At Vitosha Hospital we have something to celebrate! We treat patients day in and day out using tried and trusted techniques, but we’re also committed to new innovation in our field. Our chief surgeon, Dr Orlin Filipov, has finished work on groundbreaking research into treating fractures of the femoral neck – the top of the thigh bone, and the most common location for fractures of the hip. His work’s been recognised across the world – including a book deal with a highly-regarded American publisher. Here he tells us about his work, and what it means for patients.

Dr Filipov – what’s so different about the techniques you’re writing about?

One of the new techniques I’m writing about is something called BDSF – biplane double-supported screw fixation. This is a new way of mending fractures of the femoral neck. It’s 40% stronger than the usual fixation technique using parallel screws (the AO technique). We’ve found 96% of fractures heal when they’re treated with the BDSF technique, compared to just 70% with the usual AO technique. These are great results for patients – and they’ve been backed up in large clinical studies carried out by different authors in different countries – in the USA, India, Egypt and Malaysia.

Also – we have evidence that femoral neck fractures treated with the BDSF technique are more biomechanically stable than fractures treated the usual way. This was demonstrated through a finite element model computer analysis (FEM) carried out at Guangdong University in China. Also a biomechanical test has been carried out using human cadaveric femoral bones, revealing 40% stronger fixation strength for BDSF than the usual fixation technique using parallel screws. These results were published in the top-ranked journal, Injury.

This book also describes a new surgical technique for total hip replacement, called the anatomical direct lateral approach. This novel technique allows for much less blood loss during the surgery, compared to conventional surgical techniques. Also, the anatomical direct lateral approach provides a much more stable hip joint, avoiding the risk of mechanical complications like joint dislocation. This means a big step towards less operative trauma, easier rehabilitation, and less blood loss, by using the anatomical direct lateral approach which I write about in my book.

You were asked to turn your research into a book by an American publisher. How did that come about?

Yes – Nova Science Publishers got in touch with me from the United States. I was really pleased about this as they are a highly-regarded scientific publisher. They said they’d been impressed with my publications on femoral neck fractures and biomechanics, which have appeared in specialist orthopaedic journals. They asked if I’d like to write a book for them, so we signed contracts, and a year later my book – “Surgical Treatment of Femoral Neck Fractures” – was published in New York.

How significant is it that you got this book deal?

This is a big success for us, and Bulgarian orthopaedic surgeons generally. Competition is fierce in the United States, and our research had to meet very high standards to be published on the American scientific market. All the best, most widely-used, orthopaedic manuals all over the world are American!

What sort of interest has there been in the book so far?

It sounds like there’s lots of interest. I describe a few new surgical techniques in the book, and there’s also a big section on biomechanics, and a huge literature review discussing all the most important topics relating to the surgical treatment of femoral neck fractures.

The main reason other surgeons are looking at my book, and learning from it, is that the BDSF technique is becoming more and more popular. The rate of complications using the conventional AO technique, with parallel screws, is unacceptably high – so high, in fact, that internal fixation of femoral neck fractures has been abandoned over the last few years. Today there’s renewed interest in internal fixation, because surgeons now have my BDSF technique available to them.

So you’re a Bulgarian surgeon with an American publisher – what other international interest has there been in your technique?

There’s been plenty. There are many surgeons in different countries now using the BDSF technique. There are studies reporting results from the clinical application of BDSF to large numbers of patients in the USA, India, Egypt and Malaysia. It’s now used as well in Switzerland, Norway, and by some of my colleagues here in Bulgaria.