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PubMedDate not supplied

[Femoral neck fracture in children].

Fractures of the femoral neck in childhood and adolescence are a rare accident injury. Despite their rarity they are significant for the individual child because of the probability of complications, reported in up to 60% of the cases in the literature. They are caused on the one hand by direct damage to the growth joint, which according to recent studies is regarded as a single, continuous, transverse growth plate which includes the trochanteric joint; and on the other by damage resulting from a circulation disorder. Most authors advocate emergency surgical treatment to relieve the hemarthrosis, even though according to the review by Niethard (1982) surgical treatment was not shown to be superior. The patient's age, the localization of the fracture and the extent of dislocation have a major impact on the prognosis. Among the 19 patients treated by the present authors between 1975 and 1989 there were 3 cases of femoral head necrosis in 10 to 15-year-old patients. Seventeen patients underwent surgery. During the same period a number of pathologic fractures of the femoral neck in children were also seen.

Child↗
PubMed1991

[Increasing incidence of femoral neck fractures in Alborg].

The object of this investigation was to analyse the frequency of medial and pertrochanteric fractures of the femoral neck and to calculate the future number. During the period 1976-1988, 3,099 patients aged over 50 years were admitted to hospital with fractures of the femoral neck. 60% were medial femoral neck fractures. The sex ratio women:men was 2.94. The median age rose from 78 to 80 years. The annual number of fractures rose from 151 to 344. The population over 50 years of age had increased by 5.4%. The incidence increased from 3.31 per 1,000 in 1976 to 7.15 per 1,000 in 1988. By means of linear regression, the frequency in year 2010 was calculated to be 14.5 per 1,000 and the number of fractures 794. During the course of the coming 17 years, doubling of the number of medial and pertrochanteric femoral neck fractures may be anticipated, provided linear increase in the frequency occurs.

Aged↗
PubMed2001

Neglected bilateral femoral neck fractures in a patient with end-stage renal disease before chronic dialysis.

Bilateral femoral neck fractures are rarely reported in patients with end-stage renal disease before chronic dialysis. We report on a 39-year-old woman with neglected bilateral femoral neck fractures, who presented with severe uremic complications prior to chronic dialysis. Three years before admission, she had injured herself in a trivial slip with subsequent bilateral hip pain. She had progressively waddled since then. Pelvic X-ray taken after admission revealed bilateral femoral neck fractures. Bilateral hip hemiarthroplasties were subsequently performed. Displaced femoral neck fractures were found intraoperatively. Pathologic findings and results of examinations supported the coexistence of osteoporosis and high turnover renal osteodystrophy, rendering this woman at high risk of bilateral femoral neck fractures. Therefore, preventing a simple fall or trivial accident and treating renal osteodystrophy and osteoporosis are paramount in patients with chronic renal failure even before the start of dialysis therapy. We also emphasize the need to seek any possible underlying metabolic bone disease once a patient presents with unusual fractures.

Adult↗
PubMed2006

Computerized navigation for the internal fixation of femoral neck fractures.

BACKGROUND: Accurate placement of cannulated screws is essential to ensure secure fixation of femoral neck fractures. We compared computerized navigation and conventional fluoroscopy with regard to the accuracy of screw placement for the fixation of femoral neck fractures. METHODS: We retrospectively compared two groups of twenty consecutive patients with a femoral neck fracture who underwent internal fixation with three cannulated screws. Computer-based navigation was used to guide screw placement in one group, and conventional fluoroscopy was used in the other group. Radiographic evaluation included the measurement of screw parallelism and spread, the calibrated distance from the lesser trochanter, and joint penetration. The follow-up period was two years. The rates of complications in both groups were evaluated. RESULTS: The navigation-assisted group had better screw parallelism and greater spread of the screws. There was a tendency for fewer reoperations and significantly fewer overall complications in the patients in whom computerized navigation was used (p < 0.018). CONCLUSIONS: Computerized navigation improves the accuracy of cannulated screw placement in the internal fixation of femoral neck fractures. It may provide better mechanical stability and improved fracture outcome.

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PubMed1999

Endoprosthetic treatment of displaced femoral neck fractures in the year 2000.

Endoprosthetic treatment of intracapsular, subcapital displaced femoral neck fracture in the elderly patients is widely accepted. According to increase in total number of femoral neck fractures in the last decades, there will be about 5 500 femoral neck fractures in Finland suitable for endoprosthetic treatment in the year 2020. Uncemented or cemented unipolar, bipolar or total hip replacements have been alternatives to internal fixation. For active elderly patients with a much younger physiologic than actual age and living a fully independent life, cemented bipolar or total hip arthroplasty should be preferred to unipolar arthroplasty in the year 2 000.

Aged↗
PubMedDate not supplied

Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome.

Pediatric femoral neck fracture is rare and known to be associated with a high complication rate. The effect of early decompression and operative fixation is not frequently reported in the literature. This is a retrospective study of 14 patients younger than 16 years with traumatic fractures of the femoral neck and intertrochanteric region over a 10-year period with a follow-up of 2-11 years (mean, 4.6 years). Road traffic accidents and falls from a height were the main causative factors, and the fractures were subclassified into transcervical, 58%; intertrochanteric, 29%; transepiphyseal, 7%; and cervicotrochanteric, 7%. Of all the fractures, 10 (71%) were displaced. Decompression of the hip by aspiration and closed reduction and internal fixation was performed for all the displaced fractures within 24 h after admission. Three cases required open reduction. Complete fracture healing and functional recovery was achieved in 13 patients with only one delayed union. No patient had radiographic evidence of avascular necrosis. When compared with earlier studies, the current aggressive management protocol for displaced fracture significantly minimized the complications of avascular necrosis, non-union, delayed union, and premature physeal closure.

Adolescent↗
PubMed2005

Perception of Garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons.

The Garden classification is the most popular femoral neck fracture classification system. We surveyed orthopaedic surgeons about their preferences for femoral neck fracture classification systems and their belief about their ability to discriminate between the four different Garden fracture types. A questionnaire was developed to examine surgeons' training and experience and their preferences for classification of femoral neck fractures by consulting five orthopaedic surgeons in Canada and the United States, and the previous literature. The Garden classification was the preferred femoral neck fracture classification for 72% of all the surveyed surgeons (n=298). Only 39% of all the surveyed surgeons believed they were able to distinguish all four Garden fracture types. However, 96% of the surgeons felt they could differentiate between undisplaced (Garden I/II) and displaced (Garden III/IV) fractures. High variability in the surgeons' perceptions of the Garden classification system provides a rationale for discontinuing the use of this system in daily practice.

Adult↗
PubMed1993

Ununited femoral neck fractures by open reduction and vascularized iliac bone graft.

Neglected femoral neck fractures are frequently complicated with nonunion and avascular necrosis of the femoral head. The treatment is especially difficult in young adults because arthroplasty is not indicated. Five cases of neglected femoral neck fractures in young patients were treated by open reduction and internal fixation with pins. The defect of the femoral neck was filled with a block of vascularized iliac bone graft. After at least two years, the fractures were healed without avascular necrosis of the femoral head. The leg-length discrepancy was corrected in all but one case. The pedicled iliac graft provided a viable bone graft, which maintained the viability of the head and hastened fracture healing.

Adolescent↗
PubMed1987

Vitamin D metabolism in women with femoral neck fracture.

Abnormalities in plasma vitamin D metabolites and an increased prevalence of osteomalacia have been described in elderly patients sustaining a fracture of the femoral neck. In order to investigate whether the plasma concentrations of the vitamin D metabolites are normal, and whether vitamin D deficient osteomalacia in patients with femoral fracture can be diagnosed using biochemical criteria alone, we have studied before and after 7 days of 40 micrograms oral 25-hydroxyvitamin D3 elderly patients admitted to hospital with a femoral fracture, elderly patients undergoing elective replacement of the femoral head and elderly control patients in hospital with no clinical evidence of bone disease. Plasma 25-hydroxyvitamin D (25(OH)D) and 24,25-dihydroxyvitamin D increased after 7 days of oral 25-hydroxyvitamin D3 to the same levels in the three groups, but in contrast to the controls there was no significant increase in plasma 1,25-dihydroxyvitamin D or radiocalcium absorption in femoral fracture and hip replacement patients. However, when femoral fracture patients were restudied 6-12 months after fracture, plasma 1,25-dihydroxyvitamin D increased after oral 25-hydroxyvitamin D3 to the same extent as it had in the control patients. We conclude that reduced calcium absorption due to low plasma 25(OH)D levels, i.e., vitamin D insufficiency is common in all elderly patients. Furthermore biochemical criteria for diagnosis of vitamin D-deficient osteomalacia are of very limited use at the time of fracture in elderly patients since there is a failure of production of 1,25 dihydroxyvitamin D which resolves within 6-12 months of the fracture. This failure makes the 1,25-dihydroxyvitamin D response to oral 25(OH)D an unreliable guide to the presence of vitamin D-deficient osteomalacia at the time of fracture. The abnormality in 1,25-dihydroxyvitamin D is also present in patients undergoing hip replacement surgery, and is therefore unlikely to be involved in the aetiology of femoral neck fracture. It may, however, contribute to the morbidity after fracture.

24,25-Dihydroxyvitamin D 3↗
PubMedDate not supplied

Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery.

This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years' follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.

Adult↗
PubMed1987

[Comparative results of compression and non-compression operation methods following medial femoral neck fracture].

This is a personal clinical and radiological follow-up of 65 patients with fractures of the femoral neck who were treated in 1973 to 1984 at our hospital. 30 patients were operated by nailing according to Smith-Petersen and in 35 patients osteosynthesis was performed by means of three or four lag screws. A comparative study between these two methods was done. The two main complications of femoral neck fracture, a vascular head necrosis and pseudarthrosis, were of special interest. The mean follow-up time was 7.2 years with the fracture fixed by nailing and 4.1 years, with the fractures operated by lag screws. Out of the 65 patients the total rate of femoral head necroses was 21.5% and 10.7% of pseudarthrosis. In the fractures treated by the nailing method the rate of necrosis was 23.3% and the rate of pseudarthrosis 13.3%. In the fractures operated by lag screws the incidence of head necrosis was 20% and 8.5% by pseudarthrosis. Fracture displacement was primarily responsible for the development of aseptic necrosis, but we could see also a relation between head necrosis and the inclination of the fracture line. Fractures of the type PIII/GIII/IV are those with the highest rate of avascular necrosis. Furthermore, the development of both, aseptic necrosis and pseudarthrosis, is strongly influenced by incomplete reduction.

Adult↗
PubMed1996

Femoral neck fractures in the elderly patient: a preventable injury.

There is growing evidence that many fractures of the femoral neck in the elderly occur spontaneously because of stresses imposed on osteoporotic bone, rather than because of the trauma of the fall. A case of a spontaneous femoral neck fracture (Garden type IV) in an elderly woman with osteoporosis is presented. Early detection and medical management of osteoporosis complemented with assistive technology could have prevented this common injury.

Aged↗
PubMed1987

[Results of osteosynthesis of medial femoral neck fractures with the angled plate].

Among 82 patients still alive after osteosynthesis of femoral neck fractures between 1974 and 1983, 67 (i.e. 81.7%) were controlled clinically and radiologically. The average follow-up period was 57.0 months. The average age of 36 men was 45.3 years, the average age of 31 women was 56.1 years. Fractures were divided in lateral and medial femoral neck fractures, the medial fractures were classified according to Pauwels and Garden. The rate of avascular head necrosis mounted 20.7%, the rate of non union 13.8%. Both complications were dependent on the type of fracture. Besides reduction and impaction of fragments time of operation proved to be important: In 37 fractures type Garden III and IV the rate of avascular head necrosis was 3-fold higher after secondary osteosynthesis than after emergency operation at the day of accident. Our concept in treatment of femoral neck fractures is based on these factors: Emergency operation, decompressive capsulotomy, valgus reduction, impaction of the fragments and internal fixation to allow movement.

Adult↗
PubMed2000

Transesophageal echocardiography and clinical features of fat embolism during cemented total hip arthroplasty. A randomized study in patients with a femoral neck fracture.

Forty patients suffering from a medial femoral neck fracture participated in a prospective, randomized study. In 20 patients, the femoral component was cemented using a contemporary technique. In the patient group operated on with the bone vacuum technique, the medullary cavity was drained during the insertion of the stem. The proximal draining hole was placed in the intertrochanteric region, along the prolongation of the linea aspera. The distal hole was placed 2 cm below the tip of the femoral component. Embolic phenomena were documented intraoperatively by continuous transesophageal echocardiographic imaging of the right atrium and ventricle. The clinical relevance of the emboli was noted simultaneously by recording hemodynamic and blood gas parameters. Patients of the control group showed severer and longer-lasting episodes of embolism than patients of the bone vacuum group. Ongoing emboli were first seen during the injection of the cement, and continued during stem insertion. Massive emboli of small particles could be verified in 19 patients (95%) of the control group and in 1 patient (5%) of the bone vacuum group (P < 0.05). During massive emboli, a distinct decrease in the arterial oxygen saturation and the end-expiratory carbon dioxide level was observed. The calculated average pulmonary shunt volume showed an increase after the insertion of the stem using the contemporary technique (36.5%; P < 0.05). These distinct hemodynamic changes were not observed in the bone vacuum group. This study was able to show a clearly reduced risk of pulmonary emboli using the bone vacuum cementing technique. The presence of pre-existing disease greatly magnified the clinical relevance of fat embolism.

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PubMed1977

[Cephalic prostheses in femoral neck fractures: Comparison of immediate complications and late functional results of Moore's prosthesis and sealed prosthesis].

In this study the authors compared the mortality of fractures of the neck of the femur treated by femoral prostheses with early walking compared with trochanteric fractures treated by a nail plate and non-weight bearing activity for 2 to 3 months. The mortality in the two series (about 20 per cent) was the same. The authors then compared two series of fractures of the femoral neck, one treated by Moore's prosthesis without cement and the other by an alternative type of femoral prosthesis with cement. They conclude that the mortality was the same in the two groups but that the cemented prosthesis had better functionnal results. Long-term tolerance of the acetabulum was the same in the two types of prosthesis. Total hip replacement is very rarely indicated in recent fractures of the femoral neck.

Aged↗