Fluoroscopy-Based Surgical Navigation versus Fluoroscopic Guidance to Control Guide Wire Insertion for Osteosynthesis of Femoral Neck Fractures

European Journal of Trauma and Emergency Surgery - Long fluoroscopic times and related radiation exposure are a universal concern when C-arm fluoroscopy is used to guide percutaneous procedures....     

Treatment of Displaced Fractures of the Femoral Neck: Smith-Petersen Osteosynthesis versus Sliding-Nail-Plate Osteosynthesis

In a prospectively planned follow-up study 383 cases of displaced medial fractures of the femoral neck were allocated either to Smith-Petersen Osteosynthesis or to sliding-nail-plate Osteosynthesis. Two hundred and forty-nine cases were followed for more than 2 years. The two differently treated groups were alike. The results showed that sliding-nail-plate Osteosynthesis was significantly superior to Smith-Petersen Osteosynthesis. We recommend that Smith-Petersen Osteosynthesis be abandoned.     

Accurate Placement of Cannulated Screws in Femoral Neck Fractures: Screw and Guide Wire Combined Technique

Cannulated screw fixation is widely used in the treatment of femoral neck fractures. During surgery, we often face the situation that a guide wire needs to be adjusted because of poor positioning in the femoral neck. It is difficult to adjust the direction of the guide wire in the neck of the femur due to its elasticity. This study developed a practical technique to adjust the guide wire to the correct position. When the direction of insertion of the guide wire has deviated, first, measure the length of the guide wire. Second, select the appropriate cannulated screw based on the measurement, and screw the cannulated screw in along the direction of the guide wire to Ward''s triangle. Then return the guide wire to the front of the cannulated screw. At this time, the cannulated screw can be used as a built‐in guide, and a screwdriver can be used to fine‐tune the position of the screw to the optimal direction under the X‐ray guidance. Finally, the cannulated screw is screwed in in this direction until it passes through the Ward triangle area, and the guide wire is inserted. This technique can help doctors insert a guide wire more quickly and accurately, reducing intraoperative injury and the operation time.     

Femoral Neck Stress Fractures in South Korean Male Military Recruits

BackgroudFemoral neck stress fractures (FNSFs) are rare but potentially disabling injuries if the diagnosis is missed or delayed and proper treatment is not provided. The aim of this study was to investigate and describe the characteristics and clinical course of FNSFs in South Korean male military recruits.MethodsBetween May 2015 and October 2019, 16 fractures in 12 young male military recruits were reviewed. The characteristics of the fractures were ascertained by detailed analysis of the history and clinical course, as well as radiographs, bone scintigrams, and magnetic resonance images.ResultsThe median duration between endurance training and the development of hip pain was 5 weeks, while the median duration of pain before the patient sought medical attention was 3 weeks. Four patients (33.3%) exhibited bilateral fractures, and concomitant lesions involving the proximal tibia were found in 3 patients (25%). Fourteen of the 16 fractures (87.5%) were compression-type fractures, and surgery was performed for 7 hips. Complete union without malunion or osteonecrosis was achieved in all cases, and all cadets returned to their full activity levels in an average of 10 weeks.ConclusionsWe observed excellent prognosis of FNSFs. Our report highlights the importance of early reporting, detection, and treatment regarding the challenging management of FNSFs. When a military recruit reports hip pain, a FNSF should be considered; furthermore, the bilaterality of the fracture and the presence of concomitant lesions should also be investigated.     

Comparison of Early Clinical Results for Femoral Neck System and Cannulated Screws in the Treatment of Unstable Femoral Neck Fractures

ObjectiveTo compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures.MethodsA retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type‐3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age, and similar body mass index (BMI). A total of 30 pairs were successfully matched at a 1:1 ratio, including 12 males and 18 females. The average age of the patients in the FNS group was 54.53 ± 6.71 years. In the cannulated screw group, the average age of the patients was 53.14 ± 7.19 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analog scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate, and complication rate were compared between the groups.ResultsPostoperative re‐examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10–22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow‐up, and lower complication rates (P < 0.05). VAS scores were lower in the FNS group (3.13 ± 1.07 scores) than in the cannulated screw group (3.77 ± 1.04 scores) (P = 0.018). Patients in the FNS group (5.23 ± 1.33 months) recovered to walking without crutches earlier than did those in the cannulated screw group (6.03 ± 1.45 months) (P<0.001). In addition, a statistically higher postoperative Harris score was detected in the FNS group (86.16 ± 7.26) than in the cannulated screw group (82.37 ± 7.52) (P = 0.039). Overall, a higher incidence of complications was observed in the cannulated screw group (9/30) than in the FNS group (2/30) (P = 0.042). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P < 0.05). Intraoperative blood loss was greater in the FNS group (99.73 ± 4.69) than in the cannulated screw group (30.27 ± 9.04) (P<0.001). In addition, patients in the FNS group (46976 ± 2270 ¥) spent more on hospitalization costs than did those in the cannulated screw group (15626 ± 1732 ¥) (P<0.001). No statistically significant difference in operation time, hospital stay, or femoral head necrosis rate was observed between the two groups (P > 0.05).ConclusionFor patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive.     

同侧股骨干合并股骨颈骨折的手术治疗

目的探讨同侧股骨干合并股骨颈骨折的临床特点及治疗方法。方法选择2000年2月至2006年4月,14例经手术复位内固定治疗的同侧股骨干合并股骨颈骨折患者进行回顾性分析,其中股骨颈骨折漏诊4例,采用股骨重建髓内钉固定4例,股骨逆行交锁髓内钉及空心螺钉固定5例,股骨交锁髓内钉结合空心螺钉固定2例,股骨干骨折加压钢板及空心钉固定3例。结果本组14例均获随防,随访时间为12~48个月,平均27个月。14例股骨干骨折均在术后7个月内获得愈合,股骨颈骨折在6个月内愈合。无切口感染、血管神经损伤、内固定断裂及股骨头缺血性坏死等并发症发生。所有患者髋关节功能的恢复无活动障碍,膝关节活动受限1例。结论同侧股骨干合并股骨颈骨折时股骨颈骨折常常无移位或轻度移位,其漏诊率高,在骨折治疗的微创理念指导下,运用医生熟练掌握的内固定方法,经过合理的术后功能锻炼,可获得满意的临床疗效。     

股骨颈穿针导航器的研制与临床应用

目的研制股骨颈穿针导航器(FPN)并进行临床评价.方法用不锈钢材料制造一种可全方位调节股骨颈颈干角与前倾角的FPN,应用FPN对股骨颈与股骨粗隆部骨折病例施术46例(高龄组16例,导航组30例),与对照组(30例)做对比分析.结果导航组的术中股骨颈穿针次数与平均手术时间明显少于对照组(P=0.002～0.019);导航组与高龄组的股骨颈植钉(针)满意率为100%,明显高于对照组(P＜0.05);高龄组手术安全、快捷,无1例发生手术意外,术后卧床时间短,康复快.结论FPN可在股骨颈内全方位导航,定位准确、穿针成功率高,可缩短手术时间、减少手术创伤、提高手术疗效,适用于股骨颈与股骨粗隆部骨折的多种固定术式,尤其适用于高龄、体弱、合并症多、不宜行传统开放性手术的经皮穿刺多针内固定术.     

股骨颈骨折内固定治疗的探讨

目的：探讨股骨颈骨折4种内固定方法的效果。方法：回顾性分析107例股骨颈骨折。分别采用三翼钉，加压螺钉，多针固定，肌蒂骨瓣移植加固定4种方法，对比骨折愈合率，髋关节功能恢复，股骨头坏死发生率。结果：三翼钉固定21例。加压螺钉固定25例。多针固定35例。带肌蒂骨瓣移植加内固定26例。骨折愈合89例（83.1%)。髋关节功能优良75例（84.2%)。差11例（12.3%)。骨折不愈合18例（16.9%)。股骨头坏死21例（19.5%)。结论：内固定手术对股骨颈骨折有意义。70岁以下的患者均可应用。三翼钉的骨折愈合率低，股骨头坏死发生率高，不宜采用；加压螺钉操作简单，，固定牢固，但股骨头坏死率较高，不宜作为首选方法；多针内固定操作简单，骨折愈合率高，可作首选内固定；肌蒂骨瓣移植加内固定治疗骨折愈合率高。但手术操作复杂，不适合老年患者。     

阶梯形切骨治疗内收型股骨颈骨折的临床研究

报告阶梯形切骨治疗内收型股骨颈骨折的疗效。采用阶梯形切骨结合折断式加压螺纹钉内固定术治疗内收型股骨颈骨折,并与单纯复位、加压螺纹钉固定术进行前瞻性对照研究。经12～28个月的随访,结果:治疗组31例,全部骨性愈合,优良率为90.3％,1例发生股骨头节段性坏死;对照组17例,15例骨性愈合,优良率为70.6％,2例发生股骨头坏死;治疗组总体疗效明显优于对照组(P<0.05),骨折线消失时间明显缩短(P<0.001),肢体短缩、颈干角明显好于对照组(P<0.05)。表明阶梯形切骨将不稳定的内收型骨折转化为稳定的嵌插型骨折,有利于良好对位和维持稳定,促进骨折愈合,降低股骨头坏死率,减少髋内翻畸形的发生。     

双头空心加压螺钉经皮固定治疗股骨颈骨折

目的　探索双头加压螺钉经皮固定治疗股骨颈骨折的临床效果。方法　C形臂X线机透视下 ,手法复位股骨颈骨折后 ,经皮穿置直径 2mm骨圆针 4～ 6根预固定 ,选用股骨颈轴线上下的三枚骨针作为导针 ,引导旋入直径为 5mm双头加压螺纹钉3枚 ,治疗股骨颈骨折 5 7例 ,术后随访 2～ 5年 ,对其临床功能、X线片、CT等作总结分析。结果　功能正常或轻度受限者47例 ,占 86 2 % ,骨折愈合 5 3例 ,占 92 7% ,股骨头坏死 6例 ,占 10 5 %。骨折不愈合并股骨头坏死者 1例 ,术后 3年 2个月 ,仍有良好的功能。结论　空心双头加压螺纹钉经皮固定股骨颈骨折 ,方法简单 ,固定可靠 ,治疗效果好 ,适合治疗各型股骨颈骨折     

股骨干骨折合并同侧股骨颈骨折的漏诊分析与对策

目的 分析同侧股骨干骨折合并股骨颈骨折出现漏诊的原因及治疗。方法 回顾性分析7例同侧股骨干骨折合并股骨颈骨折的治疗方法、结果和漏诊原因。结果 漏诊病例与入院时未重视髋部损伤及X线片未明确显示骨折有关,但经正确治疗后效果满意。结论 提高对股骨干骨折合并同侧股骨颈骨折损伤的注意并行相应的查体及影像学检查可避免股骨颈骨折的漏诊,出现漏诊后如果采取正确及时的治疗仍可得到较满意的效果。     

Osteosynthesis of Displaced Fractures of the Femoral Neck: A Comparison Between Smith-Petersen Osteosynthesis and Sliding-Nail-Plate Osteosynthesis - A Radiological Study

Smith-Petersen osteosynthesis has been compared with sliding-nail-plate osteosynthesis in a prospectively planned, randomized, follow-up study of 197 cases of displaced medial fractures of the femoral neck. A total of 131 patients were followed for more than 2 years. After Smith-Petersen osteosynthesis 66 per cent of the fractures united and after sliding-nail-plate osteosynthesis 77 per cent united. The results showed that the choice of fixation devices is of minor importance compared with exact reduction of the fracture and optimal positioning of the nail.     

股骨颈骨折内固定治疗的选择

对多种内固定治疗股骨颈骨折效果进行评价。105例新鲜股骨颈骨折分别采用三翼钉、滑槽加压螺钉加接骨板以及经皮多钉内固定进行治疗。对手术及住院时间、术中失血量、早期并发症以及骨折不愈合和头坏死发生率进行分析比较。结果显示经皮多钉内固定组的骨折不愈合和头坏死发生率为10％,功能优良率93％;三翼钉和滑槽加压螺钉加接骨板内固定组的骨折不愈合和头坏死发生率分别为35％、31％,功能优良率分别为73％、79％;此外,经皮多钉内定的术中出血、手术时间及住院时间等均少于另外两组。认为经皮多钉内固定治疗股骨颈骨折具有创伤小、疗效好以及安全、简便等优点。     

Osteosynthesis of Displaced Fractures of the Femoral Neck: A Comparison Between Smith-Petersen Osteosynthesis and Sliding-Nail-Plate Osteosynthesis - A Radiological Study

Smith-Petersen osteosynthesis has been compared with sliding-nail-plate osteosynthesis in a prospectively planned, randomized, follow-up study of 197 cases of displaced medial fractures of the femoral neck. A total of 131 patients were followed for more than 2 years. After Smith-Petersen osteosynthesis 66 per cent of the fractures united and after sliding-nail-plate osteosynthesis 77 per cent united. The results showed that the choice of fixation devices is of minor importance compared with exact reduction of the fracture and optimal positioning of the nail.     

植骨内固定术治疗股骨颈骨折

目的　探讨植骨内固定术治疗移位型和陈旧性股骨颈骨折的疗效。方法　本文回顾分析 34例股骨颈骨折 ,采用植骨和内固定术治疗 ,所有病例新鲜骨折平均随访 4 5年 ,陈旧性为 4 9年 ,其中新鲜骨折GardenⅣ型 1 1例 ,陈旧性 2 3例。早期采用三刃钉固定 1 5例和钉板固定 1例 ,空心松质骨螺钉固定 1 5例 ,DHS内固定 2例 ,1例单纯行植骨术。植骨方式采用髂骨松质骨植骨 2 3例 ,带肌蒂植骨 1 1例。结果　骨折愈合率 :新鲜骨折为 1 0 0 % ,陈旧性骨折为 82 6 % ;缺血坏死 1 2例。比较单纯松质骨植骨和带肌蒂骨植骨治疗结果 ,骨愈合率分别为 91 3%和 90 9% ,坏死率分为 2 6 1 %和 5 4 5 %。结论　正确认识股骨颈骨折的创伤病理特点 ,稳定的内固定和植骨术可提高骨折愈合率 ,单纯松质骨植骨发生股骨头坏死明显低于带肌蒂植骨     

闭合复位、空心加压螺钉治疗新鲜股骨颈骨折疗效分析

目的　将使用闭合复位、空心加压螺钉治疗新鲜股骨颈骨折的 15 5例病人资料采用回顾性方法进行研究 ,从中分析本治疗方法的骨折愈合率和股骨头坏死等方面的情况。方法　对骨折类型、伤后何时手术、年龄、性别、下地时间、空心钉种类和数量、取钉后情况各方面因素与骨折不愈合、股骨头缺血性坏死发生率关系列表分析。结果　平均随访 3年 4个月。本组 15 5例骨折病人愈合率 93 5 %。股骨头缺血性坏死发生率为 7 4 %。该方法的总体治愈率为 87 1%。结论　闭合复位、空心加压螺钉治疗新鲜股骨颈骨折疗效可靠 ,有较高的骨折愈合率 ,是可以提倡的治疗方法。高龄病人 (6 0岁以上 )身体条件好 ,首先可考虑Ⅰ期行内固定治疗。严重骨折类型会影响预后。对新鲜股骨颈骨折的治疗原则是早期手术、良好复位、有效固定。控制好老年内科并发症 ,会使总体治愈率再一步提高     

带臀中肌蒂骨移植加内固定治疗股骨颈骨折

应用带臀中肌蒂骨移植加加压螺纹钉内固定治疗不稳定型股骨颈骨折.通过对31例5年以上的随访,骨折愈合率达96.8%,优良率达92.9%.切除该肌骨瓣不影响臀中肌功能,骨块用七号丝线固定.对采用Watson—Jones氏切口行切开整复的不稳定型股骨颈骨折,本法可首选.