ABSTRACTObjectivesTreating femoral neck fractures remains a significant challenge for orthopedic surgeons and imposes a substantial economic burden on developing regions. Current novel internal fixation methods demonstrate excellent biomechanical performance. However, these new internal fixation methods are still associated with various complications. This study aimed to report the clinical complications of femoral neck system (FNS) and biplane double‐supported screw fixation (BDSF) treatments for femoral neck fractures at our institution and provide directions for selecting cost‐effective internal fixation methods.MethodsA retrospective case–control study of adult patients with femoral neck fractures treated with BDSF or FNS was conducted at Nanfang Hospital from April 2019 to April 2022. General medical records were collected both preoperatively and intraoperatively. Primary complication measures included osteonecrosis of the femoral head, nonunion, screw‐out, and subtrochanteric fractures, along with femoral neck shortening. The primary functional measure evaluated was the Harris hip score. This study employed t‐test, Wilcoxon rank‐sum test, and chi‐square test to statistically analyze the data.ResultsStatistically significant differences were observed between the BDSF and FNS groups in terms of surgery duration (60.8 ± 12.6 min vs. 71.0 ± 12.0 min), incision length (5.5 ± 1.2 cm vs. 9.1 ± 1.6 cm) and hospitalization costs (39563.8 ± 9086.4 RMB vs. 24960.4 ± 10154.4 RMB). No statistically significant differences between the BDSF and FNS groups were found in the baseline data, blood loss or hospital stay. Moderate femoral neck shortening was significantly less common in the BDSF group than in the FNS group (27.1% vs. 61.5%, p = 0.016). Postoperatively, no statistically significant differences in complication rates, such as femoral head necrosis, nonunion, subtrochanteric fractures or screw‐out, were observed between the BDSF and FNS groups.ConclusionsThis study revealed no significant difference in the incidence of postoperative complications such as femoral head necrosis, nonunion or screw cut‐out between BDSF and FNS. Although BDSF has drawbacks, such as a long learning curve and the potential to cause subtrochanteric fractures, it is cost‐effective and better maintains the length of the femoral neck. The modified BDSF technique may be more suitable for developing regions with limited health care budgets.

The descending genicular artery (DGA) and medial thigh region have been underused as donor sites for perforator flaps. This study evaluated the anatomical relationship between the perforators of the DGA and the saphenous vein (SV) to review the clinical applications of the free descending genicular artery perforator (DGAP) flap for locoregional reconstruction. Fifteen cadavers were arterially perfused with red latex and dissected. Thirty-one patients with extremity tissue defects were treated with a free DGAP flap, including six patients who received a chimeric flap. The minimum distance between the DGAP and the SV was measured during surgery. In all patients, the skin branch of the descending genicular artery was found in the medial femoral condyle plane in front of the SV. The average distance between the descending genicular artery perforator and the SV was 3.71 ± 0.38 cm (range: 2.9–4.3 cm). Thirty flaps survived completely, and one flap developed partial necrosis; however, this flap healed two weeks after skin grafting. The average follow-up time was 11.23 months. We conclude that the SV can be preserved when harvesting the descending genicular artery perforator flap, causing less damage to the donor site and having no effect on flap survival. The free descending genicular artery perforator flap without the SV is a better therapy for complicated tissue defects.

Treatment of adult femoral neck fracture is still a great challenge faced by trauma orthopedists. As treatment effects can be infleunced by multiple factors, like age, gender and preoperative physical condition, they may vary with different treatment schemes. Classification of femoral neck fractures plays an important guiding role in choosing a proper treatment scheme and judging the prognosis. The current classic clinical classification systems for femoral neck fractures include Garden, AO/OTA and Pauwels classifications. Since the recent progress in science and technology has put more advanced technologies into clinic application, such as CT, MRI and Digital Subtraction Angiography (DSA), new ways of classification have appeared. However, each classification has its own shortcomings which need to be improved. This paper reviews the research progress in classification of adult femoral neck fractures and their treatment principles.

股骨颈骨折中青壮年的年龄界限尚无明确定义,文献报道多以60岁以下作为青壮年,有学者认为应根据生理年龄判定年轻或老年,那些活动较多,功能要求高,骨质量好,医疗问题少的人被认为“年轻”,而那些活动要求低的人(使用辅助设备走路)、慢性病或骨质量差被认为是“老年人”.统计表明,青壮年股骨颈骨折仅占股骨颈骨折的3％ (95/3147),然而,一旦发生骨折,常伴有骨折断端的粉碎,甚至是合并股骨干、股骨头或髋臼骨折,骨折类型多为Garden Ⅲ型、Garden Ⅳ型或者Pauwels Ⅱ型、Pauwels Ⅲ型.有学者认为Pauwels分型更适用于青壮年股骨颈骨折,因其可以反映骨折的相对稳定性,预测获得稳定固定的难度.国外相关大数据的研究显示,青壮年股骨颈骨折骨不连发生率为8.9％～9.3％,股骨头坏死率为14.3％～23.0％.