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Buchinsky JC, Heckert RM. Case Series: Bilateral Operative Femoral Neck Stress Fractures in Marine Corps Recruits. Mil Med 2024:usae407. [PMID: 39172653 DOI: 10.1093/milmed/usae407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/26/2024] [Accepted: 08/08/2024] [Indexed: 08/24/2024] Open
Abstract
Bone stress injuries are well-documented injury patterns among U.S. Armed Forces recruits because of the rapid increase in frequency and intensity of bone-impacting activities throughout training. In the recruit population, femoral neck stress fractures are of great concern because of their propensity to progress, displace, and lead to lifelong complications like avascular necrosis. We present two cases of bilateral operative femoral neck stress fractures. The first is of a 28-year-old male Marine Corps recruit who experienced bilateral groin pain during the first week of training. He was found to have bilateral grade 4 femoral neck stress fractures with concomitant effusions. Operative management was pursued with bilateral percutaneous pinning. For this patient, one hip had classically indicated operative involvement while on the contralateral hip the decision to operate was based on recent literature predicting progression based on the presence of a joint effusion. The second case is of a 23-year-old male Marine Corps recruit who experienced hip pain in the final few weeks of training. He was also found to have bilateral grade 4 femoral neck stress fractures with concomitant effusions and was similarly operated on. To the best of our knowledge, this is the first reported operative bilateral femoral neck stress fracture case series in a military-aged patient in the literature. A high clinical suspicion for femoral neck stress injuries with early diagnostic imaging for high-risk groups was important in these cases and ultimately led to timely definitive management for this patient.
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Affiliation(s)
- Jonathan C Buchinsky
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Reed M Heckert
- Department of Orthopaedic Surgery, Naval Hospital Beaufort, Beaufort, SC 29902, USA
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2
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Uhrenholt L, Bakkegaard JH, Hansen K, Doktor KK. Towards the diagnosis of osteoporosis - contributions from coincidental diagnostic imaging findings in chiropractors' practice. Chiropr Man Therap 2024; 32:24. [PMID: 38915085 PMCID: PMC11194920 DOI: 10.1186/s12998-024-00545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Osteoporosis is significantly associated with fractures and burdens the health of especially older people. Osteoporotic fractures cause pain, disability, and increased mortality. Early diagnosis of osteoporosis allows earlier initiation of treatment, thereby reducing the risk of osteoporotic fractures. Chiropractors encounter potential osteoporotic patients daily, and perform radiological evaluation of these and other patients, including evaluation of X-rays done for other purposes than osteoporosis. Therefore, chiropractors may identify vertebral fractures, vertebral deformity or osteopenia not otherwise suspected or recorded. METHODS This study examines procedures available to the chiropractor to describe conventional X-rays with the focus of osteoporosis related findings. We review the indications for radiological examination in chiropractic practice, and in the realm of osteoporosis we describe radiological methods available for examination of conventional radiographs, and the necessity of inter-disciplinary communication. RESULTS National guidelines are available regarding referral for X-rays in chiropractic practice. Standardized protocols ensure image acquisition of the highest quality in the chiropractors' radiological department. Conventional X-ray examination is not indicated on clinical suspicion of osteoporosis alone, as bone mineral density testing is the diagnostic test. Radiological assessment of all available X-rays of patients above the age of 50 years should include evaluation of the bone quality, and hip and vertebral fracture assessment. The Singh index, Genant Semi-Quantitative tool (GSQ), and Algorithm-Based Qualitative method (ABQ) should be used consistently during interpretation. Referral for additional imaging and evaluation should be prompt and systematic when needed. CONCLUSIONS This article presents an overview of evidence-based radiological procedures for the purpose of promoting early diagnosis of osteoporosis. We present recommendations to the clinicians where we propose an opportunistic evaluation of X-rays, done for any reason, which include systematic evaluation of bone quality, presence of hip and vertebral fractures, and vertebral deformation of all patients above the age of 50 years. Detailed referral to healthcare professionals for further diagnostic evaluation is performed when needed. Consistent, high-quality radiological procedures in chiropractic practices could feasibly contribute to the timely diagnosis of osteoporosis, ultimately minimizing the impact of osteoporosis-related complications on patients' health.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Nortvig & Uhrenholt Kiropraktisk Klinik, Jens Baggesens Vej 88A, 8200, Aarhus N, Denmark.
| | | | - Kasper Hansen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Klaus Knarberg Doktor
- Chiropractic Knowledge Hub, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Rygcenter Midtvest, Dalgas Alle 2, 7400, Herning, Denmark
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3
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Fu WH, Hu ZL, Liao YJ, Chen RJ, Qiu JB, Que WT, Wang WT, Li WH, Lan WB. Relationship between preoperative psychological stress and short-term prognosis in elderly patients with femoral neck fracture. World J Psychiatry 2024; 14:838-847. [PMID: 38984342 PMCID: PMC11230083 DOI: 10.5498/wjp.v14.i6.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Older adults are at high risk of femoral neck fractures (FNFs). Elderly patients face and adapt to significant psychological burdens, resulting in different degrees of psychological stress response. Total hip replacement is the preferred treatment for FNF in elderly patients; however, some patients have poor postoperative prognoses, and the underlying mechanism is unknown. We speculated that the postoperative prognosis of elderly patients with FNF may be related to preoperative psychological stress. AIM To explore the relationship between preoperative psychological stress and the short-term prognosis of elderly patients with FNF. METHODS In this retrospective analysis, the baseline data, preoperative 90-item Symptom Checklist score, and Harris score within 6 months of surgery of 120 elderly patients with FNF who underwent total hip arthroplasty were collected. We analyzed the indicators of poor short-term postoperative prognosis and the ability of the indicators to predict poor prognosis and compared the correlation between the indicators and the Harris score. RESULTS Anxiety, depression, garden classification of FNF, cause of fracture, FNF reduction quality, and length of hospital stay were independent influencing factors for poor short-term postoperative prognoses in elderly patients with FNF (P < 0.05). The areas under the curve for anxiety, depression, and length of hospital stay were 0.742, 0.854, and 0.749, respectively. The sensitivities of anxiety, depression, garden classification of FNF, and prediction of the cause of fracture were 0.857, 0.786, 0.821, and 0.821, respectively. The specificities of depression, FNF quality reduction, and length of hospital stay were the highest at 0.880, 0.783, and 0.761, respectively. Anxiety, depression, and somatization scores correlated moderately with Harris scores (r = -0.523, -0.625, and -0.554; all P < 0.001). CONCLUSION Preoperative anxiety, depression, and somatization are correlated with poor short-term prognosis in elderly patients with FNF and warrant consideration.
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Affiliation(s)
- Wen-Hui Fu
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Zhi-Long Hu
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Yuan-Jun Liao
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Ri-Jiang Chen
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Jian-Bin Qiu
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Wu-Tang Que
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Wan-Tao Wang
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Wei-Hua Li
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
| | - Wei-Bin Lan
- Department of Orthopedics, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 361000, Fujian Province, China
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4
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Bisciotti GN, Di Pietto F, Rusconi G, Bisciotti A, Auci A, Zappia M, Romano S. The Role of MRI in Groin Pain Syndrome in Athletes. Diagnostics (Basel) 2024; 14:814. [PMID: 38667460 PMCID: PMC11049591 DOI: 10.3390/diagnostics14080814] [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: 02/25/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Groin pain syndrome (GPS) is one of the most frequent injuries in competitive sports. Stresses generated in the lower limbs by quick turns and accelerations, such as in soccer, basketball or hockey, can produce localized regions of increased forces, resulting in anatomical lesions. The differential diagnoses are numerous and comprise articular, extra-articular, muscular, tendinous and visceral clinical conditions and a correct diagnosis is crucial if treatment is to be efficient. MRI is the gold standard of diagnostic techniques, especially when an alternative pathology needs to be excluded and/or other imaging techniques such as ultrasound or radiography do not lead to a diagnosis. This paper, based on the current literature, gives a comprehensive review of the anatomy of the pubic region and of the typical MRI findings in those affected by GPS. Many clinical conditions causing GPS can be investigated by MRI within appropriate protocols. However, MRI shows limits in reliability in the investigation of inguinal and femoral hernias and therefore is not the imaging technique of choice for studying these clinical conditions.
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Affiliation(s)
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Giovanni Rusconi
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | | | - Alessio Auci
- Dipartimento delle Diagnostiche, Azienda USL Toscana Nord Ovest, 56121 Massa, Italy;
| | - Marcello Zappia
- Department of Medicine and Health Science V. Tiberio, Università degli Studi del Molise, 86100 Campobasso, Italy;
| | - Stefania Romano
- Department of Radiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
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Sax AJ. Osseous Stress Injuries: Treatment Algorithms and Return to Play. Semin Musculoskelet Radiol 2024; 28:130-138. [PMID: 38484765 DOI: 10.1055/s-0043-1778030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Osseous stress injuries are common in athletes. Specifically, lower extremity injuries are prevalent in running athletes and upper extremity injuries are prevalent in throwing athletes. Such injuries are suspected when there is focal bone tenderness and increased pain with the inciting activity. In elite athletes, osseous stress injuries are a relatively common culprit in lost play time. Thus rapid diagnosis and treatment is imperative to expedite return to play (RTP). The radiologist's role in these cases is not only for diagnosis, but also to grade the injury, which has implications in determining a treatment regimen. The high sensitivity and specificity of magnetic resonance imaging is thus the preferred imaging modality. This article discusses common osseous stress injuries, the imaging findings, and how different treatment regimens affect RTP.
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Affiliation(s)
- Alessandra J Sax
- The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island
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Melero-Pardo AL, Pimentel-Soler TC, Benitez-Colón CR. Uncommon Twist: Femoral Neck Stress Fracture in a High-Performance Athlete With an Incidental Diagnosis of Femoroacetabular Impingement. Cureus 2024; 16:e59224. [PMID: 38807826 PMCID: PMC11132732 DOI: 10.7759/cureus.59224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
Femoral neck stress fractures (FNSFs) are rare but significant injuries, often leading to delayed diagnosis due to nonspecific symptomatology. This case report presents a 30-year-old professional surfer who experienced acute groin pain during a half marathon, ultimately diagnosed with a left intertrochanteric line femur stress fracture and with femoroacetabular impingement (FAI) in the opposite hip. Despite being physically fit, his presentation challenges the prevailing notion that FNSFs predominantly occur in military personnel or the elderly. The patient underwent surgical left hip osteosynthesis without complications. This case highlights the importance of early suspicion of FNSFs in young, active individuals and emphasizes the need for comprehensive evaluation to prevent complications like osteonecrosis and malunion. It underscores the value of a broad differential diagnosis and timely intervention in optimizing outcomes, especially in the context of rising high-impact sports participation.
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Khired ZA. A Case of a Young Military Officer with Bilateral Simultaneous Femoral Neck Stress Fracture. Int Med Case Rep J 2024; 17:131-135. [PMID: 38404752 PMCID: PMC10887935 DOI: 10.2147/imcrj.s411460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/04/2023] [Indexed: 02/27/2024] Open
Abstract
Stress fractures of the femoral neck are rare in young adults and usually happen when the bone is repeatedly put under a lot of stress or because of a bone disease. The incidence of stress fractures is a major health concern for soldiers. Most often, stress fractures affect the metatarsals and tibias, while injuries to the femoral neck are less common. Exertional groin or anterior thigh discomfort that develops gradually over time is often vague and subtle; therefore, a high index of clinical suspicion is indicated. In most cases, the first radiographs will be normal. In order to properly diagnose a stress fracture in the femur, a CT scan is very helpful. Because most femoral neck fractures are not displaced when patients present with them, a diagnosis is often delayed. In conclusion, new military soldiers feeling hip pain should have a thorough medical evaluation to establish an early diagnosis and prevent any consequences.
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Affiliation(s)
- Zenat Ahmed Khired
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
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Hasegawa K, Takegami Y, Tokutake K, Nakashima H, Mishima K, Kobayashi K, Imagama S. Early versus delayed weight bearing after internal fixation for femoral neck fracture in younger adults: A multicenter retrospective study. Injury 2024; 55:111292. [PMID: 38157758 DOI: 10.1016/j.injury.2023.111292] [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: 09/25/2023] [Revised: 11/26/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Femoral neck fracture (FNF) is among the most common and devastating injuries that orthopedic surgeons encounter. However, the incidence of FNF is lower in younger adults than in elderly individuals. In elderly FNF patients, early weight bearing (EWB) is preferred to prevent loss of function and decreased activity. In younger adults, some surgeons decide on delayed-weight bearing (DWB) after surgery because EWB may cause femoral neck shortening. We aimed to compare the postoperative results (clinical outcome, radiological evaluation, and complications) of EWB and DWB after FNF surgery in younger adults. METHODS The study included 151 younger adults (age: ≤65 years at injury; nondisplaced, n = 100; displaced, n = 51) who underwent internal fixation at 11 university-affiliated hospitals in 2016-2020, and who were followed for ≥1 year. Patients were divided into the EWB (EWB in early postoperative period) and DWB (beginning weight bearing at 4 weeks after surgery) groups. The two groups were matched for age, and nondisplaced (EWB and DWB, both n = 24) and displaced (EWB and DWB, both n = 11) FNF were analyzed. The study items were age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), presence of diabetes, days waiting for surgery, fracture type, Parker mobility score (PMS) at last follow-up examination, pain (Numerical Rating Scale: NRS), radiological evaluation (femoral neck shortening, Canulated Cancellous screws (CCS) backout, and complications (nonunion, femoral head osteonecrosis). RESULTS The patient backgrounds of the nondisplaced and displaced types did not differ. The PMS was significantly higher in the DWB group at the last follow-up examination (nondisplaced: 8.00±2.20 vs. 6.67±2.22, p = 0.005, displaced: 8.67±0.89 vs. 6.91±2.77, p<0.001). NRS and the amount of femoral neck shortening were significantly lower in the DWB group (nondisplaced: 1.65±0.70 mm vs. 3.94±3.03 mm, p<0.001, displaced: 4.26± 2.64 mm vs. 8.91±5.69 mm, p<0.001). CCS backout did not differ between the groups. One case of each of nonunion and femoral head osteonecrosis were observed in the displaced EWB and DWB groups; these differences were not significant. CONCLUSIONS DWB after internal fixation for FNF in younger adults was associated with better outcomes than EWB.
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Affiliation(s)
- Kanta Hasegawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Katsuhiro Tokutake
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Chung BH, Shaw KA, Burke JS, Jackson KL, Schmitz MR, Boomsma S, Hurvitz AP, Moreland CM, O'Brien FP, Antosh IJ, Huh J, Waterman BR, Wheatley BM, Potter BK. Consensus and Equipose in the Management of Military Trainee Femoral Neck Stress Fractures: A Survey of Military Surgeons. Mil Med 2024; 189:e82-e89. [PMID: 37261898 DOI: 10.1093/milmed/usac426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/25/2022] [Accepted: 12/23/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Femoral neck stress fractures (FNSFs) are a unique injury pattern not commonly treated in the civilian trauma population; however, it is particularly high with military trainees engaged in basic combat training. To date, no study has surveyed a population of military orthopedic surgeons on treatment preferences for military service members (SMs) with FNSF. QUESTIONS We aim to evaluate the extent of clinical equipoise that exists in the management of these injuries, hypothesizing that there would be consensus in the factors dictating surgical and non-surgical intervention for FNSF. PATIENTS AND METHODS A 27-question survey was created and sent to U.S. military orthopedic surgeon members of the Society of Military Orthopaedic Surgeons. The survey was designed in order to gather the experience among surgeons in treating FNSF and identifying variables that play a role in the treatment algorithm for these patients. In addition, seven detailed, clinical vignettes were presented to further inquire on surgeon treatment preferences. Binomial distribution analysis was used to evaluate for common trends within the surgeon's treatment preferences. RESULTS Seventy orthopedic surgeons completed the survey, the majority of whom were on active duty status in the U.S. Military (82.86%) and having under 5 years of experience (61.43%). Majority of surgeons elected for a multiple screw construct (92.86%), however the orientation of the multiple screws was dependent on whether the fracture was open or closed. Management for compression-sided FNSF involving ≥50% of the femoral neck width, tension-sided FNSF, and stress fractures demonstrating fracture line progression had consensus for operative management. Respondents agreed upon prophylactic fixation of the contralateral hip if the following factors were involved: Complete fracture (98.57%), compression-sided fracture line >75% (88.57%), compression-sided fracture line >50-75% with hip effusion (88.57%), contralateral tension-sided fracture (87.14%), and compression-sided fracture line >50-75% (84.29%). An FNSF < 50% on the contralateral femoral neck or a hip effusion was indeterminate in surgeons indicating need for prophylactic fixation. Majority of surgeons (77.1%) utilized restricted toe-touch weight-bearing for postoperative mobility restrictions. CONCLUSIONS Consensus exists for surgical and non-surgical management of FNSF by U.S. military orthopedic surgeons, despite the preponderance of surgeons reporting a low annual volume of FNSF cases treated. However, there are certain aspects in the operative and non-operative management of FNSF that are unanimously adhered to. Specifically, our results demonstrate that there is no clear indication on the management of FNSF when an associated hip effusion is involved. Additionally, the indications for surgically treating contralateral FNSF are unclear. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - K Aaron Shaw
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Joseph S Burke
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
| | - Keith L Jackson
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Matthew R Schmitz
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Shawn Boomsma
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
- Jackson Memorial Hospital, Miami, FL 33136, USA
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | - Ivan J Antosh
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- San Antonio Military Medical Center, San Antonio, TX 78219, USA
| | - Jeannie Huh
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- San Antonio Military Medical Center, San Antonio, TX 78219, USA
| | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, NC 27109, USA
- U.S. Ski & Snowboard, Park City, UT 84060, USA
| | | | - Benjamin K Potter
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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10
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Guo X, Zeng Y, Xu H, Zhan X. Spontaneous femoral neck fracture resulting from osteonecrosis involving lateral femoral head-neck junction: a retrospective study. BMC Musculoskelet Disord 2023; 24:913. [PMID: 38012595 PMCID: PMC10680177 DOI: 10.1186/s12891-023-07058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Spontaneous femoral neck fracture is a rare condition that remains controversial due to limited reported cases. This retrospective study aims to provide further insights into the etiology and characteristics of the disease. METHOD We conducted a retrospective review of data from 963 patients with femoral neck fractures. The data encompassed demographic information, medical histories, radiographic records, bone mineral density (BMD) measurements, and pathological examinations. Patients were categorized into two groups: spontaneous femoral neck fracture (SFF) group (30 cases) and control group (933 cases), based on their medical histories. Logistic regression analysis was employed to identify risk factors for SFF. Statistical analysis was performed to compare and elucidate the characteristics of SFF within each group. RESULTS Logistic regression analysis revealed osteonecrosis of the femoral head, steroid use, and osteoporosis as three significant risk factors for SFF. Furthermore, a higher proportion of Garden type I and II fractures, as well as Pauwels type I fractures, were observed in the SFF group compared to the control group. Within the SFF group, a higher proportion of patients with osteonecrosis exhibited Garden type III and IV fractures compared to those with osteoporosis. Additionally, both magnetic resonance imaging (MRI) and pathological examinations demonstrated that osteonecrosis in the SFF group predominantly occurred at the lateral femoral head-neck junction. CONCLUSIONS Osteonecrosis of the femoral head, particularly involving the lateral head-neck junction, was confirmed as a major risk factor for SFF. Furthermore, SFF exhibits internal heterogeneity based on its different causes.
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Affiliation(s)
- Xin Guo
- Department of Orthopedics, Wuhan Fourth Hospital, Wuhan, China
| | - Yihui Zeng
- Department of Radiology, Wuhan Fourth Hospital, Wuhan, China
| | - Haijun Xu
- Department of Orthopedics, Wuhan Fourth Hospital, Wuhan, China
| | - Xinyuan Zhan
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
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11
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Zeng H, Yuan X, Xiang B, Zheng M. Clinical application of the Femoral Neck System in femoral neck fractures. Asian J Surg 2023; 46:4885-4886. [PMID: 37330297 DOI: 10.1016/j.asjsur.2023.05.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023] Open
Affiliation(s)
- Hao Zeng
- Department of Orthopaedic Surgery, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, China
| | - Xiaobo Yuan
- Department of Orthopaedic Surgery, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, China
| | - Bo Xiang
- Department of Orthopaedic Surgery, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, China
| | - Maowen Zheng
- corresponding address: Department of Geriatrics, Sichuan Provincial Peoples Hospital, Chengdu, China.
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12
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Cong B, Han Z, Zhang H. Exploring the displacement characteristics of Garden III femoral neck fractures and the reliability, validity, and value of the anteroposterior Garden Index in assessing displacement severity. J Orthop Surg Res 2023; 18:797. [PMID: 37875945 PMCID: PMC10594693 DOI: 10.1186/s13018-023-04269-4] [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: 08/20/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Femoral neck fractures represent a significant public health concern, particularly in the elderly population. A thorough understanding and assessment of these fractures are deemed essential for optimal treatment and management. Displacement characteristics of Garden III femoral neck fractures were explored in this study, and the reliability, validity, and clinical utility of the anteroposterior Garden Index in evaluating displacement severity were investigated. METHODS Patients diagnosed with Garden III femoral neck fractures were included in this study. The anteroposterior Garden Index was computed from X-ray images by three experienced orthopedic doctors. Additionally, the contact area of the fracture endpoint and displacement of the femoral neck were evaluated using 128-slice 3D CT scans. Inter-observer and retest reliability of the Garden Index measurements were assessed, along with its correlation with CT measurements. RESULTS In this study, a total of 110 patients with Garden III femoral neck fractures were analyzed, showcasing an almost equal gender distribution and an age range spanning from 20 to 88 years. An average Garden Index of 135° (± 16°) was observed. The intra-observer repeatability of the Garden Index was found to exceed 90%. A significant positive correlation was identified between the Garden Index and the contact surface area of the fracture endpoint (r = 0.82, P < 0.001), while a significant negative correlation was noted with the upward displacement of the femoral neck (r = - 0.79, P < 0.001). CONCLUSIONS The anteroposterior Garden Index has been demonstrated to have promising potential as a reliable and valid tool for assessing the displacement severity of Garden III femoral neck fractures. Nonetheless, further research is needed to elucidate its relationship with other fracture characteristics and to enhance its criterion and construct validity.
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Affiliation(s)
- Bo Cong
- Yantai Key Laboratory for Repair and Reconstruction of Bone and Joint, Yantaishan Hospital Affiliated to Binzhou Medical University, 10087 Keji Avenue, Laishan District, Yantai, 264003 China
| | - Ziyin Han
- Yantai Key Laboratory for Repair and Reconstruction of Bone and Joint, Yantaishan Hospital Affiliated to Binzhou Medical University, 10087 Keji Avenue, Laishan District, Yantai, 264003 China
| | - Haiguang Zhang
- Yantai Key Laboratory for Repair and Reconstruction of Bone and Joint, Yantaishan Hospital Affiliated to Binzhou Medical University, 10087 Keji Avenue, Laishan District, Yantai, 264003 China
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13
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Zhou Y, Li Z, Lao K, Wang Z, Zhang L, Dai S, Fan X. Femoral neck system vs. cannulated screws on treating femoral neck fracture: a meta-analysis and system review. Front Surg 2023; 10:1224559. [PMID: 37533744 PMCID: PMC10390772 DOI: 10.3389/fsurg.2023.1224559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Objective This meta-analysis aimed to compare the relative safety and efficacy of cannulated compression screw (CCS) and femoral neck system (FNS) in treating patients with femoral neck fractures and to provide evidence-based medical evidence for FNS in treating femoral neck fractures. Methods PubMed, Embase, Cochrane, and China National Knowledge Infrastructure databases were searched to collect outcomes related to femoral neck fractures treated with FNS and CCS, including time to fracture healing, incidence of non-union, incidence of osteonecrosis of the femoral head, incidence of failure of internal fixation, rate of femoral neck shortening, Harris hip score, Barthel index, operative time, intraoperative blood loss, fluoroscopy frequency, and complications. A meta-analysis was performed using RevManv5.4 (The Cochrane Collaboration) and Stata v14.0 software. Results This analysis included 21 studies involving 1,347 patients. The results showed that FNS was superior to CCS in terms of fracture healing time [mean difference (MD) = -0.75, 95% CI = (-1.04, -0.46), P < 0.05], incidence of bone non-union [odds ratio (OR) = 0.53, 95% CI = (0.29, 0.98), P = 0.04], incidence of osteonecrosis of the femoral head [OR = 0.49, 95% CI = (0.28, 0.86), P = 0.01], incidence of internal fixation failure [OR = 0.30, 95% CI = (0.18, 0.52), P < 0.05], rate of femoral neck shortening [OR = 0.38, 95% CI = (0.27, 0.54), P > 0.05], Harris hip score [MD = 3.31, 95% CI = (1.99, 4.63), P < 0.001], Barthel index [MD = 4.31, 95% CI = (3.02, 5.61), P < 0.05], intraoperative bleeding [MD = 14.72, 95% CI = (8.52, 20.92), P < 0.05], fluoroscopy frequency [OR = 0.53, 95% CI = (0.29, 0.98), P = 0.04], and complications [OR = 0.31, 95% CI = (0.22, 0.45), P < 0.05]. The difference between FNS and CCS in operative time was not statistically significant [MD = -2.41, 95% CI = (-6.88, 2.05), P = 0.29]. Conclusion FNS treatment of femoral neck fracture can shorten the fracture healing time; reduce the incidence and translucent rate of bone non-union, osteonecrosis of the femoral head, and internal fixation failure; reduce intraoperative blood loss and postoperative complications; and improve hip joint function and activity. We are confident in the findings that FNS, an effective and safe procedure for internal fixation of femoral neck fractures, is superior to CCS.
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Affiliation(s)
- Yimin Zhou
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Zongyang Li
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Kecheng Lao
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Zixiu Wang
- College of Pharmacy, Gannan Medical University, Ganzhou, China
| | - Li Zhang
- Department of Rehabilitation and Health, Fujian Vocational College of Bio-engineering, Fuzhou, China
| | - Shiyou Dai
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xiao Fan
- Department of Osteoarticular and Sports Medicine, Qingdao Municipal Hospital, Qingdao, China
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14
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Gao C, Feng LL, Zheng JH, Cao J, Sun HJ. Case report: A rare Salter-Harris V metaphyseal fatigue fracture of the knee in an adolescent patient with obesity. Front Pediatr 2023; 11:1209369. [PMID: 37425269 PMCID: PMC10323821 DOI: 10.3389/fped.2023.1209369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Stress fractures are rare, occurring in 1.5/100,000 high school athletes. High impact, repetitive loading participation in woman's sports, and being a white athlete have been identified as risk factors for stress fractures. Mostly treated conservatively, they are more common in the tibia (33%). Stress fractures requiring surgery, which are extremely rare, have been reported in the scaphoid, fifth metatarsal, and neck of femur. Herein, a 16-year-old adolescent patient with obesity presented with atypical knee pain after prolonged exercise. Advanced imaging revealed a stress fracture of the left tibia with a Salter-Harris type V fracture and varus deformity of the knee. We initially managed the fatigue fracture conservatively, followed by surgical correction of the varus deformity in the knee joint. The patient made a satisfactory recovery with equal limb length and no evidence of claudication. This is the first case of a proximal tibial metaphyseal stress fracture requiring surgery. The clinical manifestations of proximal tibial metaphyseal stress fractures and potential treatment strategies and the use of magnetic resonance for tibial stress fractures have been discussed. Understanding the location of unusual stress fractures can improve early diagnostic efficiency and reduce complication rates, healthcare costs, and recovery time.
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Affiliation(s)
- Chao Gao
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Ling Le Feng
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Jiang Hua Zheng
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Jin Cao
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Hua Jing Sun
- Department of Clinical Laboratory, Wu Xiang Health Center, Ningbo University Affiliated People's Hospital, Ningbo, China
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15
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Skedros JG, Cronin JT, Dayton MR, Bloebaum RD, Bachus KN. Exploration of the synergistic role of cortical thickness asymmetry ("Trabecular Eccentricity" concept) in reducing fracture risk in the human femoral neck and a control bone (Artiodactyl Calcaneus). J Theor Biol 2023; 567:111495. [PMID: 37068584 DOI: 10.1016/j.jtbi.2023.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023]
Abstract
The mechanobiology of the human femoral neck is a focus of research for many reasons including studies that aim to curb age-related bone loss that contributes to a near-exponential rate of hip fractures. Many believe that the femoral neck is often loaded in rather simple bending, which causes net tension stress in the upper (superior) femoral neck and net compression stress in its inferior aspect ("T/C paradigm"). This T/C loading regime lacks in vivo proof. The "C/C paradigm" is a plausible alternative simplified load history that is characterized by a gradient of net compression across the entire femoral neck; action of the gluteus medius and external rotators of the hip are important in this context. It is unclear which paradigm is at play in natural loading due to lack of in vivo bone strain data and deficiencies in understanding mechanisms and manifestations of bone adaptation in tension vs. compression. For these reasons, studies of the femoral neck would benefit from being compared to a 'control bone' that has been proven, by strain data, to be habitually loaded in bending. The artiodactyl (sheep and deer) calcaneus model has been shown to be a very suitable control in this context. However, the application of this control in understanding the load history of the femoral neck has only been attempted in two prior studies, which did not examine the interplay between cortical and trabecular bone, or potential load-sharing influences of tendons and ligaments. Our first goal is to compare fracture risk factors of the femoral neck in both paradigms. Our second goal is to compare and contrast the deer calcaneus to the human femoral neck in terms of fracture risk factors in the T/C paradigm (the C/C paradigm is not applicable in the artiodactyl calcaneus due to its highly constrained loading). Our third goal explores interplay between dorsal/compression and plantar/tension regions of the deer calcaneus and the load-sharing roles of a nearby ligament and tendon, with insights for translation to the femoral neck. These goals were achieved by employing the analytical model of Fox and Keaveny (J. Theoretical Biology 2001, 2003) that estimates fracture risk factors of the femoral neck. This model focuses on biomechanical advantages of the asymmetric distribution of cortical bone in the direction of habitual loading. The cortical thickness asymmetry of the femoral neck (thin superior cortex, thick inferior cortex) reflects the superior-inferior placement of trabecular bone (i.e., "trabecular eccentricity," TE). TE helps the femoral neck adapt to typical stresses and strains through load-sharing between superior and inferior cortices. Our goals were evaluated in the context of TE. Results showed the C/C paradigm has lower risk factors for the superior cortex and for the overall femoral neck, which is clinically relevant. TE analyses of the deer calcaneus revealed important synergism in load-sharing between the plantar/tension cortex and adjacent ligament/tendon, which challenges conventional understanding of how this control bone achieves functional adaptation. Comparisons with the control bone also exposed important deficiencies in current understanding of human femoral neck loading and its potential histocompositional adaptations.
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Affiliation(s)
- John G Skedros
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA; Research Service, Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - John T Cronin
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA
| | - Michael R Dayton
- University of Colorado, Department of Orthopedics, Aurora, CO, USA
| | - Roy D Bloebaum
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA; Research Service, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Kent N Bachus
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA; Research Service, Veterans Affairs Medical Center, Salt Lake City, UT, USA
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16
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Arora A, Asnake G, Sonkawade V. Stress Fracture of the Femoral Neck Following Total Knee Arthroplasty: A Case Series. Cureus 2023; 15:e36702. [PMID: 37113371 PMCID: PMC10128462 DOI: 10.7759/cureus.36702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
A stress fracture of the femoral neck after total knee arthroplasty (TKA) is rare, with few reported cases in the English literature. We defined a stress fracture following TKA as a nontraumatic fracture developing in the femoral neck within six months of TKA. This retrospective case series highlights the predisposing factors, diagnostic challenges, and management of stress femoral neck fractures following TKA. In our series, the major risk factors for the fracture are an increase in the level of activity in osteoporotic bone after a period of relative immobility after TKA, steroid intake, and rheumatoid arthritis. Preoperative dual-energy X-ray absorptiometry (DEXA) screening may help in the early initiation of osteoporosis treatment as the majority of our cases come late in the knee arthritis stage and long after a period of relative inactivity. Timely diagnosis and management of a stress femur neck fracture in the early period may prevent fracture displacement, avascular necrosis, and nonunion.
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17
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Potter BK. CORR Insights®: Surgically Treated Femoral Neck Stress Fractures Are Likely to Result in Military Separation During Basic Combat Training. Clin Orthop Relat Res 2022; 480:1692-1693. [PMID: 35543571 PMCID: PMC9384948 DOI: 10.1097/corr.0000000000002247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin K Potter
- Norman M. Rich Professor and Chair, Department of Surgery, Uniformed Services University-Walter Reed, Bethesda, MD, USA
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18
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SUNDKVIST J, MÖLLER M, ROGMARK C, WOLF O, MUKKA S. Stress fractures of the femoral neck in adults: an observational study on epidemiology, treatment, and reoperations from the Swedish Fracture Register. Acta Orthop 2022; 93:413-416. [PMID: 35417029 PMCID: PMC9007069 DOI: 10.2340/17453674.2022.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Stress fractures of the femoral neck (sFNFs) are uncommon injuries. Studies on sFNFs are rare. We describe the demographics, classification, treatment, reoperation rates, and mortality in a cohort of sFNF patients from the Swedish Fracture Register (SFR). PATIENTS AND METHODS We included 146 patients ≥ 18 years of age with an sFNF registered in the SFR between 2011 and 2020. The cohort was linked with the Swedish Arthroplasty Register and reviewed using medical records and radiographs. We assessed the presence of disorders of bone remodeling, duration of symptoms, fracture classification, treatment, reoperations, and mortality. RESULTS The mean age was 58 years (21-96), 75% were women and the median duration of symptoms was 23 days (1-266). 40% of patients had disorders of bone remodeling. 54% were undisplaced (uFNF), 30% displaced (dFNF), and 16% basicervical (bFNF). 14% of patients < 60 years were treated nonoperatively, by internal fixation (IF) in 77% and by arthroplasty in 10%. Patients ≥ 60 years were treated nonoperatively in 10%, IF in 40%, and arthroplasty in 49%. Nonoperative treatment was reserved for uFNFs or bFNFs, resulting in 35% receiving late surgery. The overall secondary or late surgery rate was 19%. Mortality was 2% at 90 days and increased to 3% at 1 year. INTERPRETATION sFNF has a biphasic age distribution. One-third of patients presented with a displaced FNF and those managed nonoperatively for an undisplaced sFNF were at risk of late surgery. The mortality rates for patients with these injuries was low.
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Affiliation(s)
- Jonas SUNDKVIST
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University
| | - Michael MÖLLER
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg
| | - Cecilia ROGMARK
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö
| | - Olof WOLF
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Sebastian MUKKA
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University
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