New technology: clinical efficacy of intracapsular decompression and supported hollow screw treatment for Garden IV femoral neck fractures

Abstract

Abstract Background The management of Garden IV femoral neck fractures presents a formidable challenge. This study aimed to assess the safety and efficacy of a novel technological approach for treating Garden IV femoral neck fractures, involving intracapsular decompression and the utilization of supported hollow screws. Methods Between October 2018 and October 2021, a cohort of 46 patients, comprising 25 males and 21 females, was admitted for Garden IV femoral neck fractures. The surgical intervention employed a novel methodology, involving closed reduction of femoral neck fractures on a traction bed and percutaneous implantation of decompression support hollow screw internal fixation in the capsule. Operative parameters such as intraoperative bleeding volume, incision length, and fluoroscopy frequency were recorded. Postoperative angiography was performed to evaluate the blood supply to the femoral neck and femoral head, while long-term follow-up records documented femoral neck fracture healing and patient functional recovery. Results The closed reduction and minimally invasive implantation of decompression support screws in the femoral neck capsule proved effective in successfully fixing Garden IV femoral neck fractures. The screw placement time was 20–45 min, with an average of 25.2 min. The number of fluoroscopy was 6–14, with an average of 7. The postoperative follow-up was 20–25 months, with an average duration of 22 months. All patients exhibited uneventful single-stage wound healing, devoid of complications such as nerve, blood vessel, or important tissue structure injuries. While femoral head necrosis occurred in one case and femoral neck shortening in another, all femoral neck fractures exhibited healing. Post-surgery, patients experienced rapid recovery, enabling early functional exercise with satisfactory functional restoration. Conclusion The innovative technology, employing femoral neck capsule decompression support hollow screws, not only offers structural support, but also facilitates capsule decompression post-femoral neck fracture surgery. This approach promotes the restoration of blood flow to the femoral head and neck, accelerates fracture healing, diminishes the likelihood of femoral head necrosis, and enhances the overall therapeutic outcome for Garden IV femoral neck fractures. The merits of this novel technique warrant its widespread adoption and application.

Keywords

• Intracapsular decompression and supported hollow screw
• Femoral neck fracture
• Garden IV
• Minimally invasive percutaneous treatment