PMC9837256_01
Illustrative diagram of closed reduction technique. Before closed reduction, the affected limb is placed in position of slight flexion, abduction, and external rotation. Step 1, axial traction of the affected limb restores the length of the femoral neck. Step 2, appropriate adduction of the affected limb is performed. Step 3, internal rotation of the affected limb makes the patella facing upwards
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Attempt closed reduction with orthopaedic traction table (Figure 1).
Illustrative diagrams of positions of Steinmann pins for fracture reduction. (A) Anteroposterior view of position of Steinmann pin, which passes through the superior third of greater trochanter to the femoral head. (B) Lateral view of positions of Steinmann pins. Steinmann pin (A) In patients with valgus-impacted femoral neck fractures without posterior tilt, the pin is parallel with femoral neck and the tip is positioned at center of femoral head. Steinmann pin (B) In patients with posterior tilt existing, Steinmann pin is inserted posteriorly, angling forward to the posterior third of femoral head
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If posterior tilt existed, Steinmann-pin would be inserted posteriorly, angling forward to the posterior third of femoral head (Figure 2).
Images of continuous intraoperative fluoroscopies at anteroposterior view. The end of Steinmann pin is gently hammered under fluoroscopy dynamically, achieving anatomical reduction of femoral neck fracture at image C. (Arrow: impacted part of the femoral neck fracture)
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After satisfactory position of Steinmann-pin was ascertained by both planes of fluoroscopy, the end of Steinmann-pin would be gently hammered under fluoroscopy to achieve anatomical reduction (Figures 3 and 4).
Intraoperative fluoroscopy showing a case (female, 63 years old) of valgus-impacted femoral neck fracture with posterior tilt of femoral head before and after reduction within "in-out-in" percutaneous reduction technique. (A) Intraoperative anteroposterior view showing severe valgus-impacted femoral neck fracture. (B) Intraoperative lateral view showing severe posterior tilt of femoral head. The posterior tilt is measured as the angle (alpha) between the d line and the e line, which is drawn from the center (o) of the caput circle to the crossing of the caput circle and the d line. (C, D) Intraoperative fluoroscopy showing femoral neck fracture achieving reduction within "in-out-in" percutaneous reduction technique
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After satisfactory position of Steinmann-pin was ascertained by both planes of fluoroscopy, the end of Steinmann-pin would be gently hammered under fluoroscopy to achieve anatomical reduction (Figures 3 and 4). The reduction qualities of femoral neck fracture, including collodiaphyseal angle, posterior tilt angle (Figure 4(B)), and amount of FNS (Figure 5), were evaluated by two surgical fellows within 24 h, 6 months, and 2 years postoperatively.
Measurement of femoral neck shortening on anteroposterior radiographs of the pelvis. Draw a line passing the center of the femoral head and the center of the femoral neck. The length of line segment is from vertex of femoral head to lateral wall of femur. The femoral head shortening is defined as difference between the uninjured side and the injured side
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The reduction qualities of femoral neck fracture, including collodiaphyseal angle, posterior tilt angle (Figure 4(B)), and amount of FNS (Figure 5), were evaluated by two surgical fellows within 24 h, 6 months, and 2 years postoperatively.