Treatment of femoral neck fracture with cancellous bone screw fixation

Clinical study of Chinese bone injury.

Treatment of femoral neck fracture with cancellous bone screw fixation Since 1999, 35 cases of adult femoral neck fractures have been treated with three cancellous bone screws. The clinical results are satisfactory.

1 clinical data ~ 72 years old, an average of 52 years old; 23 cases of falls, 6 cases of bruises, 6 cases of car accident accidents; type of fracture: 13 cases of basal type, 19 cases of middle neck, 3 cases of sub-type, course of disease 1~ 18 days, an average of 4...5 days.

2 The treatment method used epidural anesthesia, the patient was in a supine position, the hip pad was 25~30cm high, and the lateral hip incision was taken. The large trochanter as the center point was longitudinally cut and the length was about 8~10cm, in the gluteus medius and The tensor fascia lata muscles are separated, the hip joint capsule is exposed and cross-cut, that is, the fracture site is seen, the fracture is detected, and the operation such as traction is performed. After the reduction is satisfied, the lateral femoral muscle is longitudinally cut, and the separated tissue is exposed to a large thickness. The lower femoral shaft is about 4~5cm, and the distance between the front and the back of the femoral shaft is about 1.5~2cm on the l~2cm line. Take 2 points and then the 2nd line to the distal end of the femur. At about 3cm, 1 point is an inverted isosceles triangle, three apexes of the triangle are used as needle insertion points, and 3 diameters of 2.5 to 3.0 gram needles are selected, from the three vertices of the triangle to the femoral neck to the femoral head, about 135 *145* corners can be drilled to the cartilage surface of the femoral head for 1cm. After checking the stability of the fracture position, the X-side photo of the bedside is checked. The positions of the three Kirschner wires are checked correctly, and the Kirschner wire is pulled out in turn and the pine needle is twisted. Bone screw, re-check the fracture end, and lift the affected limb to move the hip joint in all directions to understand the bone After the satisfaction, the incision was closed, and the hip joint extension and flexion activity was gradually performed after the operation. After 6 weeks, help the double-crowded to avoid weight-bearing walking, gradually strengthen the functional exercise, and gradually abandon the walking in about 4 months.

3 treatment results judgment: excellent: fracture healing, hip no pain, no claudication, normal activity, restore the original work; good: fracture healing hip joint activity is basically normal, but there is mild pain or slight lame; can: life is basically normal, Self-care, limp; hip pain during walking, fracture dislocation healing; poor: fracture non-healing, severe re-displacement, femoral head necrosis, severe claudication, hip pain, life can not take care of themselves or need to walk. After 12 months to 3 years and 6 months follow-up, 26 cases were excellent, accounting for 74.29%, good 5 cases, accounting for 14.29%, 2 cases, accounting for 5.71%, 2 cases, accounting for 5.71%, excellent rate 88.58%. The screw exits and penetrates the femoral head. Fracture healing in 33 cases, accounting for (Fongxian Integrated Traditional Chinese and Western Medicine Orthopaedic Hospital, Rong County, Guangxi 537500) 4 Discussion of femoral neck fractures, especially subtotal fractures, due to anatomical specificity, limited local blood supply, prone to delayed fracture healing Or no healing, osteoporosis of the fracture end, absorption, avascular necrosis of the femoral head and other complications. Clinically, various solid and effective internal fixation or prosthetic implant replacement are used to improve the clinical efficacy of femoral neck fracture and reduce complications. However, artificial joint replacement has certain limitations and is not suitable for most patients. Thus, effective internal fixation remains a priority for our clinicians.

The femoral trochanter, femoral neck, and femoral head are of cancellous bone structure. The cancellous bone screws are used. The front screw is deep and wide, and the grip is strong. It can be firmly folded in the trabecular bone in the femoral head. The action is to make the fracture surface close together, which can avoid the slippage, looseness and separation of the fracture surface of the screw.

The three screws are arranged in an inverted triangle, respectively, through the proximal femur, the neck and the femoral head, forming a stable three-dimensional mechanical distribution, forming the maximum tensile stress required for the stabilization of the femoral head, and having a strong anti-rotation effect, preventing the femoral head Rotate, sink and loose. The needle insertion angle of the screw has an effect on its compression and tensile resistance and stability. The load subjected to a large angle is relatively large compared to the load subjected to a small angle. Therefore, it is stronger to select the needle from 140*. The role of the load.

The cancellous bone screw is small and small, which has little effect on the blood supply of the femoral head, which is helpful for fracture healing and reducing the occurrence of femoral head necrosis. The screw cap is close to the bone surface, the outer part of the bone is short, and the suture fascia is covered, which has little effect on local soft tissue, and there is no local pain and bursitis, which is beneficial to postoperative functional exercise and rehabilitation.

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