A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fractures
ObjectiveThe inverted triangle configuration of the three cannulated screws is the classic fixation method most commonly performed for undisplaced femoral neck fractures in young and geriatric patients. However, the posterosuperior screw has a high incidence of cortical breach, known as an in-out-in...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Surgery |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1142135/full |
| _version_ | 1797867045615828992 |
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| author | Shi-Jie Li Shou-Chao Du Sun-Jun Hu Shi-Min Chang Ying-Qi Zhang Ying-Qi Zhang |
| author_facet | Shi-Jie Li Shou-Chao Du Sun-Jun Hu Shi-Min Chang Ying-Qi Zhang Ying-Qi Zhang |
| author_sort | Shi-Jie Li |
| collection | DOAJ |
| description | ObjectiveThe inverted triangle configuration of the three cannulated screws is the classic fixation method most commonly performed for undisplaced femoral neck fractures in young and geriatric patients. However, the posterosuperior screw has a high incidence of cortical breach, known as an in-out-in (IOI) screw. In this study, we present a novel posterosuperior screw placement strategy to prevent the screw from becoming IOI.MethodsUsing computed tomography data and image-processing software, 91 undisplaced femoral neck fractures were reconstructed. The anteroposterior (AP), lateral, and axial radiographs were simulated. To simulate the intraoperative screw placement process, participants used three screw insertion angles (0°, 10°, and 20°) to place the screw on the AP and lateral views of the radiograph according to the three established strategies. On the AP radiograph, a screw was placed abutting (strategy 1), 3.25 mm away from (strategy 2), or 6.5 mm away from (strategy 3) the superior border of the femoral neck. On the lateral radiograph, all the screws were placed abutting the posterior border of the femoral neck. Axial radiographs were used to evaluate the screw position.ResultsIn strategy 1, all the placed screws were IOI regardless of the screw insertion angle. In strategy 2, 48.3% (44/91) of IOI screws occurred at a 0° screw insertion angle, 41.7% (38/91) of IOI screws occurred at a 10° screw insertion angle, and 42.9% (39/91) of IOI screws occurred at a 20° screw insertion angle situation. In strategy 3, no IOI screw occurred, and the screw insertion angles did not affect the safety and accuracy of screw placement.ConclusionsScrews placed according to strategy 3 are safe. The reliability of this screw placement strategy is unaffected by a screw insertion angle of less than 20 degrees. |
| first_indexed | 2024-04-09T23:34:01Z |
| format | Article |
| id | doaj.art-75b847a1db064f18adb879a09ee42ef3 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-09T23:34:01Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-75b847a1db064f18adb879a09ee42ef32023-03-20T15:23:56ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-03-011010.3389/fsurg.2023.11421351142135A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fracturesShi-Jie Li0Shou-Chao Du1Sun-Jun Hu2Shi-Min Chang3Ying-Qi Zhang4Ying-Qi Zhang5Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, ChinaObjectiveThe inverted triangle configuration of the three cannulated screws is the classic fixation method most commonly performed for undisplaced femoral neck fractures in young and geriatric patients. However, the posterosuperior screw has a high incidence of cortical breach, known as an in-out-in (IOI) screw. In this study, we present a novel posterosuperior screw placement strategy to prevent the screw from becoming IOI.MethodsUsing computed tomography data and image-processing software, 91 undisplaced femoral neck fractures were reconstructed. The anteroposterior (AP), lateral, and axial radiographs were simulated. To simulate the intraoperative screw placement process, participants used three screw insertion angles (0°, 10°, and 20°) to place the screw on the AP and lateral views of the radiograph according to the three established strategies. On the AP radiograph, a screw was placed abutting (strategy 1), 3.25 mm away from (strategy 2), or 6.5 mm away from (strategy 3) the superior border of the femoral neck. On the lateral radiograph, all the screws were placed abutting the posterior border of the femoral neck. Axial radiographs were used to evaluate the screw position.ResultsIn strategy 1, all the placed screws were IOI regardless of the screw insertion angle. In strategy 2, 48.3% (44/91) of IOI screws occurred at a 0° screw insertion angle, 41.7% (38/91) of IOI screws occurred at a 10° screw insertion angle, and 42.9% (39/91) of IOI screws occurred at a 20° screw insertion angle situation. In strategy 3, no IOI screw occurred, and the screw insertion angles did not affect the safety and accuracy of screw placement.ConclusionsScrews placed according to strategy 3 are safe. The reliability of this screw placement strategy is unaffected by a screw insertion angle of less than 20 degrees.https://www.frontiersin.org/articles/10.3389/fsurg.2023.1142135/fullfemoral neck fracturein-out-infemoral neck safe zonescrew placement strategyinsertion angle |
| spellingShingle | Shi-Jie Li Shou-Chao Du Sun-Jun Hu Shi-Min Chang Ying-Qi Zhang Ying-Qi Zhang A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fractures Frontiers in Surgery femoral neck fracture in-out-in femoral neck safe zone screw placement strategy insertion angle |
| title | A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fractures |
| title_full | A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fractures |
| title_fullStr | A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fractures |
| title_full_unstemmed | A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fractures |
| title_short | A new posterosuperior screw placement strategy to avoid in-out-in screws in femoral neck fractures |
| title_sort | new posterosuperior screw placement strategy to avoid in out in screws in femoral neck fractures |
| topic | femoral neck fracture in-out-in femoral neck safe zone screw placement strategy insertion angle |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1142135/full |
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