摘要
Abstract Objective To describe the clinical and radiographic outcomes of a cohort of patients with acetabular fractures treated with the modified Stoppa approach. Methods We conducted a prospective analysis of adult patients with acetabular fractures treated using the modified Stoppa approach from June 2020 to June 2021, with a minimum follow-up period of 12 months. The analysis included demographic, epidemiological, and perioperative data, as well as postoperative radiographic and functional outcomes. Results The study included 15 cases, with 14 men (93.3%) and 1 woman (6.67%). A postoperative tomographic evaluation revealed an anatomical reduction in 50%, an imperfect reduction in 13.6%, and a poor reduction in 36.4% of the subjects. Regarding the functional scores, the Harris Hip Score ranged from 56 to 100, with a mean value of 92.5. The Majeed Pelvic Score classified the functional outcome as excellent in 36.5%, good in 40.6%, moderate in 18.7%, and poor in 4.2% of the cases. Conclusion The present case series study demonstrated positive statistical relevance between reduction quality and functional outcomes and between the time until surgery and the reduction quality. The functional outcomes at a one-year of follow-up demonstrate that this approach can be an excellent alternative for anterior acetabulum fractures.
Resumo Objetivo Descrever os resultados clínicos e radiográficos de uma coorte de pacientes com fraturas de acetábulo tratados com o acesso de Stoppa modificado. Métodos Foi realizada uma análise prospectiva de pacientes adultos com fraturas de acetábulo tratados pela via de Stoppa modificada de junho de 2020 a junho de 2021 e com seguimento mínimo de 12 meses. Foram analisados dados demográficos, epidemiológicos e perioperatórios, e resultados radiográficos e funcionais pós-operatórios. Resultados Foram estudados 15 casos, sendo 14 homens (93,3%) e 1 mulher (6,67%). Na avaliação tomográfica pós-operatória, redução anatômica foi observada em 50% dos casos, imperfeita, em 13,6%, e ruim, em 36,4%. Nos escores funcionais, encontramos uma variação de 56 a 100, com média de 92,5 no Harris Hip Score. No Majeed Pelvic Score, o resultado funcional foi excelente em 36,5% dos casos, bom, em 40,6%, moderado, em 18,7%, e ruim, em 4,2%. Conclusão O estudo da série de casos demonstrou relevância estatística positiva entre a qualidade da redução e os desfechos funcionais, assim como entre o tempo até a cirurgia e a qualidade da redução. Os resultados funcionais no seguimento de um ano demonstram que o uso dessa via pode ser uma excelente alternativa para as fraturas anteriores do acetábulo.
摘要
INTRODUCCION En los últimos años, se ha descrito el uso de placas horizontales para la fijación de fracturas que comprometen el reborde articular de los platillos tibiales, lo que se conoce como placa rim. La mayoría de las publicaciones al respecto describen su uso en columnas posteriores y posterolaterales de los platillos tibiales, y a la fecha hay escasos reportes del uso de este tipo de placa en la columna anteromedial y ninguno para la posteromedial. El objetivo de este artículo es presentar dos casos clínicos de fracturas conminutas del platillo tibial medial mostrando su tratamiento con el uso de placas rim. CASOS CLINICOS El primer caso presentaba compromiso anteromedial y posteromedial, y el segundo, compromiso posteromedial. En ambos casos, se logró la reducción mediante un abordaje posteromedial y su fijación con placa bloqueada de 2,7 mm como placa rim. En cada caso, se detalló la estrategia de reducción y el manejo postoperatorio. RESULTADOS Ambos pacientes consiguieron la consolidación ósea entre las semanas 14 y 18 tras la osteosíntesis definitiva, sin presentar pérdidas de reducción. Ambos lograron rango de movilidad articular completo (0°125°), y retornaron a sus trabajos a los 4 y 6 meses respectivamente. CONCLUSIONES Estas placas ofrecen una buena opción de tratamiento para fracturas articulares conminutas del borde del platillo tibial, tanto en la columna anteromedial como en la posteromedial. A pesar de la ausencia de grandes series de pacientes con uso de placas rim mediales, el resultado de los casos presentados aquí nos permite plantear su utilidad al momento de enfrentarnos a fracturas del reborde articular
INTRODUCTION In recent years, the use of horizontal plates has been described to achieve fixation of fractures that compromise the articular ridge of the tibial plateau; these plates are known as "rim plates." Most publications report their use in the posterior and posterolateral columns of the tibial plateau, and to date there are few reports of its use for the fixation of the anteromedial column and none for the posteromedial column. The objective of the present article is to report two clinical cases of comminuted fractures of the medial tibial plateau, showing their treatment with the use of medial rim plates. CLINICAL CASES The first case presented with an anteromedial and posteromedial tibial plateau fracture, and the second, a posteromedial fracture. In both cases, reduction was achieved through a posteromedial approach, and the fixation was performed with a 2.7-mm locked rim plate. The reduction strategy and postoperative management were detailed in each case. RESULTS Both patients achieved bone consolidation during the 14th and 18th weeks after the definitive osteosynthesis, without presenting loss of reduction. Both patients achieved full range of joint motion (0°125°) and returned to work after four and six months respectively. CONCLUSION These plates offer a good treatment option for comminuted fractures of the rim of the tibial plateau, for both the anteromedial and posteromedial columns. Despite the absence of large series of patients with the use of medial rim plates, the results of the two cases herein presented enables us to propose it as a useful tool when dealing with fractures of the medial rim of the tibial plateau
INTRODUCTION In recent years, the use of horizontal plates has been described to achieve fixation of fractures that compromise the articular ridge of the tibial plateau; these plates are known as "rim plates." Most publications report their use in the posterior and posterolateral columns of the tibial plateau, and to date there are few reports of its use for the fixation of the anteromedial column and none for the posteromedial column. The objective of the present article is to report two clinical cases of comminuted fractures of the medial tibial plateau, showing their treatment with the use of medial rim plates. CLINICAL CASES The first case presented with an anteromedial and posteromedial tibial plateau fracture, and the second, a posteromedial fracture. In both cases, reduction was achieved through a posteromedial approach, and the fixation was performed with a 2.7-mm locked rim plate. The reduction strategy and postoperative management were detailed in each case. RESULTS Both patients achieved bone consolidation during the 14th and 18th weeks after the definitive osteosynthesis, without presenting loss of reduction. Both patients achieved full range of joint motion (0°125°) and returned to work after four and six months respectively. CONCLUSION These plates offer a good treatment option for comminuted fractures of the rim of the tibial plateau, for both the anteromedial and posteromedial columns. Despite the absence of large series of patients with the use of medial rim plates, the results of the two cases herein presented enables us to propose it as a useful tool when dealing with fractures of the medial rim of the tibial plateau
Subject(s)
Humans , Male , Middle Aged , Tibial Fractures/surgery , Tibial Fractures/diagnostic imaging , Tomography, X-Ray Computed/methods , Fractures, Comminuted/surgery , Fractures, Comminuted/diagnostic imaging , Fracture Fixation, Internal/methods , Aftercare摘要
OBJECTIVE@#To compare the role and importance of fibular fixation in tibiofibular fractures by Meta-analysis.@*METHODS@#The literature related to the comparison of the efficacy of fixation of the fibula with or without fixation on the treatment of tibiofibular fractures was searched through the databases of China Knowledge Network, Wipu, Wanfang, The Cochrane Library, Web of science and Pubmed, and statistical analysis was performed using RevMan 5.3 software. The rates of malrotation, rotational deformity, internal/external deformity, anterior/posterior deformity, non-union, infection, secondary surgery and operative time were compared between the fibula fixation and non-fixation groups.@*RESULTS@#A total of 11 publications were included, six randomised controlled trials and five case-control trials, eight of which were of high quality. A total of 813 cases were included, of which 383 were treated with fibula fixation and 430 with unfixed fibulae.Meta-analysis results showed that fixation of the fibulae in the treatment of tibiofibular fractures reduced the rates of postoperative rotational deformity[RR=0.22, 95%CI(0.10, 0.45), P<0.000 1] and internal/external deformity[RR=0.34, 95%CI(0.14, 0.84), P=0.02] and promoted fracture healing [RR=0.76, 95%CI(0.58, 0.99), P=0.04]. In contrast, the rates of poor reduction [RR=0.48, 95% CI(0.10, 2.33), P=0.36], anterior/posterior deformity[RR=1.50, 95%CI(0.76, 2.96), P=0.24], infection[RR=1.43, 95%CI(0.76, 2.72), P=0.27], secondary surgery[RR=1.32, 95%CI(0.82, 2.11), P=0.25], and operative time[MD=10.21, 95%CI(-17.79, 38.21), P=0.47] were not statistically significant (P>0.05) for comparison.@*CONCLUSION@#Simultaneous fixation of the tibia and fibula is clinically more effective in the treatment of tibiofibular fractures.
Subject(s)
Humans , Fibula/surgery , Fractures, Bone/complications , Tibia/surgery , Fracture Healing , Fracture Fixation, Internal , Treatment Outcome摘要
Objective:To investigate the clinical efficacy of two different internal fixations in the treatment of femoral intertrochanteric fractures in older adult patients.Methods:The clinical data of 152 older adult patients with femoral intertrochanteric fractures who were treated at the Second People's Hospital of Hefei from January 2019 to December 2022 were retrospectively analyzed. All patients underwent closed reduction and internal fixation surgery. They were divided into two groups based on the different types of internal fixations used. Among them, 76 patients received internal fixation using proximal femoral intramedullary nails (group A), while 76 patients received internal fixation using Intertan nails (group B). The intraoperative blood loss volume, surgical time, postoperative complications, fracture healing time, and hip joint function score were compared between the two groups.Results:The intraoperative blood loss volume in group A was (197.11 ± 37.85) mL, which was significantly less than that in group B [(226.84 ± 54.17) mL, t = 1.62, P < 0.001]. Surgical time in group A was (71.16 ± 15.64) minutes, which was significantly shorter than that in group B [(78.49 ± 15.88) minutes, t = 1.67, P < 0.001]. The fracture healing time in group A was (13.29 ± 0.94) weeks, which was not significantly different from that in group B [(13.20 ± 0.64) weeks, t = 0.33, P > 0.05]. However, the incidence of postoperative complications in group A was 5.26% (4/76), which was significantly higher than 1.32% (1/76) in group B ( χ2 = 4.04, P = 0.048). At 1 and 3 months and 1 year after surgery, the hip joint function score in group A was (63.13 ± 2.41) points, (73.50 ± 3.99) points, and (84.13 ± 7.57) points, respectively, and it was (68.65 ± 2.65) points, (79.07 ± 3.38) points, and (89.56 ± 7.71) points, respectively, in group B. At the above-mentioned time points, the difference in hip joint function score between the two groups was statistically significant ( t = 1.89, 2.48, 2.49, all P < 0.001). Conclusion:Both internal fixation methods have significant therapeutic effects on femoral intertrochanteric fractures. Internal fixation using Intertan nails leads to higher hip joint function scores and fewer postoperative complications compared with internal fixation using proximal femoral intramedullary nails, but it results in more blood loss and a longer surgical time.
摘要
Objective:To compare the biomechanical properties of the modified and traditional iliolumbar pedicle screw-rod system for the fixation of vertically unstable posterior pelvic ring dislocation.Methods:The CT images of the lumbar spine, pelvis, and femur from a 31-year-old healthy male volunteer were used to establish models of posterior pelvic ring dislocation and unilateral and bilateral fixation models of modified and traditional iliolumbar pedicle screw-rod systems with the three-dimensional virtual software using the finite element method. By restraining the distal ends of the femurs of both sides and applying a vertical load of 500 N to the L 1 vertebral body, the maximum stress of the intact pelvis model and the stiffness of the posterior pelvic ring dislocation model were evaluated to validate the reliability of the models. After the validation of the models, a follower load of 400 N was applied in the direction of the L 1 vertebral curve to simulate the upper body weight; the maximum vertical displacement, the maximum posterior displacement, the maximum right displacement, and the overall maximum displacement of the sacrum of the modified and traditional iliolumbar pedicle screw-rod system models were compared. Additionally, stress distributions of the implant and the pelvis were also compared. Results:(1) The maximum stress of the intact pelvis model was 22.0 MPa, with the stiffness of the posterior pelvic ring dislocation model as 180.03 N/mm. (2) In terms of the maximum vertical displacement of the sacrum, the bilateral modified iliolumbar pedicle screw-rod system was similar to the bilateral traditional iliolumbar pedicle screw-rod system. However, the maximum posterior displacement, the maximum right displacement, and the overall maximum displacement of the sacrum in the bilateral modified iliolumbar pedicle screw-rod system were 0.57 mm, 0.19 mm and 0.68 mm respectively, which were markedly smaller than those of the bilateral traditional iliolumbar pedicle screw-rod system (1.38 mm, 0.26 mm and 1.41 mm respectively). (3) The maximum vertical displacement, the maximum posterior displacement, the maximum right displacement, and the overall maximum displacement of the sacrum in the unilateral modified iliolumbar pedicle screw-rod system were 0.70 mm, 0.73 mm, 0.17 mm and 0.88 mm respectively, which were markedly smaller than those of the unilateral traditional iliolumbar pedicle screw-rod system (1.17 mm, 2.21 mm, 0.31 mm and 2.29 mm respectively). (4) The stress of the implant was concentrated on the connecting rod between the iliac pedicle screw-rod and the lumbar pedicle screw-rod in the modified iliolumbar pedicle screw-rod system, but it was mainly concentrated on the connecting rod at the upper edge of the iliac screw in the traditional iliolumbar pedicle screw-rod system. The maximum stress of the implant was 340.84 MPa in the bilateral modified iliolumbar pedicle screw-rod system, which was 30.4% less than that in the bilateral traditional iliolumbar pedicle screw-rod system (489.77 MPa), and was 351.23 MPa in the unilateral modified iliolumbar pedicle screw-rod system, which was 15.5% less than that in the unilateral traditional iliolumbar pedicle screw-rod system (415.82 MPa). (5) In both modified and traditional iliolumbar pedicle screw-rod systems, the stress of the pelvis was concentrated on the contact area between the iliac screw and the cortical bone. The maximum stress of the pelvis was 19.21 MPa in the bilateral modified iliolumbar pedicle screw-rod system, which was 78.1% less than that in the bilateral traditional iliolumbar pedicle screw-rod system (87.59 MPa), and was 39.91 MPa in the unilateral modified iliolumbar pedicle screw-rod system, which was 70.4% less than that in the unilateral traditional iliolumbar pedicle screw-rod system (134.98 MPa).Conclusion:Compared with the traditional iliolumbar pedicle screw-rod system, the modified iliolumbar pedicle screw-rod system can effectively reduce the displacements of all directions in vertically unstable posterior pelvic ring dislocation and significantly reduce the stress of the implant and the pelvis, thus having good biomechanical stability.
摘要
Objective:To investigate the long-term efficacy of self-designed posterior atlas polyaxial screw-plate in the treatment of unstable atlas fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 20 patients with unstable atlas fracture who were admitted to Affiliated Honghui Hospital of Xi′an Jiaotong University from January 2011 to April 2013, including 14 males and 6 females, aged 23-60 years [(42.7±8.6)years]. All the patients were treated with internal fixation using self-designed posterior atlas polyaxial screw-plate. The operation time and intraoperative bleeding volume were recorded. The fracture reduction was evaluated by CT scan at 3 days after surgery. The bone healing was observed by X-ray (anterior-posterior and lateral views of the cervical spine) and CT scan at 9 months after surgery. The delayed spinal cord injuries were evaluated by Frankel grade at 1 and 2 years after surgery and at the last follow-up. The Visual Analogue Scale (VAS) before surgery, at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. The axial rotation, flexion and extension range of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were compared. Intraoperative and postoperative complications were observed.Results:All the patients were followed up for 121-148 months [(135.0±6.8)months]. The operation duration was 68-122 minutes [(86.0±14.1)minutes], with the intraoperative blood loss of 90-400 ml [(120.0±67.9)ml]. The CT scan of the cervical spine at 3 days after surgery showed all satisfactory fracture reduction. Satisfactory bone reunion was observed at 9 months after surgery. All patients were scaled as Frankel grade E at 1 year, 2 years and at the last follow-up after surgery, with no delayed spinal cord injuries observed. The VAS scores of the cervical spine at 3 months, 1 year, 2 years after surgery and at the last follow-up were 2.0(1.3, 3.0)points, 1.0(1.0, 1.8)points, 1.0(0.3, 1.0)points and 1.0(0.3, 1.0)points, which were significantly lower than that before surgery [7.0(6.0, 7.8)points] ( P<0.05), with significantly lower scores at 1-, 2-year after surgeny and at the last follow-up than at 3 months after surgery ( P<0.05). There were no significant differences among the other time points ( P>0.05). The axial rotation ranges of the cervical spine were (103.0±8.3)°, (128.3± 11.4)° and (129.8±13.6)° at 1 year, 2 years after surgery and at the last follow-up respectively, which were significantly higher than that at 3 months after surgery [(85.3±7.0)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference at the last follow-up compared with that at 2 years after surgery ( P>0.05). The flexion and extension range of the cervical spine at 1 year, 2 years after surgery and at the last follow-up were (65.5±4.8)°, (78.3±6.5)° and (79.3±6.9)° respectively, which were significantly higher than that at 3 months after surgery [(54.3±4.4)°] ( P<0.05); It was further improved at 2 years after surgery and at the last follow-up compared with that at 1 year after surgery ( P<0.05), with no significant difference between the last follow-up and 2 years after surgery ( P>0.05). No intraoperative injuries such as arteriovenous injury were observed. No incision infection or dehiscence occurred after surgery, with no complications caused by long-term bed rest such as lung or urinary tract infection, pressure sore formation or deep vein thrombosis occurred. No loosening or breakage of the screw and atlas plate was observed at the long-term follow-up. One patient had mild cervical pain, snap during rotation, and limited range of motion at the last follow-up. Conclusion:Self-designed posterior atlas polyaxial screw-plate has merits including small surgical wounds, satisfactory reduction, solid fixation, obvious pain relief, effective preservation of the previous cervical motion, few complications, and satisfactory long-term efficacy in the treatment of unstable atlas fracture.
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Objective:To compare the efficacy of the horizontal plate plus raft screws above the acetabulum and fixation with screws only for acetabular fractures combined with dome impaction in the aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 20 aged patients with acetabular fractures combined with dome impaction, who were admitted to Tianjin hospital between May 2013 and January 2023, including 5 males and 15 females, aged 61-84 years [(72.2±7.3)years]. According to Letournel and Judet classification, 13 patients had anterior column fracture, 5 anterior column fracture combined with posterior transverse fracture and 2 two-column fracture. All the patients underwent open reduction and internal fixation through an anterior approach. Of them, 11 patients were treated with the fixation with the horizonal plate plus raft screws above the acetabulum (plate plus raft screw group) and 9 with the screws only (screw only group). The operative time, intraoperative blood loss, and intraoperative fluoroscopy times were compared between the two groups. The quality of fracture reduction was evaluated with the Matta′s radiographic criteria at 3 days after surgery and the function of the hip joint was assessed with Merle D′Aubigné and Postel scoring system at 3 months after surgery and at the last follow-up as well as the excellent and good rate at te last follow-up. The occurrence of postoperative complications was observed.Results:All the patients were followed up for 6-18 months [(13.1±3.1)months]. There were no significant differences in the operative time, intraoperative blood loss or intraoperative fluoroscopy times between the two groups ( P>0.05). According to the Matta′s radiographic criteria at 3 days after surgery, patients with anatomical reduction and satisfactory reduction accounted 6 and 5 in the plate plus raft screw group, compared to 5 and 4 respectively in the screw only group ( P>0.05). The values of Merle D′Aubigné and Postel score at 3 months after surgery and at the last follow-up were (14.0±2.4)points and (15.8±2.2)points in the plate plus raft screw group, which were higher than those in the screw only group [(11.0±2.6)points and (13.0±3.1)points] ( P<0.01). The values of Merle D′Aubigné and Postel score at the last follow-up of both groups were further enhanced from those at 3 months after surgery ( P<0.01). At the last follow-up, 3 patients were rated excellent, 6 good, 1 fair and 1 poor in the plate plus raft screw group, with an excellent and good rate of 81.8%, while in the screw only group, 3 were rated good, 2 fair and 4 poor, with an excellent and good rate of 33.3% ( P<0.05). One patient in the plate plus raft screw group and 5 in the screw only group had displacement of the dome impaction fragment combined with traumatic arthritis after surgery ( P<0.05). Conclusion:For acetabular fractures combined with dome impaction in the aged patients, the horizontal plate plus raft screw above the acetabulum can effectively improve the function restoration of the hip joint and reduce the occurrence of the displacement of the dome impaction fragment and traumatic arthritis after surgery compared to the fixation with screws only.
摘要
Objective:To evaluate the reliability of a region-locked 3D-printed template combined with a bi-directional matching scheme in assistance of screw placement for thoracolumbar fractures.Methods:From January 2019 to March 2023, 52 patients with thoracolumbar fracture were treated at Department of Orthopedics, The People's Hospital of Liyang. They were 29 males and 23 females, with an age of (58.2±13.3) years. They were divided into a template group and a free-hand group according to the different screw placements. In the template group of 25 cases, a region-locked 3D-printed template combined with a bi-directional matching scheme was used to assist the pedicle positioning; in the free-hand group of 27 cases, the free hand screw placement was assisted only by image data and C-arm fluoroscopy. The operation time, intraoperative fluoroscopy frequency, intraoperative blood loss, complications, and placement accuracy were compared between the 2 groups. Visual analogue scale (VAS), Oswestry disability index (ODI), and anterior height ratio of the injured vertebra were compared between preoperation, 1 week postoperation, and the final follow-up, as well as between the 2 groups.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All patients were followed up for (11.2±4.2) months. The differences were not statistically significant between the 2 groups in intraoperative blood loss, rate of complications, VAS or ODI at preoperation, 1 week postoperation, or the final follow-up, or in anterior height ratio of the injured vertebra ( P>0.05). In the template group, the operation time [(80.1±18.5) min] was significantly longer than that in the free-hand group [(69.4±16.6) min], the intraoperative fluoroscopy frequency [2 (2, 3) times] significantly lower than that in the free-hand group [3 (3, 4) times], and the placement accuracy [98.4% (127/129)] significantly higher than that in the free-hand group [91.8% (112/122)] (all P<0.05). All patients showed significant improvements in VAS, ODI and anterior height ratio of the injured vertebra at postoperative 1 week compared with the preoperative values, and the improvements at the last follow-up were significantly larger than those at postoperative 1 week ( P<0.05). No injury to the spinal cord, nerve root or blood vessel was observed postoperatively. Conclusions:In the treatment of thoracolumbar fractures, the screw placement assisted by a region-locked 3D-printed template combined with a bi-directional matching scheme is better than free-hand screw placement in terms of improved accuracy and reduced fluoroscopy, but the former incurs longer operative exposure than the latter. There is no significant difference between the 2 methods of screw placement in clinical efficacy.
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Objective:To compare the medium and long-term efficacy between the deltoid split approach and the conventional deltopectoral approach in locking plate fixation for proximal humerus fractures.Methods:A retrospective study was performed in the 65 patients with proximal humerus fracture who had been operatively treated at Department of Orthopedics, The Third People's Hospital of Nantong from January 2018 to December 2020. They were 20 males and 45 females with an age of (64.6±9.2) years. Of them, 34 were assigned to fixation with proximal humerus internal locking system (PHILOS) through the deltoid split approach (minimally invasive group), and 31 to PHILOS fixation through the deltopectoral approach (conventional group). The 2 groups were compared in terms of general data, operation time, intraoperative blood loss, hospital stay, fracture union time, intraoperative fluoroscopy, postoperative 2-year imaging scores, and Constant-Murley shoulder score at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). In the minimally invasive group and the conventional group, respectively, the intraoperative blood loss was (97.9±16.6) mL and (155.8±27.4) mL, and the frequency of intraoperative fluoroscopy (12.0±1.8) times and (6.7±1.8) times, both showing a statistically significant difference ( P<0.05). There was no significant difference in operation time, hospital stay, or fracture union time ( P>0.05). All patients were followed up for (43.9±5.5) months. There was no statistically significant difference between the 2 groups in postoperative 2-year imaging scores ( P>0.05). Compared with the conventional group, patients in the minimally invasive group had significantly lower Constant-Murley strength scores and significantly lower Constant-Murley scores for the Neer four-part fractures ( P<0.05). Postoperatively, one case of screw protrusion and one case of complete ischemic necrosis occurred in both groups while one case of partial ischemic necrosis was observed in the minimally invasive group and 3 cases of partial ischemic necrosis were observed in the conventional group. Conclusions:In locking plate fixation for proximal humerus fractures, compared with the deltopectoral approach, the deltoid split approach shows advantages of less soft tissue damage, less intraoperative bleeding, and less destruction of the blood supply to the humeral head. However, the deltopectoral approach may be more appropriate for the Neer four-part fractures.
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Objective:To explore the clinical effectiveness of a self-designed robot reduction system for femoral intertrochanteric fractures.Methods:A retrospective study was conducted to analyze the 57 patients with intertrochanteric fracture who had been treated at Department of Orthopedics, The Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to February 2023. The patients were divided into a robot group (using the self-designed robot reduction system to assist intramedullary nailing) and a traction bed group (using a traction bed to assist intramedullary nailing) based on their fracture reduction method. The robot group: 31 patients, 11 males and 20 females, with an age of (78.7±9.3) years; 16 left and 15 right sides; 17 cases of type 31-A1, 12 cases of type 31-A2 and 2 cases of type 31-A3 by the AO/OTA classification. The traction bed group: 26 patients, 12 males and 14 females, with an age of (78.7±7.7) years; 13 left and 13 right sides; 16 cases of type 31-A1, 9 cases of type 31-A2 and 1 cases of type 31-A3 by the AO/OTA classification. The 2 groups were compared in terms of reduction and operation time, intraoperative blood loss, fluoroscopy frequency, reduction quality, and VAS and Harris score at preoperation, 1 week and 6 months postoperation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The robot group was significantly better than the traction bed group in reduction time [(4.4±2.2) min versus (9.4±3.2) min], operation time [(29.0±13.5) min versus (49.3±13.3) min], intraoperative blood loss [(76.5±30.5) mL versus (115.0±38.4) mL], fluoroscopy frequency [(10.2±2.6) times versus (14.8±3.2) times], and good/excellent rate of reduction [80.6% (25/31) versus 50.0% (13/26)] ( P<0.05). All patients were followed up for (6.8±0.3) months. Respectively, the VAS scores at preoperation and 6 months postoperation was (6.2±1.3) and (2.4±0.8) points for the robot group, and (6.3±1.3) and (2.7±0.8) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the VAS score was (3.3±1.2) points for the robotic group and (4.8±1.5) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.001). Respectively, the Harris scores at preoperation and 6 months postoperation were (35.3±3.0) and (88.7±3.4) points for the robot group, and (35.6±2.9) and (87.2±3.5) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the Harris score was (57.3±3.7) points for the robotic group and (46.7±2.8) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.05). The patient satisfaction rates in the robot and traction bed groups were 96.8% (30/31) and 92.3% (24/26), respectively, showing no statistically significant difference ( P>0.05). Conclusion:Our self-designed robot reduction for femoral intertrochanteric fractures can effectively shorten reduction and operation time, reduce bleeding and fluoroscopy frequency, and enhance anatomical reduction.
摘要
Objective:To evaluate our self-designed pre-positioned 3D honeycomb guide device in the internal fixation with percutaneous cannulated screws for femoral neck fractures.Methods:A retrospective study was conducted to analyze the data of 60 patients with femoral neck fracture who had been treated with cannulated screw fixation at Department of Orthopaedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine from June 2019 to June 2022. According to the difference in intraoperative positioning for placement of cannulated screws, the patients were divided into a study group of 30 cases whose placement of cannulated screws was assisted by our self-designed pre-positioned 3D honeycomb guide device, and a control group of 30 cases whose cannulated screws were positioned freehand. In the study group, there were 17 males and 13 females with an age of (44.9±9.2) years, and 2 cases of type Ⅱ, 18 cases of type Ⅲ, and 10 cases of type Ⅳ by the Garden classification. In the control group, there were 11 males and 19 females with an age of (43.5±7.9) years), and 1 case of type Ⅱ, 16 cases of type Ⅲ, and 13 cases of type Ⅳ by the Garden classification. Closed reduction and inverted triangle internal fixation with 3 cannulated screws were conducted for all fractures. The Garden crossline index, operation time, fluoroscopy frequency, needle drillings, fracture healing time, and Harris hip functional score at the last follow-up were compared between the 2 groups. The postoperative imaging indicators in the 2 groups were measured, including screw spacing, distance from screw to neck cortex, screw coverage area, parallel deviation between screws, and deviation from screw to neck axis.Results:There were no statistically significant differences in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (14.4±1.9) months after surgery. In the study group, operation time [(33.1±5.5) min], fluoroscopy frequency [(13.7±2.2) times], needle drillings [(3.7±0.6) times], distance from screw to neck cortex [(12.4±2.8) mm], parallel deviation between screws in the anteroposterior view (2.2°±1.1°), parallel deviation between screws in the lateral view (2.4°±1.0°), deviation from screw to neck axis in the anteroposterior view (4.0°±0.9°) and deviation from screw to neck axis in the lateral view (3.2°±0.8°) were all significantly smaller than those in the control group [(46.5±8.6) min, (23.1±5.2) times, (11.0±2.2) times, (19.0±3.3) mm, 6.5°±2.6°, 7.1°±2.9°, 7.7°±2.6°, and 9.2°±3.1°] (all P<0.05). The screw spacing [(45.7±5.8) mm] and screw coverage area [(74.1±10.9) mm 2] in the study group were both significantly larger than those in the control group [(31.3±7.7) mm and (55.5±9.0) mm 2] ( P<0.05). There was no statistically significant difference between the 2 groups in Garden crossline index, fracture healing time, follow-up time, or Harris hip functional score at the last follow-up ( P>0.05). Follow-ups revealed 1 case of bone non-union in the study group and 2 cases of bone non-union and screw withdrawal in the control group, but no such complications as infection, deep vein thrombosis, screw penetration or rupture, or femoral head necrosis in either group. Conclusion:In the internal fixation with percutaneous cannulated screws for the treatment of femoral neck fractures, our self-designed pre-positioned 3D honeycomb guide device can shorten surgical time, significantly reduce fluoroscopy frequency and needle drillings, and effectively improve accuracy of screw placement.
摘要
Objective:To evaluate the reliability and clinical application of a self-established classification system for the lower 1/3 humeral fractures in adults.Methods:A retrospective study was performed to analyze the 88 patients with lower 1/3 humeral fracture who had been admitted to Department of Orthopedics, The Second Hospital of Fuzhou between January 2013 and December 2020. There were 61 males and 27 females with an age of (34.6±12.7) years. The lower 1/3 humeral fractures were classified according to the location of the fracture line, displacement, and bone mass into 3 types: type Ⅰ: transverse and short oblique ones; type Ⅱ: oblique and spiral ones; type Ⅲ: oblique and spiral ones with butterfly-shaped bone mass. After a junior orthopedic surgeon, an intermediate orthopedic surgeon, a senior orthopedic surgeon, and a radiologist had learned this novel classification system, they were asked to classify the lower 1/3 humeral fractures in this cohort independently to assess the reliability of the classification system. Our treatments were based on this novel classification. Open reduction and internal fixation with a unilateral plate through a lateral approach was performed for type Ⅰ fractures, internal fixation with a unilateral plate plus compression screws through a lateral approach for type Ⅱ fractures, and double plate internal fixation through the ulnar and anterolateral approaches for type Ⅲ fractures. The functions of the radial, ulnar, and musculocutaneous nerves and fracture healing time were observed postoperatively. The shoulder and elbow functions were evaluated using Neer shoulder function score and Mayo elbow function score.Results:Of the 88 patients in this cohort, 20 were type Ⅰ, 25 type Ⅱ, and 43 type Ⅲ. The mean Kappa value for inter-observer reliability was 0.878 at the first stage and 0.914 at the second stage, and the mean Kappa value for intra-observer reliability was 0.950. All patients were followed up for (14.1±3.7) months. Iatrogenic injury to the radial nerve was observed in 2 patients, but no injury to the ulnar nerve, the musculocutaneous nerve or important blood vessels or failure of internal fixation was reported. All patients achieved bony union after (12.7±2.0) weeks. The maximum elbow flexion was 137.8°±4.8°, and the maximum elbow extension 2.4°±1.6°. The Mayo elbow function score was (92.0±3.1) points and the Neer shoulder function score (92.2±3.2) points.Conclusions:Our classification system for the lower 1/3 humeral fractures in adults is reliable. As the treatments corresponding to the novel classification system can achieve satisfactory clinical outcomes, the classification system has a clinical value.
摘要
Objective:To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children.Methods:A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing comparability ( P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] ( P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] ( P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] ( P<0.05). Conclusions:Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.
摘要
Objective:To compare the clinical efficacy between a single palmar lateral transverse approach and the modified Henry approach in the locking plate fixation for distal radius fractures.Methods:A retrospective study was conducted to analyze the data of 82 patients with distal radius fracture who had undergone locking plate fixation through either a single palmar lateral approach or the modified Henry approach between January 2016 and December 2022 at Department of Traumatic Orthopaedics, Taihe Hospital, Affiliated to Hubei University of Medicine. There were 25 males and 57 females, with an age of (53.8±12.7) years. Based on the difference in surgical approach, the patients were divided into a single transverse approach group ( n=42) and a modified Henry approach group ( n=40). The 2 groups were compared in terms of injury cause, injury location, time from injury to surgery, AO fracture classification, tourniquet time during surgery, incision length, fracture reduction, Patient and Observer Scar Assessment Scale (PSAS & OSAS) and Disability of the Arm, Shoulder, and Hand (DASH) score at the last follow-up, and complications after surgery. Results:There were no statistically significant differences in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (8.2±3.5) months. Follow-ups revealed one case of injury to the palmar cutaneous branch of the median nerve but no other complications like infection, non-union, internal fixation failure, or tendon injury in the single transverse approach group. The single transverse approach group was significantly superior over the modified Henry approach group in incision length [(2.4±0.9) cm versus (5.3±1.6) cm], OSAS (8.1±4.2 versus 10.3±5.7), and PSAS (10.1±5.8 versus 14.7±6.4) ( P<0.05). There were no significant differences between the 2 groups in tourniquet time, fracture reduction quality, and DASH score at the last follow-up ( P>0.05). Conclusion:In locking plate fixation for distal radius fractures, in comparison with the modified Henry approach, a single palmar lateral approach is more minimally invasive so that more aesthetically pleasing outcomes can be achieved to facilitate patients' rapid return to work and society.
摘要
Objective:To investigate the efficacy of double S-shaped elastic stable intramedullary nailing in the treatment of paediatric fractures of the distal tibia diaphyseal metaphyseal junction.Methods:From January 2018 to January 2022, a total of 25 children with fracture of the distal tibia diaphyseal metaphyseal junction were treated at Department of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University. All of them were treated with closed reduction and double S-shaped elastic stable intramedullary nailing. There were 16 males and 9 females with an average age of (10.4±3.3) years, and 14 left sides and 11 right sides. The operation time, imaging results and complications were recorded after operation. At the last follow-up, the American Orthopaedic Foot & Ankle Society (AOFAS) scoring was used to evaluate the efficacy.Results:Closed reduction succeeded in all patients. The operation time was (55.6±23.7) min. Follow-up lasted (20.5±4.7) months for this cohort. Bony union was achieved in all patients after (11.5±2.7) weeks. No postoperative complications occurred in the patients, like infection, loss of reduction, disparity in length of lower limbs, delayed union or non-union. The AOFAS scoring at the last follow-up yielded 23 excellent and 2 good cases, and an excellent and good rate of 100% (25/25).Conclusion:In the treatment of paediatric fractures of the distal tibia diaphyseal metaphyseal junction, double S-shaped elastic stable intramedullary nailing is a safe, effective and feasible option.
摘要
Objective:To evaluate the effect of the impaction of posterior wall on the prognosis following open reduction and internal fixation for fractures of acetabular posterior wall.Methods:A retrospective study was conducted to analyze the data from the 83 patients with fracture of acetabular posterior wall who had been consecutively treated by open reduction and internal fixation at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from January 2017 to December 2020. The patients were divided into 2 groups based on involvement of posterior wall impaction. In the impaction group of 33 cases, there were 26 males and 7 females with an age of (47.4±11.6) years; in the non-impaction group of 50 cases, there were 43 males and 7 females with an age of (41.3±12.0) years. The quality of postoperative fracture reduction, the function of the affected hip at the last follow-up, and the complication rate during follow-up were compared between the 2 groups. Multifactorial binary logistic regression and age subgroups were used to analyze the effects of posterior wall impaction on functional outcomes.Results:The age, rate of associated injuries in other body parts, and rate of posterior wall comminution in the impaction group were significantly higher than those in the non-impaction group ( P<0.05), but there was no statistically significant difference in other general data of patients between the 2 groups ( P>0.05). All patients were followed up for (44.5±13.3) months after surgery. The rate of anatomical reduction in the non-impaction group (96.0%, 48/50) was significantly higher than that in the impaction group (57.6%, 19/33) ( P<0.05), and the good and excellent rate by the modified Merle d'Aubigné & Postel scale at the last follow-up in the non-impaction group (84.0%, 42/50) was significantly higher than that in the impaction group (51.5%, 17/33) ( P<0.05). There was no significant difference in the incidence of complications between the 2 groups ( P>0.05). After adjusting for age and gender, the difference in hip function was still significantly different between the 2 groups ( OR=0.23, 95% CI: 0.06 to 0.79, P=0.020). The effect of posterior wall impaction on functional outcomes was statistically significant in patients aged ≥50 years ( P=0.008), whereas the difference was not statistically significant in patients aged <50 years ( P=0.194). Conclusions:Compared with non-impaction ones, acetabular fractures of posterior wall impaction tend to lead to poorer quality of reduction, which in turn affects the postoperative recovery of hip joint function. The impact of impaction fractures on functional recovery is more significant in patients aged 50 years and above.
摘要
Objective:To investigate the effectiveness of the modified Bikini approach in the fixation of acetabular fracture with an integrated wing-shaped anatomical locking plate.Methods:A retrospective study was conducted to analyze the data of 54 patients with acetabular fracture who had been treated at Department of Trauma Orthopedics, Orthopedic Medical Center, The Third Hospital Affiliated to Southern Medical University from May 2017 to June 2021. The patients were divided into 2 groups based on different surgical approaches: an observation group [26 cases, 6 males, 20 females; aged 40.0 (29.8, 46.8) years] treated with fixation with an integrated wing-shaped anatomical locking plate through the modified Bikini approach, and a control group [28 cases, 10 males, 18 females; aged 34.5 (24.0, 43.5) years] treated with fixation with an integrated wing-shaped anatomical locking plate through the lateral-rectus approach. The incision length, operation time, intraoperative bleeding, length of hospital stay, quality of postoperative fracture reduction, visual analog scale (VAS) for pain, hip function, Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were compared between the 2 groups.Results:The differences in the preoperative general data between the 2 groups were not statistically significant, indicating comparability ( P>0.05). There were no statistically significant differences between the 2 groups either in terms of incision length, operation time, intraoperative bleeding, or hospital stay ( P>0.05). The 2 groups were not significantly different in the excellent/good rate of fracture reduction [100.0% (26/26) versus 92.9% (26/28)], VAS at 1 month postoperation [2.0(1.0, 3.0) versus 2.0(1.0, 3.0)], or the modified Merle d'Aubigné and Postel hip score at 12 months postoperation [13.5(12.3, 14.8) versus. 14.0(13.0, 15.0)] ( P>0.05). However, the VSS [4.50(4.00, 6.00)] and POSAS (29.85±10.05) at 12 months postoperation in the observation group were significantly lower than those in the control group [6.50(5.00, 8.25) and 37.11±11.75] ( P<0.05). Conclusion:In the fixation of acetabular fracture with an integrated wing-shaped anatomical locking plate, the modified Bikini approach can not only achieve as fine early clinical efficacy as the lateral-rectus approach, but also demonstrate the aesthetic advantages of smaller incision scar and more hidden incision.
摘要
Objective:To investigate the surgical outcomes of acetabular posterior wall fractures in patients aged 50 and above.Methods:A retrospective study was conducted to analyze the clinical data of 67 patients with acetabular posterior wall fracture who had been treated through the Kocher-Langenbeck approach and fully followed up from August 2003 to November 2021. There were 54 males and 13 females, aged 59.0 (54.0, 63.0) years. The time from injury to surgery was 8.0 (5.0, 13.0) days. Open reduction and internal fixation was performed for 63 cases and hip arthroplasty for 4 cases by one stage. The operation time, intraoperative bleeding, quality of postoperative fracture reduction, recovery of hip function at the last follow-up, and incidence of complications during the follow-up period were recorded.Results:The operation time for the 67 patients was 90.0 (67.5, 101.3) min, and the intraoperative bleeding 350.0 (300.0, 450.0) mL. According to the Matta criteria, 63 patients with internal fixation achieved anatomical reduction. All the 67 patients were followed up for (112.8±62.4) months. According to the modified Merle d'Aubigné & Postel scoring system, the function of the affected hip was assessed at the last follow-up in the 63 patients with internal fixation as excellent in 56 cases, as good in 3 cases, as fair in 2 cases, and as poor in 2 cases, giving an excellent and good rate of 93.6% (59/63). The prostheses survived in all the 4 patients who underwent one-stage hip replacement, with hip Harris scores of 94, 92, 91, and 93, respectively. Complications included 15 cases (23.8%, 15/63) of heterotopic ossification and 1 case (1.6%, 1/63) of transient sciatic nerve palsy. Femoral head ischemic necrosis and traumatic arthritis occurred in 2 patients (3.2%, 2/63) who had to receive total hip arthroplasty 3 years after surgery.Conclusion:Open reduction and internal fixation is still the main treatment method for acetabular posterior wall fractures in patients aged 50 and above, because it can achieve good clinical outcomes and help the patients recover joint function and quality of life at an early stage.
摘要
Objective:To explore the clinical efficacy of operative treatment of geriatric pelvic fractures.Methods:A retrospective study was conducted to analyze the clinical data of 55 geriatric patients with pelvic fracture who had been operatively treated at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2020 to October 2023. There were 13 males and 42 females with an age of 72.0 (68.0, 83.3) years. By the AO/OTA classification, there were 47 cases of type B and 8 cases of type C; by the classification for fragility fractures of pelvis, there were 5 cases of type Ⅱ, 44 cases of type Ⅲ, and 6 cases of type Ⅳ. The patients received operative treatment 4.0 (3.0, 6.3) days after injury. Of the 10 patients treated by open reduction and closed reduction, the posterior ring was fixated by a plate in 7 and by screws in 3, and the anterior ring was fixated by either a plate, an external fixator or a minimally invasive anterior pelvic ring internal fixator except in the 2 cases receiving no fixation. Of the other 45 patients treated by closed reduction and fixation, the posterior ring was all fixated by screws except in the 2 cases receiving no fixation, and the anterior ring was fixated by either screws, an external fixator or a minimally invasive anterior pelvic ring internal fixator except in the 10 cases receiving no fixation. The major peri-operative complications, quality of fracture reduction, mortality, and functional recovery of the pelvis at the last follow-up were recorded.Results:There were no major peri-operative complications. According to the Matta criteria, the quality of fracture reduction was excellent in 31, good in 14, fair in 8 and poor in 2 cases, giving a good to excellent rate of 81.8% (45/55). Fifty-four cases were followed up for (15.4±9.1) months and 1 case was lost to the follow-up. Four cases died within 1 year after operation, giving a mortality of 7.4% (4/54). The modified Majeed score at the last follow-up was 69 (54, 76) for the 46 cases who had been followed up for longer than 4 months; the functional recovery of the pelvis at the last follow-up was rated as excellent in 27 cases, as good in 8 cases and as fair in 11 cases, giving a good to excellent rate of 76.1% (35/46) according to the criteria proposed by the faculty of the writers. The internal fixation failed in 3 cases during the follow-up.Conclusion:For the geriatric pelvic fractures, operative treatment can lead to satisfactory clinical outcomes.
摘要
Objective:To compare the therapeutic efficacy between femoral neck system (FNS) and cannulated compression screws (CCS) in the fixation of femoral neck fractures in the elderly patients aged 65 to 75 years old.Methods:A retrospective study was conducted to analyze the data of 39 patients aged 65 to 75 years old who had been treated for femoral neck fractures at Department of Trauma Surgery, Hospital Affiliated to Qingdao University from January 2015 to September 2022. The patients were divided into 2 groups according to their internal fixation methods. In the FNS group of 18 cases subjected to FNS fixation, there were 8 male and 10 females with an age of (71.1±2.8) years. In the CCS group of 21 cases subjected to CCS fixation, there were 7 males and 14 females with an age of (70.1±2.9) years. The 2 groups were compared in terms of intraoperative fluoroscopy frequency, surgical time, intraoperative bleeding, hospitalization costs, fracture healing time, internal fixation failure, and Harris hip score, changes in neck shaft angle, and femoral neck shortening at 1 year after surgery.Results:The differences were not statistically significant in the preoperative general data or follow-up time between the 2 groups, indicating comparability ( P>0.05). In the FNS group, the intraoperative fluoroscopy frequency [(15.1±2.3) times] was significantly lower than that in the CCS group [(19.5±3.5) times], the surgical time [(49.2±5.2) minutes] was significantly shorter than that in CCS group [(62.4±11.2) minutes], and the intraoperative bleeding [(74.2±15.6) mL] and hospitalization costs [(39,928.7±1,438.3) yuan] were significantly higher than those in the CCS group [(53.1±17.3) mL and (23,527.9±2,126.3) yuan] (all P<0.05). The difference in fracture healing time was not statistically significant between the 2 groups ( P>0.05). In the FNS group, the decreased neck shaft angle (2.65°±1.66°) and femoral neck shortening (3.9±1.3 mm) were significantly smaller than those in the CCS group [4.18°±2.13° and (6.3±2.5) mm] at 1 year after surgery, and the Harris hip score [(82.2±7.2) points] was significantly higher than that in the CCS group [(76.4±5.9) points] (all P<0.05). Internal fixation failure occurred in 1 case in the FNS group and in 4 cases in the CCS group, respectively, showing no statistically significant difference ( P>0.05). Conclusions:Compared with CCS fixation, FNS fixation may lead to better therapeutic efficacy in patients with femoral neck fracture aged 65 to 75 years old. However, the risk of internal fixation failure should also be taken into consideration.