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Doğan N, Büyükdoğan H. Investigation of Novel Radiological Parameters to Predict Treatment Failure and Ideal Surgical Interventions in Young Femoral Neck Fractures Treated with Triple Cannulated Screw: A Retrospective Analysis. Indian J Orthop 2024; 58:1134-1144. [PMID: 39087045 PMCID: PMC11286911 DOI: 10.1007/s43465-024-01198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/31/2024] [Indexed: 08/02/2024]
Abstract
Introduction Treatment failure remains a challenge in young femoral neck fractures treated with triple cannulated screws (TCS). This study aims to identify novel radiological parameters that can predict treatment failure and propose surgical techniques to enhance the success of TCS or aid in selecting alternative methods. Patients and methods We conducted a retrospective analysis of 87 patients who underwent surgery for femoral neck fractures between February 2014 and June 2022, meeting the inclusion criteria. Patients achieving union were categorized as Non-Fail (Group 1), while those experiencing nonunion were categorized as Fail (Group 2). Various demographic and clinical factors were assessed, including age, gender, fracture side, and fracture classification (Garden and Pauwels). Radiological parameters such as fragmentation in the medial cortex, postoperative fracture displacement in the calcar region, collo-diaphyseal angle (CDA) difference (varus/valgus alignment), and several newly defined parameters (modified tip apex distance (m-TAD), tip cortex distance (TCD), upper-lower screw-cortex distance/neck diameter, the calcar screw-cortex distance/neck diameter (Buyukdogan index), and sub-capital area/basocervical area (Dogan index) were evaluated. Patients developing nonunion were studied to establish potential cut-off values based on radiological parameters. Results Of the patients, 61 were classified as Non-Fail (Group 1) and 26 as Fail (Group 2). Both groups exhibited similar distributions in terms of gender, fracture side, Pauwels classification, and follow-up times (p > 0.05). However, Group 2 had a higher mean age than Group 1 (p = 0.006). There was a significant difference between the two groups in terms of Garden classification (p = 0.0003). Furthermore, postoperative calcar displacement, varus alignment, m-TAD, TCD, upper-lower screw-cortex distance/neck diameter ratio, Buyukdogan index, and Dogan index showed significant differences between the groups (p < 0.05). Conversely, medial calcar fragmentation did not differ significantly between the groups (p > 0.05). Conclusions The Dogan index (≤ 0.5) can serve as an independent preoperative predictor of treatment failure, aiding in the selection of more effective surgical interventions than TCS. Varus alignment (> 10 degrees), the upper-lower screw-cortex distance to the neck diameter (> 0.45) and Buyukdogan index (> 0.2) are influenced by the surgical technique of TCS application and should be considered to decrease the success of TCS.
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Affiliation(s)
- Necati Doğan
- Department of Orthopaedics and Traumatology, Basaksehir Cam and Sakura City Hospital, Basaksehir Olimpiyat Bulvarı Yolu, Basaksehir, 34480 Istanbul, Turkey
| | - Halil Büyükdoğan
- Department of Orthopaedics and Traumatology, Beykent University Hospital, Istanbul, Turkey
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Hendriks FK, Weijzen MEG, Goessens JPB, Zorenc AHG, Gijsen AP, Kramer IF, van den Bergh JPW, Poeze M, Blokhuis TJ, van Loon LJC. Trabecular, but not cortical, bone tissue protein synthesis rates are lower in the femoral head when compared to the proximal femur following an intracapsular hip fracture. Bone 2023; 177:116921. [PMID: 37769955 DOI: 10.1016/j.bone.2023.116921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND All musculoskeletal tissues are in a constant state of turnover, with a dynamic equilibrium between tissue protein synthesis and breakdown rates. The synthesis of protein allows musculoskeletal tissues to heal following injury. Yet, impaired tissue healing is observed following certain injuries, such as geriatric hip fractures. It is assumed that the regenerative properties of femoral head bone tissue are compromised following an intracapsular hip fracture and therefore hip replacement surgery is normally performed. However, the actual impact on in vivo bone protein synthesis rates has never been determined. DESIGN In the present study, 10 patients (age: 79 ± 10 y, BMI: 24 ± 4 kg/m2) with an acute (<24 h) intracapsular hip fracture received a primed continuous intravenous infusion of L-[ring-13C6]-phenylalanine before and throughout their hip replacement surgery. Trabecular and cortical bone tissue from both the femoral head and proximal femur were sampled during surgery to assess protein synthesis rates of affected (femoral head) and unaffected (proximal femur) bone tissue, respectively. In addition, tissue samples of gluteus maximus muscle, synovium, ligamentum teres, and femoral head cartilage were collected. Tissue-specific protein synthesis rates were assessed by measuring L-[ring-13C6]-phenylalanine incorporation in tissue protein. RESULTS Femoral head trabecular bone protein synthesis rates (0.056 [0.024-0.086] %/h) were lower when compared to proximal femur trabecular bone protein synthesis rates (0.081 [0.056-0.118] %/h; P = 0.043). Cortical bone protein synthesis rates did not differ between the femoral head and proximal femur (0.041 [0.021-0.078] and 0.045 [0.028-0.073] %/h, respectively; P > 0.05). Skeletal muscle, synovium, ligamentum teres, and femoral head cartilage protein synthesis rates averaged 0.080 [0.048-0.089], 0.093 [0.051-0.130], 0.121 [0.110-0.167], and 0.023 [0.015-0.039] %/h, respectively. CONCLUSION In contrast to the general assumption that the femoral head is avital after an intracapsular displaced hip fracture in the elderly, our data show that bone protein synthesis is still ongoing in femoral head bone tissue during the early stages following an intracapsular hip fracture in older patients. Nonetheless, trabecular bone protein synthesis rates are lower in the femoral head when compared to the proximal femur in older patients following an acute intracapsular hip fracture. Trial register no: NL9036.
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Affiliation(s)
- Floris K Hendriks
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Michelle E G Weijzen
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Joy P B Goessens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Antoine H G Zorenc
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Annemie P Gijsen
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Irene Fleur Kramer
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Surgery, division of Trauma Surgery Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joop P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Martijn Poeze
- Department of Surgery, division of Trauma Surgery Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Taco J Blokhuis
- Department of Surgery, division of Trauma Surgery Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Luc J C van Loon
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
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Ren B, Lv X, Ma Q. Fine-tuning reduction of femoral neck fracture with crossed Kirschner wires. Asian J Surg 2023; 46:5037-5038. [PMID: 37596227 DOI: 10.1016/j.asjsur.2023.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 08/20/2023] Open
Affiliation(s)
- Bufang Ren
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China.
| | - Xin Lv
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Quanping Ma
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
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Lu V, Gowrishankar S, Arshad Z, Thahir A, Lenihan J, Mcdonald S, Rawal J, Hull P, Chou D, Carrothers A. The clinical characteristics and management of paediatric pelvic fractures: a changing landscape based on skeletal maturity. Eur J Trauma Emerg Surg 2023; 49:559-570. [PMID: 36190546 PMCID: PMC9925612 DOI: 10.1007/s00068-022-02108-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Paediatric pelvic fractures (PPFs) are uncommon but signify serious trauma. A comprehensive multidisciplinary approach is needed due to a high number of associated injuries. This study aims to retrospectively analyse PPFs over a 5-year period and evaluate how advancing skeletal maturity changes fracture patterns and management plans. METHODS The trauma database was retrospectively reviewed for pelvic fractures in patients aged ≤ 18 years. Radiographs and CT scans were used to classify pelvic injuries according to the modified Torode classification and determine the status of the triradiate cartilage (open: skeletally immature; closed: skeletally mature). Data collected also included the mechanism of injury, clinical and functional outcomes, and associated injuries. Logistic regression analysis was performed to identify risk factors for associated abdominal injuries. RESULTS 65 PPFs (2.8% of paediatric trauma admissions during the study period) were classified as type I (3.1%), type II (7.7%), type IIIa (32.3%), type IIIb (38.5%), type IV (18.5%) according to the modified Torode classification. The mean age was 13.41 ± 3.82. Skeletally immature children were more likely to be hit by a motor vehicle as a pedestrian (p < 0.001), be intubated (p = 0.009), acquire Torode type II (p = 0.047) and rami fractures (p = 0.037), and receive chest (p = 0.005) and head injuries (p = 0.046). Skeletally immature children were also less likely to acquire Torode type IV fractures (p = 0.018), receive surgical treatment for their pelvic injuries (p = 0.036), and had a faster time to full weight bearing (p = 0.013). Pelvis AIS score ≥ 4 (OR 5.3; 95% CI 1.3-22.6; p = 0.023) and a pedestrian accident (OR 4.9; 95% CI 1.2-20.7; p = 0.030) were risk factors for associated abdominal injuries. There was a strong association between a higher pelvic fracture grade and the proportion of patients with closed triradiate cartilage (p = 0.036), hospital length of stay (p = 0.034), mean pelvic AIS score (p = 0.039), a pelvis AIS score of ≥ 4 (p = 0.022), mean ISS (p = 0.003), an ISS score between 25 and 75 (p = 0.004), average time to FWB (p = 0.001), requirement of blood products (p = 0.015), and a motor vehicle accident (p = 0.037). CONCLUSION PPFs occurring in skeletally mature and immature patients are significantly different in terms of mechanism of injury, fracture severity, fracture pattern, and management strategy. There is a high rate of associated injuries, necessitating an integrated multidisciplinary approach in paediatric trauma centres.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK. .,Christ's College, St. Andrew's Street, Cambridge, CB2 3BU, UK.
| | - Shrav Gowrishankar
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Zaki Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Jonathan Lenihan
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Scott Mcdonald
- Department of Radiology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Jaikirty Rawal
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Peter Hull
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Daud Chou
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Andrew Carrothers
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
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Giordano V, Freitas A, Pires RE, Battaglion LR, Lobo MDO, Belangero WD. Evaluation of a Locking Autocompression Screw Model in Pauwels Type-3 Femoral Neck Fracture: In Vitro Analysis. Bioengineering (Basel) 2022; 9:bioengineering9090464. [PMID: 36135010 PMCID: PMC9495566 DOI: 10.3390/bioengineering9090464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Femoral neck fractures in young adults are uncommon, resulting from high-energy trauma. Despite their infrequency in this population, there is higher rate of complications, especially in the more vertical fracture line, classified by Pauwels as a type-3 femoral neck fracture. The implant type is of paramount importance for maintaining anatomical reduction, since it must resist the deforming forces that act on the fracture. We comparatively evaluated two constructions of the novel locking autocompression implant (X-PIN and X-PIN+P) using the finite element method and previously established methods for treating Pauwels type-3 femoral neck fractures. Six fixation models were developed for the study: a dynamic hip screw (DHS), a DHS with an anti-rotation screw (DHS+P), the inverted triangle multiple cannulated screws construction (ASNIS), the multiple cannulated screws in an L-configuration (L), and the two models of the novel locking autocompression screw (X-PIN and X-PIN+P). Under the same conditions with a load of 2100 N, the following parameters were evaluated using SIMLAB® software: the main maximum (Max P), main minimum (Min P), localized maximum P1 (Max P1), localized maximum P2 (Max P2), total displacement, localized displacement, rotation displacement, and von Mises stress. Compared to the DHS+P and ASNIS models, the X-PIN+P model presented, respectively, increases of 51.6% and 64.7% for Max P, 85% and 247% for Min P, and 18.9% and 166.7% for von Mises stress. Max P1 did not differ between the models, but Max P2 was 55% and 50% lower for X-PIN+P than ASNIS and L, respectively. All displacement values were lower for X-PIN+P than the other models. In this FEM testing, the X-PIN+P was superior to the other models, which was due to improvement in all parameters of stress distribution, displacement, and von Mises stress compared to models using a lateral plate (DHS and DHS+P) or not (ASNIS and L).
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Affiliation(s)
- Vincenzo Giordano
- Orthopedics and Traumatology Service Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, 117, Rio de Janeiro 22430-160, RJ, Brazil
- Correspondence: ; Tel.: +55-21-997516859
| | - Anderson Freitas
- Home Hospital Ortopédico e Medicina Especializada, SGAS Quadra 613-Conjunto C-Asa Sul, Brasília 70200-730, DF, Brazil
- Orthopedics and Traumatology Service, Hospital Regional do Gama, Área Especial No. 01, Brasília 72405-901, DF, Brazil
| | - Robinson Esteves Pires
- Department of the Locomotive Apparatus, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Leonardo Rigobello Battaglion
- Ribeirão Preto School of Medicine, Universidade de São Paulo (FMRP-USP), Av. Dr. Arnaldo, 455, Ribeirão Preto 01246-903, SP, Brazil
| | - Mariana de Oliveira Lobo
- Orthopedics and Traumatology Service, Hospital Regional do Gama, Área Especial No. 01, Brasília 72405-901, DF, Brazil
| | - William Dias Belangero
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Rua Vital Brasil, 80, Campinas 13083-888, SP, Brazil
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Addressing posterior tilt displacement during surgery to lower failure risk of sub-capital Garden types 1 and 2 femoral fractures. Arch Orthop Trauma Surg 2022; 142:1885-1893. [PMID: 33959801 DOI: 10.1007/s00402-021-03900-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Sub-capital femoral fractures (SCFF) are impacted or non-displaced in Garden types 1 and 2, respectively. Non-surgical treatment is protected weight-bearing combined with physiotherapy and radiographic follow-up in selected patients. Traditionally, in situ pinning is the surgical treatment of choice. The aim of this study was to estimate whether the valgus deformity in Garden types 1 and 2 (AO classification 31B1.1 and 31B1.2) SCFF is a virtual perception of a posterior tilt deformity and if addressing this deformity improves patients' outcomes. MATERIALS AND METHODS The records of 96 patients with Garden Types 1 and 2 SCFF treated in tertiary medical center between 1/2014 and 9/2017 were retrospectively reviewed. They all had preoperative hip joint anteroposterior and lateral radiographic views. 75 patients had additional computed tomography (CT) scans. Femoral head displacement was measured on an anteroposterior and axial radiograph projections and were performed before and after surgery. Preoperative 3D reconstructions were performed for a better fracture characterization, and assessment of the imaging was performed by the first author. RESULTS The average age of the study cohort was 73 years (range 28-96, 68% females). There were 58 right-sided and 38 left-sided fractures. Ninety patients had Type 1 and six patients had Type 2 fractures. The average preoperative posterior tilt was 15 degrees and the average valgus displacement was 10 degrees on plain radiographs compared to 28 degrees and 11 degrees, respectively, on CT scans. Posterior tilt was found with a virtual perception as valgus-impacted fractures. The postoperative posterior tilt was corrected to an average of 3 degrees and the valgus displacement to 5 degrees. CONCLUSION CT provides an accurate modality for measuring femoral head displacement and fracture extent. The posterior tilt displacement should be addressed during surgery to lower failure risk and the need for additional procedures. IRB APPROVAL TLV-0292-15. LEVEL OF EVIDENCE IV.
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Oosterhoff JHF, Savelberg ABMC, Karhade AV, Gravesteijn BY, Doornberg JN, Schwab JH, Heng M. Development and internal validation of a clinical prediction model using machine learning algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above. Eur J Trauma Emerg Surg 2022; 48:4669-4682. [DOI: 10.1007/s00068-022-01981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Abstract
Abstract
Purpose
Preoperative prediction of mortality in femoral neck fracture patients aged 65 years or above may be valuable in the treatment decision-making. A preoperative clinical prediction model can aid surgeons and patients in the shared decision-making process, and optimize care for elderly femoral neck fracture patients. This study aimed to develop and internally validate a clinical prediction model using machine learning (ML) algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above.
Methods
A retrospective cohort study at two trauma level I centers and three (non-level I) community hospitals was conducted to identify patients undergoing surgical fixation for a femoral neck fracture. Five different ML algorithms were developed and internally validated and assessed by discrimination, calibration, Brier score and decision curve analysis.
Results
In total, 2478 patients were included with 90 day and 2 year mortality rates of 9.1% (n = 225) and 23.5% (n = 582) respectively. The models included patient characteristics, comorbidities and laboratory values. The stochastic gradient boosting algorithm had the best performance for 90 day mortality prediction, with good discrimination (c-statistic = 0.74), calibration (intercept = − 0.05, slope = 1.11) and Brier score (0.078). The elastic-net penalized logistic regression algorithm had the best performance for 2 year mortality prediction, with good discrimination (c-statistic = 0.70), calibration (intercept = − 0.03, slope = 0.89) and Brier score (0.16). The models were incorporated into a freely available web-based application, including individual patient explanations for interpretation of the model to understand the reasoning how the model made a certain prediction: https://sorg-apps.shinyapps.io/hipfracturemortality/
Conclusions
The clinical prediction models show promise in estimating mortality prediction in elderly femoral neck fracture patients. External and prospective validation of the models may improve surgeon ability when faced with the treatment decision-making.
Level of evidence
Prognostic Level II.
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Marchand LS, Butler B, McKegg P, DeLeon G, O'Hara NN, Lebrun CT, Sciadini MF, Nascone JW, O'Toole RV, Slobogean GM. Fixed angle device comparison in young femoral neck fractures: Dynamic hip screw vs dynamic helical hip system. Injury 2022; 53:590-595. [PMID: 34802699 DOI: 10.1016/j.injury.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral neck fractures in the young patient present a unique challenge. Most surgeons managing these injuries prefer a fixed angle implant, however these devices are fraught with problems. A dynamic hip screw (DHS) is one such fixed angle device that risks malreduction through rotational torque during screw insertion. To avoid this risk some surgeons utilize a dynamic helical hip system (DHHS), however little is known about the complication profile of this device. We hypothesized that the complication rate between these two devices would be similar. PATIENTS AND METHODS All patients presenting to a single tertiary referral center with a femoral neck fracture were identified from a prospectively collected trauma database over an 11-year period. Patients were included if they were less than 60 years of age, treated with a DHS or DHHS, and had at least 6 months of follow-up. Demographic data, injury characteristics, and post-operative complications were obtained through chart review. Standard statistical comparisons were made between groups. A total of 77 patients met inclusion criteria. RESULTS Average age of patients was 38 years (range: 18-59) and 56 (73%) were male. The DHS was used in 37 (48%) patients and the DHHS was used in 40 (52%) patients. Demographic data including average age, gender, body mass index, and smoking status did not differ between the groups. There were 29 (39%) total complications of interest (femoral neck shortening >5 mm, non-union requiring osteotomy, conversion to THA, and osteonecrosis. There were 19 (51%) complications in the DHS group and 10 (25%) in the DHHS group (p = 0.01, risk difference 25%, 95% CI 7-43). Comparisons of the individual complications about the DHS and DHHS cohort did not reach statistical significance for non-union (8% vs 3%) or THA (16% vs 13%) (p = 0.33, p = 0.64, respectively) but a difference was detected in the rate of shortening (27% vs 10%; p = 0.05). CONCLUSION This study demonstrates a high risk of complication when managing young femoral neck fractures in line with prior literature. The major complication rate of non-union requiring osteotomy or fixation failure resulting in THA was no different between the two groups, but the rate of shortening was greater the DHS group. This data suggests the DHHS may be a suitable device to manage the young femoral neck fracture and without increased risk of complication.
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Affiliation(s)
- Lucas S Marchand
- Department of Orthopedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Bennet Butler
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Phillip McKegg
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Genaro DeLeon
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Christopher T Lebrun
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Marcus F Sciadini
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Jason W Nascone
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
| | - Gerard M Slobogean
- R Adams Cowley Shock Trauma Center, Department of Orthopedics, University of Maryland, Baltimore, MD, USA
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Ma C, Liu Y, Liu J, Chen L, Huang J, Luo X, Xie Z. The role of the medial buttress plate in the treatment of Pauwels type II and III femoral neck fracture in nonelderly patients: a retrospective study and preliminary results. BMC Musculoskelet Disord 2022; 23:100. [PMID: 35101030 PMCID: PMC8802514 DOI: 10.1186/s12891-022-05056-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to compare the effectiveness of multiple cannulated screws combined with medial buttress plate or not for the treatment of unstable femoral neck fracture in nonelderly patients. Methods Sixty-nine nonelderly patients with Garden type III-IV femoral neck fracture were retrospectively analyzed. The patients were divided into MCS (multiple cannulated screws) group and CMBP (combined with medial buttress plate) group according to the surgical method. Patient’s demographic data, Harris Hip Score, EQ-5D index and complications at a minimum of 2 years follow-up were analyzed. Results There were 47 patients in the MCS group (35 male and 12 females) with a mean age of 40.28 ± 12.64 years, whereas 22 patients in the CMBP group (17 male and 5 females) with a mean age of 43.86 ± 12.55 years. In the MCS group, there were 1 (2.1%) avascular necrosis, 5 (10.6%) postoperative nonunion, 5 (10.6%) implant failure, and 2 (4.3%) femoral neck shortening. While 1 (4.5%) implant failure, 2 (9.1%) postoperative nonunion and 2 (9.1%) impingement in the CMBP group. For patients with Pauwels type II and III femoral neck fracture, the CMBP group had higher HHS scores at 3 months after surgery than the MCS group (P < 0.05), whereas there was no statistical significance at 6 months, 1 year, and 2 years (P > 0.05). The same results were found in the EQ-5D index. Conclusions In our cohort, we observed better outcomes in the CMBP group at 3 and 6 months, with later results similar between groups. However, there were fewer complications in the CMBP group, without obviously blood-supply disruption, especially in Pauwels type II and III. Further, anatomic reduction and stable fixation may contribute to satisfactory outcomes in the treatment of nonelderly displaced femoral neck fractures.
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Affiliation(s)
- Chao Ma
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Chen
- Department of Ophthalmology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jinyong Huang
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xuefeng Luo
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zengru Xie
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Rajak MK, Kumar S, Thakur R, Bhaduri I. A Rare Case of Simultaneous Fracture Neck of Femur on One Side and Contralateral Intertrochanteric Fracture Femur in a 41-Year-Old Female - A Case Report. J Orthop Case Rep 2021; 11:61-64. [PMID: 34790606 PMCID: PMC8576774 DOI: 10.13107/jocr.2021.v11.i07.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Simultaneous fractures in the neck of femur on the one side and contralateral intertrochanteric fracture of the femur with only trivial injury are among rarest injuries. Fracture neck of femur or intertrochanteric fracture either isolated or in combination such as simultaneous bilateral fracture neck of femur and simultaneous bilateral intertrochanteric fractures are relatively commonly reported in literature. Herein, we report a very rare case of a young female with chronic kidney disease who presented with simultaneous fractures neck of femur on the one side and contralateral intertrochanteric fracture of femur after a fall from standing height. Case Report A 41-year-old female with chronic kidney disease from the past 5 years presented to us with severe pain at both hip and inability to stand after a fall from standing height. Clinical examination and investigations were done. She suffered fracture neck of femur on the right side and intertrochanteric fracture femur on the left side. Single stage fixation of both these fractures by two different methods was done successfully after optimization of her medical condition with multidisciplinary approach. She was advised weight bearing according to fixation method used and progress of fracture union. She regained her preoperative walking status gradually in 6 months. Conclusion Simultaneous fractures in the neck of femur on the one side and intertrochanteric fracture of the femur on the other side are very rare presentation and can happen in patients with primary or secondary bone disease. Multidisciplinary team effort is needed for overall effective management and prompt surgical treatment can help achieve favorable outcome.
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Affiliation(s)
- M K Rajak
- Department of Orthopaedics, Tata Main Hospital, Bistupur, Jamshedpur, Jharkhand, India
| | - S Kumar
- Department of Orthopaedics, Tata Main Hospital, Bistupur, Jamshedpur, Jharkhand, India
| | - R Thakur
- Department of Orthopaedics, Tata Main Hospital, Bistupur, Jamshedpur, Jharkhand, India
| | - I Bhaduri
- Department of Orthopaedics, Tata Main Hospital, Bistupur, Jamshedpur, Jharkhand, India
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Agar A, Utkan A. The Effect of Anatomical Reduction on Functional Outcomes in Femoral Neck Fracture: A Novel Modified Garden Index. Cureus 2021; 13:e19863. [PMID: 34976490 PMCID: PMC8712223 DOI: 10.7759/cureus.19863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Femoral neck fracture is a common cause of morbidity in the younger population with potentially poor prognosis and functional results. The purpose of this study was to evaluate how the success of anatomic reduction affects hip functional outcomes by using a new numerical index modified from the Garden index. Methods: Twenty-six patients who underwent closed reduction and internal fixation by means of three cannulated screws due to femoral neck fracture between 2010 and 2014 were scanned retrospectively and included in the study. Harris hip scores of the patients at nine to 12 months were evaluated using the new index modified from Garden which is the sum of the differences from the ideal Garden index calculated on early postoperative anteroposterior and lateral pelvis radiographs. Results: The mean hip score was 73.1 (± 16.4), the minimum score was 32, the maximum score was 93. Postoperative anteroposterior radiographs revealed a mean Garden alignment index of 153.6°, the lowest value was 135° and the highest value was 168°. In the lateral radiographs, the mean Garden alignment index was 173.1°, the lowest value was 160° and the highest value was 178°. The mean value of the novel index was found as 14.2°, the lowest value was 2°, and the highest value was 40°. There was an inverse correlation between the novel index we defined and the Harris hip score (p<0.01). Conclusion: In femoral neck fractures, the success of anatomic reduction is an important factor affecting the patient’s functional outcome. We believe the new reduction index we proposed will contribute to literature comparing the success of reduction in femoral neck fractures.
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Affiliation(s)
- Anil Agar
- Orthopedic and Traumatology, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Ali Utkan
- Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
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Abstract
ABSTRACT Hip fractures are considered a significant public health issue, representing a substantial burden on our healthcare system and society. They are one of the leading causes of disability among older adults, especially women. Globally, an estimated 18% of women and 6% of men will be affected by hip fractures at some time in life. Hip fractures are a major cause of long-term disability among older adults and more significant than mortality, as only 60% of patients regain their preinjury level of mobility. This has detrimental effects on quality of life and activities of daily living, imposing a level of dependence that has personal, social, and systemic consequences.
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Affiliation(s)
- Meagan L Barry
- At the time this article was written, Meagan L. Barry was a student in the PA program at the University of Tennessee Health Science Center in Memphis. She now practices at Dallas (Tx.) Orthopaedic Joint Institute. Kristopher R. Maday is an associate professor and program director in the PA program at the University of Tennessee. The authors have disclosed no potential conflicts of interest, financial or otherwise
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13
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Ochieng SR, Kingori J, Awori KO, Ating'a JEO. Recovery of pre-injury functional state following operative treatment of displaced femoral neck fractures; a prospective cohort study. Ann Med Surg (Lond) 2021; 69:102682. [PMID: 34429951 PMCID: PMC8367854 DOI: 10.1016/j.amsu.2021.102682] [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] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
Background The incidence of fracture neck of femur (FNF) has been projected to increase significantly. This study sought to determine the recovery of preinjury functional state following operative treatment of displaced FNF. Materials and methods A six-month prospective cohort study was conducted at Kenyatta National Hospital (KNH) and PCEA Kikuyu Mission Hospital (KMH) between November 2008 and May 2009. Sixty patients were enrolled using a pre-tested questionnaire. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores were used. The functional outcome measures included pain, stiffness and activities of daily living (ADL). Stratification and subgroup analysis were done especially based on age. Student's t-test and χ2 test were used for comparison between variables as appropriate with a p < 0.05 being considered statistically significant. Results Majority of the patients recruited were males (68%) with a mean age of 51.6 years. Eighty eight percent of the patients had a mean negative early functional outcome score. Hemiarthroplasty (HA) and Total Hip Arthroplasty (THA) had comparable early post-operative functional outcome while Osteosynthesis (OS) had a poorer ADL outcome. Prolonged hospital stay was associated with a poor ADL outcome (p = 0.020). Use of the antero-lateral approach to the hip was associated with a better ADL outcome in patients older than 50 years (p = 0.007). Conclusions At three months post-operatively, most patients have not fully recovered their pre-injury level of function and independence. Both HA and THA are associated with better early functional outcome compared to OS. Study type Original research.
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Key Words
- ADL, Activities of Daily Living
- ASA, American Society of Anesthesiologists
- Arthroplasty
- FNF, Femoral Neck Fracture/ Fracture Neck of Femur
- FNFs, Femoral Neck Fractures
- Fracture neck femur
- Functional outcome
- HA, Hemiarthroplasty
- Hip fracture
- KMH, PCEA Kikuyu Mission Hospital
- KNH, Kenyatta National Hospital
- LOS, Length of Hospital Stay
- OS, Osteosynthesis (Internal fixation)
- Osteosynthesis
- RTI, Road Traffic Injuries
- SPSS, Statistical Package for the Social Sciences
- THA/R, Total Hip Arthroplasty/ Replacement
- UON, University of Nairobi
- WOMAC, Western Ontario and MacMaster Universities Osteoarthritis Index
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Affiliation(s)
- Sephenia Raduma Ochieng
- Defence Forces Memorial Hospital, Nairobi, Kenya.,School of Medicine, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
| | - John Kingori
- School of Medicine, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya.,PCEA Kikuyu Mission Hospital, P.O. Box 45-00902, Kikuyu, Kenya
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14
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Yoo JI, Cha Y, Kwak J, Kim HY, Choy WS. Review on Basicervical Femoral Neck Fracture: Definition, Treatments, and Failures. Hip Pelvis 2020; 32:170-181. [PMID: 33335865 PMCID: PMC7724026 DOI: 10.5371/hp.2020.32.4.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/11/2023] Open
Abstract
Basicervical femoral neck fracture is an uncommon fracture that accounts for only 1.8% of all proximal femoral fractures. Previous studies have recommended that the choice of implant to treat this fracture should be similar to that of intertrochanteric fracture. However, in previous studies on basicervical fractures, the definition and treatment results of these fractures were different, and there were also debates on the implant that had to be used. Therefore, the purpose of this study was to review the studies that performed surgical treatment of basicervical femoral fractures and to assess the definition of basicervical fracture, the use of implants, and failure rates and clinical results. Study selection was based on the following inclusion criteria: (1) treatment outcome for basicervical femoral neck fracture was reported; and (2) dynamic hip screw, proximal femoral nail, or multiple screw fixation was used as treatment. PubMed Central, OVID MEDLINE, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched to identify relevant studies published up to March, 2020 with English language restriction. A total of 15 studies were included in this study. Differences were found in the definition of basicervical fracture, treatment results, rehabilitation protocol, and fixation failure rate. Definitions and treatment methods for basicervical fractures varied, and treatment outcomes also differed among the enrolled studies. Further research is needed that would be restricted to those fractures that conform to the definition of basicervical fracture.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Joonhyeok Kwak
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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15
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Medial Plating of Pauwels Type III Femoral Neck Fractures Decreases Shear and Angular Displacement Compared with a Derotational Screw. J Orthop Trauma 2020; 34:639-643. [PMID: 32502057 DOI: 10.1097/bot.0000000000001852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this mechanical study was to compare 2 methods of augmented stabilization of Pauwels type III femoral neck fractures. METHODS Ten matched pairs of young cadaveric femurs were cut 22 cm distal to the lesser trochanter. All specimens received a 70-degree osteotomy, which was stabilized with a 135-degree sliding hip screw. One of each pair received augmented fixation with a 6.5 mm fully threaded cannulated screw. The other specimen in the matched pair had additional fixation with a 3.5 mm 5-hole tubular plate placed at the inferior-medial femoral neck. Each specimen was tested under cyclic axial loading conditions (5000 cycles between 200 and 1400 N at 2 cycles/sec) and subsequently loaded to failure. The angular displacement (varus), interfragmentary (shear) displacement, and failure loads were calculated. RESULTS In the augmented plate group, 7 specimens failed by angular displacement and 3 failed by shear displacement. In the augmented screw group, 8 specimens failed by angular displacement and 2 by shear displacement. The plate group was found to have significantly less angular displacement, regardless of completed cycles, than the augmented screw group (0.75 ± 0.35 degrees vs. 2.15 ± 1.99 degrees averaged across completed cycles, P < 0.01). Similarly, the plate group was found to have significantly less shear displacement, regardless of completed cycles, than the augmented screw group (0.77 ± 0.70 mm vs. 1.22 ± 0.92 mm averaged across completed cycles, P = 0.01). The average failure load of the plate group (4930 ± 1578 N) was also larger but not significantly different from the screw group (3824 ± 2140 N), P = 0.12. CONCLUSIONS Augmenting sliding hip screw stabilization of a Pauwels type III fracture with a medial plate applied to the femoral neck significantly decreases angular displacement and shear displacement compared with augmentation with a derotational screw.
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Haj-Mirzaian A, Eng J, Khorasani R, Raja AS, Levin AS, Smith SE, Johnson PT, Demehri S. Use of Advanced Imaging for Radiographically Occult Hip Fracture in Elderly Patients: A Systematic Review and Meta-Analysis. Radiology 2020; 296:521-531. [PMID: 32633673 DOI: 10.1148/radiol.2020192167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The overall rate of hip fractures not identified on radiographs but that require surgery (ie, surgical hip fractures) remains unclear in elderly patients who are suspected to have such fractures based on clinical findings. Moreover, the importance of advanced imaging in these patients has not been comprehensively assessed. Purpose To estimate the frequency of radiographically occult hip fracture in elderly patients, to define the higher-risk subpopulation, and to determine the diagnostic performance of CT and bone scanning in the detection of occult fractures by using MRI as the reference standard. Materials and Methods A literature search was performed to identify English-language observational studies published from inception to September 27, 2018. Studies were included if patients were clinically suspected to have hip fracture but there was no radiographic evidence of surgical hip fracture (including absence of any definite fracture or only presence of isolated greater trochanter [GT] fracture). The rate of surgical hip fracture was reported in each study in which MRI was used as the reference standard. The pooled rate of occult fracture, diagnostic performance of CT and bone scanning, and strength of evidence (SOE) were assessed. Results Thirty-five studies were identified (2992 patients; mean age, 76.8 years ± 6.0 [standard deviation]; 66% female). The frequency of radiographically occult surgical hip fracture was 39% (1110 of 2835 patients; 95% confidence interval [CI]: 35%, 43%) in studies of patients with no definite radiographic fracture and 92% (134 of 157 patients; 95% CI: 83%, 98%) in studies of patients with radiographic evidence of isolated GT fracture (moderate SOE). The frequency of occult fracture was higher in patients aged at least 80 years (44%, 529 of 1184), those with an equivocal radiographic report (58%, 71 of 126), and those with a history of trauma (41%, 977 of 2370) (moderate SOE). CT and bone scanning yielded comparable diagnostic performance in the detection of radiographically occult hip fracture (P = .67), with a sensitivity of 79% and 87%, respectively (low SOE). Conclusion Elderly patients with acute hip pain and negative or equivocal findings at initial radiography have a high frequency of occult hip fractures. Therefore, the performance of advanced imaging (preferably MRI) may be clinically appropriate in all such patients. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Arya Haj-Mirzaian
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - John Eng
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Ramin Khorasani
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Ali S Raja
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Adam S Levin
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Stacy E Smith
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Pamela T Johnson
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
| | - Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological Science, (A.H., J.E., P.T.J., S.D.) Department of Orthopaedic Surgery (A.S.L.), and High Value Practice Academic Alliance (A.H., A.S.R., P.T.J., S.D.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3140D, Baltimore, MD 21287; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.K., S.E.S.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.S.R.); and Library of Evidence, Harvard Medical School, Boston, Mass (R.K., A.S.R.)
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Marchand LS, Karns M, Higgins TF, Aoki SK. Femoral Neck Fracture Fixation with a Medial Buttress Plate That Led to Impingement with Hip Flexion: A Case Report. JBJS Case Connect 2020; 9:e21. [PMID: 30921000 DOI: 10.2106/jbjs.cc.18.00135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CASE A 47-year-old man with an isolated femoral neck fracture was treated with open reduction and internal fixation with a medial femoral neck buttress plate and a dynamic hip screw. Union was achieved without osteonecrosis of the femoral head. However, hip arthroscopy that was performed for persistent hip pain following the fracture union revealed an intra-articular impingement of the buttress plate and a substantial anterior acetabular chondral injury. CONCLUSIONS To our knowledge, this is the first reported complication associated with the application of a medial buttress plate for a femoral neck fracture. This case report may help surgeons who employ this technique to avoid a similar complication.
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Affiliation(s)
- Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Michael Karns
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Thomas F Higgins
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Şahin A, Agar A, Gülabi D, Ertürk C. Comparison of dynamic hip screw and antirotation screw with cannulated screw in the treatment of transcervical collum femoris fractures. Jt Dis Relat Surg 2020; 31:320-327. [PMID: 32584732 PMCID: PMC7489184 DOI: 10.5606/ehc.2020.73416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES This study aims to compare the results of internal fixation with dynamic hip screw (DHS)/antirotation screw and conventional cannulated screw (CS) for femoral neck fracture. PATIENTS AND METHODS This retrospective study included a total of 78 patients (57 males, 21 females) with collum femoris fractures treated with internal fixation between January 2015 and January 2019. Group 1 comprised 41 patients with a mean age of 45.7 years (range, 19 to 62 years) treated with DHSs/antirotation screws, while group 2 comprised 37 patients with a mean age of 41.9 years (range, 17 to 75 years) treated with CSs. The patients were evaluated for union, avascular necrosis (AVN), femoral neck shortness, operation time, duration of fluoroscopy exposure, and functional outcomes. RESULTS Age, gender, and Garden classification stages were similar in both groups. No significant difference was found between the groups in respect of AVN and non-union rates. The non-union rate was 12.2% in group 1 and 21.6% in group 2 (p>0.05). The duration of fluoroscopy exposure was statistically significantly higher in group 2 (p=0.001) and the operation time was statistically significantly longer in group 1 (p=0.001). In group 2, femoral neck shortness stature was significantly higher (p=0.007). At the final follow-up examination, the Harris hip score was statistically significantly higher in group 1 (p=0.04). CONCLUSION Dynamic hip screw/antirotation screw was a more relevant treatment method for transcervical femoral neck fractures compared to CS with more favorable functional outcomes and less fluoroscopy exposure.
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Affiliation(s)
| | - Anıl Agar
- Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 34303 Küçükçekmece, İstanbul, Türkiye.
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19
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Treatment of Ipsilateral Femoral Neck and Shaft Fractures With Cannulated Screws and Antegrade Reconstruction Nail. J Orthop Trauma 2020; 34:e176-e180. [PMID: 31688439 DOI: 10.1097/bot.0000000000001689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ipsilateral femoral neck and shaft fractures are challenging injuries, and there are different fixation options but no consensus on a superior construct. Our preferred method is cannulated screw fixation of the femoral neck and antegrade reconstruction nailing of the shaft. Compressive fixation of the femoral neck fracture with cancellous lag screws followed by reconstruction nail placement provides compressive fixation and fixed angle support of the neck fracture while allowing for more optimal treatment of femoral shaft fractures at or above the isthmus. The purpose of this submission is to describe the surgical decision-making, surgical technique, and all surgically related complications of this technique.
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Bergman J, Nordström A, Nordström P. Epidemiology of osteonecrosis among older adults in Sweden. Osteoporos Int 2019; 30:965-973. [PMID: 30627759 PMCID: PMC6502772 DOI: 10.1007/s00198-018-04826-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022]
Abstract
UNLABELLED This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. INTRODUCTION The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort. METHODS In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs). RESULTS The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% (n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69-8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59-8.99), dialysis (SIR, 6.65; 95% CI, 5.62-7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70-7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases. CONCLUSIONS Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden.
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Affiliation(s)
- J Bergman
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - A Nordström
- Department of Public Health and Clinical Medicine, Unit of Occupational and Environmental Medicine, Umeå University, 90187, Umeå, Sweden
- School of Sport Sciences, UiT Arctic University of Norway, Postboks 1621, 9509, Alta, Norway
| | - P Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden.
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Li J, Zhao Z, Yin P, Zhang L, Tang P. Comparison of three different internal fixation implants in treatment of femoral neck fracture-a finite element analysis. J Orthop Surg Res 2019; 14:76. [PMID: 30871584 PMCID: PMC6419341 DOI: 10.1186/s13018-019-1097-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/05/2019] [Indexed: 01/25/2023] Open
Abstract
Background Current surgical interventions for the femoral neck fracture are using either cannulated screws (CCS) or a single large screw at a fixed angle with a side-plate (i.e., a sliding hip screw, AKA dynamic hip screw, DHS). Despite these interventions, the need for reoperation remains high (10.0–48.8%) and largely unchanged over the past 30 years. Femoral neck fracture is associated with substantial morbidity, mortality, and costs. Methods In this study, our group designed a plate that combines the strength of both CCS and sliding hip screw, through providing three dynamic screws at a fixed angle with a side-plate, namely the slide compression anatomic place-femoral neck (SCAP-FN). Finite element analyses (FEA) were carried out to compare the outcomes of the combination of our SCAP-FN plate with DHS+DS (derotational screw) and to those of using cannulated screws alone. Results SCAP-FN produces more stable fixation with respect to the femur and the stress distributions, stress peaks, and rotational angles. Conclusions The FEA encouraged us that in the following biomechanical experiment, SCAP-FN may remain the strengths of both CCS and DHS+DS and show a better performance in resisting shearing and rotational forces, therefore achieving the best stability in terms of smallest displacement and rotational angle. Electronic supplementary material The online version of this article (10.1186/s13018-019-1097-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jia Li
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168, Li Tang Road, Changping District, Beijing, 102218, China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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Cha YH, Yoo JI, Hwang SY, Kim KJ, Kim HY, Choy WS, Hwang SC. Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods. Clin Orthop Surg 2019; 11:1-14. [PMID: 30838102 PMCID: PMC6389527 DOI: 10.4055/cios.2019.11.1.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this systematic review was to investigate various fixation methods or implants used in the treatment of Pauwels type III femoral neck fractures. Methods PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, Embase, and AHRQ databases were searched to identify relevant studies published until August 2017 with English language restriction. Studies were selected on the basis of the following inclusion criteria: biomechanical study of Pauwels type III femoral neck fractures and the use of dynamic hip screw (DHS) or multiple screw fixation or other devices for fixation of the fracture. Results A total of 15 studies were included in the systematic review. Eight studies were conducted using cadavers, six studies using sawbones, and one using a finite element model. During the mechanical testing, each study measured mechanical stiffness, failure to cyclic loading, failure to vertical loading of each fixation device. DHS was included in 11 studies, multiple screw fixation in 10 studies, and other devices in six studies. Baitner et al. and Samsami et al. reported that the mechanical stiffness of DHS was superior to three inverted triangular screw fixation. Hawks et al. and Gumustas et al. reported that using a transverse calcar screw can withstand vertical loading better than three inverted triangular screw fixation. In addition, there were some studies where instruments such as Intertan nail, locking plate or other devices showed excellent biomechanical properties. Conclusions There are a variety of methods and instruments for fixation of the Pauwels type III fractures. However, it is difficult to conclude that any method is more desirable because there are advantages and disadvantages to each method. Therefore, we should pay attention to the implant choice and consider adequate weight bearing affecting the stiffness of the implant.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Seok-Young Hwang
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
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Abstract
Femoral neck fractures in young patients are uncommon but are often associated with surgical challenges and complications. The quality of reduction, more than time to surgery, has the most impact on optimizing outcomes and function. There is no consensus in the best fixation construct for these fractures. Neck shortening and varus collapse are the most common challenges of current fixation options. Use of newer implants is being reported with cautious optimism, and further studies are needed. LEVEL OF EVIDENCE:: Therapeutic Level V.
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Hoskins W, Rayner J, Sheehy R, Claireaux H, Bingham R, Santos R, Bucknill A, Griffin XL. The effect of patient, fracture and surgery on outcomes of high energy neck of femur fractures in patients aged 15-50. Hip Int 2019; 29:77-82. [PMID: 29734844 DOI: 10.1177/1120700018761154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: High-energy femoral neck fractures in young patients can be devastating, with the risk of osteonecrosis, nonunion, malunion and lifelong morbidity. The aim of this study is to define the effects of patient, fracture and surgical factors on the outcome of high-energy femoral neck fractures in patients aged from 15 to 50 years. METHODS: A retrospective review was conducted of high-energy femoral neck fractures in patients aged 15-50 managed surgically at a Level 1 Trauma Centre, using a prospectively recorded trauma database. Low energy trauma (including falls from <1 m), medical conditions adversely affecting bone density, and pathological fractures were excluded. A clinical and radiological review was performed. The primary outcome measures were the development of osteonecrosis or nonunion leading to total hip arthroplasty (THA). Secondary outcome measures included osteotomy or other surgical procedures, quality of reduction and malunion. RESULTS: 32 patients meeting the inclusion criteria were identified between January 2008 and July 2015. The mean follow-up was 58.5 months (range 980-3,048 days). 3 patients (9.4%) required THA. No other surgical procedures were performed. None of the 29 other patients developed radiologically apparent osteonecrosis. Fracture type, displacement, anatomical reduction and fixation type were not statistically significant risk factors affecting these outcomes. For all patients, an average of 8% loss of femoral neck height and 10% femoral neck offset were seen. CONCLUSIONS: At a mean 4.9-year follow-up, the incidence of high-energy femoral neck fractures leading to THA was 9.4%, as a consequence of osteonecrosis or nonunion. Malunion was common.
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Affiliation(s)
- Wayne Hoskins
- 1 Traumaplasty Melbourne, East Melbourne, Victoria, Australia.,2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Johnny Rayner
- 3 Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rohan Sheehy
- 3 Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Harry Claireaux
- 4 Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK.,5 John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford, UK
| | - Roger Bingham
- 1 Traumaplasty Melbourne, East Melbourne, Victoria, Australia.,3 Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Roselyn Santos
- 6 Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrew Bucknill
- 3 Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Xavier L Griffin
- 4 Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK.,5 John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford, UK
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Optimum Configuration of Cannulated Compression Screws for the Fixation of Unstable Femoral Neck Fractures: Finite Element Analysis Evaluation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1271762. [PMID: 30627534 PMCID: PMC6304632 DOI: 10.1155/2018/1271762] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/16/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Objectives In the present study, we evaluated the mechanical outcome of different configurations of cannulated compression screws for the fixation of Pauwels type III femoral neck fracture and the stress distribution around the holes corresponding to fixation protocol after screws removal. Methods The Pauwels type III of femoral neck fracture was created in 3-matic software and the models of cannulated compression screws were constructed using UG-NX software. Five fixation systems were assembled to the fracture models. Abaqus software was used to perform the process of finite element analysis. Values of stress distribution, maximum stress, model principal strains of proximal fragment, and stress distribution around the holes of femur model were recorded. Results Stress of cannulated compression screws was intensely focused on the middle area of the screw near the fragment of each group. Inverted triangle model showed the highest peak stress on screws under different phases of load. Each screw dispersed some stresses, but at least one underwent the peak stress. Fracture model fixed by inverted triangle configuration showed the lowest volume of yielding strain in the proximal fragment. The area of higher stress around the holes was largest after triangle screws removal when compared with other four models. Conclusions Our study indicated that different cannulated compression screws fixation configurations for the unstable femoral neck fractures showed the different mechanical efficiency. Inverted triangular configuration showed the mechanical advantage and being less likely to cutout. The fixation strategy of triangle configuration was least recommended if patients tended to remove the implants.
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Babcock S, Kellam JF. Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients. Adv Orthop 2018; 2018:1912762. [PMID: 30595922 PMCID: PMC6286768 DOI: 10.1155/2018/1912762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022] Open
Abstract
In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity and mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk of nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be completed for all patients suspected of nonunion. Failed internal fixation of intracapsular hip fractures is typically treated with arthroplasty, while extracapsular proximal femur nonunions may be amenable to revision internal fixation or arthroplasty. While not a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and are historically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunion given the altered biologic environment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation. Having a thorough understanding of nonunion risks, recognition, evaluation, and treatment is necessary for appropriate patient care.
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Affiliation(s)
- Sharon Babcock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - James F. Kellam
- Department of Orthopaedic Surgery, UT Health Science Center at Houston, Houston, TX, USA
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Wang Z, Yin Y, Li Q, Sun G, Peng X, Yin H, Ye Y. Comparison of early complications between the use of a cannulated screw locking plate and multiple cancellous screws in the treatment of displaced intracapsular hip fractures in young adults: a randomized controlled clinical trial. J Orthop Surg Res 2018; 13:201. [PMID: 30103792 PMCID: PMC6090639 DOI: 10.1186/s13018-018-0901-3] [Citation(s) in RCA: 14] [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: 03/20/2018] [Accepted: 07/30/2018] [Indexed: 11/19/2022] Open
Abstract
Background The incidence of early postoperative complications of displaced intracapsular hip fractures is high. The purpose of this study was to compare the early postoperative complications and assess the incidence of femoral neck shortening on using a newly designed proximal femoral cannulated screw locking plate (CSLP) versus multiple cancellous screws (MCS) in the treatment of displaced intracapsular hip fractures in young adults. Methods Sixty-eight young adult patients with displaced intracapsular hip fractures were randomly assigned to either the CSLP group or the MCS group and treated routinely by internal fixation with either the CSLP or the MCS. Harris Hip Score, nonunion, failure of fixation, overall complications, and femoral neck shortening were recorded and compared. Results Two patients (5.88%) in the CSLP group and eight (23.53%) in the MCS group had postoperative nonunion (P < 0.05). There was one case (2.94%) of fixation failure in the CSLP group and three cases (8.82%) in the MCS group (P > 0.05). Three patients (8.82%) in the CSLP group and 11 (32.35%) in the MCS group had overall complications (P < 0.05). Mean femoral neck shortening was 5.10 mm in the vertical plane and 5.11 mm in the horizontal plane in the CSLP group and 11.14 mm in the vertical plane and 10.51 mm in the horizontal plane in the MCS group. Severe femoral neck shortening (≥ 10 mm) did not occur in either the vertical or the horizontal plane in any patient of the CSLP group but occurred in 10 patients (28.57%) in the vertical plane and in 8 (22.86%) patients in the horizontal plane in the MCS group. Conclusions Compared with MCS, the use of CSLP in the treatment of displaced intracapsular hip fractures in young adults can reduce the rates of postoperative nonunion and overall complications and minimize femoral neck shortening. Trial registration ChiCTR1800016032. Registered 8 May 2018. Retrospectively registered.
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Affiliation(s)
- Zhiqiang Wang
- Department of Orthopaedics Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Yi Yin
- Department of Orthopaedics Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Qingshan Li
- Department of Orthopaedics Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Guanjun Sun
- Department of Orthopaedics Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Xu Peng
- Department of Orthopaedics Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Hua Yin
- Department of Orthopaedics Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Yongjie Ye
- Department of Orthopaedics Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China.
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Li G, Jin D, Shao X, Liu Z, Duan J, Akileh R, Cao S, Liu T. Effect of cannulated screws with deep circumflex iliac artery-bone grafting in the treatment of femoral neck fracture in young adults. Injury 2018; 49:1587-1593. [PMID: 29929779 DOI: 10.1016/j.injury.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Surgical treatment of femoral neck fracture in young adults is clinically challenging due to the high incidence of avascular necrosis of femoral head and fracture nonunion. The objective of this study is to evaluate the effectiveness of cannulated screws with deep circumflex iliac artery bone grafting (DCIABG) by comparing to the routinely used method in the treatment of femoral neck fracture in young adults. METHODS From March 2006 to December 2012, a total of 185 patients with femoral neck fracture were admitted to the hospital for internal fixation surgery, 103 patients (61 males and 42 females, mean age of 39.1 years) were treated with three cannulated screws with DCIABG (group A), and 82 patients (49 males and 33 females, mean age of 35.5 years) were treated with three cannulated screws without DCIABG (group B). RESULTS All patients were followed up for at least 24 months after the surgery. The patients in group A had a significantly higher Harris Hip Score (p < 0.001), shorter fracture healing time (p < 0.001), lower occurrence rate of avascular necrosis of femoral head (p = 0.008) and fracture nonunion (p = 0.012) compared to the patients in group B. However, the operation time and intraoperative blood loss were significantly lower in patients in group B than those in group A (p < 0.001). CONCLUSIONS Cannulated screws with DCIABG significantly reduced femoral head osteonecrosis and fracture nonunion. Therefore, it is a feasible and effective method in the treatment of young adult patients with femoral neck fracture.
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Affiliation(s)
- Guanghui Li
- Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, 510630, China; Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Dadi Jin
- Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, 510630, China.
| | - Xianfang Shao
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Zhijun Liu
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Jianhui Duan
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Raji Akileh
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, 24901, United States
| | - Shousong Cao
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Tuoen Liu
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, 24901, United States.
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Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation? Clin Orthop Relat Res 2018; 476:1468-1476. [PMID: 29698292 PMCID: PMC6437565 DOI: 10.1097/01.blo.0000533627.07650.bb] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A well-reduced femoral neck fracture is more likely to heal than a poorly reduced one, and increasing the quality of the surgical exposure makes it easier to achieve anatomic fracture reduction. Two open approaches are in common use for femoral neck fractures, the modified Smith-Petersen and Watson-Jones; however, to our knowledge, the quality of exposure of the femoral neck exposure provided by each approach has not been investigated. QUESTIONS/PURPOSES (1) What is the respective area of exposed femoral neck afforded by the Watson-Jones and modified Smith-Petersen approaches? (2) Is there a difference in the ability to visualize and/or palpate important anatomic landmarks provided by the Watson-Jones and modified Smith-Petersen approaches? METHODS Ten fresh-frozen human pelvi underwent both modified Smith-Petersen (utilizing the caudal extent of the standard Smith-Petersen interval distal to the anterosuperior iliac spine and parallel to the palpable interval between the tensor fascia lata and the sartorius) and Watson-Jones approaches. Dissections were performed by three fellowship-trained orthopaedic traumatologists with extensive experience in both approaches. Exposure (in cm) was quantified with calibrated digital photographs and specialized software. Modified Smith-Petersen approaches were analyzed before and after rectus femoris tenotomy. The ability to visualize and palpate seven clinically relevant anatomic structures (the labrum, femoral head, subcapital femoral neck, basicervical femoral neck, greater trochanter, lesser trochanter, and medial femoral neck) was also recorded. The quantified area of the exposed proximal femur was utilized to compare which approach afforded the largest field of view of the femoral neck and articular surface for assessment of femoral neck fracture and associated femoral head injury. The ability to visualize and palpate surrounding structures was assessed so that we could better understand which approach afforded the ability to assess structures that are relevant to femoral neck fracture reduction and fixation. RESULTS After controlling for age, body mass index, height, and sex, we found the modified Smith-Petersen approach provided a mean of 2.36 cm (95% confidence interval [CI], 0.45-4.28 cm; p = 0.015) additional exposure without rectus femoris tenotomy (p = 0.015) and 3.33 cm (95% CI, 1.42-5.24 cm; p = 0.001) additional exposure with a tenotomy compared with the Watson-Jones approach. The labrum, femoral head, subcapital femoral neck, basicervical femoral neck, and greater trochanter were reliably visible and palpable in both approaches. The lesser trochanter was palpable in all of the modified Smith-Petersen and none of the Watson-Jones approaches (p < 0.001). All modified Smith-Petersen approaches (10 of 10) provided visualization and palpation of the medial femoral neck, whereas visualization of the medial femoral neck was only possible in one of 10 Watson-Jones approaches (p < 0.001) and palpation was possible in eight of 10 Watson-Jones versus all 10 modified Smith-Petersen approaches (p = 0.470). CONCLUSIONS In the hands of surgeons experienced with both surgical approaches to the femoral neck, the modified Smith-Petersen approach, with or without rectus femoris tenotomy, provides superior exposure of the femoral neck and articular surface as well as visualization and palpation of clinically relevant proximal femoral anatomic landmarks compared with the Watson-Jones approach. CLINICAL RELEVANCE Open reduction and internal fixation of a femoral neck fracture is typically performed in a young patient (< 60 years old) with the objective of obtaining anatomic reduction that would not be possible by closed manipulation, thus enhancing healing potential. In the hands of surgeons experienced in both approaches, the modified Smith-Petersen approach offers improved direct access for reduction and fixation. Higher quality reductions and fixation are expected to translate to improved healing potential and outcomes. Although our experimental results are promising, further clinical studies are needed to verify if this larger exposure area imparts increased quality of reduction, healing, and improved outcomes compared with other approaches. The learning curve for the exposure is unclear, but the approach has broad applications and is frequently used in other subspecialties such as for direct anterior THA and pediatric septic hip drainage. Surgeons treating femoral neck fractures with open reduction and fixation should familiarize themselves with the modified Smith-Petersen approach.
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Gumustas S, Tosun HB, Isyar M, Serbest S, Oznam K, Bulut G. Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study. Pan Afr Med J 2018; 30:112. [PMID: 30364439 PMCID: PMC6195237 DOI: 10.11604/pamj.2018.30.112.13643] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 05/25/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction Femur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method. Methods Files of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by Ficat-Arlet classification system whereas acetabular fractures and hip functionality was evaluated by Letournel and Judet system, which is based on direct graph of fracture line. Results Mean age at the time of surgery for 31 cases included in the study was 40.04 ± 9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to Judet System, 67.7% of cases showed excellent/good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P>0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications. Conclusion Because of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.
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Affiliation(s)
- Seyitali Gumustas
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Haci Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Isyar
- Medicalpark Bahcelievler, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Kadir Oznam
- Istanbul Medipol University School of Medicine, Department of Orthopaedic and traumatology, 34214, Istanbul, Turkey
| | - Güven Bulut
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review. Hip Int 2018; 28:18-28. [PMID: 28665454 DOI: 10.5301/hipint.5000532] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Although the preferred treatment for displaced femoral neck fractures in the elderly is hip arthroplasty, the treatment for impacted or undisplaced femoral neck fractures (UFNF) is still a subject of controversy. Our purpose was to systematically review studies of elderly patients with UFNF treated with internal fixation using screws: (i) what is the reported mortality; (ii) what is the reoperation rate; (iii) what are the clinical and radiological outcomes; and (iv) what is the methodological quality of the included studies? METHODS This systematic review was performed through a search of PubMed and the Cochrane database using a structured search algorithm including studies enrolling patients older than 60 years old, with UFNF treated with internal fixation using screws. Our literature search returned 950 studies and 11 were selected for final abstraction. RESULTS 6 studies reported mortality rate. At 1-year follow-up mortality was reported by 3 studies: 18.8%; 22%, and 19%. At 5 years, 1 study reported mortality rate of 42%. Overall reoperation rate was reported by 9 studies and ranged from 8%-19%, while conversion to hip arthroplasty was performed in the range between 8% and 16% according to 6 studies. CONCLUSIONS Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.
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Affiliation(s)
- Mohit Bhandari
- From the Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada (M.B.); and the Department of Orthopedic Surgery, University of Minnesota, Minneapolis (M.S.)
| | - Marc Swiontkowski
- From the Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada (M.B.); and the Department of Orthopedic Surgery, University of Minnesota, Minneapolis (M.S.)
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Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 2017; 389:1519-1527. [PMID: 28262269 PMCID: PMC5597430 DOI: 10.1016/s0140-6736(17)30066-1] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. METHODS For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. FINDINGS Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63-1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06-3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). INTERPRETATION In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. FUNDING National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.
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Samy AM. The role of platelet rich plasma in management of fracture neck femur: new insights. INTERNATIONAL ORTHOPAEDICS 2015; 40:1019-24. [PMID: 26156712 DOI: 10.1007/s00264-015-2844-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/31/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study is evaluation of the efficacy of the use of platelet rich plasma (PRP) in management of femoral neck fractures. MATERIALS AND METHODS This is a prospective study that was conducted between February 2010 and March 2013. A total of 60 patients were included in this study, categorized randomly into two groups. Group A included fracture neck femur treated by closed reduction and internal fixation with three cannulated screws and group B by addition of PRP to internal fixation. We planned to compare time of healing, need for revision and incidence of complications between the two groups. RESULTS Union occurred in 53 patients (88.33 %) in both groups, 25 cases (83.3 %) in group A and 28 cases (93.3 %) in group B, including three cases (5 %) with avascular necrosis (AVN): two in group A (6.7 %) and one case in group B (3.3 %).Revision surgery was done for six cases (20 %) in group A and for two cases (6.7 %) in group B. In both groups, all united cases had good to excellent clinical outcome as regards Harris hip score (HHS) at the end of the follow up. CONCLUSION Despite advances in surgical techniques and medical care, the risk of nonunion and avascular necrosis (AVN) after treatment of femoral neck fractures have not been changed appreciably in the last 50 years. Results of this study generally showed that both the median clinical and radiographic healing time were lower in group B compared to group A.
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Affiliation(s)
- Ahmed Mohamed Samy
- Orthopaedic Department, Tanta University, Elnady St., Kasr Elnady A, Tanta, Egypt.
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A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. INTERNATIONAL ORTHOPAEDICS 2015; 39:2069-71. [PMID: 26152248 DOI: 10.1007/s00264-015-2881-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE In younger adults with fractures of the femoral neck, anatomic reduction is compulsory and maintaining the reduction is crucial. Both cannulated screws and dynamic hip screw (DHS) have the capacity of compression in the fracture site but the strength for keeping reduction is not the same. The aim of this study was to compare the results with fixations of the femoral neck fractures with cannulated screws versus dynamic hip screw. METHODS This is a randomized clinical trial study on 58 cases with a minimum of one year follow-up. Leg length discrepancy, Harris Hip Score, infection, avascular necrosis of femoral head, and union of the fracture site were evaluated. RESULTS There were two failures in the first trimester in the cannulated screw group and three more failures in the second and third trimesters in this group. In the DHS group, there was no reduction and fixation failure in the follow-up period. There was no fixation failure (0 %) in Group B (DHS) but there were five fixation failures (18 %) in Group A (screw), and there is significant difference between the groups (p < 0.001). The rate of avascular necrosis was the same in both groups. CONCLUSIONS It seems to us that in our practice the fixation of femoral neck fracture in young adults with the DHS is a better option compared with the osteosynthsis with multiple cannulated screws.
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Ghayoumi P, Kandemir U, Morshed S. Evidence based update: open versus closed reduction. Injury 2015; 46:467-73. [PMID: 25554424 DOI: 10.1016/j.injury.2014.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/06/2014] [Indexed: 02/02/2023]
Abstract
Outcomes after operative treatment of displaced femoral neck fractures in young adults are fraught with high complications rates including non-union and avascular necrosis. Among the therapeutic controversies that persist is the role of open reduction, which would allow surgeons a direct means to improve the quality of reduction, a predictor of successful treatment. We performed a systematic review of the literature to compare the outcomes (nonunion, avascular necrosis, and deep infection) after open reduction with internal fixation (ORIF) to closed reduction with internal fixation (CRIF) of acute (surgery performed less than 6 weeks from injury) femoral neck fractures in young adults (average age of 50 or younger) followed for at least one year. Despite the large literature investigating outcomes after operative treatment of femoral neck fracture, relatively few studies aimed to determine the relative risk of complications associated with method of reduction. Therefore, both observational and randomised studies as well as case series with clear descriptions of surgical approach and outcomes were included. We identified 21 studies that matched our inclusion criteria. The incidence of nonunion was 11.6% in closed reduction and 14.9% in the open reduction group (P=0.25). The incidence of avascular necrosis for CRIF and ORIF were 17.2% and 17.7% respectively (P=0.91). The incidence of deep wound infection was 0.49% in the closed reduction group and 3.9% in the open reduction group (P=0.0019). Meta-analysis of risk ratios estimated from six of the studies with comparative data revealed no significant difference in the incidence of nonunion, avascular necrosis or total complications between the two reduction techniques. In summary, systematic review of the literature reveals a lack of evidence in support of ORIF versus CRIF as a means of treating displaced femoral neck fractures in young patients with respect to union and avascular necrosis; however, the incidence of surgical site infections may be lower with CRIF. Firm conclusions cannot be drawn given the lack of high quality prospective studies and patient reported outcomes. In the future, randomised controlled trials will be required to test the effect of reduction method.
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Affiliation(s)
- Pouriya Ghayoumi
- University of California, San Francisco School of Medicine, United States.
| | - Utku Kandemir
- University of California, San Francisco, Orthopaedic Trauma Institute at San Francisco General Hospital, United States.
| | - Saam Morshed
- University of California, San Francisco, Orthopaedic Trauma Institute at San Francisco General Hospital, United States.
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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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Li M, Cole PA. Anatomical considerations in adult femoral neck fractures: how anatomy influences the treatment issues? Injury 2015; 46:453-8. [PMID: 25549821 DOI: 10.1016/j.injury.2014.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
Femoral neck fractures in physiologically young adults are relatively uncommon. The reported incidence of avascular necrosis and nonunion rates remain relatively high despite the advancement in understanding and surgical management. Understanding the normal femoral neck anatomy and its relationship to presenting fracture pathology in young adults could help to lessen reported high complication rates to provide better clinical outcomes.
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Affiliation(s)
- Mengnai Li
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St Paul, MN 55101, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter A Cole
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St Paul, MN 55101, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
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Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures. Knee Surg Sports Traumatol Arthrosc 2014; 22:793-800. [PMID: 24488220 DOI: 10.1007/s00167-014-2835-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (≥ 50 years) who have undergone internal fixation for femoral neck fracture. METHODS A total of 187 frog-leg lateral radiographs of elderly patients who underwent internal fixation for a femoral neck fracture were reviewed by two independent reviewers. The alpha angle, beta angle, and femoral head-neck offset ratio were calculated. The presence of two abnormal radiographic parameters was deemed to be diagnostic of radiographic CAM-type impingement. RESULTS Radiographic CAM-type FAI was identified in 157 out of 187 (84 %) patients who underwent internal fixation for fractures of the femoral neck. Moderate-to-good inter-observer reliability was achieved in the measurement of radiographic parameters. With reference to fracture subtypes and prevalence of radiographic features of CAM-type morphology, 97 (72 %) out of 134 patients were positive for CAM in Garden subtypes I and II, whereas 49 (85.9 %) out of 57 patients had radiographic CAM in Garden III and IV subtypes. CONCLUSION There was a high prevalence of CAM-type FAI in patients that underwent surgical fixation of femoral neck fractures. This is significantly higher than the reported prevalence in non-fracture patient populations. The high prevalence of CAM morphology could be related to several factors, including age, fracture morphology, quality of reduction, type of fixation, and fracture healing.
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Osteosynthesis of unstable intracapsular femoral neck fracture by dynamic locking plate or screw fixation: early results. J Orthop Trauma 2014; 28:70-6. [PMID: 23860134 DOI: 10.1097/bot.0b013e3182a225fa] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the postoperative radiologic and clinical outcomes of telescopic femur neck screws and small locking plate device (Targon FN) (group 1) with multiple cancellous screws (group 2) for displaced intracapsular femoral neck fractures. DESIGN Comparison of a prospective collected data to a historical control group (retrospective). SETTING One community teaching hospital. PATIENTS Seventy-eight patients (group 1, 31; group 2, 47) underwent reduction and internal fixation of displaced intracapsular femoral neck fractures with either Targon FN device or multiple cancellous screws from March 2000 to July 2010. Their mean age was 53.7 years (SD: 16.4), and the mean follow-up period was 28.6 months. MAIN OUTCOME MEASURES Treatment failure was considered to be either a nonunion, osteonecrosis, or revision surgery of any type. Treatment was regarded as successful in patients who did not show failure and had at least 1-year follow-up. RESULTS One patient in group 1 (3.2%) and 22 (46.8%) in group 2 had a nonunion (P = 0.0001). Four (12.9%) group 1 patients and 16 (34.0%) group 2 patients underwent revision surgery (P = 0.036). Four (12.9%) patients in group 1 and 4 (8.5%) group 2 patients had osteonecrosis of the femoral head (P = 0.531). Multivariate logistic regression showed that internal fixation by the fixed-angle fixation device decreased the odds ratio for overall complication by a factor of 0.23, for example, by 77% (P = 0.018). CONCLUSIONS Performing internal fixation by a fixed-angle fixation device decreased nonunion rates and revision rates. It did not affect the rate of osteonecrosis. LEVEL OF EVIDENCE Therapeutic level III. See instructions for authors for a complete description of levels of evidence.
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Elmi A, Tabrizi A, Rouhani A, Mirzatolouei F. Long-term follow-up results of delayed fixation of femoral neck fractures in adults. Trauma Mon 2013; 18:8-11. [PMID: 24350142 PMCID: PMC3860650 DOI: 10.5812/traumamon.11275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 12/04/2022] Open
Abstract
Background Femoral neck fractures are urgent injuries that require precise reduction and stable fixation. In some cases, however, early treatment is not possible. Objectives The present study aimed to evaluate long-term results of delayed fixation of femoral neck fractures using cannulated screws. Patients and Methods This retrospective descriptive-analytical study was conducted on 26 patients with femoral neck fractures. The patients were treated through a closed reduction and fixation method using cannulated screws. Patients were followed up for at least five years and the rate of complications was determined. Results In this study, 26 patients with mean age of 34.3 years were assessed. Average time interval from injury to surgery was 46.4 ± 12.2 hours; 18 patients (69%) were operated on with more than 36 hours of delay. Incidence of AVN and nonunion was reported in 10 (38.4%) and 3 (11.5%) patients, respectively. Conclusions Time plays an important role in treatment results of femoral neck fractures. To treat the fractures, closed reduction and fixation using cannulated screws may still be the best option.
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Affiliation(s)
- Asghar Elmi
- Department of Orthopedics and Trauma Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Ali Tabrizi
- Department of Orthopedics and Trauma Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding author: Ali Tabrizi, Department of Orthopedics and Trauma Surgery, Orthopedic Surgery Center, Shohada Educational Hospital, Golshahr St., Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel.: +98-9148883851, Fax: +98-4113363846, E-mail:
| | - Alireza Rouhani
- Department of Orthopedics and Trauma Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Fardin Mirzatolouei
- Department of Orthopedic Surgery, Motahari Hospital, Urumieh University of Medical Sciences, Urumieh, IR Iran
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Jameson SS, Lees D, James P, Johnson A, Nachtsheim C, McVie JL, Rangan A, Muller SD, Reed MR. Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data. Injury 2013; 44:1940-4. [PMID: 23618782 DOI: 10.1016/j.injury.2013.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 02/09/2013] [Accepted: 03/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The treatment of choice for intracapsular neck of femur (NOF) fractures in younger, more active patients remains unknown. Some surgeons advocate total hip replacement (THR). AIM This study aimed to compare complications following THR and hemiarthroplasty using the Hospital Episode Statistics (HES) database in England. METHOD Dislocation and revision rates were extracted for all patients with NOF fracture who underwent either cemented hemiarthroplasty or cemented THR between January 2005 and December 2008. To make a 'like for like' comparison all 3866 THR patients were matched to 3866 hemiarthroplasty patients (from a total of 41,343) in terms of age, sex and Charlson score. RESULTS AND CONCLUSION Eighteen-month dislocation was significantly higher in the THR group (2.4% vs. 0.5%, odds ratio (OR) 3.90 (2.99-5.05), p<0.001). This difference was sustained at the 4-year stage (2.9% vs. 0.9%, OR 3.18 (1.58-6.94), p=0.001) in a subset of patients with longer follow-up. There was no significant difference in revision rate up to 4 years (1.8% vs. 2.1%, OR 0.85 (0.46-1.55), p=0.666). In this national analysis of matched patients short- and medium-term dislocation rates following THR were significantly higher than following cemented hemiarthroplasty, without any difference in revision rates at 4 years. The low risk of dislocation may be acceptable in order to experience the apparent functional benefits of THR.
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Affiliation(s)
- Simon S Jameson
- National Orthopaedic Research and Surgical Outcomes Collaboration, UK; Northern Deanery Trauma & Orthopaedic Training Scheme, Waterfront 4, Goldcrest Way, Newcastle NE15 8NY, UK.
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Hawks MA, Kim H, Strauss JE, Oliphant BW, Golden RD, Hsieh AH, Nascone JW, O'Toole RV. Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures? A biomechanical analysis in cadaveric bone. Clin Biomech (Bristol, Avon) 2013; 28:886-91. [PMID: 24050951 DOI: 10.1016/j.clinbiomech.2013.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND We assessed the biomechanical performances of a trochanteric lag screw construct and a traditional inverted triangle construct in the treatment of simulated Pauwels type 3 femoral neck fractures. METHODS An inverted triangle construct (three 7.3-mm cannulated screws placed in inverted triangle orientation) and a trochanteric lag screw construct (two 7.3-mm cannulated screws placed across the superior portion of the femoral neck and one 4.5-mm lag screw placed perpendicular to the fracture in superolateral to inferomedial orientation) were tested in nine matched pairs of non-osteoporotic human cadaveric femora. We used a previously described vertically oriented femoral neck fracture model and testing protocol that incrementally loaded the constructs along the mechanical axis of the femur to 1400 N. Specimens that survived incremental loading underwent cyclic loading. Apparent construct stiffness, force at 3mm of displacement, and survival of incremental loading were recorded. FINDINGS The trochanteric lag screw group had a 70% increase in stiffness (261 N/mm [29 standard deviation] versus 153 N/mm [16 standard deviation]; P=0.026) and a 43% increase in force required for displacement (620 N versus 435 N; P=0.018) compared with the inverted triangle group. One trochanteric lag screw and no inverted triangle specimen survived incremental loading. INTERPRETATION A trochanteric lag screw construct applied to vertically oriented femoral neck fractures provides marked improvement in mechanical performance compared with the inverted triangle construct.
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Affiliation(s)
- Michael A Hawks
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Li Z, Chen W, Su Y, Zhang Q, Hou Z, Pan J, Zhang Y. The application of closed reduction internal fixation and iliac bone block grafting in the treatment of acute displaced femoral neck fractures. PLoS One 2013; 8:e75479. [PMID: 24040414 PMCID: PMC3769404 DOI: 10.1371/journal.pone.0075479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 08/19/2013] [Indexed: 01/29/2023] Open
Abstract
Objective This study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF) with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting. Methods From December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females) with a mean age of 44.8 years (range, 20-64 years). There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females) with a mean age of 46.3 years (range, 23-64 years). There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting. Results In study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months). All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100). In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months). The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68) and 16.2% (11/68), respectively, significantly higher than those in study group (both P<0.05). The mean Harris score in control group was 83.8 (41–100), significantly lower than that in study group (P<0.05). Conclusion Acute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.
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Affiliation(s)
- Zhiyong Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Yanling Su
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Qi Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Jinshe Pan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
- * E-mail:
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Makki D, Mohamed AM, Gadiyar R, Patterson M. Addition of an anti-rotation screw to the dynamic hip screw for femoral neck fractures. Orthopedics 2013; 36:e865-8. [PMID: 23823042 DOI: 10.3928/01477447-20130624-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors investigated the use of an anti-rotation screw with the dynamic hip screw (DHS) during internal fixation of Garden I and II femoral neck fractures. Sixty-five patients with Garden I and II femoral neck fractures (mean age, 70 years) were treated with internal fixation at the authors' institution. In 31 patients, a 2-hole DHS was used alone (group 1), and in 34 patients, the DHS was combined with an anti-rotation screw placed in the cranial part of femoral head and neck (group 2). Patients' preinjury function and mental level were assessed using the Barthel index and the Abbreviated Mental test, respectively. The outcome measures included cost implications, operative time, and intraoperative radiation dose. The modified Harris Hip Score and a radiological assessment were performed at a mean of 11 months (range, 8-24 months) postoperatively. The use of the anti-rotation screw was associated with a longer operative time (mean, 44.54 minutes in group 1 vs 51.52 minutes in group 2; P<.0001) and more fluoroscopy screening (mean dose area product, 28.39 cGy/cm(2) in group 1 vs 44.33 cGy/cm(2) in group 2; P=.03). The additional cost of using an anti-rotation screw was £106 ($170) per case. No difference existed between the 2 groups with regard to radiological union, onset of avascular necrosis, and rate of revision surgeries. An anti-rotation screw, used with the dynamic hip screw, involves extra costs, prolongs operative time, and requires more intraoperative fluoroscopy screening but offers no advantages with regard to fracture union.
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Affiliation(s)
- Daoud Makki
- Department of Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton and University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, United Kingdom.
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Gadegone WM, Ramteke AA, Lokhande V, Salphade Y. Valgus intertrochanteric osteotomy and fibular strut graft in the management of neglected femoral neck fracture. Injury 2013; 44:763-8. [PMID: 23063702 DOI: 10.1016/j.injury.2012.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 09/07/2012] [Accepted: 09/19/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE A prospective study of neglected femoral neck fractures in mostly young patients was conducted to evaluate whether our technique of valgus intertrochanteric osteotomy with fibular strut grafting and osteosynthesis with dynamic hip screw and double-angle side plate can facilitate union with consistent satisfactory clinical outcomes. METHODS Forty-one consecutive patients (27 males, 14 females) of neglected femoral neck fractures treated between April 2002 and December 2009 were studied. The average age of patients was 45.41 years (±11.67, range 20-62 years). The average interval since injury was 14 weeks (±10.21, range 4-44 weeks). The cases were evaluated radiographically and clinically. RESULTS The average follow-up period was 32.5 months (±8, range 24-54 months). Radiographically union was seen in 39 patients at the nonunion site. The average time to radiographic union was 16.82 weeks (±3 weeks, range 12-24 weeks). Average Harris Hip Score (HHS) was 19.9 (±7.9, range 10-35) preoperatively and 90.9 (±10.35, range 62-100) at the latest follow-up. At that time clinical outcomes were excellent in 31, good in four, fair in three and poor in three patients. CONCLUSION Our mechanobiological surgical technique is reproducible with radiographic union achieved in 95.12% cases (39 patients) at the nonunion site and consistent excellent or good functional outcome in 85% of patients over a 32-month average follow-up. We recommend this procedure for neglected femoral neck fractures.
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Affiliation(s)
- Wasudeo M Gadegone
- Department of Orthopaedics & Traumatology, Chandrapur Multispeciality Hospital, Mul Road, Chandrapur, India.
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Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, Lian YT. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am 2013; 95:61-9. [PMID: 23283374 DOI: 10.2106/jbjs.k.01081] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intracapsular femoral neck fractures are associated with high rates of nonunion. We aimed to identify risk factors for nonunion in patients with both displaced and nondisplaced intracapsular femoral neck fractures treated with three 7-mm parallel cannulated screws, placed in either a triangle or an inverted triangle configuration, using failure of fixation as the primary outcome. METHODS Clinical and radiographic data for patients with intracapsular femoral neck fractures treated with either triangle fixation (one proximal screw and two distal screws) or inverted triangle fixation (two proximal screws and one distal screw), between January 1, 2000, and July 30, 2009, were analyzed. RESULTS A total of 202 patients, seventy-six men and 126 women with an average age (and standard deviation) of 64.53 ± 15.81 years (range, nineteen to ninety-three years), were included in the analysis. Union occurred in 158 patients, and nonunion occurred in forty-four. There were no differences between the union and nonunion groups with respect to age, sex, fracture side, fracture angle, fracture level, or estimated bone density. There were significant differences in fracture type, fixation configuration, reduction quality, and screw-tip subchondral purchase between patients with and without union. The estimated odds ratio for fracture nonunion was 2.93 (95% confidence interval [CI], 1.08, 7.96) in subjects with displaced fractures compared with those without displaced fractures (p = 0.035), 18.92 (95% CI, 1.91, 187.09) in subjects with borderline and unacceptable reduction compared with those with anatomic reduction (p = 0.012), and 2.92 (95% CI, 1.27, 6.69) for internal fixation with a triangle configuration compared with fixation with an inverted triangle configuration (p = 0.010). CONCLUSIONS Screw fixation with a triangle configuration, a displaced fracture, and poor reduction are risk factors for nonunion in intracapsular femoral neck fractures treated with fixation with multiple screws.
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Affiliation(s)
- Jui-Jung Yang
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Abstract
OBJECTIVE To evaluate the outcomes of displaced intracapsular femoral neck fractures treated with a cephalomedullary device. DESIGN Retrospective study. SETTING Level I trauma center. PATIENTS Between 2002 and 2008, 18 patients with displaced intracapsular femoral neck fractures were treated at our Level I trauma center with a cephalomedullary nail. There were 12 males and six females. Six patients were younger than 60 years of age with a mean age of 63 years (range, 40-88 years). Thirteen fractures were midcervical (Orthopaedic Trauma Association [OTA] 31-B2.2 and B2.3), and five fractures were subcapital (OTA 31-B3). Patients with basicervical fractures (OTA 31-B2.1) and nondisplaced subcapital fractures (OTA 31-B1) were excluded. INTERVENTION All patients underwent cephalomedullary nail fixation of their femoral neck fractures under the supervision of fellowship-trained orthopaedic trauma surgeons. MAIN OUTCOME MEASUREMENTS Postoperative radiographs were evaluated for fracture reduction quality. Clinical follow-up was available on 13 patients with a minimum of 12 months (range, 12-25 months). A radiographic and chart review was done to identify complications and outcomes. RESULTS Seven of eight fractures that healed were anatomically reduced. No failures occurred in the six patients younger than 60 years. Fixation failed in five of 13 fractures (38.4%) with varus collapse as the typical failure mode. The mean time to failure in these cases was 3.8 months (range, 1-7 months). Overall, the failure rate for the subcapital fractures was 100% (three of three) and for midcervical 20% (two of 10) with all failures being in patients older than 60 years (71.4%). Osteonecrosis without fixation failure or cutout occurred in one case. CONCLUSION Cephalomedullary nail fixation of displaced intracapsular femoral neck fractures demonstrated mixed results. For younger patients with midcervical fractures that were well reduced, the fixation performed well. Displaced subcapital fractures in patients older than 60 years demonstrated a 100% failure rate. As a result, we cannot advocate cephalomedullary fixation for displaced intracapsular femoral neck fractures in patients older than 60 years, although in younger patients, these implants may provide an alternative to side-plate based fixation devices.
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Flóris I, Cserháti P, Baktai J, Gál T, Gloviczki B, Vendégh Z. Treatment of the displaced femoral neck fractures: indications and limits of osteosynthesis. Eur J Trauma Emerg Surg 2011; 37:277-85. [PMID: 26815110 DOI: 10.1007/s00068-011-0107-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Opinions about the optimal treatment of displaced femoral neck fractures in the elderly are still divided. The two main options are internal fixation and arthroplasty. The aim of our study was to determine the most adequate surgical procedure for displaced, Garden type III-IV femoral neck fractures: which patients should undergo an osteosynthesis or primary arthroplasty, with the least prospect of complications? METHODS We analyzed 489 femoral neck fractures treated by percutaneous osteosynthesis. We also compared the results of displaced fractures treated with primary arthroplasty versus secondary arthroplasty performed due to the failure of primary osteosynthesis. RESULTS The rate of redisplacement in the Garden type III group was 7.6%, and in the Garden type IV group, it was 25.5%, mainly in the case of subcapital fractures. Also, walking ability was examined 4 months after injury. In the ASA score II-III group, most of the patients were able to walk with or without walking aids, but in the case of ASA score IV, most of them were immobile or died during the hospital or posthospital phase. Our research also proved that, in cases of femoral neck fractures treated with primary arthroplasty, the complication rate is lower than after secondary arthroplasty due to failure of the primary osteosynthesis. CONCLUSIONS Based on our results, we recommend osteosynthesis in the case of Garden type III femoral neck fractures and, in turn, arthroplasty with respect to the high rate of early redisplacement in the case of Garden type IV fractures, especially in the case of subcapital fractures. For patients confined to a bed and in poor general condition (ASA score IV), the first choice treatment option is the minimally invasive percutaneous osteosynthesis.
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Affiliation(s)
- I Flóris
- Péterfy Sándor Hospital, Trauma Center, Fiumei út 17, Budapest, 1081, Hungary.
| | - P Cserháti
- Péterfy Sándor Hospital, Trauma Center, Fiumei út 17, Budapest, 1081, Hungary
| | - J Baktai
- Péterfy Sándor Hospital, Trauma Center, Fiumei út 17, Budapest, 1081, Hungary
| | - T Gál
- Péterfy Sándor Hospital, Trauma Center, Fiumei út 17, Budapest, 1081, Hungary
| | - B Gloviczki
- Péterfy Sándor Hospital, Trauma Center, Fiumei út 17, Budapest, 1081, Hungary
| | - Z Vendégh
- Péterfy Sándor Hospital, Trauma Center, Fiumei út 17, Budapest, 1081, Hungary
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Abstract
PURPOSE To assess treatment outcomes in adults with neglected femoral neck fractures, and propose a treatment protocol based on bone quality measured by the Singh index. METHODS 16 men and 6 women aged 18 to 48 (mean, 33) years presented with neglected (>3 weeks old) femoral neck fractures. Those with good bone quality (Singh index, >3) underwent closed reduction and valgus osteotomy and fixation with 120º double angle blade plates (group 1, n=8), whereas those with poor bone quality (Singh index, >3) and/or communition of the posterior femoral neck underwent fibular grafting and internal fixation with one or two 7-mm cannulated cancellous screws (group 2, n=14). Functional outcome was assessed at the 6-month follow-up, according to modified Askin and Bryan criteria. RESULTS The mean delay in surgery was 12 (range, 4-21) weeks. Patients were followed up for a mean of 19 (range, 12-24) months. The mean time to union was 20 (range, 12-52) weeks. The mean time to full weight bearing was 18 (range, 12-40) weeks. All patients achieved bone union except one in group 1 who had non-union and breakage of the blade plate at week 20 and underwent total hip arthroplasty. Other complications included slippage of fibular graft (n=1), delayed union (n=1), avascular necrosis of the femoral head (n=2), limb length discrepancy (n=3), and superficial infection (n=1). Functional outcome was excellent in 2 patients, good in 17, and poor in 3. CONCLUSION Valgus osteotomy and double angle blade plate fixation, and fibular grafting and cancellous screw fixation appeared to be appropriate treatments for neglected femoral neck fractures in adults.
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Affiliation(s)
- Gurvinder Singh Kainth
- Department of Orthopaedics, Maulana Azad Medical College and associated Lok Nayak Hospital, Delhi, India
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