Surgical Fixation with Cannulated Screws in the Adult Femoral Neck Fractures

Year 2023, Volume: 5 Issue: 1, 96 - 102, 15.01.2023

İsmail Güzel , Oktay Belhan , Tarık Altunkılıç

https://doi.org/10.37990/medr.1174776

Abstract

Aim: Femoral neck fractures are common injuries in orthopedic practice and result in significant morbidity and mortality. They are fractures in the intra-capsule area of the proximal femur. They usually occur in the elderly patient group. However, younger age groups could also experience femoral neck fractures as a result of high-energy traumas. The aim of the present study was to compare with the literature the outcomes in adult patients for whom surgical fixation was performed after femoral neck fracture using cannulated screws in our clinic.
Materials and Methods: The study included patients for whom surgical fixation was performed for femoral neck fractures using cannulated screws between August 2010 and August 2012. Fracture non-union, delayed union, avascular necrosis and arthrosis were evaluated in patients. Avascular necrosis evaluation was performed using Ficat and Arlet classification. Functional outcomes were evaluated using Harris hip score.
Results: The average follow-up period of our patients was 32 months (range: 24-48 months). Follow-ups indicated that 16 patients recovered without problems, walked with a double wand starting from about the third month with respect to the bone union status and full union was achieved in an average of six months. Non-union was observed in four patients. Ficat and Arlet avascular necrosis classification showed that four patients had avascular necrosis. The average time for these patients to be admitted to surgery was seven days. Five of our patients developed superficial wound infections. Antibiotic treatment and wound care were applied to our patients. When the patients were evaluated based on Harris hip score numerical rating chart, it was found that excellent outcomes were obtained in five patients, very good results in eight patients, good results in four patients, moderate results in two patients and poor results in one patient.
Conclusion: Femoral neck fractures are a common type of injury in orthopedic practice and they result in significant morbidity and mortality when treated inappropriately. In order to reduce the rate of bone non-union, avascular necrosis or other complications that could be observed in patients who underwent surgical fixation after femoral neck fractures, and appropriate and acceptable reduction of femoral neck fracture should be realized as soon as possible, and stable fixation should be achieved.

Keywords

Femoral neck fractures, internal fixation, Garden classification, ficat- arlet classification, Harris hip score

References

• 1. Caviglia HA, Osorio PQ, Comando D. Classification and diagnosis of intracapsular fractures of the proximal femur. CORR. 2002; 399:17-27.
• 2. Yaradılmış YU, Okkaoğlu MC, Huri P, et al. Correlation between instability and fracture location in femur neck fracture: Biomechanical analysis. ETD. 2020;59:160-4.
• 3. Leighton RK. Fractures of the neck of the femur. Bucholz RW, Heckman JD, Court-Brown CM (Editors). Rockwood & Green’s Fractures in Adults. Chapter 44, 8th ed. Philadelphia: Lippincott Williams & Wilkins. 2015:1754-91.
• 4. Öner K, Paksoy AE, Özer A. Fixation of femoral neck fractures with three cannulated screws: biomechanical changes at critical fracture angles. JOSAM. 2020;4:660-3.
• 5. Alolabi B, Bajammal S, Shirali J, et al. Treatment of displaced femoral neck fractures in the elderly: a cost-benefit analysis. JOT. 2009;23:442-6.
• 6. Jain AK. Surgical Treatment of Orthopaedic Trauma: A Comprehensive Text and Video Guide. Indian J Orthop. 2018;52:539-561.
• 7. Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH) and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. ACR. 2011;63-11:200-7.
• 8. Edwards PK, Queen RM, Butler RJ, et al. Are Range of Motion Measurements Needed When Calculating the Harris Hip Score? J Arthroplasty. 2016;31:815-9.
• 9. Gurusamy K, Parker MJ, Rowlands TK. The complications of displaced intracapsular fractures of the hip: the effect of screw positioning and angulation on fracture healing. J Bone Joint Surg Br. 2005;87:632-4.
• 10. Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015;46:484-91.
• 11. Ozturkmen Y, Karamehmetoglu M, Azboy İ, Acikgoz İ, Canikoglu M. Comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation for displaced femoral neck fractures in elderly patients. AOTT. 2006;40:291-300.
• 12. Han Z, Taxi W, Jia H, et al. Multiple cannulated screw fixation of femoral neck fractures with comminution in young- and middle-aged patients. JOSR. 2022;18:280.
• 13. Karslı B, Gönder N. Displaced Femoral Neck Fractures: Anatomic Reduction or Early Surgery?. Eur J Ther. 2021;27: 1-7.
• 14. Wazir NN, Mukundala VV, Choon DS. Early results of prosthetic hip replacement for femoral neck fracture in active elderly patients. J Orthop Surg. 2006;14:43-6.
• 15. Lavelle DG. Fractures and dislocations of the hip. Canale ST (Editor) Campbell’s Operative Orthopaedics. Chapter 52, 10th ed. Philadelphia: Mosby Inc. 2003:2908-22.
• 16. Lee KB, Howe TS, Chang HC. Cancellous screw fixation for femoral neck fractures: one hundred and sixteen patients. Ann Acad Med Singap. 2004;33:248-51.
• 17. Petersen MB, Jørgensen HL, Hansen K, Duus BR. Factors affecting postoperative mortality of patients with displaced femoral neck fracture. Injury. 2006;37:705-11.
• 18. Kınık H, Polat O, Mergen E. Femoral neck fractures treated with cannulated screw. AOTT. 2006;33:13-17.
• 19. Rogmark C, Carlsson A, Johnell O, Sernbo I. Primary hemiarthroplasty in old patients with displaced femoral neck fracture: a 1-year follow-up of 103 patients aged 80 years or more. Acta Orthop Scand. 2002;73:605-10.
• 20. Grosso MJ, Danoff JR, Murtaugh TS, et al. Hemiarthroplasty for displaced femoral neck fractures in the elderly has a low conversion rate. J Arth. 2017;32:150-4.
• 21. Kumar S, Geevarughese NM, Rajnish RK, et al. Outcomes of displaced, comminuted, intracapsular neck femur fracture in young adults managed with three screw inverted triangle versus four screw diamond configuration: a comparative pilot study. Indian J Orthop. 2021;56:566-72.
• 22. Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of Pediatric Femoral Neck Fracture. JAAOS. 2018;26:411-9.