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Sadeghpour A, Mahdipour S, Ghanjpour Sales J, Aslani H, Moharrami MR, Alizadeh H. Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial. J Orthop 2024; 51:32-38. [PMID: 38299065 PMCID: PMC10825919 DOI: 10.1016/j.jor.2023.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024] Open
Abstract
Background The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent. Methods This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS). Results Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001). Conclusion Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.
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Affiliation(s)
- Alireza Sadeghpour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahab Mahdipour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Ghanjpour Sales
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Aslani
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Moharrami
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Alizadeh
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Cao D, Yin J, Yu P, Li C, Yuan H, Sheng W, Li S. Treatment of Pauwels III femoral neck fracture in young patients using biplane double support screw internal fixation technology based on X-ray image. Med Eng Phys 2024; 125:104135. [PMID: 38508796 DOI: 10.1016/j.medengphy.2024.104135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Traditional treatment methods have certain limitations. In recent years, the technique of internal fixation with double-plane double-supported screws based on X-ray images has been proposed to improve the therapeutic effect. The main objective of this research was to examine the effectiveness of the X-ray image-based bi-planar double-braced screw internal fixation technique . During surgery, the procedure was determined based on X-ray images, followed by an open reduction procedure at the fracture site, and finally internal fixation using bi-planar double-support screws. All patients were successfully treated with X-ray image-based bi-planar double support screw fixation. After surgery, X-ray images showed a good reduction of the fracture site without significant loosening or failure of the internal fixation. At the postoperative follow-up, the patient's pain symptoms were significantly relieved, and no significant complications occurred during recovery.
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Affiliation(s)
- Diping Cao
- Department of Orthopaedic, Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Yin
- Department of Orthopaedic, Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pei Yu
- Department of Orthopaedic Surgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chao Li
- Department of Orthopaedic, Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hantao Yuan
- Department of Orthopaedic, Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenbo Sheng
- Department of Orthopaedic, Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sibo Li
- Department of Orthopaedic, Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Hamburger E, Cohen N, Rosenthal Y, Mazilis B, Drexler M, Shemesh S. 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; 144:723-729. [PMID: 38006435 DOI: 10.1007/s00402-023-05128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Femoral neck shortening is a common phenomenon following osteosynthesis for femoral neck fractures, which was shown to have a negative effect on hip function. There is paucity of literature on the effect of shortening on the ipsilateral limb mechanical axis and knee coronal alignment. We hypothesized that postoperative femoral neck shortening can alter the limb's mechanical axis into valgus. METHODS Of 583 patients screened, 13 patients with severe neck shortening (< 10 mm) following femoral neck fracture fixation, were found eligible and agreed to participate. A full-length lower limb radiographs were obtained and radiographic parameters (offset, neck-shaft angle, HKA, mLPFA, mDLFA, mMPTFA, MAD, MAD-r) as well as functional scores were obtained. RESULTS Statistically significant differences in mechanical axis deviation ratio (MAD-r) were found between the ipsilateral and the contralateral extremities (0.41 ± 0.16 versus 0.55 ± 0.11, p = 0.03). A correlation between femoral neck length differences and MAD was not statistically significant although a tendency towards lateral deviation of the mechanical axis was noted (r = - 0.5, p = 0.077). A negative correlation was found between a greater difference in the femoral neck length and the SF12 score, both in the physical and the mental parts (r = - 0.69, p = 0.008; r = - 0.58, p = 0.035, respectively). CONCLUSION We found a more lateralized mechanical axis in limbs that demonstrated post-operative ipsilateral femoral neck severe shortening. These findings may provide a possible explanation and rationale for knee pain and perhaps for the development of knee osteoarthritis as a sequalae of femoral neck shortening. Further investigation and larger cohort, long-term studies are needed to further explore this hypothesis.
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Affiliation(s)
- Ehud Hamburger
- Department of Orthopaedic Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel
| | - Nir Cohen
- Department of Orthopaedic Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel
| | - Yoav Rosenthal
- Department of Orthopaedic Surgery, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel
| | - Bar Mazilis
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, 7, Ha'Refua Street, 7747629, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Drexler
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, 7, Ha'Refua Street, 7747629, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shai Shemesh
- Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, 7, Ha'Refua Street, 7747629, Ashdod, Israel.
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Jin Y, Yin B, Shu L, Fan Z, Sherrier MC, Liu C, Sun H, Zhang W. Morphological characteristics of femoral neck fractures in young and middle-aged population: a retrospective descriptive study. BMC Musculoskelet Disord 2024; 25:100. [PMID: 38287282 PMCID: PMC10823608 DOI: 10.1186/s12891-024-07207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND A understanding of morphological characteristics are important to femoral neck fractures (FNFs) resulting in high rates of complications in the young and middle-aged adults and the detailed data is lack in the literature. We aimed to report on the detailed morphological characteristics and the relationship between them in young and middle-aged adults with femoral neck fractures (FNFs). METHODS The postoperative CT images of one hundred and fifty-two adults with FNFs were retrospectively reviewed. After image standardization, morphological characteristics including fracture orientation, cortex comminution, and intraosseous bone defects were measured and analyzed. Additionally, the distribution and correlation of these morphological features were analyzed using Pauwels classification, the right angle of the neck axis (VNA) classification, and the anteromedial oblique angle (AMA). RESULTS Pauwels III fractures accounted for approximately half (55.2%) of the FNFs analyzed. Pauwels II and III could be detected in all four VNA types, and the distribution of the Pauwels types in VNA classification showed significant differences (χ2 = 106.363, p < 0.001). The VNA (9.0° ± 12.1) showed positive correlation with the neck-shaft angle (139.5° ± 6.3) and modified Pauwels angle (49.8° ± 10.6) (r = 0.441, r = 0.855, all p < 0.001). Cortical comminutions were commonly observed in the posterior (86.7%) and the inferior (80.7%). AMAs within the cases without posterior and inferior cortex comminutions were significantly larger than those with comminution (t = 2.594, 2.1196; p = 0.01, 0.036), but no difference could be detected after the AMA being divided into three groups (< 85°, 85°-95°, > 95°). The MPA, VNA and AMA of the group with an intraosseous defect were significantly different compared with those without (t = 2.847, 2.314, 2.268; p = 0.005, 0.022,0.025). The incidence of intraosseous defects within the groups with coronal and axial cortex comminutions were significantly higher than those within the groups without comminutions (χ2 = 34.87, 25.303; p < 0.001). CONCLUSIONS The present study highlights the morphological diversity and complexity within FNFs in young and middle-aged adults, which allows for more accurate simulation of FNF patterns in the future biomechanical studies.
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Affiliation(s)
- Yingzhe Jin
- Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, 1111 JiangNan Road, Ningbo, 315040, China
| | - Bohao Yin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Linyuan Shu
- Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Zhiyuan Fan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Matthew C Sherrier
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Chenjun Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China
| | - Hui Sun
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China.
| | - Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China.
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Kılıç F, Polat A, Yamak F, Bozdag E, Fidan F, Başar H. Biomechanical comparison of fixation methods on third-generation femoral composite bone models in Pauwels type 3 femoral neck fractures: Contribution of the medial buttress plate to fixation. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2023; 57:243-249. [PMID: 37823742 PMCID: PMC10724781 DOI: 10.5152/j.aott.2023.22127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To compare the use of cannulated screws in an inverted triangular configuration, medial buttress plates, and the combination of these 2 fixation methods in the treatment of Pauwels type 3 femoral neck fractures. METHODS Twenty-eight anatomical composite third-generation femoral bone models were divided into 4 groups. The control group (group 1) was formed with 7 third-generation intact bone models. The fracture model was created with a 70° cutting block to fit 21 Pauwels type 3 fracture configurations. Seven models were fixed with an isolated 3.5 mm one-third semi-tubular medial buttress plate (group 2), 7 were fixed in an inverted triangular configuration with 6.5 mm cannulated screws (group 3), and 7 were fixed using a combination of 6.5 mm cannulated screws and a medial buttress plate (group 4). Cyclic loading was applied using axial forces ranging from 60 N to 600 N and moments ranging from 0.7 Nm to 7.0 Nm for 500 cycles. Once the cyclic loading stage was completed, the loads were removed from the system, and the quasi-static loading stage was employed to determine the stiffness and failure forces of the system under both axial and torsional forces. Quasi-static tests were performed with an axial speed of 1.8 mm/min and a torsional speed of 4.5°/min. The biomechanical properties of all groups were examined in terms of axial stiffness, torsional stiffness, and maximum axial force parameters. RESULTS The stiffness values of groups 1, 2, 3, and 4 were 303 ± 35.8 N/mm, 159.6 ± 25 N/mm, 232 ± 35.9 N/mm, and 366.9 ± 58 N/mm, respectively, under axial forces (P < .01); 2172.7 ± 252.1 Nmm/°, 1225.3 ± 238.6 Nmm/°, 2123 ± 359.4 Nmm/°, and 2721.85 ± 304 Nmm/°, respectively, under torsional moments (P < .01); and 2072.1 ± 256.1 N, 1379.9 ± 290.6 N, 2099.1 ± 454.2 N, and 2648.4 ± 364.6 N, respectively, under the maximum force (P < .01). CONCLUSION This study showed that in the fixation of Pauwels type 3 fractures formed on third-generation bone models, the utilization of half-thread cannulated screws in an inverted triangle configuration, along with a medial buttress plate, provided stronger fixation compared to the remaining implant groups and the control group. According to the evaluation of the parameters, the isolated application of a medial buttress plate had poorer biomechanical properties than other fixation methods.
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Affiliation(s)
- Feyzi Kılıç
- Department of Orthopaedics and Traumatology, Doğubeyazıt State Hospital, Ağrı, Turkey
| | - Abdulkadir Polat
- Department of Orthopaedics and Traumatology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
| | - Fatih Yamak
- Istanbul Technical University, Faculty of Mechanical Engineering, Istanbul, Turkey
| | - Ergün Bozdag
- Istanbul Technical University, Faculty of Mechanical Engineering, Istanbul, Turkey
| | - Fırat Fidan
- Department of Orthopaedics and Traumatology, Istanbul Aydın University, Faculty of Medicine, Istanbul, Turkey
| | - Hakan Başar
- Department of Orthopaedics and Traumatology, University of Health Sciences Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
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Lu Y, Huang Z, Xu Y, Huang Q, Ren C, Li M, Li Z, Sun L, Xue H, Zhang K, Wang Q, Ma T. Femoral neck system versus cannulated screws for fixation of femoral neck fracture in young adults: a systematic review and meta-analysis. Am J Transl Res 2022; 14:5480-5490. [PMID: 36105033 PMCID: PMC9452327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Femoral neck fracture treatment in young adults remains controversial. Cannulated screws (CS) and femoral neck system (FNS) are well-accepted methods for femoral neck fracture treatment; however, these methods are associated with complications. This meta-analysis aimed to evaluate the relative safety and effectiveness of CS and FNS for treating young patients with femoral neck fractures. METHODS We searched the following sources for studies that compared CS and FNS fixation: Cochrane library, Embase, PubMed, Web of Science, Wanfang data, China National Knowledge Infrastructure, China Biology Medicine disc, and Chinese Science and Technology Journals. The outcomes were surgical and prognostic results and complications. RESULTS This meta-analysis included eight studies. The pooled results revealed that the two fixation methods were similar in terms of the operation time, length of hospital stay, healing time, intraoperative blood loss, non-union, femoral head necrosis, and internal fixation cut-out. Compared with CS fixation, FNS fixation required fewer intraoperative fluoroscopies and had better Harris Hip Score, earlier weight-bearing, lower number of total complications, lesser femoral neck shortening, and lesser extent of nail retreat. CONCLUSION FNS fixation outperforms CS fixation in terms of intraoperative fluoroscopies, Harris Hip Score, and morbidity in young patients with femoral neck fractures. Clinicians should consider FNS as a first choice in treating femoral neck fracture in young adults, except where this approach is contraindicated.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Zhilong Huang
- Department of Orthopaedic Surgery, The Nuclear Industry 417 HospitalXi’an 710600, Shaan’xi Province, China
| | - Yibo Xu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an 710054, Shaan’xi Province, China
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Chang JZ, Xiao YP, Li L, Bei MJ. The efficacy of dynamic compression locking system vs. dynamic hip screw in the treatment of femoral neck fractures: a comparative study. BMC Musculoskelet Disord 2022; 23:661. [PMID: 35820870 PMCID: PMC9275283 DOI: 10.1186/s12891-022-05631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background There is still a lack of consensus on which internal fixation method can better maintain the stability of femoral neck fractures (FNF), promote fracture healing, and reduce postoperative complications such as femoral head necrosis and nonunion. Therefore, the purpose of this study was to evaluate the clinical efficacy of the novel dynamic compression locking system (DCLS) versus dynamic hip screw (DHS) in the treatment of FNF. Methods Fifty cases of FNF from July 2018 to February 2020 were retrospectively analyzed. According to different treatment methods, they were divided into DCLS group (26 cases) and DHS group (24 cases). Baseline data, intraoperative and postoperative clinical data, reoperation rate, and Harris score were collected to evaluate the clinical efficacy. Results All patients were followed up for 24 months. All “fractures” were caused by fall. The baseline data of the two groups were comparable (P > 0.05). There weren’t significant differences in the length of hospital stay and mobility after two years postoperatively between the two groups (P > 0.05). The operation time, blood loss, incision length, fluoroscopy times and the degree of femoral neck shortening after two years postoperatively in the DCLS group were significantly less than those in the DHS group (all P < 0.05). Harris score after two years postoperatively in the DCLS group was significantly higher than that in the DHS group (P < 0.05). Although the reoperation rate in the DHS group was slightly higher than that in the DCLS group, it wasn’t statistical significance (P > 0.05). Conclusions Compared with DHS, DCLS in the treatment of FNF had less surgical trauma, shorter incision length, shorter operation time, lower radiation dose and higher Harris scores. Although the reoperation rate in the DHS group was slightly higher than that in the DCLS group, it wasn’t statistical difference. Further research is needed.
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Affiliation(s)
- Jian-Zhong Chang
- Department of Orthopedic Surgery, CR & WISCO General Hospital, Wuhan University of Science and Technology, No. 209, Yejin Avenue, Hubei Province, 430080, Wuhan, P.R. China
| | - Ya-Ping Xiao
- Department of Orthopedic Surgery, CR & WISCO General Hospital, Wuhan University of Science and Technology, No. 209, Yejin Avenue, Hubei Province, 430080, Wuhan, P.R. China. .,Department of Orthopedic Surgery, Tongren Hospital of Wuhan University, Wuhan Third Hospital, No. 241, Pengliuyang Road, Hubei Province, 430000, Wuhan, P.R. China.
| | - Ling Li
- Department of Orthopedic Surgery, Tongren Hospital of Wuhan University, Wuhan Third Hospital, No. 241, Pengliuyang Road, Hubei Province, 430000, Wuhan, P.R. China
| | - Ming-Jian Bei
- Department of Traumatology, Beijing Ji Shui Tan Hospital, Xinjiekoudongjie 31, Xicheng dis, 100035, Beijing, P.R. China
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