Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults

Abstract

Background To compare the clinical efficacy of a femoral neck system (FNS) and cannulated screws (CS) in the treatment of femoral neck fracture in young adults. Methods Data from 69 young adults, who were admitted for femoral neck fracture between March 2018 and June 2020, were retrospectively analyzed. Patients were divided into two groups according to surgical method: FNS and CS. The number of intraoperative fluoroscopies, operative duration, length of hospital stay, fracture healing time, Harris score of hip function, excellent and good rate of hip function, and postoperative complications (infection, cut out the internal fixation, nail withdrawal, and femoral neck shortening) were compared between the two groups. Hip joint function was evaluated using the Harris Hip Scoring system. Results All 69 patients had satisfactory reduction and were followed up for 12–24 months, with a mean follow-up of 16.91 ± 3.01 months. Mean time to fracture healing was13.82 ± 1.59 and 14.03 ± 1.78 weeks in the FNS and CS groups, respectively. There was a statistical difference in the number of intraoperative fluoroscopies between the 2 groups (P = 0.000). There were no significant differences, in operation duration, hospital length of stay, fracture healing time, complications, Harris Hip Score for hip function and excellent and good rate between the two groups (P > 0.05). The incidence of complications was 6.1%(2/33) in the FNS group lower than 25%(9/36) in the CS group, a difference that was statistically significant (P = 0.032). At the last follow-up, the Harris Hip Score of the hip joint in the FNS group was 90.42 ± 4.82and 88.44 ± 5.91 in the CS group. Conclusions Both treatment methods resulted in higher rates of fracture healing and excellent hip function. Compared with CS, the FNS reduced the number of intraoperative fluoroscopies, radiation exposure to medical staff and patients, and short-term complications including femoral neck shortening and bone nonunion.

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

“…Non-displaced fractures in high-risk patients with multiple comorbidities also represent well-accepted indications for fixation. Since its introduction in 2018, the FNS has expanded the spectrum of available fixation systems [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 22 , 24 ]. It is assumed to be less invasive, thereby potentially reducing perioperative risks [ 10 , 11 ].…”

“…Other studies compared the FNS with three cannulated screws [ 14 , 15 , 16 , 18 ] and observed heterogeneous outcomes. He et al reported shorter but not significantly different ORT, less radiation, a lower complication rate, and no differences in LOS [ 14 ]. Tang et al confirmed the reduced fluoroscopy time in the FNS group [ 16 ].…”

“…However, the most frequent surgical complication following the osteosynthesis of the FNF is the shortening of the femoral neck and the development of avascular necroses (AVN), which is observed in up to 20% of cases [ 27 , 28 ]. Accordingly, the data showed a conversion rate to arthroplasty in up to 10% of cases after osteosynthesis of the femoral neck [ 14 , 17 , 22 ]. Therefore, pre-existing comorbidities, such as osteoarthrosis of the hip, severe osteoporosis, rheumatoid arthritis, and chronic kidney disease, should be taken into account, as they confer a high risk of secondary osteosynthesis failure [ 29 ].…”

“…Biomechanical studies have shown that the FNS is as a valid alternative to the DHS with ARS and is superior to cannulated screws for the management of Pauwels type III fractures [ 13 ]. Recent clinical studies have shown that reconstructions using the FNS lead to satisfactory perioperative and clinical outcome measures [ 14 , 15 , 16 , 17 , 18 ]. To date, only one group of authors has compared the FNS with the DHS for Garden type I and II fractures in elderly patients [ 17 ].…”

Association between General Anesthesia and the Occurrence of Cerebrovascular Accidents in Hip Fracture Patients

“…With increasing age, the hip joint undergoes gradual wear, which, combined with the decreasing fracture resistance capacity of the elderly, leads to high incidence of hip fracture [ 1 – 3 ]. According to a World Health Organization survey report, 30.0% of hip fractures worldwide occur in China [ 4 ], and surgery is the preferred treatment modality for patients without surgical contraindications, but 32.3% of patients will experience perioperative complications, with a probability of dying from complications reaching 30.0% 1 year after surgery and risk of death lasting for up to 10 years [ 5 – 7 ]. Among all the causes of postoperative death in patients with hip fracture, cerebrovascular accidents take the first place, so it is extremely important to explore the risk factors that induce cerebrovascular accidents.…”