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Hafez AT, Aly M, Omar I, Richardson G, James K. Does open or closed reduction with internal fixation reduces the incidence of complications in neck of femur fractures in pediatrics: a meta-analysis and systematic review. J Pediatr Orthop B 2024:01202412-990000000-00200. [PMID: 38700872 DOI: 10.1097/bpb.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
The neck of femur fracture (FNF) in children is a rare injury with a high incidence of complications such as avascular necrosis (AVN), coxa-vara and nonunion. The aim of this review is to compare the incidence of complications between open reduction with internal fixation (ORIF) and closed reduction with internal fixation (CRIF) of FNF in children. Two independent reviewers searched EMBASE, MEDLINE, COCHRANE and PUBMED databases from inception until April 2022 according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies included comparison of complications between open and closed approaches with fixation of FNF in patients less than 18 years old. Publication bias was assessed using Egger's test while the Newcastle-Ottawa tool was used to assess the methodological quality of the studies. A total of 724 hip fractures from 15 included studies received either ORIF or CRIF. Overall, the rate of AVN was approximately 21.7% without statistical significance between both reduction methods [relative risk (RR) = 0.909, using fixed effect model at 95% confidence interval (CI, 0.678-1.217)]. No significant heterogeneity among AVN studies ( I2 = 3.79%, P = 0.409). Similarly, neither coxa-vara nor nonunion rates were statistically significant in both treatment groups (RR = 0.693 and RR = 0.506, respectively). Coxa-vara studies showed mild heterogeneity ( I2 = 27.8%, P = 0.218), while significant publication bias was encountered in nonunion studies ( P = 0.048). No significant difference in the incidence of AVN, coxa-vara and nonunion between ORIF or CRIF of FNF in children. High-quality studies as Randomised Controlled Trials can resolve the inconsistency and heterogeneity of other risk factors including age, initial displacement, fracture type, reduction quality and time to fixation.
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Affiliation(s)
- Ahmed T Hafez
- University College London Hospitals NHS Foundation Trust
- The Blizard Institute Centre for Trauma Sciences, Queen Mary University of London Barts and the London School of Medicine and Dentistry, London
| | - Mohammed Aly
- University College London Hospitals NHS Foundation Trust
- The Blizard Institute Centre for Trauma Sciences, Queen Mary University of London Barts and the London School of Medicine and Dentistry, London
| | - Islam Omar
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim
| | | | - Kyle James
- The Blizard Institute Centre for Trauma Sciences, Queen Mary University of London Barts and the London School of Medicine and Dentistry, London
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Lin T, Zhang W, He X, He M, Li Z, He W, Chen Z, Zhang Q, Wei Q. Lateral classification system predicts the collapse of JIC type C1 nontraumatic osteonecrosis of the femoral head: a retrospective study. BMC Musculoskelet Disord 2023; 24:757. [PMID: 37749534 PMCID: PMC10521389 DOI: 10.1186/s12891-023-06890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSES The aim of this study was to construct a lateral classification system for nontraumatic osteonecrosis of femoral head (NONFH) through three-dimensional reconstruction of the necrotic area to assist in evaluating the prognosis of patients with JIC type C1. METHODS Retrospective analysis of patients with JIC type C1 NONFH from January 2018 to December 2020. All patients were followed up for more than 3.5 years. The patients were divided into collapse group and non-collapse group according to whether the femoral head collapsed during the follow-up.Lateral classification system for femoral head necrosis is constructed through three-dimensional reconstruction of the necrotic area.Comparison of lateral classification system,midsagittal necrosis angle(MNA)and general data between the two groups.Furthermore, ROC curve analysis and survival analysis were performed. RESULTS 318 patients were included in this study.There was a significant difference between the two groups in the lateral classification system (P < 0.05). In addition, the MNA in the collapsed group was significantly greater than that in the non-collapse group(P < 0.05). As revealed by the results of ROC analysis, the cutoff point of MNA was 104.5° (P < 0.05).According to the survivorship analysis, the mean survival time of the hips of patients with MNA less than 104.5°was greater than that of patients with MNA over 104.5° (P < 0.05). The survival rates of 3.5 years femoral head were 45.8%, 33.7%, 14.8%, 93.0%, and 100% for lateral classification system 1, 2, 3, 4, and 5, respectively. CONCLUSION Necrosis involving the anterior aspect of the femoral head is an important risk factor for collapse. The Lateral classification system can effectively predict the femoral head collapse in JIC C1 type NONFH patients, supplementing the deficiency of JIC classification in evaluating the front of the femoral head.
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Affiliation(s)
- Tianye Lin
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Wensheng Zhang
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Xiaoming He
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Mincong He
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Ziqi Li
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Wei He
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Zhenqiu Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Qingwen Zhang
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Qiushi Wei
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
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Chen Z, Feng F, Su X, Xu Y, Zhang Y, Tan H. Experimental study of a 3D-printing technique combined with biphasic calcium phosphates to treat osteonecrosis of the femoral head in a canine model. J Orthop Surg Res 2023; 18:693. [PMID: 37716998 PMCID: PMC10504695 DOI: 10.1186/s13018-023-04185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/10/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVE This study was aimed to use a digital design of 3D-printing technology to create a surgical navigation template. At the same time, biphasic calcium phosphate (BCP) was applied to treat osteonecrosis of the femoral head (ONFH) in animal models, based on accurate positioning of necrotic lesions in the navigation templates and observation of its therapeutic effect. METHODS Fifteen healthy adult male and female beagle dogs weighing 20 + 2 kg were randomly divided into three groups (n = 5) after establishing a model of ONFH using the liquid nitrogen freezing method. Each model underwent necrotic lesion creation and BPC implantations on one side of the femoral head and only necrotic lesion creation on the other side of the femoral head. Each group underwent CT examination, gross observation, histological examination and immunohistochemical staining at 6 weeks, 12 weeks and 18 weeks postoperatively. RESULTS At weeks 6, 12, and 18, CT and gross examination showed that the necrotic area in the experimental group was basically intact and had been completely raised by BCP material. In the control group, there were signs of bone repair in the femoral head, but there were still large bone defects and cavities. At week 18, extensive collapse of the cartilage surface was observed. Through histological examination, in the experimental group at 12 and 18 weeks, a large number of new and reconstructed bone trabeculae containing a large amount of collagen fibres were observed (P < 0.05), while in the control group, there was extensive necrosis of the bone trabeculae without cellular structural areas. Immunohistochemical examination observation: A large number of CD31-positive cells were observed in the experimental group at 6 weeks, gradually decreasing at 12 and 18 weeks (P < 0.05), while a small number of CD31-positive cells were observed in the control group at 18 weeks. CONCLUSION The 3D-printed navigation template can accurately locate ONFH lesions. Implantation of BCP material can effectively play a supporting role, prevent the collapse of the loading surface, and induce bone formation and angiogenesis to some extent.
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Affiliation(s)
- Zhian Chen
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Fanzhe Feng
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Xixiong Su
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Yongqing Xu
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Ying Zhang
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
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Wang P, Wang C, Meng H, Liu G, Li H, Gao J, Tian H, Peng J. The Role of Structural Deterioration and Biomechanical Changes of the Necrotic Lesion in Collapse Mechanism of Osteonecrosis of the Femoral Head. Orthop Surg 2022; 14:831-839. [PMID: 35445585 PMCID: PMC9087473 DOI: 10.1111/os.13277] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a crippling disease which is due to a lack of effective therapeutic measures. Its natural progression is rapid, the internal bone structure of the femoral head changes dramatically, and the subsequent fractures and collapse cause severe hip pain and loss of hip function. Femoral head collapse is a critical turning point in the development of ONFH and is related to the prognosis of patients. Early prevention and intervention help to preserve the hip joint and delay femoral head collapse. However, the mechanism of collapse still needs to be further studied because it is affected by different complex factors. This review discusses the underlying causes of femoral head collapse from two aspects: structural degradation and regional changes of biomechanical properties in the necrotic femoral head.
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Affiliation(s)
- Peng Wang
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Cheng Wang
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Haoye Meng
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Guangbo Liu
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Huo Li
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Jianming Gao
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Hua Tian
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Jiang Peng
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
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Zhao G, Liu M, Li B, Sun H, Wei B. Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality. J Orthop Surg Res 2021; 16:450. [PMID: 34256786 PMCID: PMC8276405 DOI: 10.1186/s13018-021-02580-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023] Open
Abstract
Objective Femoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction, and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation. Methods Retrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018. According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group, and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months, and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening, and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference. Results A total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification, and follow-up time among the three groups (P > 0.05). However, there was significant difference in Harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05). Conclusion Both positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.
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Affiliation(s)
- Gan Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Sports Medicine, Linyi Traditional Chinese Medicine Hospital, Linyi, 276000, Shandong, China
| | - Ming Liu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Pain, Linyi People's Hospital, Linyi, 276000, Shandong Province, China
| | - Bin Li
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Haizhong Sun
- Department of Orthopedic, Linyi People's Hospital, Linyi, 276000, Shandong Province, China
| | - Biaofang Wei
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China. .,Department of Orthopedic, Linyi People's Hospital, Linyi, 276000, Shandong Province, China.
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