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Cannulated screws fixation is usually the method of choice for NOF fracture specially in younger patients
Keywords:
Outcome, cannulated hip screws fixation, nondisplaced femur neck fracturesAbstract
ABSTRACT
Objective: To determine the radiological outcome of cannulated hip screws fixation in nondisplaced femoral neck fractures.
Methods: This is a cross sectional study conducted between March 2011 to March 2016 at Orthopedic Surgery Department, Liaquat National Hospital, Karachi. Total 251 patients with nondisplaced femur neck fracture with Garden variety classification type I & II were indulged. All patients underwent cannulated screws fixation. Post-operative hip radiographs and MRI were analyzed for non-union and avascular necrosis. Calculation of descriptive statistics performed. Chi-square test was applied.
Results: Study comprises 106 males and 56 females. Mean age was 37.98±8.02 years. Mean span of fracture 3.64±1.59 days. Mean hospital stay was 8.49±0.87 days. Nonunion was observed in 12.4% patients and avascular necrosis was observed in 6.0% cases. Significant association of non-union was observed with age and duration of fracture. While avascular necrosis was observed with hospital stay.
Conclusion: Neck of femur fracture fixation through cannulated hip screws remains a valid option with postoperative complications less than 15%.
References
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2. Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures no problems? a consecutive study of 224 patients treated with internal fixation. Injury. Mar:2009;40(3):274-6.
3. Kaplan T, Akesen B, Demirag B, Bilgen S, Durak K. Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures. Ulus Travma Acil Cerrahi Derg. 2012 Jan;18(1):65-70.
4. Yih-Shiunn L, Chien-Rae H, Wen-Yun L. Surgical treatment of nondisplaced femoral neck fractures in the elderly. Int Orthop. 2007 Oct;31(5):677-82.
5. Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlström O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. ActaOrthop Scand. 2000 Dec;71:597–602.
6. Selvan VT, Oakley MJ, Rangan A, Al-Lami MK. Optimum configuration of cannulated hip screws for the fixation of intracapsularhip fractures: a biomechanical study. Injury. 2004 Feb;35:136–41.
7. Rupprecht M, Grossterlinden L, Ruecker AH, de Oliveira AN, Sellenschloh K, Nüchtern J, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. J Trauma. 2011 Sep;71(3):625-34.
8. Swiontkowski MF. Intracapsular fractures of the hip. J Bone Joint Surg Am. 1994 Jan;76(1):129-38.
9. Liporace F, Gaines R, Collinge C, Haidukewych GJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008 Aug;90(8):1654–59.
10. Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults: A meta-analysis of 18 published studies involving 564 fractures. Injury. 2005 Jan;36(1):131–41.
11. Crock HV. An atlas of the arterial supply of the head and neck of the femur in man. Clin Orthop. 1990 Oct;152:17–27.
12. Nikolopoulos KE, Papadakis SA, Kateros KT, Themistocleous GS, Vlamis JA, Papagelopoulos PJ, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury. 2003 Jul;34(7):525–528.
13. Koval KJ, Zuckerman JD. Hip fractures: I. Overview and evaluation and treatment of femoral-neck fractures. J Am Acad Orthop Surg. 1994 May;2(3):141–49.
14. Bout CA, Cannegieter DM, Juttmann JW. Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle. Injury. 1997 Mar;28(2):135–39.
15. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. Instr Course Lect. 2009;58:69–81.
16. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002 Jun;399:110–18.
17. Cserhati P, Kazar G, Manninger J, Fekete K, Frenyo S. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury. 1996 Oct;27:583–88.
18. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchi 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 Aug;86:1711–16.
19. Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures – no problems? A consecutive study of 224 patients treated with internal fixation. Injury. 2009 Mar;40:274–76.
20. Angelini M, McKee MD, Waddell JP, Haidukewych G, Schemitsch EH. Salvage of failed hip fracture fixation. J Orthop Trauma. 2009 Jul;23:472–78.
21. Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, Obremskey W, Koval KJ. Et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003 Sep;85:1673–81
22. Bosch U, Schreiber T, Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res. 2002 Jun;399:59–71.
23. Khoo CC, Haseeb A, Singh VA. Cannulated screw fixation for femoral neck fractures: A 5-year experience in a single institution. Malaysian orthopaedic journal. 2014 Jul;8(2):14.
24. Graham J. Early or delayed weight-bearing after internal fixation of transcervical fracture of the femur. A clinical trial. J Bone Joint Surg Br. 1968 Aug;50:562–69.
25. Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of the femur. A prospective review. J Bone Joint Surg Br. 1976 Feb;58:2–24.
26. Loizou, C.L, Parker. M.J. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients Injury. Int. J. Care Injured. 2009 Nov;40:1143–46.
27. Shih CH, Wang KC. Femoral neck fractures. 121 cases treated by Knowles pinning. Clin Orthop Relat Res. 1991 Oct;271:195–200.
28. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early & delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg. 2002 Sep;84:1605–12.
29. Manninger J, Kazar G, Fekete G, Fekete K, Frenyo S, Gyarfas F. et al. Significance of urgent (within 6 hrs) internal fixation in the management of fractures of the neck of the femur. Injury. 1989 Mar;2:101–105
30. Trueta J, Harrison MHM. The normal vascular anatomy of the femoral head in adult man. Bone Joint Surg Br. 1953 Aug;35:442–61.
31. Sevitt S, Thompson G. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br. 1965 Aug;47:560–73
32. Alho A, Benterud JG, Muller C, Husby T. Prediction of fixation failure in femoral neck fractures. Comminution and avascularity studied in 40 patients. Acta Orthop Scand. 1993 Aug;64:408–10.
33. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck: results of cannulated screw fixation. J Bone Joint Surg Am. 1994 Dec;76:1793–03.
34. Tooke MT, Favero KJ. Femoral neck fractures in skeletally mature patient, fifty years old or less. J Bone Joint Surg Am. 1985 Oct;67:1255–60
35. Protzman RR, Burkhalter WE. Femoral neck fractures in young adults. J Bone Joint Surg. Am. 1976 Jul;58:689–95.
2. Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures no problems? a consecutive study of 224 patients treated with internal fixation. Injury. Mar:2009;40(3):274-6.
3. Kaplan T, Akesen B, Demirag B, Bilgen S, Durak K. Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures. Ulus Travma Acil Cerrahi Derg. 2012 Jan;18(1):65-70.
4. Yih-Shiunn L, Chien-Rae H, Wen-Yun L. Surgical treatment of nondisplaced femoral neck fractures in the elderly. Int Orthop. 2007 Oct;31(5):677-82.
5. Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlström O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. ActaOrthop Scand. 2000 Dec;71:597–602.
6. Selvan VT, Oakley MJ, Rangan A, Al-Lami MK. Optimum configuration of cannulated hip screws for the fixation of intracapsularhip fractures: a biomechanical study. Injury. 2004 Feb;35:136–41.
7. Rupprecht M, Grossterlinden L, Ruecker AH, de Oliveira AN, Sellenschloh K, Nüchtern J, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. J Trauma. 2011 Sep;71(3):625-34.
8. Swiontkowski MF. Intracapsular fractures of the hip. J Bone Joint Surg Am. 1994 Jan;76(1):129-38.
9. Liporace F, Gaines R, Collinge C, Haidukewych GJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008 Aug;90(8):1654–59.
10. Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults: A meta-analysis of 18 published studies involving 564 fractures. Injury. 2005 Jan;36(1):131–41.
11. Crock HV. An atlas of the arterial supply of the head and neck of the femur in man. Clin Orthop. 1990 Oct;152:17–27.
12. Nikolopoulos KE, Papadakis SA, Kateros KT, Themistocleous GS, Vlamis JA, Papagelopoulos PJ, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury. 2003 Jul;34(7):525–528.
13. Koval KJ, Zuckerman JD. Hip fractures: I. Overview and evaluation and treatment of femoral-neck fractures. J Am Acad Orthop Surg. 1994 May;2(3):141–49.
14. Bout CA, Cannegieter DM, Juttmann JW. Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle. Injury. 1997 Mar;28(2):135–39.
15. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. Instr Course Lect. 2009;58:69–81.
16. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002 Jun;399:110–18.
17. Cserhati P, Kazar G, Manninger J, Fekete K, Frenyo S. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury. 1996 Oct;27:583–88.
18. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchi 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 Aug;86:1711–16.
19. Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures – no problems? A consecutive study of 224 patients treated with internal fixation. Injury. 2009 Mar;40:274–76.
20. Angelini M, McKee MD, Waddell JP, Haidukewych G, Schemitsch EH. Salvage of failed hip fracture fixation. J Orthop Trauma. 2009 Jul;23:472–78.
21. Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, Obremskey W, Koval KJ. Et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003 Sep;85:1673–81
22. Bosch U, Schreiber T, Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res. 2002 Jun;399:59–71.
23. Khoo CC, Haseeb A, Singh VA. Cannulated screw fixation for femoral neck fractures: A 5-year experience in a single institution. Malaysian orthopaedic journal. 2014 Jul;8(2):14.
24. Graham J. Early or delayed weight-bearing after internal fixation of transcervical fracture of the femur. A clinical trial. J Bone Joint Surg Br. 1968 Aug;50:562–69.
25. Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of the femur. A prospective review. J Bone Joint Surg Br. 1976 Feb;58:2–24.
26. Loizou, C.L, Parker. M.J. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients Injury. Int. J. Care Injured. 2009 Nov;40:1143–46.
27. Shih CH, Wang KC. Femoral neck fractures. 121 cases treated by Knowles pinning. Clin Orthop Relat Res. 1991 Oct;271:195–200.
28. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early & delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg. 2002 Sep;84:1605–12.
29. Manninger J, Kazar G, Fekete G, Fekete K, Frenyo S, Gyarfas F. et al. Significance of urgent (within 6 hrs) internal fixation in the management of fractures of the neck of the femur. Injury. 1989 Mar;2:101–105
30. Trueta J, Harrison MHM. The normal vascular anatomy of the femoral head in adult man. Bone Joint Surg Br. 1953 Aug;35:442–61.
31. Sevitt S, Thompson G. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br. 1965 Aug;47:560–73
32. Alho A, Benterud JG, Muller C, Husby T. Prediction of fixation failure in femoral neck fractures. Comminution and avascularity studied in 40 patients. Acta Orthop Scand. 1993 Aug;64:408–10.
33. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck: results of cannulated screw fixation. J Bone Joint Surg Am. 1994 Dec;76:1793–03.
34. Tooke MT, Favero KJ. Femoral neck fractures in skeletally mature patient, fifty years old or less. J Bone Joint Surg Am. 1985 Oct;67:1255–60
35. Protzman RR, Burkhalter WE. Femoral neck fractures in young adults. J Bone Joint Surg. Am. 1976 Jul;58:689–95.
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2018-02-16
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Cannulated screws fixation is usually the method of choice for NOF fracture specially in younger patients. (2018). Journal of Pakistan Orthopaedic Association, 29(04), 157-162. https://jpoa.org.pk/index.php/upload/article/view/42
