Effectiveness analysis of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Yonghui ^1,2 , LI Lei ¹ , LI Chong ¹ , LI Meng ¹ , LI Li ¹ , XU Lei ¹ , YAO Gang ¹ , XU Wei ¹ ,  FANG Shiyuan ¹

1. Department of Trauma Orthopedics, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Heifei Anhui, 230001, P. R. China;
2. Graduate School, Wannan Medical College, Wuhu Anhui, 241002, P. R. China;

Corresponding author：

FANG Shiyuan, Email: Fangshiyuan2008@163.com

Keywords：

Femoral neck fracture; internal fixation; hollow screw; biplanar vertical fixation; inverted triangle fixation; young and middle-aged

DOI：

10.7507/1002-1892.202404070

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Objective To compare the effectiveness of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients. Methods The clinical data of 55 young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture between June 2021 and December 2022 was retrospectively analyzed. All patients were treated with closed reduction and internal fixation with hollow screws, 25 cases were treated with biplanar vertical fixation (study group), 30 cases with inverted triangle fixation (control group). There was no significant difference in gender, age, affected side, cause of injury, underlying diseases, and time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, guide needle puncture times, starting time of weight bearing, time of full weight bearing, time of fracture healing, and complications were recorded and compared between the two groups. The hip joint function was evaluated by Harris score at 1 day, 6 months, 12 months after operation, and at last follow-up, and the pain relief was evaluated by visual analogue scale (VAS) score. The femoral neck shortening was measured on the X-ray film at last follow-up. Results All patients were followed up 12-31 months (mean, 22.0 months), and there was no significant difference in follow-up time between the two groups (P>0.05). The operation time, intraoperative blood loss, and fluoroscopy times in the study group were higher than those in the control group, but the difference was not significant (P>0.05). The guide needle puncture times in the study group was more than that in the control group, and the time of starting weight bearing and the time of full weight bearing in the study group were shorter than those in the control group, the differences were significant (P<0.05). Bony healing was achieved in both groups, and there was no significant difference in fracture healing time between the two groups (P>0.05). No osteonecrosis of the femoral head and incision-related complication was found in the two groups during follow-up, and the femoral neck shortening length in the study group was significantly shorter than that in the control group at last follow-up (P<0.05). There was no significant difference in Harris score between the two groups at 1 day after operation (P>0.05), and the Harris score of the study group was significantly better than that of the control group at other time points (P<0.05); there was no significant difference in VAS score between the two groups at each time point after operation (P>0.05). Conclusion Compared with the inverted triangle fixation, the treatment of Pauwels type Ⅲ femoral neck fracture with biplanar vertical fixation can effectively reduce femoral neck shortening without affecting fracture healing, and improve hip joint function in early stage.

Citation： ZHOU Yonghui, LI Lei, LI Chong, LI Meng, LI Li, XU Lei, YAO Gang, XU Wei, FANG Shiyuan. Effectiveness analysis of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 961-967. doi: 10.7507/1002-1892.202404070 Copy

1.	Wang K, Ni M, Liao P, et al. Fracture morphology and biomechanical characteristics of Pauwels Ⅲ femoral neck fractures in young adults. Injury, 2021, 52(11): 3227-3238.
2.	Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg (Am), 2008, 90(8): 1654-1659.
3.	Hamburger E, Cohen N, Rosenthal Y, et al. Femoral neck shortening as a sequela of internal fixation for femoral neck fractures and its effect on the coronal alignment of the limb: a pilot study. Arch Orthop Trauma Surg, 2024, 144(2): 723-729.
4.	Wang K, Lin D, Chen P, et al. Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system. J Orthop Surg Res, 2023, 18(1): 317. doi: 10.1186/s13018-023-03787-5.
5.	程培焱. 不同数量和排列方式的空心拉力螺钉治疗股骨颈骨折的有限元分析. 石家庄: 河北医科大学, 2017.
6.	刘英科, 马文龙, 田可为, 等. 三种手术方式治疗中青年PauwelsⅢ型股骨颈骨折的疗效比较. 中国修复重建外科杂志, 2024, 38(4): 412-421.
7.	段强民, 李光磊, 张冰, 等. 4枚与3枚空心钉固定PauwelsⅢ型股骨颈骨折比较. 中国矫形外科杂志, 2022, 30(2): 113-118.
8.	张伟, 陈宇浩, 吴沼锋, 等. 不同内固定方式治疗PauwelsⅢ型股骨颈骨折术后并发症发生率的网状Meta分析. 现代医学, 2024, 52(3): 369-378.
9.	中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
10.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
11.	Liu Y, Liang H, Zhou X, et al. Micro-computed tomography analysis of femoral head necrosis after long-term internal fixation for femoral neck fracture. Orthop Surg, 2022, 14(6): 1186-1192.
12.	Rajfer RA, Carlson BA, Johnson JP. High-energy femoral neck fractures in young patients. J Am Acad Orthop Surg, 2024, 32(7): e302-e312.
13.	李磊, 朱晨, 方诗元, 等. 股骨颈骨折空心钉内固定术后长期疗效分析. 中华关节外科杂志 (电子版), 2018, 12(3): 310-316.
14.	Yu X, Rong PZ, Pang QJ, et al. The effect on the fracture healing following femoral neck shortening after osteoporotic femoral neck fracture treated with internal fixation: Finite element analysis. Biomed Res Int, 2021, 2021: 3490881. doi: 10.1155/2021/3490881.
15.	Yan SG, Cui Y, Li D, et al. Femoral neck system versus three cannulated screws for fixation of femoral neck fractures in younger patients: A retrospective cohort study. J Invest Surg, 2023, 36(1): 2266752. doi: 10.1080/08941939.2023.2266752.
16.	Huang ZY, Su YH, Huang ZP, et al. Medial buttress plate and allograft bone-assisted cannulated screw fixation for unstable femoral neck fracture with posteromedial comminution: A retrospective controlled study. Orthop Surg, 2022, 14(5): 911-918.
17.	苏郁晖, 王博文, 陈瑞松, 等. 空心螺钉加内侧支撑钢板结合同种异体骨植骨治疗伴后内侧粉碎的不稳定性股骨颈骨折. 中国修复重建外科杂志, 2021, 35(11): 1434-1439.
18.	潘林华, 汪金平, 胡斌, 等. 横行拉力螺钉在后内侧皮质粉碎的股骨颈骨折中的应用效果观察. 中国骨与关节损伤杂志, 2024, 39(2): 179-181.
19.	Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: Results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
20.	Jiang D, Zhan S, Cai Q, et al. Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury, 2021, 52(11): 3408-3414.
21.	Cuellar DO, Garcia Velez DA, Bledsoe G, et al. Hybrid screw fixation for femoral neck fractures: Does it prevent mechanical failure? Injury, 2022, 53(8): 2839-2845.
22.	Dong Q, Han Z, Zhang YG, et al. Comparison of transverse cancellous lag screw and ordinary cannulated screw fixations in treatment of vertical femoral neck fractures. Orthop Surg, 2019, 11(4): 595-603.
23.	Jiang D, Zhan S, Wang L, et al. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res, 2021, 39(8): 1669-1680.
24.	Ding K, Zhu Y, Li J, et al. Age-related changes with the trabecular bone of ward’s triangle and neck-shaft angle in the proximal femur: A radiographic study. Orthop Surg, 2023, 15(12): 3279-3287.
25.	Al-Naseem AO, Gonnah AR, Al-Ali H, et al. Robot-assisted versus conventional freehand fluoroscopy-guided percutaneous screw fixation in femoral neck fractures: A systematic review and meta-analysis. Cureus, 2022, 14(4): e24258. doi: 10.7759/cureus.24258.
26.	Wan L, Zhang X, Wu D, et al. Application of robot positioning for cannulated screw internal fixation in the treatment of femoral neck fracture: Retrospective study. JMIR Med Inform, 2021, 9(1): e24164. doi: 10.2196/24164.
27.	杨家赵, 周雪锋, 李黎, 等. 股骨颈动力交叉钉系统和倒三角空心钉治疗Pauwels Ⅲ型股骨颈骨折疗效比较. 中国修复重建外科杂志, 2021, 35(9): 1111-1118.

1. Wang K, Ni M, Liao P, et al. Fracture morphology and biomechanical characteristics of Pauwels Ⅲ femoral neck fractures in young adults. Injury, 2021, 52(11): 3227-3238.
2. Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg (Am), 2008, 90(8): 1654-1659.
3. Hamburger E, Cohen N, Rosenthal Y, et al. Femoral neck shortening as a sequela of internal fixation for femoral neck fractures and its effect on the coronal alignment of the limb: a pilot study. Arch Orthop Trauma Surg, 2024, 144(2): 723-729.
4. Wang K, Lin D, Chen P, et al. Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system. J Orthop Surg Res, 2023, 18(1): 317. doi: 10.1186/s13018-023-03787-5.
5. 程培焱. 不同数量和排列方式的空心拉力螺钉治疗股骨颈骨折的有限元分析. 石家庄: 河北医科大学, 2017.
6. 刘英科, 马文龙, 田可为, 等. 三种手术方式治疗中青年PauwelsⅢ型股骨颈骨折的疗效比较. 中国修复重建外科杂志, 2024, 38(4): 412-421.
7. 段强民, 李光磊, 张冰, 等. 4枚与3枚空心钉固定PauwelsⅢ型股骨颈骨折比较. 中国矫形外科杂志, 2022, 30(2): 113-118.
8. 张伟, 陈宇浩, 吴沼锋, 等. 不同内固定方式治疗PauwelsⅢ型股骨颈骨折术后并发症发生率的网状Meta分析. 现代医学, 2024, 52(3): 369-378.
9. 中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
10. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
11. Liu Y, Liang H, Zhou X, et al. Micro-computed tomography analysis of femoral head necrosis after long-term internal fixation for femoral neck fracture. Orthop Surg, 2022, 14(6): 1186-1192.
12. Rajfer RA, Carlson BA, Johnson JP. High-energy femoral neck fractures in young patients. J Am Acad Orthop Surg, 2024, 32(7): e302-e312.
13. 李磊, 朱晨, 方诗元, 等. 股骨颈骨折空心钉内固定术后长期疗效分析. 中华关节外科杂志 (电子版), 2018, 12(3): 310-316.
14. Yu X, Rong PZ, Pang QJ, et al. The effect on the fracture healing following femoral neck shortening after osteoporotic femoral neck fracture treated with internal fixation: Finite element analysis. Biomed Res Int, 2021, 2021: 3490881. doi: 10.1155/2021/3490881.
15. Yan SG, Cui Y, Li D, et al. Femoral neck system versus three cannulated screws for fixation of femoral neck fractures in younger patients: A retrospective cohort study. J Invest Surg, 2023, 36(1): 2266752. doi: 10.1080/08941939.2023.2266752.
16. Huang ZY, Su YH, Huang ZP, et al. Medial buttress plate and allograft bone-assisted cannulated screw fixation for unstable femoral neck fracture with posteromedial comminution: A retrospective controlled study. Orthop Surg, 2022, 14(5): 911-918.
17. 苏郁晖, 王博文, 陈瑞松, 等. 空心螺钉加内侧支撑钢板结合同种异体骨植骨治疗伴后内侧粉碎的不稳定性股骨颈骨折. 中国修复重建外科杂志, 2021, 35(11): 1434-1439.
18. 潘林华, 汪金平, 胡斌, 等. 横行拉力螺钉在后内侧皮质粉碎的股骨颈骨折中的应用效果观察. 中国骨与关节损伤杂志, 2024, 39(2): 179-181.
19. Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: Results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
20. Jiang D, Zhan S, Cai Q, et al. Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury, 2021, 52(11): 3408-3414.
21. Cuellar DO, Garcia Velez DA, Bledsoe G, et al. Hybrid screw fixation for femoral neck fractures: Does it prevent mechanical failure? Injury, 2022, 53(8): 2839-2845.
22. Dong Q, Han Z, Zhang YG, et al. Comparison of transverse cancellous lag screw and ordinary cannulated screw fixations in treatment of vertical femoral neck fractures. Orthop Surg, 2019, 11(4): 595-603.
23. Jiang D, Zhan S, Wang L, et al. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res, 2021, 39(8): 1669-1680.
24. Ding K, Zhu Y, Li J, et al. Age-related changes with the trabecular bone of ward’s triangle and neck-shaft angle in the proximal femur: A radiographic study. Orthop Surg, 2023, 15(12): 3279-3287.
25. Al-Naseem AO, Gonnah AR, Al-Ali H, et al. Robot-assisted versus conventional freehand fluoroscopy-guided percutaneous screw fixation in femoral neck fractures: A systematic review and meta-analysis. Cureus, 2022, 14(4): e24258. doi: 10.7759/cureus.24258.
26. Wan L, Zhang X, Wu D, et al. Application of robot positioning for cannulated screw internal fixation in the treatment of femoral neck fracture: Retrospective study. JMIR Med Inform, 2021, 9(1): e24164. doi: 10.2196/24164.
27. 杨家赵, 周雪锋, 李黎, 等. 股骨颈动力交叉钉系统和倒三角空心钉治疗Pauwels Ⅲ型股骨颈骨折疗效比较. 中国修复重建外科杂志, 2021, 35(9): 1111-1118.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients

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