Surgical Treatment of Femoral Neck Fractures (CD Included)

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 – as a joint-preserving procedure – is the treatment of choice in the majority of the patients below the age of 65 years, as well as life-saving fracture care for those who are not fit for arthroplasty. Femoral neck fracture osteosynthesis in the elderly has been partially abandoned in recent years due to poor clinical outcomes following conventional fixation with parallel cannulated screws or DHS.

Based on clinical evidence with excellent outcomes, laboratory testing and computational analyses, the novel method of biplane double-supported screw fixation (BDSF) has proved to offer superior stability for femoral neck fracture osteosynthesis when compared to the conventional fixation. With its innovative biomechanical concept, BDSF provides unique 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 the clinical practice, which is much higher than the conventional parallel screw fixation data.

The excellent BDSF stability is provided by buttressing two out of three medially diverging cannulated screws on the calcar. Being oriented in different coronal inclinations, the two calcar screws are able to achieve constant fixation strength during a variety of patient activities and load directions. Biomechanically, the most effective BDSF 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, reaching an unprecedented high fracture healing rate, and can therefore be routinely applied in the clinical practice. The full BDSF surgical technique is described in this book, including quality criteria and surgical recommendations for its successful implementation according to vast clinical experience of 10 years with this highly effective fixation method.

Moreover, this book describes a novel surgical approach for hip arthroplasty. So far, the current trends – aiming at decreasing operative trauma and blood loss – have not been entirely satisfactory with respect to most of the standard approaches for hip arthroplasty. Those surgeries are often associated with blood loss and the necessity to restrict patients’ activities in the early 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. This technique is associated with minimal blood loss, decreased operative trauma and high joint stability, resulting in easier rehabilitation and higher patients’ satisfaction. Patients are allowed to exercise activities within the normal range of motion and without any special restrictions except excessive flexion in the early postoperative period. Dislocation precautions are reported to be unnecessary with some contemporary minimally invasive techniques using the direct anterior approach, however with our novel approach a conventional technique is applied and the risks of minimally invasive techniques avoided.

This book describes also the history of internal fixation in femoral neck fractures, as well as the biomechanics of the hip joint and its osteosynthesis constructions, the role of the implants and the contemporary trends in surgical methods of internal fixation and arthroplasty.

Volume I. Introduction

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

Chapter 2. Epidemiology of Fractures of the Femoral Neck

Chapter 3. Biological Aspects and Risk Factors for Fractures
of the Femoral Neck

Chapter 4. Surgical Anatomy of the Femoral Neck

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 of Femoral Neck Fractures

Chapter 8. Clinical Diagnosis and Imaging of Femoral Neck Fractures

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 in Femoral Neck Fractures

Chapter 15. Post-Surgical Treatment of the Femoral Neck

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

Chapter 20. The Anatomical Direct Lateral Approach for Hip Arthroplasty: Less Dissection, Minimal Blood Loss and Optimal Soft-tissue Restoration

Chapter 21. Posterolateral Approach for Hip Arthroplasty

Volume VI. Internal Fixation versus Primary Arthroplasty

Chapter 22. Femoral Neck Fractures in Young Patients

Chapter 23. Femoral Neck Fractures in Senile Patients

Chapter 24. 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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