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European Journal of Orthopaedic Surgery & Traumatology

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22-05-2024 | Original Article

Cannulated screws fixation for nondisplaced femoral neck fractures: early versus late weight-bearing—a prospective analysis

Authors: Donato Carola, Giuliano Lattanzi, Letizia Senesi, Daniele Massetti, Antonio Pompilio Gigante, Raffaele Pascarella, Simone Cerbasi

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 5/2024

Abstract

Purpose

Nondisplaced intracapsular fractures (Garden I/II) are predominantly treated with an internal fixation technique. The purpose of the study is to identify the best rehabilitation protocol after internal fixation with 3 parallel cannulated screws.

Methods

All patients operated on from 2016 to 2021 for femoral neck fractures by internal fixation with 3 cannulated screws were enrolled into this prospective study. The population was divided into two groups: Group A (n = 34) who followed a postoperative rehabilitation protocol involving full and immediate loading, and Group B (n = 22) who followed a postoperative rehabilitation protocol involving late full loading (after 30 days).

The two groups were compared with each other by mortality rate, postoperative complications and need for re-interventions. Functional outcome and quality of life were assessed at the minimum follow-up of 1 year using the modified Harris Hip Score (HHS) and the Short form health survey (SF-12) questionnaire.

Results

Group A showed a lower complication rate (2.9% vs. 18.2%), a lower 1-year mortality rate (5.9% vs. 9.1%), a better perception of mental health status (SF12-MCS 56.2 vs. 51.4, p = 0.03) but a worse perception of one's physical health status (SF12-PCS 48.1 vs. 56.7, p < 0.01). The two groups were also statistically overlapping in terms of the functional outcome achieved after the intervention (HHS was 90.94 in Group A vs. 93.15 in Group B, p = 0.32).

Conclusion

Postoperative complications, mortality and revision rate were higher in patients who followed a late-loaded rather than early loaded rehabilitation protocol. Functional outcome at 1-year survival is not significantly different.

In nondisplaced intracapsular hip fractures treated with cannulated screws, an immediate full load should be preferred. Query

Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650. https://doi.org/10.1007/s00198-009-0920-3CrossRefPubMed

Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 80:243–248. https://doi.org/10.1302/0301-620x.80b2.7762CrossRefPubMed

Lewis SR, Macey R, Eardley WG, Dixon JR, Cook J, Griffin XL (2021) Internal fixation implants for intracapsular hip fractures in older adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD013409.pub2CrossRefPubMedPubMedCentral

Khoo C, Haseeb A, Ajit Singh V (2014) Cannulated screw fixation for femoral neck fractures: a 5-year experience in a single institution. Malays Orthop J 8:14–21. https://doi.org/10.5704/MOJ.1407.010CrossRefPubMedPubMedCentral

Cserhati P, Kazar G, Manninger J, Fekete K, Frenyó S (1996) Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury 27:583–588. https://doi.org/10.1016/s0020-1383(96)00073-3CrossRefPubMed

Haidukewych GJ, Rothwell WS, Jacofsky DJ, Orchia ME, Berry DJ (2004) Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 86:1711–1716. https://doi.org/10.2106/00004623-200408000-00015CrossRefPubMed

Rogmark C, Flensburg L, Fredin H (2009) Undisplaced femoral neck fractures – no problems? A consecutive study of 224 patients treated with internal fixation. Injury 40:274–276. https://doi.org/10.1016/j.injury.2008.05.023CrossRefPubMed

Chen C, Yu L, Tang X, Liu MZ, Sun LZ, Liu C, Zhang Z, Li CZ (2017) Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures: a retrospective study. Acta Orthop Traumatol Turc 51:381–387. https://doi.org/10.1016/j.aott.2017.07.006CrossRefPubMedPubMedCentral

Bisaccia M, Ceccarini P, Rinonapoli G, Di Giacomo LM, Teodori J, Schiavone A, Ibanez Vicente C, De Trana G, Caraffa A (2018) Dhs plus anti-rotational screw versus cannulated screws for femoral neck fractures: an analysis of clinical outcome and incidence regarding avn. Acta Orthop Belg 84:279–283PubMed

10.

Warschawski Y, Sharfman ZT, Berger O, Steinberg EL, Amar E, Snir N (2016) Dynamic locking plate versus simple cannulated screws for nondisplaced intracapsular hip fracture: a comparative study. Injury 47:424–427. https://doi.org/10.1016/j.injury.2015.10.054CrossRefPubMed

11.

Parker MJ, Porter KM, Eastwood DM, SchembiWismayer M, Bernard AA (1991) Intracapsular fractures of the neck of femur. Parallel or crossed garden screws? J Bone Joint Surg Br 73:826–827. https://doi.org/10.1302/0301-620X.73B5.1894675CrossRefPubMed

12.

Wu Y, Leu TH, Chuang TY, Ho WP, Chen YP, Lin CY (2019) Screw trajectory affects screw cut-out risk after fixation for nondisplaced femoral neck fracture in elderly patients. J Orthop Surg 27:2309499019840252. https://doi.org/10.1177/2309499019840252CrossRef

13.

Bjørgul K, Reikerås O (2007) Outcome of undisplaced and moderately displaced femoral neck fractures. Acta Orthop 78(4):498–504. https://doi.org/10.1080/17453670710014149CrossRefPubMed

14.

Bjørgul K, Reikerås O (2006) Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: a prospective study of 683 patients treated with hemiarthroplasty or internal fixation. Acta Orthop 77:368–374. https://doi.org/10.1080/17453670610046271CrossRefPubMed

15.

Estrada LS, Volgas DA, Stannard JP, Alonso JE (2002) Fixation failure in femoral neck fractures. Clin Orthop Relat Res 399:110–118. https://doi.org/10.1097/00003086-200206000-00013CrossRef

16.

Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. an end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755CrossRefPubMed

17.

Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233. https://doi.org/10.1097/00005650-199603000-00003CrossRefPubMed

18.

Kodraliu G, Mosconi P, Groth N, Carmosino G, Perilli A, Gianicolo EA, Rossi C, Apolone G (2001) Subjective health status assessment: evaluation of the Italian version of the SF-12 health survey. Results from the MiOS Project. J Epidemiol Biostat 6:305–316. https://doi.org/10.1080/135952201317080715CrossRefPubMed

19.

Apolone G, Mosconi P, Quattrociocchi L et al. (2005) Questionario sullo stato di salute SF-12. Versione italiana ed. Guerini e Associati

20.

Ottesen TD, McLynn RP, Galivanche AR, Bagi PS, Zogg CK, Rubin LE, Grauer JN (2018) Increased complications in geriatric patients with a fracture of the hip whose postoperative weight-bearing is restricted: an analysis of 4918 patients. Bone Joint J 100-B(10):1377–1384. https://doi.org/10.1302/0301-620X.100B10.BJJ-2018-0489.R1CrossRefPubMed

21.

Mariconda M, Costa GG, Cerbasi S, Recano P, Orabona G, Gambacorta M, Misasi M (2016) Factors predicting mobility and the change in activities of daily living after hip fracture: a 1-year prospective cohort study. J Orthop Trauma 30:71–77. https://doi.org/10.1097/BOT.0000000000000448CrossRefPubMed

22.

Pfeufer D, Zeller A, Mehaffey S, Böcker W, Kammerlander C, Neuerburg C (2019) Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg 139:1253–1259. https://doi.org/10.1007/s00402-019-03193-9CrossRefPubMed

23.

Koval KJ, Sala DA, Kummer FJ, Zuckerman JD (1998) Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Joint Surg Am 80:352–356. https://doi.org/10.2106/00004623-199803000-00007CrossRefPubMed

Title: Cannulated screws fixation for nondisplaced femoral neck fractures: early versus late weight-bearing—a prospective analysis
Authors: Donato Carola
Giuliano Lattanzi
Letizia Senesi
Daniele Massetti
Antonio Pompilio Gigante
Raffaele Pascarella
Simone Cerbasi
Publication date: 22-05-2024
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 5/2024
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-024-04004-7

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Cannulated screws fixation for nondisplaced femoral neck fractures: early versus late weight-bearing—a prospective analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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