Department of Orthopaedics, P.G.I Swasthiyog Pratishthan, Miraj, Maharashtra, India.
Department of Orthopaedics, P.G.I Swasthiyog Pratishthan, Miraj, Maharashtra, India.
Injury. 2024 Jun;55 Suppl 2:111594. doi: 10.1016/j.injury.2024.111594. Epub 2024 Aug 2.
Intra capsular fracture of the neck of femur (FNF) treated traditionally with a dynamic hip screw (DHS) or three cancellous screws (3CS) has a high incidence of complications with reoperation rates between 20 % and 45 %. We hypothesized that FNF unites by primary healing. Therefore, intra-operative compression and absolute stability post-operatively until healing are essential. We postulated that FNF requires 2 types of implants- those which provide absolute stability for young patients with good bone stock and another with sliding mechanism for elderly patients with osteoporosis. We developed three novel fixation systems at our research institute in India using a modified DHS. In patients with good bone stock, locking DHS, called LHS and GSK triangular system (GSKT) provided intra-operative compression and absolute stability during the post-operative period. In those with poor bone stock, the controlled sliding DHS (CSDHS)was used as a locking implant might penetrate the hip joint.
42 patients of FNF <55 years of age were studied. Among 39 patients with good bone stock, LHS was used in five patients and GSKT system was used in 34 patients. CSDHS was used in three patients with poor bone stock or communition. The patients were followed up for a minimum of eight months up to a maximum of two years, with the average follow up duration of 14 months.
32 out of 34 fractures treated by GSKT system united. Five cases managed by LHS and three by CSDHS, all united. The union rate was 95.2 %. Of the two failed cases, one patient had nonunion (NU), the other had deep infection. Avascular necrosis of the head (AVN) was detected in three patients treated with GSKT system in the second year following surgery. Two of them had hip pain while one was asymptomatic. Eight cases of FNF Pauwels type III underwent a primary valgus osteotomy. All of them united without complications.
In patients with good bone stock, LHS and GSKT system allowed intra-operative compression and absolute post-operative stability without sliding of head fragment as the triangle construct is biomechanically the strongest. When bones are osteoporotic, a CSDHS provided controlled sliding (1 to 5 mm only). This pilot study showed a promising success rate of 95.2 %. We propose that the GSKT system may be used to treat intertrochanteric and other metaphyseal fractures as well. Further biomechanical studies are underway to strenghten the evidence needed for the widespread use of these implants.
传统上采用动力髋螺钉（DHS）或 3 枚松质骨螺钉（3CS）治疗股骨颈囊内骨折（FNF），其并发症发生率较高，再手术率为 20%至 45%。我们假设 FNF 通过一期愈合。因此，术中加压和术后直至愈合的绝对稳定性至关重要。我们假设 FNF 需要 2 种植入物-一种为骨量良好的年轻患者提供绝对稳定性，另一种为骨质疏松的老年患者提供带滑动机制的植入物。我们在印度的研究所使用改良 DHS 开发了三种新型固定系统。对于骨量良好的患者，称为 LHS 的锁定 DHS 和 GSK 三角系统（GSKT）在术后期间提供术中加压和绝对稳定性。对于骨量差的患者，使用可控滑动 DHS（CSDHS）作为锁定植入物，因为它可能穿透髋关节。
研究了 42 例年龄<55 岁的 FNF 患者。在 39 例骨量良好的患者中，LHS 用于 5 例患者，GSKT 系统用于 34 例患者。CSDHS 用于 3 例骨量差或粉碎的患者。患者的随访时间至少为 8 个月，最长为 2 年，平均随访时间为 14 个月。
GSKT 系统治疗的 34 例骨折中有 32 例愈合。LHS 治疗 5 例，CSDHS 治疗 3 例，均愈合。愈合率为 95.2%。在 2 例失败的病例中，1 例发生骨不连（NU），另 1 例发生深部感染。术后第二年，GSKT 系统治疗的 3 例患者检测到股骨头缺血性坏死（AVN）。其中 2 例髋关节疼痛，1 例无症状。8 例 Pauwels Ⅲ型 FNF 行原发性外展截骨术。均无并发症愈合。
对于骨量良好的患者，LHS 和 GSKT 系统允许术中加压和术后绝对稳定性，而不会出现头片段滑动，因为三角形结构在生物力学上是最强的。当骨骼骨质疏松时，CSDHS 提供可控滑动（仅 1 至 5 毫米）。这项初步研究显示出 95.2%的有希望的成功率。我们建议 GSKT 系统也可用于治疗转子间和其他骨干骨折。目前正在进行进一步的生物力学研究，以加强广泛使用这些植入物所需的证据。
