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Wang M, Zhang Z, Sun F, Zhu Y, Han R, Pei Z, He Z, Liu J, Wen L. Global trends of Pauwels type III femoral neck fractures: bibliometric analysis and visualized study. Front Surg 2024; 11:1372310. [PMID: 39351289 PMCID: PMC11439767 DOI: 10.3389/fsurg.2024.1372310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/28/2024] [Indexed: 10/04/2024] Open
Abstract
Background Pauwels type III femoral neck fractures, as a serious type of femoral neck fractures, have brought about a heavy economic burden on families and society for the high disability rate. Through bibliometric research and visualized analysis, this study aimed at elucidating the global research status of Pauwels type III femoral neck fractures to date, and predicting the future research trends in this field. Methods Publications and associated information on Pauwels type III femoral neck fractures to date were retrieved from Web of Science Core Collection, and by VoSviewer and R package "bibliometrix", bibliometric analysis and visual presentation was conducted. Results By retrieval, a total of 98 studies were refinedly extracted, and the volume of publications in this field increased year-over-year. China ranked first in terms of total publication volume and H-Index, with its total citation records second only to the United States. The country with the highest average citation frequency was Switzerland. SHANGHAI JIAO TONG UNIVERSITY was the most productive research institution. Among the authors in this field, Li, Jiantao had published the most researches. INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED and JOURNAL OF ORTHOPAEDIC TRAUMA were the two magazines with the highest publication volume, total citation records, and H-index. According to keywords co-occurrence analysis, the research content in the past 24 years is mainly divided into four different dimensions. Finite element analysis, femoral neck system, medial buttress plate, cannulated screws, hip screw, open reduction, complications are hot topics for future research. Conclusions According to the global trends analysis of publications production, Pauwels type III femoral neck fractures are receiving increasing attention and input from scholars. China has made the greatest scientific research contribution among countries, but its academic quality should be improved further. The modified therapeutic methods designed for addressing the complications of traditional internal fixation for Pauwels III femoral neck fractures will be the future research hotspot.
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Affiliation(s)
- Mengyu Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- The Fifth Clinical Medical College of Perking University, Beijing, China
| | - Ze Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, China
| | - Fengpo Sun
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Zhu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruining Han
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijie Pei
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhaoshuo He
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Junzhi Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Liangyuan Wen
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, China
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Kim CH, Kim JW. A recent update on the fixation techniques for femoral neck fractures: A narrative review. J Clin Orthop Trauma 2024; 54:102497. [PMID: 39157173 PMCID: PMC11326900 DOI: 10.1016/j.jcot.2024.102497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/29/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Femoral neck fractures present significant challenges in orthopedic surgery, particularly due to technical difficulties and a high complication rate. Surgical intervention is generally recommended, with osteosynthesis and arthroplasty being the main treatment options. Osteosynthesis techniques, including dynamic hip screw (DHS), multiple cannulated screws (MCS), and the femoral neck system (FNS), aim to achieve stable fixation and facilitate fracture healing. Factors influencing the choice of osteosynthesis include fracture displacement, bone quality, patient age, and the presence of posterior tilt. While DHS offers high stability, MCS is preferred in stable type fractures with minimal invasive procedures. FNS, a newer technique, combines the advantages of DHS and MCS, providing strong fixation with minimal soft tissue damage. Considering the comprehensive findings of biomechanical and clinical studies to date, when performing osteosynthesis for unstable femoral neck fractures, caution should be exercised with MCS as it may have slightly inadequate fixation strength compared to DHS and FNS. FNS, being the newest technique, demonstrates superior fixation strength comparable to DHS and is as minimally invasive as MCS. However, it is essential to remember that long-term follow-up results are lacking for FNS.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Obey MR, Falgons CG, Eastman JG, Choo AM, Achor TS, Munz JW, Warner SJ. Low reoperation rate after fixation of displaced femoral neck fractures with the femoral neck system (FNS). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2581-2588. [PMID: 38700518 DOI: 10.1007/s00590-024-03962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/14/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Operative fixation of femoral neck fractures (FNFs) remains challenging. Complications are not infrequent, especially in displaced patterns. Numerous fixation techniques have been previously described in the literature; however, there remains a paucity of data regarding outcomes of these injuries treated with the femoral neck system (FNS). METHODS Patients with a displaced FNF (OTA/AO 31B) treated with the FNS at a single level 1 academic trauma center between 1/1/2019 and 1/1/2023 were identified. Radiographs were reviewed to assess fracture displacement, location, and characteristics. Patient records were further reviewed to assess for complications, reoperations, and osseous union. RESULTS Forty-three patients (65% male) with 44 FNFs were identified with a mean age of 35.0 years (range, 13-61 years). Two patients developed a deep infection requiring surgical debridement, four patients underwent a total hip arthroplasty, and one patient underwent a valgus intertrochanteric osteotomy for nonunion. There were three cases of femoral head AVN. Mean follow-up was 482.5 days among all patients, and 36 fractures had at least 6 months of follow-up or reached bony union. CONCLUSIONS Here, we present a series of patients treated with the FNS for internal fixation and report a 18% reoperation rate. This is lower than the average rate that has been previously reported in similar patient populations in the literature treated with alternative methods of internal fixation. Thus, the FNS appears to be a safe and effective option for treatment of these injuries.
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Affiliation(s)
- Mitchel R Obey
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Washington University in St. Louis, 660 S. Euclid, Campus Box 8233, St. Louis, MO, 63110, USA.
| | - Christian G Falgons
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonathan G Eastman
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Andrew M Choo
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Timothy S Achor
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John W Munz
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephen J Warner
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
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Yoon JY, Byun SE, Cho YH. Fixation of femoral neck fracture with femoral neck system: a retrospective cohort study of 43 patients. BMC Musculoskelet Disord 2024; 25:8. [PMID: 38166882 PMCID: PMC10759579 DOI: 10.1186/s12891-023-07113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUNDS This study aimed to analyze the clinical outcomes of femoral neck fractures (FNF) in patients treated with a femoral neck system (FNS, DePuy Synthes), which is a recently introduced device. METHODS This retrospective cohort study of 43 patients who underwent osteosynthesis using FNS for FNF between July 2019 and June 2021 with a minimum follow-up of 6 months. The researchers examined the patients' demographic factors and radiologically evaluated the fracture type and fixation status, bone union, and postoperative complications. RESULTS Of 43 patients, 25 were female, and the patients' mean age and body mass index were 62.1 years and 22.5 kg/m2, respectively. According to the Association of Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, the most common fracture types were 31B1.1 and B1.2 (13 cases each), followed by B2.3, B2.1, and B2.2 (seven, five, and four cases, respectively). Radiological bone union was confirmed in 39 patients (90.7%), and the mean time to union was 3.6 months. Two cases of nonunion, one case of lag screw cut-out, and one case of osteonecrosis were confirmed; all four cases later underwent arthroplasty. The mean time to reoperation was 4.5 months. Meanwhile, five patients underwent implant removal after the bone union, and distal locking screw stripping was noted in three patients. All three patients required metal plate cutting to remove the implants. CONCLUSIONS Osteosynthesis of FNF using the newly introduced FNS showed favorable clinical outcomes and no specific hardware-related complications were reported during the follow-up. However, attention must be paid to the issue regarding distal locking screw failure during hardware removal.
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Affiliation(s)
- Jae Youn Yoon
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
| | - Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Republic of Korea
| | - Young-Ho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, 99, Ayang-ro, Dong-gu, Daegu, Republic of Korea.
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Haase DR, Achor TS, Choo AM, Warner SJ. Multidimensional Fluoroscopy to Assess Closed Reduction in Displaced Young Femoral Neck Fractures: A Report of 3 Cases. JBJS Case Connect 2024; 14:01709767-202403000-00018. [PMID: 38271549 DOI: 10.2106/jbjs.cc.23.00592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CASE The authors present 3 physiologically young patients with displaced femoral neck fractures who underwent initial closed reduction and provisional fixation. Multidimensional fluoroscopy was used to assess fracture reduction before definitive fixation, with 1 patient requiring an open approach because of inadequate fracture reduction after closed attempts. CONCLUSION Displaced femoral neck fractures in young patients remain difficult injuries to treat. Reduction quality is a significant predictor of patient outcomes. Intraoperative multidimensional fluoroscopy provides treating surgeons with a tool to assess fracture reduction after closed reduction maneuvers and allows for intraoperative treatment adjustment as needed.
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Affiliation(s)
- Douglas R Haase
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri
| | - Timothy S Achor
- Department of Orthopaedic Surgery, McGovern Medical School and Memorial Hermann Medical Center, University of Texas Health Science Center at Houston, Houston, Texas
| | - Andrew M Choo
- Department of Orthopaedic Surgery, McGovern Medical School and Memorial Hermann Medical Center, University of Texas Health Science Center at Houston, Houston, Texas
| | - Stephen J Warner
- Department of Orthopaedic Surgery, McGovern Medical School and Memorial Hermann Medical Center, University of Texas Health Science Center at Houston, Houston, Texas
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Li H, Chen H, She R, Li Y, Qin G, Gan F, Liang H, Hu B. Clinical observation of Gofried positive buttress reduction in the treatment of young femoral neck fracture: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36424. [PMID: 38050256 PMCID: PMC10695552 DOI: 10.1097/md.0000000000036424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Femoral neck fractures in young adults(<65 years), have always been a difficult problem, characterized by high rates of nonunion and avascular necrosis (AVN). The clinical efficacy of anatomical reduction and non-anatomical reduction methods needs to be supported by clinical data. Therefore, we conduct a meta-analysis on the clinical efficacy of different reduction methods to better guide clinical practice. METHODS Relevant studies published using internal fixation to treat femoral neck fracture in several databases were searched. The outcomes sought included Harris score and the rate of AVN, nonunion and femoral neck shortening (<5 mm). Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored. RESULTS The clinical results showed that compared with the anatomical reduction and positive buttress, there is no significant difference in the rate of AVN (OR = 0.87, 95%CI: 0.55-1.37, P = .55), nonunion (OR = 0.54, 95%CI: 0.21-1.41, P = .21), femoral neck shortening (<5 mm) (OR = 1.03,95%CI: 0.57-1.86, P = .92), the Harris score (MD = -0.28, 95%CI: -1.36-0.80, P = .61) and the excellent and good rate of Harris score (OR = 1.73, 95%CI: 0.84-3.56, P = .61). However, compared with negative buttress, the rate of AVN (OR = 0.62, 95%CI: 0.38-1.01, P = .05), nonunion (OR = 0.34, 95%CI: 0.12-1.00, P = .05) and femoral neck shortening (<5 mm) (OR = 0.27, 95%CI: 0.16-0.45, P < .00001) were significantly lower, and the Harris score (MD = 6.53, 95%CI: 2.55 ~ 10.51, P = .001) was significantly better in positive buttress. CONCLUSIONS In the case of difficult to achieve anatomical reduction, for young patients (< 65 years) with femoral neck fracture, reduction with positive buttress can be an excellent alternative and negative buttress should be avoided as much as possible.
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Affiliation(s)
- Huankun Li
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Hongjun Chen
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Ruihao She
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China
| | - Yanhong Li
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Gang Qin
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Fukai Gan
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Huahui Liang
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
| | - Baijun Hu
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, China
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Halvachizadeh S, Martin DP, Pfeifer R, Jukema GN, Gueorguiev B, Pape HC, Berk T. Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years? BMC Musculoskelet Disord 2023; 24:405. [PMID: 37210475 DOI: 10.1186/s12891-023-06539-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND/PURPOSE Impaired healing is a feared complication with devastating outcomes for each patient. Most studies focus on geriatric fracture fixation and assess well known risk factors such as infections. However, risk factors, others than infections, and impaired healing of proximal femur fractures in non-geriatric adults are marginally assessed. Therefore, this study aimed to identify non-infection related risk factors for impaired fracture healing of proximal femur fractures in non-geriatric trauma patients. METHODS This study included non-geriatric patients (aged 69 years and younger) who were treated between 2013 and 2020 at one academic Level 1 trauma center due to a proximal femur fracture (PFF). Patients were stratified according to AO/OTA classification. Delayed union was defined as failed callus formation on 3 out of 4 cortices after 3 to 6 months. Nonunion was defined as lack of callus-formation after 6 months, material breakage, or requirement of revision surgery. Patient follow up was 12 months. RESULTS This study included 150 patients. Delayed union was observed in 32 (21.3%) patients and nonunion with subsequent revision surgery occurred in 14 (9.3%). With an increasing fracture classification (31 A1 up to 31 A3 type fractures), there was a significantly higher rate of delayed union. Additionally, open reduction and internal fixation (ORIF) (OR 6.17, (95% CI 1.54 to 24.70, p ≤ 0.01)) and diabetes mellitus type II (DM) (OR 5.74, (95% CI 1.39 to 23.72, p = 0.016)), were independent risk factors for delayed union. The rate of nonunion was independent of fracture morphology, patient's characteristics or comorbidities. CONCLUSION Increasing fracture complexity, ORIF and diabetes were found to be associated with delayed union of intertrochanteric femur fractures in non-geriatric patients. However, these factors were not associated with the development of nonunion.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - David Paul Martin
- Department of Orthopedics and Rehabilitation, University of Wisconsin, 1685 Highland Ave, Madison, WI, 53705, USA
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Gerrolt Nico Jukema
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Till Berk
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland.
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Lim EJ, Kim BS, Kim M, Shon HC, Kim CH. Open reduction versus closed reduction in internal fixation of displaced femoral neck fracture in children: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:49. [PMID: 36650541 PMCID: PMC9843841 DOI: 10.1186/s13018-023-03525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The quality of reduction is an important factor affecting clinical outcomes for displaced femoral neck fractures (FNFs). However, concerns remain about the invasiveness of open reduction and internal fixation (ORIF) as compared to that of closed reduction and internal fixation (CRIF), and the choice between ORIF and CRIF as an optimal treatment strategy for displaced pediatric FNF remains controversial. MATERIALS AND METHODS MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to December 22, 2022, that compared ORIF and CRIF techniques for treating FNF in children. Pooled analysis identified differences in surgical outcomes between ORIF and CRIF, especially regarding postoperative complications, such as osteonecrosis of the femoral head (ONFH), nonunion, coxa vara deformity, leg-length discrepancy LLD, and premature physeal closure (PPC). RESULTS We included 15 studies with 635 pediatric FNF cases in our review. Of these, 324 and 311 were treated with ORIF and CRIF, respectively. The pooled analysis revealed that no significant differences existed between each reduction technique for ONFH (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.51-1.56; P = 0.69), nonunion (OR = 0.51; 95% CI 0.18-1.47; P = 0.21), coxa vara deformity (OR = 0.58; 95% CI 0.20-1.72; P = 0.33), LLD (OR = 0.57; 95% CI 0.18-1.82; P = 0.35), and PPC (OR = 0.72; 95% CI 0.11-4.92; P = 0.74). CONCLUSIONS Despite concerns about the invasiveness of ORIF, no differences in complications exist between ORIF and CRIF after FNF in children. Therefore, we believe that ORIF should be performed in FNF when the fracture is irreducible by closed manner.
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Affiliation(s)
- Eic Ju Lim
- grid.254229.a0000 0000 9611 0917Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Boo-Seop Kim
- grid.254224.70000 0001 0789 9563Department of Orthopaedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Namyangju-Si, Kyunggi-Do Republic of Korea
| | - Minboo Kim
- grid.254229.a0000 0000 9611 0917Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hyun-Chul Shon
- grid.254229.a0000 0000 9611 0917Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Chul-Ho Kim
- grid.267370.70000 0004 0533 4667Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea ,grid.254224.70000 0001 0789 9563Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Dai M, Furuya-Kanamori L, Syed A, Lin L, Wang Q. An empirical comparison of the harmful effects for randomized controlled trials and non-randomized studies of interventions. Front Pharmacol 2023; 14:1064567. [PMID: 37025494 PMCID: PMC10070801 DOI: 10.3389/fphar.2023.1064567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction: Randomized controlled trials (RCTs) are the gold standard to evaluate the efficacy of interventions (e.g., drugs and vaccines), yet the sample size of RCTs is often limited for safety assessment. Non-randomized studies of interventions (NRSIs) had been proposed as an important alternative source for safety assessment. In this study, we aimed to investigate whether there is any difference between RCTs and NRSIs in the evaluation of adverse events. Methods: We used the dataset of systematic reviews with at least one meta-analysis including both RCTs and NRSIs and collected the 2 × 2 table information (i.e., numbers of cases and sample sizes in intervention and control groups) of each study in the meta-analysis. We matched RCTs and NRSIs by their sample sizes (ratio: 0.85/1 to 1/0.85) within a meta-analysis. We estimated the ratio of the odds ratios (RORs) of an NRSI against an RCT in each pair and used the inverse variance as the weight to combine the natural logarithm of ROR (lnROR). Results: We included systematic reviews with 178 meta analyses, from which we confirmed 119 pairs of RCTs and NRSIs. The pooled ROR of NRSIs compared to that of RCTs was estimated to be 0.96 (95% confidence interval: 0.87 and 1.07). Similar results were obtained with different sample size subgroups and treatment subgroups. With the increase in sample size, the difference in ROR between RCTs and NRSIs decreased, although not significantly. Discussion: There was no substantial difference in the effects between RCTs and NRSIs in safety assessment when they have similar sample sizes. Evidence from NRSIs might be considered a supplement to RCTs for safety assessment.
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Affiliation(s)
- Minhan Dai
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QL, Australia
| | - Asma Syed
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Qiang Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Qiang Wang,
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Berk T, Halvachizadeh S, Martin DP, Hierholzer C, Müller D, Pfeifer R, Jukema GN, Gueorguiev B, Pape HC. Trochanteric fracture pattern is associated with increased risk for nonunion independent of open or closed reduction technique. BMC Geriatr 2022; 22:990. [PMID: 36544094 PMCID: PMC9773584 DOI: 10.1186/s12877-022-03694-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Soft tissue injury and soft tissue injury as risk factors for nonunion following trochanteric femur fractures (TFF) are marginally investigated. The aim of this study was to identify risk factors for impaired fracture healing in geriatric trauma patients with TFF following surgical treatment with a femoral nail. METHODS This retrospective cohort study included geriatric trauma patients (aged > 70 years) with TFF who were treated with femoral nailing. Fractures were classified according to AO/OTA. Nonunion was defined as lack of callus-formation after 6 months, material breakage, and requirement of revision surgery. Risk factors for nonunion included variables of clinical interest (injury pattern, demographics, comorbidities), as well as type of approach (open versus closed) and were assessed with uni- and multivariate regression analyses. RESULTS This study included 225 geriatric trauma patients. Nonunion was significantly more frequently following AO/OTA 31A3 fractures (N = 10, 23.3%) compared with AO/OTA type 31A2 (N = 6, 6.9%) or AO/OTA 31A1 (N = 3, 3.2%, p < 0.001). Type 31A3 fractures had an increased risk for nonunion compared with type 31A1 (OR 10.3 95%CI 2.2 to 48.9, p = 0.003). Open reduction was not associated with increased risk for nonunion (OR 0.9, 95%CI 0.1 to 6.1. p = 0.942) as was not the use of cerclage (OR 1.0, 95%CI 0.2 to 6.5, p = 0.995). Factors such as osteoporosis, polytrauma or diabetes were not associated with delayed union or nonunion. CONCLUSION The fracture morphology of TFF is an independent risk factor for nonunion in geriatric patients. The reduction technique is not associated with increased risk for nonunion, despite increased soft tissue damage following open reduction.
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Affiliation(s)
- Till Berk
- grid.412004.30000 0004 0478 9977Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Sascha Halvachizadeh
- grid.412004.30000 0004 0478 9977Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - David Paul Martin
- grid.28803.310000 0001 0701 8607Department of Orthopedics and Rehabilitation, University of Wisconsin, 1685 Highland Ave, Madison, WI 53705 USA
| | - Christian Hierholzer
- grid.412004.30000 0004 0478 9977Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Dominik Müller
- grid.413349.80000 0001 2294 4705Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
| | - Roman Pfeifer
- grid.412004.30000 0004 0478 9977Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Gerrolt Nico Jukema
- grid.412004.30000 0004 0478 9977Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Boyko Gueorguiev
- grid.418048.10000 0004 0618 0495AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Hans-Christoph Pape
- grid.412004.30000 0004 0478 9977Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Harald-Tscherne Laboratory for Orthopedic and Trauma Research, Sternwartstrasse 14, 8091 Zurich, Switzerland
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11
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Stassen RC, Jeuken RM, Boonen B, Meesters B, de Loos ER, van Vugt R. First clinical results of 1-year follow-up of the femoral neck system for internal fixation of femoral neck fractures. Arch Orthop Trauma Surg 2022; 142:3755-3763. [PMID: 34734328 DOI: 10.1007/s00402-021-04216-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Closed reduction and internal fixation (CRIF) is the preferred treatment to retain the native joint and maintain optimal functionality in femoral neck fractures. Sliding hip screw (SHS) and cannulated hip screws (CHS) are established CRIF options. SHS offer high biomechanical stability, whereas CHS are minimally invasive. These established systems have a 17-21% failure rate. The Femoral neck system (FNS) was recently developed to combine the advantages of both predecessors. The aim of this study was to describe the first clinical experience with this novel implant with special emphasis on the safety and efficacy. METHODS During a 1-year period all patients in our level-2 trauma centre with a FNF indicated for CRIF were treated using the FNS and evaluated at 2, 6, 12 weeks, 6 months and 1 year postoperatively using patient and fracture characteristics, surgical notes and radiographic imaging. RESULTS Thirty-four patients were included, mean age was 63 years (SD 8), 58.2% was female. Fractures were classified as Pauwels I (n = 10), Pauwels II (n = 15), Pauwels III (n = 9), Garden I (n = 1), Garden II (n = 17), Garden III (n = 12) and Garden IV (n = 4). Eight reoperations were reported after 1-year follow-up; osteosyntheses failed in 6 patients due to avascular necrosis (n = 4) and cut-out (n = 2). In two patients the implant was removed due to inexplicable pain. Age (< 65 years) was related to lower risk for failure. There was a trend for females having more failures. CONCLUSION This study indicates that the FNS is a potential safe and effective CRIF modality. Age (< 65 years) is an important factor to keep in mind when selecting patients for CRIF as it is related to lower risk for failure. Future long-term follow-up studies with larger populations should indicate if functional results and risk factors for failure are comparable to SHS or CHS.
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Affiliation(s)
- Robert C Stassen
- Department of Traumatology, Zuyderland Medisch Centrum, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - Ralph M Jeuken
- Department of Traumatology, Zuyderland Medisch Centrum, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - Bert Boonen
- Department of Orthopaedics, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Berry Meesters
- Department of Traumatology, Zuyderland Medisch Centrum, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Traumatology, Zuyderland Medisch Centrum, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - Raoul van Vugt
- Department of Traumatology, Zuyderland Medisch Centrum, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
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12
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Sami A, Prabhakar R, Kumar Yadav A, Kumar Jain V. Biplane double supported screw fixation for femoral neck fracture in young adults: A prospective cohort study. J Orthop 2022; 33:117-123. [PMID: 35958981 PMCID: PMC9361214 DOI: 10.1016/j.jor.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Achieving accurate anatomic reduction and stable internal fixation is mandatory in the management of femoral neck fractures (FNF) in adults. The spatial configuration and direction of the screws have been reported to provide stability to the fracture. The study's goal is to analyse the clinico-radiological outcome of the newer biplane double-supported screw fixation (BDSF) technique in the Indian cohort. Materials and methods Patients with isolated FNFs underwent osteo-synthesis by BDSF technique. Radiological outcome was evaluated by time to union and fracture healing on plain radiographs. Clinical outcome was measured using the Harris hip score (HHS) at 1, 3, 6, and 12 months after surgery. The pain reduction was measured using the VAS score. Results Twenty-seven patients with a mean age of 37.33 ± 9.84 years (24-55 years) were followed up for at least 12 months (12-31 months). The mean HHS at 12 months was 94.81 ± 8.18 (range: 68-100). Twenty-five patients were able to achieve radiological union within a mean time of 14.60 ± 4.69 weeks (range: 8-28). The overall complication rate was found to be 18.51% (5 out of 27 patients). Individual complications were non-union (2 patients; 7.4%), AVN (3 patients; 11.11%), and screw back out with femoral neck shortening (4 patients; 14.81%). Conclusion Screw configuration using the BDSF technique provides a good union rate with minimum complications. The majority of patients resulted in a good (HHS >80) to excellent functional outcome. Based on the clinico-radiological outcome obtained, we conclude that this technique is effective in the fixation of FNF in adults. Level of study Level II.
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Affiliation(s)
- Abdus Sami
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Rahul Prabhakar
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Ajay Kumar Yadav
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
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13
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Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, Kotela A. Avascular Necrosis of Femoral Head-Overview and Current State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127348. [PMID: 35742595 PMCID: PMC9223442 DOI: 10.3390/ijerph19127348] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022]
Abstract
Avascular necrosis (AVN) of the femoral head is caused by disruption of the blood supply to the proximal femur. The alterations in the blood supply may occur following a traumatic event or result from a non-traumatic cause. Femoral neck fracture and hip dislocation and associated surgical procedures, corticosteroid therapy, and alcohol abuse frequently lead to AVN development. Type of fracture (displaced or undisplaced) and time between injury and surgery are the most critical factors in assessing the risk of developing AVN. Diagnosis of AVN can be established based on patients’ complaints, medical history, and radiographic findings. There is no consensus on the treatment of patients with AVN to date. Non-surgical methods are dedicated to patients in the early pre-collapse stages of the disease and consist of pharmacotherapy and physiotherapy. Surgery is recommended for patients with advanced disease.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
- Correspondence: ; Tel.: +48-(50)-2110863
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Andrzej Śliwczyński
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Martyna Hordowicz
- General Psychiatry Unit III, Dr Barbara Borzym’s Independent Public Regional Psychiatric Health Care Center, 26-600 Radom, Poland;
| | - Andrzej Kotela
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland;
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14
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Qiu L, Huang Y, Li G, Wu H, Zhang Y, Zhang Z. Essential role of reliable reduction quality in internal fixation of femoral neck fractures in the non-elderly patients-a propensity score matching analysis. BMC Musculoskelet Disord 2022; 23:346. [PMID: 35410332 PMCID: PMC8996399 DOI: 10.1186/s12891-022-05307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background The rate of failure of internal fixation for femoral neck fractures has remained largely unchanged over the past 30 years. The current study attempted to identify the controllable variables influencing the failure of internal fixation of femoral neck fractures. Methods The study included 190 patients aged from 20 to 65 with femoral neck fracture caused by low energy violent injuries (fall from standing height), who were treated with multiple cannulated screws over the period 2005–2019 at a single centre. Kaplan–Meier (KM) survival analysis was firstly utilized to evaluate the potential interaction between each variable and cumulative rates of reoperation. If P < 0.1 in KM survival analysis, the variables would be included in subsequent Cox survival analysis to explore the influencing need for reoperation of a femoral neck fracture. Next, all of the 190 patients were divided into perfect reduction group (Garden Alignment Index I) and imperfect reduction group (Garden Alignment Index II, III, IV). Propensity score matching (PSM) analysis resulted in 39 pairs. After the baseline variables were balanced between the two groups, cox survival analysis was utilized again to explore the variables influencing the need of reoperation of a femoral neck fracture. Finally, KM survival analysis was utilized to compare the cumulative rate of reoperation between perfect reduction (Group PR) and imperfect reduction (Group IR) as a subgroup analysis. Results Before PSM analysis, the mean age was 49.96 ± 12.02 years and the total reoperation rate was 17.40%. Cox survival analysis showed that only reduction quality was interrelated with the need for reoperation before PSM analysis and after PSM analysis. Kaplan–Meier cumulative reoperation rate was higher in Group IR than in Group PR after PSM analysis. Conclusion To prolong the service life of the original femoral head, it is essential to achieve a completely anatomical reduction and maintain the reduction quality until the patient fully recovers.
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Affiliation(s)
- Longhai Qiu
- Department of Traumatology and Orthopaedic Surgery, Orthopaedic Institute, Huizhou Municipal Central Hospital, Huizhou, 516001, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yuliang Huang
- Department of Traumatology and Orthopaedic Surgery, Orthopaedic Institute, Huizhou Municipal Central Hospital, Huizhou, 516001, China
| | - Guowen Li
- Department of Traumatology and Orthopaedic Surgery, Orthopaedic Institute, Huizhou Municipal Central Hospital, Huizhou, 516001, China
| | - Hongbo Wu
- Department of Traumatology and Orthopaedic Surgery, Orthopaedic Institute, Huizhou Municipal Central Hospital, Huizhou, 516001, China
| | - Yu Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China. .,Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academic of Medical Science, Guangzhou, 510080, China.
| | - Zhiwen Zhang
- Department of Traumatology and Orthopaedic Surgery, Orthopaedic Institute, Huizhou Municipal Central Hospital, Huizhou, 516001, China.
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15
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Lin S, Li J, Wang R, Ou Y, Jia Z, Zhang Y, Xia H, Li B, Chen B. The effect of anteromedial support plate with three cannulated screws in the treatment of Pauwels type III femoral neck fracture in young adults. Eur J Trauma Emerg Surg 2022; 48:4011-4017. [PMID: 35288767 DOI: 10.1007/s00068-022-01931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study is aimed to evaluate the clinical effects of anteromedial support plate combined with three cannulated screws on Pauwels type III femoral neck fractures in young adults. METHODS We conducted a retrospective study of 27 patients with Pauwels type III femoral neck fracture treated by anteromedial support plate combined with three cannulated screws. The results of fracture healing and complications for all patients were assessed by postoperative imaging examination. The Harris hip score was used to evaluate the functional outcome of the hip at the last follow-up. RESULTS The fracture union was achieved in 25 patients (92.6%). However, two patients required reoperation (two for nonunion). Early implant failure occurred in one patient, neck shortening in one patient and coxa vara in one patient. The excellent or good outcome of the Harris hip score was 96% for the 25 patients with satisfactory fracture union. CONCLUSION Our preliminary results indicate that anteromedial support plate combined with three cannulated screws is a good alternative in the treatment of Pauwels type III femoral neck fractures in young adults with high union rate and low incidence of complications including nonunion and avascular necrosis of the femoral head.
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Affiliation(s)
- Shanghui Lin
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, People's Republic of China
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Jinmei Li
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, People's Republic of China
| | - Renkai Wang
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Yongliang Ou
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Zhenyu Jia
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Ying Zhang
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Hong Xia
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China
| | - Baofeng Li
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, No. 111, Liuhua Avenue, Guangzhou, 510010, China.
| | - Bei Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, People's Republic of China.
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16
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Zhang J, Zhuang Y, Dai L, Huang D. A Comparative Study between Proximal Femoral Locking Plate and Multiple Cannulated Screws for Fixation of Femoral Neck Fractures in Young Adults. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1286419. [PMID: 35222875 PMCID: PMC8866011 DOI: 10.1155/2022/1286419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the clinical effect of proximal femoral locking plate (PFLP) versus multiple cancellous screw (MCS) for FNF. METHODS FNF patients were treated with the PFLP implant or multiple cancellous screws (MCSs). Patient has been followed up for at least 12 months after surgery nonunion, and the occurrence of complications, femoral neck shortening, fracture healing time, and Harris hip score were recorded and compared. RESULTS 77 FNF patients were treated with the PFLP (36 patients) or MCS (41 patients). The sex, age, side of the injured limb, type of Garden fracture, time from injury to surgery, and fracture healing time of two groups patients were comparable. The operation time and intraoperative blood loss in the PFLP group were worse than those in the MCS group. Two patients with the PFLP (5%) and nine patients (21%) with the MCS experienced cut out of the lag screw or avascular necrosis of the femoral head or nonunion and received hip replacement. However, the number of fluoroscopies in the PFLP group was significantly lower than that in the MCS group. Additionally, the femoral neck shortening and Harris hip score were all strongly better in the PFLP group than in the MCS group. CONCLUSIONS Compared with the MCS, PFLP treatment for FNF in young adults can decrease the fluoroscopy times, improve hip functional recovery, and reduce the complications rate and femoral neck shortening.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo 315040, China
| | - Yunqiang Zhuang
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo 315040, China
| | - Li Dai
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo 315040, China
| | - Dichao Huang
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo 315040, China
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17
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Radiographic outcomes of femur fractures following SIGN Fin nailing in low- and middle-income countries. OTA Int 2021; 4:e141. [PMID: 34746673 PMCID: PMC8568381 DOI: 10.1097/oi9.0000000000000141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
Objective: To measure the effectiveness of the Surgical Implant Generation Network (SIGN) Fin nail for achieving satisfactory postoperative radiographic alignment following femoral shaft fractures. Methods: Femoral shaft fractures stabilized with the SIGN Fin nail were identified using the SIGN Online Surgical Database. A random number generator was used to identify 500 femur fractures fixed within 6 weeks of injury for which postoperative radiographs were available. Fractures were classified using OTA/AO and Winquist-Hansen classification systems. Deviation from anatomic alignment was measured on anterior-posterior and lateral radiographs using an on-screen protractor tool. Other clinical variables recorded in the SIGN Online Surgical Database were also analyzed. Simple logistic regression was used to assess for associations between subject and surgical characteristics and misalignment status. Intra- and inter-rater agreement was assessed with intraclass correlation coefficient (ICC). Results: The overall rate of malalignment >5° was 9.4%. Factors associated with increased incidence of malalignment include older age, increased time to surgery, distal diaphyseal location, closed (vs open) reduction, degree of comminution, and fracture classification. Intra-rater ICC was 0.70 (0.52, 0.82) in the coronal plane and 0.55 (0.32, 0.72) in the sagittal plane. Inter-rater ICC was 0.37 (0.08, 0.60) and 0.32 (0.05, 0.54), respectively. Conclusion: The SIGN Fin nail is an effective implant for fixation of femoral shaft fractures in resource-limited regions, achieving rates of satisfactory postoperative alignment comparable to that of the standard SIGN nail as well as femoral shaft fractures treated in North American Trauma Centers. Further research is required to investigate rotational alignment and long-term clinical outcomes for the SIGN Fin nail. Level of evidence: IV.
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18
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Chandankere V, Shah H. Controversies in the management of pediatric neck femur fractures- a systematic review. J Orthop 2021; 27:92-102. [PMID: 34588744 DOI: 10.1016/j.jor.2021.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/12/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose To review controversies systematically in the management of pediatric neck femur fracture from the literature and to develop consensus for the optimum management. Methods Authors searched literature by using keywords of pediatric neck femur fracture, proximal femur fracture, complications, management by following PRISMA guidelines. A common dilemma was listed. Results Age, mechanism of injury, fracture type, presentation, treatment method, implant, and nature of complications were compared. Inference from recent literature was extracted for optimum management. Conclusion Immediate anatomical reduction with stable fixation must be accomplished. Complications continue to happen despite the best efforts and a longer follow-up is important.
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Affiliation(s)
| | - Hitesh Shah
- Pediatric Orthopaedics Services, Department of Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
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19
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Patterson JT, Ishii K, Tornetta P, Leighton RK, Friess DM, Jones CB, Levine A, Maclean JJ, Miclau T, Mullis BH, Obremskey WT, Ostrum RF, Reid JS, Ruder JA, Saleh A, Schmidt AH, Teague DC, Tsismenakis A, Westberg JR, Morshed S. Smith-Petersen Versus Watson-Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture. J Orthop Trauma 2021; 35:517-522. [PMID: 34510125 DOI: 10.1097/bot.0000000000002068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches. DESIGN Retrospective cohort study. SETTING Twelve Level 1 North American trauma centers. PATIENTS Eighty adults 18-65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation. INTERVENTION Thirty-two modified Smith-Petersen anterior approaches versus 48 Watson-Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons. MAIN OUTCOME Reduction quality as assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs. RESULTS No difference was observed in the rate of acceptable reduction by modified Smith-Petersen (81%) versus Watson-Jones (81%) approach (risk difference null, 95% confidence interval -17.4% to 17.4%, P = 1.00) with 90.4% panel agreement (Fleiss' weighted κ = 0.63, P < 0.01). Stratified analyses did not identify a significant difference in the rate of acceptable reduction between approaches when stratified by Pauwels angle, basicervical or transcervical fracture location, or posterior comminution. The Smith-Petersen approach afforded a better reduction when preoperative skeletal traction was not applied (RR = 1.67 [95% CI 1.10-2.52] vs. RR = 0.87 [95% CI 0.70-1.08], P = 0.006). CONCLUSIONS No difference was observed in the quality of open reduction of displaced femoral neck fractures in young adults when a Watson-Jones anterolateral approach versus a modified Smith-Petersen anterior approach was performed by orthopaedic trauma surgeons. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Keisuke Ishii
- Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Paul Tornetta
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA
| | - Ross K Leighton
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
| | - Darin M Friess
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS
| | - Clifford B Jones
- Division of Orthopaedic Surgery, Dignity Health Arizona, Creighton Medical School, Phoenix, AZ
| | - Ari Levine
- Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH
| | - Jeffrey J Maclean
- Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Theodore Miclau
- Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Brian H Mullis
- Department of Orthopaedic Surgery, Indiana University, Indianapolis, IN
| | - William T Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN
| | - Robert F Ostrum
- Department of Orthopaedic Surgery, University of North Carolina, Charlotte, NC
| | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Penn State University, Hersey Medical Center, Hersey, PA
| | - John A Ruder
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC
| | - Anas Saleh
- Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH
| | - Andrew H Schmidt
- Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, MN; and
| | - David C Teague
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK
| | | | - Jerald R Westberg
- Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, MN; and
| | - Saam Morshed
- Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
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20
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Femoral neck fractures: Key points to consider for fixation or replacement a narrative review of recent literature. Injury 2021; 54 Suppl 1:S70-S77. [PMID: 34615597 DOI: 10.1016/j.injury.2021.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral neck fractures (FNF) are frequent injuries and not rarely complicated by non-union, implant failure, and avascular necrosis. Some of these fractures represent a dilemma for trauma surgeons. Which fracture should be fixed? Which replaced with a prosthesis? How? The aim of this narrative review is to investigate the literature in order to provide the most updated and evidence-based knowledge about FNF' treatment. MATERIALS AND METHODS A literature research has been performed to find the essential key points to consider when dealing with FNF and their treatment. The most representative papers and the new meta-analysis were matched with authors' experience to give a concise but comprehensive view of the problem. Timing, age, comorbidities, vascularization of the femoral head, displacement, instability, comminution of the fracture, bone quality, and surgeon experience seem to be the major topics to consider in the decision making. We then focus on the optimal fixation or replacement as suggested by the literature. RESULTS Age is the main independent factor to consider. Timing seems essential in the elderly population to reduce mortality and important in the younger patients to reduce complications. Vascular supply should be always considered. Displacement, instability, and comminution of the fracture are negative prognostic factors for fixation as well as, theoretically, bone quality. In the elderly hip replacement is mostly indicated. A stable and solid fixation is mandatory to allow early mobilization. Sliding Hip Screws (SHS) seem preferable to cannulated screws for displaced/unstable (Pauwels II-III, posterior comminution) and basicervical fracture patterns or in smokers. There is a tendency toward Total Hip Arthroplasty (THA) also in the elderly if the patient is an indipendent ambulator without severe comorbidities. Dual mobility cups are gaining popularity in THA for FNF. CONCLUSIONS FNF are frequent injuries and represent, in some cases, a dilemma for the trauma surgeon. Age, timing, comorbidities, bone quality, femoral head vascularization, fracture displacement, intrinsic instability, and comminution as surgeon experience should be carefully evaluated before surgery. A case-to-case analysis of the patient-related factors helps the surgeon to make the right choice and reduce the well-known complications.
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Young Intertrochanteric Femur Fractures Are Associated With Fewer Complications than Young Femoral Neck Fractures. J Orthop Trauma 2021; 35:356-360. [PMID: 33165209 DOI: 10.1097/bot.0000000000002005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the complication profile of femoral neck (FN) and intertrochanteric (IT) femur fractures in young patients. DESIGN A retrospective database review. SETTING Large, national private insurer claims database with longitudinal follow-up. PATIENTS Individuals undergoing surgical fixation of IT or FN fractures from 2010 to 2017 were identified. Patients were included if they were 18-50 years of age and had 1-year postoperative follow-up. Those with comorbid conditions of chronic kidney disease, congestive heart failure, diabetes, or coronary artery disease were excluded from the primary analysis. MAIN OUTCOME MEASURES Complication data, including a diagnosis of nonunion, malunion, avascular necrosis (AVN), or need for revision surgery at 1-year follow-up, were compared. In addition, medical complication data at 90 days postoperatively were evaluated. RESULTS In total, 808 patients were identified: 392 (48.5%) patients with IT femur fractures and 416 (51.5%) patients with FN fractures. On multivariate analysis, FN fractures had nearly twice the risk of nonunion compared with IT femur fractures (odds ratio = 1.89; confidence interval, 1.09-3.30). IT femur fractures had a 5.4% rate of nonunion, a 3.6% rate of revision surgery, a 1% rate of AVN, and a 0.8% rate of conversion into total hip arthroplasty. By contrast, FN fractures had significantly higher rates of nonunion (10.3%; P = 0.009), revision surgery (9.4%; P = 0.001), AVN (5.8%; P < 0.001), and conversion to total hip arthroplasty (6%; P < 0.001). CONCLUSION The results of this study demonstrate that IT fractures in young patients have superior outcomes when compared with their intracapsular counterparts. This is the only series of its kind to evaluate the complication profile of young IT femur fractures on a large scale. This information will be helpful in counseling patients in the perioperative setting. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Huang K, Fang X, Li G, Yue J. Assessing the effect of Gotfried reduction with positive buttress pattern in the young femoral neck fracture. J Orthop Surg Res 2020; 15:511. [PMID: 33160395 PMCID: PMC7648971 DOI: 10.1186/s13018-020-02039-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although many available surgical procedures for displaced femoral neck fractures in young patients, there are still many challenges to achieve satisfactory results. The incidence of avascular necrosis and nonunion rates remains relatively high despite the progress in our understanding and surgical technique. The purpose of this study was to evaluate the clinical efficacy of Gotfried reduction and cannulated screw fixation in the treatment of femoral neck fracture for young adults. METHODS A retrospective analysis was made on 67 cases from May 2013 to March 2019. They were divided into three groups according to the first postoperative anteroposterior view of hip X-ray: Anatomic reduction (group A), Gotfried positive buttress reduction (group B), and Gotfried negative buttress reduction (group C). The incidence of avascular osteonecrosis of the femoral head (AVN) and the Harris scores of hip joints were compared in three groups at the last follow-up. RESULTS The mean follow-up period after surgery was 22.5 ± 11.3 (range, 11-34) months. There were 21 cases (mean age, 49.7 ± 11.6) in group A, 24 cases (mean age, 48.6 ± 11.3) in group B, 22 cases (mean age, 48.3 ± 12.4) in group C. No significant difference in general preoperative demographics (P > 0.05). The incidence of avascular necrosis of femoral head in group A, B, and C was 19.05%, 20.83%, and 22.73%, respectively, showing no significant difference between groups (P = 0.156). The mean Harris hip scores at the final follow-up for groups A (85.6 ± 6.7) and B (84.5 ± 6.2) were significantly higher than group C (74.3 ± 8.3), and the difference was statistically significant (P = 0.043). The incidence of femoral neck shortening in group A and group B was significantly lower than that in group C in postoperative 1 year, and the difference was statistically significant (P < 0.05). CONCLUSIONS Gotfried positive buttress reduction and fixation for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better than Gotfried negative buttress reduction. For the patients of femoral neck fracture with severe displacement and difficulty reduction, it is not necessary to pursue anatomical reduction. Achieving positive valgus reduction can also obtain satisfactory clinical results, and should try to avoid negative buttress.
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Affiliation(s)
- Kai Huang
- Department of Orthopedics, Changzhou Cancer Hospital Soochow University, No. 68 Honghe Road, Changzhou, 213001, Jiangsu, China.
| | - Xiaohui Fang
- Department of Orthopedics, Changzhou Cancer Hospital Soochow University, No. 68 Honghe Road, Changzhou, 213001, Jiangsu, China
| | - Guijun Li
- Department of Orthopedics, Changzhou Cancer Hospital Soochow University, No. 68 Honghe Road, Changzhou, 213001, Jiangsu, China
| | - Jiajun Yue
- Department of Intensive Care Unit, Changzhou Cancer Hospital Soochow University, No. 68 Honghe Road, Changzhou, 213001, Jiangsu, China
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Yoon JY, Lee SJ, Yoon KS, Yoon PW. The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study. BMC Musculoskelet Disord 2020; 21:517. [PMID: 32746824 PMCID: PMC7397520 DOI: 10.1186/s12891-020-03538-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/23/2020] [Indexed: 12/05/2022] Open
Abstract
Backgrounds One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head. Methods A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient’s contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio). Results Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3, 75.0, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85–1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28–0.38). In contrast, the ratio was 1.30 (95% CI: 1.03–1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio (P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups (P < 0.001). Conclusions SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.
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Affiliation(s)
- Jae Youn Yoon
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Abstract
BACKGROUND Closed reduction (CR) is sufficient to reduce the majority of femur fractures treated with flexible intramedullary nailing (FIN). No previous study has examined factors associated with failed CR of pediatric femoral shaft fractures treated with FIN. We sought to determine preoperative factors associated with failed CR. We hypothesized that fracture, patient, and surgeon characteristics would impact the need for open reduction (OR). METHODS A retrospective review of children treated for femur fracture between 2012 and 2017 at a tertiary pediatric hospital was performed. Comparisons were made between 2 groups: FIN with CR group and FIN that required OR group. Demographic and baseline characteristics were compared between treatment groups using either χ tests or Fisher exact tests for categorical variables and general linear models for continuous variables. Odds ratios with 95% confidence intervals were calculated using univariate logistic regression tests. RESULTS Of 449 consecutive pediatric femur fractures treated at our center, 85 children were treated with FIN and constituted the study cohort. CR failed in 14 patients (16.5%) necessitating OR of the fracture site. Significant differences between study groups were found in fracture location (P=0.018), the mechanism (P=0.003), and displacement on the anteroposterior radiograph (P=0.027). Surgical time was found to be longer in the OR group (P=0.010). We identified 3 preoperative predictors of OR for FIN including fractures caused by high energy mechanisms (odds ratio=7.5), distal third fractures (odds ratio=15.3), and fracture displacement on the anteroposterior view (odds ratio=1.06). Surgeon years in practice, patient weight, age, and time from injury to surgery were not associated with OR. CONCLUSIONS This study presents 3 preoperative risk factors that predict the need for OR of femur fractures treated with FIN. Surgical time was longer in cases that required OR. Our findings suggest that surgeons should avoid lengthy attempts at CR and consider a lower threshold for OR of at-risk fractures or use another technique other than flexible nails. LEVEL OF EVIDENCE Level III-prognostic.
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Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18-65 Years. J Orthop Trauma 2020; 34:294-301. [PMID: 32079891 DOI: 10.1097/bot.0000000000001711] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation. DESIGN Retrospective cohort study with radiograph and chart review. SETTING Twelve Level 1 North American trauma centers. PATIENTS Two hundred thirty-four adults 18-65 years of age with an isolated, displaced, OTA/AO type 31-B2 or type 31-B3 femoral neck fracture treated with internal fixation with minimum of 6-month follow-up or reoperation. Exclusion criteria were pathologic fractures, associated femoral head or shaft fractures, and primary arthroplasty. INTERVENTION Open or closed reduction technique during internal fixation. MAIN OUTCOME Cox proportional hazard of reoperation adjusting for propensity score for open reduction based on injury, demographic, and medical factors. Reduction quality was assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs. RESULTS Median follow-up was 1.5 years. One hundred six (45%) patients underwent open reduction. Reduction quality was not significantly affected by open versus closed approach (71% vs. 69% acceptable, P = 0.378). The propensity to receive an open reduction was associated with study center; younger age; male sex; no history of injection drug use, osteoporosis, or cerebrovascular disease; transcervical fracture location; posterior fracture comminution; and surgery within 12 hours. A total of 35 (33%) versus 28 (22%) reoperations occurred after open versus closed reduction (P = 0.056). Open reduction was associated with a 2.4-fold greater propensity-adjusted hazard of reoperation (95% confidence interval 1.3-4.4, P = 0.004). A total of 35 (15%) patients underwent subsequent total hip arthroplasty or hemiarthroplasty. CONCLUSIONS Open reduction of displaced femoral neck fractures in nonelderly adults is associated with a greater hazard of reoperation without significantly improving reduction. Prospective randomized trials are indicated to confirm a causative effect of open versus closed reduction on outcomes after femoral neck fracture. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Yang H, Liu Y, Liu L. [Progress of hip fracture treatment in children]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:404-408. [PMID: 32174091 DOI: 10.7507/1002-1892.201907005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review the progress of hip fracture treatment in children. Methods Literature about the hip fracture treatment in children was extensively reviewed and summarized in terms of anatomy and blood supply, fracture classification, surgical treatment principles, and complications. Results The anatomical structure of children's hips and the characteristics of peripheral blood supply constantly change with age. Delbet classification is the most classic classification of hip fracture in children. Children's age and Delbet classification have significant effects on surgical treatment strategies and post-fracture complications. The timing of surgical treatment, accurate anatomical reduction, and appropriate internal fixation can effectively improve the prognosis and reduce the incidence of complications. Common complications include osteonecrosis of the femoral head, coxa vara, premature physeal closure, and nonunion. Conclusion There are still some controversies on the treatment concept and internal fixation choice for children's hip fracture. So it is necessary to further study the anatomy and blood supply characteristics of children's hip, improve the selection and application skills of internal fixation devices, so as to avoid serious complications.
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Affiliation(s)
- Hai Yang
- Department of Othopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yang Liu
- Department of Othopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Lei Liu
- Department of Othopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Pan Y, Lu X, Lin R, Zhang X, Mei H, Guo Y, Chen S. Free Fracture Fragment Predicts Poorer Outcomes in Adolescents With Delbet II Femoral Neck Fracture. J Surg Res 2019; 248:14-19. [PMID: 31841732 DOI: 10.1016/j.jss.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/09/2019] [Accepted: 10/05/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND This retrospective multicenter study investigated whether the presence of free fracture fragments is associated with the clinical outcome of adolescents with Delbet II femoral neck fracture (FNF). MATERIALS AND METHODS The study population comprised 74 adolescents with Delbet II FNF, with an average age of 13.31 y (range, 10-17 y). There were 19 and 55 patients, respectively, with and without (control) free fracture fragments. The patients underwent open (n = 41) or closed (n = 33) fracture reduction and then cannulated screw internal fixation. Postoperative functional evaluation was performed using Ratliff's criteria, and complications such as femoral head necrosis, premature epiphyseal closure, and coxa vara were recorded. RESULTS All patients achieved bony union during the mean follow-up period of 15.6 mo (range, 12-78 mo). By Ratliff's criteria, the clinical outcomes of the patients with free fracture fragment (three excellent, eight good, eight poor) were significantly worse compared with the control group (26 excellent, 20 good, and nine poor). The rate of complications (femoral head necrosis, premature epiphyseal closure, and coxa vara) of patients with free fracture fragments was significantly higher than that of the control patients. CONCLUSIONS In adolescents with Delbet II FNF, the presence of free fracture fragments is associated with poorer clinical outcomes. Delbet II FNF in adolescents with free fracture fragment may be a special clinical entity with a poorer outcome.
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Affiliation(s)
- Yuancheng Pan
- Department of Orthopedics, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China
| | - Xiaokun Lu
- Department of Orthopedics, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China
| | - Ran Lin
- Department of Orthopedics, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China
| | - Xinzhao Zhang
- Department of Orthopedics, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China
| | - Haibo Mei
- Department of Orthopedics, Hunan Children's Hospital, Changsha, China
| | - Yueming Guo
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Shunyou Chen
- Department of Orthopedics, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, China.
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Posttraumatic Avascular Necrosis After Proximal Femur, Proximal Humerus, Talar Neck, and Scaphoid Fractures. J Am Acad Orthop Surg 2019; 27:794-805. [PMID: 31149969 DOI: 10.5435/jaaos-d-18-00225] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Posttraumatic avascular necrosis (AVN) is osteonecrosis from vascular disruption, commonly encountered after fractures of the femoral neck, proximal humerus, talar neck, and scaphoid. These locations have a tenuous vascular supply; the diagnosis, risk factors, natural history, and treatment are reviewed. Fracture nonunion only correlates with AVN in the scaphoid. In the femoral head, the risk is increased for displaced fractures, but the time to surgery and open versus closed treatment do not seem to influence the risk. Patients with collapse are frequently symptomatic, and total hip arthroplasty is the most reliable treatment. In the humeral head, certain fracture patterns correlate with avascularity at the time of injury, but most do not go on to develop AVN due to head revascularization. Additionally, newer surgical approaches and improved construct stability appear to lessen the risk of AVN. The likelihood of AVN of the talar body rises with increased severity of talar injury. The development of AVN corresponds with a worse prognosis and increases the likelihood of secondary procedures. In proximal pole scaphoid fractures, delays in diagnosis and treatment elevate the risk of AVN, which is often seen in cases of nonunion. The need for vascularized versus nonvascularized bone grafting when repairing scaphoid nonunions with AVN remains unclear.
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Shehata MSA, Aboelnas MM, Abdulkarim AN, Abdallah AR, Ahmed H, Holton J, Consigliere P, Narvani AA, Sallam AA, Wimhurst JA, Imam MA. Sliding hip screws versus cancellous screws for femoral neck fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1383-1393. [PMID: 31165917 DOI: 10.1007/s00590-019-02460-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/29/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Both sliding hip screws (SHS) and cancellous screws are used in the surgical management of intracapsular femoral neck fracture. However, there is paucity of information as to which is the superior treatment modality. We performed this systematic review and meta-analysis study to compare the clinical outcomes of SHS and cancellous screws for the treatment of femoral neck fractures in adult patients. METHODS We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL, up to December 2017. Randomized controlled trials (RCTs) directly comparing the clinical outcomes of SHS and cancellous screws for femoral neck fractures were retrieved with no language or publication year restrictions. Data retrieved included operative details, nonunion rate, avascular necrosis, reoperation, infection and mortality, hip pain, functional hip scores, and medical complications. These were pooled as risk ratio or mean difference (MD) with their corresponding 95% confidence interval (CI). Heterogeneity was assessed by Chi-square test. RESULTS Ten RCTs involving 1934 patients were included in the final analysis. The pooled estimate showed that the SHS group was associated with more intraoperative blood loss (MD = 110.01 ml, 95% CI [52.42, 167.60], p = 0.00002) than the cancellous screws. There was no significant difference in terms of operative time, postoperative hip function, nonunion, avascular necrosis, reoperation rate, infection, fracture healing, hip pain, medical complications, and mortality rate. CONCLUSION Based on our study, the cancellous screws group was associated with less intraoperative blood loss in comparison with the SHS group. No other significant differences were found between the two interventions.
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Affiliation(s)
| | | | | | | | - Hussien Ahmed
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Ali A Narvani
- Rowley Bristow Orthopaedic Center, St Peter's Hospital, Chertsey, UK
| | - Asser A Sallam
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt.
| | - James A Wimhurst
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, UK
| | - Mohamed A Imam
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt.,Norfolk and Norwich University Hospital, University of East Anglia, Norwich, UK
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Wang G, Tang Y, Wang B, Yang H. Minimally invasive open reduction combined with proximal femoral hollow locking plate in the treatment of Pauwels type III femoral neck fracture. J Int Med Res 2019; 47:3050-3060. [PMID: 31142201 PMCID: PMC6683904 DOI: 10.1177/0300060519850962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
ObjectiveThis study was performed to investigate the clinical effects of minimally invasive open reduction and internal fixation with a proximal femoral hollow locking plate on Pauwels type III femoral neck fractures.MethodsThe clinical data of 45 patients aged 32.0 ± 8.1 years (range, 19–45 years) with Pauwels type III femoral neck fractures treated from March 2012 to August 2016 were retrospectively analyzed. All patients underwent anterolateral minimally invasive open reduction and proximal femoral hollow locking plate fixation of the hip joint. Garden’s index was used to evaluate the quality of fracture reduction. Complications and fracture healing were recorded in all patients. At the last follow-up, the functional outcome was recorded using the Harris hip score.ResultsNo complications such as femoral neck shortening, internal fixation loosening, or refracture occurred. However, three patients required reoperation (one with nonunion and two with femoral head necrosis). At the last follow-up, the mean Harris hip score was 92.1 ± 4.5 (range, 76–98). The rate of excellent and good Harris hip scores was 93.3%.ConclusionThe herein-described strategy for Pauwels type III femoral neck fractures is advantageous in terms of high reduction quality, firm fixation, and prevention of neck shortening.
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Affiliation(s)
- Gang Wang
- 1 Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,2 Department of Orthopaedics, No. 98 Hospital of PLA, Huzhou, Zhejiang, China
| | - Yong Tang
- 2 Department of Orthopaedics, No. 98 Hospital of PLA, Huzhou, Zhejiang, China.,3 Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bin Wang
- 1 Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- 1 Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Abstract
Femoral neck fractures in the physiologically young patient are challenging injuries to manage. A tenuous blood supply and the intrasynovial nature of the fracture create a challenging biological environment. To make matters worse, the biomechanics are equally problematic. Frequently, these fractures in younger populations are high Pauwel angle fractures that see considerable force, especially shear. These factors combine to make nonunion and avascular necrosis all too common. In the current study, we will highlight the challenges inherent to managing these injuries and will discuss techniques and implants that may help mitigate some of these challenges.
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Abstract
Young femoral neck fractures remain challenging fractures to treat. Reduction has repeatedly been shown to be the single most important determinant of patient outcome, and treating surgeons should do all they can to achieve anatomic reduction because this is an outcome variable within the surgeon's control. Whether an open or closed reduction is performed, we hope to provide the reader with reduction strategies when faced with this difficult fracture pattern. In addition, we hope to review indications and techniques for using the various treatment implants/modalities that are currently available as they pertain to reduction and fixation.
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Rogmark C, Kristensen MT, Viberg B, Rönnquist SS, Overgaard S, Palm H. Hip fractures in the non-elderly-Who, why and whither? Injury 2018; 49:1445-1450. [PMID: 29983171 DOI: 10.1016/j.injury.2018.06.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome. 2-11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism. Studies contradict on whether surgery within 8-12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%. The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover. While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!
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Affiliation(s)
- Cecilia Rogmark
- Lund University, Skane University Hospital, Department of Orthopedics, Malmö, Sweden.
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Department of Orthopedics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - Part of Hospital Lillebaelt, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark
| | - Henrik Palm
- Department of Orthopedics, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation? Clin Orthop Relat Res 2018; 476:1468-1476. [PMID: 29698292 PMCID: PMC6437565 DOI: 10.1097/01.blo.0000533627.07650.bb] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A well-reduced femoral neck fracture is more likely to heal than a poorly reduced one, and increasing the quality of the surgical exposure makes it easier to achieve anatomic fracture reduction. Two open approaches are in common use for femoral neck fractures, the modified Smith-Petersen and Watson-Jones; however, to our knowledge, the quality of exposure of the femoral neck exposure provided by each approach has not been investigated. QUESTIONS/PURPOSES (1) What is the respective area of exposed femoral neck afforded by the Watson-Jones and modified Smith-Petersen approaches? (2) Is there a difference in the ability to visualize and/or palpate important anatomic landmarks provided by the Watson-Jones and modified Smith-Petersen approaches? METHODS Ten fresh-frozen human pelvi underwent both modified Smith-Petersen (utilizing the caudal extent of the standard Smith-Petersen interval distal to the anterosuperior iliac spine and parallel to the palpable interval between the tensor fascia lata and the sartorius) and Watson-Jones approaches. Dissections were performed by three fellowship-trained orthopaedic traumatologists with extensive experience in both approaches. Exposure (in cm) was quantified with calibrated digital photographs and specialized software. Modified Smith-Petersen approaches were analyzed before and after rectus femoris tenotomy. The ability to visualize and palpate seven clinically relevant anatomic structures (the labrum, femoral head, subcapital femoral neck, basicervical femoral neck, greater trochanter, lesser trochanter, and medial femoral neck) was also recorded. The quantified area of the exposed proximal femur was utilized to compare which approach afforded the largest field of view of the femoral neck and articular surface for assessment of femoral neck fracture and associated femoral head injury. The ability to visualize and palpate surrounding structures was assessed so that we could better understand which approach afforded the ability to assess structures that are relevant to femoral neck fracture reduction and fixation. RESULTS After controlling for age, body mass index, height, and sex, we found the modified Smith-Petersen approach provided a mean of 2.36 cm (95% confidence interval [CI], 0.45-4.28 cm; p = 0.015) additional exposure without rectus femoris tenotomy (p = 0.015) and 3.33 cm (95% CI, 1.42-5.24 cm; p = 0.001) additional exposure with a tenotomy compared with the Watson-Jones approach. The labrum, femoral head, subcapital femoral neck, basicervical femoral neck, and greater trochanter were reliably visible and palpable in both approaches. The lesser trochanter was palpable in all of the modified Smith-Petersen and none of the Watson-Jones approaches (p < 0.001). All modified Smith-Petersen approaches (10 of 10) provided visualization and palpation of the medial femoral neck, whereas visualization of the medial femoral neck was only possible in one of 10 Watson-Jones approaches (p < 0.001) and palpation was possible in eight of 10 Watson-Jones versus all 10 modified Smith-Petersen approaches (p = 0.470). CONCLUSIONS In the hands of surgeons experienced with both surgical approaches to the femoral neck, the modified Smith-Petersen approach, with or without rectus femoris tenotomy, provides superior exposure of the femoral neck and articular surface as well as visualization and palpation of clinically relevant proximal femoral anatomic landmarks compared with the Watson-Jones approach. CLINICAL RELEVANCE Open reduction and internal fixation of a femoral neck fracture is typically performed in a young patient (< 60 years old) with the objective of obtaining anatomic reduction that would not be possible by closed manipulation, thus enhancing healing potential. In the hands of surgeons experienced in both approaches, the modified Smith-Petersen approach offers improved direct access for reduction and fixation. Higher quality reductions and fixation are expected to translate to improved healing potential and outcomes. Although our experimental results are promising, further clinical studies are needed to verify if this larger exposure area imparts increased quality of reduction, healing, and improved outcomes compared with other approaches. The learning curve for the exposure is unclear, but the approach has broad applications and is frequently used in other subspecialties such as for direct anterior THA and pediatric septic hip drainage. Surgeons treating femoral neck fractures with open reduction and fixation should familiarize themselves with the modified Smith-Petersen approach.
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Cannada LK. CORR Insights®: Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation? Clin Orthop Relat Res 2018; 476:1477-1478. [PMID: 29794867 PMCID: PMC6437572 DOI: 10.1097/corr.0000000000000361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Okcu G, Özkayın N, Erkan S, Tosyali HK, Aktuğlu K. Should full threaded compression screws be used in adult femoral neck fractures? Injury 2015; 46 Suppl 2:S24-8. [PMID: 26021662 DOI: 10.1016/j.injury.2015.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Operative treatment consisting of fracture reduction and fixation, or arthroplasty to permit early patient mobilization, continues to be the treatment of choice for most femoral neck fractures. Options for internal fixation have included a variety of implants; however most recent reports and textbooks cite parallel multiple cancellous screws as the surgical technique of choice. METHODS The study was prospective, randomized and IRB approved. Inclusion criteria included skeletal maturity, closed femoral neck fracture without concomitant fractures or injuries with complete charts and adequate radiographs obtained from the initial injury till the last follow-up. Forty-four patients were enrolled in this study during one-year period at two university centers. 22 were randomized to be treated with full threaded, cannulated compression screws (Acutrak 6/7, ACUMED) (Group 1) and the other 22 with 16mm partial threaded, 6.5mm or 7.3mm cannulated screws (SYNTHES) (Group 2). Three or four screws were used in both groups according to fracture type and surgeon's preference. Data evaluated included surgical time, fluoroscopy time, fracture type, radiological outcome, complications and functional status using the Harris Hip Score. RESULTS Both groups were comparable in terms of age and gender. There was not a significant difference in terms of surgical time, follow-up period, fracture type, or fluoroscopy time. There were eight complications in Group 1 and two in Group 2 (P=0.049) Time to union was significantly longer in Group 1 (P=0.001). However, Hip Scores were not significantly different in both groups (P=0.20). CONCLUSION When compared with full threaded compression screws, partial-threaded cannulated screws provides a shorter union time and less complication rate while providing equivalent functional results in adult femoral neck fractures.
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Affiliation(s)
- Güvenir Okcu
- Celal Bayar University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Manisa, Turkey.
| | - Nadir Özkayın
- Ege University, Faculty of Medicine, Department of Orthopaedics and Traumatology, İzmir, Turkey
| | - Serkan Erkan
- Celal Bayar University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Manisa, Turkey
| | - H Koray Tosyali
- Bozyaka Education and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey
| | - Kemal Aktuğlu
- Ege University, Faculty of Medicine, Department of Orthopaedics and Traumatology, İzmir, Turkey
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