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Mohammed Alshareef H, Elbarbary A, Hassan AS, Alzahrani FA. Cementless Hemiarthroplasty for a Femoral Neck Fracture in a 93-Year-Old Female Patient: A Case Report. Cureus 2024; 16:e68050. [PMID: 39347328 PMCID: PMC11436256 DOI: 10.7759/cureus.68050] [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] [Accepted: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Displaced femoral neck fractures are prevalent in the elderly, necessitating surgical intervention to restore function and mobility. Hemiarthroplasty, available in both cemented and cementless forms, is a common treatment. While cemented hemiarthroplasty is traditionally preferred, cementless options are gaining attention for their potential advantages, including reduced operative time, decreased blood loss, and preservation of bone stock for future revisions. This case report details the successful application of cementless hemiarthroplasty in a 93-year-old female with a displaced femoral neck fracture, underscoring its feasibility and potential benefits in the very elderly. The patient, with multiple comorbidities including hypertension, cerebrovascular accident, osteoarthritis, dementia, chronic kidney disease, diabetes mellitus, osteoporosis, and limited mobility, presented with left hip pain following a fall. Radiographs confirmed a displaced femoral neck fracture. Cementless hemiarthroplasty was performed using the lateral Harding approach, achieving stable fixation without cement. Postoperative care involves standard pain management, early mobilization, and monitoring for complications. This case highlights the potential benefits of cementless hemiarthroplasty, such as reduced operative time and decreased risk of cement-related complications, particularly in elderly patients with good bone quality. The successful outcome, characterized by stable fixation and absence of intraoperative or early postoperative complications, emphasizes the importance of individualized patient assessment and tailored surgical approaches. Further research is needed to refine guidelines and expand the evidence base for the use of cementless techniques in this demographic.
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Affiliation(s)
| | - Ahmed Elbarbary
- Orthopedic Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
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da Silva AC, da Silva Santos G, Maluf EMCP, Borba VZC. Incidence of hip fractures during the COVID-19 pandemic in the Brazilian public health care system. Arch Osteoporos 2022; 17:89. [PMID: 35763078 PMCID: PMC9243893 DOI: 10.1007/s11657-022-01134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/15/2022] [Indexed: 02/03/2023]
Affiliation(s)
| | | | | | - Victoria Zeghbi Cochenski Borba
- Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Av. Agostinho Leão Júnior, 285 – 80030-110, Curitiba, Paraná Brazil
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Tao K, Li M, Ling J, Tu Y. Prevalence and correlative factors of hyperhomocysteinemia in elderly patients with femoral neck fracture: A cross-sectional study. J Clin Lab Anal 2022; 36:e24563. [PMID: 35712847 PMCID: PMC9279943 DOI: 10.1002/jcla.24563] [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: 04/13/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Aims The occurrence of hyperhomocysteinemia (HHcy) in elderly patients with femoral neck fracture (FNF) draws little attention from surgeons preoperatively. The aim of our study was to determine the prevalence and correlative factors of HHcy in elderly patients (≥65 years) with FNF prior to surgery. Methods We retrospectively investigated 286 elderly FNF patients aged 65–98 years admitted to our institution from September 2020 to September 2021. Categorical variables were compared using the Chi‐squared test, and continuous variables were compared using the Mann–Whitney U test. Univariable and multivariable logistic regression were used to determine the associations of variables with the odds of HHcy. Results Among the 286 elderly FNF patients, the prevalence of HHcy was 30.77% and the mean Hcy level was 14.52 ± 10.49 μmol/L. The mean Hcy level and the prevalence of HHcy in male patients were significantly higher than that in female patients (16.41 ± 9.58 μmol/L vs. 14.00 ± 10.69 μmol/L, p = 0.002; 43.55% vs. 27.23%, p = 0.014). Multivariate analysis indicated that being male patient (OR 2.187, 95% CI 1.187–4.028, p = 0.012), hypertension (OR 1.993, 95% CI 1.141–3.479, p = 0.015), and low HDL‐C (OR 2.979, 95% CI 1.353–6.558, p = 0.007) were significant correlative factors of HHcy among elderly FNF patients. Conclusions This study found a high prevalence of HHcy in elderly FNF patients, with being male patient, hypertension, and low levels of HDL‐C as the significant correlative factors after adjusting for age and other covariables. However, further large‐scale studies in wider regions are warranted to confirm these findings. Hyperhomocysteinemia (HHcy), which have been associated with increased cardiovascular, cerebrovascular, and thromboembolic diseases in elderly patients, are frequently neglected by orthopedic surgeons in their clinical practices. Using the descriptive statistical analysis and logistic regression model, we found a high prevalence (30.77%) of HHcy among elderly patients with femoral neck fracture (FNF), with being male patient, hypertension, and low levels of HDL‐C as the significant correlates after adjusting for age and other covariables. The current findings may help to the preoperative assessment and optimization of patient with FNF.
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Affiliation(s)
- Kun Tao
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
| | - Ming Li
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
| | - Jing Ling
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
| | - Yiji Tu
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
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Peng P, Xiao F, He X, Fang W, Huang J, Wang B, Luo Y, Zhang Q, Zhang Y, He W, Wei Q, He M. Global Research Status and Trends of Femoral Neck Fracture Over the Past 27 Years: A Historical Review and Bibliometric Analysis. Front Surg 2022; 9:875040. [PMID: 35784942 PMCID: PMC9241583 DOI: 10.3389/fsurg.2022.875040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Femoral neck fracture (FNF) is a commonly encountered injury in orthopedic practice, and many studies have been conducted in this field. However, no bibliometric studies regarding the global research trend concerning FNF have been performed. This study aims to analyze the knowledge framework, research hotspots, and theme trends in the field of FNF research. Methods The scientific outputs related to FNF from 1994 to 2021 were retrieved from the Web of Science Core Collection. Three bibliometric tools were used for this study. The main analyses include publication and citation counts, contributions of countries, institutions, authors, funding agencies and journals, and clustering of keywords. Results In total, 3,553 articles were identified. The annual publication counts of FNF showed an ascending tendency as a whole. The United States has the most prominent contributions, with the most number of publications and the highest H-index. Karolinska Institutet devoted the most in this domain. Professors Bhandari M, Schemitsch EH, Frihagen F, Parker MJ, and Rogmark C were the core authors in this field. The most productive journal was Injury International Journal of the Care of the Injured. Keywords were divided into four clusters: epidemiology and mortality, fracture prevention, internal-fixation and risk factors, and hip replacement. A trend of balanced and diversified development existed in these clusters. Keywords with the ongoing bursts, including “outcome,” “reoperation,” “complication,” “revision,” “displaced intracapsular,” “fracture,” and “adult,” are considered as the research hotspots in the future and deserve more attention. Conclusions The management of FNF in young patients is drawing more attention from orthopedic surgeons, and it is expected that these research topics may continue to be the research hotspots and focus in the near future.
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Affiliation(s)
- Peng Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangjun Xiao
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoming He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weihua Fang
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiewen Huang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Wang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiwen Luo
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qinwen Zhang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital (Orthopedics Hospital of Henan), China
| | - Wei He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiushi Wei
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
| | - Mincong He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
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Long-term results after over 17 years - Intramedullary gliding nail as treatment for traumatic femoral neck fractures. J Orthop 2021; 26:1-7. [PMID: 34140760 DOI: 10.1016/j.jor.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background For the treatment of femoral neck fracture there are many different implants present on the market. Postoperative complications still exist. Patients and methods The aim of this retrospective study was to evaluate the Gliding Nail in patients with medial femoral neck fractures and their long-term complications. Results In a collective of 113 patients we had all together 21 major complications in 2018.12/113 minor complications in 2008 and all together 13/78 in 2018 has been detected. Conclusions The Gliding Nail as an intramedullary implant shows a high load-bearing capacity with a high rotational stability and a low cut-out rate.
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Raven TF, Friedl W, Moghaddam A. Treatment of Traumatic Femoral Neck Fractures with an Intramedullary Nail in Osteoporotic Bones. Indian J Orthop 2021; 55:621-628. [PMID: 33995865 PMCID: PMC8081773 DOI: 10.1007/s43465-020-00292-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Sufficient anchoring of intramedullary osteosynthesis in the femoral head in a femoral neck fracture is a challenge with increasing age of the patients and decreasing bone quality. For older patients with inferior bone quality, it has not been investigated whether the application of an intramedullary force carrier, as a minimally invasive and rapid intervention, can provide a considerable benefit and reduce the postoperative complication and lethality rate. This retrospective study aimed to investigate the stability and functionality after the acute treatment of a femoral neck fracture in osteoporotic bone using an intramedullary force carrier even with higher grade fracture types. MATERIAL AND METHODS The retrospective analysis was based on a collective of 82 patients over 60 years of age with a femoral neck fracture treated with a gliding nail in our centre between 1999 and 2006. RESULTS The average time to follow-up was 69.05 months (median 71.0; minimum 27.0-maximum 108.0). Female patients made up more than two-thirds of the patient collective at 63 of the 82 patients (76.83%). The average age of the patients was 77.76 years (median 78.00; range 60.00-93.00).In 66 patients (80.49%), the implantation showed good results and no complications or further treatments. 24/82 patients of our collective had died in our re-evaluation. In no case, a pseudarthrosis or severe impaction with neck shortening occurred (loss of offset).11/82 patients had femoral head necrosis which led to total hip replacement in 8 cases, a hemiarthroplasty in 2 cases and in 1 case a remaining Girdlestone situation because of a deep infection. Another five patients also had to undergo a total hip replacement because of a central perforation of the blade in one case, breakout of the blade after another fall in another two cases and a lateral dislocation of the blade in two cases. CONCLUSION The use of an intramedullary force carrier in the osteoporotic bone can mean distinct advantages for the selected patient as a minimally invasive and rapid surgical method compared to extensive surgery, even in the case of severe injuries. However, the advantages and disadvantages for the patient should be considered critically.
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Affiliation(s)
- Tim Friedrich Raven
- ATORG-Aschaffenburg Trauma and Orthopaedic Research Group, Center for Orthopaedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, 63739 Aschaffenburg, Germany
| | - Wilhelm Friedl
- Division of Orthopaedics and Trauma Surgery, Rotkreuzklinik Wertheim gGmbH, Rotkreuzstraße 2, 97877 Wertheim am Main, Germany
| | - Arash Moghaddam
- ATORG-Aschaffenburg Trauma and Orthopaedic Research Group, Center for Orthopaedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, Am Hasenkopf 1, 63739 Aschaffenburg, Germany
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Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures. Arthroplast Today 2021; 8:92-95. [PMID: 33732832 PMCID: PMC7943958 DOI: 10.1016/j.artd.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background Total hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral). Methods A retrospective review identified 52 patients who underwent primary THA for FNF between 2009 and 2018, including 20 via the DA approach and 32 by alternative approaches. All procedures were exclusively performed by high-volume arthroplasty surgeons. Perioperative results, complications, and clinical outcomes were compared with those of routine statistical methods. Mean follow-up duration was 3 years (range, 1-8). Results The average age was 74 years (range, 57-92) with similar baseline characteristics between the 2 groups (P = .09). The DA cohort demonstrated significantly shorter length of stay (3 days vs 5 days, P < .01) and discharge to home vs skilled nursing facility (40.0% vs 9.4% P = .014). There was a trend toward decreased complications (0% vs 16%, P = .08). There were no dislocations or fractures in either cohort. Final Harris Hip Scores (94 vs 81, P = .07) and return to community ambulation (96%) were similar between DA and alternative approach groups. Conclusion The DA approach to THA performed for FNF appears safe with improved outcomes compared with alternative approaches. Larger studies are needed to verify these results.
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Lim J. Big Data-Driven Determinants of Length of Stay for Patients with Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144949. [PMID: 32659953 PMCID: PMC7400185 DOI: 10.3390/ijerph17144949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
It is important that length of stay (LOS) management for alleviating health care financial burdens and improving patient outcomes. The aim of this study was to report the differences of LOS and the factors affecting LOS of hip fracture patients using big data. A total of 463,194 data were collected from 2016 to 2017 KNHDS. Of those, 2238 patients with the hip fracture primary diagnosis were included in the study population. As independent variables were used gender, age, type of insurance, admission route, result of treatment, number of hospital beds, the presence of surgery, and comorbidities. Statistical analysis performed using the IBM SPSS Statistics for Windows, version 25.0. A statistically significant difference was observed in the length of stay of hip fracture patients according to the healthcare insurance type. The difference in LOS associated with comorbidities was statistically significant for hypertension, peptic ulcer disease, coagulopathy, and alcohol abuse (p < 0.05). Independent variables that affected LOS of hip fracture patients with national health insurance were the treatment result, operation presence, comorbidity count, and hospital beds (p < 0.001). The factors associated with the length of stay for hip fracture patients were the difference according to the healthcare insurance type. The results of this study can be used as a basic data for the national health policy for the proper distribution and utilization of medical resources.
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Affiliation(s)
- Jihye Lim
- Department of Healthcare Management, Youngsan University, Yangsan 50510, Korea
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Effect of cortical bone micro-structure in fragility fracture patients on lamellar stress. J Biomech 2019; 100:109596. [PMID: 31898977 DOI: 10.1016/j.jbiomech.2019.109596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 11/22/2022]
Abstract
This work investigates how changes in cortical bone microstructure alter the risk of fragility fractures. The secondary osteons of non-osteoporotic (by DXA) women with fragility fractures have reduced lamellar width and greater areas of birefringent brightness in transverse sections, a pathological condition. We used hierarchical finite element (FE) models of the proximal femur of two women aged 67 and 88 (younger and older) during one-legged stance. At specific locations of the anterior-inferior neck (ROI), we analyzed micro-models containing osteons comprised of alternating birefringent extinct and bright lamellae. The plane of lamellar isotropy (XY) was transverse to the osteon longitudinal axis (Z) which was parallel to the femoral neck axis. To evaluate changes in fracture risk with changes in microstructure, we investigated principal and von Mises stresses, and planar stress measures that accounted for transverse isotropy. For both younger and older femurs, 48% to 100% of stress measures were larger in models with healthy architecture than in models with pathological architecture, while controlling for type of lamella and osteon. These findings suggest that bone adaptation reduces stress at most pathological lamellar sites. However, in the bright lamellae of the younger femur, the pathological tensile, compressive and distortional stresses in the transverse plane and distortional stress in the longitudinal planes were larger than the non-negligible corresponding stresses in 6 of the 28 osteon models with healthy architecture, in 5 of the 7 locations. Therefore, a minority of sites with pathological architecture present greater stress, and therefore, greater fracture risk.
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Maluta T, Toso G, Negri S, Samaila EM, Magnan B. Correlation between hip osteoarthritis and proximal femoral fracture site: could it be protective for intracapsular neck fractures? A retrospective study on 320 cases. Osteoporos Int 2019; 30:1591-1596. [PMID: 31177291 DOI: 10.1007/s00198-019-05015-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022]
Abstract
UNLABELLED Proximal femoral fractures affect elderly people, showing high morbidity and mortality incidence resulting in a major economic burden on national healthcare systems. Understanding the causes of these injuries is of paramount importance to prevent the serious consequences of these fractures. INTRODUCTION Hip osteoarthritis and proximal femoral fractures mainly affect elderly patients. Several authors, in their studies, tried to document a correlation between these conditions, but the results are conflicting. The aim of this study was to evaluate the relationship between hip osteoarthritis and the fracture site. Secondly, to evaluate if the grade of osteoarthritis could influence the fracture pattern. METHODS A retrospective study on 320 patients admitted for hip fracture between June 2015 and December 2016 was carried on. Radiographic images were evaluated, assessing the type of fracture, presence and grade of osteoarthritis according to Kellgren-Lawrence and Tönnis classifications, and their correlations. RESULTS Osteoarthritis was found to affect the fracture site showing a higher prevalence among subjects with extracapsular than those with intracapsular fractures (p < 0.00001). Patients with radiographic signs of arthritis had mainly trochanteric fracture. Conversely, patients without arthritis more frequently presented a femoral neck fracture. This correlation was even more significant as the severity of the OA increased. CONCLUSIONS Results support the hypothesis that hip osteoarthritis could represent a protective factor for intracapsular fractures and a risk factor for trochanteric ones. The severity of arthritis is also associated with the fracture pattern.
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Affiliation(s)
- Tommaso Maluta
- Department of Orthopedics and Trauma Surgery, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Giovanna Toso
- Department of Orthopedics and Trauma Surgery, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Stefano Negri
- Department of Orthopedics and Trauma Surgery, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Elena Manuela Samaila
- Department of Orthopedics and Trauma Surgery, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
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Kahlenberg CA, Richardson SS, Schairer WW, Cross MB. Rates and Risk Factors of Conversion Hip Arthroplasty After Closed Reduction Percutaneous Hip Pinning for Femoral Neck Fractures-A Population Analysis. J Arthroplasty 2018; 33:771-776. [PMID: 29089225 DOI: 10.1016/j.arth.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Closed reduction with percutaneous pinning (CRPP) for nondisplaced or valgus impacted femoral neck fractures is a relatively low-risk operation that can produce excellent union rates in some patients; however, failure can occur in selected patients requiring conversion to arthroplasty. The primary aim of this study was to perform a population-level analysis to determine the rate and timeframe of conversion from CRPP to total hip arthroplasty (THA) or hemiarthroplasty. METHODS The PearlDiver database was queried from 2007-2015 for all patients who underwent CRPP for a femoral neck fracture. Survival analysis was used to evaluate the rate of conversion of CRPP to hemiarthroplasty or THA. Risk factors for conversion arthroplasty were identified using a multivariable cox proportional hazards model that included patient demographics and comorbidities. RESULTS There were 5122 patients in the Humana database and 4840 patients in the Medicare database that were included in analysis. At 5 years after CRPP, the conversion rate was 10.0% in the Medicare patients and 10.8% in the Humana patients. Risk factors for undergoing conversion from CRPP to arthroplasty in the Medicare cohort included preexisting diagnoses of pulmonary and/or circulatory comorbidities, peripheral vascular disease, hypertension, hypothyroidism, and metastatic cancer. In the Humana cohort, the only risk factors were male gender and acute blood loss anemia. CONCLUSION Although CRPP remains a successful operation in elderly patients and patients with certain comorbidities, failure of CRPP for the treatment of a femoral neck fracture is high at approximately 10%-11%, which is much higher than reported failure rates for THA in the same population. Patients with femoral neck fractures being considered for CRPP should be counseled about the possibility of further surgery.
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Affiliation(s)
- Cynthia A Kahlenberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shawn S Richardson
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - William W Schairer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Michael B Cross
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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12
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Multiple cannulated screws vs. dynamic hip screws for femoral neck fractures. DER ORTHOPADE 2017; 46:954-962. [DOI: 10.1007/s00132-017-3473-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Discontinuation of Plavix ® (clopidogrel) for hip fracture surgery. A systematic review of the literature. Orthop Traumatol Surg Res 2016; 102:1097-1101. [PMID: 27863918 DOI: 10.1016/j.otsr.2016.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/06/2016] [Accepted: 08/24/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED The elderly population is increasing worldwide, associated with an increase in diseases related to aging, such as hip fractures. These patients are sometimes treated with clopidogrel. There are no arguments at present to clearly determine the risk/benefit ratio of early surgical management of traumatic hip fractures in patients treated with clopidogrel (perioperative blood loss, postoperative complications). The goal of this systematic review of the literature was to show that early surgical management (<48h) of patients treated with clopidogrel does not increase postoperative morbidity or mortality. Systematic review of the literature: level of evidence IV. A bibliographic search was performed in July 2015 in PubMed, Embase and Cochrane databases using the MeSh keywords "Clopidogrel or Plavix®" AND "hip fracture". Two of the authors analyzed 48 articles based on the title and abstract. Twenty-one articles were selected and read completely with an analysis of the references. Nine articles were chosen. Early surgical management (<48h) of patients receiving clopidogrel did not increase mortality at 30days, 3months or 1 year (between 25 and 30% mortality at 1 year) and did not result in an increase in perioperative bleeding. The risk/benefit ratio of early surgical management of patients with hip fractures receiving clopidogrel is good; morbidity and mortality are not increased in these patients if surgery is performed immediately or less than 48h after admission. LEVEL OF EVIDENCE IV.
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14
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Gupta M, Arya RK, Kumar S, Jain VK, Sinha S, Naik AK. Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults. Chin J Traumatol 2016; 19:209-12. [PMID: 27578376 PMCID: PMC4992136 DOI: 10.1016/j.cjtee.2015.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Both cannulated cancellous screw (CCS) and sliding hip screw (SHS) are used in femoral neck fracture fixations, but which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults. METHODS Adults (16e60 years) with femoral neck fracture were divided into Group 1 fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed. RESULTS Group 1 (n=40) achieved radiological union at mean of 7.6 months, with the union rate of 87.5% (n=35), avascular necrosis (AVN) rate of 7.5% (n=3) and mean Harris Hip Score (HHS) of 86.15 at the end of 4 years. In Group 2 (n=45) these parameters were union at 7.1 months, union rate of 82.22% (n=37), AVN rate of 6.67% (n=3) and HHS of 88.65. Comparative results were statistically insignificant. CONCLUSION There is no significant difference in clinicoradiological outcome between the two implants.
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What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2015; 40:1843-8. [DOI: 10.1007/s00264-015-3033-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/01/2015] [Indexed: 12/21/2022]
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Abstract
Anatomic reduction of femoral neck fractures is difficult to obtain in a closed fashion. Open reduction provides for direct and controlled manipulation of fracture fragments. This can be accomplished via multiple approaches. The anterolateral, or Watson-Jones, approach or Smith-Petersen, or direct anterior, approach are the two most frequently used. Percutaneous techniques have also been described, though they lack the visual confirmation of reduction of a traditional open approach. These can be performed using a fracture table or with a free leg on a radiolucent table in either supine or lateral positions. Knowledge of the hip and pelvis anatomy is crucial for the preservation of critical femoral neck vasculature. Intra-operative fluoroscopy together with direct visualization provides the framework for successful manipulation of the fracture fragments, temporary stabilization, and ultimately fracture fixation.
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Daniel M, Mohammed S, Francis A, William Y, Joseph K, Cornilius E. Early result of hemiarthroplasty in elderly patients with fracture neck of femur. Niger Med J 2015; 56:64-8. [PMID: 25657497 PMCID: PMC4314864 DOI: 10.4103/0300-1652.149174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Fractured neck of femur is a frequent and severe injury in elderly patients with consequent high morbidity and mortality. Hemiarthroplasty is an established treatment modality for displaced intracapsular femoral neck fractures in elderly patients above 60 years. This study analysed the early functional outcome and complications of Austin Moore endoprosthesis in elderly patients above 60 years with fractured neck of femur. Materials and Methods: Retrospective data were obtained over a 5 year period from January 2007 to December 2012. Thirty-five elderly patients of 60 years and above with displaced intracapsular fracture neck of femur treated with hemiarthroplasty using Austin Moore endoprosthesis were included. Data were analysed using SPSS version 21. Results: A total of 35 patients were involved. The age-range was 60-90 years with mean age of 69.7 ± 7 years. The predominant mechanism of injury was trivial falls in 18 (66.7%) patients. The commonest complication was pressure sore in 2 (5.7%) patients, followed by surgical site infection in 1 (2.9%) patient and periprosthetic fracture in 1 (2.9%) patients. Early post-operative mortality was 2.9%. Post-operative hip functional status according to Postel and Merle d Aubigne revealed that majority (66.6%) of patients had satisfactory hip function. Conclusion: Functional outcome of Austin Moore in elderly patients above 60 years with fracture neck of femur was satisfactory in most of the cases with minimal morbidity. Careful patient selection for hemiarthroplasty is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.
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Affiliation(s)
- Mue Daniel
- Department of Surgery, Benue State University, Makurdi, Nigeria
| | - Salihu Mohammed
- Department of Clinical Services, National Orthopaedic Hospital Dala, Kano, Nigeria
| | - Awonusi Francis
- Department of Clinical Services, National Orthopaedic Hospital Dala, Kano, Nigeria
| | - Yongu William
- Department of Surgery, Benue State University, Makurdi, Nigeria
| | - Kortor Joseph
- Department of Surgery, Benue State University, Makurdi, Nigeria
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Wang W, Wei J, Xu Z, Zhuo W, Zhang Y, Rong H, Cao X, Wang P. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis. BMC Musculoskelet Disord 2014; 15:167. [PMID: 24885566 PMCID: PMC4047776 DOI: 10.1186/1471-2474-15-167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/23/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A meta-analysis was performed to assess the association between healing rate, avascular necrosis (AVN) of femoral head and two reductions-open reduction internal fixation (ORIF) and closed reduction internal fixation (CRIF) for femoral neck fracture. METHODS A literature-based search was conducted to identify all relevant studies published before September 10, 2013. The odd ratio (OR) and 95% confidence interval (CI) were used for estimating the effects of the two reduction methods. Data were independently extracted by two investigators who reached a consensus on all of the items. The heterogeneity between studies was examined by χ2-based Q statistic. Egger's regression analysis was used to evaluate publication bias. Statistical analysis was performed by Stata 10.0 software. RESULTS We examined 14 publications. The results of the present meta-analysis showed that AVN of femoral head were significant associated with the two reductions (CRIF vs. ORIF, OR=1.746, 95% CI 1.159-2.628, p=0.008), while the healing rate were not (CRIF vs. ORIF, OR=0.853, 95% CI 0.573-1.270, p=0.433). CONCLUSION The present meta-analysis indicated the risk of AVN of femoral head was significant higher after CRIF fixation compared with ORIF, but no association between the healing rate and the two reductions for femoral neck fracture.
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Affiliation(s)
- Weiguo Wang
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Command, 250031 Jinan, China
- Research on 2013 stage doctoral student of TCM Orthopaedics, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Junjie Wei
- Outpatient Department, General Hospital of Jinan Military Command, 250031 Jinan, China
| | - Zhanwang Xu
- Department of Orthopaedics, The First Affiliated Hospital of Shandong University of Traditional Chinese Medicine, NO.16369, Jingshi Road, 250014 Jinan, China
| | - Wenkun Zhuo
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Command, 250031 Jinan, China
| | - Yuan Zhang
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Command, 250031 Jinan, China
| | - Hui Rong
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Command, 250031 Jinan, China
| | - Xuecheng Cao
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Command, 250031 Jinan, China
| | - Pingshan Wang
- Department of Orthopaedic Surgery, General Hospital of Jinan Military Command, 250031 Jinan, China
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Azar MS, Saravi MS, Kariminasab MH, Taghipour M, Sharifian R. Complete spontaneous improvement of non-displaced femoral neck fracture without any surgery modality. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:22-5. [PMID: 23569478 PMCID: PMC3616177 DOI: 10.12659/ajcr.882472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/20/2011] [Indexed: 11/29/2022]
Abstract
Background: Fracture of the femoral neck is still a medical dilemma due to high rates of complications and the choice of treatment. Although rigid internal fixation with cannulated screws through open or percutaneous approaches is the traditional treatment for undisplaced fractures (Garden type I and II) to avoid secondary displacement, considerable controversy still exists regarding the rate of this problem, thus it seems that a new trend in conservative management of this types of femoral neck fracture is emerging. Case Report: Our case is a 46-year-old woman with Garden type II femoral neck fracture, who refused all surgical options and willingly ignored her problem. Six months later she returned to our center with uneventful recovery of her fracture. Conclusions: The previous belief about the absolute poor prognosis of Garden type II with 100% rate of secondary displacement with non-operative management must have been an overestimation or the success histories in the literature about non-operative treatment of these fractures originates from inherited weakness of the Garden classification in differentiating type I from type II. The patient gave the informed consent prior being included into the study.
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Affiliation(s)
- Masoud Shayesteh Azar
- Department of Orthopedic Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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20
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Su Y, Chen W, Zhang Q, Li B, Li Z, Guo M, Pan J, Zhang Y. An irreducible variant of femoral neck fracture: a minimally traumatic reduction technique. Injury 2011; 42:140-5. [PMID: 20570257 DOI: 10.1016/j.injury.2010.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 04/20/2010] [Accepted: 05/03/2010] [Indexed: 02/02/2023]
Abstract
We present 25 cases of irreducible variant femoral neck fractures that require surgical management after routine manipulative manoeuvre attempts have failed. In our study, an irreducible variant of femoral neck fractures is defined as a reduction that cannot be achieved after multiple attempts at closed reduction. This was evident radiographically, as seen in displaced–impacted femoral neck fractures when the proximal femur compacts and rotates along with the distal part, and anatomical reduction cannot be achieved with manipulative manoeuvres. Another rare situation also included is when the proximal fragment disconnects from the femur and dislocates as a ‘floating’ component, consequently resulting in failure of alignment of the distal fragment to the proximal femur.Here, we describe a technique, applied as a minimally traumatic procedure to achieve anatomic reduction in such cases. With the patient placed in supine position on the fracture table under general anaesthesia, the injury site is exposed and the procedure performed under intra-operative radiographic control. Location of the femoral artery is done first by palpation. The insertion site of the K-wires or Steinman pins on the proximal thigh is 1.5–3 cm lateral to the femoral artery. The K-wires or Steinmanpins are inserted vertically into the middle 1/2–2/3 of the femoral head and more than 1 cm inferior to the sub-chondral bone of the femoral head to a depth of approximately, 1/2 diameter of the femoral head. The pins are then used as a joystick to control the movement of the proximal femur. With the help of the K-wires, surgeons can manually control the movement of the proximal femur and ensure anatomic reduction with the distal fragment using routine-closed reduction. Three cannulated screws are used to stabilise the fracture after anatomic reduction is achieved and maintained in a stable position. All cases were treated with this minimally invasive procedure and internal fixation, 25 fractures united,uneventfully, whilst two of them developed femoral head necrosis at 10 months and 4.5 years postoperatively, respectively.
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Affiliation(s)
- Yanling Su
- Department of Orthopaedics, 3rd Hospital, Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei 050051, PR China
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21
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The Technique: Surgical Approach and Tactics for Open Reduction/Internal Fixation of a Femoral Neck Fracture in a Young Patient. Tech Orthop 2008. [DOI: 10.1097/bto.0b013e3181909770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Dhar SA, Gani NU, Butt MF, Farooq M, Mir MR. Delayed union of an operated fracture of the femoral neck. J Orthop Traumatol 2008; 9:97-9. [PMID: 19384623 PMCID: PMC2656958 DOI: 10.1007/s10195-008-0012-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 03/03/2008] [Indexed: 11/26/2022] Open
Abstract
Fracture of the femoral neck continues to be a vexing clinical and therapeutic challenge for the orthopedic surgeon. The fracture has a propensity for non-union and avascular necrosis. It is a challenge for the orthopedic surgeon to decide when to intervene in a case with non-union where the implant continues to be in place. We present a case with persistent clinical and radiological non-union signs where the fracture eventually united after 32 months. The case bolsters the view that a continued conservative regime might entail good results in such situations.
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23
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Molnar RB, Routt MLC. Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure. J Orthop Trauma 2007; 21:490-4. [PMID: 17762484 DOI: 10.1097/bot.0b013e31804a7f7f] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The Smith-Petersen or modified direct anterior hip surgical exposures have not previously been described for open reduction of femoral neck fractures. This technique of reduction provides a direct approach to the femoral neck and hip joint. Displaced fractures of the femoral neck can easily be reduced through this approach, local osseus defects resulting from impaction can be supported with bone graft, and fracture fixation is then placed through a separate lateral exposure or through small stab incisions. The technique of reduction is presented.
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Affiliation(s)
- Robert B Molnar
- Harborview Medical Center, Department of Orthopaedic Surgery, Seattle, Washington 98104, USA.
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Peter B, Gauthier O, Laïb S, Bujoli B, Guicheux J, Janvier P, van Lenthe GH, Müller R, Zambelli PY, Bouler JM, Pioletti DP. Local delivery of bisphosphonate from coated orthopedic implants increases implants mechanical stability in osteoporotic rats. J Biomed Mater Res A 2006; 76:133-43. [PMID: 16254957 DOI: 10.1002/jbm.a.30456] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with osteoporosis and joint disabilities represent a constant growing and challenging population to be treated in the musculoskeletal clinical field. Especially in the case of total hip arthroplasty, new solutions should be developed to compensate for the double negative factors, peri-implant osteolysis, and osteoporotic bone loss, affecting the quality of implant outcome. The goal of this study was then to establish a proof of concept for orthopedic implant used as Zoledronate delivery in osteoporotic rats, and in particular, to verify if this approach could increase the initial implant stability. Twenty-five female 6-month-old Wistar rats were ovariectomized 6 weeks before the implantation to induce osteoporosis. The animals were randomly separated in five groups representing the different Zoledronate concentrations in the HA coating: 0, 0.2, 2.1, 8.5, and 16 microg/implant. Histomorphometric measures and peri-implant bone volume fraction were assessed and mechanical stability tests were performed. Bone volume fraction and biomechanical results clearly illustrate the positive effect of Zoledronate coated implants in the osteoporotic rats. A remarkable result was to show the existence of a window of Zoledronate content (0.2 to 8.5 microg/implant) in which the mechanical fixation of the implant increased. We were able to establish the proof of concept for orthopedic implants used as a drug delivery system in osteoporotic rats. The local bisphosphonate delivery from a calcium phosphate coating allowed increase of the mechanical fixation of an orthopedic implant. This study shows that orthopedic implants containing bisphosphonates could be beneficial for osteoporotic patients in need of a total joint replacement.
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Affiliation(s)
- Bastian Peter
- Bone Bioengineering Group, Laboratory of Orthopedic Research, Swiss Federal Institute of Technology Lausanne (EPFL), Switzerland
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Krischak GD, Wachter NJ, Zabel T, Suger G, Beck A, Kinzl L, Claes LE, Augat P. Influence of preoperative mechanical bone quality and bone mineral density on aseptic loosening of total hip arthroplasty after seven years. Clin Biomech (Bristol, Avon) 2003; 18:916-23. [PMID: 14580835 DOI: 10.1016/s0268-0033(03)00175-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To test mechanical bone quality and bone mineral density of the femoral head at the day of implantation as indicators for femoral prosthesis loosening. METHODS Mechanical bone quality of a femoral head slice was assessed by destructive compression testing combined with bone mineral density measurements using peripheral quantitative computed tomography. Fourteen patients with walking pains were attainable for a radiographical follow-up mean 7.1 years after implantation. RESULTS Radiolucent lines along the stem were evident in 11 of 14 femurs, most of them seen in Gruen zones 7, 6, 1, 3, 14, and showed strong correlations to preoperative bone strength (r=-0.80; P<0.001) and axial stiffness (r=-0.75; P=0.002), yet not to bone mineral density (r=-0.67; P=0.009). Slight varus deviations <3 degrees were noted in six femurs. Preoperative strength was reduced in this femurs to 54% (P=0.006), and stiffness to 61% (P=0.038), while bone mineral density did not differ significantly. CONCLUSIONS Femoral prosthesis loosening after seven years can be predicted by mechanical bone quality of the femoral head at the time of implantation. Bone mineral density measurements may also indicate future stem loosening but have to interpreted carefully, keeping in mind a poorer predictive value. RELEVANCE Indications and choice of type of hip arthroplasty should be balanced in osteoporotic bones in particular. While preoperative bone mineral density measurement allows the prediction of mechanical bone quality, its relevance in predicting failure in arthroplasty treatment remains unclear.
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Affiliation(s)
- Gert D Krischak
- Department of Traumatology, Hand and Reconstructive Surgery, University of Ulm, Steinhoevelstrasse 9, D-89075 Ulm, Germany.
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Marks R, Allegrante JP, Ronald MacKenzie C, Lane JM. Hip fractures among the elderly: causes, consequences and control. Ageing Res Rev 2003; 2:57-93. [PMID: 12437996 DOI: 10.1016/s1568-1637(02)00045-4] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This review examines all pertinent literature sources published in the English language between 1966 to the present concerning hip fracture epidemiology, hip fracture injury mechanisms, and hip fracture management strategies. These data reveal hip fractures have several causes, but among these, the impact of falls and muscle weakness, along with low physical activity levels seems to be the most likely explanation for the rising incidence of hip fracture injuries. Related determinants of suboptimal nutrition, drugs that increase fall risk and lower the safety threshold and comorbid conditions of the neuromuscular system may also contribute to hip fracture disability. A number of interventions may help to prevent hip fracture injuries, including, interventions that optimize bone mass and quality, interventions that help prevent falls and falls dampening interventions. Rehabilitation outcomes may be improved by comprehensive interventions, prolonged follow-up strategies and ensuring that all aging adults enjoy optimal health.
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Affiliation(s)
- Ray Marks
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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