮質粉碎的股骨頸骨折中的應用效果觀察. 中國骨與關節損傷雜志, 2024, 39(2): 179-181.
19. Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: Results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
20. Jiang D, Zhan S, Cai Q, et al. Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury, 2021, 52(11): 3408-3414.
21. Cuellar DO, Garcia Velez DA, Bledsoe G, et al. Hybrid screw fixation for femoral neck fractures: Does it prevent mechanical failure? Injury, 2022, 53(8): 2839-2845.
22. Dong Q, Han Z, Zhang YG, et al. Comparison of transverse cancellous lag screw and ordinary cannulated screw fixations in treatment of vertical femoral neck fractures. Orthop Surg, 2019, 11(4): 595-603.
23. Jiang D, Zhan S, Wang L, et al. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res, 2021, 39(8): 1669-1680.
24. Ding K, Zhu Y, Li J, et al. Age-related changes with the trabecular bone of ward’s triangle and neck-shaft angle in the proximal femur: A radiographic study. Orthop Surg, 2023, 15(12): 3279-3287.
25. Al-Naseem AO, Gonnah AR, Al-Ali H, et al. Robot-assisted versus conventional freehand fluoroscopy-guided percutaneous screw fixation in femoral neck fractures: A systematic review and meta-analysis. Cureus, 2022, 14(4): e24258. doi: 10.7759/cureus.24258.
26. Wan L, Zhang X, Wu D, et al. Application of robot positioning for cannulated screw internal fixation in the treatment of femoral neck fracture: Retrospective study. JMIR Med Inform, 2021, 9(1): e24164. doi: 10.2196/24164.
27. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients

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