Comparison of Femoral Neck System and Three Cannulated Cancellous Screws in the Treatment of Vertical Femoral Neck Fractures: Clinical Observation and Finite Element Analysis

Overview

Journal Biomed Eng Online

Publisher Biomed Central

Specialty Biomedical Engineering

Date 2023 Mar 1

PMID 36859241

Authors

Shaolong Huang

Yazhong Zhang

Xu Zhang

Chengqiang Zhou

Wenbo Li

Yunqing Wang

Bin Wang

Ziqiang Zhu

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this study was to compare the biomechanical and clinical results of two surgical methods for the treatment of vertical femoral neck fractures: Femoral neck system (FNS) and traditional three cannulated cancellous screws (CCS).

Methods: First, we developed three different vertical femoral neck fracture models for the finite element analysis, with angles of 55°, 65°, and 75°, respectively. Two experimental groups were set up: the FNS group and the CCS group. Each fracture group was tested under axial loads of 2100 N to measure the femur's displacement, Von Mises stress (VMS), and its internal fixation components. Secondly, we retrospectively included the cases of vertical femoral neck fractures with FNS and CCS in our hospital from May 2019 to May 2021. In this study, we compared the duration of intraoperative fluoroscopy, operative time, hospital stay, fracture healing time, Hemoglobin loss, Harris score of hip joint function, and postoperative complications among patients undergoing hip joint replacement.

Results: In terms of finite element analysis, FNS has better anti-displacement stability than CCS at 55°and 65°, while FNS is greater than CCS in Von Mises stress. Clinically, we followed up on 87 patients for an average of 12 months. FNS was superior to traditional CCS in fracture healing time, operation time, fluoroscopy duration, fracture healing time, and Harris hip function score.

Conclusion: FNS is superior to traditional CCS in biomechanical and clinical aspects of treating vertical femoral neck fractures. There is potential for FNS to become a new treatment option for vertical femoral neck fractures.

Citing Articles

Computational evaluation of the biomechanical effects of position changes in the femoral neck system on Pauwels type III femoral neck fractures: an in silico study.

Zhang X, Zhang S, Zhong Z, Zhang W, Xiong Z Front Bioeng Biotechnol. 2025; 13:1493555.

PMID: 40066362 PMC: 11891373. DOI: 10.3389/fbioe.2025.1493555.

Femoral neck system (FNS) versus 4 cannulated compression screws (CCSs) in the treatment of young patients with Pauwels type III femoral neck fracture: a retrospective comparative study.

Gao Y, Ma T, Chang X, Jia P, Li X, Tang X J Orthop Surg Res. 2025; 20(1):65.

PMID: 39827144 PMC: 11742197. DOI: 10.1186/s13018-025-05461-4.

Biomechanical evaluation of percutaneous compression plate and femoral neck system in Pauwels type III femoral neck fractures.

Xie X, Bi S, Song Q, Zhang Q, Yan Z, Zhou X J Orthop Traumatol. 2024; 25(1):61.

PMID: 39614019 PMC: 11607197. DOI: 10.1186/s10195-024-00792-0.

Biomechanical effects of FNS on femoral neck fractures based on different reduction quality: finite element analysis.

Zhang X, Zhang Y, Huang S, Qi X, Li W, Lv Y BMC Musculoskelet Disord. 2024; 25(1):914.

PMID: 39548463 PMC: 11566252. DOI: 10.1186/s12891-024-08041-5.

The Effects and Risk Factors of Femoral Neck Shortening after Internal Fixation of Femoral Neck Fractures.

Lee D, Kwon J, Kim K Clin Orthop Surg. 2024; 16(5):718-723.

PMID: 39364104 PMC: 11444948. DOI: 10.4055/cios24089.

References

Guo J, Dong W, Yin B, Jin L, Lin Z, Hou Z . Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures. J Int Med Res. 2018; 47(2):557-568. PMC: 6381514. DOI: 10.1177/0300060518816185. View

Ye Y, Chen K, Tian K, Li W, Mauffrey C, Hak D . Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results. Injury. 2017; 48(10):2189-2193. DOI: 10.1016/j.injury.2017.08.017. View

Moon J, Lee J, Hwang K, Yang J, Park Y, Park K . Biomechanical comparison of the femoral neck system and the dynamic hip screw in basicervical femoral neck fractures. Sci Rep. 2022; 12(1):7915. PMC: 9098555. DOI: 10.1038/s41598-022-11914-1. View

Davey M, Flynn S, Hayes J, Feeley I, Grant Freemantle M, Burke N . Two-hole versus four-hole plate dynamic hip screw: a systematic review of current evidence. Ir J Med Sci. 2020; 189(4):1317-1322. DOI: 10.1007/s11845-020-02184-9. View

Zhang Y, Tian L, Yan Y, Sang H, Ma Z, Jie Q . Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures. Injury. 2011; 42(11):1372-6. DOI: 10.1016/j.injury.2011.07.004. View

Matheus Guimaraes J, Rocha L, Noronha Rocha T, Bonfim D, da Costa R, Cavalcanti A . Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw. Injury. 2017; 48 Suppl 4:S10-S16. DOI: 10.1016/S0020-1383(17)30769-6. View

Mir H, Collinge C . Application of a medial buttress plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults. Med Hypotheses. 2015; 84(5):429-33. DOI: 10.1016/j.mehy.2015.01.029. View

Hu H, Cheng J, Feng M, Gao Z, Wu J, Lu S . Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. J Orthop Surg Res. 2021; 16(1):370. PMC: 8188789. DOI: 10.1186/s13018-021-02517-z. View

Luo D, Zou W, He Y, Xian H, Wang L, Shen J . Modified dynamic hip screw loaded with autologous bone graft for treating Pauwels type-3 vertical femoral neck fractures. Injury. 2017; 48(7):1579-1583. DOI: 10.1016/j.injury.2017.05.031. View

10.

Samsami S, Saberi S, Sadighi S, Rouhi G . Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations. J Med Biol Eng. 2015; 35(5):566-579. PMC: 4609309. DOI: 10.1007/s40846-015-0085-9. View

11.

Fan Z, Huang Y, Su H, Jiang T . How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury. 2021; 52(8):2116-2125. DOI: 10.1016/j.injury.2021.05.043. View

12.

Okcu G, Ozkayin N, Erkan S, Tosyali H, Aktuglu K . Should full threaded compression screws be used in adult femoral neck fractures?. Injury. 2015; 46 Suppl 2:S24-8. DOI: 10.1016/j.injury.2015.05.028. View

13.

Freitas A, Toledo Junior J, Ferreira Dos Santos A, Aquino R, Leao V, Pericles de Alcantara W . Biomechanical study of different internal fixations in Pauwels type III femoral neck fracture - A finite elements analysis. J Clin Orthop Trauma. 2021; 14:145-150. PMC: 7920117. DOI: 10.1016/j.jcot.2020.06.006. View

14.

Tang Y, Zhang Z, Wang L, Xiong W, Fang Q, Wang G . Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: a preliminary comparative study. J Orthop Surg Res. 2021; 16(1):504. PMC: 8365927. DOI: 10.1186/s13018-021-02659-0. View

15.

Schopper C, Zderic I, Menze J, Muller D, Rocci M, Knobe M . Higher stability and more predictive fixation with the Femoral Neck System versus Hansson Pins in femoral neck fractures Pauwels II. J Orthop Translat. 2020; 24:88-95. PMC: 7387742. DOI: 10.1016/j.jot.2020.06.002. View

16.

MacLeod A, Rose H, Gill H . A Validated Open-Source Multisolver Fourth-Generation Composite Femur Model. J Biomech Eng. 2016; 138(12). DOI: 10.1115/1.4034653. View

17.

Jacob G, Pai S, Huggi V, Kotekar M, Yogesh K, Kumar M . Lag screw with DHS (LSD) for vertical angle femoral neck fractures in young adults. Injury. 2020; 51(11):2628-2633. DOI: 10.1016/j.injury.2020.07.050. View

18.

Slobogean G, Stockton D, Zeng B, Wang D, Ma B, Pollak A . 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. 2017; 48(8):1837-1842. DOI: 10.1016/j.injury.2017.06.013. View

19.

Luttrell K, Beltran M, Collinge C . 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) membership. J Orthop Trauma. 2014; 28(9):e221-5. DOI: 10.1097/BOT.0000000000000080. View

20.

Nowotarski P, Ervin B, Weatherby B, Pettit J, Goulet R, Norris B . Biomechanical analysis of a novel femoral neck locking plate for treatment of vertical shear Pauwel's type C femoral neck fractures. Injury. 2011; 43(6):802-6. DOI: 10.1016/j.injury.2011.09.012. View