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PubMed2000

Treatment of subcapital femoral neck fractures with bioabsorbable or metallic screw fixation. A preliminary report.

BACKGROUND AND AIMS: Cancellous bone fractures and arthrodeses have been treated successfully with bioabsorbable polyglycolide and poly-L-lactide implants. In this study bioabsorbable poly-L-lactide lag screws and metallic screws were compared in the fixation of subcapital femoral neck fractures. PATIENTS AND METHODS: Forty patients with femoral neck fractures were treated by internal fixation using three bioabsorbable self-reinforced poly-L-lactide (SR-PLLA) lag screws of 6.3 mm in diameter and 38 patients using three metallic screws of 7 mm in diameter. In addition, one patient was operated on using two and one using four metallic screws. The patients did not differ in age, body weight or primary dislocation of the fracture. There were six males in the lactide group versus 14 in the metallic fixation group. There were two Garden Stage I, 27 Garden Stage II, nine Garden Stage III, and two Garden Stage IV fractures in both groups. RESULTS: In the Garden I and II fractures there were 5/29 redislocations after SR-PLLA fixation and 8/29 after metallic fixation. In the Garden III fractures there were 4/9 and in the Garden IV fractures 2/2 redislocations in both groups. The ability to walk and the range of movement were better after bioabsorbable fixation. CONCLUSION: Self-reinforced poly-L-lactide lag screws can be used safely to fix subcapital femoral neck fractures in Garden Stage I and II fractures and in younger patients in Garden III fractures.

Absorbable Implants↗
PubMed1984

Vitamin D and femoral neck fractures in elderly South Australian women.

The vitamin D status of women with femoral neck fractures and of male and female nursing-home residents in South Australia was assessed and compared with that of ambulant normal elderly women and young male and female controls. Serum 25-hydroxyvitamin D (25OHD) was assayed with a competitive protein-binding method including a chromatography step. The mean serum 25OHD levels in the patients with femoral neck fractures (39.2 [SE 2.6] nmol/L) and in the nursing-home residents (28.9 [SE 1.3] nmol/L) were significantly lower than those in the ambulant elderly women (67.6 [SE 3.9] nmol/L) and young controls (76.9 [SE 3.7] nmol/L) (P less than 0.001 in each case). The serum 25OHD levels were unrelated to age in the normal ambulant subjects. There was a significant seasonal variation in the results of routine 25OHD assays performed in our laboratory, but no such variation was seen in the nursing-home residents. We conclude that vitamin D deficiency is common in housebound subjects, and that femoral neck fractures occur mainly in subjects who were housebound before the fracture.

Adult↗
PubMed1986

The cardiac pacemaker patient with a femoral neck fracture.

More than half the patients with permanent cardiac pacemakers (PCPMs) are over the age of 70 years. Patients in this age group are also more susceptible to fractures of the femoral neck requiring surgical intervention. The authors studied five patients with PCPMs who underwent surgery for femoral neck fracture. They discuss the special precautions necessary during surgery to prevent electromagnetic interference with the cardiac pacemaker as well as the special management of these patients.

Aged↗
PubMed2003

Relevance of primary reduction for the clinical outcome of femoral neck fractures treated with cancellous screws.

INTRODUCTION: Femoral head-preserving treatment for femoral neck fractures with cancellous screws is a method widely performed, but its success depends on the quality of primary reduction. The goal of our study was to evaluate the relevance of reduction quality on the clinical outcome. PATIENTS AND METHODS: We retrospectively analyzed the postoperative reduction result of 39 patients. The angular rotation and the inferior displacement of the proximal fracture fragment were digitally assessed from AP radiographs. The clinical outcome was recorded by a follow-up after a mean 5.5 years. RESULTS: Unsuccessful healing was observed in eight patients, femoral head necrosis in three patients, non-union in two patients, implant loosening in one patient, and posttraumatic arthritis in two patients, all resulting in the need for a total hip replacement. This clinical course was strongly associated with a primary reduction in varus position, whereas reduction in anatomic or valgus angulation had no negative effect on the clinical outcome. An inferior offset was no negative predictor for successful healing. CONCLUSION: We conclude that a non-anatomic reduction in varus angulation significantly increases the risk of healing failure and therefore should be avoided. Reduction in valgus position should be performed if secondary redislocation is imminent.

Adult↗
PubMed1993

Factors predicting healing complications in femoral neck fractures. 138 patients followed for 2 years.

We have previously studied the radiographic outcome of femoral neck fracture osteosynthesis with either two hook-pins or a four-flanged nail performed by a small group of surgeons with special interest in the methods. In 138 femoral neck fractures a backwards stepwise logistic regression analysis was used to study the significance of preoperative fracture-related factors, intraoperative factors and the osteosynthesis. The development of non-union/redisplacement and segmental collapse of the femoral head was influenced by fracture displacement (P 0.001) and method of osteosynthesis (P 0.007). The postoperative scintimetric ratio was influenced by the method of osteosynthesis (P 0.0003), fracture displacement (P 0.004) and by the presence of a posterior fragment (P 0.03). Reduction of the fracture and positioning of the osteosynthesis were to a large extent within the accepted limits. This may explain why the previously well documented negative effects of malpositioning of the osteosynthesis and inferior reduction were not demonstrated to influence the rate of healing-complications. We conclude that neither patient age, sex nor preoperative fracture variables, with the exception of the extent of fracture displacement, can be used to predict radiographic healing-complications in femoral neck fractures.

Adult↗
PubMedDate not supplied

Early prediction of avascular necrosis of the femoral head following femoral neck fractures.

The treatment of acute fracture of the femoral neck remains an unsolved problem. Fifty-three patients are presented using 99mTc phosphate scintigraphy with quantitative computer interpretation to predict the viability of the femoral head following acute fracture. The accuracy of prediction was 92.5%; the scans were incorrect in four patients. Armed with a safe, simple diagnostic procedure and a greater than 90% accurate prognosis, a rational program of treatment can be prescribed for the individual patient.

Adolescent↗
PubMed2005

Total hip replacement for the treatment of femoral neck fractures. Long-term results.

OBJECTIVE: To evaluate the outcome of total hip replacement after femoral neck fractures and analyze implant survival rates, complication rates, and mortality after surgery. MATERIAL AND METHODS: We analyzed 135 primary hip replacements and 8 revision hip replacements performed in 1991-2003 years. Femoral neck fracture was the diagnosis for all primary hip replacements. All patients we analyzed prospectively: special form was filled in for every patient participating in the study. Personal data, operation data, revision date, diagnosis and complications were recorded. Personal patient's identification number was used to determine the death date if it was present, and it was checked if the patient was operated on in other orthopedic centers. Study ended up on 31st of December, 2003. RESULTS: Total cumulative implant survival rate was 92% and 94% for revision because of aseptic loosening 10 years postoperatively. Stem survival was 95% for revision because of aseptic loosening. Cup survival was 94% for revision because of aseptic loosening. Implant type had no influence on survival rates. Dislocation rate after hip replacement was 10%. Mortality was 25% at the end of the follow-up. CONCLUSIONS: Total hip replacement after femoral neck fracture showed high implant survival and low additional surgery rate. Total hip replacement after femoral neck fracture was associated with high dislocation rate. Low patient's mortality rate was associated with relatively lower mean patient's age.

Adult↗
PubMed1997

[Quantitative CT assessment of the proximal femur. Experimental studies on its correlation with breaking load in femoral neck fractures].

PURPOSE: In an experimental study, the correlation between the trabecular bone density of the different regions of the proximal femur and the fracture load in the setting of femoral neck fractures was examined. METHODS: The bone mineral density of 41 random proximal human femora was estimated by single-energy quantitative CT (SE-QCT). The trabecular bone density was measured at the greatest possible extracortical volume at midcapital, midneck and intertrochanteric level and in the 1 cm3 volumes of the centres of these regions in a standardised 10 mm thick slice in the middle of the femoral neck axis (in mg/ml Ca-hydroxyl apatite). The proximal femora were then isolated and mounted on a compression/bending device under two-legged stand conditions and loaded up to the point when a femoral neck fracture occurred. RESULTS: Statistical analysis revealed a linear correlation between the trabecular bone density and the fracture load for the greater regions, with the highest value in the maximal area of the head (coefficient factor r = 0.76). CONCLUSION: According to our data, the measurement of the trabecular bone by SE-QCT at the femoral head is a more confident adjunct than the neck or trochanteric area to predict a femoral neck fracture.

Adult↗
PubMed2004

Femoral head preservation in non-united femoral neck fracture and head osteonecrosis in Cushing's disease.

There have been few reports associating avascular necrosis of bone with Cushing's disease. Patients with Cushing's disease and avascular necrosis of the femoral head usually receive total hip arthroplasty. However, hip prosthetic replacement in younger patients has been criticized due to a high incidence of component loosening. We report a case of successful femoral head preservation in non-united femoral neck fracture and head osteonecrosis in a 14-year-old girl with Cushing's disease (adrenocorticotropic hormone-secreting pituitary adenoma) who developed avascular necrosis of the right femoral head and pathologic fracture of the right femoral neck 2 years after the onset of hypercortisolism. Subtrochanteric valgus osteotomy was performed to preserve the femoral head after successful transsphenoidal surgery to remove pituitary microadenoma. At follow-up 10 years after the osteotomy, the femoral head had revascularized and the femoral neck fracture were united with much improvement of hip function. Dual energy X-ray absorptiometry scan of the right hip showed +0.86 SD from the normal bone densitometry. Aggressive femoral head preservation may be an effective alternative to treat this rare situation in a teenager.

Child↗
PubMed1986

Percutaneous Neufeld pinning for femoral neck fractures.

Percutaneous Neufeld pinning was performed for 32 femoral neck fractures in elderly medically debilitated patients (mean age, 75 years). The technical complications were minimal in the 25 impacted or nondisplaced fractures and in the seven displaced fractures. Although 23 of the 25 patients with impacted or nondisplaced fractures were ambulatory at a mean follow-up period of two years, none of the patients with displaced fractures achieved functional ambulation. Percutaneous Neufeld pinning may be considered for elderly, medically unstable patients with impacted or nondisplaced fractures, using no more than three pins. Some other internal fixation device, endoprosthetic arthroplasty, or another implant should be considered for displaced fractures.

Aged↗
PubMed1982

Serum levels of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D and parathyroid hormone in patients with femoral neck fracture in southern Finland.

Serum concentrations of 25-hydroxyvitamin D (25-OHD), 24,25-dihydroxyvitamin D [24,25(OH)2D] and immunoreactive parathyroid hormone (PTH) were determined in elderly patients with fracture of the femoral neck and in age-matched controls during summer, winter and early spring in southern Finland. The expected seasonal variation in 25-OHD values was observed in both patients and controls, though the patient group had significantly lower values during winter (P less than 0.02) and spring (P less than 0.01). The 24,25(OH)2D:25-OHD ratio remained constant in both patients and controls throughout the study. A significant negative correlation between PTH and 25-OHD values was found in the patient group. Thus, vitamin D deficiency may contribute to the high incidence of femoral neck fractures in elderly people, and the increased PTH activity, observed in many patients with these fractures, is secondary to vitamin D deficiency.

24,25-Dihydroxyvitamin D 3↗
PubMed1986

Femoral neck fractures: admissions, bed use, outcome and projections.

A number of epidemiological studies have shown that the incidence of femoral neck fractures in industrialized countries increases at an exponential rate with age and that age-adjusted incidence rates are approximately twice as high in women than in men. Femoral neck fractures often have serious consequences for the aged, including permanently limiting their mobility, which results in increased dependence on others and hence an increased probability of being admitted to an institution. In this study, hospital inpatient statistics for New South Wales were examined to elucidate age-related trends in admissions to hospital for acute care, length of stay, bed use and outcome of this condition. Projections of the number of persons expected to suffer from femoral neck fractures, the associated number of bed-days that are required and the expected cost of hospital care to the year 2011 have been made. It seems probable that hospital services will not be provided at the necessary rate to cater for the expected increase in bed use from femoral neck fractures and other age-related conditions. Therefore, rational planning of scarce hospital resources will be required. Reductions in acute care hospital bed use for patients with femoral neck fractures could be made by reducing the number of technical failures in surgical treatment, providing more intensive nursing care to reduce postoperative and bed-rest complications, and by providing integrated slow-stream beds for the physical and social rehabilitation of patients.

Adult↗
PubMed1992

[Intravenous peripheral digital subtraction angiography after stabilization of medial femoral neck fractures. Results and value].

In patients with medial femoral neck fractures the condition of the blood vessels is the decisive factor as to whether or not femoral capital necrosis will develop. Therefore, conventional angiography has been used both preoperatively for the diagnostic work-up and for selecting the best mode of management and postoperatively for prognostic purposes. Its routine use has, however, been limited by the long examination time, the complexity of the technique and the potential complications. Peripheral intravenous digital subtraction angiography (DSA) for imaging peripheral vessels is a far less demanding procedure. Its usefulness was studied postoperatively in 7 patients. The vascular information obtained was inferior to that of conventional angiography because of the inherently poorer vessel imaging qualities. Moreover, since its applicability is limited to patients with a completely intact cardiovascular system and normal cardiac output, it is not suitable for most geriatric patients. It is, therefore, concluded that peripheral intravenous DSA cannot (yet) be recommended as a routine procedure. It remains to be seen whether technical improvements in system features will improve the diagnostic performance.

Adult↗