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PubMed2006

The Bristol Hip View: a new hypothetical radiographic projection for femoral neck fractures.

This experimental study is to evaluate a modified radiographic view of the femoral neck in the assessment of femoral fractures. A dry femur and pelvis was set up in a rig to simulate the positioning of a routine anteroposterior (AP) pelvis X-ray view. Films were exposed to create a routine AP pelvis, AP hip and two views with external tube angulation of 15 degrees and 30 degrees. Observers were asked to evaluate the films using a visual analogue score on two separate occasions. The same films were performed on a further fractured femoral neck to assess the fracture clarity. There was good intraobserver and interobserver correlation. Observers ranked the 15 degrees and 30 degrees angled films as showing the femoral neck most clearly, over and above the traditional views (p<0.001). The fracture was best demonstrated on the 30 degrees angled film (p<0.001). The 30 degrees angled view appears to demonstrate the femoral neck anatomy more clearly than the traditional views but also showed increased fracture sharpness. The authors are proceeding to a clinical trial to assess this in trauma practice.

Femoral Neck Fractures↗
PubMed2003

Quality of life and femoral neck fractures.

The worldwide increase in hip fractures is a major challenge to the health care system and society. The proper treatment of femoral neck fractures in the elderly is still controversial, and even more so from an international perspective. Optimising the treatment for improved outcomes and a reduced need for secondary surgery is mandatory for humanitarian and economical reasons. The importance of incorporating the patient's perspective of the outcome in clinical trials has been acknowledged and there are now numerous instruments for assessing the quality of life. We evaluated two quality of life instruments, the EQ-5D and the SF-36, in patients with femoral neck fractures and also measured the quality of life two years after different interventions. The EQ-5D was validated in two prospective studies and it appeared to be an appropriate quality of life instrument in elderly patients with femoral neck fractures. There was a good correlation between the quality of life (EQ-5Dindexscores) and other outcome measures such as pain, mobility and independence in activities of daily living (ADL). The results also showed high responsiveness, i.e., ability to capture clinically important changes, for both the EQ-5D and the SF-36. The questionnaire response rate for both instruments was high. The rated prefracture EQ-5Dindexscores showed good correspondence with the scores of an age-matched Swedish reference population. The quality of life in patients with femoral neck fractures treated with internal fixation (IF) decreased, particularly in patients with fracture healing complications. The fracture healing complications rate at two years in patients with displaced femoral neck fractures treated with IF was 36% compared with 7% in patients with undisplaced fractures. The quality of life of patients with uneventfully healed fractures at two year was lower in patients with primary displaced fractures than in patients with primary undisplaced fractures. In a prospective randomised trial, patients with displaced femoral neck fractures were randomised to IF or total hip replacement (THR). IF resulted in more complications than THR, 36% versus 4%, and necessitated more reoperations, 42% versus 4%. Hip function and quality of life (EQ-5D) were generally better in the THR group. In summary, THR yielded a better outcome than IF for an elderly, relatively healthy, lucid patient with a displaced femoral neck fracture. In a study of elderly women with femoral neck fractures, nearly half of the patients displayed signs of protein-energy malnutrition. Underweight was associated with muscle fatigue, cognitive dysfunction and a low quality of life (Nottingham Health Profile). In a prospective randomised trial, protein-rich liquid supplementation in combination with an anabolic steroid given for 6 months to lean elderly women after a femoral neck fracture was shown to positively affect lean body mass, ADL and quality of life (EQ-5D). Fracture healing complications had a negative impact on body weight, lean body mass and quality of life.

Aged↗
PubMedDate not supplied

Comparison of fixation in the treatment of femoral neck fractures.

Two hundred ninety patients with femoral neck fractures of the Garden Type III or IV were treated during the years 1965 through 1978 using one of four types of internal fixation devices. The results divided the devices into two distinct groups. Those allowing highly stable fixation (Calandruccio compression and Deyerle devices) had a higher rate of union and a higher rate of early complications. Those less stable devices (Smith-Peterson nail with Knowles pins and Knowles pins alone) had lower rates of union and early complication. Although avascular necrosis is recorded, no significant comparison could be made because of the lack of a two-year follow-up study in a significant number of cases.

Adolescent↗
PubMed1998

Biases in a randomized comparison of three types of screw fixation in displaced femoral neck fractures.

We studied fixation of displaced femoral neck fractures prospectively in a randomized multicenter study, comparing 2 Olmed screws, 2 Tronzo screws and 3 Ullevaal hip screws. The study population consisted of 482 women and 125 men, of whom 432 women and 100 men were older than 65 years of age. Their median age was 80 (54-97) years. Despite agreement on criteria, the rates of reoperations for pain and failure--salvage (prosthesis replacement) and other reoperations (removal of implant)--differed significantly between the 3 hospitals regardless of type of fixation. In total, the percentages of salvage operations were: Olmed screw 17/175, Tronzo 17/130 and Ullevaal screw 11/302 (n.s.); the percentages of other reoperations were 11, 6 and 13, respectively (n.s.). In the whole series, the 2-year rate of salvage operations was 14%. No differences between the implants were found in patients older than 65 years of age. We conclude that an agreed, common definition of a hard end-point (reoperation) does not ensure comparability of results, because of differences in clinical decision making.

Aged↗
PubMedDate not supplied

Femoral neck fractures in young adults.

In 17 patients with femoral neck fractures who were between 15 and 40 years old the incidence of aseptic necrosis in patients followed more than 2 years was 18.7 per cent. The fracture was associated with other severe injuries in 40 per cent of the cases, probably reflecting the level of violence necessary to induce the fracture in young adults. Two of the 7 fractures treated with large-bore internal fixatives required secondary procedures to correct fracture displacement (this was not a complication with threaded devices). While the incidence of aseptic necrosis is no higher than that in other adult series, subsequent degenerative changes may supervene in many femoral neck fractures in this age group.

Adolescent↗
PubMed1990

The treatment of femoral neck fractures by percutaneous pinning.

Sixty two patients with displaced femoral neck fractures treated by percutaneous pinning are reviewed. There were 37 females and 25 males with an average age of 63.7 years. There were 36 Garden grade III and 26 grade IV fractures. Twenty three patients had other medical conditions. Fourteen patients were operated under local anaesthesia. Superficial wound infection was found in three cases with no deep infection. Union occurred in 41 patients by eight months. Of the 21 non-unions 15 remained painless. The pins migrated outwards in seven cases but caused no clinical problem. Avascular necrosis was seen in 11 patients by 18 months. Avascular necrosis and non-union occurred together in six patients. Secondary hemiarthroplasty was performed in only ten patients. Routine hemiarthroplasty for femoral neck fractures is not always indicated. Femoral head preservation should be attempted before prosthetic replacement. The pinning surgery is simple, fast and can be performed under local anaesthesia. Hemiarthroplasty should be reserved for failed cases only.

Aged↗
PubMed1984

Sliding screw-plate for fixation of femoral neck fracture.

Ninety-eight fractures of the femoral neck treated with a sliding screw-plate system were followed from 6 to 65 months. Two cases developing deep infection and four cases of primary technical failure were reoperated. Union was encountered in 80/92 of the fractures; 13/80 of the united fractures developed necrosis of the femoral head. Serious complications were thus encountered in 31/98 of the fractures, and 27 of these were reoperated. On the basis of comparison with reports on other methods for internal fixation, the sliding screw-plate method is recommended for fixation of femoral neck fractures.

Adult↗
PubMed1996

[Pediculated anterior graft for reducing necrosis of the femur head in femoral neck fractures].

This article in addition of reviewing the current techniques of surgical treatment of femoral neck fractures, also presents a newly devised technique, in which by anterior approach the pediculated muscle bone graft from the anterior part of the greater trochanter with attached gluteus medius insertion is placed at anterosuperior part of the fractured femoral neck (type 3 & 4 Garden and old neglected fractures). This paper reviews the older techniques of Judet and Meyer in which the pediculated bone graft is taken from quadratus femoris insersion and placed posteriorly to the femoral neck which may compromise the important vascular supply (posterior subsynovial retinacular artery) posteriorly to the neck. The new anterior technique has been used for 20 patients successfully for the first time in department of orthopaedic surgery in Imam Reza Medical Center. In Mashhad-Iran from 21/3/93. The ultimate analysis of results will be possible 3 years after operation.

Bone Transplantation↗
PubMed1997

Sequential scintigraphy and orthoradiographic measurement of femoral shortening after femoral neck fracture.

The objective of the study was to assess scintigraphic patterns and femoral shortening after femoral neck fracture in order to select predictive parameters for late complications. Eighty-eight patients with osteosynthesized femoral neck fractures were followed for 2 years with regular scintigraphic evaluations and orthoradiographic measurements of femoral length shortening. Four different patient categories were identified with regard to the late outcome two different groups with uneventful healing and two different groups with late complications. Accordingly, a high scintigraphic uptake at 1 month may either point to an uneventful healing if combined with minor femoral shortening or indicate failure if combined with a high degree of femoral shortening. In contrast, low scintigraphic uptake may either reflect primary fracture healing if accompanied by minor femoral shortening or predict failure if a high degree of femoral shortening is present. Compared with using scintigraphy alone, combined scintigraphic evaluation and assessment of femoral shortening increased the accuracy for prediction of late failures from 80% to 93%. Early scintigraphic patterns after osteosynthesis of femoral neck fractures have to be validated with care. Radiographic assessment of femoral shortening, which is less invasive, gives better prognostic accuracy and should therefore be preferred for this purpose.

Adult↗
PubMed2005

Operative management of displaced femoral neck fractures in elderly patients. An international survey.

BACKGROUND: Hip fractures occur in 280,000 North Americans each year. Although surgeons have reached consensus with regard to the treatment of undisplaced fractures of the hip, the surgical treatment of displaced fractures remains controversial. Identifying surgeons' preferences in techniques, and the rationale for their choices, may aid in focusing educational activities to the orthopaedic community as well as planning future clinical trials. Our objective was to clarify current opinion with regard to the operative treatment of displaced fractures of the femoral neck. METHODS: We used a cross-sectional survey design and a sample-to-redundancy strategy to examine surgeons' preferences in the treatment of displaced femoral neck fractures. We mailed this survey to members of the Orthopaedic Trauma Association and European-AO International-affiliated trauma centers. RESULTS: Of 442 surgeons who received the questionnaire, 298 (67%) responded. The typical respondent was a North American man over the age of forty years who was in academic practice, supervised residents, had fellowship training in trauma, and worked in a low-volume center (<100 hip fractures per year), treating an equal proportion of displaced and undisplaced femoral neck fractures. Most surgeons believed that internal fixation was the procedure of choice in younger patients (those who are less than sixty years old) with a displaced fracture (Garden type III or IV). For patients over eighty years old with Garden type-III or IV fractures, almost all surgeons preferred arthroplasty. Respondents varied widely in their preferences for the treatment of patients who were sixty to eighty years old with a displaced fracture (Garden type III or IV) or active patients with a Garden type-III fracture. Many surgeons believed there was no difference between arthroplasty and internal fixation when considering mortality (45%), infection rates (30%), and quality of life (37%). Surgeons also revealed variable preferences in their choice of the optimal approach to arthroplasty for patients between sixty and eighty years old with a type-IV fracture (32% preferred unipolar; 41%, bipolar; and 17%, total hip arthroplasty) and in the optimal choice of implant for internal fixation. CONCLUSIONS: While surgeons prefer internal fixation for younger patients and arthroplasty for older patients, they disagree about the optimal approach to the management of patients between sixty and eighty years old with a displaced fracture and active patients with a Garden type-III fracture. Surgeons also disagree on the optimal implants for internal fixation or arthroplasty.

Adult↗
PubMed1987

Screening for osteomalacia in elderly patients with femoral neck fractures.

In this study 201 elderly patients with femoral neck fractures were compared with 30 osteomalacic patients with the same injury. Hypocalcaemia and a raised alkaline phosphatase level are common biochemical abnormalities in elderly patients with femoral neck fractures. In only a minority of patients, however, were they associated with histologically proven osteomalacia. By using the combination of hypocalcaemia and a raised alkaline phosphatase it is possible to identify a subgroup (approximately 10% of all admissions) in whom osteomalacia is relatively likely.

Aged↗
PubMed1997

Intracapsular hip pressure after femoral neck fracture.

A consecutive series of 34 patients with femoral neck fractures was included in a prospective study aimed at evaluating preoperative variations in intracapsular pressure after changes in hip position, hip traction, and aspiration of hemarthrosis and their influence on the development of femoral head necrosis. Patients were observed for 7 years after surgery. Before aspiration, the mean intracapsular pressure in the antalgic physiologic position was 44.4 mm Hg. There were no differences between displaced and undisplaced fractures. The pressure was a maximum (mean value, 124.8 mm Hg) with the hip in extension and inward rotation, this pressure being greater than the blood systolic pressure in most cases. Hip traction of 3 kg in the antalgic physiologic position was found to be highly effective in preventing any bone flow tamponade effect in displaced and undisplaced femoral neck fractures: the mean intracapsular pressure decreased to 28.5 mm Hg. Aspiration of the hemarthrosis induced a significant decrease in intracapsular pressure only in cases with impaired vascularity of the femoral head as measured by scintigraphy using 99mTc labeled methyldiphosphonate. Aspiration of the hemarthrosis therefore is indicated only in the above cases, although it is less effective than hip traction in the antalgic position. There was no significant correlation between intracapsular pressure and the scintigraphy ratio. Avascular necrosis of the femoral head was detected in six cases. Among these, five patients had an intracapsular pressure below their diastolic blood pressure. This could indicate that vascular damage related to the fracture could be an important cause of bone necrosis despite that blood supply can be decreased by a tamponade effect.

Adolescent↗
PubMed2001

Simultaneous bilateral femoral neck fractures: case report.

Bilateral fractures of the femoral neck are rare injuries. We report about the case of a 33-year old male with multiple injuries including fractures of both femoral neck after a fall from great height. The fractures were successfully treated with 130 degrees blade plates, allowing early mobilisation.

Adult↗
PubMed1984

Radionuclide scintimetry for diagnosis of complications following femoral neck fracture.

A scintimetric study using Tc-99m MDP was made of 54 patients with delayed union, nonunion, or late segmental collapse of the femoral head, 4-92 months after femoral neck fracture. In radiographically verified collapse, the radionuclide uptake ratio between the femoral head on the fractured and on the intact side (HHR) was significantly higher than in fractures resulting in delayed union or nonunion. On the basis of scintimetric and radiographic findings, the patients with healing disturbances could be divided into three groups, characterized by the following features: Satisfactory post-reduction position of the fracture without subsequent redisplacement and a high HHR, which as a rule turned out to be delayed union; The same radiographic pattern but with a lower HHR, which in most cases resulted in nonunion; Inadequate reduction or early redisplacement of the fracture with a high HHR, which resulted in nonunion. The fractional precision in discriminating between different types of disturbed fracture healing by means of skeletal scintimetry was 0.86 in this study. This non-invasive and technically simple method would therefore be a valuable complement to radiography in the assessment of healing, more than 4 months after fracture of the femoral neck.

Adult↗
PubMed1980

Trochanteric intra-osseous venography in femoral neck fractures in the dog.

This study of the healing of femoral neck fractures in dogs clearly indicates: 1. that the restoration of the intra-osseous flow through the fracture site occurs first followed by the appearance of venous drainage in the medial femoral circumflex vein and the vein of the ligamentum teres. 2. That if the intra-osseous flow is restored to the head through the fracture callus, normal fracture healing will proceed. 3. That avascular necrosis following a femoral neck fracture is also dependant on fracture union, and 4. that the incidence of traumatic avascular necrosis can be minimised by adquate fracture treatment. Thus accurate reduction and rigid immobilisation of the fracture promotes early formation of good endosteal callus and the restoration of intra-osseous venous blood flow and so early fracture union. The diagnosis of avascular necrosis of the femoral head may be established by measuring the clearance time of contrast medium flowing into the head via the crossing veins. If the contrast medium is cleared rapidly by the draining veins, it suggests that the head is viable.

Animals↗
PubMed1982

85Sr-scintimetry in femoral neck fracture.

In 40 patients with fracture of the femoral neck 85Sr scintimetry was performed at the time of nailing and 4 months postoperatively. The fractures were radiographed repeatedly for 5 years; thirteen fractures healed without complications, 22 developed necrosis of the femoral head, and 5 pseudarthrosis. The early isotope measurement did not distinguish between normal and necrosis cases even with detailed analysis. The 4 months activities were high in osteonecrosis and low pseudarthrosis. The latter observation is interpreted as evidence that non-union of a femoral neck fracture is due to severe permanent vascular damage.

Adult↗