Comparison of dynamic hip screw and antirotation screw with cannulated screw in the treatment of transcervical collum femoris fractures

Abstract

Femoral neck fractures in young patients are mostly seen after high-energy trauma. Internal fixation methods are the gold treatment choice in young, healthy, and active patients with good bone quality. [1] Potential complications after trauma and surgery make the treatment of these fractures more challenging. Various surgical methods and fixation options have been proposed for the surgical treatment of femoral neck fractures. [2] Anatomic reduction is the most important factor in internal fixation of femoral neck fractures. The time to surgery (from trauma to operating theatre), capsulotomy, and the implant choices are controversial in the literature. [3] Many types of implants are used for internal fixation of femoral neck fractures. [3] Osteosynthesis with cannulated screws (CSs) and dynamic hip screws (DHSs) are the most commonly used modalities. [4] Although internal fixation of femoral neck fractures provides blood flow to the femoral neck, complications such as non-union and avascular necrosis (AVN) are still seen in 10-20% and 10-30% of cases, respectively. [5,6] In addition, joint replacement is performed in 20-36% of these Objectives: This study aims to compare the results of internal fixation with dynamic hip screw (DHS)/antirotation screw and conventional cannulated screw (CS) for femoral neck fracture. Patients and methods: This retrospective study included a total of 78 patients (57 males, 21 females) with collum femoris fractures treated with internal fixation between January 2015 and January 2019. Group 1 comprised 41 patients with a mean age of 45.7 years (range, 19 to 62 years) treated with DHSs/antirotation screws, while group 2 comprised 37 patients with a mean age of 41.9 years (range, 17 to 75 years) treated with CSs. The patients were evaluated for union, avascular necrosis (AVN), femoral neck shortness, operation time, duration of fluoroscopy exposure, and functional outcomes. Results: Age, gender, and Garden classification stages were similar in both groups. No significant difference was found between the groups in respect of AVN and non-union rates. The non-union rate was 12.2% in group 1 and 21.6% in group 2 (p>0.05). The duration of fluoroscopy exposure was statistically significantly higher in group 2 (p=0.001) and the operation time was statistically significantly longer in group 1 (p=0.001). In group 2, femoral neck shortness stature was significantly higher (p=0.007). At the final follow-up examination, the Harris hip score was statistically significantly higher in group 1 (p=0.04). Conclusion: Dynamic hip screw/antirotation screw was a more relevant treatment method for transcervical femoral neck fractures compared to CS with more favorable functional outcomes and less fluoroscopy exposure.

Dynamic Hip Screw versus Cannulated Cancellous Screw in Pauwels Type II or Type III Femoral Neck Fracture: A Systematic Review and Meta-Analysis

“…In terms of biomechanics, it has been shown that one DHS device is stronger than three parallel CCS devices in the treatment of basicervical fractures, the orientation of which is similar but distal to that of Pauwels type III fractures [2,23]. Further, in a recent clinical study of 78 patients with FNF conducted by Sahin et al, nonunion rates of 12% and 21% were reported in the DHS and CCS groups, respectively [24]. On the basis of the results of our pooled analysis, the risk of fracture nonunion is higher with the CCS fixation technique than with the DHS fixation technique, especially in patients with vertically oriented FNF.…”

Reversed Z-effect and Z-effect phenomena in femoral neck fracture treated with a dynamic locking plate fixation: Case report

“…Femoral head preserving surgery for femoral neck fracture (FNF) is under continuous discussion and research. [ 1 , 2 ] Some internal fixation systems rely on no or minimal sliding, but most implants (e.g. parallel cancellous screws, sliding hip screw) consider sliding as an inevitable part of the healing process, during which controlled impaction across the fracture line allows bony contact between the proximal and distal fragments.…”

Is Stage 2 idiopathic osteonecrosis of the hip joint associated with version angles on imaging methods?

“…The necrosis may result from trauma or may develop with no history of trauma. [ 3 ] In non-traumatic cases, both hips are affected in about 40 to 70% of cases. [ 4 ] In the literature, the known risk factors of ON have been reported to be alcoholism, smoking, systemic lupus erythematosus, human immunodeficiency virus infection, chronic corticosteroid therapy, diabetes mellitus, hemoglobinopathies, myeloproliferative disorders (e.g., Gaucher disease, leukemia), coagulation disorders, pregnancy-related conditions, Caisson disease, chronic renal failure, and hyperlipidemia.…”

“…[1,2] The necrosis may result from trauma or may develop with no history of trauma. [3] In non-traumatic cases, both hips are affected in about 40 to 70% of cases. [4] In the literature, the known risk factors of ON have been reported to be alcoholism, smoking, systemic lupus erythematosus, human immunodeficiency virus infection,Objectives: In this study, we aimed to investigate whether anatomical variations of acetabulum were associated to idiopathic osteonecrosis (ON) of the femoral head.Patients and methods: Between January 2014 and March 2020, a total of 46 patients (32 males, 14 females; mean age: 43 years; range, 18 to 66 years) who were diagnosed with unilateral or bilateral ON of the hip joint and 44 healthy age-and sex-matched controls (30 males, 14 females; mean age: 46 years; range, 18 to 79 years) with no signs of ON of the hip joint were retrospectively analyzed.…”

“…[1,2] The necrosis may result from trauma or may develop with no history of trauma. [3] In non-traumatic cases, both hips are affected in about 40 to 70% of cases. [4] In the literature, the known risk factors of ON have been reported to be alcoholism, smoking, systemic lupus erythematosus, human immunodeficiency virus infection,…”