Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
J Orthop Surg Res. 2024 Sep 16;19(1):571. doi: 10.1186/s13018-024-05056-5.
Displaced femoral neck fractures are associated with a high revision rate. The new femoral neck system(FNS) offers advantages in fixation stability, potentially reducing the need for revision. The purpose of this study was to compare the revision rate of patients with different reduction quality treated with the FNS and cannulated screws (CS).
This retrospective study included patients with Garden III or IV femoral neck fractures who underwent osteosynthesis in a level 1 trauma center between July 2019 and June 2023. A total of 141 cases met the inclusion criteria and received treatment with either the FNS (N = 65) or CS (N = 76). The quality of fracture reduction, surgical complications (such as femoral neck shortening, avascular necrosis of femoral head, nonunion of fracture, implant failure and withdrawal), revision surgery and the reasons for revision were analyzed.
The mean age of the 141 cases was 52.0 years (range 18-65); with sixty-five cases being male (46.1%). Eighty-four fractures (59.6%) were classified as Garden type III. Reduction quality was good in 71 cases (50.4%) and fair in 70 cases. The mean follow-up period was 25.9 months (range 12-46). A total of 26 cases(18.4%) underwent revision surgery. The revision rate in cases with good reduction was 11.3% (8/71 cases), with seven cases (four hardware removal and three arthroplasty) in the CS group and one case (arthroplasty for fracture nonunion and implant failure) in the FNS group, a significant difference was found between the two groups(P = 0.041). Among the 18 cases (25.7%, 18/70) with fair reduction who underwent revision surgery, nine cases (six hardware removal and three arthroplasty) in the CS group, and nine cases (arthroplasty for implant failure and cut-out) in the FNS group, and there was no significant difference between the two groups (P = 0.672). The total revision rate between the FNS group (15.4%, 10/65) and the CS group (21.1%, 16/76) was not significantly different (P = 0.387).
The total revision rate between the FNS and CS group showed no difference. However, in cases with good reduction, the revision rate was lower in the FNS group compared to the CS group.
移位性股骨颈骨折与高翻修率相关。新型股骨颈系统（FNS）在固定稳定性方面具有优势，可能减少翻修的需求。本研究旨在比较不同复位质量的患者使用 FNS 和空心螺钉（CS）治疗的翻修率。
这是一项回顾性研究，纳入 2019 年 7 月至 2023 年 6 月在 1 级创伤中心接受治疗的 Garden III 或 IV 型股骨颈骨折患者。共有 141 例符合纳入标准，并接受 FNS（n=65）或 CS（n=76）治疗。分析骨折复位质量、手术并发症（如股骨颈缩短、股骨头缺血性坏死、骨折不愈合、植入物失败和退出）、翻修手术以及翻修原因。
141 例患者的平均年龄为 52.0 岁（18-65 岁）；男性 65 例（46.1%）。84 例骨折（59.6%）为 Garden Ⅲ型。71 例复位质量良好，70 例复位质量一般。平均随访时间为 25.9 个月（12-46 个月）。共 26 例（18.4%）行翻修手术。复位质量良好者的翻修率为 11.3%（71 例中有 8 例），CS 组有 7 例（4 例为内固定物取出，3 例为关节置换），FNS 组有 1 例（骨折不愈合和植入物失败行关节置换），两组间差异有统计学意义（P=0.041）。在 18 例复位质量一般（25.7%，70 例中有 18 例）且行翻修手术的患者中，CS 组有 9 例（6 例为内固定物取出，3 例为关节置换），FNS 组有 9 例（植入物失败和穿出行关节置换），两组间差异无统计学意义（P=0.672）。FNS 组（15.4%，65 例中有 10 例）和 CS 组（21.1%，76 例中有 16 例）的总翻修率无显著差异（P=0.387）。
FNS 组和 CS 组的总翻修率无差异。然而，在复位质量良好的患者中，FNS 组的翻修率低于 CS 组。
