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PubMed1980

The incidence of femoral neck fractures in New Zealand.

This study reviews the incidence of femoral neck fractures in New Zealand Maoris and non-Maoris. A comparison made with corresponding overseas studies shows that the New Zealand non-7aori age-sex incidence is one of the highest yet observed. Maori women are shown to have an incidence of hip fracture significantly lower than non-Maori women. These results are discussed in the light of the current debate on the aetiology of femoral neck fractures.

Adolescent↗
PubMed2001

[Endoprosthesis in medial femoral neck fractures].

UNLABELLED: Alloarthroplasty of the hip joint in the elderly has improved significantly the outcome of femoral neck fractures. The indication for a hip replacement is based on the biological age of the patient and the type of fracture. In our hospital in a 5-years period (1996-2000) we treated operatively 305 patients with femoral neck fractures (248 medial, 57 lateral). Of these, 239 patients received a endoprosthesis (190 total hip joint replacements, 49 hemialloarthroplasty). The other 66 patients (most of them younger patients) were treated by osteosynthesis. The complication rate of the endoprosthetic hip replacement was low; five hematoma/seroma and two deep infections had to be treated operatively. In 21 patients (8.79%) we saw hip luxation; 17 could be treated by closed and four by open reduction. Reluxation was found in nine of these 21 patients. Only two patients (both over 80 years old) died between the first 2 postoperative weeks. Eighty percent of the patients were able to walk, half of them alone or with help outside their homes. Fifteen percent of the patients could be mobilized in a wheel chair; only 5% were confined to bed. CONCLUSION: For the treatment of femoral neck fractures in older patients, the cemented hip endoprosthesis is the method of choice.

Adult↗
PubMed1988

[Late results of surgical management of medial femoral neck fractures by spongiosa traction screws].

In 36 cases of medial fracture of the femoral neck percutaneous compression osteosynthesis by a specific traction-screw was carried out. During a 3-year follow up five femoral head necroses and three cases of non-union occurred. 28 patients showed good or excellent results. Comparison with results of AO-spongiosa screws and sliding-screw plate reveals no significant differences. Due to small additional operative trauma this percutaneous fixation technique is an appropriate alternative of osteosynthesis of medial fractures of the femoral neck, especially in polytraumatised patients and old patients with high operative risk.

Adolescent↗
PubMed1995

Bipolar hemiarthroplasty in femoral neck fractures.

Thirty-two elderly patients with a femoral neck fracture treated by bipolar hemiarthroplasty and 36 patients (matched for age) with an Austin-Moore hemiarthroplasty were followed-up and compared. Bipolar replacement resulted in a higher percentage of satisfactory results, less postoperative pain, greater range of movement, more rapid return to unassisted activity, fewer unsatisfactory results and no acetabular erosion. The device functioned as bipolar in all the cases studied for inner-bearing motion.

Aged↗
PubMed1988

[The effect of primary nailing on the immediate fate of patients with femoral neck fractures].

Based on their 494 own cases with femoral neck fractures authors investigate the impact on time elapse between the injury and the osteosynthesis upon the outcome of these patients. By comparing two groups with equal severity it was concluded that an operation within 6 hours after the injury is favourable both with regard to the mortality and the systemic or local complications. They provide an explanation for the good results through the analysis of their cases and give a brief review of the literature on this subject as well.

Aged↗
PubMed1996

[Long-term outcome of managing medial femoral neck fractures with ceramic head endoprostheses].

Total hip replacement is often recommended for the treatment of femoral neck fractures in elderly patients. A less invasive approach with shorter operating time is the replacement of the femoral head only, leaving the acetabular cartilage in situ. Hemiarthroplastic hip replacement using a metallic head prosthesis was not successful in the past, because the majority of patients developed protrusio acetabuli after surgery. In the present study hemiarthroplastic hip replacement using an Al2O3-ceramic head was shown to be a useful method for the treatment of femoral neck fractures in elderly patients. From 1985 to 1990 277 patients were treated with hemiarthroplasty. The average age at the time of accident and operation was 81.7 years. At the time of follow-up in 1993 only 77 survivors were available for examination. A standardized score was calculated assessing activity, gait, hip pain, etc., with the patients obtaining an average score of 58 out of possible 78 points. Only three patients had hip pain, and in four cases the roentgenographic examination revealed protrusio acetabuli. Two of these four patients underwent revision surgery for replacement of the cup, leaving the stem in situ. In view of the small number of approach-related complications, hemiarthroplastic hip replacement using an Al2O3-ceramic head is the recommended surgical treatment for femoral neck fractures in elderly patients. In the rare patient with protrusio acetabuli, revision surgery can be performed to replace the cup, leaving the stem in situ.

Activities of Daily Living↗
PubMed2005

Treatment of pathologic femoral neck fractures with modified Pauwels' osteotomy.

UNLABELLED: Treatment of pathologic femoral neck fractures secondary to extensive lesions of fibrous dysplasia and simple bone cysts has been controversial. We think that modified Pauwels' intertrochanteric osteotomy and osteosynthesis can result in sound healing of the lesion and of the fracture, with no recurrence, low complication rates, and good functional results. Seven patients were treated with a uniform approach consisting of biopsy (Stage I) and osteotomy with osteosynthesis (Stage II). Curettage of the lesion and bone grafting were not done. The average followup was 79.28 months (range, 32-142 months). All of the fractures and osteotomy sites healed in means of 14 weeks (range, 12-16 weeks) and 9.1 weeks (range, 8-10 weeks), respectively. All fibrous dysplasia lesions healed radiologically. Grade IV radiographic healing was seen in both patients with simple bone cysts after 35 and 92 months. Using the Musculoskeletal Tumor Society functional evaluation and Toronto Extremity Salvage Score, all the patients had good to excellent results. Complications such as infection, local recurrence, refracture, femoral neck deformity, osteonecrosis of the femoral head, and growth arrest of capital femoral physis were not seen. In addition to biomechanical advantages, the procedure seems to have had a biologic role in healing of the fracture and of the lesion by initiating osteogenesis to replace the defect with new bone. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed1989

Subchondral screw fixation for femoral neck fractures.

We describe a method of internal fixation for femoral neck fractures which has been newly developed to reduce the frequency of early complications. Two cannulated screws are inserted in the axis of the femoral neck to reach into the subchondral bone of the femoral head. The screws are inserted over guide pins and the tip of the screw is self-tapping and designed to provide good anchorage in the femoral head. We used this method in 44 consecutive patients in a prospective study with no exclusions, followed for a minimum of 24 months. All fractures healed within 12 months, and there were no cases of early loosening or nonunion. In four cases, late segmental collapse had developed during the mean follow-up period of 30 months.

Aged↗
PubMedDate not supplied

Utilization of a partially threaded Kirschner wire in the treatment of femoral neck fractures.

OBJECTIVE: This report introduces a new type of pin for treatment of femoral neck fractures. DESIGN: Retrospective analysis. METHODS: The pin used in this study has a tapered thread in its middle portion to facilitate fixation in the lateral femoral cortex, as well as a simple tip that allows percutaneous pinning without displacement of the reduced position. Between 1978 and 1993, we used our pins on 218 hips in 214 patients, all age sixty years or more. We were able to observe postoperative osteosynthesis in 176 hips (172 patients) during a mean follow-up period of thirty-two months; the incidence of osteosynthesis and local postoperative complications was also charted. RESULTS: Osteosynthesis was obtained in 153 hips (87 percent); for groups based on Garden's classification, results were as follows: twenty-four of twenty-four hips in type 1, fifteen of sixteen in type 2, sixty-three of seventy-one in type 3, and fifty-one of sixty-five in type 4. Some local postoperative complications were observed, including second fractures at the pin insertion point (three hips), pin penetration of the femoral head (twenty-four hips), and pin slippage (three hips). CONCLUSION: This pin is effective in the treatment of femoral neck fractures and has the added benefits of being minimally invasive and low in cost.

Aged↗
PubMed1996

Falls leading to femoral neck fractures in lucid older people.

OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people. DESIGN: A cross-sectional study. SETTING: An orthopedic university hospital department. PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures. MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall-risk index was calculated for each subject. RESULTS: It was ascertained that 95% of the fractures were caused by falls and < 2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P < .001). Extrinsic fallers presented a significantly lower fall-risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) wre hypoxemic (pO2 < 8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P = .006). CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night.

Accidental Falls↗
PubMed2006

Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients.

OBJECTIVES: To identify whether differences exist in the outcomes between patients undergoing hemodialysis and elderly nonhemodialysis patients with a femoral neck fracture. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/INTERVENTIONS: A total of 71 femoral neck fractures in 62 patients undergoing hemodialysis treated nonoperatively or operatively. MAIN OUTCOME MEASUREMENTS: Clinical outcomes were analyzed to identify factors that may be correlated with life expectancy and functional prognosis. RESULTS: The overall survival rates in this study at 1-year and 5-years postfracture were found to be 89.8% and 51.5%, respectively. There were significant correlations among the survival rate, patients' age, type of treatment, prefracture ambulation status, and prefracture activities of daily living status. However, using multivariate analysis, the only significant predictor of life expectancy was prefracture ambulation status. As for functional prognosis, the rates of total ambulation recovery and total activities of daily living recovery at 1-year postfracture were 50.0% and 71.2%, respectively. Both patients' age and age at the onset of hemodialysis may contribute considerably to functional prognosis in patients undergoing hemodialysis after femoral neck fracture. CONCLUSIONS: The present study suggests that the clinical outcomes of patients with femoral neck fractures who undergo hemodialysis are considerably superior to those of previous studies. In addition, when those fractures are treated surgically with specific management in patients undergoing hemodialysis, it may be possible to expect a life expectancy and functional prognosis similar to elderly nonhemodialysis patients with hip fractures.

Adult↗
PubMed1986

Bilateral "simultaneous" femoral neck fractures following minimal stress.

Following jogging, a 53-year-old man experienced bilateral hip discomfort. Two weeks later, after stepping backward suddenly, he had severe pain in the right hip. Radiographs showed a displaced fracture of the right femoral head; this was pinned. Bone imaging revealed intense uptake in the other femoral head as well. This also was believed to be fractured, and therefore was repaired. During the two operations, no pathological cause of the bilateral femoral neck fractures was noted. The literature on simultaneous bilateral femoral neck fractures, without underlying bone disease, was reviewed.

Athletic Injuries↗
PubMed1979

Surgical repair of femoral neck fractures in two dogs and a calf.

The surgical techniques employed in the repair of femoral neck fractures in two dogs and a Charolais calf are described. All the fractures were extracapsular; one of the dogs also had a fractured femoral diaphysis. For both dogs, exposure of the femoral neck was made from a dorsal approach after removal of the greater trochanter, while for the calf, a gluteal transection technique was used. All the fractures were successfully fixed using cortical screws, and in the case of the femoral diaphysis, a vitallium plate was used. All the animals were walking with minimal lameness eight weeks after surgery.

Animals↗