International Orthopaedics

, Volume 42, Issue 8, pp 1949–1955 | Cite as

A new configuration of cannulated screw fixation in the treatment of vertical femoral neck fractures

  • Baokun Zhang
  • Jingwen Liu
  • Yi Zhu
  • Wei Zhang
Original Paper



The treatment of vertical femoral neck fractures in young patients is a worldwide challenge. The purpose of this study is to introduce a new configuration of cannulated screw fixation in vertical femoral neck fractures by comparing with using ordinary cannulated compression screw (OCCS) alone biomechanically and clinically.

Material and method

Biomechanically, 20 synthetic femur models of femoral neck fractures with 20° of VN angle were divided into two groups. The first group was fixed with three ordinary cannulated compression screws defined as OCCS group; the second group was fixed with two Headless Cannulated Compression Screws (HCCS) plus an OCCS, defined as combination group and tested for axial stiffness and load to failure. Clinically, a prospective study was designed with 59 patients who have vertical femoral neck fractures and were treated with cannulated screw, including 31 patients with three ordinary cannulated compression screws alone and 28 patients with an ordinary cannulated compression screw plus two headless cannulated compression screws.


Biomechanically, our results showed that there was no significant difference of axial stiffness between OCCS group and combination group (109.92 ± 10.81 vs. 123.49 ± 15.13 N/mm, P = 0.145). But, the maximum load to failure of the combination group performed significant advantages than that of the OCCS group (446.85 ± 76.25 vs. 302.92 ± 80.46 N, P = 0.007). Clinically, the rates of fixation failure in the group treated with OCCS alone were 41.9%, while in the group treated with two types of screws were14.3% (P = 0.048).


Our results suggested that using new configuration of an OCCS plus two HCCSs improved the outcome of vertical femoral neck fractures (FNF) patients compared to those using OCCS alone, which provides a new choice for treatment of FNF.


Vertical Femoral neck fracture Cannulated screws 



We thank the staff of Sports Biomechanics Laboratory in Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and colleagues who provided us a lot of useful inspiration.

Compliance with ethical standards

Conflict of interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article and no conflict outside the current study.


  1. 1.
    Liporace F, Gaines R, Collinge C, Haidukewych GJ (2008) Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am 90(8):1654–1659CrossRefPubMedGoogle Scholar
  2. 2.
    Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ (2004) Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am 86:1711–1716CrossRefPubMedGoogle Scholar
  3. 3.
    Saglam N, Kucukdurmaz F, Kivilcim H, Kurtulmus T, Sen C, Akpinar F (2014) Biomechanical comparison of antirotator compression hip screw and cannulated screw fixations in the femoral neck fractures. Acta Orthop Traumatol Turc 48:196–201CrossRefPubMedGoogle Scholar
  4. 4.
    Lee YS, Chen SH, Tsuang YH, Huang HL, Lo TY, Huang CR (2008) Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. J Trauma 64:155–162CrossRefPubMedGoogle Scholar
  5. 5.
    van Embden D, Roukema GR, Rhemrev SJ, Genelin F, Meylaerts SA (2011) The Pauwels classification for intracapsular hip fractures: is it reliable? Injury 42:1238–1240CrossRefPubMedGoogle Scholar
  6. 6.
    Zhang YL, Zhang W, Zhang CQ (2017) A new angle and its relationship with early fixation failure of femoral neck fractures treated with three cannulated compression screws. Orthop Traumatol Surg Res 103(2):229–234CrossRefPubMedGoogle Scholar
  7. 7.
    Nowotarski PJ, Ervin B, Weatherby B, Pettit J, Goulet R, Norris B (2012) Biomechanical analysis of a novel femoral neck locking plate for treatment of vertical shear Pauwel’s type C femoral neck fractures. Injury 43:802–806CrossRefPubMedGoogle Scholar
  8. 8.
    Rupprecht M, Grossterlinden L, Ruecker AH, de Oliveira AN, Sellenschloh K, Nuchtern J, Puschel K, Morlock M, Rueger JM, Lehmann W (2011) A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. J Trauma 71:625–634CrossRefPubMedGoogle Scholar
  9. 9.
    Huang TW, Hsu WH, Peng KT, Lee CY (2011) Effect of integrity of the posterior cortex in displaced femoral neck fractures on outcome after surgical fixation in young adults. Injury 42:217–222CrossRefPubMedGoogle Scholar
  10. 10.
    Zlowodzki M, Brink O, Switzer J, Wingerter S, Woodall J Jr, Petrisor BA, Kregor PJ, Bruinsma DR, Bhandari M (2008) The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg Br 90:1487–1494CrossRefPubMedGoogle Scholar
  11. 11.
    Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 67:3–9CrossRefPubMedGoogle Scholar
  12. 12.
    Collinge CA, Mir H, Reddix R (2014) Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma 28:270–275CrossRefPubMedGoogle Scholar
  13. 13.
    Enocson A, Lapidus LJ (2012) The vertical hip fracture—a treatment challenge. A cohort study with an up to 9-year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskelet Disord 13:171CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Freitas A, Maciel RA, Lima Rde A, Souto DR, Ferrer Mde A (2014) Mechanical analysis of femoral neck fracture fixation with dynamic condylar screw in synthetic bone. Acta Ortop Bras 22:264–268CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Selvan VT, Oakley MJ, Rangan A, Al-Lami MK (2004) Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury 35:136–141CrossRefPubMedGoogle Scholar
  16. 16.
    Warschawski Y, Sharfman ZT, Berger O, Steinberg EL, Amar E, Snir N (2016) Dynamic locking plate vs. simple cannulated screws for nondisplaced intracapsular hip fracture: a comparative study. Injury 47:424–427CrossRefPubMedGoogle Scholar
  17. 17.
    Aminian A, Gao F, Fedoriw WW, Zhang LQ, Kalainov DM, Merk BR (2007) Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma 21:544–548CrossRefPubMedGoogle Scholar
  18. 18.
    Fowler JR, Ilyas AM (2010) Headless compression screw fixation of scaphoid fractures. Hand Clin 26(3):351–361CrossRefPubMedGoogle Scholar
  19. 19.
    Capelle JH, Couch CG, Wells KM, Morris RP, Buford WL Jr, Merriman DJ, Panchbhavi VK (2013) Fixation strength of anteriorly inserted headless screws for talar neck fractures. Foot Ankle Int 34(7):1012–1016CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina

Personalised recommendations