Comparison of the Surgical Outcome between the Multiple Screw Fixation and Fixed Angle Devices for the Basicervical Femoral Neck Fractures
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Surgical Technique
2.3. Outcome Variables
2.4. Statistical Analysis
2.5. Ethical Approval
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Watson, S.T.; Schaller, T.M.; Tanner, S.L.; Adams, J.D.; Jeray, K.J. Outcomes of Low-Energy Basicervical Proximal Femoral Fractures Treated with Cephalomedullary Fixation. J. Bone Joint Surg. Am. 2016, 98, 1097–1102. [Google Scholar] [CrossRef]
- Lee, Y.K.; Choi, Y.H.; Ha, Y.C.; Lim, J.Y.; Koo, K.H. Does venous thromboembolism affect rehabilitation after hip fracture surgery? Yonsei Med. J. 2013, 54, 1015–1019. [Google Scholar] [CrossRef]
- Park, C.H.; Lee, Y.K.; Koo, K.H. Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty. Hip Pelvis 2017, 29, 30–34. [Google Scholar] [CrossRef]
- Pincus, D.; Desai, S.J.; Wasserstein, D.; Ravi, B.; Paterson, J.M.; Henry, P.; Kreder, H.J.; Jenkinson, R. Outcomes of After-Hours Hip Fracture Surgery. J. Bone Joint Surg. Am. 2017, 99, 914–922. [Google Scholar] [CrossRef]
- Nauth, A.; Creek, A.T.; Zellar, A.; Lawendy, A.-R.; Dowrick, A.; Gupta, A.; Dadi, A.; van Kampen, A.; Yee, A.; de Vries, A.C.; et al. Fracture fixation in the operative management of hip fractures (FAITH): An international, multicentre, randomised controlled trial. Lancet 2017, 389, 1519–1527. [Google Scholar] [CrossRef]
- Saarenpaa, I.; Partanen, J.; Jalovaara, P. Basicervical fracture—A rare type of hip fracture. Arch. Orthop. Trauma. Surg. 2002, 122, 69–72. [Google Scholar] [CrossRef]
- Sundkvist, J.; Bruggeman, A.; Sayed-Noor, A.; Moller, M.; Wolf, O.; Mukka, S. Epidemiology, classification, treatment, and mortality of adult femoral neck and basicervical fractures: An observational study of 40,049 fractures from the Swedish Fracture Register. J. Orthop. Surg. Res. 2021, 16, 561. [Google Scholar] [CrossRef]
- Yoo, J.I.; Cha, Y.; Kwak, J.; Kim, H.Y.; Choy, W.S. Review on Basicervical Femoral Neck Fracture: Definition, Treatments, and Failures. Hip Pelvis 2020, 32, 170–181. [Google Scholar] [CrossRef]
- Chen, C.Y.; Chiu, F.Y.; Chen, C.M.; Huang, C.K.; Chen, W.M.; Chen, T.H. Surgical treatment of basicervical fractures of femur—A prospective evaluation of 269 patients. J. Trauma. 2008, 64, 427–429. [Google Scholar] [CrossRef]
- Dekhne, M.S.; Thomas, H.M.; Haider, T.; Mortensen, S.; Rodriguez, E.K.; Weaver, M.J.; von Keudell, A. Treatment and outcomes of basicervical femoral neck fractures: A systematic review. J. Orthop. Surg. 2021, 29, 23094990211003344. [Google Scholar] [CrossRef]
- Enocson, A.; Lapidus, L.J. The vertical hip fracture—A treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskelet. Disord. 2012, 13, 171. [Google Scholar] [CrossRef]
- Kim, J.T.; Ha, Y.C.; Park, C.H.; Yoo, J.I.; Kim, T.Y. Single screw type of lag screw results higher reoperation rate in the osteosynthesis of basicervical hip fracture. J. Orthop. Sci. 2020, 25, 152–155. [Google Scholar] [CrossRef]
- Kuokkanen, H.O. Treatment options for basicervical fractures of the femoral neck. A clinical follow-up. Acta Orthop. Belg. 1991, 57, 162–168. [Google Scholar]
- Lee, Y.K.; Yoon, B.H.; Hwang, J.S.; Cha, Y.H.; Kim, K.C.; Koo, K.H. Risk factors of fixation failure in basicervical femoral neck fracture: Which device is optimal for fixation? Injury 2018, 49, 691–696. [Google Scholar] [CrossRef]
- Massoud, E.I. Fixation of basicervical and related fractures. Int. Orthop. 2010, 34, 577–582. [Google Scholar] [CrossRef]
- Okano, I.; Sawada, T.; Kushima, N.; Tachibana, T.; Inagaki, K. Treatment With Helical Blade Cephalomedullary Nail for Two-Part Basicervical Proximal Femoral Fracture in Elderly Patients: A Retrospective Observational Study. Geriatr. Orthop. Surg. Rehabil. 2017, 8, 244–251. [Google Scholar] [CrossRef]
- Su, B.W.; Heyworth, B.E.; Protopsaltis, T.S.; Lipton, C.B.; Sinicropi, S.M.; Chapman, C.B.; Kuremsky, M.A.; Rosenwasser, M.P. Basicervical versus intertrochanteric fractures: An analysis of radiographic and functional outcomes. Orthopedics 2006, 29, 919–925. [Google Scholar] [CrossRef]
- Tasyıkan, L.; Ugutmen, E.; Sanel, S.; Soylemez, M.S.; Ozkan, K.; Solakoglu, C. Short-term results of surgical treatment with cephalomedullary nails for basicervical proximal femoral fractures. Acta Orthop. Belg. 2015, 81, 427–434. [Google Scholar]
- Bhandari, M.; Devereaux, P.J.; Tornetta, P., 3rd; Swiontkowski, M.F.; Berry, D.J.; Haidukewych, G.; Schemitsch, E.H.; Hanson, B.P.; Koval, K.; Dirschl, D.; et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J. Bone Joint Surg. Am. 2005, 87, 2122–2130. [Google Scholar] [CrossRef]
- Hoshino, C.M.; O’Toole, R.V. Fixed angle devices versus multiple cancellous screws: What does the evidence tell us? Injury 2015, 46, 474–477. [Google Scholar] [CrossRef]
- Sharma, A.; Sethi, A.; Sharma, S. Comparative analysis of treatment of basicervical femur fractures in young adults with CCS, DHS, and PFN. Rev. Bras. Ortop. 2018, 53, 783–787. [Google Scholar] [CrossRef]
- Quach, S.; Hennessy, D.A.; Faris, P.; Fong, A.; Quan, H.; Doig, C. A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients. BMC Health Serv. Res. 2009, 9, 129. [Google Scholar] [CrossRef]
- Koval, K.J.; Zuckerman, J.D. Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures. J. Am. Acad. Orthop. Surg. 1994, 2, 141–149. [Google Scholar] [CrossRef]
- Dorr, L.D.; Faugere, M.C.; Mackel, A.M.; Gruen, T.A.; Bognar, B.; Malluche, H.H. Structural and cellular assessment of bone quality of proximal femur. Bone 1993, 14, 231–242. [Google Scholar] [CrossRef]
- Owens, W.D.; Felts, J.A.; Spitznagel, E.L., Jr. ASA physical status classifications: A study of consistency of ratings. Anesthesiology 1978, 49, 239–243. [Google Scholar] [CrossRef]
- Cho, Y.; Shin, J.U.; Kim, S. Comparative Study for Osteosynthesis of Femoral Neck Fractures: Cannulated Screws versus Femoral Neck System. Hip Pelvis 2023, 35, 47–53. [Google Scholar] [CrossRef]
- Chung, H.; Kim, Y.; Kook, I.; Kwak, J.W.; Hwang, K.T. Comparative Short-Term Outcomes of Femoral Neck System (FNS) and Cannulated Screw Fixation in Patients with Femoral Neck Fractures: A Multicenter Study. Clin. Orthop. Surg. 2024, 16, 184–193. [Google Scholar] [CrossRef]
- Ryu, H.G.; Shin, D.W.; Han, B.S.; Kim, S.M. Risk Factors Associated with Fixation Failure in Intertrochanteric Fracture Treated with Cephalomedullary Nail. Hip Pelvis 2023, 35, 193–199. [Google Scholar] [CrossRef]
- Kitcharanant, N.; Atthakomol, P.; Khorana, J.; Phinyo, P.; Unnanuntana, A. Prognostic Factors for Functional Recovery at 1-Year Following Fragility Hip Fractures. Clin. Orthop. Surg. 2024, 16, 7–15. [Google Scholar] [CrossRef]
- Crosby, J.M.; Parker, M.J. Femoral neck collapse after internal fixation of an intracapsular hip fracture: Does it indicate a poor outcome? Injury 2016, 47, 2760–2763. [Google Scholar] [CrossRef]
- Kweon, S.H.; Lee, S.H.; Kook, S.H.; Choi, Y.C. Outcomes of Cephalomedullary Nailing in Basicervical Fracture. Hip Pelvis 2017, 29, 270–276. [Google Scholar] [CrossRef]
- Mallick, A.; Parker, M.J. Basal fractures of the femoral neck: Intra- or extra-capsular. Injury 2004, 35, 989–993. [Google Scholar] [CrossRef]
- Chapman, T.; Zmistowski, B.; Krieg, J.; Stake, S.; Jones, C.M.; Levicoff, E. Helical Blade Versus Screw Fixation in the Treatment of Hip Fractures With Cephalomedullary Devices: Incidence of Failure and Atypical “Medial Cutout”. J. Orthop. Trauma. 2018, 32, 397–402. [Google Scholar] [CrossRef]
- Zeelenberg, M.L.; Plaisier, A.C.; Nugteren, L.H.T.; Loggers, S.A.I.; Joosse, P.; Verhofstad, M.H.J.; Den Hartog, D.; Van Lieshout, E.M.M.; Group, S.-H.S. Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2): A systematic review and meta-analysis. Arch. Orthop. Trauma. Surg. 2024, 144, 1189–1209. [Google Scholar] [CrossRef]
- Warren, J.A.; Sundaram, K.; Hampton, R.; McLaughlin, J.; Patterson, B.; Higuera, C.A.; Piuzzi, N.S. Cephalomedullary nailing versus sliding hip screws for Intertrochanteric and basicervical hip fractures: A propensity-matched study of short-term outcomes in over 17,000 patients. Eur. J. Orthop. Surg. Traumatol. 2020, 30, 243–250. [Google Scholar] [CrossRef]
- Blair, B.; Koval, K.J.; Kummer, F.; Zuckerman, J.D. Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques. Clin. Orthop. Relat. Res. 1994, 306, 256–263. [Google Scholar]
- Imren, Y.; Gurkan, V.; Bilsel, K.; Desteli, E.E.; Tuna, M.; Gurcan, C.; Tuncay, I.; Sen, C. Biomechanical comparison of dynamic hip screw, proximal femoral nail, cannulated screw, and monoaxial external fixation in the treatment of basicervical femoral neck fractures. Acta Chir. Orthop. Traumatol. Cech. 2015, 82, 140–144. [Google Scholar] [CrossRef]
- Koraman, E.; Iyetin, Y.; Ozyaman, O.; Akyurek, M. A biomechanical comparison of three fixation methods for unstable femoral neck fractures with medial calcar defect. J. Orthop. Surg. Res. 2023, 18, 614. [Google Scholar] [CrossRef]
- Linde, F.; Andersen, E.; Hvass, I.; Madsen, F.; Pallesen, R. Avascular femoral head necrosis following fracture fixation. Injury 1986, 17, 159–163. [Google Scholar] [CrossRef]
- Haidukewych, G.J.; Rothwell, W.S.; Jacofsky, D.J.; Torchia, M.E.; Berry, D.J. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J. Bone Joint Surg. Am. 2004, 86, 1711–1716. [Google Scholar] [CrossRef]
Parameters | MCS (n = 17) | FAD (n = 36) | p-Value |
---|---|---|---|
Sex (male:female), patients | 7:10 | 9:27 | 0.231 |
Age, years * | 65.4 ± 12.0 | 79.6 ± 8.0 | <0.001 |
BMI, kg/m2 * | 21.8 ± 2.8 | 21.7 ± 3.6 | 0.894 |
FU period, months | 25.5 ± 14.0 | 21.8 ± 7.7 | 0.213 |
Side (left:right), patients | 11:6 | 21:15 | 0.658 |
CCI (Charlson Comorbidity index) * | 0.5 ± 0.7 | 1.9 ± 1.6 | <0.001 |
Walking ability, patients (%) § | 0.122 | ||
Outdoor (Koval’s grade I–III) | 14 (82.4%) | 22 (61.1%) | |
Housebound (Koval’s grade IV–VII) | 3 (17.6%) | 14 (38.9%) | |
Dorr classification | 0.045 | ||
Type A | 3 (17.6%) | 4 (11.1%) | |
Type B | 13 (76.5%) | 18 (50.0%) | |
Type C | 1 (5.9%) | 14 (38.9%) | |
ASA score | 1.6 ± 0.6 | 2.2 ± 0.5 | 0.002 |
Parameters | MCS (n = 17) | FAD (n = 36) | p-Value |
---|---|---|---|
Type of anesthesia, patients (%) | 0.570 | ||
Regional | 12 (70.6%) | 28 (77.8%) | |
General | 5 (29.4%) | 8 (22.2%) | |
Time to surgery, days * | 1.0 (0.5–7.5) | 3.0 (2.0–4.0) | 0.507 |
Operation time, minutes * | 50 (40–66) | 49 (40–54) | 0.066 |
Estimated blood loss, mL * | 50 (40–100) | 50 (50–100) | 0.303 |
Length of hospital stays, days * | 16 (6–25) | 9.5 (8–16.25) | 0.654 |
Complications | 0.642 | ||
Fracture site collapse | 2 (11.8%) | 6 (16.7%) | |
Osteonecrosis | 2 (11.8%) | 0 | |
Reoperation | 4 (23.5%) | 1 (2.8%) | 0.016 |
Study | No. of Patients | Type of Implants | Fixation Failure Rate | Reoperation Rate |
---|---|---|---|---|
Watson et al. (2016) [1] | 11 | CMN | 54.5% (6/11) | 45.5% (5/11) |
Chapman et al. (2018) [33] | 6 | CMN | 33.3% (2/6) | 33.3% (2/6) |
Tasylkan et al. (2015) [18] | 25 | CMN | 0 | 0 |
Okano et al. (2017) [16] | 14 | CMN | 0 | 0 |
Kweon et al. (2017) [31] | 15 | CMN (Gamma 3 nail) | 0 | 0 |
Massoud (2010) [15] | 13 | Gamma nail or DHS or cancellous screw | 0 | 0 |
Su et al. (2006) [17] | 28 | DHS | 17.9% (5/28) | 17.9% (5/28) |
Chen et al. (2008) [9] | 269 | DHS | 2.2% (6/269) | 2.2% (6/269) |
Kuokkanen (1991) [13] | 6 | DHS | 0 | 0 |
Lee et al. (2018) [14] | 69 | DHS | 17.2% (5/29) | 17.2% (5/29) |
PFNA | 2.5% (1/40) | 2.5% (1/40) | ||
Kim et al. (2020) [12] | 106 | DHS | 12.8% (5/39) | 2.6% (1/39) |
CMN | 7.5% (5/67) | 6.0% (4/67) | ||
Enocson and Lapidus (2012) [11] | 93 | DHS | 16.1% (15/93) | 16.1% (15/93) |
Saarenpää et al. (2002) [6] | 30 | CMN | 0 | 0 |
DHS | 10% (1/10) | 10% (1/10) | ||
CS | 42.9% (3/7) | 42.9% (3/7) | ||
Nauth et al. (2017) [5] | 76 | DHS | Not mentioned | 11.1% (5/45) |
CS | 16.1% (5/31) | |||
Sharma et al. (2018) [21] | 90 | CS | 17.2% (5/29) | Not mentioned |
DHS | 3.7% (1/27) | |||
PFN | 3.1% (1/32) |
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Kim, J.-W.; Park, J.-W.; Kim, H.-J.; Kim, T.-Y.; Yoo, J.-I.; Lee, Y.-K.; Jang, B.-W. Comparison of the Surgical Outcome between the Multiple Screw Fixation and Fixed Angle Devices for the Basicervical Femoral Neck Fractures. Medicina 2024, 60, 680. https://doi.org/10.3390/medicina60050680
Kim J-W, Park J-W, Kim H-J, Kim T-Y, Yoo J-I, Lee Y-K, Jang B-W. Comparison of the Surgical Outcome between the Multiple Screw Fixation and Fixed Angle Devices for the Basicervical Femoral Neck Fractures. Medicina. 2024; 60(5):680. https://doi.org/10.3390/medicina60050680
Chicago/Turabian StyleKim, Jin-Woo, Jung-Wee Park, Hyo-Jung Kim, Tae-Young Kim, Jun-Il Yoo, Young-Kyun Lee, and Byung-Woong Jang. 2024. "Comparison of the Surgical Outcome between the Multiple Screw Fixation and Fixed Angle Devices for the Basicervical Femoral Neck Fractures" Medicina 60, no. 5: 680. https://doi.org/10.3390/medicina60050680