Does fully-threaded Headless Compression Screw provide a length-stable fixation in undisplaced femoral neck fractures?

Chiang, Ming-Hung; Wang, Chun-Liang; Fu, Shau-Huai; Hung, Chung-Chan; Yang, Rong‐Sen

doi:10.1016/j.asjsur.2018.05.009

Cited by 19 publications

(18 citation statements)

References 21 publications

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“…This type of fracture is dominated by shear force, which causes the proximal femur to shift and collapse during varus and is prone to internal fixation failure and other complications [28]. In recent years, the use of medial femoral neck support plate combined with cannulated screw internal fixation has been proposed for the treatment of Pauwels type III femoral neck fracture [16,29,30], which can reduce the incidence of complications, such as nonunion of femoral neck fracture and femoral head necrosis.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Chiang et al [21] recently reported that three fully threaded headless compression screws, which were normally regarded as a non-sliding length-stable construct, failed to prevent FNS and varus collapse in Garden and femoral neck fractures compared with partially threaded screws. We think that though the patient population were all non-displaced fractures, the tendency of fracture displacement (in threedimensional orientation) may not be the same due to potential heterogeneity in fracture geometry, bone quality, etc., and thus, the universally used three fully threaded screws may not be effective in all patients.…”

Section: Discussionmentioning

confidence: 99%

Anterior Positioning Screw in Proximal Femoral Plating Restricts Posterior Tilt of Retroverted Femoral Neck Fractures: a Retrospective Cohort Study

Nie

Liu

Zhu

et al. 2021

Preprint

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Background: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt.Methods: We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt.Results: Demographic data showed no significant difference. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1 – 4.3°) than that in the NTS group (5.3°, 4.2 – 8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1 – 4.7) mm vs. 4.3 (3.1 – 6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0 – 90.0 vs. 82.0, 76.0 – 84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6 – 70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6 – 56.1, p = 0.002), and NTS configuration (ref: ALTS configuration) (OR 21.9, 95% CI 4.1 – 116.4, p < 0.001) as risk factors for developing posterior tilt.Conclusions: Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (ref: ALTS) are risk factors for developing posterior tilt.Trial registration: Retrospectively registered.

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“…Fourth, the limited sample size and unblinded design in their study could result in unknown bias. 44 . They mainly focused on the complication rates, femoral neck shortening and the change of neck shaft angle.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Cohort Study of the Variable Pitch Fully Threaded Headless Screws and Partially Threaded Screws in the Treatment of Femoral Neck Fractures

Wang¹,

Han²,

Zhang³

et al. 2020

Preprint

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(1) Introduction: The choices of the treatments for femoral neck fractures remain controversial. The purpose of this study is to evaluate the prognoses of the variable pitch fully threaded headless screws in the fixation of femoral neck fractures and to compare them with those of partially threaded cannulated screws. (2) Materials and Methods: Between 1st January 2012 and 31st December 2016, there were 89 patients with the main diagnose of femoral neck fracture who accepted the treatment of closed reduction cannulated screw fixation in Peking University People’s Hospital. 34 cases of partially threaded screws and 23 cases of fully threaded screws met the criterion. The characteristics, prognoses and the imaging changes of all cases were described and the differences between the two groups were compared. Statistical analyses were performed using SPSS version 23.0 (SPSS Inc., USA). Mann-Whitney U test, Analysis of Variance and Chi-square test were used. Statistical significance was defined as P value (two sided) less than 0.05. (3) Results: There was no significant difference in the general characteristics, fracture classifications and reduction quality between the two groups. The fully threaded group had a significant lower angle decrease rate (30.4% vs. 58.8%, P = 0.035), femoral neck shortening rate (26.1% vs. 52.9%, P = 0.044) and screw back-sliding rate (21.7% vs. 50.0%, P = 0.032), but a higher screw cut-out rate (21.7% vs. 0.0%, P = 0.008). No significant difference was found in the nonunion rate (8.7% vs. 0.0%, P = 0.159), avascular necrosis rate (17.4% vs. 23.5%, P = 0.744) and the good and excellent rate of Harris score (73.9% vs. 82.4%, P = 0.443). (4) Conclusion: Compared with the partially threaded screws, the variable pitch fully threaded headless screws had a lower screw back-sliding rate, femoral shortening rate, angle decrease rate and similar function score, but would result in more screw cut-outs and nonunions in Garden III-IV and Pauwels III fractures. As a conclusion, the variable pitch full threaded screws are recommended in stable undisplaced fractures rather than displaced unstable fractures. Further qualified investigations with a larger scale of patients and longer follow-up are needed in the future.

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Does fully-threaded Headless Compression Screw provide a length-stable fixation in undisplaced femoral neck fractures?

Abstract: The FTHCSs may be a substitute for PTCSs, but it cannot prevent femoral neck shortening and varus collapse after fracture fixation. Future studies should focus on how to preserve femoral neck length and hip function after femoral neck fractures.

Cited by 19 publications

References 21 publications

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

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

Anterior Positioning Screw in Proximal Femoral Plating Restricts Posterior Tilt of Retroverted Femoral Neck Fractures: a Retrospective Cohort Study

A Retrospective Cohort Study of the Variable Pitch Fully Threaded Headless Screws and Partially Threaded Screws in the Treatment of Femoral Neck Fractures

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