Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients

Abstract

Objective To investigate whether four‐screw fixation in rhombic configuration could improve the clinical outcomes and decrease the complication rate compared with three‐screw fixation in inverted triangle configuration in elderly patients with nondisplaced femoral neck fractures. Method From January 2018 to January 2019, 91 elderly patients with nondisplaced femoral neck fractures who were treated with a cannulated screw system were reviewed retrospectively. The inverted triangle configuration was applied in 51 patients and rhombic configuration in 40 patients. The demographic and perioperative information of the patients were extracted from medical records and surgical records. Variables including incision size, surgical blood loss, surgical time, fluoroscopy time, hospital stays, fracture union time, postoperative visual analogue scale (VAS) scores, and complications were compared between the two groups. Also, Harris hip score at the final follow‐up was used to evaluate the functional outcomes. Results All patients were followed up from 24 to 36 months, with an average of 29.75 months. The average age of patients was 72.37 ± 7.16 years. No significant differences were found between the two groups with regard to patients' age, gender, affected side, Garden classification, Pauwels classification and comminution of posterior wall (P > 0.05). We found shorter incision size (P < 0.001), less blood loss (P = 0.020), less surgical time (P = 0.026), and shorter fluoroscopy time (P < 0.001) in inverted triangle configuration group. However, shorter hospital stays (P = 0.001) and fracture union time (P = 0.002) were found in the rhombic configuration group. The VAS scores were lower in the rhombic configuration group at the first (P < 0.001) and third months (P = 0.010), but no significant difference was found at the sixth month (P = 0.075). Meanwhile, the total complication rate was relatively lower in the rhombic configuration group compared to the inverted triangle configuration group (P = 0.041). Harris hip score presented no significant difference between the two groups at final follow‐up (P = 0.078). No wound infection or cortical perforation occurred in either group. Conclusion Four‐screw fixation in rhombic configuration was superior to three‐screw fixation in inverted triangle configuration in the treatment of nondisplaced femoral neck fractures in elderly patients in terms of less early postsurgical pain, shorter fracture union time, and lower complication rate.

Complications and Outcomes of the Internal Fixation of Non-displaced Femoral Neck Fracture in Old Patients: A Two-Year Follow-Up

“…A number of studies have since shown that it is a poor predictor of non-union [25]. However, others, such as the study by Zhu et al [26], have found it useful in predicting reoperation after initial fixation. The Dutch Surgical Society guidelines for the treatment of femoral neck fractures are based on Pauwels grade of the fracture [27].…”

Surgical Tool Handle Vibration‐Based Drilling State Recognition During Hip Fracture Fixation

“…Three cannulated screws are inserted in a parallel inverted triangle configuration (inferior, posteromedial, and anterosuperior) because they can provide high mechanical stability. [11][12][13][14][15] Moreover, surgeons usually place the cannulated screws tightly on the posteromedial cortex and try to keep the screws inside the cortical bone, which provides better support and stabilization of the fracture area. 16,17 For fracture repositioning and fixation stability, surgeons place cannulated screws as close to the posteromedial cortex as possible; however, this operation is often performed using intraoperative fluoroscopy and is based on their own experience.…”

“…Three cannulated screws are inserted in a parallel inverted triangle configuration (inferior, posteromedial, and anterosuperior) because they can provide high mechanical stability. 11 , 12 , 13 , 14 , 15 Moreover, surgeons usually place the cannulated screws tightly on the posteromedial cortex and try to keep the screws inside the cortical bone, which provides better support and stabilization of the fracture area. 16 , 17 …”