Should a low starting point be abandoned for cannulated screw fixation of femoral neck fractures?

Abstract

A validated femoral neck fracture model stabilized with three inverted cannulated screws was used to consider different intraoperative scenarios when the inferior screw hole is inadvertently started too inferiorly. These scenarios were to: (1) abandon the misplaced inferior screw hole and restart this hole more proximally, or (2) accept the mispositioned placement of the inferior screw and insert the remaining superior screws parallel or convergent to the inferior screw. Utilizing the second option and accepting the errant hole was associated with the greatest interfragmentary motion and stresses in the bone and hardware. In contrast, the first option created an improved mechanical environment for healing.

Keywords:

• Femoral neck fracture
• cannulated screw fixation
• iatrogenic subtrochanteric fracture

Acknowledgements

The authors gratefully acknowledge Joseph Vyskocil’s assistance in model data preparation for this study and Drake Coy, BS and Daniel Kielminski, MD for their contributions to the initial modeling efforts.

Disclosure statement

There are no relevant financial or non-financial competing interests to report.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.