Biomechanical Analysis of Fixation Devices for Basicervical Femoral Neck Fractures

Johnson, Joseph R.; Deren, Matthew E.; Chambers, Alison; Cassidy, Dale; Koruprolu, Sarath; Born, Christopher T.

doi:10.5435/jaaos-d-17-00155

Cited by 18 publications

(17 citation statements)

References 27 publications

(42 reference statements)

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“…The K-wire could also be used as guide pin of the derotation screw. The additional derotation screw could improve strength and rotational control of DHS in a biomedical study [26] although ambivalent results have been reported by Imren [13]. As basicervical fractures in the elder population treated with osteosynthesis resulted to high rates of surgical complications, revision surgery is also an importance factor when choosing initial treatment.…”

Section: Discussionmentioning

confidence: 91%

Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Jian

et al. 2020

Preprint

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Background Basicervical proximal femoral fractures have greater biomechanical instability and higher incidence of implant-related complications than other types of proximal femoral fractures. The present retrospective study was performed to find a proper fixation treating basicervical proximal femoral fractures by a comparation of clinical outcomes between cephalomedullary nails and dynamic hip screws, and introduce our experience in surgical tricks and perioperative management. Methods Between January 2015 and December 2018, 821 patients aged 60 years or older suffering from a proximal femoral fracture and receive internal fixation surgery were reviewed. 25 patients of basicervical femoral fractures were included in the study according to inclusion and exclusion criteria. 7 patients were treated with a DHS, 18 with the CMN. Relevant operational data and clinical evaluation were collected. Results Reduction qualities of 6 patients were good (85.7%), 1 were acceptable (14.3%) in DHS Group and 14 of the 18 patients were good (77.8%), 4 were acceptable (22.2%) in CMN Group. The mean TAD in DHS Group of was 17.4 mm while 20.3 mm in CMN Group. Bone union had been achieved 19.9 weeks in DHS Group and 17.8 weeks in CMN Group. The mean Harris score at the final follow up was 83.9, 84.4 respectively in DHS and CMN Group with no significant difference. Conclusions DHS was not inferior for the treatment of basicervical proximal femoral fractures compared to CMNs with blade type or two integrated screw type. When applied properly, both CMNs with blade type or two integrated screw type and DHS can achieve satisfied prognosis. Our unique experiences included anatomic reduction during surgery, anti-osteoporosis treatment and prolonged weight-bearing time.

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Section: Discussionmentioning

confidence: 91%

Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Jian

et al. 2020

Preprint

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“…Some studies suggest that this type of fracture is treated by using a nail plate system. Hollow nails and medial support plates are an emerging treatment method that can be used to treat Pauwels type III femoral neck fractures [13][14][15]. At present, a medial femoral neck support plate combined with hollow screw internal fixation is an emerging treatment of Pauwels type III femoral neck fracture in clinical practice [16,17].…”

Section: Introductionmentioning

confidence: 99%

Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis

Liang

Hao

2021

BMR

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BACKGROUND: Femoral neck fractures often occur in the elderly, which usually results in hip pain. OBJECTIVE: The purpose of this study was to evaluate the difference in the treatment of Pauwels type III femoral neck fractures with medial femoral support plate combined with cannulated screws and cannulated screws alone. METHODS: PubMed, ScienceDirect, China Academic Journals Full-text Database (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), Embase and Cochrane Library were used to collect clinical controlled trials of the medial femoral support plate combined with hollow screw internal fixation and simple hollow screw internal fixation for Pauwels type III femoral neck fracture. RESULTS: Seven articles (n= 409 cases) were evaluated for quality and included in this meta-analysis. Four hundred and nine patients with Pauwels type III femoral neck fractures were included: 202 in the experimental group and 207 in the control group. The results showed that, compared with simple hollow screw internal fixation, the medial femoral support plate combined with hollow screw internal fixation has a longer operation time (MD= 23.05, 95% CI= 13.86–32.24), and more intraoperative blood loss (MD= 91.55, 95% CI= 50.72–132.39), shorter healing time (MD=-1.48, 95% CI (-1.71, -1.26)), lower incidence of complications (RR= 0.34, 95% CI= 0.19–0.61), lower VAS score (MD=-1.28, 95% CI (-1.83, -0.72)), and higher Harris score (MD= 8.49, 95% CI (4.15, 12.83)). CONCLUSION: Medial femoral plate combined with cannulated screw for Pauwels type III femoral neck fracture can shorten healing time, reduce postoperative complications, and improve the postoperative Harris score.

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“…There are very little data in the literature regarding the comparison of clinical outcomes of CMN and SHS used in basicervical fractures of the femur (10). There have been several studies of the biomechanical properties of CMN and SHS, which have not shown any clear superiority of either implant in the treatment of these fractures (4,9,13). The objective of this randomized, prospective study was to evaluate the rate of basicervical fractures of the femur and to compare outcomes and complications of the two different treatment methods of SHS and CMN.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intramedullary and Extramedullary Fixation of Basicervical Fractures of the Femur in the Elderly: A Prospective Randomized Study

Ecevız¹,

Çevi̇k²,

Bulut³

2020

Haseki

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Basicervical fractures of the femur are a unique type of unstable hip fracture, usually treated with sliding hip screw (SHS) or cephalomedullary nail (CMN). The aim of this randomized, prospective study was to evaluate the outcomes and complications of the two different treatment methods, SHS and CMN, in the management of basicervical fractures of the femur in the elderly osteoporotic bones. Methods: Patients aged over 65 years, who presented to our clinic with basicervical fracture of the femur between January 2016 and January 2018, were included in the study. The permuted block randomization method was used to randomize the participants into groups. The patients were allocated to one of two groups treated via CMN (n=29) or SHS (n=27). Functional and radiological evaluations included mobility score, Harris Hip score, modified Barthel index, Singh index, tip-apex distance, and fracture settling. Results: Continuous improvement in the Barthel index was seen over the 12-month period in either group (p<0.05). The average mobility score was found to be decreased at the 6 th week follow-up visits in either group (p<0.05). The fracture settling measurements in SHS group was higher than in CMN group (p<0.01). Conclusion: The clinical and radiological outcomes of both CMN and SHS groups showed no superiority of one technique over the other in the treatment of basicervical fractures of the femur.

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Biomechanical Analysis of Fixation Devices for Basicervical Femoral Neck Fractures

Abstract: Given our results and those of previous studies, we could not determine superiority of one implant and recommend that surgeons select fixation constructs based on the individual patient's anatomy and the surgeon's comfort with the implant.

Cited by 18 publications

References 27 publications

Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis

Comparison of Intramedullary and Extramedullary Fixation of Basicervical Fractures of the Femur in the Elderly: A Prospective Randomized Study

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