2024, Vol. 28 ›› Issue (33): 5351-5356

Inverted triangle cannulated screw assisted transverse lag screw and femoral neck system fixation for Pauwels III femoral neck fractures

Shen Shi, Xu Yulin, Li Yujie, Xu Xuepeng, Xiang Feifan, Ye Junwu, Zhuo Naiqiang   

Abstract: BACKGROUND: Pauwels III femoral neck fracture is a typical unstable fracture characterized by high vertical shear force and high incidence of postoperative complications. At present, there are many fixation methods for Pauwels III fracture, and there is no clear conclusion as to which internal fixation is the best fixation method for Pauwels III femoral neck fracture in young adults.
OBJECTIVE: To compare the clinical effect of three inverted triangle cannulated screws assisted transverse lag screws and femoral neck system in fixing Pauwels III femoral neck fractures of young adults.
METHODS: From May 2021 to December 2022, 21 young and middle-aged patients with Pauwels III femoral neck fracture were treated with three inverted triangle cannulated screws assisted by transverse lag screws and femoral neck system in Affiliated Hospital of Southwest Medical University. Of them, 9 patients were treated with three inverted triangle cannulated screws and one transverse lag screws perpendicular to the fracture line as the 3+1 cannulated screw group and 12 patients were treated with femoral neck system as the femoral neck system group. The two fixation methods were compared in terms of operation time, intraoperative blood loss, total incision length, intraoperative fluoroscopy times, fracture healing time, and limb function.
RESULTS AND CONCLUSION: (1) All patients were followed up. Patients in the 3+1 cannulated screw group were followed up for 10-25 months, with a mean of (17.44±4.30) months. The patients in the femoral neck system group were followed up for 8-24 months, with a mean of (15.58±4.68) months. (2) The intraoperative fluoroscopy times and Harris score at 3 months postoperatively in the femoral neck system group were better than those in the 3+1 cannulated screw group, and the difference was statistically significant (P < 0.05). The intraoperative blood loss, total incision length, and femoral neck shortening distance in the 3+1 cannulated screw group were better than those in the femoral neck system group, and the differences were statistically significant (P < 0.05). There was no significant difference in operation time, fracture healing time, and Harris score at the last follow-up between the two groups (P > 0.05). (3) It is indicated that three inverted triangle cannulated screws assisted transverse lag screw and femoral neck system can achieve good clinical effects in the treatment of young and middle-aged Pauwels III femoral neck fracture. The femoral neck system has fewer intraoperative fluoroscopy times and better early overall stability, while the 3+1 cannulated screw is more minimally invasive, easier to operate. Both fixation methods are worthy of clinical application and promotion, and can be selected according to the actual clinical situation.

Key words: femoral neck fracture, Pauwels III, femoral neck system, inverted triangle cannulated screw, transverse lag screw