Innovations in the management of hip fractures

A study of femoral neck fracture repair using a recombinant human bone morphogenetic protein-2 directional release system

OBJECTIVE

Significant difficulties are caused by the delayed union of femoral neck fractures. To address this issue, we designed a new device that applies recombinant human bone morphogenetic protein-2 (rhBMP-2) to promote fracture union.

METHODS

A cannulated screw with holes was used to deliver rhBMP-2 to the fracture site. Fibrin glue was used as an adhesive agent to hold rhBMP-2 in the vicinity of fracture. RhBMP-2 was protected with polylactide-glycolide acid microspheres. RhBMP-2 release was evaluated to determine the effect of the improved screws.

RESULT

When polylactide-glycolide acid microspheres were used, 3.65% of the rhBMP-2 was released in the first 2 h, 5.17% was released within 8 h, and 8.95% was released within 24 h. In the microsphere + fibrin glue group, 1.15% of the rhBMP-2 was released in the first 2 h, 1.75% was released within 8 h, and 6.68% was released within 24 h. Over 42 days, about 76.75% of the rhBMP-2 was released when using fibrin glue, which was lower than the amount released using microspheres alone (91.75%). In dog, a faster repair rate was observed on the side with the improved screw than on the side with traditional screw.

CONCLUSION

The directional release system described here can improve the process of fracture healing and is a promising technique for repairing femoral neck fracture.

Primary total hip arthroplasty for displaced intracapsular fracture of the femoral neck: Medium-term functional and radiographic outcomes

The number of complications after primary total hip arthroplasty for displaced intracapsular fractures of the femoral neck is higher than that after operations for osteoarthritis. The aim of this study is to evaluate the number of complications and mid-term functional and radiological findings of patients after primary THA for displaced intracapsular fractures of the femoral neck. Between 1995 and 1998, we operated on a total of 89 patients for acute displaced intracapsular fractures of the femoral neck, i.e. Garden Type 3 and 4. In all the patients we evaluated intraoperative and early postoperative complications. We reviewed clinical and radiological results in 65 patients. The only intraoperative complication was abruption of the greater trochanter. Early postoperative complications occurred in 13 patients (15%). The specific complications, THA dislocation, occurred in 3 patients. Non-specific complications were recorded in 10 patients. No delayed healing of the surgical wound, neural lesion or early, delayed or late infection was recorded. Of 65 patients followed-up for an average of 78 months (range, 62–109 months), 8 patients underwent revision surgery. Of 57 patients with primary THA, very good and good clinical results according to the Harris Hip Score were recorded in 48 patients (84%) and poor results in only 2 patients (4%). Nine of 57 followed-up patients showed radiological signs of loosening (16%). The radiolucent line could be seen in 3 patients in the region of the cup, in 1 patient in the region of the femoral component and in 5 patients in both components. Clinical complaints that would result in indication for reimplantation were recorded in none of the mentioned patients. Number of complications, functional results and resumption of full self-reliance by patients after THA for an intracapsular fracture of the femoral neck are so positive that we consider the indication of THA for a displaced femoral neck fracture fully justified.