Stability of Screw Fixation of Femoral Neck Fractures - A Biomechanical Trial

Abstract

With a growing percentage of elderly people in the population and, correspondingly, an increasing rate of fractures of the proximal femur, the question how to stabilize medial femoral-neck fractures is gaining increasing importance. Especially in Hungary and Scandinavian countries, femoral-head-preserving surgery is advocated. However, the main problems of this procedure are re-dislocation and necrosis of the femoral head. Encouraged by two theoretical mathematical considerations, a biomechanical experiment was performed to investigate two different methods of screw fixation of medial femoral-neck fractures. The results showed that a head-preserving internal fixation with two cranial screws and a three-point supported screw at the bottom of the neck had distinct biomechanical advantages compared to conventional screw fixation. This has encouraged us to more frequently perform this minimally invasive and head-preserving surgery in Pauwels I and II medial fractures of the femoral head.

femoral neck fracture - screw fixation - biomechanical stability - cadaver experiment - mathematical model

References

• 1 Baitner A C, Maurer S G, Hickey D G, Jazrawi L M, Kummer F J, Jamal J, Goldman S, Koval K J. Vertical shear fractures of the femoral neck.  Clin Orthop Rel Research. 1999;  367 300-305
• 2 Bergmann G, Graichen F, Rohlmann A. Hip joint loading during walking and running, measured in two patients.  J Biomechanics. 1993;  26 969-990
• 3 Bonnaire F. Neue Aspekte zur Biomechanik und Osteosynthese von Schenkelhalsfrakturen. Springer, Berlin 2000
• 4 Bout C A, Cannegieter D M, Juttmann J W. Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle.  Injury. 1997;  28 135-139
• 5 Braun W, Ruter A, Wiedemann M, Kissing F. Femoral head preserving therapy in medial femoral neck fractures. A clinical study of the effects of treatment method on the outcome.  Unfallchirurg. 1991;  94 325-330
• 6 David A, Richter J, Huffner T. Medial femoral neck fracture - femur head preserving therapeutic concepts.  Zentralbl Chir. 1995;  120 841-849
• 7 Degreif J, Hammer M, Wenda K, Ritter G. Long-term outcome of managing medial femoral neck fractures with ceramic head endoprostheses.  Unfallchirurg. 1996;  99 744-749
• 8 Einert A, Bonnaire F, Simon G H, Kuner E, Moser E. 3-phase bone scintigraphy: perfusion and vitality of the femur head after medial femoral neck fracture and osteosynthesis.  Aktuelle Radiol. 1996;  6 219-224
• 9 Fekete K, Manninger J, Kazar G, Cserhati P, Bosch U. Die perkutane Osteosynthese der medialen Schenkelhalsfraktur mit kanülierten Schrauben und einer kleinen Zuggurtungsplatte.  Operat Orthop Traumatol. 2000;  12 272-286
• 10 Gallinaro P, Tabasso G, Negretto R, Brach del Prever E M. Experience with bipolar prosthesis in femoral neck fractures in the elderly and debilitated.  Clin Orthop. 1990;  251 26-30
• 11 Gaulke R. Spontaneous bilateral fractures of the femoral neck. Etiology-frequency-diagnosis-therapy.  Z Orthop Ihre Grenzgeb. 2002;  140 297-303
• 12 Husby T, Alho A, Hoiseth A, Fonstelien E. Strength of femoral neck fixation.  Acta Orthop Scand. 1987;  58 634-637
• 13 Jenny J-Y, Rapp E, Cordey J. Type of screw does not influence holding power in the femoral head.  Acta Orthop Scand. 1999;  70 435-438
• 14 Kiefer S, Kleinfeld F. An unusual fistula formation after the surgical treatment of a medial femoral neck fracture.  Aktuelle Traumatol. 1990;  20 64-66
• 15 Kinzl L, Bischoff M, Beck A. Endoprosthesis in medial femoral neck fractures.  Chirurg. 2001;  72 1266-1270
• 16 Kutscha-Lissberg F, Schildhauer T A, Kollig E, Muhr G. Die Osteosynthese der medialen Schenkelhalsfraktur.  Chirurg. 2001;  72 1253-1265
• 17 Langer R, Langer M, Scholz A, Astinet F, Schwetlick G, Felix R. Femoral head perfusion in patients with femoral neck fracture and femoral head necrosis.  J Belge Radiol. 1993;  76 145-149
• 18 Langer R, Scholz A, Langer M, Astinet F, Schwetlick G, Ferstl F, Felix R. Superselective intra-arterial DSA in femur head necrosis and femoral neck fractures.  Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr. 1991;  154 587-592
• 19 Malowsky J, Jackle T. Use of alloarthroplasty in treatment of medial femoral neck fracture.  Z Arztl Fortbild (Jena). 1991;  85 523-526
• 20 Marti R, Raaymakers E L, Nolte P, Besselaar P P. Pseudarthrosis of the proximal femur.  Orthopäde. 1996;  25 454-462
• 21 Meissner A. Developments in osteosynthesis of proximal femoral fractures - rational change in therapy based on clinical results and experiences.  Zentralbl Chir. 1994;  119 81-87
• 22 Müller L P, Degreif J, Basten K, Zophel O, Rommens P M. Is there still an indication for operative treatment of femoral neck fractures with a ceramic hemiprosthesis? Four-year results.  Arch Orthop Trauma Surg. 2000;  120 299-303
• 23 Niebuhr H, Nahrstedt U, Bruning M, Ruckert K. Variable head endoprosthesis in the treatment of femoral neck and trochanteric fractures.  Unfallchirurgie. 1994;  17 146-151
• 24 Paschke G, Losch H. Osteosynthesis of fractures of the coxal femoral end with the dynamic compression hip screw.  Zentralbl Chir. 1991;  116 1061-1070
• 25 Peterhans M, von Flue M, Hildell J, Vogt B. Follow-up results of osteosynthesis of medial femoral neck fractures with the dynamic hip screw.  Helv Chir Acta. 1991;  57 815-819
• 26 Pfefferkorn S, Tausch W. Surgical therapy of medial femoral neck fracture.  Zentralbl Chir. 1991;  116 501-504
• 27 Pitto R P, Blunk J, Kossler M. Transesophageal echocardiography and clinical features of fat embolism during cemented total hip arthroplasty. A randomized study in patients with a femoral neck fracture.  Arch Orthop Trauma Surg. 2000;  120 53-58
• 28 Purbach B, Kloti M, Ochsner P E. Management of femoral neck fractures at the Liestal Canton Hospital.  Helv Chir Acta. 1993;  59 533-537
• 29 Raaymakers E L, Schafroth M. Medial femoral neck fracture. Controversies in treatment.  Unfallchirurg. 2002;  105 178-186
• 30 Rzesacz E H, Weinberg A M, Reilmann H. Covered osteosynthesis through cannulated screws in medial Garden type I and II femoral neck fractures.  Unfallchirurg. 1995;  98 478-482
• 31 Saito N, Miyasaka T, Toriumi H. Radiographic factors predicting non-union of displaced intracapsular femoral neck fractures.  Arch Orthop Trauma Surg. 1995;  114 183-187
• 32 Schatzler A, Mollers M, Stedtfeld H W. Outcome of management of femoral neck fractures with cemented bipolar endoprostheses.  Zentralbl Chir. 1997;  122 1028-1032
• 33 Sim E, Erben W. Intravenous peripheral digital subtraction angiography after stabilization of medial femoral neck fractures. Results and value.  Wien Klin Wochenschr. 1992;  104 345-348
• 34 Sjostedt A, Zetterberg C, Hansson T, Hult E, Ekstrom L. Bone mineral content and fixation strength of femoral neck fractures. A cadaver study.  Acta Orthop Scand. 1994;  65 161-165
• 35 Smektala R, Paech S, Wenning M, Hupe K, Ekkernkamp A. Does hospital structure influence the outcome of operative treatment of femoral neck fractures?.  Zentralbl Chir. 2002;  127 231-237
• 36 Stankovski V, Bratko I, Demsar J, Smrke D. Induction of hypotheses concerning hip arthroplasty: a modified methodology for medical research.  Methods Inf Med. 2001;  40 392-396
• 37 Strauli C, Seekamp A, Lehmann U, Bosch U. Bone screw osteosynthesis of medial femoral neck fracture in elderly patients.  Swiss Surg. 2001;  7 167-172
• 38 Swiontkowski M F, Harrington R M, Keller T S, van Patten P K. Torsion and bending analysis of internal fixation techniques for femoral neck fractures.  J Orthop Res. 1987;  5 433-444
• 39 Templin F, Schoppmeier K. Combined total endoprosthesis implantation in bilateral femoral neck fracture with osteogenesis imperfecta tarda.  Unfallchirurg. 1996;  99 454-456
• 40 Zilch H, Naseband K. Mechanische Verhältnisse der Osteosynthese mit 3 AO-Spongiosazugschrauben nach Schenkelhalsfraktur.  Akt Traumatol. 1980;  10 85-103