Peri-Implant Fracture Following Prior Fixation of Femoral Neck Fracture Using the Femoral Neck System: A Case Report

Introduction

Peri-implant fractures (PIF) reported after cannulated screw and dynamic hip screw fixation historically occur distal to the implant within the subtrochanteric region secondary to the development of a stress riser. Newer implant designs for femoral neck fractures have attempted to combine the benefits of minimally invasive techniques without forgoing rigid angular stability but bring new potential complications.

Case Report

We present a case of an intertrochanteric PIF in the setting of a non-displaced femoral neck fracture treated with the DePuy Synthes Femoral Neck System (FNS).

Conclusion

We present this case of a unique PIF pattern with the hope of identifying a potential complication associated with the novel FNS. Furthermore, we present a successful treatment option avoiding the need for conversion to hemiarthroplasty.

[Early effectiveness of Ti-Robot assisted femoral neck system for minimally invasive treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures]

Objective

To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures.

Methods

A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up.

Results

The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488).

Conclusion

Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.

Femoral Neck System versus Three Cannulated Screws for Fixation of Femoral Neck Fractures in Younger Patients: A Retrospective Cohort Study

OBJECTIVE

To compare the clinical results of a new femoral neck system (FNS) and cannulated compression screws (CCS) for the treatment of femoral neck fractures in younger patients.

METHODS

Retrospective study was performed in younger patients with femoral neck fractures that were treated with FNS or CCS from August 2017 to August 2022. The hip functional outcomes were assessed with the Harris hip score (HHS). Secondary outcomes included the surgical time, surgical blood loss, satisfaction visual analog scale (VAS), fluoroscopy frequency, fracture healing time and complications.

RESULTS

A total of 49 patients (22 FNS and 27 CCS) with a minimum follow-up of 12 months were included. There was also no significant difference in HHSs (p = 0.27) and satisfaction VAS (p = 0.10) between them. Patients with FNS had more blood loss (50.45 ± 5.28 mL vs. 20.67 ± 4.71 ml, p < 0.01), lower fluoroscopy frequency (16.64 ± 3.32 vs. 23.59 ± 3.39, p < 0.01) and lower fracture healing time (3.76 ± 0.42 vs. 4.46 ± 0.59 months, p < 0.01). The femoral neck shortening and incidence of nail withdrawal in the FNS group was significantly lower than CCS group (2.91 ± 1.95 vs. 4.44 ± 1.52 mm, p < 0.01; 4.5% vs. 22.2%, p = 0.03).

CONCLUSIONS

The FNS and CCS get similar hip functions. The FNS can reduce fluoroscopy exposure and the complications such as femoral neck shortening and nail withdrawal. Thus, FNS can be an alternative to CCS for the fixation of femoral neck fractures in younger patients.

Restoration of Hip Geometry after Femoral Neck Fracture: A Comparison of the Femoral Neck System (FNS) and the Dynamic Hip Screw (DHS)

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.

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.

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

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.

Comparison of femoral neck system vs. dynamic hip system blade for the treatment of femoral neck fracture in young patients: A retrospective study

Background

Femoral neck fracture is a common fracture in orthopedic practice. This study aimed to compare the clinical outcomes between the femoral neck system and dynamic hip system blade for the treatment of femoral neck fracture in young patients.

Methods

This retrospective study included 43 and 52 patients who underwent treatment for femoral neck fracture with the femoral neck system and dynamic hip system blade, respectively, between August 2019 and August 2020. Operative indexes, including operation duration, blood loss, incision length, postoperative complications (femoral neck shortening, non-union, screw pull-out, femoral head necrosis), and Harris scale scores were recorded and analyzed.

Results

Compared to that with the dynamic hip system blade, the femoral neck system showed significantly less operation duration (femoral neck system vs. dynamic hip system blade: 47.09 ± 9.19 vs. 52.90 ± 9.64, P = 0.004), less blood loss (48.53 ± 10.69 vs. 65.31 ± 17.91, P < 0.001), and shorter incision length (4.04 ± 0.43 vs. 4.93 ± 0.53, P < 0.001). Femoral neck shortening was significantly lower with the femoral neck system than with the dynamic hip system blade (3.93 ± 2.40, n = 39 vs. 5.22 ± 2.89, n = 44, P = 0.031). No statistical differences were observed between the two groups in nonunion, screw pull-out, and femoral head necrosis. In addition, the latest follow-up Harris scale score was significantly higher with the femoral neck system than with the dynamic hip system blade (92.3 ± 4.5 vs. 89. 9 ± 4.9, P = 0.015).

Conclusion

The femoral neck system results in less trauma, less femoral neck shortening, and better hip joint function than the dynamic hip system blade for the treatment of femoral neck fracture in young patients.

Early Results of Internal Fixation with Femoral Neck System in Young Patients with Femoral Neck Fracture

BACKGROUND

Femoral neck fractures are intracapsular hip fractures. There are several surgical implants that have been used to treat femoral neck fractures. Depuy Synthes Products and the lower extremity expert group have developed an innovative femoral neck system (FNS) for fixing femoral neck fractures. With minimally invasive procedures, FNS can provide angular stability.

MATERIALS AND METHODS

A non-randomized single centre prospective study was conducted in 30 patients of less than 60 years of age at Maharishi Markandeshwar Institute of Medical Sciences and Research between August 2020 to May 2022. All patients underwent internal fixation with FNS within 48 hours of presentation.

RESULTS

Although blood loss and operative time in our operated group was more than that in conventional fixation by cannulated screws, our group had better VAS scores, better Harris scores and lower complication rates.

CONCLUSIONS

1. The Femoral Neck System resulted in better biomechanical properties and good early results in femoral neck fractures. FNS gives both angular stability and rotational stability. The last follow-up in our study showed Harris score to be significantly higher, and the incidence of complications were lower. 2. The combination of FNS bolts with anti-rotation screws avoids the "Z" effect and improves the overall stability and anti-rotation effect. 3. In addition, the novel sliding compression mechanism of FNS allows the fracture ends to come in close contact with each other, benefitting fracture healing.

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.

Management of Femoral Neck Fracture in Above Knee Amputee with Femoral Neck System: A Case Report

Introduction

Femoral neck fractures in patients with a history of above knee amputation present as a strain for orthopedic surgeons due to the difficulty of positioning and handling of the limb for proper reduction. Surgical treatment options typically involve open reduction internal fixation versus arthroplasty depending on patient factors such as age, surgeon skill, and available equipment.

Case Report

We present a case of a femoral neck fracture (OTA 31-B2) in a relatively active 89-year-old Caucasian male after a ground level fall that has been ambulating with a prosthesis since his teenage years. In this report, we describe the patient positioning, technique used to treat a femoral neck fracture (OTA 31-B2) using the femoral neck system, and the successful outcome of our patient 1 year from the injury.

Conclusion

We conclude that using the femoral neck system (FNS) is a viable option for patients with a high above knee amputation where, due to the length of the limb and potentially the lack of appropriately sized implants, dislocating and reducing the hip for total hip arthroplasties and hemiarthroplasties provide a challenge.

[Short-term effectiveness of orthopedic robot-assisted femoral neck system fixation for fresh femoral neck fractures]

OBJECTIVE

To investigate the short-term effectiveness and advantages of the orthopedic robot-assisted femoral neck system (FNS) fixation in the treatment of fresh femoral neck fractures compared with the traditional manual operation.

METHODS

A clinical data of 74 patients with fresh femoral neck fractures, who had undergone internal fixation with FNS between April 2020 and September 2021, was retrospectively analyzed. Among them, there were 31 cases of TiRobot-assisted operation (trial group) and 43 cases of traditional manual operation (control group). There was no significant difference between groups ( P>0.05) in terms of gender, age, cause of injury, time from injury to operation, fracture side and type. The fracture fixation time (intraoperative fracture reduction to the end of suture), invasive fixation time (incision of internal fixation to the end of suture), the number of placing key-guide needle, incision length, intraoperative blood loss, fracture healing, and Harris score of hip function were recorded and compared.

RESULTS

All operations were performed with no neurovascular injury or incision complications. The invasive fixation time, intraoperative blood loss, the number of placing key-guide needle, and the incision length in the trial group were superior to the control group ( P<0.05), and there was no significant difference in fracture fixation time between groups ( P>0.05). All patients were followed up 4-16 months (mean, 7 months). The fracture did not heal in 1 patient of trial group, and the other fractures healed in 2 groups; the fracture healing time was (17.6±1.9) weeks in trial group and (18.2±1.9) weeks in control group, and there was no significant difference between groups ( t=0.957, P=0.345). At last follow-up, the Harris score of the trial group was 82.4±5.8, which was higher than that of the control group (79.0±7.7), but the difference was not significant ( t=-1.483, P=0.147).

CONCLUSION

Orthopedic robot-assisted FNS fixation in the treatment of fresh femoral neck fractures has the similar short-term effectiveness as the traditional method, but the former has advantages in terms of operation time, intraoperative blood loss, and the number of placing key-guide needle, making the operation more minimally invasive and quicker, and more suitable for older patients.

Is Femoral Neck System a Valid Alternative for the Treatment of Displaced Femoral Neck Fractures in Adolescents? A Comparative Study of Femoral Neck System versus Cannulated Compression Screw

Background and Objectives: The femoral neck system (FNS) is a new minimally invasive internal fixation system for femoral neck fractures (FNFs), but its use has not been reported in adolescents. The aim of this study was to compare the clinical and radiographic outcomes of displaced FNF in adolescents treated with FNS or a cannulated compression screw (CCS). Materials and Methods: A retrospective study of 58 consecutive patients with displaced FNF treated surgically was performed; overall, 28 patients underwent FNS and 30 CCS fixation. Sex, age at injury, type of fracture, associated lesions, duration of surgery, radiation exposure, and blood loss were collected from the hospital database. The clinical and radiographic results, as well as complications, were recorded and compared. Results: The patients were followed up for 16.4 ± 3.1 months on average after index surgery (range, 12 to 24). Consolidation time among patients treated with FNS was significantly lower than those managed by CCS (p = 0.000). The functional scores of patients treated with FNS were significantly higher than those managed by CCS (p = 0.030). Unplanned hardware removal in patients treated with FNS was significantly lower than in those managed by CCS (p = 0.024). Conclusions: FNS has a lower complication rate and better functional outcome than CCS. It may be a good alternative to treat femoral neck fractures in adolescents.

Comparison Between Femoral Neck Systems and Cannulated Cancellous Screws in Treating Femoral Neck Fractures: A Meta-Analysis

Background

We performed a meta-analysis to compare the efficacy and safety of the femoral neck system (FNS) with cannulated cancellous screws (CCSs) in treating femoral neck fractures (FNFs) in controlled clinical trials.

Methods

Eligible scientific articles published prior to September 2021 were retrieved from the PubMed, Web of Science, Springer, ScienceDirect and Cochrane Library databases. The statistical analysis was performed with RevMan 5.1.

Results

Seven retrospective studies met the inclusion criteria. Meta-analysis showed that there were significant differences in perioperative blood loss, the postoperative Harris score, healing time, fluoroscopy frequency, total complications, femoral head necrosis, femoral neck shortening and screw cutout. No significant differences were found regarding operation time, length of hospital stay or nonunion between the two groups.

Conclusion

Compared with CCSs, the FNS showed better clinical efficacy and fewer complications in treating FNFs. Due to the limited quality and data of the currently available evidence, more high-quality randomized controlled trials are needed.

Comparing Perioperative Outcome Measures of the Dynamic Hip Screw and the Femoral Neck System

Background and Objective: Various fixation devices and surgical techniques are available for the management of proximal femur fractures. Recently, the femoral neck system (FNS) was introduced, and was promoted on the basis of less invasiveness, shorter operating time, and less fluoroscopy time compared to previous systems. The aim of this study was to compare two systems for the internal fixation of femoral neck fractures (FNF), namely the dynamic hip screw (DHS) with an anti-rotation screw (ARS) and an FNS. The outcome measures included operating room time (ORT), dose−area product (DAP), length of stay (LOS), perioperative changes in haemoglobin concentrations, and transfusion rate. Materials and Methods: A retrospective single-centre study was conducted. Patients treated for FNF between 1 January 2020 and 30 September 2021 were included, provided that they had undergone closed reduction and internal fixation. We measured the centrum-collum-diaphyseal (CCD) and the Pauwels angle preoperatively and one week postoperatively. Results: In total, 31 patients (16 females), with a mean age of 62.81 ± 15.05 years, were included. Fracture complexity assessed by the Pauwels and Garden classification did not differ between groups preoperatively. Nonetheless, the ORT (54 ± 26.1 min vs. 91.68 ± 23.96 min, p < 0.01) and DAP (721 ± 270.6 cGycm² vs. 1604 ± 1178 cGycm², p = 0.03) were significantly lower in the FNS group. The pre- and postoperative CCD and Pauwels angles did not differ statistically between groups. Perioperative haemoglobin concentration changes (−1.77 ± 1.19 g/dl vs. −1.74 ± 1.37 g/dl) and LOS (8 ± 5.27 days vs. 7.35 ± 3.43 days) were not statistically different. Conclusions: In this cohort, the ORT and DAP were almost halved in the patient group treated with FNS. This may confer a reduction in secondary risks related to surgery.

[Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle femoral neck fractures]

Objective

To compare the effectiveness of the femoral neck system (FNS) and inverted triangle cannulated screws (ITCS) for the treatment of Pauwels type Ⅲ femoral neck fractures.

Methods

The clinical data of 59 patients with Pauwels type Ⅲ femoral neck fractures treated between May 2019 and November 2020 were retrospectively analysed. The patients were divided into FNS group (28 cases) and ITCS group (31 cases) according to the different internal fixation. There was no significant difference in gender, age, affected side, body mass index, cause of injury, smoking history, alcohol abuse history, Pauwels angle, Garden classification, AO/Orthopaedic Trauma Association (AO/OTA) classification, and time from injury to operation between the two groups ( P>0.05). The operation time, incision length, intraoperative blood loss, extra assisted reduction procedures (Kirschner wire prying reduction or open reduction), hospitalization stay, and early complications were recorded and compared between the two groups. Garden index and Haidukewych score were used to evaluate fracture reduction. Fracture healing time, lateral thigh irritation, time of partial or total weight-bearing postoperatively, shortening length and degree of femoral neck, change of caput-collum-diaphysis (CCD) angle (the difference of CCD angle between immediate after operation and last follow-up), incidence of osteonecrosis of femoral head and revision surgery were recorded and compared between the two groups. Hip joint function were evaluated by Harris score.

Results

The operation time of FNS group was significantly shorter than ITCS group, and the incision length was significantly longer than ITCS group ( P<0.05). There was no significant difference in intraoperative blood loss, assisted reduction, Garden index, Haidukewych score, and hospitalization stay between the two groups ( P>0.05). All the incisions healed by first intention. There were 2 deep vein thrombosis in the FNS group and 1 pulmonary infection and 1 deep vein thrombosis in the ITCS group. No significant difference was found in the incidence of early postoperative complications (7.1% vs. 6.5%) between the two groups ( P=1.000). Patients in both groups were followed up 3-14 months, and there was no significant difference in follow-up time between the two groups ( t=-0.553, P=0.582). The fracture healing time, Harris score, and the partial weight-bearing time after operation of the FNS group were significantly better than those of the ITCS group ( P<0.05). However, there was no significant difference in total weight-bearing time between the two groups ( Z=-1.298, P=0.194). No lateral thigh irritation was found in the FNS group, while 10 patients in the ITCS group had lateral thigh irritation, and the incidence between the two groups (0 vs. 32.3%) was significant ( P=0.001). At last follow-up, the shortening length and degree of femoral neck and the change of CCD angle in FNS group were significantly less than those in ITCS group ( P<0.05). There was no patient with osteonecrosis of femoral head or reoperation in the FNS group, while 4 patients in the ITCS group underwent reoperation (including 2 cases of osteonecrosis of the femoral head). However, the incidences (0 vs. 6.5%; 0 vs.12.9%) between the two groups were not significant ( P=0.493; P=0.114).

Conclusion

Using FNS to treat Pauwels type Ⅲ femoral neck fracture is simple as well as able to reduce the shortening of the femoral neck and the change of the CCD angle. Also, FNS is conducive to the recovery of hip joint function, which should be considered as a new choice for the treatment of young femoral neck fracture patients.

[Short-term effectiveness of femoral neck system in the treatment of femoral neck fracture]

Objective

To investigate the short-term effectiveness of femoral neck system (FNS) in the treatment of femoral neck fracture.

Methods

The clinical data of 34 patients with femoral neck fracture admitted between January 2019 and April 2020 who met the selection criteria were retrospectively analyzed and divided into group A (19 patients were treated with conventional cannulated screw internal fixation) and group B (15 patients were treated with FNS internal fixation) according to the different methods of internal fixation. There was no significant difference between the two groups in general data such as gender, age, affected side, cause of injury, fracture type, and time from injury to operation ( P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency, and fracture healing time were recorded and compared between the two groups. X-ray film and CT examinations were performed postoperatively to evaluate fracture reduction and internal fixation, and the shortening of the femoral neck on the affected side was measured compared with that on the healthy side. The Harris score was used to evaluate hip function.

Results

There was 1 unsatisfied reduction case in groups A and B respectively, the rest of the patients in both groups were obtained satisfied reduction. There was no significant difference in the quality of reduction between the two groups ( Z=-0.195, P=0.854). There was no significant difference in operation time between the two groups ( t=0.649, P=0.064). The intraoperative blood loss in group A was significantly less than that in group B, and the fluoroscopy frequency was significantly more than that in group B, with significant differences ( P<0.05). Except for 1 case in group A with screw out at 3 months after operation and no obvious callus formation, all fractures in the two groups reached clinical healing, and there was no significant difference in fracture healing time between the two groups ( t=-0.127, P=0.899). There was no necrosis of femoral head in the two groups. At last follow-up, there were 4 cases of femoral neck shortening in group A and 2 cases in group B. The hip function of both groups recovered well, and there was no significant difference in Harris score at last follow-up ( t=0.956, P=0.346).

Conclusion

The treatment of femoral neck fracture using FNS has less trauma. Compared with cannulated screw internal fixation, it can reduce the intraoperative fluoroscopy frequency and obtain satisfactory short-term effectiveness.