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LETTER TO EDITOR  
Year : 2014  |  Volume : 48  |  Issue : 1  |  Page : 112-113
"Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients


1 Department of Orthopaedics, Mumbai Port Trust Hospital, Mumbai, Maharashtra, India
2 Department of Orthopaedics, Soonawalla Orthopaedic Clinic, Mumbai, Maharashtra, India
3 Department of Orthopaedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
4 Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

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Date of Web Publication21-Jan-2014
 

How to cite this article:
Biraris SR, Soonawalla DF, Sonawane DV, Nemade PS. "Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients. Indian J Orthop 2014;48:112-3

How to cite this URL:
Biraris SR, Soonawalla DF, Sonawane DV, Nemade PS. "Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients. Indian J Orthop [serial online] 2014 [cited 2019 Sep 23];48:112-3. Available from: http://www.ijoonline.com/text.asp?2014/48/1/112/125541
Sir,

We read the article titled "Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients" by Satish et al. [1] with deep interest. We would like to congratulate the authors for this informative paper. We would like to comment on a few points as follows:

We have been using diamond-shaped configuration [2] with four screws, where we insert one screw at the apex (Superior-S), one at the bottom of the neck (Inferior-I), and two in the middle portion of the neck, one anteriorly (MA) and the other one posteriorly (MP) [Figure 1]b. We feel this is a superior construct compared to the rectangular configuration, as the distance between the screws is more, giving better rotational control. Also, this technique allows skimming the neck cortex and calcar femorale, giving additional stability [Figure 1].
Figure 1: Schematic representation of screw construct in neck: (a) four quadrant parallel configuration (b) diamond shaped configuration

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  1. In the rectangular configuration, putting two screws superiorly and inferiorly will result in the screws being very close to each other [Figure 1]a. Also, it is not possible to skim the calcar with two screws parallel to each other. When this is done, then chances of perforation of neck are higher.
  2. Authors have not mentioned about the patients with posterior or medial comminution, as literature mentions that there is increased risk of re-displacement and avascular necrosis if the posterior cortex is comminuted. [2] Fourth screw is shown to be useful in fractures with comminution. [3]
  3. We would like to know why this study does not include patients of less than 50 years of age.


 
   References Top

1.Satish BR, Ranganadham AV, Ramalingam K, Tripathy SK. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients. Indian J Orthop 2013;47:174-81.  Back to cited text no. 1
  Medknow Journal  
2.Huang TW, Hsu WH, Peng KT, Lee CY. Effect of integrity of the posterior cortex in displaced femoral neck fractures on outcome after surgical fixation in young adults. Injury 2011;42:217-22.  Back to cited text no. 2
[PUBMED]    
3.Ly TV, Swiontkowski MF. Management of femoral neck fractures in young adults. Indian J Orthop 2008;42:3-12.  Back to cited text no. 3
[PUBMED]  Medknow Journal  

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Correspondence Address:
Sandeep R Biraris
Department of Orthopaedics, Mumbai Port Trust Hospital Nadkarni Park, Wadala (E), Mumbai - 400037, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.125541

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1 "Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients: Authoręs reply
Satish, B.R.J., Ranganadham, A.V., Ramalingam, K., Tripathy, S.K.
Indian Journal of Orthopaedics. 2014; 48(1): 113
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