Efficacy of internal fixation using cannulated screw combined with fibular allograft in the treatment of femoral neck fracture in young and middle-aged patients
Objective To compare the efficacy of internal fixation using cannulated screw combined with fibular allograft and internal fixation using cannulated screw alone in the treatment of femoral neck fracture in young and middle-aged patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 75 young and middle-aged patients with femoral neck fracture admitted to the Third Hospital of Hebei Medical University from January 2020 to December 2022,including 44 males and 31 females,aged 34-56 years[(46.1±12.7)years].According to Garden classification,26 patients were classified as type Ⅱ,35 type Ⅲ and 14 type Ⅳ.According to the Pauwels classification,9 patients were classified as type Ⅰ,31 type Ⅱ and 35 type Ⅲ.Forty-nine patients were treated with internal fixation using three cannulated screws alone(cannulated screw group)and 26 with internal fixation using three cannulated screws combined with double-barrel fibular allograft(cannulated screw combined with bone grafting group).The operation time,intraoperative blood loss,length of hospital stay,and quality of fracture reduction were compared between the two groups.At 4,8 months after operation and at the last follow-up,grading of femoral neck shortening,number of patients walking with crutches,Barthel index,and Harris hip function score were evaluated.The incidence of complications was measured at the last follow-up.Results All the patients were followed up for 16-37 months[(23.2±4.5)months].The operation time of the cannulated screw combined with bone grafting group was(86.3±16.1)minutes,longer than(76.9±20.8)minutes of the cannulated screw group(P＜0.05).The intraoperative blood loss was 100.0(50.0,200.0)ml in the cannulated screw combined with bone grafting group,more than 50.0(50.0,100.0)ml in the cannulated screw group(P＜0.01).There were no significant differences in the length of hospital stay or the quality of fracture reduction between the two groups(P＞0.05).At 4 months after operation,grading of the femoral neck shortening in the cannulated screw combined with bone grafting group[24 patients(92.3％)with grade 1,2(7.7％)with grade 2,and 0(0.0％)with grade 3]was better than that in the cannulated screw group[18 patients(36.7％)with grade 1,28(57.1％)with grade 2,and 3(6.2％)with grade 3](P＜0.01).At 8 months after operation,grading of femoral neck shortening in the cannulated screw combined with bone grafting group[22 patients(84.6％)with grade 1,3(11.5％)with grade 2,and 1(3.8％)with grade 3]was better than that in the cannulated screw group[13 patients(26.5％)with grade 1,27(55.1％)with grade 2,and 9(18.4％)with grade 3](P＜0.01).At the last follow-up,grading of femoral neck shortening in the cannulated screw combined with bone grafting group[19 patients(73.0％)with grade 1,5(19.2％)with grade 2,and 2(7.6％)with grade 3]was better than that in the cannulated screw group[8 patients(16.3％)with grade 1,31(63.2％)with grade 2,and 10(20.4％)with grade 3](P＜0.01).At 4,8 months after operation and at the last follow-up,12(46.2％),8(30.8％)and 5(19.2％)patients in the cannulated screw combined with bone grafting group and 38(77.6％),27(55.1％)and 20(40.8％)patients in the cannulated screw group had to walk with crutches,respectively,showing significant difference between the two groups at the other two time points(P＜0.05 or 0.01)except for at the last follow-up(P＞0.05).The Barthel index values were 85.3±3.2,90.3±4.3,and 95.3±3.9 in the cannulated screw combined with bone grafting group at 4,8 months after operation and at the last follow-up,significantly higher than 80.8±7.3,85.4±7.4,and 90.9±7.8 in the cannulated screw group(P＜0.05 or 0.01).The Harris hip scores were(87.0±2.9)points,(92.0±2.9)points and(91.3±2.4)points in the cannulated screw combined with bone grafting group at 4,8 months after operation and at the last follow-up,significantly higher than(81.0±6.1)points,(85.7±5.8)points,and(89.6±2.0)points in the cannulated screw group(P＜0.01).At the last follow-up,the complication rate was 3.8％(1/26)in the cannulated screw combined with bone grafting group,significantly lower than 22.4％(11/49)in the cannulated screw group(P＜0.05).Conclusion For femoral neck fractures in young and middle-aged patients,compared with internal fixation using cannulated screw alone,internal fixation using cannulated screw combined with fibular allograft has more advantages in correcting femoral neck shortening,restoring independent living activities and hip joint function,and reducing the incidence of complications despite its longer operation time and more intraoperative blood loss.
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