Key result
The 150° tangential fluoroscopic view successfully identified posterosuperior screw in-out-in placement in 8 patients missed by standard views, and demonstrated a significantly shorter screw-to-cortex distance in contained screws.
Why the study?
The study investigated using a 150-degree tangential fluoroscopic projection to detect posterosuperior screw in-out-in placement during inverted triangle cannulated screw fixation of femoral neck fractures.
Does the 150° tangential fluoroscopic view improve detection of posterosuperior screw in-out-in position in patients with femoral neck fractures?
Observational (n=33)
No
Does the 150° tangential fluoroscopic view improve detection of posterosuperior screw in-out-in position in patients with femoral neck fractures?
The 150° tangential fluoroscopic view effectively identifies posterosuperior screw in-out-in placement during femoral neck fracture fixation, which is missed by standard AP and lateral views.
May aid screw malposition detection in femoral neck fixation; leaves open whether routine use improves outcomes.
Objective: This study investigates the application of the 150° tangential fluoroscopic projection as a novel fluoroscopic view to detect the posterosuperior screw in-out-in (IOI) in the inverted triangle cannulated screws fixation of femoral neck fractures.Methods: A retrospective analysis was conducted including 33 patients with femoral neck fractures enrolled from April to November 2021. All patients underwent closed reduction and internal fixation with inverted triangular cannulated screws under intra-operative C-arm fluoroscopy. The posterosuperior femoral neck screw position (whether in-out-in and the distance to the femoral neck cortex) was evaluated from the standard anteroposterior (AP), lateral view, and tangential view images. Postoperative computed tomography (CT) scan results are considered the gold standard for detecting the femoral neck screw locations.Results: Of 33 patients, no femoral neck screws were found to be placed IOI under the standard AP and lateral views. The tangential view revealed the posterosuperior screw was IOI in 8 patients, whereas the average distance between the posterosuperior screw and the posterior femoral neck cortex was 2.73±1.06 mm under the standard lateral view. Postoperative CT verified that posterosuperior screw was placed IOI in these 8 patients. In the other 25 patients, the average distance between the posterosuperior screw and the posterior femoral neck cortex was 5.48±1.26 mm under the standard lateral view and 2.76±1.08 mm under the tangential view, with a statistically significant difference between the two groups (p<0.05). Post-operative CT demonstrated that the femoral neck screws were completely contained in the femoral neck in these 25 patients.Conclusions: Intra-operative tangential view of 150° can effectively identify the posterosuperior screw IOI in the inverted triangle cannulated screws fixation of femoral neck fractures. Based on our study, we highly recommend the tangential view as a routine intraoperative fluoroscopic angle to avoid the posterosuperior screw IOI.
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Zhang et al. (2022) conducted an observational in Femoral neck fractures (n=33). 150° tangential fluoroscopic view vs. Standard anteroposterior (AP) and lateral views was evaluated on Average distance between the posterosuperior screw and the posterior femoral neck cortex in contained screws (mm) (p=<0.05). The 150° tangential fluoroscopic view successfully identified posterosuperior screw in-out-in placement in 8 patients missed by standard views, and demonstrated a significantly shorter screw-to-cortex distance in contained screws.
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