Feature Article
The Effect of Configuration of Rhombic Cannulated Screws on Internal Fixation of Femoral Neck Fractures
Abstract
Femoral neck fractures are commonly encountered clinical problems, especially in patients with osteoporosis, and have high morbidity and mortality. Internal fixation of femoral neck fractures using 3 cannulated screws placed in an inverse triangle configuration is commonly performed. Recently, the use of 4 cannulated screws in a rhombic configuration has been proposed. The aim of this study was to investigate the outcomes of femoral neck fractures treated using either an inverse triangle or rhombic configuration to determine which had a better clinical prognosis. A total of 138 consecutive patients without any previous hip surgery who had femoral neck fractures treated with cannulated compression screws in either an inverse triangle or rhombic configuration were reviewed. Patients' demographic and radiological data were collected from the authors' institutional database. The authors found that the rhombic configuration did not have a better result in decreasing complications, such as femoral neck shortening or screw exit, or in Harris Hip Scores and other clinical prognoses compared with the inverse triangle configuration. In addition, the technique used for applying 4 screws (especially the posterior ones) needs to be improved, so until then, using 3 screws in an inverse triangle configuration remains the gold standard for the treatment of femoral neck fractures. [Orthopedics. 2020; 43(2):e72–e78.]
- 1.Broderick JM, Bruce-Brand R, Stanley E, Mulhall KJ. Osteoporotic hip fractures: the burden of fixation failure. Scientific World Journal. 2013; 2013:515197. https://doi.org/10.1155/2013/515197 PMID:
10.1155/2013/515197 23476139 Crossref Medline, Google Scholar - 2.Wilk R, Skrzypek M, Kowalska M, Standardized incidence and trend of osteoporotic hip fracture in Polish women and men: a nine year observation. Maturitas. 2014; 77(1):59–63. https://doi.org/10.1016/j.maturitas.2013.09.004 PMID:
10.1016/j.maturitas.2013.09.004 Crossref Medline, Google Scholar - 3.Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002; 399:110–118. https://doi.org/10.1097/00003086-200206000-00013 PMID:
10.1097/00003086-200206000-00013 Crossref, Google Scholar - 4.Miller BJ, Lu X, Cram P. The trends in treatment of femoral neck fractures in the Medicare population from 1991 to 2008. J Bone Joint Surg Am. 2013;18; 95:e132.
10.2106/JBJS.L.01163 24048563 Crossref Medline, Google Scholar - 5.Parker MJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2009; 91(2):490–491. PMID:
19182004 Medline, Google Scholar - 6.Filipov O, Gueorguiev B. Unique stability of femoral neck fractures treated with the novel biplane double-supported screw fixation method: a biomechanical cadaver study. Injury. 2015; 46(2):218–226. https://doi.org/10.1016/j.injury.2014.11.013 PMID:
10.1016/j.injury.2014.11.013 Crossref Medline, Google Scholar - 7.Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am. 2004; 86(8):1711–1716. https://doi.org/10.2106/00004623-200408000-00015 PMID:
10.2106/00004623-200408000-00015 15292419 Crossref Medline, Google Scholar - 8.Kauffman JI, Simon JA, Kummer FJ, Pearlman CJ, Zuckerman JD, Koval KJ. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study. J Orthop Trauma. 1999; 13(3):155–159. https://doi.org/10.1097/00005131-199903000-00001 PMID:
10.1097/00005131-199903000-00001 10206245 Crossref Medline, Google Scholar - 9.Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment. J Bone Joint Surg Br. 2005; 87(4):523–529. https://doi.org/10.1302/0301-620X.87B4.15764 PMID:
10.1302/0301-620X.87B4.15764 15795204 Crossref Medline, Google Scholar - 10.Yih-Shiunn L, Chien-Rae H, Wen-Yun L. Surgical treatment of undisplaced femoral neck fractures in the elderly. Int Orthop. 2007; 31(5):677–682. https://doi.org/10.1007/s00264-006-0243-3 PMID:
10.1007/s00264-006-0243-3 Crossref Medline, Google Scholar - 11.Boraiah S, Paul O, Hammoud S, Gardner MJ, Helfet DL, Lorich DG. Predictable healing of femoral neck fractures treated with intra-operative compression and length-stable implants. J Trauma. 2010; 69(1):142–147. https://doi.org/10.1097/TA.0b013e3181bba236 PMID:
10.1097/TA.0b013e3181bba236 Crossref Medline, Google Scholar - 12.Zlowodzki M, Jönsson A, Paulke R, Kregor PJ, Bhandari M. Shortening after femoral neck fracture fixation: is there a solution?Clin Orthop Relat Res.2007; 461 (461):213–218. https://doi.org/10.1097/BLO.0b013e31805b7ec4 PMID:
17415006 Crossref Medline, Google Scholar - 13.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. https://doi.org/10.2106/00004623-196951040-00012 PMID:
10.2106/00004623-196951040-00012 5783851 Crossref Medline, Google Scholar - 14.Marchetti P, Binazzi R, Vaccari V, Long-term results with cementless Fitek (or Fitmore) cups. J Arthroplasty. 2005; 20(6):730–737. https://doi.org/10.1016/j.arth.2004.11.019 PMID:
10.1016/j.arth.2004.11.019 16139709 Crossref Medline, Google Scholar - 15.Satish BR, Ranganadham AV, Ramalingam K, Tripathy SK. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients. Indian J Orthop.2013; 47(2):174–181.
10.4103/0019-5413.108912 23682180 Crossref Medline, Google Scholar - 16.Filipov O, Stoffel K, Gueorguiev B, Sommer C. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg. 2017; 137(6):779–788. https://doi.org/10.1007/s00402-017-2689-8 PMID:
10.1007/s00402-017-2689-8 28391429 Crossref Medline, Google Scholar - 17.Hoskinson S, Morison Z, Shahrokhi S, Schemitsch EH. Managing AVN following internal fixation: treatment options and clinical results. Injury. 2015; 46(3):497–506. https://doi.org/10.1016/j.injury.2014.11.016 PMID:
10.1016/j.injury.2014.11.016 Crossref Medline, Google Scholar - 18.Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury. 2015; 46(3):445–452. https://doi.org/10.1016/j.injury.2014.12.031 PMID:
10.1016/j.injury.2014.12.031 25597514 Crossref Medline, Google Scholar - 19.Schwartsmann CR, Lammerhirt HM, Spinelli LF, Ungaretti Neto ADS. Treatment of displaced femoral neck fractures in young patients with DHS and its association to osteonecrosis. Rev Bras Ortop. 2017; 53(1):82–87. https://doi.org/10.1016/j.rboe.2017.03.003 PMID:
10.1016/j.rbo.2017.01.007 Crossref Medline, Google Scholar - 20.Nakanishi Y, Hiranaka T, Shirahama M, Ideal screw positions for multiple screw fixation in femoral neck fractures: study of proximal femur morphology in a Japanese population. J Orthop Sci. 2018; 23(3):521–524. https://doi.org/10.1016/j.jos.2018.01.012 PMID:
10.1016/j.jos.2018.01.012 29459082 Crossref Medline, Google Scholar - 21.Schwartsmann CR, Jacobus LS, Spinelli LF, Dynamic hip screw for the treatment of femoral neck fractures: a prospective study with 96 patients. ISRN Orthop. 2014; 2014:257871. https://doi.org/10.1155/2014/257871 PMID:
10.1155/2014/257871 24967124 Crossref Medline, Google Scholar - 22.Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of the femur: a prospective review. J Bone Joint Surg Br. 1976; 58(1):2–24. https://doi.org/10.1302/0301-620X.58B1.1270491 PMID:
10.1302/0301-620X.58B1.1270491 1270491 Crossref Medline, Google Scholar - 23.Lewis PM, Waddell JP. When is the ideal time to operate on a patient with a fracture of the hip? A review of the available literature. Bone Joint J. 2016; 98-B(12):1573–1581. https://doi.org/10.1302/0301-620X.98B12.BJJ-2016-0362.R2 PMID:
10.1302/0301-620X.98B12.BJJ-2016-0362.R2 27909117 Crossref Medline, Google Scholar - 24.Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality: relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984;(186):45–56. PMID:
6723159 Medline, Google Scholar - 25.Razik F, Alexopoulos AS, El-Osta B, Time to internal fixation of femoral neck fractures in patients under sixty years: does this matter in the development of osteonecrosis of femoral head?Int Orthop.2012; 36(10):2127–2132. https://doi.org/10.1007/s00264-012-1619-1 PMID:
10.1007/s00264-012-1619-1 22829122 Crossref Medline, Google Scholar - 26.Guo J, Dong W, Yin B, Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures. J Int Med Res. 2019; 47(2):557–568.
10.1177/0300060518816185 Crossref Medline, Google Scholar
