FNS NOF

1. Journal club
Femur Neck Fractures treated
with the Femoral Neck System
Presenter - Dr. Shubhanshu
Guide - Dr. John Mukhopadhaya

2. Introduction
• 50% account for all hip fracture (PhysicianRCo 2017,NHFD London)
• Young – high energy violence, elderly- low energy
violence (Elgeidi A, 2017 J child Orthop)
• Standard treatment is surgical
• Internal fixation
• Arthroplasty
• Depends on bone quality, fracture severity and
patient age (Zelle BA et al.,2022 Int Orthop)
• Young patient- surgical

3. • Shear stress and rotational instability at
fracture fragments.
• Complications
• Varus tilting
• Implant removal/screw loosening
• Femoral neck shortening
• Fracture displacement
• Non-union
• Femoral head necrosis

4. Classification
• Anatomical
• Gardens
• Pauwells

5. Treatment
• 3Cannulated screws fixation
• Dynamic Hip Screws
• DHS combined with anti-rotation screws
• Non union 33%
• Revision surgery 18%
• Femoral Neck System
• AVN rate( Parker et al.,2013 bone joint J)
– undisplaced #- 4.5%
– Displaced #- 11.1%
• Reoperation rate(Rogmark et al., 2002 JBJS)(Frihagen F et al., 2007 BMJ)(Onativia IJ, 2018 Hip Int)
– 8% Non displaced fracture
– 42% in displaced fracture

6. Methods
• Retrospective study
• Sample size - 69
• Study duration- Oct 2019- May 2020
• Mean age 54(28-66)
• type of fracture was AO31-B(Garden Types II,
III, and IV)
• 33 patients were subjected to FNS treatment
and 36 were subjected to 3CS treatment.

7. Inclusion criteria
• younger than 65 years with fresh femoral neck
fractures
• fractures were AO31-B type
• patients treated with FNS or 3CS
• patients who completed at least half a year of follow-
up
• Patients with postoperative radiological and joint
function measurement data
• retrospective studies. The exclusion
• criteria were: (i) hip dysfunction before injury; and

8. Exclusion criteria
• hip dysfunction before injury
• presence of other fractures or other diseases
that affect femoral neck treatment
(pathological fractures and rheumatoid
diseases among others).
– Ethical approval for this study was obtained

9. Surgical Methods
• Under the G-arm machine, traction bed was used to reduce the
fracture.
• FNS:
– The anti-rotation guide pin was fixed in the femoral neck while
insertion of the anti-rotation guide needle in the center of the femoral
neck was avoided.
– A longitudinal incision was made on the lateral side of the femur to
reach the lateral femoral cortex (about 3–4 cm).
– The bolt guide needle was located in the center of the femoral neck,
then, the reaming drill was used to guide the needle along the bolt to
ream the medulla.
– With the aid of a connecting rod, the bolt was gently tapped into the
femoral neck medullary cavity and the outer steel plate placed on the
outside.
– After satisfactorily fitting the bolt and plate, 1–2 locking screws (5 mm)
and the anti-rotation screw were inserted

12. • Pre-op – Routine, xrays, CT with 3D
• Post op-
• 2nd day onwards bed functional rehabilitation excersices
were performed
• Weight bearing based on bone healing weight bearing
walking allowed.
• Surgical time
• Hemogloboin loss
• Fluoroscopy duration
• Hospitalization length cost
• Follow up minimum 6 months
• Harris score

13. Result
• 6 month follow up Harris score better than #
CS
• Low operative time
• Low fluroscopy duration intraop
• Intraop blood loss less
• Cost and length of hospital stay reduced

14. Complication
• No mortality and Pulmonary embolism noted
• Femoral neck inversion
• Shortening of femoral neck
• Implant withdrawal
• Difference in shortening and varus not
significant between 3CS and FNS

15. Take Home Message
• FNS safe treatment for femur neck fracture
• Accurate reduction and sufficient implant
stability to reduce complication
• FNS has Varus roration and neck shortening
less than 3CS.
• For assessment of AVN and Non union
requires longer follow-up