Four Screws Diamond Configuration Fixation for Displaced, Comminuted Intracapsular Fracture Neck Femur in Young Adults

Abstract

Background: Four cannulated cancellous screws (CCS) in diamond configuration have been recommended by some authors for fixation of intracapsular neck of femur (ICNF) fracture with posterior comminution in adults. This is also supported by biomechanical studies. However, the clinical usefulness of this biomechanical advantage is not known. This study evaluates the outcomes of displaced, comminuted ICNF fracture in young adults managed by four CCS fixation in diamond configuration. Materials and Methods: 25 patients who met the inclusion criteria were operated during the study period. Four patients were lost to followup in the first 6 weeks postoperatively, and one patient died in first 6 months of followup unrelated to surgery. Thus, twenty patients were followed up for a mean period of 33.3 months (range 25–38 months). In all patients, fracture fixation was done with four CCS in diamond configuration. Union at fracture site and avascular necrosis (AVN) of femoral head was assessed on serial plain radiographs. Functional outcome was evaluated by Harris hip score. Results: Eighteen patients had union, two patients had nonunion, and two patients had AVN of femoral head. All the sixteen patients who had union without AVN had good or excellent functional outcome. Conclusions: The present study concludes that four CCS fixation in diamond configuration appears to be a reasonable choice of fixation for displaced fracture ICNF with comminution in young adults. However, further evaluation with better study design and larger patient population is required for definite conclusions.

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

“…Several studies reported cortical perforation when rhombic configuration was used to fix femoral neck fractures and attributed it to the limited space of femoral neck 20,22 . In our study, no case in either group had cortical perforation.…”

“…Besides, fixation with three cannulated screws usually causes a tendency toward screw exit accompanied by femoral neck shortening, which would have a significant negative impact on the hip function 18 . Therefore, in order to reduce the complication rate and improve fracture stability, different numbers and configuration of cannulated screws have been explored by researchers 19,20 . In a biomechanical study, Kauffman et al .…”

Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system

“…Femoral neck fractures are often associated with cortical comminution, especially the posterior medial cortex, with an incidence of up to 90% [17] , and more severe bone resorption after repositioning, with continued compression of the comminuted cortex under compression of the longitudinal load along the internal xation after weight-bearing of the hip joint begins, leading to more severe femoral neck shortening [18] . Current studies have reported that in femoral neck fractures with posterior medial cortical comminution, placement of a single screw can compensate for the negative effects of cortical loss [19,20] , in the current study, there were unincluded patients with this type of xation and postoperative femoral neck shortening < 10 mm (Figure G, H, I).…”

Anatomical Features of the Proximal Femur in the Turkish Population

“…Generally, 6.5-mm cannulated screws can be used for fixation of femoral neck fractures. Fixation can be achieved with 3 or 4 screws (Rajnish et al, 2019). Considering the femoral neck widths of patients living in Turkey, it should be kept in mind that fixation with 4 screws may be difficult and may cause intraoperative complications, especially for female patients.…”