Department of Traumatology, Zuyderland Medisch Centrum, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
Department of Orthopaedics, Zuyderland Medisch Centrum, Heerlen, The Netherlands.
Arch Orthop Trauma Surg. 2022 Dec;142(12):3755-3763. doi: 10.1007/s00402-021-04216-0. Epub 2021 Nov 3.
Closed reduction and internal fixation (CRIF) is the preferred treatment to retain the native joint and maintain optimal functionality in femoral neck fractures. Sliding hip screw (SHS) and cannulated hip screws (CHS) are established CRIF options. SHS offer high biomechanical stability, whereas CHS are minimally invasive. These established systems have a 17-21% failure rate. The Femoral neck system (FNS) was recently developed to combine the advantages of both predecessors. The aim of this study was to describe the first clinical experience with this novel implant with special emphasis on the safety and efficacy.
During a 1-year period all patients in our level-2 trauma centre with a FNF indicated for CRIF were treated using the FNS and evaluated at 2, 6, 12 weeks, 6 months and 1 year postoperatively using patient and fracture characteristics, surgical notes and radiographic imaging.
Thirty-four patients were included, mean age was 63 years (SD 8), 58.2% was female. Fractures were classified as Pauwels I (n = 10), Pauwels II (n = 15), Pauwels III (n = 9), Garden I (n = 1), Garden II (n = 17), Garden III (n = 12) and Garden IV (n = 4). Eight reoperations were reported after 1-year follow-up; osteosyntheses failed in 6 patients due to avascular necrosis (n = 4) and cut-out (n = 2). In two patients the implant was removed due to inexplicable pain. Age (< 65 years) was related to lower risk for failure. There was a trend for females having more failures.
This study indicates that the FNS is a potential safe and effective CRIF modality. Age (< 65 years) is an important factor to keep in mind when selecting patients for CRIF as it is related to lower risk for failure. Future long-term follow-up studies with larger populations should indicate if functional results and risk factors for failure are comparable to SHS or CHS.
闭合复位内固定（CRIF）是保留原生关节并维持股骨颈骨折最佳功能的首选治疗方法。滑动髋螺钉（SHS）和空心髋螺钉（CHS）是既定的 CRIF 选择。SHS 提供了高生物力学稳定性，而 CHS 则具有微创性。这些既定系统的失败率为 17-21%。股骨颈系统（FNS）最近被开发出来，旨在结合前两者的优势。本研究的目的是描述这种新型植入物的首次临床经验，并特别强调其安全性和有效性。
在我们的 2 级创伤中心，在 1 年期间，所有需要 CRIF 的 FNF 患者均采用 FNS 进行治疗，并在术后 2、6、12 周、6 个月和 1 年时通过患者和骨折特征、手术记录和影像学进行评估。
共纳入 34 例患者，平均年龄 63 岁（标准差 8），女性占 58.2%。骨折分类为 Pauwels I 型（n=10）、Pauwels II 型（n=15）、Pauwels III 型（n=9）、Garden I 型（n=1）、Garden II 型（n=17）、Garden III 型（n=12）和 Garden IV 型（n=4）。在 1 年随访后报告了 8 例再次手术；6 例因缺血性坏死（n=4）和穿出（n=2）而导致骨愈合失败。在 2 例患者中，由于无法解释的疼痛而取出了植入物。年龄（<65 岁）与较低的失败风险相关。女性的失败率更高，这是一种趋势。
本研究表明，FNS 是一种潜在的安全有效的 CRIF 方式。年龄（<65 岁）是选择 CRIF 患者时需要考虑的一个重要因素，因为它与较低的失败风险相关。未来需要进行更大人群的长期随访研究，以确定功能结果和失败的危险因素是否与 SHS 或 CHS 相当。
