Dynamic hip screws have both dynamic and static tension band functions, making them effective at maintaining angle stability, promoting the anatomical reduction of fractures, and accelerating fracture healing. believed that adding a fourth screw did not provide any biomechanical benefits. demonstrated that the use of quadruple cannulated screws to stabilize femoral neck fractures significantly reduces axial and anterior displacement compared with using three screws. In a biomechanical study of cadavers, Kuffman et al. Thus, to improve the stability of internal fixation and achieve better resistance to vertical shear stress, some researchers have made improvements to the structure and number of cannulated screws. As a result, its ability to resist vertical shear and torsion is poor, potentially leading to the loosening and displacement of the fracture end, femoral head necrosis and nonunion, and femoral neck shortening. However, there is no correlation among the three cannulated screws, and the screw position can be easily influenced by subjective and objective factors related to the surgeon. This method enhances compressive stress between fracture ends during and after the operation, promotes close contact between the fracture ends, and facilitates fracture healing. The triangular distribution constructed in this technique can create a three-dimensional structure with skeleton and bone tissue, reducing stress on the rotation of the femoral head. Among these, triple cannulated screws fixation remains the classic surgical method. Current internal fixation methods include the use of cannulated screws (CS), dynamic hip screws (DHS), and the femoral neck system (FNS). Despite these advantages, the choice of internal fixation remains a challenge in the field of traumatic orthopedics. Furthermore, if internal fixation fails, second-stage revision becomes easier. For younger patients with greater mobility, internal fixation offers the benefits of reduced trauma, preservation of the femoral head, and improved postoperative hip joint activity. Additionally, patients may require one or more revision surgeries for artificial hip joints owing to infection, aseptic loosening, or other factors this eventually increases the financial burden and causes limb damage. However, as time continues to pass after artificial hip replacement, the function of the hip joint gradually diminishes. Arthroplasty is typically preferable to internal fixation for patients aged ≥ 65 years with femoral neck fractures. As the population ages, the number of older patients with this type of injury continues to increase. Furthermore, TAD may serve as a predictive indicator of the potential success of femoral neck fracture treatment.įemoral neck fractures frequently occur in orthopedic clinics and are associated with a high incidence of disability and mortality. The femoral neck system alone or combined with a cannulated screw demonstrated better short-term efficacy in the treatment of femoral neck fractures. Subgroup analysis revealed that when the TAD was less than 25 and 49 mm for the femoral neck system and combined groups, respectively, there was less femoral neck shortening, less change in the neck-shaft angle, and a higher HHS score. At the last follow-up surgery, the combined treatment group achieved the highest HHS score. The femoral neck shortening was also lower in groups with the femoral neck system or combined with a cannulated screw. Differences were observed in the change of neck-shaft angle among the four groups (P < 0.001), with the smallest change observed in the aforementioned group (0.76 ± 0.54°). The group who received treatment with the femoral neck system combined with a cannulated screw exhibited the shortest fracture healing time. ResultsĪll 129 patients were followed up for at least one year. Analysis and comparisons of the four group were performed according to age, ASA score, operation time, blood loss, fracture classification, fracture healing time, Harris score, TAD value, presence of complications (osteonecrosis of the femoral head, screw failure, and femoral neck shortening), and changes in the neck-shaft angle. The patients were categorized into four groups based on the different internal fixation methods. Methodsĭata from 129 young adults with femoral neck fractures followed up at The Second Affiliated Hospital of Fujian Medical University between January 2016 and June 2022 were retrospectively collected. We further investigated the predictive effects of tip-apex distance (TAD) on clinical efficacy. This study aimed to evaluate the clinical efficacy of the femoral neck system alone or in combination with a cannulated screw compared with other internal fixation methods for treating femoral neck fractures.
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