Short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in middle-aged and elderly patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Zhirong ¹ , GE Yunlin ^2△ ,  DING Shuchen ¹ , JIN Xiaojun ¹ , FENG Jiangbiao ¹ , FU Chudi ² , YU Rongbin ³ , LIN Zongyang ¹

1. The 4th Department of Orthopedics, the 117th Hospital of Chinese PLA, Hangzhou Zhejiang, 310001, P.R.China;
2. The 2nd Department of Orthopedics, the 117th Hospital of Chinese PLA, Hangzhou Zhejiang, 310001, P.R.China;
3. Prevention and Healthcare Section, Ningbo City Medical Treatment Center Li Huili Hospital, Ningbo Zhejiang, 315040, P.R.China;

Corresponding author：

DING Shuchen, Email: hheellll@126.com

Keywords：

Femoral neck fracture; internal fixation; polyaxial locking plate; femoral neck shortening

DOI：

10.7507/1002-1892.201607116

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Objective To evaluate the feasibility and short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in the middle-aged and elderly patients. Methods A retrospective analysis was made on the clinical data of 13 patients with femoral neck fracture undergoing fixation with polyaxial locking plates between September 2013 and June 2015 (group A) and 13 patients with femoral neck fracture undergoing fixation with three cannulated screws in the same period (group B). There was no significant difference in gender, age, side, cause of injury, Garden type, type of fracture position, type of Pauwels angle, Singh index, time between injury and operation, and preoperative complications between 2 groups (P>0.05). The femoral neck shortening at 1 year postoperatively, and fracture nonunion, femoral head necrosis, and Harris hip score at last follow-up were compared between 2 groups. Results The follow-up time was (19.23±3.98) months in group A and (18.00±3.61) months in group B, showing no significant difference between 2 groups (t=2.063,P=0.417). No femoral head necrosis occurred in group A, but head necrosis occurred in 1 case of group B, and hemiarthroplasty was performed. There was no significant difference in the rate of femoral head necrosis between 2 groups (χ²=0.000,P=1.000). Bone union was obtained in the other patients of 2 groups. The Harris hip score of group A (85.23±2.95) was significantly higher than that of group B (81.92±3.64) at last follow-up (t=2.064,P=0.018). No infection or internal fixation failure occurred in 2 groups. One case had pain at the outer thigh at 1 month after operation in group A, but pain relief was achieved at 3 months after operation. At 1 year after operation, no femoral neck shortening occurred in group A, but degree I, II, and III femoral neck shortening was observed in 3, 2, and 8 cases of group B, respectively, showing significant difference between 2 groups (Z=–4.714,P=0.000). Conclusion Although fixation with polyaxial locking plate for femoral neck fracture in the middle-aged and elderly patients has similar femoral head necrosis rate to fixation with cannulated screws, it has advantages in preventing neck shortening and improving hip joint function after operation.

Citation： LIUZhirong, GEYunlin, DINGShuchen, JINXiaojun, FENGJiangbiao, FUChudi, YURongbin, LINZongyang. Short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in middle-aged and elderly patients. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 5-10. doi: 10.7507/1002-1892.201607116 Copy

1.	Bhandari M, Tornetta P 3rd, Hanson B, et al. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? J Orthop Trauma, 2009, 23(6): 403-407.
2.	Samsami S, Saberi S, Sadighi S, et al. Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations. J Med Biol Eng, 2015, 35(5): 566-579.
3.	Hoffmann MF, Lotzien S, Schildhauer TA. Clinical outcome of interprosthetic femoral fractures treated with polyaxial locking plates. Injury, 2016, 47(4): 934-938.
4.	Ruchholtz S, Hauk C, Lewan U, et al. Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study. J Trauma, 2011, 71(6): 1737-1744.
5.	Barnhart MD, Rides CF, Kennedy SC, et al. Fracture repair using a polyaxial locking plate system (PAX). Vet Surg, 2013, 42(1): 60-66.
6.	Hanschen M, Aschenbrenner IM, Fehske K, et al. Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial. Int Orthop, 2014, 38(4): 857-863.
7.	刘鹄, 杨睿, 沈慧勇, 等. 空心钉正三角形与倒三角形排列方式治疗股骨颈骨折的疗效比较.中华创伤骨科杂志, 2012, 14(8): 726-728.
8.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
9.	夏希, 刘智. 老年股骨颈骨折空心螺钉固定术后颈短缩的测量及其对髋关节功能的影响. 中华创伤骨科杂志, 2014, 16(8): 651-655.
10.	Bonnaire FA, Weber AT. The influence of haemarthrosis on the development of femoral head necrosis following intracapsular femoral neck fractures. Injury, 2002, 33 Suppl 3: C33-40.
11.	刘粤, 张长青, 孟炜, 等. 闭合复位空心钉治疗中老年股骨颈骨折后股骨头坏死的多元相关研究. 中华创伤骨科杂志, 2006, 8(7): 617-621.
12.	谢建军, 曾剑文, 付剑平, 等. 股骨近端空心钉锁定钢板治疗股骨颈骨折. 中国矫形外科杂志, 2014, 22(10): 1526-1528.
13.	叶永杰, 银毅, 王志强, 等. 空心钉锁定钢板治疗青壮年股骨颈骨折近期疗效. 中国修复重建外科杂志, 2012, 26(12): 943-945.
14.	Wiss DA. Fractures. 3rd eds. 姜保国, 主译. 山东: 山东科学技术出版社, 2015: 256.
15.	Wang C, Xu GJ, Han Z, et al. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures. Medicine (Baltimore), 2015, 94(47): e2139.
16.	Yu XB, Zhao DW, Zhong SZ, et al. Prospective and comparative analysis of internal fixation of femoral neck fractures with or without vascularized iliac graft in young adults. Orthopedics, 2013, 36 (2): e132-138.
17.	Ai ZS, Gao YS, Sun Y, et al. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci, 2013, 18(2): 271-276.

1. Bhandari M, Tornetta P 3rd, Hanson B, et al. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? J Orthop Trauma, 2009, 23(6): 403-407.
2. Samsami S, Saberi S, Sadighi S, et al. Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations. J Med Biol Eng, 2015, 35(5): 566-579.
3. Hoffmann MF, Lotzien S, Schildhauer TA. Clinical outcome of interprosthetic femoral fractures treated with polyaxial locking plates. Injury, 2016, 47(4): 934-938.
4. Ruchholtz S, Hauk C, Lewan U, et al. Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study. J Trauma, 2011, 71(6): 1737-1744.
5. Barnhart MD, Rides CF, Kennedy SC, et al. Fracture repair using a polyaxial locking plate system (PAX). Vet Surg, 2013, 42(1): 60-66.
6. Hanschen M, Aschenbrenner IM, Fehske K, et al. Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial. Int Orthop, 2014, 38(4): 857-863.
7. 刘鹄, 杨睿, 沈慧勇, 等. 空心钉正三角形与倒三角形排列方式治疗股骨颈骨折的疗效比较.中华创伤骨科杂志, 2012, 14(8): 726-728.
8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
9. 夏希, 刘智. 老年股骨颈骨折空心螺钉固定术后颈短缩的测量及其对髋关节功能的影响. 中华创伤骨科杂志, 2014, 16(8): 651-655.
10. Bonnaire FA, Weber AT. The influence of haemarthrosis on the development of femoral head necrosis following intracapsular femoral neck fractures. Injury, 2002, 33 Suppl 3: C33-40.
11. 刘粤, 张长青, 孟炜, 等. 闭合复位空心钉治疗中老年股骨颈骨折后股骨头坏死的多元相关研究. 中华创伤骨科杂志, 2006, 8(7): 617-621.
12. 谢建军, 曾剑文, 付剑平, 等. 股骨近端空心钉锁定钢板治疗股骨颈骨折. 中国矫形外科杂志, 2014, 22(10): 1526-1528.
13. 叶永杰, 银毅, 王志强, 等. 空心钉锁定钢板治疗青壮年股骨颈骨折近期疗效. 中国修复重建外科杂志, 2012, 26(12): 943-945.
14. Wiss DA. Fractures. 3rd eds. 姜保国, 主译. 山东: 山东科学技术出版社, 2015: 256.
15. Wang C, Xu GJ, Han Z, et al. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures. Medicine (Baltimore), 2015, 94(47): e2139.
16. Yu XB, Zhao DW, Zhong SZ, et al. Prospective and comparative analysis of internal fixation of femoral neck fractures with or without vascularized iliac graft in young adults. Orthopedics, 2013, 36 (2): e132-138.
17. Ai ZS, Gao YS, Sun Y, et al. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci, 2013, 18(2): 271-276.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in middle-aged and elderly patients

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