Biplane Double Support Screw Fixation due to femoral neck fracture

Background. Femoral neck fracture is one of the most common fractures in the elderly. The number of femoral neck fractures is increasing due to an increase in the incidence of osteoporosis, impaired vision in the elderly, impaired neuromuscular coordination, sedentary lifestyle, and an increase in life expectancy in general. Traditional methods of fixing such fractures often lead to poor results and a high level of complications. Thus, the incidence of complications in osteosynthesis of the femoral neck is up to 46%. The two-pole bipolar fixation method is a new approach that involves the simultaneous placement of screws in two planes, creating a two-point support for screws in the neck and head of the femur.
Aim. The purpose of this study is to evaluate the effectiveness of the two-support bipolar fixation method in the treatment of patients with femoral neck fracture aged 22-86 years.
Methods. A total of 28 patients with fresh hip fractures (less than two weeks old) underwent closed reposition and internal fixation using the method of two-support fixation. The functional results of the patients were evaluated using the Harris scale, and the radiological results of fusion, shortening of the femoral neck, lateralization of screws and avascular necrosis of the femoral head (AVN) were also evaluated.
Results. The results showed that the technique of double-support bipolar fixation is a safe and effective osteosynthesis for fracture of the femoral neck in both young and elderly patients. Of the 28 subjects under observation, 1 patient refused further follow-up. On average, within 20 months (range 6-24 months), 21 (78%) fractures radiographically healed in an average of 6 months. Non-union occurred in three patients (22%), and three patients (12%) had implant migration. One patient had a peri-implant fracture (2.7%). Two patients had varus collapse, but their fractures successfully healed (7.4%).
Conclusion. The two-support fixation technique has a number of advantages over traditional methods, including increased stability and strength of fixation. It can be considered as an alternative to traditional methods of treating femoral neck fractures with a low incidence of non-union, avascular necrosis and the absence of cases of fixation disorders or varus collapse.

1. Sami A, Prabhakar R, Kumar Yadav A, Kumar Jain V. Biplane double supported screw fixation for femoral neck fracture in young adults: A prospective cohort study. J Orthop. 2022 Jul 31;33:117-123. https://doi.org/10.1016/j.jor.2022.07.012

2. Liddicoat M. National Hip Fracture Data Base (NHFD), 2017. https://www.researchgate.net/publication/329673879_National_Hip_Fracture_Data_Base_NHFD_2017_annual_report

3. Campenfeldt P, Al-Ani A, Ekström W, Zeraati B, Greve K, Cederholm T, Hedström M. Function, sarcopenia and osteoporosis 10 years after a femoral neck fracture in patients younger than 70 years. Injury. 2022 Apr;53(4):1496-1503. https://doi.org/10.1016/j.injury.2021.12.030. Epub 2021 Dec 22.

4. Ramadanov N, Jóźwiak K, Hauptmann M, Lazaru P, Marinova-Kichikova P, Dimitrov D, Becker R. Cannulated screws versus dynamic hip screw versus hemiarthroplasty versus total hip arthroplasty in patients with displaced and non-displaced femoral neck fractures: a systematic review and frequentist network meta-analysis of 5703 patients. J Orthop Surg Res. 2023 Aug 26;18(1):625. https://doi.org/10.1186/s13018-023-04114-8

5. Vluggen TPMJ, van Vugt R, Boonen B, Keulen MHF. Management of two-level proximal femoral fractures. BMJ Case Rep. 2021 May 31;14(5):e240684. https://doi.org/10.1136/bcr-2020-240684

6. Filipov OB. Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes. J Am Acad Orthop Surg. 2019 Jun 1;27(11):e507-e515. https://doi.org/10.5435/JAAOS-D-17-00117

7. Galal S, Nagy M. Non-parallel screw fixation for femoral neck fractures in young adults. J Clin Orthop Trauma. 2017 Jul-Sep;8(3):220-224. https://doi.org/10.1016/j.jcot.2017.07.003

8. Ren H, Zhang X, Liang Y, Yi C, Li D. Morphological analysis of posterior-medial intertrochanteric fracture patterns using fracture-mapping technique. Front Bioeng Biotechnol. 2023 Nov 9;11:1275204. https://doi.org/10.3389/fbioe.2023.1275204

9. Jaya Raj J, Kow RY, Ganthel Annamalai K, Kunasingh DE, Panicker GK, Lim BC, Low CL. Outcomes of Femoral Neck Fractures in Young Patients and the Factors Associated With Complications: A Multicenter Study From Malaysia. Cureus. 2021 Sep 19;13(9):e18110. https://doi.org/10.7759/cureus.18110

10. Kim SJ, Park HS, Lee DW. Complications after internal screw fixation of nondisplaced femoral neck fractures in elderly patients: A systematic review. Acta Orthop Traumatol Turc. 2020 May;54(3):337-343. https://doi.org/10.5152/j.aott.2020.03.113

11. Olansen J, Ibrahim Z, Aaron RK. Management of Garden-I and II Femoral Neck Fractures: Perspectives on Primary Arthroplasty. Orthop Res Rev. 2024 Jan 3;16:1-20. https://doi.org/10.2147/ORR.S340535

12. Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015 Mar;46(3):484-91. https://doi.org/10.1016/j.injury.2014.10.010

13. Konarski W, Poboży T, Kotela A, Śliwczyński A, Kotela I, Hordowicz M, Krakowiak J. The Risk of Avascular Necrosis Following the Stabilization of Femoral Neck Fractures: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Aug 15;19(16):10050. https://doi.org/10.3390/ijerph191610050

14. Yoon JY, Lee SJ, Yoon KS, Yoon PW. The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study. BMC Musculoskelet Disord. 2020 Aug 3;21(1):517. https://doi.org/10.1186/s12891-020-03538-1

15. Wu C. et al. Efficacy and complications after delayed fixation of femoral neck fractures in children. Journal of Orthopaedic Surgery. 2019;28(1). https://doi.org/10.1177/2309499019889682

16. Mukka S., Sjöholm P., Aziz A. et al. A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial. Pilot Feasibility Stud. 2020;6:98. https://doi.org/10.1186/s40814-020-00642-w

17. Pei F., Zhao R., Li F. et al. Osteonecrosis of femoral head in young patients with femoral neck fracture: a retrospective study of 250 patients followed for average of 7.5 years. J Orthop Surg Res. 2020;15:238. https://doi.org/10.1186/s13018-020-01724-4

18. Huang K., Fang X., Li G. et al. Assessing the effect of Gotfried reduction with positive buttress pattern in the young femoral neck fracture. J Orthop Surg Res. 2020;15:511. https://doi.org/10.1186/s13018-020-02039-0

19. Kim CH., Shin M., Lee D. et al. Hidden osteonecrosis of the femoral head after healed femoral neck fractures: magnetic resonance imaging study of 58 consecutive patients. Arch Orthop Trauma Surg. 2022;142:1443–1450. https://doi.org/10.1007/s00402-021-03802-6

20. Wang SH, Yang JJ, Shen HC, Lin LC, Lee MS and Pan RY. Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients. Injury. 2015;46:1969-74.

21. Su Z, Liang L, Hao Y. Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis. J Back Musculoskelet Rehabil. 2021;34(2):169-177. https://doi.org/10.3233/BMR-200183

22. Huang H, Feng Z, Wang W, Yang C, Liao J, Ouyang J. Finite Element Analysis of Femoral Neck Fracture Treated with Bidirectional Compression-Limited Sliding Screw. Med Sci Monit. 2021 Mar 30;27:e929163. https://doi.org/10.12659/MSM.929163

23. Li N, Cheng KY, Fan J, Li Y, Yang M, Zhu S, Jiang X. Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis. Sci Rep. 2024 Jul 5;14(1):15519. https://doi.org/10.1038/s41598-024-66638-1

24. Ding M, Su Z, Wang D, Mo L, Mei J, Sun W, Li S, Ni M. Biomechanical comparison of Gofried positive support reduction of Pauwels type III femoral neck fractures: A finite elements analysis. Injury. 2024 Dec;55(12):111979. https://doi.org/10.1016/j.injury.2024.111979

25. Cha YH, Yoo JI, Hwang SY, Kim KJ, Kim HY, Choy WS, Hwang SC. Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods. Clin Orthop Surg. 2019 Mar;11(1):1-14. https://doi.org/10.4055/cios.2019.11.1.1

26. Kim JW, Oh CW, Park KH, Oh JK, Yoon YC, Kim JK. Peri-implant atypical femoral fracture after nail or plate osteosynthesis. J Orthop Sci. 2022 Jul;27(4):866-875. https://doi.org/10.1016/j.jos.2021.04.008

27. Makkar B, Obremskey W, Avidano R, Ott S, Basida B, Hoffer C, Schousboe JT, Lo J, Huling J, Ristau K, Fink HA, Adler RA, Barzilay JI, Carbone L. The definition of atypical femoral fractures should include periprosthetic femoral fractures (PAFFs). Osteoporos Int. 2025 Mar;36(3):539-546. https://doi.org/10.1007/s00198-025-07401-8

28. Hashimoto J, Oh Y, Yamamoto K, Yoshii T, Fukushima K, Kitagawa M, Okawa A. Frequency and pathogenesis of periprosthetic atypical femoral fractures associated with total knee arthroplasty: A multicenter prospective study with complementary histopathological and biomechanical analysis. Injury. 2024 Jun;55(6):111136. https://doi.org/10.1016/j.injury.2023.111136

29. Jeong SY, Hwang KT, Oh CW, Kim JW, Sohn OJ, Kim JW, Cho YH, Park KC. Mid-term outcomes after the surgical treatment of atypical femoral fractures: minimum three-year follow-up. Bone Joint J. 2021 Nov;103-B(11):1648-1655. https://doi.org/10.1302/0301-620X.103B11

30. Woo SB, Choi ST, Chan WL. Atypical periprosthetic femoral fracture: a case report. J Orthop Surg (Hong Kong). 2016 Aug;24(2):269-72. https://doi.org/10.1177/1602400230