Outcome of proximal femoral fractures caused by cycling in the young and mid-aged

Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants

INTRODUCTION

Fractures of the proximal femur accompanied by a fracture of the femoral shaft are relatively rare, with a reported prevalence between 1 and 12%. Multiple surgical options are available, consisting of treatment with a single implant or with double implants. Controversy exists about the optimal management. A systematic review and pooled analysis were performed to assess the most reliable treatment for bifocal femoral fractures of the femur.

MATERIALS AND METHODS

A literature search was conducted on July 15, 2022. Selected studies were screened on title and abstract by two researchers independently, and full texts were read by both authors. Emphasis was put on adverse events such as postoperative infection, healing complications, malalignment, and functional outcome using either a single implant or double implants.

RESULTS

For the proximal femoral fractures, no significant difference could be confirmed for avascular necrosis of the femoral neck (5.1% for single implant and 3.8% for double implants), nonunion (6.4% for single implant and 7.8% for double implants), or varus malalignment (6.6% for single implant and 10.9% for double implants). This study also suggests that the number of implants is irrelevant for complications of the femoral shaft regarding the rates of postoperative infection and healing complications. Pooled rates of bone healing complications were 1.6-2.7-fold higher when patients were treated with a single implant, but statistical significance could not be confirmed. For hardware failure, revision surgery, leg length discrepancy, and functional outcome, no difference between the two groups was found either.

CONCLUSIONS

The pooled proportions of all postoperative complications had overlapping confidence intervals; thus, no inference about a statistically significant difference on the number of implants used for treating ipsilateral fractures of the femur can be made. Both treatment groups showed a similar functional outcome at the last moment of follow-up, with more than 75% of the patients reporting a good outcome.

Incremental Element Deletion-Based Finite Element Analysis of the Effects of Impact Speeds, Fall Postures, and Cortical Thicknesses on Femur Fracture

The proximal femur’s numerical simulation could give an effective method for predicting the risk of femoral fracture. However, the majority of existing numerical simulations is static, which does not correctly capture the dynamic properties of bone fractures. On the basis of femoral fracture analysis, a dynamic simulation using incremental element deletion (IED)-based finite element analysis (FEA) was developed and compared to XFEM in this study. Mechanical tests were also used to assess it. Different impact speeds, fall postures, and cortical thicknesses were also studied for their implications on fracture types and mechanical responses. The time it took for the crack to shatter was shorter when the speed was higher, and the crack line slid down significantly. The fracture load fell by 27.37% when the angle was altered from 15° to 135°, indicating that falling forward was less likely to cause proximal femoral fracture than falling backward. Furthermore, the model with scant cortical bone was susceptible to fracture. This study established a theoretical foundation and mechanism for forecasting the risk of proximal femoral fracture in the elderly.

Hip fractures in cyclist - a six-year cohort study at a single large volume trauma centre

Cycling has gained in popularity as a recreational activity and method or travel, in part due to its recognised health benefits in maintenance of good cardiovascular strength and also for environmental issues. As a consequence of this, there is unfortunately an increased number of cycling related injuries. One particular injury incurred is a proximal femoral fracture, but there is little information in the literature with regarding this and its management. This retrospective, single centre, observation study looks at the number of cycling injuries over a six-year period in those under the age of 80. 50 patients were identified at an occurrence of 4.5% of the hip fracture population. The majority were male (n=37, 74%) with an average age of 60. Operative treatment was used for 48 (96%) patients with the majority being treated with internal fixation (n=42, 84%) and arthroplasty for the remainder. Average hospital stay was 5.6 days. One patient continued to complain of pain and subsequently underwent a total hip arthroplasty. The mean follow up for these patients was 1033 days (range 1 year to 7 years). 47 (94%) had full return back to pre-injury levels. Given that cycling is likely to increase in the future, we recommend that early surgical fixation is a viable and functionally positive treatment management in these particular group of patients.

OBJECTIVES

The aim of this retrospective observational study over a six-year period was to assess the incidence of hip fractures in those under the age of 80 following a cycling related injury, the definitive management and primary index surgery opted and to report the radiological and functional outcome of these patients with at least 1 year of follow up.

DESIGN

Retrospective, observational study SETTING: Large hip fracture unit, Level 2 Trauma Centre, single centre.

PATIENTS

Patients under the age of 80 who sustained a proximal femoral fracture secondary to a fall and not attributable to pathological processes (namely malignancy and Paget's) were identified and followed up after 1 year.

RESULTS

50 patients were identified over a six-year period of which 74% (n=37) were male and the remaining were female. 48 of these patients subsequently went on for operative management. Two patients presented late (7 days and 42 days from surgery) and were treated conservatively. The average hospital stay for these patients was 5.6 days, with index surgery occurring on average within 22 hours of admission. Mean follow up was 1033 days (range 1 year to 7 years) in all patients. Radiological union had occurred in all patients. One patient showed evidence of avascular necrosis but was asymptomatic. All but three patients had achieved the same level of mobility as pre-injury levels. All patients had the same level of social dependency. One patient continued to complain of pain and subsequently underwent a total hip arthroplasty.

CONCLUSIONS

We demonstrate that the majority of our patients undergo surgical fixation and demonstrate good functional and radiological outcomes at a mean follow up of 1033 days. This is likely as a result of good pre-morbid status in these patients and good bone stock at index intervention. This study is one of the first to show this within the literature in this cohort of elderly patients. The number of cycling related injuries in the elderly population is likely to increase and our recommendation is that early surgical fixation provides good functional outcome in this subset of patients.