Indian Journal of Orthopaedics

LETTER TO EDITOR
Year
: 2014  |  Volume : 48  |  Issue : 2  |  Page : 226-

Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients


Sachin Upadhyay, Haroon Khizir Taqi Raza 
 Department of Orthopaedics, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India

Correspondence Address:
Sachin Upadhyay
Department of Orthopaedics, Netaji Subhash Chandra Bose Medical College, Jabalpur - 482 003, Madhya Pradesh
India




How to cite this article:
Upadhyay S, Taqi Raza HK. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients.Indian J Orthop 2014;48:226-226


How to cite this URL:
Upadhyay S, Taqi Raza HK. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients. Indian J Orthop [serial online] 2014 [cited 2019 Jul 19 ];48:226-226
Available from: http://www.ijoonline.com/text.asp?2014/48/2/226/128776


Full Text

Sir,

We read with great interest the recently published article [1] entitled "Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients." Although we applaud the work, we wish to draw the attention of the authors to certain critical points which need to be clarified.

A study [2] reported that the triangular placement of screw had a higher peak load, higher ultimate load, less displacement, and more energy absorption before failure than other configurations. It has been demonstrated that the use of a fourth screw does not have a significant increase in mechanical advantage in most FNF. [3] We would like to know whether any biomechanical analysis was done before proposing the current configuration. Authors advocated the use of present technique in all possible cases of FNF in older population despite the fact that in basicervical FNF [4] and in Pauwels' Type III FNF, [5],[6] sliding hip screw with the derotational screw (biomechanical superiority) is an ideal implant for this fracture configuration. If the authors agree with this modality of treatment, how do they justify clubbing all the FNF together to compare the outcome? It has been shown in a cadaveric study [7] that the pattern of screw insertion is critical in determining the susceptibility of the bone to stress fracture. Authors [7] recommended not placing screws at the same level transversely as the vertical pattern is less apt to predispose a long bone to subsequent fracture than a horizontal pattern of screw insertion. In context of this cadaveric study we need justification from the current authors of placing parallel screws (transversely at two levels) in four quadrants. Furthermore we would like the authors to clarify the optimal screw positioning especially in cases of non-anatomical reduction (50% in present series).

Another thing that concerns us is the "absence of washers." It has been demonstrated [8] that use of washers significantly decreases the risk of fixation failure. In the present technique, authors have not used any washers. [1] We would like the authors to clarify this issue.

References

1Satish 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.
2Selvan VT, Oakley MJ, Rangan A, Al-Lami MK. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: A biomechanical study. Injury 2004;35:136-41.
3Holmes CA, Edwards WT, Myers ER, Lewallen DG, White AA 3 rd , Hayes WC. Biomechanics of pin and screw fixation of femoral neck fractures. J Orthop Trauma 1993;7:242-7.
4Blair B, Koval KJ, Kummer F, Zuckerman JD. Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques. Clin Orthop Relat Res 1994;306:256-63.
5Baitner AC, Maurer SG, Hickey DG, Jazrawi LM, Kummer FJ, Jamal J, et al. Vertical shear fractures of the femoral neck. A biomechanical study. Clin Orthop Relat Res 1999;367:300-5.
6Bonnaire FA, Weber AT. Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck. Injury 2002;33 Suppl 3:C24-32.
7Lichtblau S, Gallina J, Nasser P, Munyoki M, Jepsen K. A biomechanical comparison of two patterns of screw insertion. Bull NYU Hosp Jt Dis 2008;66:269-71.
8Zlowodzki M, Weening B, Petrisor B, Bhandari M. The value of washers in cannulated screw fixation of femoral neck fractures. J Trauma 2005;59:969-75.