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At least 217 records · Page 12Linked to original sources
PubMed2005

[Related factor analysis of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures].

OBJECTIVE: To observe the accident of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures and analysis of the related factors. METHODS: 212 cases of femoral neck fracture treated with cannulated screws between Sep. 1989 and Dec. 1999 were reviewed retrospectively. The average age was 45.2 years old, ranging from 13 to 70 years. Among the fractures, 3 were Garden stage I, 32 were Garden stage II, 107 were Garden stage III, 53 were Garden stage IV, and 17 unclassified. Average duration of follow-up was 32.7 months, ranging from 12 to 101 months. RESULTS: Fracture healing occurred in 203 cases (95.8%). Avascular necrosis of the femoral head occurred in 70 cases (33.0%) and late collapse developed in 30 cases (14.3%). The rate of the avascular necrosis and late collapse of the femoral head according to the Garden stage was 0/0, Garden stage I; 6.3%/0, Garden stage II; 33.6%/15.9%, Garden stage III; 49.1%/20.8%, Garden stage IV. Avascular necroses of the femoral head were observed within 3 years in most cases (95.7%). Correlation analysis shows Garden stage of the fracture was the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head. It also shows the low risk of avascular necrosis and late collapse of the femoral head was related to the patient's age over 60; time of surgery within 14 days and Garden's reduction index within 155-180 degrees on both AP and Lateral views. CONCLUSION: Garden stage of the fracture is the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head, emergency operation and good reduction is beneficial to reduce the accident of avascular necrosis of femoral head.

Adolescent↗
PubMed1995

[Medial femoral neck fracture--femur head preserving therapeutic concepts].

Intracapsular femoral neck fractures of patients younger than 65 should be treated by open or closed reduction and internal fixation with two to four lag screws. Garden I fractures should also be treated by percutaneous screw fixation to prevent a delayed dislocation. If the fracture is dislocated (Garden II-IV) immediate reduction and internal fixation is mandatory to improve the blood flow by "unkinking" of the supporting vessels. The rate of femoral head necrosis is about ten to fifty percent, according to the grade of posttraumatic dislocation. Early stages of total or partial femoral head necrosis can be successfully treated by vascularized cortical bone grafts. In our institute a graft vascularized by the quadratus femoris muscle is preferred. Valgisation osteotomy, alloarthroplasties and arthrodeses in very young people are performed in cases of irreversible total femoral head necrosis.

Adolescent↗
PubMedDate not supplied

Displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis.

Two patients had displaced femoral neck fractures at the bone-screw interface after in situ fixation of slipped capital femoral epiphysis. Both fractures required closed reduction and internal fixation. Inadvertent derotation of the femur occurred in both patients and allowed fixation of the fracture through the intramedullary canal of the femoral neck without anterior penetration of the pins into the joint; a nonunion occurred in this patient. The other patient developed chondrolysis and avascular necrosis. Because the femoral neck is vulnerable to stress fractures in young adults, there is some question whether pins placed anteriorly through the femoral neck cortex should be removed.

Adolescent↗
PubMed1994

Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures.

Hip fractures remain a major source of morbidity and mortality in the elderly, and their incidence is increasing as the population ages. Surgical management followed by early mobilization is the treatment of choice for most patients with hip fractures. However, all comorbid medical conditions, particularly cardiopulmonary and fluid- electrolyte imbalances, must be evaluated and stabilized prior to operative intervention. Nondisplaced femoral-neck fractures should be stabilized with multiple parallel lag screws or pins. The treatment of displaced femoral-neck fractures is based on the patient's age and activity level: young active patients should undergo open reduction and internal fixation; older, less active patients are usually treated with hemiarthroplasty, either uncemented or cemented. Regardless of treatment method, the goal is to return the patient to his or her prefracture level of function.

Journal Article↗
PubMed2006

Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: a prospective study of 683 patients treated with hemiarthroplasty or internal fixation.

BACKGROUND: Studies have shown that the degree of initial displacement and also comminution of the femoral calcar, size of the head and varus angulation are prognostic of failure in displaced femoral neck fracture. We have applied these radiographic criteria in order to select patients who would benefit from internal fixation as opposed to primary hemiarthroplasty, and this prospective study was conducted in order to monitor the results of this strategy. METHODS: 683 displaced fractures of the femoral neck were treated with internal fixation or primary hemiarthroplasty based on the proposed radiographic criteria in a prospective consecutive study, and the patients were followed for 1-6 years. We treated 228 fractures with internal fixation and 455 by bipolar hemiprosthesis. The choice of operation was based on clinical evaluation of the patient and assessment of the assumed healing potential of the fracture, as determined by radiographic evaluation. Revision and mortality were primary endpoints. RESULTS: 54 (24%) of the patients originally treated by osteosynthesis were revised, whereas 9 (2%) of the patients treated with hemiarthroplasty had revision surgery. There were no significant differences in mortality between the groups at 30, 120 or 365 days. INTERPRETATION: Even when treating only the fractures with the assumed best healing potential with internal fixation, the results are inferior to hemiarthroplasty.

Aged↗
PubMedDate not supplied

Scintimetric evaluation of complications after femoral neck fractures.

The primary surgical approach to the femoral neck fracture should be one with the lowest mortality and morbidity. Internal fixation appears to be the safe and logical approach for most of the reducible intracapsular fractures. Careful follow-up of these patients then is important. 85Sr scintimetry is a simple and accurate method in the early detection and evaluation of secondary complications in these patients. The 85Sr scintimetric pattern in the normal healing process was defined in relation to time interval after the fracture. At any time after 4 months following fracture, those hips destined for osteonecrosis, with or without non-union, showed significantly more radionuclide uptake over the femoral head than those hips which healed normally. In non-union there was a trend toward increased counts over the fracture site during 6 to 18 months after fracture, but no such tendency was noted in other periods.

Adult↗
PubMed2001

Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness.

The optimal treatment for displaced femoral neck fractures in elderly patients is a matter of controversy. Four surgical options are well supported in the orthopaedic literature: reduction with internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty. Based on a review of the outcomes literature regarding treatment of femoral neck fractures and a cost-effectiveness analysis, an algorithm for surgical treatment of displaced femoral neck fractures in elderly patients is presented. Cost-effectiveness analysis of these four surgical treatment options shows that arthroplasty is the most cost-effective treatment when complication rate, mortality, reoperation rate, and function are evaluated during a 2-year postoperative period. These data were strongly supported by a two-way sensitivity analysis that varied the effectiveness of the interventions and the costs. Literature derived outcome studies show that elderly patients with displaced femoral neck fractures achieve the best functional results with a well healed femoral neck without osteonecrosis after reduction and internal fixation. Achieving this result may be difficult, and it is not as cost effective as arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed1989

The effect of skeletal traction on femoral neck fractures.

Patients with fracture of the femoral neck often undergo skeletal traction until surgery. We found that the fracture position worsened in 5 of 15 patients during the period with skeletal traction. Accordingly, skeletal traction does not prevent further vascular damage to the femoral head. We advocate operating as soon as the patient's condition is stable.

Aged↗
PubMed1984

Comparison of skeletal and bone marrow radionuclide scintimetry of femoral neck fracture.

Twenty-six patients with late complications following femoral neck fracture were examined with both skeletal and bone marrow radionuclide scintimetry. There was no correlation between the methods with respect to the quantitative assessment of femoral head vascularity based on different uptake ratios comparing the fractured and the intact side. Skeletal scintimetry always had good image quality and permitted reliable differentiation between nonunion of the fracture and late segmental collapse, in contrast to bone marrow scintimetry which gave poor image quality. Skeletal scintimetry thus seems superior to bone marrow scintimetry for assessment and differential diagnosis of late complications following femoral neck fracture. It is emphasized that the physiological mechanisms for radionuclide uptake must be taken into account when comparing scintimetric studies using different tracers.

Aged↗
PubMed1975

Primary prosthetic replacement in acute femoral neck fractures.

This paper reports a retrospective study of acute femoral neck fractures in 123 patients treated by primary prosthetic replacement. The average age in our patient population was 80-5 years. A Christiansen trunnion-bearing hip prosthesis (Christiansen, 1969 and 1974) was used in all patients except one. The prosthesis was cemented to the femoral shaft. The postoperative mortality rate was low, and the mortality rate was 8-7 per cent. The patients were examined between 6 months and 3 1/2 years after operation. Excellent or good results according to Stinchfield's hip assessment system (Stinchfield et al., 1957) were obtained in 82 per cent of the patients. We suggest that primary prosthetic replacement in acute femoral neck fractures in elderly patients is a safe and valuable procedure. However, a definite conclusion concerning this therapy cannot be drawn before a prospective study comparing the results of internal fixation and primary prosthetic replacement is made.

Acute Disease↗
PubMed1982

Femoral neck fractures in young adults.

Seventeen young adults with subcapital femoral neck fractures that occurred after injury and with no signs of osteoporosis were treated conservatively (2 cases) or by closed reduction and internal fixation. Evaluation of the results was based on clinical, radiological and scintigraphical examinations. The incidence of non-union was 24 per cent (4/17) and the incidence of avascular necrosis of the femoral head was 41 per cent (7/17). The total failure rate was 41 per cent as all fractures with non-union also had avascular necrosis. It was found that reduction was the most important factor determining the outcome, as only 17 per cent (2/12) of fractures with a good reduction subsequently developed non-union compared with 100 per cent (5/5) with malreduction. High-velocity injury was no more crucial than low-velocity injury. The final outcome of femoral neck fractures in young persons did not differ from the known outcome in elderly persons.

Adolescent↗
PubMed1994

[Clinical analysis of femoral neck fracture in 188 adult cases].

There were 188 cases of femoral neck fracture of adult below the age of fifty-five years old admitted to our hospital from 1974 to 1989, including 152 cases of fresh fracture, 36 old fracture. The rate of femoral head necrosis after fracture was 11.8 percent in the group of patients under fifty years of age, and 9.8 percent in patients between fifty-one and fifty five years old. The operation adopted in our series was mainly the percutaneous screw-thread pinning for internal fixation. Bone graft transplantation with the pedicle of quadratus femoris muscle was simultaneously performed in some cases, 26.7 percent in patients between the age of fifteen and twenty, along with the increase of age the patient number for transplantation decreased, only 7.8 percent in patients between the age of fifty-one and fifty-five. The author suggests that in treatment of femoral neck fracture of adult generally should not consider the use of artificial prosthesis replacement. We should decide according to the patients general and local status as the basis for the choice of a reasonable internal fixation, and consider whether an operation should be performed to further improve blood circulation of the femoral head.

Adolescent↗
PubMedDate not supplied

Technetium-99m-methylenediphosphonate scintimetry after femoral neck fracture. A three-year follow-up study.

Thirty-nine patients with femoral neck fractures were followed up clinically and radiographically by technetium-99m-methylenediphosphonate (99mTc-MDP) scintimetry two to 20 days and four, eight, 12, 24, and 36 months after surgery or until redisplacement, pseudarthrosis, or segmental collapse occurred. The scintimetric data were calculated by selecting regions of interest on the fractured and intact sides over the femoral head, neck, greater trochanter, and shaft; ratios of fractured/intact side were obtained for each region. Bone metabolism after femoral neck fracture was expressed and analyzed numerically. Prognosis regarding the course of healing could be made with precision by studying femoral head isotope activity shortly after surgery, preferably one to three weeks after operation. Intact femoral head uptake (ratio greater than 1.0) was connected with uneventful healing, while defective uptake (ratio less than 1.0) was observed with healing complications. The vast majority of femoral heads with primary uptake defects showed increased uptake (greater than 1.0) after four months, often as early as six to eight weeks, indicating revascularization. Segmental collapse, as well as redisplacement and pseudarthrosis, appear to be related to femoral head vascular injury. Femoral head uptake in patients in whom healing complications developed secondary to avascularity differed significantly from that in patients with normal healing, except at investigations performed four to eight months after operation. 99mTc-MDP uptake in the femoral neck, trochanter, and shaft areas was increased for all femoral neck fractures. Subsequent normalization was considerably slower in patients with healing complications. A significant difference from normal healing did not occur until 12-24 months after operation. For patients with contralateral hip disease affecting the femoral head ratio, the prognosis regarding complications was made with the aid of the femoral head/shaft ratio on the fracture side.

Adolescent↗
PubMed2004

Outcomes of total hip arthroplasty are similar for patients with displaced femoral neck fractures and osteoarthritis.

This study attempted to evaluate whether total hip arthroplasty for displaced femoral neck fractures had significantly different outcomes when compared with total hip arthroplasty for osteoarthritis. This is a retrospective study of 60 patients who had total hip arthroplasties between 1997 and 2001. Thirty patients (mean age, 79.7 years) had total hip arthroplasties for displaced femoral neck fractures; 30 patients (mean age, 76.9 years) were treated with total hip arthroplasties for osteoarthritis. The same surgeon used the modified lateral approach for all surgeries. All patients had radiographic assessment, physical examination, and evaluation with the Harris hip score. The mean followup was 38 months. The mean Harris hip score for the 25 patients treated with a total hip arthroplasty for a femoral neck fracture was 81 points; the mean hip score for the 27 patients treated with a total hip arthroplasty for osteoarthritis was 87 points. No statistically significant differences between these groups were observed. Patients who were treated with a total hip arthroplasty for a femoral neck fracture did not have increased perioperative morbidity compared with patients who had a total hip arthroplasty for osteoarthritis. This study suggests that the outcomes for total hip arthroplasties in this consecutive series of patients treated for displaced femoral neck fractures and osteoarthritis are comparable.

Aged↗