Efficiency of an implant: new criterion of objective assessment of implants for osteosynthesis of femoral neck fracture

Ali-Zade, Chingiz; Jafarov, Afgan; Alizada, Farhad; Gulsen, Mahir; Toğrul, Emre

doi:10.1007/s00264-019-04439-2

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…may increase the incidence of avascular necrosis of the femoral head or femoral head collapse [ 18 , 19 ]. Anatomic reduction can better protect the femoral head, but if anatomical reduction is excessively pursued, especially in the treatment of irreducible femoral neck fracture, it is easy to cause repeated traction and rotation, which will destroy the blood supply of the femoral bone and increase the risk of avascular necrosis of the femoral head and nonunion [ 20 , 21 ]. Yechiel Gotfried found through clinical experience that negative buttress was associated with a high failure rate of the procedure and advocated valgus and positive buttress reduction.…”

Section: Discussionmentioning

confidence: 99%

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Zhao

Liu

et al. 2021

J Orthop Surg Res

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Objective Femoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction, and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation. Methods Retrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018. According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group, and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months, and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening, and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference. Results A total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification, and follow-up time among the three groups (P > 0.05). However, there was significant difference in Harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05). Conclusion Both positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.

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Section: Discussionmentioning

confidence: 99%

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Zhao

Liu

et al. 2021

J Orthop Surg Res

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“…Based on favorable fracture reduction, the selection of internal xation methods and implants, without any doubt, is the most important in uencing factor. Recent studies have also shown that the therapeutic effect can be affected by the selection of implants, over which controversies still exist 22 . With the advancement of studies, ideal implants conforming to the internal xation of femoral neck fracture should not only accord with the concept of minimally invasive implantation but also have good biochemical properties, which is a general consensus gradually reached by scholars.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

Zhou

et al. 2022

Preprint

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Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

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“…Anatomical reduction (AR) has been considered as the preferred reduction criterion for internal fixation to attain a good prognosis in displaced femoral neck fractures. However, it is usually difficult to achieve anatomical reduction for fractures with obvious displacement, and excessive pursuit of anatomical reduction means further damage to soft tissue vessel, [9][10][11] which leading to an increase in complication. Thus, in 2013, Gotfried et al [12] firstly proposed the concept of non-anatomical reduction.…”

Section: Introductionmentioning

confidence: 99%

Clinical observation of Gofried positive buttress reduction in the treatment of young femoral neck fracture: A systematic review and meta-analysis

Li,

Chen,

She

et al. 2023

Medicine

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Background: Femoral neck fractures in young adults(<65 years), have always been a difficult problem, characterized by high rates of nonunion and avascular necrosis (AVN). The clinical efficacy of anatomical reduction and non-anatomical reduction methods needs to be supported by clinical data. Therefore, we conduct a meta-analysis on the clinical efficacy of different reduction methods to better guide clinical practice. Methods: Relevant studies published using internal fixation to treat femoral neck fracture in several databases were searched. The outcomes sought included Harris score and the rate of AVN, nonunion and femoral neck shortening (<5 mm). Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored. Results: The clinical results showed that compared with the anatomical reduction and positive buttress, there is no significant difference in the rate of AVN (OR = 0.87, 95%CI: 0.55–1.37, P = .55), nonunion (OR = 0.54, 95%CI: 0.21–1.41, P = .21), femoral neck shortening (<5 mm) (OR = 1.03,95%CI: 0.57–1.86, P = .92), the Harris score (MD = −0.28, 95%CI: −1.36–0.80, P = .61) and the excellent and good rate of Harris score (OR = 1.73, 95%CI: 0.84–3.56, P = .61). However, compared with negative buttress, the rate of AVN (OR = 0.62, 95%CI: 0.38–1.01, P = .05), nonunion (OR = 0.34, 95%CI: 0.12–1.00, P = .05) and femoral neck shortening (<5 mm) (OR = 0.27, 95%CI: 0.16–0.45, P < .00001) were significantly lower, and the Harris score (MD = 6.53, 95%CI: 2.55 ~ 10.51, P = .001) was significantly better in positive buttress. Conclusions: In the case of difficult to achieve anatomical reduction, for young patients (< 65 years) with femoral neck fracture, reduction with positive buttress can be an excellent alternative and negative buttress should be avoided as much as possible.

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Efficiency of an implant: new criterion of objective assessment of implants for osteosynthesis of femoral neck fracture

Cited by 5 publications

References 27 publications

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

Clinical observation of Gofried positive buttress reduction in the treatment of young femoral neck fracture: A systematic review and meta-analysis

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