Calcar buttressed screw fixation for femoral neck fracture

Authors

  • K. K. Arvind Manoj Department of Orthopaedic Surgery, Government Sivagangai Medical College, Sivagangai, Tamil Nadu
  • R. Karthik Department of Orthopaedic Surgery, PSG IMSR, Coimbatore, Tamil Nadu
  • A. Vishnu Sankar Department of Orthopaedic Surgery, Government Thiruvannamalai Medical College, Thiruvannamalai, Tamil Nadu

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20185337

Keywords:

Calcar buttressed screw fixation, Femoral neck fracture, Harris hip score, Biplane double supported screw fixation

Abstract

Background: The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture as far as treatment and results are concerned. There are different views regarding the optimal method of internal fixation in femoral neck fractures. Biomechanical data from literature suggest that calcar fixation is superior to central screws placement. This study aims to analyse the functional and radiological outcome of femoral neck fractures treated by calcar buttressed screw fixation described by Filipov as biplane double supported screw fixation.

Methods: This is a prospective study conducted in our institution from May 2015 to May 2018.The study included 43 patients (31 male, 12 female) with femoral neck fracture. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Patients were followed up for average period of 2 years. Functional outcome was evaluated using Harris Hip score.

Results: Bone union occurred in 40 patients (93%) with average period of 3-4 months. 51.2% of cases had excellent outcome. 23.2% of cases had good and 16.3% of cases had fair outcome. 9.3% of cases ended with poor outcome. Non union was reported in 3 patients (7%) and AVN in one patient. Various factors like age, Garden and Pauwel fracture types, time of presentation and time of surgery were statistically significant to the final functional outcome in our study.

Conclusions: By providing additional calcar buttress compared to conventional method, this technique of screw fixation enhances femoral neck fracture fixation strength and reduces the fixation failure. 

References

Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285-9.

Tidermark J, Ponzer S, Svensson O, Soderqvist A, Tornkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br. 2003;85:380-8

Walker E, Mukherjee DP, Ogden AL, Sadasivan KK, Albright JA. A biomechanical study of simulated femoral neck fracture fixation by cannulated screws: Effects of placement angle and numbers of screws. Am J Orthop. 2007;36:680-4.

Tan V, Wong KL, Born CT, Harten R, DeLong WG Jr. Two-screw femoral neck fracture fixation: A biomechanical analysis of 2 different configurations. Am J Orthop. 2007;36:481-5.

Zdero R, Keast-Butler O, Schemitsch EH. A biomechanical comparison of two triple-screw methods for femoral neck fracture fixation in a synthetic bone model. J Trauma. 2010; 69:1537-44.

Booth KC, Donaldson TK, Dai QG. Femoral neck fracture fixation: A biomechanical study of two cannulated screw placement techniques. Orthopedics. 1999;22:477.

Lindequist S, Tornkvist H. Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma. 1995;9:215–21.

Bout CA, Cannegieter DM, Juttmann JW. Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle. Injury. 1997;28:135–9.

Selvan VT, Oakley MJ, Rangan A, Al-Lami MK. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury. 2004;35:136–41.

Garden R. Low angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–63.

Christie J, Howie CR, Armour PC. Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins. J Bone Joint Surg Br. 1988;70:199–201.

Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am. 1994;76(12):1793-803.

Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994;76(1):15-25.

Tidermark J, Ponzer S, Svensson O, Söderqvist A, Törnkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. J Bone Joint Surg Br. 2003;85-B(3):380-8.

Filipov O. Biplane double supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Traumatol. 2011;21(7):539-43.

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):218–26.

Husby T, Alho A, Nordsletten L, Bugge W. Early loss of fixation of femoral neck fractures. Comparison of three devices in 244 cases. Acta Orthop Scand. 1989;60(1):69–72.

Rehnberg L, Olerud C. Fixation of femoral neck fractures. Comparison of the Uppsala and von Bahr screws. Acta Orthop Scand. 1989;60(5):579–84.

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):779-88.

Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A metaanalysis of 18 published studies involving 564 fractures. Injury. 2005;36(1):131–41.

Loizou CL, Parker MJ. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Injury. 2009;40(11):1143–6.

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;34(7):525–8.

Downloads

Published

2018-12-25

Issue

Section

Original Research Articles