Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of three cannulated screws in a modified triangular transverse configuration for fixation of intra-capsular femoral neck fractures

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Background

Intra-capsular femoral neck fractures (FNF) are commonly encountered in trauma settings and are associated with high rates of morbidity and mortality. One of the most used methods of FNF treatment is the use of multiple cannulated screws. Many different screw constructs are reported in the literature, with no evidence of superiority of one construct over others. We present a series of patients treated by one senior surgeon with three cannulated screws positioned in a specific configuration.

Materials and methods

We conducted a retrospective monocentric analysis. All charts of patients hospitalized between January 2004 and June 2022 for an intra-capsular femoral neck fracture treated by three cannulated screws by the same senior surgeon were retrieved and analyzed. The clinical and radiological evaluations were performed by two independent researchers. Functional status of patients was assessed using the modified Harris Hip score (mHHS). Complications such as secondary displacement, non-union, avascular necrosis (AVN) and femoral neck shortening were all recorded.

Results

A total of 38 patients met the inclusion criteria. There were 17 males and 21 females with an average age of 66.3 ± 13.6 years and a follow-up period of 16 ± 20 months. Bone union was observed in 34 (89.5%) patients. Mild shortening was observed in two patients (5.2%) with no functional limitation. Four patients (10.5%) underwent reoperations, three due to another fall and one due to AVN four years post-fracture fixation.

Conclusion

In our series, we demonstrate that the use of three cannulated screws in a triangular transverse configuration for fixation of intra-capsular femoral neck fractures provides excellent results with low rates of femoral neck shortening, AVN or non-union.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Støen RØ, Nordsletten L, Meyer HE, Frihagen JF, Falch JA, Lofthus CM (2012) Hip fracture incidence is decreasing in the high incidence area of Oslo. Norway Osteoporos Int 23(10):2527–2534

    Article  PubMed  Google Scholar 

  2. Wang W, Wei J, Xu Z et al (2014) Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis. BMC Musculoskelet Disord 15:167

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lein T, Bula P, Jeffries J, Engler K, Bonnaire F (2011) Fractures of the femoral neck. Acta Chir Orthop Traumatol Cech 78:10–19

    Article  CAS  PubMed  Google Scholar 

  4. Barns R, Brown JT, Garden BS, Nicoll EA (1981) Subcapital fracture of the femur. J Bone Joint Surg 63B:357–361

    Google Scholar 

  5. Nauth A, Creek AT, Zellar A, Lawendy AR, Dowrick A, Gupta A, Dadi A, van Kampen A, Yee A, de Vries AC, van Otterloo AD (2017) Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 389(10078):1519–1527

    Article  Google Scholar 

  6. Estrada LS, Volgas DA, Stannard JP, Alonso JE (2002) Fixation failure in femoral neck fractures. Clin Orthop Relat Res 399:110–118

    Article  Google Scholar 

  7. Giordano V, Alves DD, Paes RP, Amaral AB, Giordano M, Belangero W, Freitas A, do Koch HA, Amaral NP (2019) The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws. J Exp Orthop 6(1):1–9

    Article  Google Scholar 

  8. Zhang LL, Zhang Y, Ma X, Liu Y (2017) Multiple cannulated screws vs dynamic hip screws for femoral neck fractures: a meta-analysis. Der Orthopade 46(11):954–962

    Article  PubMed  Google Scholar 

  9. Zlowodzki M, Ayieni O, Petrisor BA, Bhandari M (2008) Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function. J Trauma 64:163–169

    PubMed  Google Scholar 

  10. Li L, Zhao X, Yang X, Tang X, Liu M (2020) Dynamic hip screws versus cannulated screws for femoral neck fractures: a systematic review and meta-analysis. J of Orthop Surg Res 15(1):1–9

    Article  CAS  Google Scholar 

  11. Ly TV, Swiontkowski MF (2008) Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am 90(10):2254–2266

    PubMed  Google Scholar 

  12. Booth KC, Donaldson TK, Dai QG (1998) Femoral neck fracture fixation: a biomechanical study of two cannulated screw placement techniques. Orthopedics 21(11):1173–1176

    Article  CAS  PubMed  Google Scholar 

  13. Li J, Wang M, Zhou J, Han L, Zhang H, Li C, Li L, Hao M (2018) Optimum configuration of cannulated compression screws for the fixation of unstable femoral neck fractures: finite element analysis evaluation. Biomed res int 2018:1271762

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zlowodzki M, Brink O, Switzer J, Wingerter S, Woodall J Jr, Petrisor BA et al (2008) The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Jt Surg 90:1487–1494

    Article  CAS  Google Scholar 

  15. Zhou L, Lin J, Huang A, Gan W, Zhai X, Sun K, Huang S, Li Z (2020) Modified cannulated screw fixation in the treatment of Pauwels type III femoral neck fractures: a biomechanical study. Clin Biomech 1(74):103–110

    Article  Google Scholar 

  16. Jiang D, Zhan S, Wang L, Shi LL, Ling M, Hu H, Jia W (2021) Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res 39(8):1669–1680

    Article  PubMed  Google Scholar 

  17. Kumar P, Sen R, Aggarwal S, Agarwal S, Rajnish RK (2019) Reliability of Modified Harris Hip Score as a tool for outcome evaluation of Total Hip Replacements in Indian population. J Clin Orthop Trauma 10(1):128–130

    Article  PubMed  Google Scholar 

  18. Bartonícek J (2001) Pauwels’ classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 15:358–360

    Article  PubMed  Google Scholar 

  19. Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 43:647–663

    Article  Google Scholar 

  20. Aminian A, Gao F, Fedoriw WW, Zhang LQ, Kalainov DM, Merk BR (2007) Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma 21:544

    Article  PubMed  Google Scholar 

  21. Mont MA, Marulanda GA, Jones LC, Saleh KJ, Gordon N, Hungerford DS, Steinberg ME (2006) Systematic analysis of classification systems for osteonecrosis of the femoral head. J Bone Jt Surg. 88(Supp_3):16–26

    Google Scholar 

  22. Felton J, Slobogean GP, Jackson SS, Della Rocca GJ, Liew S, Haverlag R et al (2019) Femoral neck shortening after hip fracture fixation is associated with inferior hip function: results from the faith trial. J Orthop Trauma 33(10):487–496

    Article  PubMed  Google Scholar 

  23. Slobogean GP, Sprague SA, Scott T, Bhandari M (2015) Complications following young femoral neck fractures. Injury 46:484–491

    Article  CAS  PubMed  Google Scholar 

  24. Kevin L, Michael B, Collinge CA (2014) Preoperative decision making in the treatment of high angle “vertical” femoral neck fractures in young adult patients. An expert opinion survey of the Orthopaedic Trauma Association’s membership. J Orthop Trauma 28:e221–e225

    Article  Google Scholar 

  25. Yih-Shiunn L, Chien-Rae H, Wen-Yun L (2007) Surgical treatment of undisplaced femoral neck fractures in the elderly. Int Orthop 31(5):677–682

    Article  PubMed  Google Scholar 

  26. Xia Y, Zhang W, Zhang Z, Wang J, Yan L (2021) Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis J Orthop Surg Res 16(1):1–1

    Google Scholar 

  27. Kunapuli SC, Schramski MJ, Lee AS et al (2015) Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma 29(3):144–150

    Article  PubMed  Google Scholar 

  28. Haidukewych GJ (2004) Innovations in locking plate technology. J Am Acad Orthop Surg 12(4):205–212

    Article  PubMed  Google Scholar 

  29. Samsami S, Saberi S, Sadighi S, Rouhi G (2015) Comparison of three fixation methods for femoral neck fracture in young adults: experimental and numerical investigations. J Med Biol Eng 35(5):566–579

    Article  PubMed  PubMed Central  Google Scholar 

  30. Berkes MB, Little MTM, Lazaro LE, Cymerman RM, Helfet DL, Lorich DG (2012) Catastrophic failure after open reduction internal fixation of femoral neck fractures with a novel locking plate implant. J Orthop Trauma 26:e170

    Article  PubMed  Google Scholar 

  31. Dong Q, Han Z, Zhang YG, Sun X, Ma XL (2019) Comparison of transverse cancellous lag screw and ordinary cannulated screw fixations in treatment of vertical femoral neck fractures. Orthop Surg 11(4):595–603

    Article  PubMed  PubMed Central  Google Scholar 

  32. Selvan VT, Oakley MJ, Rangan A, Al-Lami MK (2004) Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury 35(2):136–41

    Article  CAS  PubMed  Google Scholar 

  33. Filipov O (2011) Biplane double-supported screw fixation (Ftechnique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Traumatol 21:539–543

    Article  PubMed  PubMed Central  Google Scholar 

  34. Guimarães JA, Rocha LR, Rocha TH, Bonfim DC, da Costa RS, dos Santos CA, Roesler CR, Machado JA, Aguiar DP, Duarte ME (2017) Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw. Injury 1(48):S6–S10

    Google Scholar 

  35. Jiang D, Zhan S, Cai Q, Hu H, Jia W (2021) Long-term differences in clinical prognosis between crossed-and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury 52(11):3408–14

    Article  PubMed  Google Scholar 

  36. Elmerson S, Anderson GB, Pope MH, Zetterberg C (1987) Stability of fixation in femoral neck fractures: comparison of four fixation devices in vivo and in cadavers. Acta Orthop Scand 58:109–112

    Article  CAS  PubMed  Google Scholar 

  37. Garden RS (1961) The structure and function of the proximal end of the femur. J Bone Jt Surg 3:576–589

    Article  Google Scholar 

  38. Parker MJ, Porter KM, Eastwood DM, Schembi Wismayer M, Bernard AA (1991) Intracapsular fractures of the neck of femur Parallel or crossed garden screws? J Bone Jt Surg 73(5):826–827

    Article  CAS  Google Scholar 

  39. Wang SH, Yang JJ, Shen HC, Lin LC, Lee MS, Pan RY (2015) Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients. Injury 46(10):1969–1974

    Article  PubMed  Google Scholar 

  40. Zhang B, Liu J, Zhu Y, Zhang W (2018) A new configuration of cannulated screw fixation in the treatment of vertical femoral neck fractures. Int Orthop 42(8):1949–1955

    Article  PubMed  Google Scholar 

  41. Zlowodzki M, Brink O, Switzer J, Wingerter S, Woodall J Jr, Petrisor BA et al (2008) The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Jt Surg 90(11):1487–1494

    Article  CAS  Google Scholar 

  42. Garden RS (1964) Stability and union in subcapital fractures of the femur. J Bone Jt Surg 46(4):630–647

    Article  CAS  Google Scholar 

  43. Filipov O, Stoffel K, Gueorguiev B, Sommer C (2017) 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 137:779–788

    Article  PubMed  PubMed Central  Google Scholar 

  44. Papanastassiou ID, Mavrogenis AF, Kokkalis ZT, Nikolopoulos K, Skourtas K, Papagelopoulos PJ (2011) Fixation of femoral neck fractures using divergent versus parallel cannulated screws. J Long-term Eff Med Implants 21(1):63–69

    Article  PubMed  Google Scholar 

  45. Probe R, Ward R (2006) Internal fixation of femoral neck fractures. J Am Acad Orthop Surg 14:565–571

    Article  PubMed  Google Scholar 

  46. Hawks MA, Kim H, Strauss JE et al (2013) Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures? A biomechanical analysis in cadaveric bone. Clin Biomech 28(8):886–891

    Article  Google Scholar 

  47. Gumustas SA, Tosun HB, Agir I, Orak MM, Onay T, Okcu G (2014) Influence of number and orientation of screws on stability in the internal fixation of unstable femoral neck fractures. Acta Orthop Traumatol Turc 48(6):673–678

    Article  PubMed  Google Scholar 

  48. Weil Yoram A et al (2012) Femoral neck shortening and varus collapse after navigated fixation of intracapsular femoral neck fractures. J Orthop Trauma 26(1):19–23

    Article  CAS  PubMed  Google Scholar 

  49. Galal S, Nagy M (2017) Non-parallel screw fixation for femoral neck fractures in young adults. J Clin Orthop Trauma 8(3):220–224

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sim CHS, Sultana R, Tay KXK, Howe CY, Howe TS, Koh JSB (2022) SF-36 physical function and general health domains are independent predictors of acute hospital length of stay after hip fracture surgery. Musculoskelet Surg. https://doi.org/10.1007/s12306-022-00753-y

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon

    C. Assi, K. Boulos & K. Yammine

  2. Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Jdeideh, Lebanon

    K. Yammine

Authors
  1. C. Assi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Boulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Yammine
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KY and CA designed the research. All authors contributed to data extraction. KY performed the data analysis. KY, KB and CA and JM wrote and reviewed the article. No funding has been sought.

Corresponding author

Correspondence to K. Yammine.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Assi, C., Boulos, K. & Yammine, K. Outcomes of three cannulated screws in a modified triangular transverse configuration for fixation of intra-capsular femoral neck fractures. Musculoskelet Surg 107, 423–430 (2023). https://doi.org/10.1007/s12306-023-00788-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-023-00788-9

Keywords

Search

Navigation