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PubMed1981

Knowles pinning of experimental femoral neck fractures: biomechanical study.

This experimental study demonstrates the rigidity and durability of Knowles pin fixation of femoral neck fractures. Embalmed proximal femora were utilized. A "fracture' was created by osteotomy, then reduced and fixed with Knowles pins. Four groups of reduction and pin configurations were created ("optimal reduction and pinning,' "poor reduction,' "inadequate pinning,' and "comminution') to simulate the clinical situation. With the Materials Testing Systems(MTS) machine, 3 months of walking by a patient with a femoral neck fracture were simulated. Results suggest that Knowles pinning of a femoral neck fracture can provide adequate support for immediate full weight-bearing ambulation until fracture healing. Stability and durability of fixation are compromised by loss of cortical bone support by "comminution,' short nonparallel pins not engaging the subchondral bone, and osteoporosis evidenced by a low Singh index.

Biomechanical Phenomena↗
PubMed1984

Two-year follow-up of femoral neck fractures. Comparison of osteosynthesis methods.

For 14 consecutive months, all 152 femoral neck fracture patients greater than or equal to 50 years of age admitted to the Lund University Hospital were operated on with two hook-pins if born on an uneven date and a four-flanged nail if born on an even date. A clinical 2-year follow-up revealed a 35 per cent mortality. Among survivors, radiographic healing complications were seen in undisplaced fractures in 1/13 pinned and 5/14 nailed (p greater than 0.05) and in displaced fractures in 12/36 pinned and 23/32 nailed (p less than 0.01). This outcome correlated well with the early postoperative scintimetry. Reoperation within 2 years had been performed for seven pinned and 19 nailed fractures. In hook-pinning, thus, less than one patient out of 12 needed a reoperation with THR within 2 years. This figure is interpreted as strongly favouring hook-pinning before arthroplasty as the primary procedure in femoral neck fracture.

Aged↗
PubMed2006

Outcome of non-operative management in Garden I femoral neck fractures.

BACKGROUND: We studied the operation rate for secondary displacement in Garden type 1 femoral neck fracture when treated primarily conservatively. METHODS: We reviewed the records of 115 patients with Garden type 1 femoral neck fractures primarily treated conservatively. RESULTS: Operation for secondary displacement was required in 48 cases (41%); the displacement rate was highest at age 60-80 years. There was significant difference between age and secondary displacement, but none between gender, ASA classification or Pauwels angle and secondary displacement. CONCLUSION: Garden type 1 femoral neck fractures deserve special attention because of the high rate of secondary displacement when they are conservatively treated, and surgery should therefore considered.

Adolescent↗
PubMed1989

[The femoral neck pseudarthrosis following medial femoral neck fracture. An indication for the vascularized pedicled iliac crest transplant].

Revascularisation surgery was performed in six cases following medial femoral neck fracture with femoral head necrosis and non-union of the femoral neck. A corticospongiosis pelvic graft supplied by the deep circumflex iliac artery was implanted as an autologous heterotopic pedicled transplant. The operative procedure was the same in all cases, since it was possible to lift out the pelvic graft from the same side as the affected hip joint, thus making a microvascular anastomosis unnecessary. Follow-up examination after 15-27 months revealed that, in all cases, osseous consolidation of the pseudarthrosis had been achieved and that further segmental collapse of the contour of the femoral head had been prevented. The angiographic studies performed during the examination demonstrated unimpeded circulation in the pedicle of the transplants in five of the six cases, as long as 3 months after the operation. For the first time it was possible in these five cases, by means of a transplant angiograph, to demonstrate integration of the graft into the biologically weak post-traumatic transplant region.

Bone Transplantation↗
PubMed1996

In-hospital charges associated with the treatment of adult femoral neck fractures.

A retrospective analysis of 41 adult patients treated for a femoral neck fracture was performed to determine the variables that best predict total hospital charges. The patients were treated for an isolated femoral neck fracture at our hospital from January 1993 through December 1994. There were 13 men and 28 women. The average age at the time of injury was 63 years. The average length of stay was 12.1 days, and the average total hospital charges per patient were $16,072. No physician fees were included in our analysis. Detailed multivariate regression analysis of 10 variables was performed for each patient. Stepwise linear regression analysis, which controlled for all variable (such as age at injury, number of medical illnesses, gender, and others), revealed that the strongest predictors of total hospital charges were the number of medical illnesses (P < 0.0001), age at injury (P = 0.023), length of stay (P < 0.0001), and number of complications (P = 0.0007).

Adult↗
PubMed2004

[The methods of shorting of proximal femoral and total hip arthroplasty for old femoral neck fracture with severe hip joint dislocation].

OBJECTIVE: To discuss the effective method and outcome to old femoral neck fracture with severe hip joint dislocation. METHODS: From April 1996, 7 cases of old femoral neck fracture with severe hip joint dislocation were treated by the shorting of posterior femoral and total hip arthroplasty. RESULTS: The average age of 7 patients was 51 years old and the mean follow-up was 27.3 months. The mean Harris score was improved to 84.3 from 36.7 before operation in the latest follow-up. The prosthesis position of acetabular and femoral was excellent, there was no sinking or softening of artificial joint, nonunion of femoral osteotomy. CONCLUSION: The preliminary clinical results are quite satisfactory of the shorting of posterior femoral and total hip arthroplasty to old femoral neck fracture with severe hip joint dislocation, the follow-up is necessary for further long-term outcome.

Adult↗
PubMed1997

Trabecular bone volume and microdamage accumulation in the femoral heads of women with and without femoral neck fractures.

Repetitive loading causes fragility and microdamage accumulation in the skeleton, but it is not clear whether microcracks accumulate with age in the human skeleton, or whether older women with femoral neck fractures have more microdamage than older women without fracture. This study tested the hypotheses that: (1) microcracks accumulate in the femoral head with age; and (2) older women with femoral neck fractures have significantly more microcracks than similar aged women without fractures. Nonosteoarthritic femoral heads from 9 young (16-66 years) and 12 old (73-88 years) female cadavers and those from 7 females with femoral neck fractures (56-90 years) were dissected. Midfrontal slabs were block stained with 1% basic fuchsin and 150-microm-thick specimens were measured histomorphometrically. Percent trabecular bone area (TbxAr) significantly decreased in older and fractured subjects compared with young subjects (p < or = 0.05). Microcrack density (CrxDn) was significantly higher in women older than 70 years compared with those younger than 70 (p = 0.005; Spearman's r = 0.41, p = 0.032), but was not different between older women with and without fractures. Osteocyte lacunar density (OtxDn) was significantly less in old and fractured subjects compared with young subjects (p < or = 0.01), and inversely correlated to crack density (r = -0.49, p = 0.011). CrxDn was higher in women with low TbxAr (Spearman's r = -0.56; p = 0.004), and varied inversely with OtxDn (Spearman's r = -0.47; p = 0.014). This is consistent with the idea that cracks accumulate more rapidly in women with low bone density. It is also consistent with the idea that the osteocyte network detects microcracks, and signals for their repair.

Adolescent↗
PubMed1998

Eight-year outcome associated with clinical options in the management of femoral neck fractures.

This study involved a review of the medical records of 367 patients treated surgically after femoral neck fracture. Linkage of these records with claims files from the Health Care Financing Administration allowed as many as 8 years of followup to analyze the rates of hospital readmission rates for revision, other postoperative complications and mortality. The results revealed: (1) a significantly higher revision rate was associated with internal fixation for the treatment of displaced femoral neck fractures in patients older than 80 years of age; no differences in revision rates were seen between internal fixation or hemiarthroplasty for the treatment of nondisplaced femoral neck fractures in this patient age group; (2) no differences in revision rates were found between internal fixation or hemiarthroplasty for the treatment of displaced femoral neck fractures in patients between the ages of 65 to 80 years; (3) a significantly higher mortality rate was associated with internal fixation than hemiarthroplasty for patients who were between the ages of 65 and 80 years; and (4) no differences in medical or surgical complications, revision rates, or other outcomes were found between unipolar and bipolar prostheses, or between anterior and posterior surgical approaches for hemiarthroplasty in patients who were age 65 years or older.

Age Factors↗
PubMed1989

Nail versus screw fixation of femoral neck fractures. A 2-year radiological and clinical prospective study.

137 recent femoral neck fractures were randomly allocated in a prospective study to internal fixation with either Nyström nails or Scand screws. A radiological and clinical follow-up was conducted of all survivors one and two years postoperatively. Reduction was unsatisfactory in 15 of 87 patients included in the two-year follow-up study. 13 of them developed complications. The 44 Nyström-nailed fractures included in the two-year follow-up showed sliding of the nail in 22 cases, redisplacement/nonunion in 14, and late segmental collapse in 5. The results of clinical examination were excellent or good in 30 patients and fair or poor in 14. Among the 43 Scand-screwed fractures sliding of the screw occurred in 1 case, redisplacement/nonunion in 14, and late segmental collapse in 4. In 35 patients the result was graded as excellent or good and in 8 as fair or poor. No statistical difference between the groups was found with respect to the incidence of redisplacement, nonunion and late segmental collapse, nor with respect to the results of the clinical assessment at the one-year and two-year follow-up. There was a considerably higher incidence of extrusion of the internal fixation device among the nailed fractures than those treated with screws. The results indicate that Scand screws are a better alternative to Nyström nails in the treatment of femoral neck fractures. If an adequate reduction cannot be achieved, primary hip replacement is recommended.

Aged↗
PubMed1984

Preoperative 99mTc-MDP scintimetry of femoral neck fractures.

Preoperative 99mTc-MDP-scintimetry was performed in 117 patients with femoral neck fractures. Scintimetry was shown to be superior to visual evaluation. The ratio was calculated of the uptake in the femoral head of the fractured side over that in the unfractured side, with compensation for the increased trochanteric femoral activity found on the fractured side. A ratio above 0.90 correlated well with uneventful healing in both undisplaced and displaced fractures. Preoperative scintimetry is of great value in the choice of primary treatment of femoral neck fractures.

Adult↗
PubMed1985

Femoral neck fractures in the geriatric population: the influence of perioperative health upon the selection of surgical treatment.

The use of a primary prosthetic replacement such as an Austin-Moore hemi-arthroplasty in patients sustaining fractures of the femoral neck has been associated with increased post-operative medical morbidity and mortality. A retrospective review was performed using the medical records of patients greater than 59 years of age who sustained femoral neck fractures and were treated with either internal fixation or primary hemi-arthroplastic replacement at Loyola University Medical Center between 1969 and 1979. Peri-operative data were reviewed and evaluated using computer-aided statistical analysis. Comparing the two forms of surgical treatment, statistically significant factors associated with primary hemi-arthroplastic replacement included: pre-injury nursing home residence, pre-injury ambulation requiring assistance, age greater than 79 years, slight elevation in serum creatinine values, abnormal electrocardiograms in patients over 77 years of age, time from injury to surgery of four or more days, and the use of spinal anesthesia (P less than 0.05). Factors associated with internal fixation were: patient age of 79 years or less, independent ambulation, non-nursing home residence, normal lab values, normal EKGs, less than four days from injury to surgery, and the use of general anesthesia. Within the limits imposed by a retrospective review in this specific patient population, there appears to be a tendency for older, less healthy patients to have been treated with primary hemi-arthroplasty. Possibly the previously reported increased post-operative medical morbidity and mortality associated with this procedure, as compared with internal fixation, may be a result of biased patient selection, and not a fault of the procedure.

Age Factors↗
PubMed1987

Christiansen replacement hemiarthroplasty in femoral neck fractures of the elderly.

A total of 108 femoral neck fractures were operated on by Christiansen hemiarthroplasty. Primary mortality was 4.8%, but after an average of 61 months only one-third of the patients were alive. Sixteen of the 40 hips of the living patients showed a poor result as evaluated by the Harris score or subjective outcome. Only four hips were wholly satisfactory at follow-up. It appears that Christiansen hemiarthroplasty has no advantages over other hemiendoprosthetic devices. It is suggested that undisplaced or minimally displaced fractures should not be treated by hemiarthroplasty but by compression osteosynthesis. The problem of displaced fractures still remains open. It appears, however, that primary total hip arthroplasty should be performed in cases of rheumatoid arthritis or even initial osteoarthritis, if an endoprosthetic replacement is considered.

Aged↗
PubMed1987

Treatment of acute femoral neck fractures with total hip arthroplasty.

Between 1973 and 1983, 27 patients with acute femoral neck fractures were treated at the UCLA Medical Center with total hip arthroplasty. These cases were selected on the basis of age, high activity level, and degenerative changes in the acetabular cartilage. The average age was 72 years. There were 19 women and eight men. The average follow-up period was 3.8 years with a range of one to ten years. Methods used included analysis of clinical data, roentgenograms, final pain ratings, walking ratings, and activity levels using the UCLA rating system. Pain relief and overall functional results were better than that of most series of acute femoral neck fractures treated with hemiarthroplasty and similar to that of total hip arthroplasty series. The complication rate was slightly less than both authors' elective total hip series, and considerably less than most hemiarthroplasty series. Complications included a superficial wound infection, a urinary tract infection, and a perforated colon diverticulum. Four patients died within one year from causes unrelated to the hip arthroplasty. There were no deep infections, dislocations, or reoperations. Total hip arthroplasty in selective cases of acute femoral neck fractures can give more consistent pain relief and better functional results than hemiarthroplasty, without an increase in complications.

Acute Disease↗
PubMed1996

Undisplaced femoral neck fracture in the elderly.

The results and the related conditions of 250 undisplaced femoral neck fractures managed by percutaneous Knowles pinning were evaluated. All of the patients were over 59 years old, and the protocol of management and follow-up was determined prospectively. The duration from injury to management was 3.0 (range 1-12) days, the operation time was 20 (range 10-44) min, and most of the patients were discharged without hospitalization. The follow-up period was 74 (range 24-138) months. The final results showed 226 (90.4%) fractures with smooth course of union (mean union time: 24 weeks), 15 (6.0%) fractures with nonunion, and 9 (3.6%) fractures with implant problems. Eighteen (7.2%) hips developed avascular necrosis of femoral head after union. The analysis showed that the rate of complications was higher in elderly persons with undisplaced femoral neck fractures.

Age Factors↗