Chao CHEN, Li YU, Xin TANG, Mo-zhen LİU, Li-zhong SUN, Changjian LİU, Zhen ZHANG, Chang-zhou Lİ

Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures: A retrospective study

Objective: The aim of this study was to compare clinical outcomes of patients with femoral neck fractures treated with the dynamic hip system blade (DHS-BLADE) or cannulated compression screws. Methods: Eighty-six patients with femoral neck fractures were treated by closed reduction internal fixation with a DHS-BLADE (n = 42; 18 males and 24 females; mean age: 56.3 years (37e87)) or cannulated compression screws (n = 44; 20 males and 24 females; mean age: 53.8 years (26e83)) between March 2011 and August 2013. The groups were compared with Harris hip score, operation time, surgical blood loss, incision size, hospital stay, and related complications. Results: The average follow-up time was 27 months (range, 24e36 months). There was no significant difference for the operation time, incision size, hospital stay, and Harris hip score between the groups. Also, no statistically significant differences in the rates of nonunion (4.5% vs. 0) and avascular necrosis of the femoral head (9.1% vs. 7.1%) were observed. However, the screw group experienced significantly less surgical blood loss (32.4 ± 24.7 ml) than the blade group (87.2 ± 46.6 ml; P = 0.041). The incidence of femoral neck shortening above 10 mm in the screw group was significantly higher than that in the blade group (15.9% vs. 2.4%, P = 0.031). The blade group had a significantly lower incidence of screw migration than the screw group (4.8% vs. 22.7%, P = 0.016). Conclusion: The DHS-BLADE and cannulated compression screws might be equally effective in terms of postoperative fracture union. However, the DHS-BLADE has advantages over cannulated compression screws for preventing femoral neck shortening, screw migration, and cut-out

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1. Broderick JM, Bruce-Brand R, Stanley E, et al. Osteoporotic hip fractures: the burden of fixation failure. Sci World J. 2013;2013:515197.

2. Wilk R, Skrzypek M, Kowalska M, et al. Standardized incidence and trend of osteoporotic hip fracture in Polish women and men: a nine year observation. Maturitas. 2014;77:59e63.

3. Parker MJ. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Jt Surg Am. 2009;91:490e491.

4. Sommers MB, Roth C, Hall H, et al. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma. 2004;18:361e368.

5. Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury. 2008;39:932e939.

6. Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury. 2006;37:984e989.

7. Windolf M, Muths R, Braunstein V, et al. Quantification of cancellous bonecompaction due to DHS Blade insertion and influence upon cut-out resistance. Clin Biomech (Bristol, Avon). 2009;24:53e58.

8. Windolf M, Braunstein V, Dutoit C, et al. Is a helical shaped implant a superior alternative to the Dynamic Hip Screw for unstable femoral neck fractures? A biomechanical investigation. Clin Biomech (Bristol, Avon). 2009;24:59e64.

9. Leung F, Gudushauri P, Yuen G, et al. Dynamic hip screw blade fixation for intertrochanteric hip fractures. J Orthop Surg. 2013:132e133.

10. Zhao WB, Liu L. Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis. Chin J Traumatol. 2014;17: 275e278.

12. Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001;93:82e87.

13. Wong J, Hossam E, Suntheralingam Y, Rampersaud R, Chung F. Tranexamic acid reduces blood loss and transfusion in adult patients having spinal fusion surgery. Can J Anesth. 2006;53(suppl 1):26385.

14. Boraiah S, Paul O, Hammoud S, Gardner MJ, Helfet DL, Lorich DG. Predictable healing of femoral neck fractures treated with intraoperative compression and length-stable implants. J Trauma. 2010;69:142e147.

15. Zlowodzki M, Jonsson A, Paulke R. Shortening after femoral neck fracture € fixation: is there a solution? Clin Orthop Relat Res. 2007;461:213e218.

16. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Jt Surg Am. 1969;51:737e755.

17. Marchetti P, Binazzi R, Vaccari V, et al. Long-term results with cementless Fitek (or Fitmore) Cups. J Arthroplasty. 2005;20:730e737.

18. Estrada LS, Volgas DA, Stannard JP, Alonso JE. Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002;399:110e118.

19. Kold S, Bechtold JE, Mouzin O, Elmengaard B, Chen X, Søballe K. Fixation of revision implants is improved by a surgical technique to crack the sclerotic bone rim. Clin Orthop Relat Res. 2005;432:160e166.

20. O'Neill F, Condon F, McGloughlin T, Lenehan B, Coffey JC, Walsh M. Dynamic hip screw versus DHS blade: a biomechanical comparison of the fixation achieved by each implant in bone. J Bone Jt Surg Br. 2011;935:616e621.

21. Zhang Pei-xun, Dang Yu, Xue Feng, et al. Clinical analysis of obvious and hidden blood loss during treatment of intertrochanter fracture with proximal femoral nail anti-rotation. Chin J Trauma. 2011;27:785e788.

22. Bhandari M, Rd TP, Hanson B, et al. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? J Orthop Trauma. 2009;23: 403e407.

23. Angelini M, Mckee MD, Waddell JP, et al. Salvage of failed hip fracture fixation. J Orthop Trauma. 2009;23:471.

24. Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractureseno problems? A consecutive study of 224 patients treated with internal fixation. Injury. 2009;40:274e276.

25. Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Jt Surg Am. 2004;86-A:1711e1716.

26. Bosch U, Schreiber T, Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res. 2002;399: 59e71.

27. Kold S, Bechtold JE, Mouzin O, et al. Fixation of revision implants is improved by a surgical technique to crack the sclerotic bone rim. Clin Orthop Relat Res. 2005;432:160e166.

28. Su Y, Chen W, Zhang Q, et al. An irreducible variant of femoral neck fracture: a minimally traumatic reduction technique. Injury. 2011;42:140e145.

29. Zlowodzki M, Brink O, Switzer J, et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Jt Surg Br. 2008;90:1487e1494.

30. Nüchtern JV, Ruecker AH, Sellenschloh K, et al. Malpositioning of the lagscrews by one- or two-screw nailing systems for pertrochanteric femoral fractures: a biomechanical comparison of Gamma3 and Intertan. J Orthop Trauma. 2014;28:276e282.

31. Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8:35.