From the Guidelines
The operative procedure for removal of cannulated compression (CC) screws from a femur neck fracture involves several key steps, prioritizing the patient's safety and minimizing complications, as recommended by recent guidelines 1. The procedure typically starts with the patient positioned supine on a fracture table under general or spinal anesthesia, with the affected hip prepared and draped in a sterile manner.
- The surgeon identifies the previous surgical incision site over the lateral thigh and makes an incision along the same line.
- After dissecting through subcutaneous tissue, the fascia lata is incised, and the vastus lateralis is split to expose the lateral femoral cortex where the screws were previously inserted.
- Using fluoroscopic guidance, the surgeon locates the CC screws and removes any bony overgrowth that may have formed over the screw heads.
- A compatible screwdriver is then engaged with each screw head, and the screws are rotated counterclockwise for removal.
- If screws are difficult to remove due to bony ingrowth, specialized extraction tools may be necessary, as suggested by the management of hip fractures in older adults 1. After all screws are removed, the wound is irrigated with normal saline, and hemostasis is achieved.
- The surgical site is then closed in layers: fascia with absorbable sutures, subcutaneous tissue, and finally skin closure with either sutures or staples.
- A sterile dressing is applied, and post-operative radiographs are obtained to confirm complete hardware removal, following the principles outlined in the management of patients with fragility fractures 1. This procedure is typically performed when the fracture has healed completely, or when the hardware is causing symptoms such as pain or irritation, or in cases of hardware failure or infection, considering the limited strength of options for stable femoral neck fractures 1.
From the Research
Operative Procedure Steps for Femoral Neck Fracture Managed by Cannulated Screw Removal
The operative procedure steps for a fracture of the femoral neck managed by cannulated (cc) screw removal are not explicitly outlined in the provided studies. However, the following steps can be inferred from the studies:
- Anatomical reduction and stable fixation is mandatory for nondisplaced or impacted intracapsular femoral neck fractures 2
- A cannulated screw can be used as a drill guide and sleeve to facilitate parallel screw fixation for intracapsular femoral neck fracture 2
- The surgeon can fine-tune the cannulated screw to direct the guide pin insertion and avoid deflection, then insert the screw for permanent fixation 2
- Cannulated screw fixation is a widely accepted surgical method for management of fractures of the neck of femur, especially in patients with poor premorbid conditions, minimally displaced fractures, and those from a younger age group 3
- The use of fully threaded cannulated screws can decrease femoral neck shortening after fixation of femoral neck fractures 4
- Cannulated hip screws can be used for fixation of femoral neck fractures in young adults, with comparable results in terms of healing and complication rates and loss of reduction compared to other methods of osteosynthesis 5
- Robot-assisted orthopaedic surgery can provide a more minimally invasive and precise treatment method for femoral neck fracture, with reduced radiation exposure 6
Key Considerations
- The choice of fixation method depends on various factors, including the patient's age, fracture displacement, and premorbid conditions 3, 5
- The use of fully threaded cannulated screws can improve radiographic results and reduce femoral neck shortening 4
- Robot-assisted orthopaedic surgery can provide a more precise and minimally invasive treatment method, with reduced radiation exposure 6
- The quality of reduction and fixation is crucial for the outcome of femoral neck fracture treatment 2, 3, 5