Long-term results of surgical treatment of femoral neck fractures using dynamic derotational osteosynthesis
- Authors: Dubrov V.E.1,2, Yudin A.V.1,2, Zuzin D.A.1, Filippov V.V.1, Borodai Y.R.1, Scherbakov I.M.1, Zaitsev R.V.1
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Affiliations:
- Lomonosov Moscow State University
- Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine
- Issue: Vol 32, No 1 (2025)
- Pages: 9-25
- Section: Original study articles
- URL: https://journal-vniispk.ru/0869-8678/article/view/290962
- DOI: https://doi.org/10.17816/vto634513
- ID: 290962
Cite item
Abstract
BACKGROUND: Femoral neck fractures are among the most common injuries of the human skeleton. If in 2004 in Russia the incidence of fractures of the proximal femur in patients over 50 years of age was 105.9 per 100,000 of the population (and in women this figure was almost twice as high as in men), it is expected that by 2025 the number of victims worldwide will have doubled, and by 2050 it will be almost 4.5 million. Existing osteosynthesis techniques do not take into account the peculiarities of the uneven distribution of bone density in the femoral head, which can lead to the placement of fixators in a deliberately weakened area, reduced strength of osteosynthesis, migration of fixators and, as a result, non-union of the fracture.
AIM: To compare the long-term results of dynamic derotation osteosynthesis with the results of femoral neck fracture osteosynthesis with cannulated screws, dynamic hip screws, and V-wires.
MATERIALS AND METHODS: The study was based on the analysis of the results of surgical treatment of 259 patients with femoral neck fractures. In the treatment of 114 (44%) patients (study group), the titanium dynamic derotational fixator Targon FN manufactured by Aesculap B. Braun (Germany) was used. The comparison group included 145 (56%) patients who underwent osteosynthesis using a dynamic femoral screw (40 patients), tensioned V-wires (60 patients) or 3 AO screws (40 patients). There were no significant differences in the distribution of patients by age in the groups considered, which was confirmed by pairwise tests using Holm's multiple comparison correction method.
RESULTS: In Garden III femoral neck fractures, 59.6% of the study group achieved consolidation compared to 34.5% with dynamic hip screw implantation, 22.7% with V-wires and 28.0% with cannulated screws. In Garden IV fractures, consolidation did not occur in any of the observations. The incidence of avascular necrosis of the femoral head is highest in Garden III fractures: 39.2% with dynamic femoral screw implantation, 30.1% with V-wires, 34.2% with cannulated screws and 21.8% with dynamic derotational osteosynthesis. When evaluating the long-term results in patients with consolidated fractures, claudication of the operated limb was observed (in Garden III type fractures in 64% of cases — when using a dynamic derotational fixator, 65% — when using a derotational femoral screw, 100% - when using cannulated screws and V-wires). The maximum femoral neck offset shortening of more than 15% was observed in 7 patients (39%) with dynamic derotational osteosynthesis, in 6 patients (67%) with dynamic femoral screw implantation, in 5 patients (60%) with cannulated screws and in 8 patients (80%) with V-wires.
CONCLUSION: Garden I fractures of the femoral neck do not lead to avascular necrosis of the femoral head. As the angle of the fracture plane increases and the blood supply to the femoral head decreases, the incidence of avascular necrosis increases. The development of claudication in the patients was caused by the reduction in femoral offset length due to osteolysis, which occurred as a result of both the localisation of the fracture plane (fracture factor) and the dynamic function of the implant (fixator factor). Lameness was therefore considered to be the 'payback' for the consolidation of the fracture.
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##article.viewOnOriginalSite##About the authors
Vadim E. Dubrov
Lomonosov Moscow State University; Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine
Email: vduort@gmail.com
ORCID iD: 0000-0001-5407-0432
SPIN-code: 8598-7995
MD, Dr. Sci. (Medicine), professor
Russian Federation, Moscow; 1a Malaya Pirogovskaya str., 119435 MoscowAleksandr V. Yudin
Lomonosov Moscow State University; Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine
Author for correspondence.
Email: udin_av2007@mail.ru
SPIN-code: 7945-7640
MD
Russian Federation, Moscow; 1a Malaya Pirogovskaya str., 119435 MoscowDmitry A. Zuzin
Lomonosov Moscow State University
Email: zuz-pas59@yandex.ru
MD
Russian Federation, MoscowVladislav V. Filippov
Lomonosov Moscow State University
Email: vfil@mail.ru
ORCID iD: 0000-0002-4195-3153
SPIN-code: 4934-8191
MD, Dr. Sci. (Medicine)
Russian Federation, MoscowYakov R. Borodai
Lomonosov Moscow State University
Email: ipetrovzif@gmail.com
MD
Russian Federation, MoscowIvan M. Scherbakov
Lomonosov Moscow State University
Email: imscherbackov@yandex.ru
ORCID iD: 0000-0001-5487-9039
SPIN-code: 2031-0375
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowRuslan V. Zaitsev
Lomonosov Moscow State University
Email: zaitcev-doc@gmail.com
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowReferences
- Ardashov IP, Grigoruk AA, Kalashnikov VV. Opyt lecheniya perelomov shejki bedrennoj kosti puchkami V-obraznyh spic. Medicina v Kuzbasse. 2012;11(2):18–23. (In Russ.). EDN: PUOSMF
- Belinov NV, Bogomolov NI, Ermakov VS, Namokonov EV. Zakrytyj kompressionnyj osteosintez pri perelomah shejki bedrennoj kosti sposobom avtorov. N.N. Priorov Journal of Traumatology and Orthopedics. 2005;(1):16. (In Russ.). EDN: OIONYL
- Gil’fanov SI. Lechenie perelomov proksimal’nogo otdela bedra [dissertation]. Yaroslavl, 2010. 262 р. (In Russ.).
- Bogopol’skij OE. Instrumental’naya diagnostika i predoperacionnoe planirovanie artroskopii tazobedrennogo sustava pri femeroacetabulyarnom impidzhment-sindrome: lekciya. Travmatologiya i ortopediya Rossii. 2021;27(4):155–168. (In Russ.). doi: 10.21823/2311-2905-1636 EDN: WMVHEF
- Gneteckij SF. Subkortikal’nyj osteosintez perelomov shejki bedrennoj kosti u lic molodogo i srednego vozrasta (kliniko-eksperimental’noe issledovanie) [dissertation]. Moscow, 2003. 129 р. (In Russ.). EDN: QEFLNF
- Ezhov IYu. Hirurgicheskoe lechenie perelomov shejki bedrennoj kosti i ih oslozhnenij [dissertation]. Nizhniy Novgorod, 2010. 41 р. (In Russ.). EDN: QHAOKR
- Ivanova IU. Hirurgicheskoe lechenie bol’nyh s subkapital’nymi perelomami shejki bedra [dissertation]. Petrozavodsk, 1998. 180 р. (In Russ.).
- Ismailov SI, Hodzhamberdieva DSh, Rihsieva NT. Osteoporoz i nizkoenergeticheskie perelomy shejki bedra kak oslozhnenie razlichnyh endokrinnyh zabolevanij. Mezhdunarodnyj endokrinologicheskij zhurnal. 2013;(5):113–120. (In Russ.). EDN: RCEABZ
- Karev DB, Karev BA, Boltrukevich SI. Oshibki i oslozhneniya v lechenii pacientov s medial’nymi perelomami shejki bedrennoj kosti. Vestnik Vitebskogo GMU. 2009;8(1):39–44. (In Russ.).
- Klyuchevskij VV. Hirurgiya povrezhdenij. Yaroslavl, 1999. 784 р. (In Russ.).
- Kolondaev AF, Rodionova SS, Solod EI. Kombinirovannoe lechenie perelomov shejki bedrennoj kosti na fone osteoporoza. Russkij medicinskij zhurnal. 2004;12(24):1388–1392. (In Russ.).
- Lazarev AF, Solod EI, Ragozin AO. Lechenie perelomov proksimal’nogo otdela bedrennoj kosti na fone osteoporoza. N.N. Priorov Journal of Traumatology and Orthopedics. 2004;(4):27–31. (In Russ.). EDN: OIZQQP
- Lazarev AF, Nikolaev AP, Solod EI. Politenzofascikulyarnyj osteosintez pri perelomah shejki bedrennoj kosti u bol’nyh pozhilogo i starcheskogo vozrasta. N.N. Priorov Journal of Traumatology and Orthopedics. 1999;(1):21–26. (In Russ.).
- Lazarev AF, Solod EI. Maloinvazivnyj perkutannyj osteosintez perelomov shejki bedrennoj kosti u pozhilyh bol’nyh na fone osteoporoza. Klinicheskaya gerontologiya. 2003;(6):24–27. (In Russ.).
- Lemeshko BYu. Ob oshibkah, sovershaemyh pri ispol’zovanii neparametricheskih kriteriev soglasiya. Izmeritel’naya tekhnika. 2004;(2):15–20. (In Russ.).
- Samodaj VG, Ryl’kov MI, Brekhov VL. K voprosu o lechenii zakrytyh perelomov shejki bedra. Vestnik eksperimental’noj i klinicheskoj hirurgii. 2009;2(4):335–338. (In Russ.).
- Sidorenko EV. Metody matematicheskoj obrabotki v psihologii. Saint-Petersburg: Rech’; 2007. 349 р. (In Russ.). EDN: QXQKTZ
- Bonnaire F, Zenker H, Lill C, Weber AT, Linke B. Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int. 2005;16 Suppl 2:S93–S102. doi: 10.1007/s00198-004-1746-7
- Garden RS. Classification of subcapital fractures of the femoral neck. J Bone Joint Surg. 1964;(46):630–635.
- Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment of mold arthroplasty. An end-results study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737–55.
- Horan BF, Holland RB, Warden JC. How best to fix a broken hip. Med J Aust. 2000;172(1):47–8.
- Huusko Т, Karppi P, Avikainen V. Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ. 2000;321(7269):1107–11. doi: 10.1136/bmj.321.7269.1107
- Kim JW, Nam KW, Yoo JJ. The role of preoperative bone scan for determining the treatment method for femoral neck fracture. Int Orthop. 2007;31(1):61–4. doi: 10.1007/s00264-006-0138-3
- Moroni A, Hoang-Kim A, Lio V. Current augmentation fixation techniques for the osteoporoticpatient. Scand J Surg. 2006;95(2):103–9. doi: 10.1177/145749690609500205
- Parker MJ, Stedtfeld HW. Internal fixation of intracapsular hip fractures with a dynamic locking plate; initial experience and results for 83 patients treated with a new implant. Injury. 2010;41(4):348–51. doi: 10.1016/j.injury.2009.09.004
- Schmidt J, Letsch R, Kuhling J. Stability of screw fixation of femoral neck fractures — a biomechanical trial. Osteo Trauma Care. 2005;(13):76–81.
- Instructions for processing data obtained with the SF-36 questionnaire. Available from: http://bono-esse.ru/blizzard/RPP/sf36.pdf. (In Russ.).
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