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Lin D, Liang Y, Chen P, Zheng S, Lin F. Pre-sliding technique to improve femoral neck system against the shortening: a retrospective cohort study. BMC Musculoskelet Disord 2024; 25:293. [PMID: 38627701 PMCID: PMC11020420 DOI: 10.1186/s12891-024-07391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To investigate the efficacy of using pre-sliding technique to prevent postoperative shortening of displaced femoral neck fracture fixed with femoral neck system (FNS). METHODS Retrospective analysis of 110 cases of displaced femoral neck fracture treated with femoral neck system from September 2019 to November 2022 in our center, which were divided into 56 cases in the pre-sliding group and 54 cases in the traditional group. The baseline data such as gender, age, side, mechanism of injury, fracture type, operation time, intraoperative bleeding were recorded and compared between the two groups, and the quality of fracture reduction, shortening distance, Tip Apex Distance (TAD), union time, Harris score of the hip were also compared between the two groups. RESULTS The TAD value of the pre-sliding group was smaller than that of the traditional group, and the difference was statistically significant (P < 0.001). The shortening distance in both groups on postoperative day 1 was smaller in the pre-sliding group than in the traditional group, but the difference was not statistically significant (P = 0.07), and the shortening distance was smaller than in the traditional group at 1, 3, 6, and 12 months postoperatively, and the difference was statistically significant (all P < 0.001). Of the 110 cases, 34 (30.9%) had moderate or severe shortening, of which 24 (44.4%) were in the traditional group and 10 (17.9%) in the pre-sliding group, and the difference was statistically significant (P < 0.001), and the Harris score at 1 year, which was higher in the pre-sliding group than in the traditional group, and the difference between the two groups was statistically significant (P < 0.001). There was no statistically significant difference in the comparison of baseline data such as gender, age, side, mechanism of injury, fracture type, operation time, intraoperative bleeding, and quality of reduction between the two groups (all P > 0.05), and no statistically significant difference in fracture healing time between the two groups (P = 0.113). CONCLUSION The use of the pre-sliding technique of displaced femoral neck fracture fixed with FNS reduces the incidence of moderate and severe shortening, improves the postoperative TAD value, and improves the hip function scores, with a satisfactory midterm efficacy.
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Affiliation(s)
- Dongze Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Yaqian Liang
- Department of Orthopaedics, Fuzhou Second General Hospital, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Peisheng Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China
| | - Shunze Zheng
- School of Clinical Medicine, Fujian Medical University, Fuzhou, 350007, China
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, 350007, China.
- School of Clinical Medicine, Fujian Medical University, Fuzhou, 350007, China.
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Zheng S, Lin D, Chen P, Lin C, Chen B, Zheng K, Lin F. Comparison of femoral neck shortening after femoral neck system and cannulated cancellous screw fixation for displaced femoral neck fractures in young adults. Injury 2024; 55:111564. [PMID: 38640596 DOI: 10.1016/j.injury.2024.111564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/04/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The purpose of this study was to compare the outcomes of femoral neck shortening between the femoral neck system (FNS) and the cannulated cancellous screws (CCS) for displaced femoral neck fractures in young adults PATIENTS AND METHODS: In this retrospective analysis, 225 patients aged 18-65 years with displaced femoral neck fracture were divided into two groups according to internal fixation: 135 patients in the FNS group and 90 patients in the CCS group. The length of hospital stay, duration of surgery, intraoperative blood loss, quality of reduction, extent of femoral neck shortening, incidence of femoral neck shortening, femoral neck shortening at each follow-up visit, Harris hip score (HHS), reoperation, and complications were compared between the two groups. RESULTS The median follow-up time was 28.2 (26.0, 31.2) months in the FNS group and 30.2 (26.3, 34.7) months in the CCS group. The follow-up time, age, sex distribution, body mass index (BMI), mechanism of injury, injured side, length of hospital stay, time from injury to surgery, and fracture classification were similar between the groups. Duration of surgery was longer in the FNS group (65.0 (55.0, 87.0) min versus 55.0 (50.0, 65.0) min, P<0.001); intraoperative blood loss was greater in the FNS group (50.0 (20.0, 60.0) ml versus 20.0 (10.0, 35.0) ml, P<0.001). Femoral neck shortening was 2.4 (1.0, 4.5) mm in the FNS group versus 0.6 (0.0, 2.6) mm in the CCS group at 1 month postoperatively (P<0.001); 3.7 (1.8, 6.4) mm in the FNS group versus 1.2 (0.6, 3.8) mm in the CCS group at 3 months (P<0.001); 4.1(2.4, 7.7) mm in the FNS group versus 2.3 (1.1, 4.4) mm in the CCS group at 6 months (P<0.001); 4.2 (2.6, 7.7) mm in the FNS group versus 2.6 (1.3, 4.6) mm in the CCS group at 12 months (P<0.001); and 4.5 (2.8, 8.0) mm in the FNS group versus 2.8 (1.5, 4.8) mm in the CCS group at 18 months (P<0.001). The two groups showed no significant differences in HHS, reoperation, and reduction quality. CONCLUSION Compared to CCS, FNS is deficient in preventing femoral neck shortening. Future research should focus on improving FNS in terms of preventing femoral neck shortening.
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Affiliation(s)
- Shunze Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China
| | - Dongze Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Peisheng Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Chaohui Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Bin Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Ke Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China.
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Xian H, Cheng W, Xie W, Wang L, Luo D, Liu H, Lian K, Lin D. Does the angle between dynamic hip screw and anti-rotation screw affect the outcome of vertically oriented femoral neck fractures? A biomechanical analysis and clinical results. Injury 2024; 55:111317. [PMID: 38215569 DOI: 10.1016/j.injury.2024.111317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/24/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To analyze the effects of the angle between dynamic hip screw (DHS) and anti-rotation screw (AS) on vertically oriented femoral neck fractures (VOFNFs) and investigate the clinical results of them. METHODS Eighteen synthetic femurs were simulated and divided into 3 groups. The angle between DHS and AS in anteroposterior-view was marked as α, and in lateral-view was marked as β, thus the total angle (TA) was defined as the summation of α and β. The groups were categorized as group A (TA ≤ 5°), B (5° < TA ≤ 10°), and C (TA > 10°), respectively. All samples were tested under incremental, cyclical loading, and loading to failure. In clinic, 80 consecutive VOFNFs in 78 patients were treated with DHS plus AS. The patients were divided into 2 groups, including 48 fractures in parallel group (TA ≤10°) and 32 in angular group (TA >10°). RESULTS Group A and B survived during incremental and cyclical loading and endured longer than group C. Axial stiffness and failure loads were not different between group A and B, and greater than group C. Fracture gaps compressive stress was highest in group A, followed by group B and C. Forty-one fractures in parallel group and 23 in angular group healed at final follow-up. Nonunion and osteonecrosis occurred in 3 and 4 of parallel group, and 4 and 5 of angular group. CONCLUSION The construction with TA ≤10° between DHS and AS showed superior biomechanical performance and clinical results than those with TA >10°.
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Affiliation(s)
- Hang Xian
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Institute of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an 710032, China
| | - Weike Cheng
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wei Xie
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Lei Wang
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Institute of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an 710032, China
| | - Deqing Luo
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Hui Liu
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Kejian Lian
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Dasheng Lin
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China.
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Wang T, Yin H, Zhao X, Ma C. Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study. Arch Orthop Trauma Surg 2023; 143:7063-7071. [PMID: 37668661 DOI: 10.1007/s00402-023-05029-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The optimal internal fixation for non-displaced femoral neck fractures remains controversial. This study aimed to compare the clinical results of the percutaneous compression plate (PCCP) with parallel screws (PS) in treating femoral neck fractures in elderly patients. MATERIALS AND METHODS A total of 218 patients who underwent internal fixation were randomized to receive either a percutaneous compression plate (PCCP group) or parallel screws (PS group) using a computerized random sequence generator which was used to assign the order of randomization. Patients were assessed by the operating time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stay, the time to full weight-bearing, reduction quality, fracture healing time, Harris hip score, and postoperative complications. RESULTS There was no significant difference between PCCP and PS groups regarding operative time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stays, reduction quality, and Harris hip score (p > 0.05). The time to full weight-bearing and the fracture healing time in the PCCP group were shorter than those in the PS group (p < 0.05). The overall complication rates were slightly lower in the PCCP compared to the PS patients, but there was no significant difference (p > 0.05). However, the implant failure rate was significantly higher in the PS group compared to the PCCP group (p < 0.05). CONCLUSIONS The present study suggests that the PCCP is superior to the parallel screws fixation in the treatment of non-displaced elderly femoral neck fractures in terms of earlier full weight-bearing, shorter fracture healing time, and lower implant failure rate. Therefore, it may be a better therapeutic strategy for non-displaced femoral neck fractures in elderly patients.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Shanghai, 200080, People's Republic of China
| | - Haibo Yin
- Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, People's Republic of China
| | - Xijiang Zhao
- Department of Orthopaedics, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214122, People's Republic of China.
| | - Chunhui Ma
- Department of Orthopaedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Shanghai, 200080, People's Republic of China.
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Niemann M, Maleitzke T, Jahn M, Salmoukas K, Braun KF, Graef F, Stöckle U, Meller S. Restoration of Hip Geometry after Femoral Neck Fracture: A Comparison of the Femoral Neck System (FNS) and the Dynamic Hip Screw (DHS). Life (Basel) 2023; 13:2073. [PMID: 37895454 PMCID: PMC10608621 DOI: 10.3390/life13102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The femoral neck system (FNS) was introduced as a minimally invasive fixation device for managing femoral neck fractures. OBJECTIVE To compare radiographic, clinical, and patient-reported outcome measures (PROMs) of femoral neck fracture patients following FNS compared to dynamic hip screw (DHS) implantation combined with an anti-rotational screw. METHODS Patients who underwent closed reduction and internal fixation of a femoral neck fracture between 2020 and 2022 were retrospectively included. We measured leg length, femoral offset, and centrum-collum-diaphyseal (CCD) angle in plain radiographs. Scar length, Harris Hip Score, short-form health survey 36-item score (SF-36), and Numeric Rating Scale (NRS) were assessed during follow-up visits. RESULTS We included 43 patients (22 females) with a median age of 66 (IQR 57, 75). In both groups, leg length differences between the injured and the contralateral side increased, and femoral offset and CCD angle differences were maintained over time. FNS patients had shorter scars and reported fewer emotional problems and more energy. There were no differences between groups regarding the remaining SF-36 sub-scores, Harris Hip Score, and NRS. CONCLUSIONS The FNS allows for a comparable leg length, femoral offset, and CCD angle reconstruction while achieving similarly high functional and global health scores to the DHS.
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Affiliation(s)
- Marcel Niemann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, 13353 Berlin, Germany
| | - Tazio Maleitzke
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, 13353 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Programme, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Markus Jahn
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Katharina Salmoukas
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Department of Trauma Surgery and Orthopaedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, 12683 Berlin, Germany
| | - Karl F. Braun
- Department of Trauma Surgery, University Hospital Rechts der Isar, Technical University of Munich, 81675 München, Germany;
| | - Frank Graef
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Ulrich Stöckle
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Sebastian Meller
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
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Wang Y, Ma JX, Bai HH, Lu B, Sun L, Jin HZ, Ma XL. Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications. World J Clin Cases 2023; 11:4814-4823. [PMID: 37584003 PMCID: PMC10424033 DOI: 10.12998/wjcc.v11.i20.4814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The femoral neck dynamic intersection system (FNS) is mechanically more stable than other internal fixation techniques. Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations. However, whether the suitability of the FNS's 130° main nail angle design for Asian populations has been thoroughly investigated remains unclear. AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations. METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur. The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles. Afterward, the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software. Subsequently, they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures. RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120° group and 7.416 millimeters in the 125° group; in the 130°, 135°, and 140° FNS fixation groups, the peak displacement was 7.324 millimeters, 8.138 millimeters, and 8.246 millimeters, respectively. In the 120° and 125° FNS fixation groups, the maximum stresses were concentrated at the main nail and the anti-rotation screw, which intersected the fracture line of the femur neck, resulting in peak stresses of 200.7 MPa and 138.8 MPa, respectively. Peak stresses of 208.8 MPa, 219.8 MPa, and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°, 135°, and 140° fixation groups. CONCLUSION FNS has significant stress distribution properties, a minimal proximal femoral displacement, and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130° main nail angle.
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Affiliation(s)
- Ying Wang
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Jian-Xiong Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hao-Hao Bai
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Bin Lu
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Lei Sun
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hong-Zhen Jin
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Xin-Long Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
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Wang Y, Ma JX, Bai HH, Lu B, Sun L, Jin HZ, Ma XL. Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications. World J Clin Cases 2023; 11:4810-4819. [DOI: 10.12998/wjcc.v11.i20.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The femoral neck dynamic intersection system (FNS) is mechanically more stable than other internal fixation techniques. Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations. However, whether the suitability of the FNS's 130° main nail angle design for Asian populations has been thoroughly investigated remains unclear.
AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations.
METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur. The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles. Afterward, the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software. Subsequently, they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures.
RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120° group and 7.416 millimeters in the 125° group; in the 130°, 135°, and 140° FNS fixation groups, the peak displacement was 7.324 millimeters, 8.138 millimeters, and 8.246 millimeters, respectively. In the 120° and 125° FNS fixation groups, the maximum stresses were concentrated at the main nail and the anti-rotation screw, which intersected the fracture line of the femur neck, resulting in peak stresses of 200.7 MPa and 138.8 MPa, respectively. Peak stresses of 208.8 MPa, 219.8 MPa, and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°, 135°, and 140° fixation groups.
CONCLUSION FNS has significant stress distribution properties, a minimal proximal femoral displacement, and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130° main nail angle.
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Affiliation(s)
- Ying Wang
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Jian-Xiong Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hao-Hao Bai
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Bin Lu
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Lei Sun
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Hong-Zhen Jin
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
| | - Xin-Long Ma
- Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
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Stegelmann SD, Butler JT, Mathews DJ, Ostlie HC, Boothby BC, Phillips SA. Survivability of the Femoral Neck System for the treatment of femoral neck fractures in adults. Eur J Orthop Surg Traumatol 2023. [PMID: 36645494 DOI: 10.1007/s00590-023-03474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Hip fractures are common injuries in the elderly, with an incidence that continues to rise. The femoral neck system (FNS) recently emerged as a novel treatment option for femoral neck fractures, but long-term survivability of the implant remains uncertain. The purpose of this study is to evaluate survivability of the FNS and assess risk factors for implant failure. METHODS One hundred five adult patients who received the FNS (DePuy Synthes, Raynham, MA) for femoral neck fractures (AO/OTA 31B) were included. Surgeries were performed within a regional hospital system comprising 18 facilities. All patients had a minimum follow-up of 1 year. The primary outcome measures were cumulative incidence of implant failure and 1-year mortality, including risk factor analysis. RESULTS Twelve implants failed at a follow-up ranging from 17 days to 8 months, and 7 failed within 90 days. Cumulative incidence of implant failure was 2% at 30 days, 7% at 90 days, 12% at 6 months, and 13% at 1 year. Causes of implant failure included cut-out (n = 5), non-union (n = 4), peri-implant fracture (n = 2), and avascular necrosis (n = 1). Univariate Cox regression identified Pauwels type III fractures and an increasing AP Parker ratio as significant risk factors for failure. Pauwels type III fractures showed a 5.48 times higher risk compared to Pauwels types I & II. Every 10% increase in AP Parker ratio increased risk of failure by 2.39 times. The 1-year mortality rate was 21%, and univariate logistic regression identified age as the only risk factor (odds ratio = 3.71). CONCLUSIONS The incidence of implant failure and 1-year mortality rate in this study suggests that the FNS can provide reliable fixation compared to rates in the literature, but complications are not uncommon. Avoiding Pauwels type III fractures and optimizing implant placement appear crucial to preventing implant failure. LEVEL OF EVIDENCE Therapeutic Level IV.
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Peng P, Xiao F, He X, Fang W, Huang J, Wang B, Luo Y, Zhang Q, Zhang Y, He W, Wei Q, He M. Global Research Status and Trends of Femoral Neck Fracture Over the Past 27 Years: A Historical Review and Bibliometric Analysis. Front Surg 2022; 9:875040. [PMID: 35784942 PMCID: PMC9241583 DOI: 10.3389/fsurg.2022.875040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Femoral neck fracture (FNF) is a commonly encountered injury in orthopedic practice, and many studies have been conducted in this field. However, no bibliometric studies regarding the global research trend concerning FNF have been performed. This study aims to analyze the knowledge framework, research hotspots, and theme trends in the field of FNF research. Methods The scientific outputs related to FNF from 1994 to 2021 were retrieved from the Web of Science Core Collection. Three bibliometric tools were used for this study. The main analyses include publication and citation counts, contributions of countries, institutions, authors, funding agencies and journals, and clustering of keywords. Results In total, 3,553 articles were identified. The annual publication counts of FNF showed an ascending tendency as a whole. The United States has the most prominent contributions, with the most number of publications and the highest H-index. Karolinska Institutet devoted the most in this domain. Professors Bhandari M, Schemitsch EH, Frihagen F, Parker MJ, and Rogmark C were the core authors in this field. The most productive journal was Injury International Journal of the Care of the Injured. Keywords were divided into four clusters: epidemiology and mortality, fracture prevention, internal-fixation and risk factors, and hip replacement. A trend of balanced and diversified development existed in these clusters. Keywords with the ongoing bursts, including “outcome,” “reoperation,” “complication,” “revision,” “displaced intracapsular,” “fracture,” and “adult,” are considered as the research hotspots in the future and deserve more attention. Conclusions The management of FNF in young patients is drawing more attention from orthopedic surgeons, and it is expected that these research topics may continue to be the research hotspots and focus in the near future.
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Affiliation(s)
- Peng Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangjun Xiao
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoming He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weihua Fang
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiewen Huang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Wang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiwen Luo
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qinwen Zhang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital (Orthopedics Hospital of Henan), China
| | - Wei He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiushi Wei
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
| | - Mincong He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
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