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Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study

  • Trauma Surgery
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Abstract

Background

The optimal internal fixation for non-displaced femoral neck fractures remains controversial. This study aimed to compare the clinical results of the percutaneous compression plate (PCCP) with parallel screws (PS) in treating femoral neck fractures in elderly patients.

Materials and methods

A total of 218 patients who underwent internal fixation were randomized to receive either a percutaneous compression plate (PCCP group) or parallel screws (PS group) using a computerized random sequence generator which was used to assign the order of randomization. Patients were assessed by the operating time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stay, the time to full weight-bearing, reduction quality, fracture healing time, Harris hip score, and postoperative complications.

Results

There was no significant difference between PCCP and PS groups regarding operative time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stays, reduction quality, and Harris hip score (p > 0.05). The time to full weight-bearing and the fracture healing time in the PCCP group were shorter than those in the PS group (p < 0.05). The overall complication rates were slightly lower in the PCCP compared to the PS patients, but there was no significant difference (p > 0.05). However, the implant failure rate was significantly higher in the PS group compared to the PCCP group (p < 0.05).

Conclusions

The present study suggests that the PCCP is superior to the parallel screws fixation in the treatment of non-displaced elderly femoral neck fractures in terms of earlier full weight-bearing, shorter fracture healing time, and lower implant failure rate. Therefore, it may be a better therapeutic strategy for non-displaced femoral neck fractures in elderly patients.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Zhu J, Deng X, Hu H, Cheng X, Tan Z, Zhang Y (2022) Comparison of the effect of rhombic and inverted triangle configurations of cannulated screws on internal fixation of nondisplaced femoral neck fractures in elderly patients. Orthop Surg 14(4):720–729

    Article  CAS  PubMed  Google Scholar 

  2. Zhang YZ, Lin Y, Li C, Yue XJ, Li GY, Wang B et al (2022) A comparative analysis of femoral neck system and three cannulated screws fixation in the treatment of femoral neck fractures: a six-month follow-up. Orthop Surg 14(4):686–693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Veronese N, Maggi S (2018) Epidemiology and social costs of hip fracture. Injury 49(8):1458–1460

    Article  PubMed  Google Scholar 

  4. Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M (1996) Epidemiology of hip fractures. Bone 18(Suppl 1):S57–S63

    Article  Google Scholar 

  5. Rogmark C, Leonardsson O (2016) Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 98-B(3):291–297

    Article  CAS  PubMed  Google Scholar 

  6. Xu DF, Bi FG, Ma CY, Wen ZF, Cai XZ (2017) A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res 12(1):28

    Article  PubMed  PubMed Central  Google Scholar 

  7. Raaymakers EL, Marti RK (1991) Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg Br 73-B(6):950–954

    Article  Google Scholar 

  8. Okike K, Hasegawa IG (2021) Current trends in the evaluation and management of nondisplaced femoral neck fractures in the elderly. J Am Acad Orthop Surg 29(4):e154–e164

    Article  PubMed  Google Scholar 

  9. Taha ME, Audigé L, Siegel G, Renner N (2015) Factors predicting secondary displacement after non-operative treatment of undisplaced femoral neck fractures. Arch Orthop Trauma Surg 135(2):243–249

    Article  PubMed  Google Scholar 

  10. Okike K, Udogwu UN, Isaac M, Sprague S, Swiontkowski MF, Bhandari M et al (2019) Not all garden-i and ii femoral neck fractures in the elderly should be fixed: effect of posterior tilt on rates of subsequent arthroplasty. J Bone Joint Surg Am 101(20):1852–1859

    Article  PubMed  Google Scholar 

  11. Xu X, Fan J, Zhou F, Lv Y, Tian Y, Ji H et al (2023) Comparison of femoral neck system to multiple cancellous screws and dynamic hip screws in the treatment of femoral neck fractures. Injury 54(Supple 2):S28–S35

    Article  PubMed  Google Scholar 

  12. Ma JX, Kuang MJ, **ng F, Zhao YL, Chen HT, Zhang LK et al (2018) Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: a systematic review. Int J Surg 52:89–97

    Article  PubMed  Google Scholar 

  13. Lee YS, Chen SH, Tsuang YH, Huang HL, Lo TY, Huang CR (2008) Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. J Trauma 64(1):155–162

    PubMed  Google Scholar 

  14. Zafari H, Hoveidaei AH, Mortazavi SJ (2021) Internal fixation using screw in undisplaced femoral neck fracture: educational corner. J Orthop Spine Trauma 7(1):20–23

    Google Scholar 

  15. Nauth A, Creek AT, Zellar A, Lawendy A-R, Dowrick A, Gupta A et al (2017) Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 389(10078):1519–1527

    Article  Google Scholar 

  16. Gupta M, Arya RK, Kumar S, Jain VK, Sinha S, Naik AK (2016) Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults. Chin J Traumatol 19(04):209–212

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ju FX, Hou RX, **ong J, Shi HF, Chen YX, Wang JF (2020) Outcomes of femoral neck fractures treated with cannulated internal fixation in elderly patients: a long-term follow-up study. Orthop Surg 12(3):809–818

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lu Q, Tang G, Zhao X, Guo S, Cai B, Li Q (2017) Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial. Arch Orthop Trauma Surg 137(1):27–35

    Article  PubMed  Google Scholar 

  19. Rogmark C, Flensburg L, Fredin H (2009) Undisplaced femoral neck fractures-no problems? A consecutive study of 224 patients treated with internal fixation. Injury 40(3):274–276

    Article  PubMed  Google Scholar 

  20. Do LND, Kruke TM, Foss OA, Basso T (2016) 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(12):2739–2742

    Article  PubMed  Google Scholar 

  21. Zhu F, Liu G, Shao H-G, Wang Y-J, Li R-Q, Yang H-L et al (2015) Treatment of femoral neck fracture with percutaneous compression plate: preliminary results in 74 patients. Orthop Surg 7(2):132–137

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gomez-Vallejo J, Blanco-Rubio N, Lorenzo-Lopez R, Embarba-Gascon M, Ezquerra-Herrando L, Zamora-Lozano M et al (2021) Outcomes of basicervical femoral neck fracture treated with percutaneous compression plate (PCCP). Injury 52:S42–S46

    Article  PubMed  Google Scholar 

  23. ** Z-Y, Gu C, Yang H-L, Xu M (2022) Outcome of percutaneous compression plate for treatment of femoral neck fractures: mean follow-up of 4.4 years. Int Orthop 46(8):1891–1898

    Article  PubMed  Google Scholar 

  24. Brandt E, Verdonschot N, van Vugt A, van Kampen A (2006) Biomechanical analysis of the percutaneous compression plate and sliding hip screw in intracapsular hip fractures: experimental assessment using synthetic and cadaver bones. Injury 37(10):979–983

    Article  Google Scholar 

  25. Brandt SE, Lefever S, Janzing HMJ, Broos PLO, Pilot P, Houben BJJ (2002) Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results. Injury 33(5):413–418

    Article  CAS  PubMed  Google Scholar 

  26. Wang T, Sun JY, Zha GC, Jiang T, You ZJ, Yuan DJ (2014) Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures. Orthopedics 37(12):e1117–e1123

    Article  PubMed  Google Scholar 

  27. Parker MJ, White A, Boyle A (2008) Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures. Injury 39(7):791–795

    Article  PubMed  Google Scholar 

  28. Gjertsen J-E, Engesæter LB, Furnes O, Havelin LI, Steindal K, Vinje T et al (2008) The norwegian hip fracture register: experiences after the first 2 years and 15,576 reported operations. Acta Orthop 79(5):583–593

    Article  PubMed  Google Scholar 

  29. Yih-Shiunn L, Chien-Rae H, Wen-Yun L (2007) Surgical treatment of undisplaced femoral neck fractures in the elderly. Int Orthop 31(5):677–682

    Article  PubMed  Google Scholar 

  30. Filipov O (2011) Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Tr 21(7):539–543

    Article  Google Scholar 

  31. Stoffel K, Zderic I, Gras F, Sommer C, Eberli U, Mueller D et al (2017) 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(3):131–137

    Article  PubMed  Google Scholar 

  32. Chen J-y, She G-r, Luo S-m, Wu W-r, Zhuang T-f, Huan S-w et al (2020) Hemiarthroplasty compared with internal fixation for treatment of nondisplaced femoral neck fractures in elderly patients: a retrospective study. Injury 51(4):1021–1024

    Article  PubMed  Google Scholar 

  33. Shen J, Luo F, Sun D, Huang Q, Xu J, Dong S et al (2015) Mid-term results after treatment of intertrochanteric femoral fractures with percutaneous compression plate (PCCP). Injury 46(2):347–357

    Article  PubMed  Google Scholar 

  34. Koval KJ, Sala DA, Kummer FJ, Zuckerman JD (1998) Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Joint Surg Am 80(3):352–356

    Article  CAS  PubMed  Google Scholar 

  35. Kim JW, Byun S-E, Chang JS (2014) The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg 134(7):941–946

    Article  PubMed  Google Scholar 

  36. Atzmon R, Drexler M, Ohana N, Nyska M, Palmanovich E, Dubin J (2022) The effect of postoperative weight-bearing status on mortality rate following proximal femoral fractures surgery. Arch Orthop Trauma Surg 142(6):947–953

    Article  PubMed  Google Scholar 

  37. Sjöstedt Å, Zetterberg C, Hansson T, Hult E, Ekström L (1994) Bone mineral content and fixation strength of femoral neck fractures: a cadaver study. Acta Orthop Scan 65(2):161–165

    Article  Google Scholar 

  38. Zhu J, Hu H, Deng X, Zhang Y, Cheng X, Tan Z et al (2021) Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients. J Orthop Surg Res 16(1):544

    Article  PubMed  PubMed Central  Google Scholar 

  39. Rupprecht M, Grossterlinden L, Ruecker AH, de Oliveira AN, Sellenschloh K, Nüchtern J et al (2011) A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the intertan versus cannulated screws or a dynamic hip screw. J Trauma Acute Care 71(3):625–634

    Article  Google Scholar 

  40. Chen Y, Li H, Dai L, Yin Q, Li D, Wang X (2021) Imaging observation of percutaneous compression plate use in promoting femoral neck fracture healing. J Int Med Res 49(8):03000605211033501

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Shu D-P, **ao Y-P, Bei M-J, Ji T, Peng Y-J, Ma B et al (2020) Dynamic compression locking system versus multiple cannulated compression screw for the treatment of femoral neck fractures: a comparative study. BMC Musculoskelet Dis 21(1):230

    Article  Google Scholar 

  42. Yin H, Pan Z, Jiang H (2018) Is dynamic locking plate (Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis. Int J Surg 52:30–34

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by the grants from the National Natural Science Foundation of China (82102535).

Author information

Author notes

  1. Tao Wang and Haibo Yin contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wu** Road, Shanghai, 200080, People’s Republic of China

    Tao Wang & Chunhui Ma

  2. Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, 1518 North Huancheng Road, Jiaxing, 314000, People’s Republic of China

    Haibo Yin

  3. Department of Orthopaedics, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214122, People’s Republic of China

    **jiang Zhao

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  1. Tao Wang
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Correspondence to **jiang Zhao or Chunhui Ma.

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The study was approved by Affiliated Hospital of Jiangnan University.

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Wang, T., Yin, H., Zhao, X. et al. Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study. Arch Orthop Trauma Surg 143, 7063–7071 (2023). https://doi.org/10.1007/s00402-023-05029-z

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