Surgical Treatment of Femoral Neck Fractures

Orlin Filipov, M.D., Ph.D.
Head of Orthopedic Department, Vitosha Hospital Simeonovsko, Sofia, Bulgaria

Series: Surgery – Procedures, Complications, and Results, Orthopedic Research and Therapy
BISAC: MED085020

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While arthroplasty is the preferred treatment for most elderly patients with displaced femoral neck fractures, internal fixation is the treatment of choice in the majority of patients below the age of 65 as a joint-preserving procedure. The osteosynthesis of fractures of the femoral neck in the elderly has been partly abandoned during the last years due to the poor clinical outcomes following the conventional fixation with parallel screws or DHS. Based on clinical evidence and laboratory testing, the novel method of biplane double-supported screw fixation (BDSF) offers much better fixation stability, reflecting in excellent clinical outcomes. With its innovative biomechanic principle, the BDSF method provides supreme stability for cannulated screw fixation, achieving up to 44% higher axial fixation strength in vitro, and a rate of bone union reaching up to 96.6% in clinical practice, which is much higher than the conventional parallel screw fixation data.

The method of BDSF provides supreme stability by buttressing two out of three medially diverging cannulated screws on the inferior femoral neck cortex and supporting the steeper inferior screw on the posterior femoral neck cortex. The two calcar screws are oriented in different coronal inclinations intended to provide constant fixation strength during different patient activities and load directions. Biomechanically, the most effective component is the inferior screw placed at an obtuse angle and supported on a large area along the inferior and posterior cortex of the femoral neck following its spiral anterior curve.
Given the clinical outcomes, BDSF is the perfect technique for femoral neck fracture fixation, as the fracture healing rate is high at 96% with this approach. Therefore, BDSF is not only a treatment alternative to conventional fixation, but also a much better procedure. Thus, BDSF should be routinely applied, and conventional fixation gradually abandoned in clinical practice (this has been the approach in our institution over the last ten years).
This book describes the full surgical technique of the method of BDSF for femoral neck fracture osteosynthesis; quality criteria and surgical recommendations for successful BDSF implementation, according to the vast clinical experience of ten years with this highly effective method.

A novel surgical approach for hip arthroplasty is described in this book. The current trends aimed at decreasing operative trauma and blood loss have been not entirely satisfied with respect to most of the standard approaches for hip arthroplasty. These surgeries are often associated with considerable blood loss and the necessity for restricting patients’ activities in the postoperative period due to impaired joint stability and risk of dislocations.
This book describes the full surgical technique of the novel anatomical direct lateral approach for hip arthroplasty, aimed at decreasing blood loss, minimizing operative trauma, and optimizing joint stability. This technique is associated with minimal blood loss and high joint stability. Patients are allowed to perform activities within the normal range of motion in the early postoperative period.

This book describes also the history of internal fixation in femoral neck fractures, as well as the biomechanics of femoral neck fracture osteosynthesis and the role of the implants.

Volume I. Introduction

Chapter 1. History of the Surgical Treatment of the Fractures of the Femoral Neck

Chapter 2. Epidemiology

Chapter 3. Biological Aspects and Risk Factors

Chapter 4. Surgical Anatomy

Chapter 5. Mechanism of Femoral Neck Fractures

Chapter 6. Hip Joint Biomechanics and Biomechanics of Femoral Neck Fracture Osteosynthesis Construct

Volume II. Diagnosis

Chapter 7. Classification

Chapter 8. Clinical Diagnosis and Imaging

Volume III. Treatment

Chapter 9. Treatment of Femoral Neck Fractures. Indications, Choice of Implants, Reduction

Volume IV. Surgical Techniques for Internal Fixation of Femoral Neck Fractures

Chapter 10. Biplane Double-supported Screw Fixation (BDSF) – the New Era in Femoral Neck Fracture Osteosynthesis

Chapter 11. Internal Fixation with Parallel Cannulated Screws

Chapter 12. Internal Fixation with Fixed-Angle Devices

Chapter 13. Special and Difficult Cases

Chapter 14. Auxiliary Techniques Enhancing Internal Fixation

Chapter 15. Post-Surgical Treatment

Chapter 16. Experience and Motivation of the Surgeon

Chapter 17. Results after Internal Fixation

Chapter 18. Complications after Internal Fixation of Femoral Neck Fractures

Volume V. Arthroplasty

Chapter 19. Arthroplasty Procedures in Femoral Neck Fractures

Volume VI. Internal Fixation versus Primary Arthroplasty

Chapter 20. Femoral Neck Fractures in Young Patients

Chapter 21. Femoral Neck Fractures in Senile Patients

Chapter 22. Internal Fixation versus Primary Arthroplasty

Index

“This book raises fundamental issues concerned with the surgical treatment of femoral neck fractures. Following a comprehensive account on the history of the treatment of femoral neck fractures, state of the art of the methods and novel techniques based on the author’s own development and experience are presented in detail. Thus, for internal fixation, the contemporary BDSF method offers a much better fixation strength compared to the older conventional fixation methods. For the elderly patients, where arthroplasty is normally the procedure of choice, the anatomical direct lateral approach, a modification of the standard direct lateral approach, is described. Biomechanical analyses enlighten the descriptions of the methods presented. Author Filipov has created a well written and presented didactic important resource for a broad audience of orthopedic surgeons, applied researchers and students interested in the surgical treatment of fractures of the femoral neck.” - Professor Emeritus Joseph Mizrahi, D.Sc., Fellow, American Institute for Medical and Biological Engineering, Department of Biomedical Engineering, Technion, Israel Institute of Technology; Haifa, Israel

"Surgical Treatment of Femoral Neck Fractures compiles, in concise, didactic fashion, the fundamental topics related to both internal fixation of, and arthroplasty for, femoral neck fractures in young and elderly patients. Causal biological and biomechanical aspects and mechanisms for these fractures are detailed, together with the biomechanics of the hip joint and bone-implant constructs. Detailed descriptions of the classical and contemporary methods for osteosynthesis are analyzed, including the description of supplementary techniques. This includes the author's own novel method of biplane double-supported screw fixation (BDSF), offering supreme stability and fixation strength compared to parallel screws. Additionally, surgical approaches are discussed, such as the anatomical direct lateral approach for arthroplasty of femoral neck fractures, which is introduced as a modification of the standard direct lateral approach. This book represents an important resource for a broad audience of orthopedic trauma surgeons, researchers and students." - Professor Dr Boyko Gueorguiev, Head of Biomedical Development, AO Research Institute Davos, AO Foundation, Davos, Switzerland

Keywords: Femoral neck fractures; Osteosynthesis; Hip fractures; BDSF; Biplane; Arthroplasty; Osteoarthritis; Hardinge; Hip approach; Direct lateral approach; Biomechanics; History of orthopaedics; Orthopedics

Audience: orthopaedic surgeons, applied researchers and students interested in the surgical treatment of fractures of the femoral neck, biomechanical and implant design engineers

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