본문 바로가기
KERD
논문KCI 등재

Difference of Neck Shortening in Femoral Neck Fracture between Femoral Neck System and Multiple Cannulated Cancellous Screws: Single Center, Prospective Randomized Controlled Trial

0

조회

0

다운로드

0

인용

0

참고문헌

키워드

초록

Purpose: Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared. Materials and Methods: This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups—the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up. Results: At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm. Conclusion: Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

Abstract

Purpose: Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared. Materials and Methods: This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups—the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up. Results: At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm. Conclusion: Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

참고문헌 (30)

  1. Gullberg B, "World-wide projections for hip fracture", Osteoporos Int, 7, pp.407~413 (1997)[DOI]
  2. Parker MJ, "The management of intracapsular fractures of the proximal femur", J Bone Joint Surg Br, 82, pp.937~941 (2000)[DOI]
  3. Damany DS, "Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures", Injury, 36, pp.131~141 (2005)[DOI]
  4. Zlowodzki M, "The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip : a multi-centre cohort study", J Bone Joint Surg Br, 90, pp.1487~1494 (2008)[DOI]
  5. Stockton DJ, "Incidence, magnitude, and predictors of shortening in young femoral neck fractures", J Orthop Trauma, 29, pp.e293~e298 (2015)[DOI]
  6. Stoffel K, "Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures : a comparison with the dynamic hip screw and cannulated screws", J Orthop Trauma, 31, pp.131~137 (2017)[DOI]
  7. Ly TV, "Treatment of femoral neck fractures in young adults", J Bone Joint Surg Am, 90, pp.2254~2266 (2008)
  8. Husby T, "Early loss of fixation of femoral neck fractures. Comparison of three devices in 244 cases", Acta Orthop Scand, 60, pp.69~72 (1989)[DOI]
  9. Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)[DOI]
  10. Garden RS, "Low-angle fixation in fractures of the femoral neck", J Bone Joint Surg Br, 43-B, pp.647~663 (1961)[DOI]
  11. Pauwels F, "Einteilung der Schenkelhalsbruche nach mechanischen Gesichtspunkten" (1935), Ferdinand Enke Verlag
  12. Meinberg EG, "Fracture and dislocation classification compendium-2018", J Orthop Trauma, 32(Suppl 1), pp.S1~S70 (2018)[DOI]
  13. Zlowodzki M, "Femoral neck shortening after fracture fixation with multiple cancellous screws : incidence and effect on function", J Trauma, 64, pp.163~169 (2008)[DOI]
  14. Nanty L, "Femoral neck shortening after internal fixation of Garden I fractures increases the risk of femoral head collapse", Orthop Traumatol Surg Res, 105, pp.999~1004 (2019)[DOI]
  15. Marmor M, "Accuracy of in situ neck-shaft angle and shortening measurements of the anatomically reduced, varus malreduced and shortened proximal femur : can we believe what we see on the postoperative films?", Injury, 43, pp.846~849 (2012)[DOI]
  16. Slobogean GP, "Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes : analysis of the prospective multi-center study of hip fracture outcomes in China(SHOC)", Injury, 48, pp.1837~1842 (2017)[DOI]
  17. Fleiss JL, "The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability", Educ Psychol Meas, 33, pp.613~619 (1973)[DOI]
  18. Vishwanathan K, "Is the modified Harris hip score valid and responsive instrument for outcome assessment in the Indian population with pertrochanteric fractures?", J Orthop, 15, pp.40~46 (2018)[DOI]
  19. Cella D, "The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008", J Clin Epidemiol, 63, pp.1179~1194 (2010)[DOI]
  20. Hu H, "Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients", J Orthop Surg Res, 16, pp.370~ (2021)[DOI]
  21. Alves T, "Biomechanical comparison of 3 possible fixation strategies to resist femoral neck shortening after fracture", Orthopedics, 33, pp.233~ (2010)[DOI]
  22. Patel S, "The use of the femoral neck system(FNS)leads to better outcomes in the surgical management of femoral neck fractures in adults compared to fixation with cannulated screws : a systematic review and meta-analysis", Eur J Orthop Surg Traumatol, 33, pp.2101~2109 (2023)[DOI]
  23. Stoffel K, "Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational case series", Arch Orthop Trauma Surg, 143, pp.4155~4164 (2023)[DOI]
  24. Davidson A, "Neck of femur fractures treated with the femoral neck system : outcomes of one hundred and two patients and literature review", Int Orthop, 46, pp.2105~2115 (2022)[DOI]
  25. Schuetze K, "Is new always better : comparison of the femoral neck system and the dynamic hip screw in the treatment of femoral neck fractures", Arch Orthop Trauma Surg, 143, pp.3155~3161 (2023)[DOI]
  26. Do LND, "Reoperations and mortality in 383 patients operated with parallel screws for Garden I-II femoral neck fractures with up to ten years follow-up", Injury, 47, pp.2739~2742 (2016)[DOI]
  27. Rajnish RK, "Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and metaanalysis", J Orthop, 32, pp.52~59 (2022)[DOI]
  28. Myhre L, "Determining the clinical significance of the PROMIS physical function score in the setting of femur fractures", Eur J Orthop Surg Traumatol, 33, pp.2277~2282 (2023)[DOI]
  29. Bodendorfer BM, "Defining clinically significant improvement on the patient-reported outcomes measurement information system test at 1-year follow-up for patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome", Am J Sports Med, 49, pp.2457~2465 (2021)[DOI]
  30. Nwachukwu BU, "Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 5-year follow-up", Am J Sports Med, 48, pp.901~907 (2020)[DOI]

관련 논문AI추천

이 간행물의 다른 논문 (9건)