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Chan CX, Lim JI, Singh A, Murphy D, Chen Y. Two-year outcomes of internal fixation with femoral neck system in patients with femoral neck fracture in an Asian population. J Orthop 2024; 57:98-103. [PMID: 39006207 PMCID: PMC11245931 DOI: 10.1016/j.jor.2024.06.010] [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: 04/10/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Abstract
Background Femoral neck fractures (FNF) are one of the most common fractures, with a projected increase in incidence with population growth and ageing. The Femoral Neck System (FNS) launched in 2019 was developed specifically for fixation of FNF with the purported advantages of providing both angular and rotational stability. We report our experience with the FNS and evaluate its effectiveness and associated complications. Methods A retrospective case series of 50 patients who underwent surgical fixation for FNF from August 2020 to October 2021 using the FNS in two Singapore tertiary institutions with at least 2 years follow-up were included. Clinical data (patients' demographics, fracture classification, intra-operative and post-operative complications) were reviewed. Radiological analysis assessed the pre- and immediate post-operative garden alignment index (GAI) and presence of femoral neck shortening at 3 months. Results The mean age was 63.5 years (SD 16.9, range 26-92). Five (10 %), 34 (68 %) and 11 (22 %) were ASA 1, 2 and 3 respectively. Twenty-four (48 %), 16 (32 %), 4 (8 %), and 6 (12 %) patients sustained Garden's 1, 2, 3 and 4 FNF respectively. The mean operative duration was 66.2 min (SD 20.5) and length of stay was 6.9 days (SD 4.6).The post-operative improvement in garden alignment index (GAI) was a mean of 9.1° (p < 0.001) on lateral view. The mean femoral neck shortening was 1.97 mm (SD 5.3) at 3 months. There were no intra-operative complications. Post-operatively, 1 (2 %) patient required blood transfusion, 1 (2 %) patient had implant cut-out and non-union managed non-operatively, 2 (4 %) patients developed avascular necrosis and required revision to total hip replacements. There were two (4 %) cases of 1-year mortality. Conclusion The FNS achieved good outcomes with low rates of complications. The promising results justify its continued use and further evaluation in comparison to other devices.
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Affiliation(s)
- Chloe Xiaoyun Chan
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
| | - Joshua Ian Lim
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
| | - Amritpal Singh
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
| | - Diarmuid Murphy
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - Yongsheng Chen
- Department of Orthopaedic Surgery, National University Hospital, National University Health System (NUHS), Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, National University Health System (NUHS), Singapore, 1 Jurong East Street 21, 609606, Singapore
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Genetay T, Gamulin A, Lorimier A, Sans Merce M. Assessment of radiation dose values in common orthopaedic trauma examinations performed under X-ray fluoroscopy guidance. RADIATION PROTECTION DOSIMETRY 2024; 200:1365-1371. [PMID: 39193892 PMCID: PMC11384882 DOI: 10.1093/rpd/ncae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/25/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
This study aims to provide radiation reference levels in orthopaedic surgery. A total of 753 procedures were collected within 1 y. Categories containing several similar procedures were created based on four criteria: same anatomical area, same level of complexity, only single procedures, and at least 10 cases per category. Exposure was defined in terms of air kerma-area product, fluoroscopy time, and air kerma at the patient entrance reference point. For common procedures, median effective doses to patient were calculated using the Monte Carlo Software PCXMC. Most irradiating procedure in this study i.e. intramedullary nailing of the proximal femur was equivalent to an air kerma at the patient entrance reference point of 37.1 mGy, which is ~50 times lower than the threshold for acute deterministic effects of radiation. Optimization remains a must to reduce the dose while maintaining the image quality and reducing the likelihood of stochastic effects.
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Affiliation(s)
- Tristan Genetay
- Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud Lorimier
- Care Management Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Marta Sans Merce
- Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
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Yoon JY, Byun SE, Cho YH. Fixation of femoral neck fracture with femoral neck system: a retrospective cohort study of 43 patients. BMC Musculoskelet Disord 2024; 25:8. [PMID: 38166882 PMCID: PMC10759579 DOI: 10.1186/s12891-023-07113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUNDS This study aimed to analyze the clinical outcomes of femoral neck fractures (FNF) in patients treated with a femoral neck system (FNS, DePuy Synthes), which is a recently introduced device. METHODS This retrospective cohort study of 43 patients who underwent osteosynthesis using FNS for FNF between July 2019 and June 2021 with a minimum follow-up of 6 months. The researchers examined the patients' demographic factors and radiologically evaluated the fracture type and fixation status, bone union, and postoperative complications. RESULTS Of 43 patients, 25 were female, and the patients' mean age and body mass index were 62.1 years and 22.5 kg/m2, respectively. According to the Association of Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, the most common fracture types were 31B1.1 and B1.2 (13 cases each), followed by B2.3, B2.1, and B2.2 (seven, five, and four cases, respectively). Radiological bone union was confirmed in 39 patients (90.7%), and the mean time to union was 3.6 months. Two cases of nonunion, one case of lag screw cut-out, and one case of osteonecrosis were confirmed; all four cases later underwent arthroplasty. The mean time to reoperation was 4.5 months. Meanwhile, five patients underwent implant removal after the bone union, and distal locking screw stripping was noted in three patients. All three patients required metal plate cutting to remove the implants. CONCLUSIONS Osteosynthesis of FNF using the newly introduced FNS showed favorable clinical outcomes and no specific hardware-related complications were reported during the follow-up. However, attention must be paid to the issue regarding distal locking screw failure during hardware removal.
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Affiliation(s)
- Jae Youn Yoon
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
| | - Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Republic of Korea
| | - Young-Ho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, 99, Ayang-ro, Dong-gu, Daegu, Republic of Korea.
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Niemann M, Maleitzke T, Jahn M, Salmoukas K, Braun KF, Graef F, Stöckle U, Meller S. Restoration of Hip Geometry after Femoral Neck Fracture: A Comparison of the Femoral Neck System (FNS) and the Dynamic Hip Screw (DHS). Life (Basel) 2023; 13:2073. [PMID: 37895454 PMCID: PMC10608621 DOI: 10.3390/life13102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The femoral neck system (FNS) was introduced as a minimally invasive fixation device for managing femoral neck fractures. OBJECTIVE To compare radiographic, clinical, and patient-reported outcome measures (PROMs) of femoral neck fracture patients following FNS compared to dynamic hip screw (DHS) implantation combined with an anti-rotational screw. METHODS Patients who underwent closed reduction and internal fixation of a femoral neck fracture between 2020 and 2022 were retrospectively included. We measured leg length, femoral offset, and centrum-collum-diaphyseal (CCD) angle in plain radiographs. Scar length, Harris Hip Score, short-form health survey 36-item score (SF-36), and Numeric Rating Scale (NRS) were assessed during follow-up visits. RESULTS We included 43 patients (22 females) with a median age of 66 (IQR 57, 75). In both groups, leg length differences between the injured and the contralateral side increased, and femoral offset and CCD angle differences were maintained over time. FNS patients had shorter scars and reported fewer emotional problems and more energy. There were no differences between groups regarding the remaining SF-36 sub-scores, Harris Hip Score, and NRS. CONCLUSIONS The FNS allows for a comparable leg length, femoral offset, and CCD angle reconstruction while achieving similarly high functional and global health scores to the DHS.
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Affiliation(s)
- Marcel Niemann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, 13353 Berlin, Germany
| | - Tazio Maleitzke
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, 13353 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Programme, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Markus Jahn
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Katharina Salmoukas
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
- Department of Trauma Surgery and Orthopaedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, 12683 Berlin, Germany
| | - Karl F. Braun
- Department of Trauma Surgery, University Hospital Rechts der Isar, Technical University of Munich, 81675 München, Germany;
| | - Frank Graef
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Ulrich Stöckle
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
| | - Sebastian Meller
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Centre for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (T.M.); (M.J.); (K.S.); (F.G.); (U.S.); (S.M.)
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Survivability of the Femoral Neck System for the treatment of femoral neck fractures in adults. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03474-5. [PMID: 36645494 DOI: 10.1007/s00590-023-03474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Hip fractures are common injuries in the elderly, with an incidence that continues to rise. The femoral neck system (FNS) recently emerged as a novel treatment option for femoral neck fractures, but long-term survivability of the implant remains uncertain. The purpose of this study is to evaluate survivability of the FNS and assess risk factors for implant failure. METHODS One hundred five adult patients who received the FNS (DePuy Synthes, Raynham, MA) for femoral neck fractures (AO/OTA 31B) were included. Surgeries were performed within a regional hospital system comprising 18 facilities. All patients had a minimum follow-up of 1 year. The primary outcome measures were cumulative incidence of implant failure and 1-year mortality, including risk factor analysis. RESULTS Twelve implants failed at a follow-up ranging from 17 days to 8 months, and 7 failed within 90 days. Cumulative incidence of implant failure was 2% at 30 days, 7% at 90 days, 12% at 6 months, and 13% at 1 year. Causes of implant failure included cut-out (n = 5), non-union (n = 4), peri-implant fracture (n = 2), and avascular necrosis (n = 1). Univariate Cox regression identified Pauwels type III fractures and an increasing AP Parker ratio as significant risk factors for failure. Pauwels type III fractures showed a 5.48 times higher risk compared to Pauwels types I & II. Every 10% increase in AP Parker ratio increased risk of failure by 2.39 times. The 1-year mortality rate was 21%, and univariate logistic regression identified age as the only risk factor (odds ratio = 3.71). CONCLUSIONS The incidence of implant failure and 1-year mortality rate in this study suggests that the FNS can provide reliable fixation compared to rates in the literature, but complications are not uncommon. Avoiding Pauwels type III fractures and optimizing implant placement appear crucial to preventing implant failure. LEVEL OF EVIDENCE Therapeutic Level IV.
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Current Management of Hip Fracture. Medicina (B Aires) 2022; 59:medicina59010026. [PMID: 36676650 PMCID: PMC9862304 DOI: 10.3390/medicina59010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
This Special Issue, entitled "Current Management of Hip Fracture", ran in the Medicina journal of MDPI's "Surgery" section, reports the findings of international studies regarding different aspects in the treatment of patients suffering a proximal femur fracture [...].
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Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review. INTERNATIONAL ORTHOPAEDICS 2022; 46:2105-2115. [PMID: 35538322 PMCID: PMC9372123 DOI: 10.1007/s00264-022-05414-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022]
Abstract
Introduction The recently developed femoral neck system (FNS) for treatment of femoral neck fractures (FNF), comprises theoretical biomechanical advantages compared to other implants. The aim of this study was to validate the safety and to report outcomes of patients treated with the FNS. Method A retrospective multicentric analysis of patients treated by FNS with a minimum of three months of follow-up. Details analysed from three medical centres were operative duration, estimated blood loss, initial hospitalisation duration, fixation quality as well as complications and reoperation rate. Patients who had revision surgery were compared to all other patients to identify risk factors for failure. In addition, a literature review was performed to analyse data on FNS clinical implementation and patient’s outcomes. The two data sets were combined and analysed. Results One-hundred and two patients were included in this study cohort with an average follow-up of seven months (range 3–27). Ten papers were included in the literature review, reporting data on 278 patients. Overall, 380 patients were analysed. Average age was 62.6 years, 52% of the fractures were classified as Gardens 1–2. Overall, the revision rate was 9.2% (14 patients diagnosed with cut-out of implant, 10 with AVN, 8 with non-union and 8 with hardware removal). For the 102 patients in the cohort risk factors for reoperation included patients age, surgeon seniority and inadequate placement of the implant. Conclusion This study shows that FNS is a safe treatment option for FNF. Intra-operative parameters and failure rates are comparable to previously reported rates for this implant and other frequently used implants.
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