Introduction of a guide based on a femoral neck section for fixation with multiple screws: a cadaveric study

Abstract

BackgroundThe design and application of assisted instrumentation for internal fixation of femoral neck fractures with multiple screws are still evolving. A novel guide based on a femoral neck section was designed to improve the accuracy of screw placement, and its efficacy was evaluated.MethodsA guide based on a femoral neck section was designed for assisted fixation of femoral neck fractures with multiple screws. Femoral specimens from 10 adults (20 femurs) underwent assisted internal fixation for a femoral neck fracture with 3 cannulated screws using the new guide technique or conventional technique. The accuracy of screw orientation and entry point, the accuracy of optimal screw positioning, and drilling attempts, operative time, and fluoroscopy time were recorded.ResultsAmong all 20 specimens, 60 screws were inserted successfully. Screw parallelism, operative time, and fluoroscopy time showed no statistical difference between the new guide technique and conventional technique (P > 0.05). The accuracy of optimal screw positioning was determined by the contained screw area ratio, distance between screws, distance from the centre of the femoral neck section, distance between screws and the femoral neck cortex, and Drilling attempts were statistical significantly better (data in the first three were larger and in the latter two was smaller) with the new guide technique, than with conventional technique (P < 0.05).ConclusionsThis new, two-dimensional, fluoroscopy-assisted, percutaneous guide technique enables accurate and optimal screw positioning in internal fixation of femoral neck fractures, compared with conventional technique.

Optimal position and apex–subchondral bone distance of cannulated screws for internal fixation of femoral neck fracture: A radiological study

“…[26][27][28] Different devices have been developed to guide the needle insertion, including navigation systems and surgical robots. [6][7][8][9][10][11] However, these systems are expensive and not widely available. While C-arm fluoroscopy is more widely available, there is a lack of information on the use of T A B L E 1 Parameters for the optimal position and length of cannulated screws on virtual anteroposterior and lateral fluoroscopy images experience.…”

“…Based on their results, they designed a system for convenient parallel positioning of screws for internal fixation of femoral neck fractures, although their technique requires fluoroscopy assistance. 8 Orthopedic surgical robots, such as the "TiRobot," also provide efficient and accurate assistance to surgeons for screw placement; however, planning of the screw path on the master control system software remains to be detailed. [9][10][11] The optimal screw length is a parameter that also needs further evaluation.…”

“…Based on the anatomical analysis, Zhu et al 7 confirmed that an obtuse triangle is better than an equilateral triangle configuration for screw placement to provide stability of a femoral neck fracture. Based on their results, they designed a system for convenient parallel positioning of screws for internal fixation of femoral neck fractures, although their technique requires fluoroscopy assistance 8 . Orthopedic surgical robots, such as the “TiRobot,” also provide efficient and accurate assistance to surgeons for screw placement; however, planning of the screw path on the master control system software remains to be detailed 9–11 …”

Intraoperative Frog Lateral View, An Effective and Easy Way to Avoid Screw Cutout for Femoral Neck Fractures Fixed with Multiple Cancellous Screws

“…However, due to the long clinical application time and the large number of patients receiving cannulated screw xation, clinicians have found many problems in practice. Many studies focused on the analysis of the failure of cannulated screw xation to improve the technique of cannulated screw xation for femoral neck fracture [16][17][18][19][20] . A large number of relevant studies not only improve the success rate of cannulated screw xation, but also standardize the xation method and shorten the learning curve, so that the method of cannulated screw xation is more widely used.…”

TiRobot‐Assisted Percutaneous Cannulated Screw Fixation in the Treatment of Femoral Neck Fractures: A Minimum 2‐Year Follow‐up of 50 Patients

“…Based on the acquired images, screw accuracy, including screw parallelism and distance between screws, was evaluated according to the model of Zhu et al 14 …”