# Long‐Term Outcomes of Triple Cannulated Compression Screws Combined With Bone Graft Sleeve Parallel Implantation of DBM Crunch Internal Fixation for the Treatment of Femoral Neck Fractures in Middle‐Aged and Young Adults

## TL;DR

This study compares two surgical methods for treating femoral neck fractures in young and middle-aged adults, finding that one method leads to better outcomes like reduced bone loss and faster recovery.

## Contribution

The study introduces a novel surgical technique combining triple cannulated screws with a bone graft sleeve and DBM Crunch for improved femoral neck fracture treatment.

## Key findings

- The CCSBGS group had significantly less femoral neck shortening compared to the CCS group.
- The CCSBGS group showed a lower rate of osteonecrosis of the femoral head.
- Patients in the CCSBGS group had higher Barthel and Harris scores, indicating better functional outcomes.

## Abstract

If the appropriate internal fixation surgical method is not adopted for femoral neck fractures in young people, it may lead to serious consequences such as poor fracture healing and femoral head necrosis, affecting the quality of life and working ability of young people. Therefore, it is crucial to conduct in‐depth research on the internal fixation surgical methods. This study compared the therapeutic effects of triple cannulated screws combined with a bone graft sleeve for parallel implantation of DBM Crunch internal fixation (CCSBGS) and cannulated compression screws (CCS).

Medical records on the young and middle‐aged patients with femoral neck fracture treated with two different internal fixation methods from January 2020 to June 2023 were collected and retrospectively analyzed in the Trauma Emergency Center of the Third Hospital of Hebei Medical University. Two internal fixation groups are: CCSBGS group with 50 patients, 35 males and 15 females, aged (42.44 ± 14.07) years; CCS group with 80 males and 39 females, aged (41.5 ± 13.48) years. This study compared the outcome measures of two groups of patients, including Garden alignment index, Operation duration time, Intraoperative blood loss, Length of hospital stay, Postoperative complications, Femoral neck shortening, Postoperative ambulation time, Walking with sticks, Barthel score, and Harris score.

There was a statistically significant difference in blood loss between the CCS group and the CCSBGS group; at the same time, the amount of bleeding in the CCS group was lower than that in the CCSBGS group (p < 0.01). During the follow‐up period, there was a statistically significant difference in the incidence of osteonecrosis of the femoral head among the two groups (p < 0.05), 20 patients in the CCS group and 2 patients in the CCSBGS group developed osteonecrosis of the femoral head. At the last follow‐up, the average degree of femoral neck shortening in the CCSBGS group [(0.49 ± 0.28) cm] was significantly lower than that in the CCS group [(0.87 ± 0.35) cm] (p < 0.05). Meanwhile, the postoperative ambulation time of the CCSBGS group is earlier than that of the CCS group (p < 0.05). In addition, the CCSBGS group had the highest Barthel scores [(95.50 ± 2.90)] (p < 0.05). The average Harris score in the CCSBGS group [(92.52 ± 2.41)] was higher than that in the CCS group [(90.47 ± 2.88)] (p < 0.05).

Compared with CCSBGS and CCS, CCSBGS shows better efficacy in terms of quicker return to weight‐bearing activities, preservation of femoral neck length, reduction of the rate of osteonecrosis of the femoral head, and overall enhancement of hip function.

This study compared the therapeutic effects of two internal fixation methods, including triple cannulated screws combined with a bone graft sleeve for parallel implantation of DBM Crunch internal fixation (CCSBGS), and cannulated compression screws (CCS). Fracture reduction and CCS fixation were the same as those in the CCS group. In addition, a guide pin was placed in parallel at the center of the 3 CCS, and it was confirmed that the guide pin passed through the fracture end. A suitable bone tunnel was established by expanding the central guide pin 0.5 cm to the subchondral bone. A 5 mL volume of Demineralized Bone Matrix Crunch (DBM Crunch) was verified to pass through the fracture line using fluoroscopy, guided by the BGS.