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Luo J, Ajami S, Yu H, Ma S, Chen S, Zhou F, Wang P, Yao X, Liu C. Fretting corrosion of screws contribute to the fixation failure of the femoral neck: a case report. BIOSURFACE AND BIOTRIBOLOGY 2019. [DOI: 10.1049/bsbt.2019.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jiajun Luo
- Division of Surgery & Interventional ScienceInstitute of Orthopaedic & Musculoskeletal ScienceUniversity College LondonRoyal National Orthopaedic HospitalStanmoreHA7 4LPUK
| | - Sara Ajami
- Division of Surgery & Interventional ScienceInstitute of Orthopaedic & Musculoskeletal ScienceUniversity College LondonRoyal National Orthopaedic HospitalStanmoreHA7 4LPUK
| | - Hai‐Ming Yu
- Department of OrthopaedicsSecond Affiliated Hospital of Fujian Medical UniversityQuanzhou362000People's Republic of China
| | - Shuanhong Ma
- State Key Laboratory of Solid LubricationLanzhou Institute of Chemical PhysicsChinese Academy of SciencesLanzhou730000People's Republic of China
| | - Shen‐Mao Chen
- Division of Surgery & Interventional ScienceInstitute of Orthopaedic & Musculoskeletal ScienceUniversity College LondonRoyal National Orthopaedic HospitalStanmoreHA7 4LPUK
| | - Feng Zhou
- State Key Laboratory of Solid LubricationLanzhou Institute of Chemical PhysicsChinese Academy of SciencesLanzhou730000People's Republic of China
| | - Pei‐Wen Wang
- Department of OrthopaedicsSecond Affiliated Hospital of Fujian Medical UniversityQuanzhou362000People's Republic of China
| | - Xue‐Dong Yao
- Department of OrthopaedicsSecond Affiliated Hospital of Fujian Medical UniversityQuanzhou362000People's Republic of China
| | - Chaozong Liu
- Division of Surgery & Interventional ScienceInstitute of Orthopaedic & Musculoskeletal ScienceUniversity College LondonRoyal National Orthopaedic HospitalStanmoreHA7 4LPUK
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Overmann AL, Richards JT, O'Hara NN, D'Alleyrand JC, Slobogean GP. Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis. Injury 2019; 50:2158-2166. [PMID: 31623902 DOI: 10.1016/j.injury.2019.09.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Internal fixation remains the treatment of choice for non-displaced femoral neck fractures in elderly patients. Improved outcomes with arthroplasty following displaced femoral neck fractures may indicate that outcomes of non-displaced patterns should be reexamined. The aim of our study was to conduct a systematic review of the orthopaedic literature to determine the outcomes of internal fixation for the treatment of non-displaced and minimally displaced femoral neck fractures in elderly patients. METHODS Relevant articles were identified using PubMed, Embase, and CENTRAL databases. Manuscripts were included if they contained (1) patients 60 years or older with (2) nondisplaced or minimally displaced (Garden I or II) femoral neck fractures (3) treated with internal fixation (4) separately reported outcomes in this patient population. The primary outcome was reoperation. Secondary outcomes included mortality, patient-reported outcomes, length of hospitalization, infection, and transfusions. Fixed and random effects modeling was used to determine pooled estimates of the outcomes. RESULTS Twenty-seven studies were identified with a total of 21,155 patients, all of which were treated with internal fixation. The pooled risk of reoperation was 14.1% (95% CI: 10.6-18.2). The risk of one-year mortality was 14.6% (95% CI: 11.5-18.2) based on the reporting in 15 studies. CONCLUSIONS The risk of reoperation and mortality following the treatment of nondisplaced femoral neck fractures in the elderly with internal fixation exceeds 14%. This complication profile may be unacceptably high. Arthroplasty may offer improved short-term functional outcomes and a reduced risk of reoperation. However, there is currently little evidence to consider this treatment to be an alternative to internal fixation.
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Affiliation(s)
- A L Overmann
- Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA
| | - J T Richards
- Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA
| | - N N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA
| | - J C D'Alleyrand
- Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA; Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA
| | - G P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA.
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Noda M, Nakamura Y, Adachi K, Saegusa Y, Takahashi M. Dynamic finite element analysis of implants for femoral neck fractures simulating walking. J Orthop Surg (Hong Kong) 2019; 26:2309499018777899. [PMID: 29860916 DOI: 10.1177/2309499018777899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To examine postoperative complications for osteosynthesizing femoral neck fractures (Pauwels III), biomechanical analysis should be conducted under dynamic conditions simulating for walking, not static conditions. Among the two main aims of this study, one is to pioneer the technique of dynamic finite element (FE) analysis, and the other is to compare stress distribution between two implants during walking. MATERIALS AND METHODS First, we performed an inverse dynamic analysis with optimization method using a musculoskeletal model to calculate the inter-segmental and muscular forces during walking. Second, three FE models were prepared: (I) intact hip joint, (II) fractures treated with two Hansson pins (HP), and (III) fractures with Dual SC Screws (DSCS) maintaining an angular stability. The direction and magnitude of the loadings varied continuously. Stress distribution during the walking was evaluated by using a dynamic explicit method. We examined the time-dependent von Mises stresses at two representative spots: medial cortex at the femoral neck fracture site and lateral pin (presumed) insertion holes. RESULTS In general, stress values are always changing during walking cycle. Regarding medial femoral neck cortex at the fracture line, intact model showed almost consistent value. Both HP model and DSCS model amounted the highest around 30 MPa. At lateral holes, highest values were 18.8, 104.0, and 63.1 MPa of intact, HP, and DSCS models, respectively. CONCLUSION Thus, our analysis simulating the real walking will be useful in evaluating time-varying stress distribution to assess postoperative complication. CLINICAL RELEVANCE DSCS is expected to be paramount for treatment of unstable femoral neck fractures.
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Affiliation(s)
- Mitsuaki Noda
- 1 Department of Orthopedics, Konan Hospital, Kobe, Japan
| | - Yukiko Nakamura
- 2 Kobe University Graduate School of Engineering, Kobe, Japan
| | - Kazuhiko Adachi
- 3 Department of Mechanical Engineering, Chubu University, Kasugai, Japan
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Han SK, Song HS, Kim R, Kang SH. Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old. Eur J Trauma Emerg Surg 2015; 42:191-6. [PMID: 26038046 DOI: 10.1007/s00068-015-0528-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We retrospectively analyzed the clinical results of treatment of impacted or undisplaced femoral neck fractures (Garden types 1 and 2) by osteosynthesis in elderly patients >70-year old. MATERIALS AND METHODS We retrospectively reviewed the radiological results of 52 patients who were followed up for at least 6 months from April 2002 to December 2008. The average age of the patients was 77.6 years (range 70-97 years), and 38 patients were females. The mean follow-up period was 11.7 months (range 6-19 months). Thirteen cases were Garden type 1 fractures, and 39 were Garden type 2 fractures. We assessed the relationships between the occurrence of complications and age, sex, Garden stage, bone mineral density (BMD), history of contralateral hip fracture, and any additional hip injury. RESULTS Major complications occurred in 18 cases (34.6 %), including nonunion (8 cases), osteonecrosis (6 cases), stress fracture of the subtrochanter (2 cases), excessive pull-out of a screw (1 case), and deep infection (1 case). The development of complications was associated with Garden stage 2, BMD, and additional hip injury. However, other factors were not associated with complications. Reoperations were performed in 16 cases (30.1 %), and 2 of the patients died during follow-up. CONCLUSION A relatively high rate of complications or reoperations developed after treatment of Garden 2 femoral neck fractures in senile patients >70 years of age with osteoporosis. Although internal fixation has been recommended in the literature for undisplaced femoral neck fractures, primary arthroplasty may be a better option for treatment of Garden type 2 fractures in elderly patients.
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Affiliation(s)
- S K Han
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea
| | - H S Song
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea
| | - R Kim
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea
| | - S H Kang
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Dongdaemun-gu, Seoul, 130-709, Republic of Korea.
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Hoshino CM, O'Toole RV. Fixed angle devices versus multiple cancellous screws: what does the evidence tell us? Injury 2015; 46:474-7. [PMID: 25655212 DOI: 10.1016/j.injury.2014.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
Complications, including nonunion and avascular necrosis, are relatively common after internal fixation of a femoral neck fracture. Young patients are particularly impacted by these complications as salvage options often result in a suboptimal functional result. The quality of reduction appears to be of primary importance; however, it is unknown whether the choice of internal fixation affects the incidence of complications. In this article, we present the rationale and evidence for available internal fixation options. Current evidence is insufficient to recommend an optimal method of internal fixation, and this review demonstrates the need for high-quality randomised, controlled trials to study this problem.
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Affiliation(s)
- C Max Hoshino
- Department of Orthopaedics, Harbor-UCLA Medical Center, 1000 W. Carson St, Box 422, Torrance, CA 90509, United States.
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene St, T3R62, Baltimore, MD 21201, United States
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Abstract
INTRODUCTION Femoral neck fractures in younger aged patients are particularly devastating injuries with profound impairments of quality of life and function. As there are multiple differences in patient and injury characteristics between young and elderly femoral neck fracture patients, the geriatric hip fracture literature is unlikely to be generalisable to patients under age 60. We conducted a systematic review to determine if clinically relevant outcome measures have been used in previously published clinical studies of internal fixation in young adults with femoral neck fractures. METHODS We conducted a comprehensive literature search using multiple electronic databases and conference proceedings to identify studies which used internal fixation for the management of femoral neck fractures in patients between the ages of 15 to 60. Eligibility screening and data abstraction were performed in duplicate. We classified the reported outcomes into the following categories: operative and hospital outcomes, radiographic outcomes, clinical outcomes, and functional outcomes and health-related quality of life. We calculated the frequencies of reported outcomes. RESULTS Fort-two studies met our inclusion criteria. Operative and hospital outcomes were poorly reported with less than one-quarter of studies reporting relevant data. Important radiographic outcomes were also inadequately reported with only one-third of studies reporting the quality of the fracture reduction, and methods for assessment were highly variable. The assessment of avascular necrosis was reported in almost all the included studies (95.2%); however, the assessment of nonunion was only reported in three-quarters of the studies. Re-operations were reported in 73.8% of the included studies and the assessment of fracture healing was only reported in two-thirds of the studies. Less than half of the studies reported functional outcomes or health-related quality of life (overall patient evaluation scales and systems (45.2%), patient functional outcomes (30.9%), and health-related quality of life (4.8%). DISCUSSION Our systematic review found that the assessment of clinically relevant outcomes in the young femoral neck fracture literature is lacking, which makes utilising the literature to guide clinical practice challenging. Future studies should aim to include important radiographic measures, fracture-healing complications, functional outcomes, and health-related quality of life during any assessment of young femoral neck fracture treatment.
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Kim YC, Lee JY, Song JH, Oh S. The Result of In Situ Pinning for Valgus Impacted Femoral Neck Fractures of Patients over 70 Years Old. Hip Pelvis 2014; 26:263-8. [PMID: 27536591 PMCID: PMC4971403 DOI: 10.5371/hp.2014.26.4.263] [Citation(s) in RCA: 7] [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: 08/01/2014] [Revised: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose We aimed to evaluate the outcome of fixation with cannulated screws for valgus impacted femoral neck fractures in patients over 70 years of age. Materials and Methods We reviewed the outcome in 33 patients older than 70 years with valgus impacted femoral neck fractures who were treated with cannulated screws fixation from May 2007 to December 2010. These patients were followed for at least a year. We assessed the fixation failure rate, body mass index (BMI), bone mineral density (BMD) of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation. Results We identified six patients (18.2%) with failure. Two patients with subtrochanteric fractures through the screw insertion site and another patient with osteonecrosis were excluded from the fixation failure group. No difference was found in age, BMI, BMD of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation between failure and non-failure groups. Conclusion The failure rate of cannualted screw fixation for valgus impacted femoral neck fractures in the elderly patients was not low. Risk of failure should be considered in the management of these patients and accurate assessment for fracture type should be performed using computed tomogram and clinical evaluation.
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Affiliation(s)
- Yoon-Chung Kim
- Department of Orthopedic Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Joo-Yup Lee
- Department of Orthopedic Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Joo-Hyoun Song
- Department of Orthopedic Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Seungbae Oh
- Department of Orthopedic Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
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Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures. BMC Musculoskelet Disord 2014; 15:219. [PMID: 24965132 PMCID: PMC4230242 DOI: 10.1186/1471-2474-15-219] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/18/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. METHODS/DESIGN FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. DISCUSSION This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. TRIAL REGISTRATION The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813).
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Abstract
Fragility fractures represent a growing problem with large economic and patient burdens that are likely to increase as the population ages. The elderly patient with osteopenic bone presents a unique surgical challenge with appreciable risks associated with each surgical treatment option. As demonstrated in this supplement, the current evidence suggests that the best surgical treatment options for patients with fragility fractures remains largely unknown. Additional evidence, from large clinical trials, is required before definitive treatment recommendations can be made in many cases. In this article, we review the example of the femoral neck fracture to illustrate this point.
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Tai TW, Lien FC, Lee PY, Jou IM, Lin CJ, Huang YH. Using a cannulated screw as a drill guide and sleeve: a simple technique for multiple-screw fixation for intracapsular femoral neck fracture. Orthopedics 2010; 33. [PMID: 20704114 DOI: 10.3928/01477447-20100625-05] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Management of femoral neck fractures is a challenge to orthopedic surgeons. Anatomical reduction and stable fixation is mandatory for nondisplaced or impacted intracapsular femoral neck fractures. This article introduces a simple method of parallel screw fixation for intracapsular femoral neck fracture based on the AO technique.We used a cannulated screw as a drill guide and sleeve rather than a commercial kit. With the 2-plane radiographic images, the surgeon could fine-tune the cannulated screw to direct the guide pin insertion and avoid deflection. Then the screw could be inserted for permanent fixation. This method accelerated the procedure and minimized the incisions and soft tissue dissection. The short-term results of 11 patients were compared with those of patients managed with the conventional screw fixation technique and the patients fixed with the dynamic hip system with an anti-rotation screw.This minimally invasive technique is time saving, easy to apply, and useful when commercial kits are unavailable. It facilitates and simplifies the minimally invasive parallel screw fixation procedure for intracapsular femoral neck fractures.
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Medical Center, Tainan, Taiwan
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Affiliation(s)
- Robert Probe
- Department of Orthopaedic Surgery, Scott and White Memorial Hospital and Clinic, Scott, Sherwood and Brindley Foundation, The Texas A&M University System Health Science Center College of Medicine, Temple, TX 76508, USA
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