Surgical Treatment of Femoral Neck Fractures

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Surgical Treatment of Femoral Neck Fractures

Production and Management Practices

Hardcover ISBN: 978-1-53613-757-6
eBook ISBN: 978-1-53614-286-0

While arthroplasty is the preferred treatment for most elderly patients with displaced femoral neck fractures, internal fixation – as a joint-preserving procedure – is the treatment of choice in the majority of the patients below the age of 65 years, as well as life-saving fracture care for those who are not fit for arthroplasty. Femoral neck fracture osteosynthesis in the elderly has been partially abandoned in recent years due to poor clinical outcomes following conventional fixation with parallel cannulated screws or DHS.

Based on clinical evidence with excellent outcomes, laboratory testing and computational analyses, the novel method of biplane double-supported screw fixation (BDSF) has proved to offer superior stability for femoral neck fracture osteosynthesis when compared to the conventional fixation. With its innovative biomechanical concept, BDSF provides unique stability for cannulated screw fixation, achieving up to 44% higher axial fixation strength in vitro, and a rate of bone union reaching up to 96.6% in the clinical practice, which is much higher than the conventional parallel screw fixation data. The excellent BDSF stability is provided by buttressing two out of three medially diverging cannulated screws on the calcar. Being oriented in different coronal inclinations, the two calcar screws are able to achieve constant fixation strength during a variety of patient activities and load directions. Biomechanically, the most effective BDSF component is the inferior screw placed at an obtuse angle and supported on a large area along the inferior and posterior cortex of the femoral neck following its spiral anterior curve.

Given the clinical outcomes, BDSF is the perfect technique for femoral neck fracture fixation, reaching an unprecedented high fracture healing rate, and can therefore be routinely applied in the clinical practice. The full BDSF surgical technique is described in this book, including quality criteria and surgical recommendations for its successful implementation according to vast clinical experience of 10 years with this highly effective fixation method. Moreover, this book describes a novel surgical approach for hip arthroplasty.

So far, the current trends – aiming at decreasing operative trauma and blood loss – have not been entirely satisfactory with respect to most of the standard approaches for hip arthroplasty. Those surgeries are often associated with blood loss and the necessity to restrict patients’ activities in the early postoperative period due to impaired joint stability and risk of dislocations. This book describes the full surgical technique of the novel anatomical direct lateral approach, for hip arthroplasty. This technique is associated with minimal blood loss, decreased operative trauma and high joint stability, resulting in easier rehabilitation and higher patients’ satisfaction. Patients are allowed to exercise activities within the normal range of motion and without any special restrictions except excessive flexion in the early postoperative period. Dislocation precautions are reported to be unnecessary with some contemporary minimally invasive techniques using the direct anterior approach, however with our novel approach a conventional technique is applied and the risks of minimally invasive techniques avoided.

This book describes also the history of internal fixation in femoral neck fractures, as well as the biomechanics of the hip joint and its osteosynthesis constructions, the role of the implants and the contemporary trends in surgical methods of internal fixation and arthroplasty.

Author: Series: Orlin Filipov, M.D., Ph.D. (Head of Orthopedic Department, Vitosha Hospital Simeonovsko, Sofia, Bulgaria)

Surgery – Procedures, Complications, and Results, Orthopedic Research and Therapy

Download a PDF table of contents and reviews

Published papers

Where journals allow, we reproduce Dr Filipov’s published scientific papers below

Other publications

Scientific Papers

  1. Filipov O. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Traumatol 2011; 21(7):539-543. DOI: 10.1007/s00590-010-0747-9. PMID: 21966288.
  2. Filipov O. Biomechanics of the fractured femoral neck. The new BDSF-method of positioning the implant as a simple beam with an overhanging end. (chapter 5) in: Injury and skeletal biomechanics, editor: Tarun Goswami, 2012; ISBN: 978-953-51-0690-6, InTech), pp: 81-94 (DOI: 10.5772/47839).
  3. Filipov O. (2013) The method of Biplane double-supported screw fixation (BDSF) at femoral neck fractures – principle and clinical outcomes. J of IMAB 19(1):423-428; DOI: 10.5272/jimab.2013191.423
  4. Filipov O. Epidemiology and social burden of the femoral neck fractures. J of IMAB 2014; 20(4): 516-218. DOI: 10.5272/jimab.2014204.516
  5. Filipov O. Femoral neck fractures – biological aspects and risk factors. J of IMAB 2014; 20(4): 513-515. DOI: 10.5272/jimab.2014204.513
  6. Filipov O, Gueorguiev B. Unique stability of femoral neck fractures treated with the novel biplane double-supported screw fixation method: A biomechanical cadaver study. Injury 2015; 46(2):218-226. DOI: 10.1016/j.injury.2014.11.013. PMID: 25527457.
  7. Filipov O, Stoffel K, Gueorguiev B, Sommer C. OS6-46 Filipov’s method of biplane double-supported screw fixation extremely reduces the risk of fixation failure in femoral neck fractures. Clinical outcomes in 207 patients. Injury 2016; Volume 47, Supplement 5, Page S17. DOI:
  8. Filipov O, Stoffel K, Gueorguiev B, Sommer C. Femoral neck fracture osteosynthesis by the Biplane Double–supported Screw Fixation method (BDSF) reduces the risk of fixation failure. Clinical outcomes in 207 patients. J Arch Orthop Trauma Surg 2017; 137(6):779-788. DOI: 10.1007/s00402-017-2689-8. PMID: 28391429.
  9. Filipov O, Stoffel K, Gueorguiev B, Sommer C. Biomechanics and indications for application of the method of BDSF. Answer to manuscript draft number AOTS-D- 17-00378, Letter to the Editor concerning “‘Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients’” by Filipov O, Sommer C, et al. (2017) Arch Orthop Trauma Surg. Archives of Orthopaedic and Trauma Surgery. 2017; 137(8):1167-1171. doi:10.1007/s00402-017-2716-9. PMID: 28667396.
  10. Filipov O. Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes. J Am Acad Orthop Surg, 2018; Nov 5. doi: 10.5435/JAAOS-D-17-00117. [Epub ahead of print]. PMID: 30399029.
  11. Filipov О. Treatment of femoral neck fractures until the beginning of the twentieth century. Asclepius, 2019; 2.
  12. Filipov O. History of the internal fixation of femoral neck fractures. The pioneers. Methods of osteosynthesis with a nail. Asclepius, 2019; 2.
  13. Filipov O. History of the internal fixation of femoral neck fractures. Techniques of osteosynthesis with single screws, spikes, nail-plate, telescopic implants and fixation by Garden. Asclepius, 2019; 2.
  14. Filipov O. History of the internal fixation of femoral neck fractures at the end of the 20th century. Contemporary Achievements. Asclepius, 2019; 2.
  15. Filipov O. Historical review of the screw osteosynthesis in femoral neck fractures. Screw configurations, compression, impaction, decompression of haemarthrosis. Asclepius, 2019; 2.
  16. Filipov O. Shortening of the limb after osteosynthesis of the femoral neck. Asclepius, 2019; 2.
  17. Filipov O. Fractures of the femoral neck in young adults. Medicine and sport, 2019; 1(2): 18-20.
  18. Filipov O. Avascular necrosis after femoral neck fracture osteosynthesis. Bul J Orthop Trauma, 2018; 1 [ahead of print]
  19. Filipov O. Femoral neck fractures in senile patients. Bul J Orthop Trauma, 2018; 1 [ahead of print].

Published book chapters

Filipov O. Biomechanics of the fractured femoral neck. The new BDSF-method of positioning the implant as a simple beam with an overhanging end. (chapter 5 in the book Injury and skeletal biomechanics, ed: Tarun Goswami, 2012; 81-94, ISBN: 978-953-51-0690-6, InTech).

Published books

Filipov O. Surgical treatment of femoral neck fractures. 2018; Nova Science Publishers, Inc., New York, NY. ISBN: 978-1-53613-757-6. Monograph

Presentations at orthopaedic congresses