Comparison of the short-term clinical efficacy of femoral neck system and cannulated screw in the treatment of femoral neck fracture

Abstract:

Objective：To investigate the short-term clinical effect of femoral neck system（FNS） on femoral neck fracture. Methods：A retrospective case-control study was performed to analyze the clinical data of 45 patients with femoral neck fracture admitted to the hospital from January 2019 to December 2020，including 23 males and 22 females，aged 28 to 68 years old[（52.3±11.2） years old in average]. According to the Pauwels classification，6 cases were type Ⅰ，23 type Ⅱ and 16 type Ⅲ. Twenty-four cases were fixed with cannulated screws（group A），and 21 patients were fixed with FNS（group B）. The operative time，intraoperative blood loss，reduction quality，time of weight-bearing，time of fracture healing，necrosis of femoral head，nonunion of fracture，shortening of femoral neck，nail removal of internal fixator and hip function score of the last follow-up were compared between the two groups. Results：All patients were followed up for 6-29 months，while the operative time of group A was （65.2±21.5） min and （58.4±14.5） min in group B（P >0.05），and the surgical blood loss of group A[（35.6±51.2） mL] was less than that of group B[（72.1±62.1） mL]（P<0.05）. According to the reduction standard proposed by Haidukewych et al.，20 patients in group A had good reduction quality，3 were average and 1 was poor，with an excellent and good rate of 83.33%；19 patients in group B had good reduction quality，2 were average and 0 was poor，with an excellent and good rate of 90.48%（P >0.05）. The weight-bearing time of group A was （2.9±1.3） months，and group B was （3.1±1.5） months（P >0.05）. The fracture union time in group A was （4.4±1.4） months，and that in group B was （4.5±1.5） months（P >0.05）. In group A，there were 2 cases of femoral head necrosis，4 cases of fracture nonunion and 7 cases of femoral neck shortening. In group B，there was 1 case of femoral head necrosis，3 cases of fracture nonunion，and 6 cases of femoral neck shorten－ing（P >0.05）. In group A，4 cases（17.67%） had screw with－drawal and there was no case of screw withdrawal in group B（P =0.05）. The Harris scores of group A in the last follow-up were （91.2±6.9） points，those of group B were （92.0±7.5） points（P >0.05）. Among patients with Pauwels Ⅲ，the Harris scores of the patients in group A were （89.7±4.8） points at the last follow-up and those in group B were （93.4±6.3） points（P >0.05）. The overall incidence of nonunion and necrosis of femoral head in group A was 33.33%，and there was no nonunion and necrosis in group B（P >0.05）. Conclusion：The treatment of femoral neck fracture with FNS can achieve the same clinical efficacy as cannulated nail treatment，and FNS may be a new option for the treatment of femoral neck fracture.