The role of the medial buttress plate in the treatment of Pauwels type II and III femoral neck fracture in nonelderly patients: a retrospective study and preliminary results

Comparison of augmentation effects of medial buttress plate versus trochanteric lag screw in the cannulated screw fixation of Pauwels type III femoral neck fractures: A retrospective clinical study

OBJECTIVE

This study aimed to compare the effects of a medial buttress plate (MBP) or a trochanteric lag screw (TLS) to augment cannulated screws (CSs) in fixing Pauwels type III femoral neck fractures.

METHODS

This retrospective study included 58 patients (21 female, 37 male; mean age=46 years; age=19-64 years) treated by CSs for Pauwels type III femoral neck fractures from 2014 to 2017. All the patients were divided into 2 groups based on the internal fixation patterns: the MBP-augmented group (group A, n=26) and the TLS group (group B, n=32). The mean age was 47 (range=24-57) years in group A and 45 (range=19-64) years in group B. The operation time, intraoperative blood loss, reduction quality, Harris score, and postoperative complications were recorded and compared between both groups.

RESULTS

All patients were followed up for an average of 44.8 months in group A and 47.3 months in group B (P=.406). No significant difference was noted in reduction quality (P=1.000). However, group A had a longer operation time (100.2 vs. 64.3 minutes, P < .001) and greater intraoperative blood loss (153.1 vs. 30.0 mL, P < .001) than group B. At the final follow-up, the union rate was equal between group A (96.2%) and group B (90.6%) (P=.760). The mean bone union time was 21.6 weeks in group A and 23.6 weeks in group B (P=.431). The delayed union rate was lower in group A (0%) than in group B (15.6%) (P < .001). The incidence of postoperative complications in terms of implant failure (7.7% vs. 28.1%, P=.048) and femoral neck shortening (7.7% vs. 28.1%, P=.048) were lower in group A than in group B. No significant difference was noted in avascular femoral head necrosis (P=1.000) and the Harris score (P=.659) between the 2 groups.

CONCLUSION

In the surgical treatment of Pauwels type III femoral neck fractures, medial buttress plating can offer fewer complications but equal avascular femoral head necrosis rate and functional outcome compared to trochanteric screw application.

LEVEL OF EVIDENCE

Level III, Therapeutic study.

A biomechanical comparison of three fixation methods for unstable femoral neck fractures with medial calcar defect

BACKGROUND

Unstable femoral neck fractures with medial calcar defects are difficult to manage. The optimal fixation methods for these fractures have been a subject of ongoing debate among orthopedic surgeons. In this study, three different fixation techniques for vertical, medial defected femoral neck fractures were compared.

METHODS

In this study, a biomechanical analysis was conducted to compare three fixation methods: cannulated screws (Group 1), cannulated screws combined with a medial buttress plate (Group 2), and intramedullary nails (Group 3). Synthetic composite bone models representing vertical collum femoris fractures with medial calcar defects were used. Each group consisted of seven specimens, and, to maintain consistency, a single surgeon performed the surgical procedure. Biomechanical testing involved subjecting the specimens to axial loading until failure, and the load to failure, stiffness, and displacement values were recorded. Normality was tested using the Shapiro-Wilk test. One-way ANOVA and Tukey's HSD post hoc test were used for comparisons.

RESULTS

The difference in the load to failure values was statistically significant among the groups, with Group 2 exhibiting the highest load to failure value, followed by Group 3 and Group 1. Stiffness values were significantly higher in Group 2 than in the other groups. Displacement values were not significantly different between the groups. Fracture and displacement patterns at the point of failure varied across the groups.

CONCLUSION

The results of this study indicate that fixation with a medial buttress plate in combination with cannulated screws provides additional biomechanical stability for vertical femoral neck fractures with medial calcar defects. Intramedullary nail fixation also demonstrated durable stability in these fractures. These findings can be used to better understand current management strategies for these challenging fractures to promote the identification of better evidence-based recommendations.

Femoral neck system vs. cannulated screws on treating femoral neck fracture: a meta-analysis and system review

Objective

This meta-analysis aimed to compare the relative safety and efficacy of cannulated compression screw (CCS) and femoral neck system (FNS) in treating patients with femoral neck fractures and to provide evidence-based medical evidence for FNS in treating femoral neck fractures.

Methods

PubMed, Embase, Cochrane, and China National Knowledge Infrastructure databases were searched to collect outcomes related to femoral neck fractures treated with FNS and CCS, including time to fracture healing, incidence of non-union, incidence of osteonecrosis of the femoral head, incidence of failure of internal fixation, rate of femoral neck shortening, Harris hip score, Barthel index, operative time, intraoperative blood loss, fluoroscopy frequency, and complications. A meta-analysis was performed using RevManv5.4 (The Cochrane Collaboration) and Stata v14.0 software.

Results

This analysis included 21 studies involving 1,347 patients. The results showed that FNS was superior to CCS in terms of fracture healing time [mean difference (MD) = -0.75, 95% CI = (-1.04, -0.46), P < 0.05], incidence of bone non-union [odds ratio (OR) = 0.53, 95% CI = (0.29, 0.98), P = 0.04], incidence of osteonecrosis of the femoral head [OR = 0.49, 95% CI = (0.28, 0.86), P = 0.01], incidence of internal fixation failure [OR = 0.30, 95% CI = (0.18, 0.52), P < 0.05], rate of femoral neck shortening [OR = 0.38, 95% CI = (0.27, 0.54), P > 0.05], Harris hip score [MD = 3.31, 95% CI = (1.99, 4.63), P < 0.001], Barthel index [MD =  4.31, 95% CI = (3.02, 5.61), P < 0.05], intraoperative bleeding [MD = 14.72, 95% CI = (8.52, 20.92), P < 0.05], fluoroscopy frequency [OR = 0.53, 95% CI = (0.29, 0.98), P = 0.04], and complications [OR = 0.31, 95% CI = (0.22, 0.45), P < 0.05]. The difference between FNS and CCS in operative time was not statistically significant [MD = -2.41, 95% CI = (-6.88, 2.05), P = 0.29].

Conclusion

FNS treatment of femoral neck fracture can shorten the fracture healing time; reduce the incidence and translucent rate of bone non-union, osteonecrosis of the femoral head, and internal fixation failure; reduce intraoperative blood loss and postoperative complications; and improve hip joint function and activity. We are confident in the findings that FNS, an effective and safe procedure for internal fixation of femoral neck fractures, is superior to CCS.

Research hotspots and trends in internal fixation of femoral neck fractures from 2010 to 2022: A 12-year bibliometric analysis

BACKGROUND

This study endeavors to scrutinize the hotspots and trends in the literature concerning the internal fixation of femoral neck fractures (INFNF) through a comprehensive bibliometric analysis. Notably, this analytical process encompasses both qualitative and quantitative components.

METHODS

The present study has utilized the Science Citation Index-Expanded from the Web of Science Core Collection to extract datasets ranging from January 1, 2010, to August 31, 2022. Quantitative analysis was carried out using sophisticated analytical tools such as the Bibliographic Item Co-Occurrence Matrix Builder, the Online Analysis Platform of Literature Metrology, and CiteSpace software. Further, the major Medical Subject Headings terms and their subheading counterparts associated with INFNF were extracted from the PubMed2XL website using the corresponding PMIDs. These Medical Subject Headings terms were employed in conducting a co-word clustering analysis. Ultimately, the Graphical CLUstering TOolkit program was utilized to execute a co-word biclustering analysis to discern the prevailing hotspots in this domain.

RESULTS

Between January 1, 2010, and August 31, 2022, a total of 463 publications were issued on INFNF. The INJURY-INTERNAL JOURNAL OF THE CARE OF THE INJURED stood out as the most extensively perused journal in this area. Notably, China emerged as the foremost contributor to publishing articles within the last 12 years, followed by the United States and Canada. McMaster University was identified as the leading institution in INFNF research, while Bhandari M emerged as the most prolific author in this field. Moreover, the study identified five notable research hotspots within the domain of INFNF.

CONCLUSIONS

This study has identified five critical areas of research in the field of INFNF. It suggests that the primary focus of future research is likely to center on advancing internal fixation methods and robot-assisted instrumentation for femoral neck fractures. As such, this study provides valuable insights into future research directions and ideas for those working in this field.

Femoral neck system versus cannulated screws for fixation of femoral neck fracture in young adults: a systematic review and meta-analysis

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.