ArticleJournal of clinical orthopaedics and trauma2020
Risk of bony violation with standard triple screw configurations for fixation of femoral neck fractures: A preliminary computed tomography based analysis.
Article in Journal of clinical orthopaedics and trauma, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed, 4 citations in OpenAlex.
- [Analysis of effectiveness of Holosight robot navigation-assisted percutaneous cannulated screw fixation in treatment of femoral neck fractures].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2025Article
- Intraoperative angulation of the C-arm for X-ray of each curved surface of the femoral neck wall: a cadaveric study.BMC musculoskeletal disorders · 2024Article
- In-out-in screws in femoral neck fractures: Can they be avoided?European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2022Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe reduction and fixation of femoral neck fractures is mainly an indirect one with intraoperative fluoroscopy being trusted for the safe containment of screws within the bony limits of the femoral neck. Radiologically undetected bony perforations may have an impact on the fracture stability and radiological outcomes that have not been studied previously. The purpose of this computed tomography (CT) based study is to analyze the safety of containment of triple screw configurations using standard 6.5 mm diameter screws for fixation of femoral neck fractures in the Indian population using a software-based analysis.
methodsData from consecutive CT scans with intact proximal femur performed over a six month period were retrospectively analyzed using iPlan® BrainLab AG, Feldkirchen, Germany. The safe containment of virtual screw trajectories placed in inverted triangular and non-inverted triangular configurations for a 6.5 mm diameter screw was analyzed in intact femoral necks.
resultsA total of 72 cases were considered for the final assessment. For 6.5 mm screws, the proportion for safe containment (without bony violation) of triple screw inverted triangular configuration was 75% with additional safety corridor to 1 mm around the screw trajectories and 31.94% for non-inverted triangular configuration. All male cases and 28% of female cases allowed safe placement of three 6.5 mm screw trajectories in an inverted triangular pattern with a safety margin of 1 mm around the screw. Replacement of one of the two superior 6.5 mm diameter screw trajectories with a 4.5 mm diameter trajectory resulted in 100% safe containment in female cases.
conclusionInverted triangular configuration is a relatively safer configuration compared to the non-inverted triangular configuration. Standard triple 6.5 mm screws for fixation of femoral neck fractures carry a risk of bony violation, especially in females. A preoperative radiographic assessment to screen the cases with narrow vertical and anteroposterior extents of the femoral neck can help in reducing the risk of fluoroscopically undetected violation of the bony margins. Replacement of one of the two superior screws with a 4.5 mm diameter screw can be helpful in such cases.
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