Fully threaded headless cannulated screw fixation for femora
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The objective of the present study is to compare complication rates and failure mechanisms for surgical fixation of FNF using fully threaded headless cannulated screws (FTHCS) versus partial threaded cannulated screws (PTS) in young adults.

A total of 75 patients (18–65 years old) with FNF were prospectively treated with close reduction and internal fixation using three parallel FTHCS and compared to a historical control case-matched group (75 patients) with FNF treated by PTS fixation. After 2 years follow-up, rates of fixation failure (including varus collapse, fracture displacement, and femoral neck shortening), nonunion, and avascular necrosis of the femoral head (ANFH) were compared between the two cohorts. The demographic, follow-up information, and radiological images were assessed by independent blinded investigators.

--Patient demographics and fracture patterns were similar in the two patient groups.

--The overall fixation failure rates were 8% in the FTHCS cohort, which was significantly lower than the 25.3% seen in the PTS group.

--Rates of nonunion and ANFH were significantly lower in the FTHCS group when compared to the PTS control group.

--When stratified by injury severity (high-energy vs. low-energy fractures), the rate of fixation failure was significant lower with the use of FTHCS when compared with PTS for high-energy fractures while there was no difference in the rates of nonunion or ANFH for high or low-energy fracture patterns.

--Unique to the FTHCS cohort was an atypical screw migration pattern with varus collapse (6/75, 8%).

Finally, the findings show that FTHCS fixation can significantly lower the complication risk in young patients with FNF, especially in high-energy fracture patterns (Garden III–IV, Pauwels III, or a VN angle greater than 15°). Screw "medial migration" and superior cutout, were distinct from the PTS cohort's screw withdrawal pattern.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02335-3