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Hu Y, Yang Q, Zhang J, Peng Y, Guang Q, Li K. Methods to predict osteonecrosis of femoral head after femoral neck fracture: a systematic review of the literature. J Orthop Surg Res 2023; 18:377. [PMID: 37217998 DOI: 10.1186/s13018-023-03858-7] [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: 01/25/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Femoral neck fracture (FNF) is a very common traumatic disorder and a major cause of blood supply disruption to the femoral head, which may lead to a severe long-term complication, osteonecrosis of femoral head (ONFH). Early prediction and evaluation of ONFH after FNF could facilitate early treatment and may prevent or reverse the development of ONFH. In this review paper, we will review all the prediction methods reported in the previous literature. METHODS Studies on the prediction of ONFH after FNF were included in PubMed and MEDLINE databases with articles published before October 2022. Further screening criteria were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study highlights all the advantages and disadvantages of the prediction methods. RESULTS There were a total of 36 studies included, involving 11 methods to predict ONFH after FNF. Among radiographic imaging, superselective angiography could directly visualize the blood supply of the femoral head, but it is an invasive examination. As noninvasive detection methods, dynamic enhanced magnetic resonance imaging (MRI) and SPECT/CT are easy to operate, have a high sensitivity, and increase specificity. Though still at the early stage of development in clinical studies, micro-CT is a method of highly accurate quantification that can visualize femoral head intraosseous arteries. The prediction model relates to artificial intelligence and is easy to operate, but there is no consensus on the risk factors of ONFH. For the intraoperative methods, most of them are single studies and lack clinical evidence. CONCLUSION After reviewing all the prediction methods, we recommend using dynamic enhanced MRI or single photon emission computed tomography/computed tomography in combination with the intraoperative observation of bleeding from the holes of proximal cannulated screws to predict ONFH after FNF. Moreover, micro-CT is a promising imaging technique in clinical practice.
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Affiliation(s)
- Yi Hu
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Qin Yang
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jun Zhang
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Yu Peng
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Qingqing Guang
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Kaihu Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China.
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Vinas-Rios JM, Wölm JH, Sellei RM, Ladenburger A. Challenging the dogma to "always operate" acute hip fractures: a proof-of-concept pilot study for nonoperative management of undisplaced femoral neck fractures. Patient Saf Surg 2022; 16:15. [PMID: 35449068 PMCID: PMC9026626 DOI: 10.1186/s13037-022-00324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The notion that all acute hip fractures are a surgical entity requiring either surgical fracture fixation or hip replacement represents a historic dogma, particularly within the orthopaedic community of the United States. The present study from a European regional trauma center was designed to challenge the notion that stable and undisplaced femoral neck fractures represent an absolute indication for surgical management. Methods The purpose of this study was to investigate the hypothesis that stable and undisplaced femoral neck fractures of the Garden types 1 and 2 can be safely managed nonoperatively. A retrospective observational cohort study was carried out at a regional orthopaedic trauma center in Germany from January 1, 2016 to June 30, 2021. The inclusion criteria specified patients older than 18 years suffering a < 24 h, traumatic, femoral neck fracture Garden types 1 and 2. Exclusion criteria included Garden types 3 and 4 femoral neck fractures, pregnancy, active infection or previous surgery, tumor-associated fractures, medical history of femoral neck necrosis, vascular injury associated with femoral neck fractures, nerve injury associated to a femoral neck fracture and ≥ 24 h femoral neck fracture. The primary intention of this research was to identify deterioration of fracture retention with an ensuing unplanned trip to the operating room in femoral neck fractures Garden types 1 and 2. Secondary were included unplanned readmissions and complications such as surgical site infection. Results A total of 41 undisplaced femoral neck fractures (Garden types 1 and 2) were included in this study; n = 20 were in the resulting admission operatively treated (group 1) and n = 21 were treated conservatively. The mean age in group 1 was 76 years; women (70%). In group 2 it was 81 years with a female dominance (71.4%). Admission status: Garden types 1 and 2, group 1 n = 13/7 and group 2 n = 15/6. Subsequent femoral neck fracture displacement (Y/N) (in case of operation, before operation) group 1 n = 14/6 and group 2 n = 6/15. Conclusion According with our results, patients sustaining Garden type 1 femoral neck fractures, depending on age and comorbidities, should be treated conservatively with weight bearing and under physiotherapeutic instructions. In case of femoral neck fractures Garden type 2, a surgical treatment should be performed in order to avoid femoral neck fractures to slip after weight bearing by lacking of fracture impaction.
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Affiliation(s)
- Juan Manuel Vinas-Rios
- Department of Orthopaedics and Traumatology Sana Klinikum Offenbach, Offenbach am Main, Germany. .,Department of Orthopaedics and Traumatology, Sanaklinik Offenbach am Main, Starkenburgring 66, 63069, Offenbach am Main, Germany.
| | - Jan-Henning Wölm
- Department of Orthopaedics and Traumatology Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Richard Martin Sellei
- Department of Orthopaedics and Traumatology Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Andreas Ladenburger
- Department of Orthopaedics and Traumatology Sana Klinikum Offenbach, Offenbach am Main, Germany
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Zhou Y, Zhang Y, Lu P, Chen H, Ni M, Rui Y. An overview on the treatment strategies of non-displaced femoral neck fracture in the elderly. ARTHROPLASTY 2022. [PMCID: PMC8887091 DOI: 10.1186/s42836-022-00111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background This paper aimed to review the databases on non-displaced femoral neck fractures in elderly patients. We also discussed the surgical and non-surgical treatments and selection of implants. Methods Reviewed was the literature on non-displaced femoral neck fractures in elderly patients. Four major medical databases and a combination of the search terms of “femoral neck fractures”, “nondisplaced”, “undisplaced”, “non-displaced”, “un-displaced”, “aged”, “the elderly”, and “geriatric” were used to search the literature relevant to the topic of the review. Results Patients who were unable to tolerate the operation and anesthesia could be treated conservatively. Otherwise, surgical treatment was a better choice. Specific surgical strategies and implant selection were important for the patient’s functional recovery. Conclusions The non-displaced femoral neck fractures are relatively stable but carry a risk of secondary displacement. Surgical treatments may be a better option because the implants provide additional stability and allow early exercise and ambulation. Hemiarthroplasty is also an alternative for old patients with higher risks of displacement and avascular necrosis of the femoral head.
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Zhou Y, Ni Y, Li X, Chen H, Rui Y. [Research progress in treatment of femoral neck fracture in the elderly]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1033-1040. [PMID: 31407565 DOI: 10.7507/1002-1892.201901118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective To introduce the research progress of conservative treatment, internal fixation, hip arthroplasty, and multidisciplinary team (MDT) modes in the treatment of femoral neck fracture in the elderly. Methods By consulting domestic and foreign literature in recent years, the characteristics and application of various treatment methods and new treatment modes for femoral neck fracture in the elderly were summarized and analyzed. Results The elderly non-displaced femoral neck fracture should be treated surgically, and conservative treatment has a high risk of secondary displacement. The displaced fracture should be operated as soon as possible. There is no difference in long-term functional outcome between hemiarthroplasty and total hip arthroplasty. Hemiarthroplasty has less intraoperative blood loss, shorter operation time, and is suitable for the elderly patients with poor basic condition. Total hip arthroplasty is suitable for the elderly patients with better basic condition and higher demand of life quality. MDT can effectively reduce preoperative waiting time and length of stay, reduce the incidence of medical complications, improve the nutritional status of patients, and reduce the mortality of patients. Conclusion Significant results have been achieved in the treatment of femoral neck fractures in the elderly by methods such as internal fixation, hip arthroplasty, and MDT.
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Affiliation(s)
- Yangyang Zhou
- Department of Traumatic Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopaedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Yingjie Ni
- Department of Orthopaedics, Xishan People's Hospital of Wuxi, Wuxi Jiangsu, 214105, P.R.China;Department of Orthopaedics, Wuxi Branch of Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 214105, P.R.China
| | - Xingjuan Li
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Hui Chen
- Department of Traumatic Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopaedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Yunfeng Rui
- Department of Traumatic Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopaedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Orthopaedics, Xishan People's Hospital of Wuxi, Wuxi Jiangsu, 214105, P.R.China;Department of Orthopaedics, Wuxi Branch of Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 214105,
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Fan W, Zhu L, Chen J, Guo C, Yan Z. Identifying Patients Who Will Most Benefit from Single Photon Emission Computerized Tomography and Computerized Tomography After Femoral Neck Fracture. Med Sci Monit 2017; 23:5669-5674. [PMID: 29182595 PMCID: PMC5717992 DOI: 10.12659/msm.904026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Single photon emission computerized tomography and computerized tomography (SPECT/CT) is useful for assessing blood supply within the femoral head after femoral neck fracture, but its use in all femoral neck fracture patients is not feasible. Therefore, the present study aimed to identify the patients for whom SPECT/CT examination will be most beneficial. Material/Methods Sixty-five patients with a unilateral femoral neck fracture who underwent SPECT/CT examination of the hip and were treated via closed reduction and internal fixation with three screws were enrolled between January 2009 and March 2011. A decision tree model (C 5.0) was used to identify the factors that best reflect blood supply and to build a flowchart for identifying patients who would benefit from SPECT/CT. Results Fracture type was most strongly associated with the Fracture/Normal (F/N) ratio, which reflects the blood supply to the fractured femoral head. Age and the time interval from injury to examination were also associated with the F/N ratio. SPECT/CT examination is most beneficial for patients with a displaced fracture, especially if they are over 58 years old and the time interval from injury to examination is less than 10 days. Conclusions Our results indicate that elderly people with a displaced fracture are most likely to benefit from SPECT/CT examination, which can show the blood supply to the femoral head within a relatively short window of time after the injury.
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Affiliation(s)
- Wenshuai Fan
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Liang Zhu
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Jifei Chen
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Changan Guo
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Zuoqin Yan
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
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