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PubMed1986

[Initial experience using the dynamic hip screw in osteosynthesis of femoral neck fractures].

We report about our first experience in 16 patients with femoral neck fractures, operated upon with the dynamic hip screw. All fractures united within three to six months, early avascular necrosis did not occur. In the concept of treatment of femoral neck fractures osteosynthesis with dynamic hip screw has some advantage, especially compared with the AO-nail plate: Easy correction of the guide wire position, sufficient impaction of the fragments by using the compression screw, low risk of penetration into the acetabulum during fracture healing with shortening of the femoral neck.

Adolescent↗
PubMed1993

[Bone scintigraphy in assessment of risk of complications after medial femoral neck fractures].

The value of visually evaluated bone scintigraphy in predicting postoperative non-union and avascular necrosis was examined in a prospective, consecutive series of patients with intracapsular fracture of the femoral neck. 49 patients had scintigraphy carried out preoperatively, and 37 postoperatively. In 18 scintigraphy was done preoperatively as well as postoperatively. The patients were followed clinically and radiographically for at least two years after operation. In the preoperative group 19 patients had been excluded at follow up and 13 patients in the postoperative group. The results indicate a high correlation between a reduced uptake of isotope in preoperative scintigraphy and development of late complications in these patients. It is concluded that visually evaluated preoperative planar scintigraphy is of value in selecting those patients with intracapsular femoral neck fractures, who are at risk of developing late complications.

Aged↗
PubMed1989

A review of reduction and internal fixation of adult femoral neck fractures in a county hospital.

Treatment of femoral neck fractures at a county hospital, Parkland Memorial Hospital, Dallas, Texas, from 1978 to 1983 was reviewed. A study of the use of the quadratus femoris muscle-pedicle graft (MPG) as adjunctive treatment to open reduction and internal fixation (ORIF) was in effect during that time. Patients who had primary prosthetic replacement of their femoral head were not included in the study. Two groups of patients were identified, one group that had ORIF without a muscle-pedicle graft (no-MPG) and another group that had ORIF with a muscle-pedicle graft (MPG). There were a similar number of patients in each group (MPG = 25 patients, no-MPG = 24 patients). Although the groups were not exactly similar, the overall outcome was unexpected. The no-MPG group had 76% good-to-excellent results whereas the MPG group had only 24%. A poor result or outright failure of the technique occurred in 68% of the MPG group and in only 16% of the no-MPG group. No accurate assessment of the incidence of avascular necrosis of the femoral head could be made.

Adolescent↗
PubMed2006

The role of postoperative blood recovery for patients with femoral neck fracture.

Postoperative blood recovery in eighty elderly patients (11 male, 69 female) treated for femoral neck fracture was prospectively studied. Twenty-eight patients underwent hemiarthroplasty for intracapusular fracture and 52 underwent Dynamic Hip Screw fixation for extracapsular femoral neck fracture. The mean blood drainage in the postoperative period and the mean drop in haemoglobin level was higher in the DHS group as compared to the hemiarthroplasty group. Mean drainage in the first 6 postoperative hours was 150 ml (range: 10-450 ml) in the DHS group, versus 50 ml in the hemiarthroplasty group (range: 10-100 ml). Out of 52 cases of the dynamic hip screw fixation group, only 10 patients received autologous blood transfusion (19%), among which the drains collected more than 150 ml in only 4 (7%). The blood drainage in this group occurred in the first 6 hours only. Supplementary cross matched bank blood was transfused to patients in the DHS group (8%). Among 28 patients in the hemiarthroplasty group, only 6 patients received autologous blood reperfusion (21%), among which the drains collected more than 150 ml in only 4 (14%). Overall, only six patients out of 28 in the hemiarthroplasty and 10 out 52 in the DHS group had enough blood in their drains to warrant re-perfusion. We conclude that the routine use of Bellovac drains after femoral neck fracture surgery is not necessary and is not cost effective.

Adult↗
PubMed1999

Prosthetic replacement in the management of unstable femoral neck fractures in the elderly. Analysis of the mechanical complications noted in 778 fractures.

From 1987 to 1996, 778 unstable fractures of the femoral neck Garden type III or IV in 736 patients over 70 years of age have been treated surgically. Based on age and functional preinjury status, 477 patients were treated with a hemiarthroplasty; a total hip prosthesis was implanted in another 301 patients. The overall mortality rate at one year was 20%. Of the 472 surviving patients pre-operatively classified as "independent", 68% regained an independent active level; in the remaining 32%, the femoral neck fracture caused an important additional impairment. One also has to admit that the complications after prosthetic replacement are not harmless: dislocation (2%) requiring an early revision arthroplasty in about half of the cases; deep infection (< 1%) leading to a Girdlestone situation and sometimes even to death. It is generally accepted that, if prosthetic surgery is chosen, the best implant for this category of patients is a bipolar system. Despite good functional results observed after total hip arthroplasty for fractures, we recommend this technique only in selected cases. The risk for prosthetic loosening is also much higher after replacement for fracture than after replacement for osteoarthritis (at least 14% within 5 years). Nevertheless, we prefer a total prosthesis implant in patients with a good life expectancy and good functional condition, aged between 70 and 80 years, presenting a severely displaced unstable fracture.

Activities of Daily Living↗
PubMed1986

Improved operations for femoral neck fracture. A radiographic evaluation.

A radiographic investigation was undertaken to determine whether an increased interest in femoral neck fractures improved the operative result. In 1977, all femoral neck fractures were operated on by any of 30 surgeons of the orthopedic department, but in 1981 all fractures were operated on by one of six specially devoted surgeons. Preoperative fracture classification was performed with three parameters and proved equal in the 1977 and 1981 groups of 105 and 114 fractures, respectively. The quality of fracture reduction, determined with four parameters, was improved somewhat. The position of the nail(s), also determined with four parameters, improved considerably. The technical result was better in Garden IV fractures than in Garden III fractures. An increased interest in femoral neck fracture treatment improved reduction and fixation.

Bone Nails↗
PubMed2003

Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures.

We retrospectively reviewed 84 patients who underwent internal fixation of an intracapsular femoral neck fracture. The mean age was 58 years and the time from injury to operative treatment was 5.3 days. The mean follow-up was 4.7 years (range, 2-8 years). At the latest follow-up, in the 46 patients with undisplaced (Garden I, II) fractures, nonunion occurred in two patients and avascular necrosis of the femoral head in nine. Six of these nine patients had a good or excellent result, one had a fair result, and two had a poor result. Of 35 patients with no sign of avascular necrosis, 32 patients had a good or excellent result, two a fair and one had a poor result. In the group of 38 patients with displaced (Garden III, IV) fractures, nonunion occurred in six patients and avascular necrosis of the femoral head in 15. Of these 15 patients, 10 had a good or excellent result, two had a fair result, and three had a poor result. Of 17 patients with no sign of avascular necrosis, 14 had an excellent result and three patients a poor result. Overall only five of the 24 patients who developed avascular necrosis of the femoral head had undergone total hip arthroplasty. Internal fixation remains a simple and safe, method of treatment for both undisplaced and displaced femoral neck fractures in middle-age patients. Despite the relatively high rate of avascular necrosis after internal fixation of femoral neck fractures, only a few of these patients (20%) required further surgical treatment in the follow-up period of this study.

Adolescent↗
PubMed2003

Spontaneous bilateral femoral neck fractures in a young adult with chronic renal failure.

Pathologic femoral neck fracture due to renal osteodystrophy is rare. We report the case of a young adult patient with chronic renal failure who presented with bilateral spontaneous femoral neck fractures due to renal osteodystrophy. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure is discussed.

Adult↗
PubMed1991

Senile osteoporosis and femoral neck fractures in long-stay institutions.

The incidence rates of femoral neck fractures, one of the most serious complications of senile osteoporosis, were 8.7-9.4 times greater in old people in long-stay institutions than among old people living at home. The relative proportion of fracture patients admitted from long-stay institutions was four times greater than expected. Operative intervention of femoral neck fracture patients seemed to be successful: 85.4%-88.5% of patients were discharged to the environments from which they had been admitted.

Aged↗
PubMed1963

Femoral neck fractures in the aged.

Clinical data were reviewed on 99 patients with 102 fractures of the femoral neck on the Orthopedic Service of the San Diego County General Hospital. All were elderly. Twenty-one were dead within two month of the time the fracture was reduced and 36 within a year. In 14 cases the fracture was impacted or undisplaced; there was only one of these in which the fracture did not unite following treatment, and that was for iatrogenic reasons. Sixty-one per cent of the displaced fractures healed; only 32 per cent of the total number of patients with displaced femoral neck fractures walked again.

Aged↗
PubMed1996

Complications in surgical treatment of undisplaced femoral neck fracture.

BACKGROUND: Percutaneous Knowles' pinning is a well accepted treatment of undisplaced femoral neck fracture, but there are some complications that have seldom been discussed. METHODS: One hundred and eighty two patients with undisplaced femoral neck fractures, at a mean age of 67 years, were treated by percutaneous Knowles' pinning between 1983 to 1989, and followed for an average of 102 months. The clinical results and complications were evaluated. The data were collected on the basis of age and bone density. Student's t-test was used to evaluate the significance of the results. RESULTS: The mean union time was 20 weeks. In all the patients, 85.8% had good results, 3.8% patients had acceptable results and 10.4% patients had poor results. Old age (> or = 65 years) and osteoporosis (Singh index < or = 3) were two factors of the poor result. Thirty-two cases (17.6%) developed complications. The incidence of nonunion or implant problems was apparently higher in the older or osteoporosis group, but avascular necrosis of femoral head correlated little with old age or osteoporosis. CONCLUSIONS: Although percutaneous Knowles' pinning is simple, safe, economic and reasonably effective for the treatment of undisplaced femoral neck fractures, we should pay more attention to the uncooperative, old, and osteoporotic patients.

Adult↗
PubMed2002

[Reduction of severe cardiac complications during implantation of cemented total hip endoprostheses in femoral neck fractures].

Intraoperative circulatory and pulmonary problems occuring during the repair of femoral neck fractures with cemented hip arthroplasty are a common problem, that cannot be ultimately explained. As a possible reason for this problem is air embolism during the polymerisation of the methylmethacrylat discussed. We started a prospective randomised clinical examination with 72 patients to prove the efficiency of palacos mixed in vacuum, with respect to the reduction of severe cardiovascular complication during endoprosthetic repair of femoral neck fractures. In the control group with 36 patients, surgical repair was performed with palacos mixed conventionally. In the second group (vacuum group), also consisting of 36 patients, surgical repair was performed with palacos mixed in vacuum. Invasive hemodynamic monitoring and transesophageal echocardiography was performed in all cases. In the control group pulmonary embolism occurred echocardiographically in 86% of the cases vs. 14% in the vacuum group. 53% of the control patients--vs. 11% of the vacuum patients--showed clinical complications in form of significant decrease of arterial oxygenation and circulatory insufficiency with the need of catecholamines. Clinical complications occurred in the control group in 80% of the patients--vs. 13.7% in the vacuum group--whose pulmonal arterial pressure was higher than 30 mmHg preoperatively and only in 18.8% of the cases--vs. 7.1% in the vacuum group--with a normal pulmonal arterial pressure. Mortality in the control group amounted to 13.8% in the vacuum group to 2.8%. Through the use of methylmethacrylate mixed in vacuum for surgical repair of femoral neck fractures with cemented hip arthroplasty, the incidence of severe cardiac complications could be reduced significantly. Patients with increased pulmonal arterial pressure have the highest risk for cardiac complications.

Aged↗
PubMedDate not supplied

Use of the Giliberty bipolar endoprosthesis in femoral neck fractures.

Thirty-three patients (average age, 78.9 years) with femoral neck fractures were treated with Giliberty bipolar prosthesis inserted through a posterior approach. There were four procedure-related deaths. Nine patients required readmission for treatment of complications including five patients with a dislocated prosthesis and two with a disassembled prosthesis. The average hospital stay was 30.2 days. Varus position of the cup is a possible cause of component disassembly. This prosthesis is probably unsuitable in the elderly patient with a femoral neck fracture.

Aged↗
PubMed1990

Femoral neck fractures in patients receiving long-term dialysis.

The morbidity and mortality of 11 femoral neck fractures were analyzed to compare operative and conservative management of femoral neck fractures in dialysis patients. All fractures occurred in older men with severe cardiac, pulmonary, gastro-intestinal, and neurologic conditions and with advanced renal osteodystrophy. Six of the seven operated patients survived the surgery and achieved varying degrees of ambulation. Stability of the operated hip was excellent in each case. Post-operative complications included transient confusional state related to narcotics, pneumonia, decubitus ulcers, and severe hypoalbuminemia. All four patients who were managed conservatively died from complications of the fracture. Progressive deterioration was noted in each nonoperated patient, with confusion caused by narcotics and analgesics, pneumonia, hepatic coma, decubitus ulcers, severe depression, and severe hypoalbuminemia. Therefore, operative management was superior to conservative management for femoral neck fractures of patients receiving chronic dialysis with multiple medical problems and advanced renal osteodystrophy. Narcotics must be used with great caution, and efforts should be directed toward prevention of malnutrition and decubitus ulcers.

Aged↗
PubMed1995

Shepherd's crook deformity with an intracapsular femoral neck fracture in fibrous dysplasia.

A shepherd's crook deformity with an intracapsular femoral neck fracture in the fibrous dysplasia of a 19-year-old woman is reported. The deformity and fracture were treated by bone grafting using a single fibula through the femoral neck to its head, and corrective valgus osteotomy. Blood flow measurement using electrochemically generated hydrogen clearance was useful in evaluating avascular necrosis of the femoral head affected by tumorous tissue. Osteosynthesis combined with a fibular graft, and corrective valgus osteotomy after proper evaluation of the blood flow in the femoral head, is a reliable procedure for the treatment of shepherd's crook deformity associated with an intracapsular femoral neck fracture.

Adult↗
PubMed2003

[Clinical results of hemiarthroplasty for femoral neck fracture].

UNLABELLED: Subsequent clinical results of hemiarthroplasty for the femoral neck fracture over 80 years old was examined. SUBJECTS AND METHODS: One hundred and sixteen post-op. femoral neck fractures (22 males and 94 females, mean age 86 y.o.) were included in this series. Investigation in each case was done about 10 factors (see the article) which might deteriorate post-op. mobility and mortality. RESULTS: In 74.2% of all cases in which 45.5% with senile dementia and 86.7% without senile dementia were included, ability to walk was maintained after the operation with variable degree. In 65 cases without senile dementia, ability to walk after operation was doomed by low degree of ability to walk before the injury, comparable long waiting periods till the operation and consumed condition against some post-op. inflammated complications. The post-op. mortality within 3 months was 3.5% of all cases and 1.5% without senile dementia. DISCUSSION: Since approximately half of the patients with senile dementia completely lost their gait after the operation, even if they could before the injury, an alternative approach which is not aimed to achieve the impractical gait might be needed for such patients. To achieve of better functional and vital prognosis, patients without senile dementia should be operated as soon as possible and organized their pos-op. general conditions intensively.

English Abstract↗