Anatomical imaging analysis of screw configuration for femoral neck fracture

YUAN Jian-Feng; ZHU Qiu-Liang; SHI Ben-Gong

doi:10.16098/j.issn.0529-1356.2020.03.018

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Acta Anatomica Sinica ›› 2020, Vol. 51 ›› Issue (3) : 420-424. DOI: 10.16098/j.issn.0529-1356.2020.03.018

Anatomy

Anatomical imaging analysis of screw configuration for femoral neck fracture

YUAN Jian-feng^1* ZHU Qiu-liang² SHI Ben-gong¹

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Abstract

Objective To investigate the optimal screw configuration for internal fixation of femoral neck fractures based on anatomic analysis on radiologic imaging. Methods From January to February 2017, thirty proximal femurs of 15 normal adults from Picture Archiving and Communication Systems（PACS） of Paople’s Hospibal of Anji were constructed by CT. 8 males and 7 females with a mean age of (43±8.5) years (ranging from 28 to 63 years).The medial femoral neck sections (FNS) were projected on the lateral femoral trochanteric wall. The simulated three screw configurations in the projection of FNS include: two inverted equilateral triangles symmetrized to the axis of the FNS (IET-FNS group) or the coronal axis of the proximal femur (IET-PF group) and an obtuse triangle (OT group).The distance between the screws, the distance between the centre of the FNS and the screws, and the area ratio of the triangle/FNS were calculated. Results The projection of the FNS on the lateral femoral trochanteric wall was displayed as a rotating forward ellipse. Measurements of distance between screws：OT group（5.96±0.37）cm；IET-FNS group（4.74±0.39）cm；IET-PF group（4.58±0.39）cm. Distance between the centre of the FNS to the screws：OT group（3.43±0.18）cm；IET-FNS group（2.81±0.17）cm；IET-PF group（2.72±0.14）cm. And the area ratio of triangle/FNS OT group（0.31±0.01）；IET-FNS group（0.21±0.02）；IET-PF group（0.16±0.01） were significant larger in the OT group than in the IET-FNS and IET-PF groups (P<0.05). The values of the three parameters in the IET-FNS group were also larger than those in the IET-PF group (P<0.05). Conclusion The obtuse triangle screw configuration displays advantages with respect to the parameters of distance between screws, distance between the centre of FNS to screws, and the triangle area. Therefore, the obtuse triangle screw configuration may be the ideal pattern for internal fixation of femoral neck fractures. This needs to be corroborated with biomechanics testing.

Key words

Femoral neck section / Femoral neck torsion angle / Internal fixation / Three-dimensional reconotruction / Screw configuration / Anatomy / Human

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YUAN Jian-feng ZHU Qiu-liang SHI Ben-gong. Anatomical imaging analysis of screw configuration for femoral neck fracture[J]. Acta Anatomica Sinica. 2020, 51(3): 420-424 https://doi.org/10.16098/j.issn.0529-1356.2020.03.018

References

［1］ Bhandari M，Tornetta P，Hanson B，et al.Optimal internal fixation for femoral neck fractures:multiple screws or sliding hip screws ［J］? Orthop Trauma,2009，23（6）：403-407.

［2］ Luttrell K, Beltran M, Collinge CA. Preoperative decision making in the treatment of high-angle “vertical”femoral neck fractures in young adult patients. An expert opinion survey of the Orthopaedic Trauma Association’s (OTA) menbership［J］.Orthop Trauma,2014，28(9)：221-225.

［3］ Ma Ch, Wang WB. Research progress of internal fixation for treatment of femoral neck fracture［J］. Journal of Traumatic Surgery, 2018,20(4):312-315. (in Chinese)

马超，王文波.空心螺钉治疗股骨颈骨折的研究进展［J］.创伤外科杂志 2018,20(4): 312-315.

［4］ Ye Y, Hao J, Mauffrey C, et al. Optimizing stability in femoral neck fracture fixation［J］.Orthopedics, 2015, 38(10):625-630.

［5］ Maurer SG, Wright KE, Kummer FJ, et al. Two or three screws for fixation of femoral neck fractures ［J］? Am J Orthop (Belle Mead NJ), 2003, 32(9): 438-442.

［6］ Zdero R, KeastButler O, Schemitsch EH. A biomechanical comparison of two triple-screw methods for femoral neck fracture fixation in a synthetic bone model［J］. J Trauma, 2010，69(6):1537-1544.

［7］ Wang TM, Pei BQ, Zhou L, et al.The comprehensive biomechanical analysis of the internal fixation for femoral neck fracture［J］ Beijing Biomedical Engineering, 2006, 25(6):561-564. (in Chinese)

王田苗, 裴葆青, 周力, 等. 股骨颈骨折手术空心钉内固定的生物力学综合分析［J］北京生物医学工程.2006, 25(6):561-564.

［8］ Luo Ch，Chen B, Zhou YG. The curative effect analysis of hollow compression screws treatment femoral neck fracture［J］.Journal of Imaging Research and Medical Applications, 2018, 2(20)：233-234. (in Chinese)

罗成, 陈波, 邹永根.空心加压螺钉治疗股骨颈骨折疗效分析［J］.影像研究与医学应用，2018,2(20)：233-234.

［9］ Zhang PW, Yan ShR, Ji G.Curative effect analysis on different arrangement of hollow screws for femoral neck fracture［J］.Journal of Regional Anatomy and Operative Surgery, 2016，25(11):844-847. (in Chinese)

仉培武，严少荣，姬钢. 不同排列方式空心螺钉治疗股骨颈骨折的疗效分析［J］. 局解手术学杂志, 2016，25(11):844-847.

［10］ Mei J，Liu S，Jia G，et al. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation［J］. Injury，2014，45(12): 2045-2050.

［11］ Kate BR. Anteversion versus torsion of the femoral neck［J］. Acta Anat (Basel),1976, 94(3): 457-463.

［12］ Zhu QL，Xu B，Shen LH，et al. Measurement of the femoral neck torsion angle and anteversion angle by laser projection method［J］. Acta Anatomica Sinica，2014，45 (5): 694-697. (in Chinese)

朱求亮，许斌，沈良华，等. 激光投射法测量股骨颈扭转角及前倾角［J］. 解剖学报，2014，45 (5): 694-697.

［13］ Narra N, Nikander R, Viik J, et al. Femoral neck cross-sectional geometry and exercise loading［J］.Clin Physiol Funct Imaging, 2013, 33(4): 258-266.

［14］ Zhang YQ, Chang SM, Huang YG, et al. The femoral neck safe zone: a radiographic simulation study to prevent cortical perforation with multiple screw insertion［J］. J Orthop Trauma, 2015, 29(5):178-182.

［15］ Yang GJ，Chen Y，Wang YSh, et al. Application of multi-slice spiral CT Three-dimensional reconstruction technique in femoral neck fracture surgery［J］.Chinese Journal of CT and MRI, 2017，15(6):139-141. (in Chinese)

杨广杰，陈有，王永胜,等.多层螺旋CT三维重建技术在股骨颈骨折手术中应用研究［J］.中国CT和MRI杂志，2017，15(6):139-141.

［16］ Liebergall M, Ben-David D, Weil Y, et al. Computerized navigation for the internal fixation of femoral neck fractures［J］.J Bone Joint Surg Am, 2006,88(8): 1748-1754.

［17］ Wang JQ,Fan YB. Results of treatment for femoral neck fracture will be improved by computer assisted orthopaedic surgery［J］. China Journal of Orthopaedics and Traumatology, 2018, 31（2）：99-102. (in Chinese)

王军强，樊瑜波. 计算机辅助骨科手术技术将改善股骨颈骨折治疗［J］.中国骨伤，2018, 31（2）：99-102.

［18］ Nie ShX, Ni WD. Internal fixation treatment of femoral neck fracture［J］. Chinese Journal of Clinicians (Electronic Edition), 2013，7(8): 3543-3545. (in Chinese)

聂诗鑫，倪卫东.股骨颈骨折的内固定治疗［J］. 中华临床医师杂志(电子版)，2013，7(8): 3543-3545.

［19］ Dong YL, Qian YN, Liu LL, et al.Biomechanical stability study on different interna Ⅰ fixation for acetabular fracture［J］. China Journal of Orthopaedics and Traumatology, 2018, 31 (5):420-424. (in Chinese)

董伊隆,钱约男,刘良乐,等.髋臼骨折不同内固定方式的生物力学稳定性研究［J］.中国骨伤, 2018,31 (5):420-424.

［20］ Müller MC, Belei P, Pennekamp PH, et al.Three-dimensional computer-assisted navigation for the placement of cannulated hip screws.A pilot study［J］.Int Orthop, 2012, 36 (7):1463-1469.