Preliminary clinical and radiological evaluation of osteosynthesis using the Femoral Neck System (FNS) for subcapital fractures of the femur

Abstract

Addressing subcapital fractures of the femur poses a substantial clinical challenge, complicated by the diverse range of available osteosynthesis materials. This study is dedicated to a comprehensive analysis of the clinical and radiological implications linked with the implementation of the Femoral Neck System (FNS) in osteosynthesis procedures. A descriptive study was conducted involving patients who underwent osteosynthesis for subcapital fractures of the femur utilizing the FNS during the period from 2019 to 2022. The investigation encompassed various facets, including the classification of fractures according to the Garden and Pauwells classifications, criteria for achieving precise reduction based on the Garden criteria and Tip Apex Distance (TAD). At the one-year follow-up, factors such as fracture consolidation, loss of reduction, fracture collapse, complications, and functional outcomes were evaluated utilizing the Harris Hip Score (HHS) scale. The study cohort included a total of 26 patients, among whom 22 exhibited non-displaced subcapital femur fractures categorized as Garden I and II. Successful reduction was accomplished in 23 cases, in which 24 cases (92.3%) displayed a TAD measurement below 25 mm. According to the HHS, patients achieved an average score of 90.9 (ranging from 63 to 100) following the surgical intervention, with predominantly "excellent" and "good" outcomes. The outcomes derived from our investigation corroborate the viability of the Femoral Neck System (FNS) as a reliable option for osteosynthesis in femoral neck fractures. The results obtained are comparable to those achieved with other available implants, as highlighted by previous studies.

Figure 1

(A) AP and axial radiographs of the pelvis and right hip were taken in the emergency department of a 29-year-old patient who suffered a Garden III subcapital fracture and Pauwels III fracture of the right femur. (B) Intraoperative fluoroscopy controls with AP and axial views. Correct reduction of the fracture was observed in both the AP and axial projections. (C) AP and axial hip radiographs during the annual follow-up in the clinic. Complete consolidation of the fracture was observed.

Figure 2

(A) AP and axial hip radiographs taken in the emergency department. (B) Intraoperative fluoroscopy controls with AP and axial views. (C) AP and axial hip radiographs at the 6-month follow-up. Articular surface collapse and protrusion of the bolt and anti-rotational screw are observed.