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Zoom Power Point ( FNDC Locking System)-1

The document discusses a retrospective study on the use of a new FNDC locking system for internal fixation of femoral neck fractures, highlighting its advantages over traditional methods. Results showed no complications such as avascular necrosis or nonunion, with all patients achieving solid bone union and high Harris hip scores. The study concludes that the FNDC system provides rigid fixation and promotes healing, warranting further clinical investigation.

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6 views21 pages

Zoom Power Point ( FNDC Locking System)-1

The document discusses a retrospective study on the use of a new FNDC locking system for internal fixation of femoral neck fractures, highlighting its advantages over traditional methods. Results showed no complications such as avascular necrosis or nonunion, with all patients achieving solid bone union and high Harris hip scores. The study concludes that the FNDC system provides rigid fixation and promotes healing, warranting further clinical investigation.

Uploaded by

aungmyatthu5787
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Journal Reading

Internal fixation for Femoral neck fracture


with the use of
Dynamic Compression system
(Department of orthopaedic surgery , WISCO general hospital
Wuhan , China )
Contents
• Introduction
• Methods
• Surgical procedure
• Post op management
• Results
• Discussion
• Limitations
• Conclusion
Introduction
• At present three hollow screws are often used for internal fixation
• They can compress fracture ends but lack framework structure
• Rotational resistance and vertical shear resistance were poor in some
studies
• Loosening of internal fixation , displacement of femoral head and femoral
neck nonunion are not uncommon.
• Lack of continuous locking support in healing process result in femoral
neck shortening
• FNDC locking system is new type of internal fixation which was designed
based on the three dimensional anatomical structure of femoral neck
Introduction ( Continued )
• The three locking screws are placed in the thickest bone cortex part of
the femoral neck
• Lateral pressure locking plate with locking tail caps forms the stable
structure of framework which can compress and lock fracture ends
• Can provide favorable rotational stability and rigid fixation
Methods
• Single center , Retrospective study
• Study period – May 2015 – October 2016
• 36 patients
• >50 years old
• Closed , MOI - S & F
• Garden Stage II & III , anatomical classification
• Operated by the same surgeon
Method ( Continued )
• Injury to surgery time – 1 – 4 days
• Duration of hospital stay – 8 –14 days
• Operation time – 35- 80 mins
• Haemorrhage - 40 – 80 ml
• Radiological outcomes(18-24 mths post op) – union , femoral , neck
shortening , screw back out , femoral head avascular necrosis
• Harris hip score
Surgical procedure
• Closed reduction
• 4-5 cm lateral incision over the GT
• Insertion of one or two guide needle parallel to longitudinal axis of
femoral neck
• Top guide needle inserted to anterior and superior position
• Installation of locking plate
• Two parallel guide needles were inserted along the direction of top guide
needle to distal fracture end
• Three parallel hollow locking compression screw insertion(7 mm)
positioned within 5 mm of subchondral bone
Post op management
• Wound check 2-3 days intervals- STO after 2 weeks
• Discharged 1- 3 weeks after surgery
• Passive hip motion starts few days after surgery as tolerated by the
patient
• Partial weight bear as tolerated after discharge
• Full weight bear when full union was achieved
• Recheck x ray – 1 week after surgery , monthly till complete union , 6
mth interval till final follow up
Results
Follow up 12- 29 months
• No patient mortalities
• No AVN , no nonunion , re-fracture
• No re- operation , no hip contracture
• All patients achieved solid bone union
• Time of bone union ( 3- 4 months )
• 3 cases of femoral neck shortening (< 5 mm)
• 1 case of screw back out (4 mm)
Results ( continued )
• Harris hip score – 85 – 98
• No peri-operative complication
Discussion
• Internal fixation – less trauma , short operation time , less bleeding
lower post- op complication , low cost then hip joint replacement
• There is still lack of a consistent view of what methods of internal
fixation can better maintain fracture ends , promote healing , post op
complications , AVN and fixation failures.
• Lateral locking plate and three interlocking tail caps provide rigid
fixation , dynamic compression to fracture ends
• Cadaveric study shows functions closed to the normal femoral neck
with no stress occlusion
Discussion ( continued )
• Current follow up reveals no AVN , no non-union and refracture
• 3 cases of neck shortening of <3 mm and 1 case with scre back out of
4 mm which was associated with osteoporosis
• 3 cancellous screw fixation has variable rotational
instability , instability of fracture ends and impaired healing
• In this internal fixation study the three screws are positioned in the
femoral neck with highest bone density.
• Provide rigid fixation so that anti-rotation resistence is significantly
enhanced
Discussion ( continued )
• Less stress to the three screws in this system
• Weil et al . Assessed femoral neck shortening after internal fixation of
femoral neck structure with three cannulated screw
• He found femoral neck shortening (>5mm) in 56 % of patients and
severe shortening (>10 mm ) in 22 % of patients. Screw back
out( >5mm) in 41 % of patients.
• FNDC locking system can also provide unique sliding mechanism
allowing for controlled fracture impaction.
Discussion ( continued )
• Nishiyama et al. Indicated that a sliding mechanism allow continuous
linear compression on treatment of femoral neck fracture facilitates
fracture healing.
Limitations
• Retrospective study
• Small sample size
• Lack of control group of patients treated with three cannulated
screws
Conclusion
• Can provide rigid fixation
• Sliding mechanism
• Early hip functional training in optimal time
• Satisfactory follow up
• Worth promoting for clinical practice and continuing to study its
clinical effect in 2nd stage.
Thank you

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