title: Angular stable multiple screw fixation (Targon FN) versus standard SHS for the fixation of femoral neck fractures.
abstract: OBJECTIVE
  Head-preserving fracture care especially for the elderly may be complicated by acetabular screw penetration, cut out, delayed union or femoral head necrosis. The following comparative study analyses whether a new angular stable device may overcome these shortcomings.
  
  
  METHODS
  The Targon FN plate (BBraun/Aesculap, Germany) employs up to four angular stable telescoping screws for the fixation of the head fragment. In a prospective study patients with displaced and undisplaced intracapsular femoral neck fractures where treated by closed reduction and fracture fixation using either the Targon FN implant or a standard sliding hip screw (SHS). Patients were followed up clinically, radiographically and via telephone at a mean of follow-up time of 15.5 months.
  
  
  RESULTS
  Fifty-two patients (mean age: 67 years) with femoral neck fractures were treated with either Targon FN (27 patients) or SHS (25 patients). Time for surgery did not differ within the two groups (56 min Targon FN vs. 55 min SHS). Eight patients with SHS (32%) and four patients (15%) with Targon FN experienced cut out of the lag screw and received hip replacement (p<0.05). Implant failure occurred after a mean of 1.8 months after SHS and 6.0 months after Targon FN implantation. Final radiographs revealed substantial subsidence in both groups (5.0mm Targon FN; 9.8mm SHS, p=0.055) with a clear trend to less subsidence for the Targon FN group. Furthermore, asymmetrical telescoping of the lag screws occurred in 30% (n=8), complete depletion of telescoping distance in 11% (n=3) in the Targon FN group. Functional assessment using the HHS assessment tool, however, presented with slightly better results for the SHS treatment (87.7 ± 13.9) when compared to Targon FN fixation (69.5 ± 14.5).
  
  
  CONCLUSIONS
  The study revealed less subsidence of the head fragment, lower cut out rate and a lower rate of conversion to hemiarthroplasty after Targon FN fixation in comparison to a standard SHS fixation in a small number of patients with hip fractures. However, this was not accompanied by functional limitations in the SHS group.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany. Electronic address: anica.eschler@med.uni-rostock.de.
authors.forename: Anica
authors.initials: A
authors.lastname: Eschler
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Brandt
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Gierer
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittlmeier
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Gradl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D016896:Treatment Outcome
keywords: DHS; Femoral neck fractures; Harris Hip Score; Head-preserving; SHS; Sliding hip screw; Subsidence; Targon FN