A Simple Percutaneous Technique to Reduce Valgus-Impacted Femoral Neck Fractures

Yoon, Byung‐Ho; Kim, Yoon Seok; Koo, Kyung Hoi

doi:10.4055/cios19156

Cited by 4 publications

(6 citation statements)

References 10 publications

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“…When the valgus-impaction is reduced, the original length of the femoral neck length can be restored. 15 16) One study reported that the reduction also enhanced the stability of the fixation compared to in situ fixation. 17) However, other studies recommended in situ fixation in the elderly osteoporotic patients because the reduction might lead to a fixation failure.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Short Axial Length of the Proximal Femur: A Caution in the Use of Femoral Neck System in Patients with Garden Type I/II Femoral Neck Fractures

et al. 2023

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Background In 2018, Femoral Neck System (FNS), a dedicated fixator for femoral neck fractures, was introduced. This device has been in increasing use because it provides excellent rotational and angular stability. However, the shortest bolt of FNS is 75 mm long. Thus, it is not usable when the axial length of the proximal femur (ALPF), the distance between the innominate tubercle and the surface of the femoral head, is less than 80 mm. In this study, we investigated the incidence and associated factors of small ALPF (< 80 mm) in femoral neck fracture patients. Methods We measured the ALPF on preoperative computed tomography (CT) scans of 261 patients (166 women and 55 men), who were operated due to nondisplaced or impacted femoral neck fractures. The ALPF was measured on reconstructed oblique coronal images along the femoral neck. We evaluated the distribution of ALPF, calculated the incidence of small ALPF (< 80 mm), and correlated it with patient’s height, weight, body mass index, age, bone mineral density (T-score), and caput-column-diaphysis angle. Results The ALPF ranged from 67.4 mm to 107.1 mm (mean, 88.4 mm; standard deviation, 7.2 mm). In 19 patients (8.6%, 19 / 221), the length was < 80 mm. The ALPF was strongly correlated with height (correlation coefficient = 0.707, R 2 = 0.500, p < 0.001) and moderately correlated with weight (correlation coefficient = 0.551, R 2 = 0.304, p < 0.001). The T-score was moderately correlated with the ALPF (correlation coefficient = 0.433, R 2 = 0.187, p < 0.001). The age was moderately correlated with the ALPF (correlation coefficient =–0.353, R 2 = 0.123, p < 0.001). Conclusions A considerable percentage of femoral neck fracture patients (8.6%) had small proximal femurs (ALPF < 80 mm), which cannot be operated with FNS. We recommend measuring the ALPF using reconstructed oblique coronal CT images or scaled hip radiographs: en face view of the femoral neck prior to surgery in patients with short stature and/or low body weight. If the ALPF is < 80 mm, the surgeon should prepare other fixation devices.

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Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Short Axial Length of the Proximal Femur: A Caution in the Use of Femoral Neck System in Patients with Garden Type I/II Femoral Neck Fractures

et al. 2023

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“…Valgus‐impacted fracture is considered as a stable fracture, and the goal of internal fixation is to prevent displacement of this stable fracture pattern 2 . Recently, several surgical treatment methods have been attempted for fixation after disimpaction of valgus‐impacted femoral neck fractures; good neck shortening results have been observed in percutaneous trans‐acetabular reduction method, in‐out‐in percutaneous reduction technique, Steinmann pin percutaneous technique, and Shanz pin reduction method 19–23 . In this study, a method for simultaneously correcting the caput‐collum‐diaphysis (CCD) angle and tilt while reducing damage to the surrounding soft tissue and cartilage injury was attempted, and favorable results were obtained.…”

Section: Discussionmentioning

confidence: 99%

“…Damage to surrounding soft tissue and cartilage may accompany this process. Using Steinmann pins for control has also been suggested 21,22 . A method of reducing by transversely inserting a Schanz pin was also introduced 23 .…”

Section: Introductionmentioning

confidence: 99%

Simple Minimally Invasive Method to Reduce Valgus‐Impacted and Tilted Femoral Neck Fractures without Soft Tissue or Cartilage Injury: Radiological and Clinical Results

Kweon

Song

Park

et al. 2023

Orthopaedic Surgery

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ObjectiveThis is a rare study comparing the radiological and functional outcomes of fixation after reduction with in situ fixation group using Femoral Neck System (FNS). The aim of this study was to introduce a simple, innovative, minimally invasive method to reduce valgus‐impacted and tilted femoral neck fractures without soft tissue or cartilage injury.MethodsA retrospective comparative analysis of 46 patients between May 2020 and February 2022 was performed. In the control group, 23 patients underwent in situ fixation without reduction. In the study group, another 23 patients were managed by fixation after reduction using a percutaneous pull‐out technique with a full threaded Steinmann pin. Caput‐collum‐diaphysis (CCD) angle, tilt, and femoral neck shortenings were compared between the two groups. In addition, Harris Hip Score (HHS) was evaluated and compared at 1 year after surgery. Basically, independent samples t‐test was used to compare radiological and functional results.ResultsPatients' initial valgus and tilt angles were not significantly different between the groups (n.s.). However, the CCD and tilt angles measured immediately and at one year postoperatively were significantly different between the groups (p < 0.05). Regarding femoral neck shortening, shortening in the three directions, the x, y, and z vectors, was significantly less in the reduction group immediately postoperatively and at 1 year post‐surgery (p < 0.05). The mean HHS at 1 year postoperatively was 79.7 ± 8.4 in the in situ fixation group and 87.9 ± 6.6 in the reduction groups, and there was a significant difference (p < 0.05).ConclusionThe pull‐out method with a threaded Steinmann pin to reduce valgus‐impacted and tilted femoral neck fracture is safe and effective for accomplishing anatomical restoration. This may achieve successful bone union and maintain the femoral neck length and original tilt without nearby soft tissue or cartilage injury.

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“…Steinberg et al 5) recommended internal rotation and traction and correction of posterior tilt by application of AP pressure on the femoral neck as necessary for reducing the fracture. A minimally invasive reduction technique using a Steinmann pin or Kirschner wire was introduced by Yoon et al 19) and Noda et al 20) . Park et al 6) , who compared the clinical outcomes, shortening of the femoral neck, and Harris hip score between patients with VI-FNF who underwent in situ fixation and post-reduction fixation, confirmed that more favorable outcomes were achieved in the post-reduction fixation group.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Valgus Deformity and Progression of Ostheoarthritis in Non-Displaced Femoral Neck Fractures

Kim,

Sung

2023

Hip & Pelvis

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Purpose Nondisplaced femoral neck fractures have traditionally been treated with in situ fixation. However, poor surgical and clinical outcomes have been reported for fractures with valgus deformity >15°, and the reduction of valgus impaction has recently been emphasized. In addition, early degenerative osteoarthritis can be caused by cam-type femoroacetabular impingement after healing of femoral neck fractures. This study was designed with the objective of confirming the difference in progression of radiographic osteoarthritis according to the severity of the valgus deformity. Materials and Methods Patients who underwent internal fixation using multiple cannulateld screws for management of nondisplaced femoral neck fractures were divided into two groups: high valgus group (postoperative valgus angle ≥15°) and low valgus group (postoperative valgus angle <15°). Evaluation of demographic data and changes in the joint space width from the immediate postoperative period to the latest follow-up was performed. Results A significant decrease in joint space width in both hip joints was observed in the high valgus group when compared with the low valgus group, including cases with an initial valgus angle less than 15° and those corrected to less than 15° of valgus by reduction. No complications requiring surgical treatment were observed in either group; however, two cases of avascular necrosis, one in each group, which developed in the low valgus group after reduction of the fracture, were followed for observation. Conclusion Performing in situ fixation in cases involving a valgus deformity ≥15° in non-displaced femoral neck fractures may cause accelerated narrowing of the hip joint space.

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A Simple Percutaneous Technique to Reduce Valgus-Impacted Femoral Neck Fractures

Cited by 4 publications

References 10 publications

Incidence and Risk Factors of Short Axial Length of the Proximal Femur: A Caution in the Use of Femoral Neck System in Patients with Garden Type I/II Femoral Neck Fractures

Incidence and Risk Factors of Short Axial Length of the Proximal Femur: A Caution in the Use of Femoral Neck System in Patients with Garden Type I/II Femoral Neck Fractures

Simple Minimally Invasive Method to Reduce Valgus‐Impacted and Tilted Femoral Neck Fractures without Soft Tissue or Cartilage Injury: Radiological and Clinical Results

Postoperative Valgus Deformity and Progression of Ostheoarthritis in Non-Displaced Femoral Neck Fractures

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