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PubMed2004

Bilateral femoral neck fractures after pelvic irradiation.

Our patient, who had no history of trauma, developed bilateral femoral neck fractures several years after pelvic irradiation. The well-documented sequelae of femoral neck fractures include avascular necrosis, nonunion, and malunion. Postirradiation pelvic pain, particularly in the absence of trauma, should be aggressively evaluated. With high clinical suspicion and normal plain radiographs, MRI can be used to exclude potentially serious fractures.

Aged↗
PubMed2003

Treatment of femoral neck fracture with muscle-bone flap of both tensor fasciae latae and sartorius.

OBJECTIVE: To evaluate the effect of muscular pedicle bone grafts with sartorius or tensor fasciae latae and sartorius in fresh transcervical or subcapital fractures of the femoral neck. METHODS: Thirty cases of fresh transcervical and subcapital fractures of the femoral neck were treated by the tail breakable screws and sartorius pedicle bone grafts (single muscular pedicle, SMP group). The other 23 cases were treated by cannulated pressure screws and bone grafts with the muscular pedicles of both sartorius and tensor fasciae latae (double muscular pedicles, DMP group). RESULTS: Fifty-two cases were followed up for 3 to 5 years (mean, 4 years). In SMP group, ten cases showed poor therapeutic results. Excellent therapeutic effects were achieved in all cases of DMP group. CONCLUSIONS: The transcervical or subcapital fractures of the femoral neck can be treated by double muscular pedicles bone graft. The bone graft with double muscular pedicles is more effective than single sartorius muscular pedicles for fresh transcervical and subcapital fractures of the femoral neck during short and medium terms.

Bone Transplantation↗
PubMed1993

[Late results of 351 femoral neck fractures (1986-1987 treatment period)].

A total of 351 femoral neck fractures were treated from 1986 to 1987. The fractures were classified into three groups according to Pauwels. Nineteen percent of fractures were treated conservatively; in 65% internal fixation was performed, while in 16% total hip endoprosthesis was done. Of these patients 254 were reexamined three years later. In only 24.4% of the 254 patients were poor results--necrosis of the femoral head--found.

Aged↗
PubMed1983

A new anatomic classification of capital fragments in femoral neck fractures with the epiphyseal scar as a guide.

Seventy femoral neck fractures were examined clinically, radiologically, and histologically to ascertain whether the shape of the capital fragment, irrespective of the nature or age of the fracture, could be a determinant of the biologic condition within the head. Three types of excised capital fragments were defined according to the anatomic location of the fracture surface, with particular reference to the epiphyseal scar. Type I fragments, in which the fracture surface lies along the epiphyseal scar, showed complete capital necrosis, whereas Types II and III fragments, with the fracture surface in the subepiphyseal and subcapital zones, respectively, were found to be histologically viable. Moreover, Type III specimens tended to be more abundant in biologic response than Type II specimens. Thus, the biologic condition of the capital fragment is closely related to its shape. Since the type of capital fragment is, in most cases, judged correctly on the preoperative roentgenogram, this classification can be a helpful clue to the choice of treatment. From the biologic point of view, osteosynthesis should be limited to fractures with Type III capital fragments. The authors also hypothesize that the fractured femoral head, if untreated, may decrease in size and, therefore, in vascularity during the postfracture course.

Adolescent↗
PubMed1984

Femoral neck fractures complicating Gaucher disease in children.

In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton [16, 17]. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceded by multiple bone "crises" localized to the proximal femora.

Child↗
PubMed2001

Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults.

Twenty cases of neglected (more than 1 month old) displaced femoral neck fractures in young adults were treated with a valgus intertrochanteric osteotomy. A fracture union rate of 85% (17 cases) was achieved. Two of the healed cases developed avascular necrosis. After 30 months 15 patients (75%) had achieved good to excellent results. We believe that intertrochanteric osteotomy provides good alternative management for neglected femoral neck fractures.

Adolescent↗
PubMed1997

Temporal trends and geographic variations in surgical treatment of femoral neck fractures.

BACKGROUND: The objectives of this study were to examine temporal trends in treatment of femoral neck fractures, factors associated with treatment, and variations in practice patterns among counties and hospitals in Ontario, Canada. METHODS: Hospital discharge data were analyzed. Cases were defined as age > 50 years with a surgically treated femoral neck fracture between 1981 and 1992 (n = 29,391). RESULTS: The age-adjusted and sex-adjusted proportion of patients treated with hemiarthroplasty (HA) increased from 45% in 1981 to 61% in 1992 (p < 0.0001). HA is more likely to be performed among women, older patients, and nursing home patients. Among counties there was a 38-fold variation for total hip arthroplasty (0.5-38%) and a 9-fold variation in use of HA (9-83%). The degree of variation in treatment was mainly the result of individual hospitals. CONCLUSION: The wide regional variations in treatment of femoral neck fractures reflect a lack of consensus in Ontario.

Age Factors↗
PubMed1994

[Surgical treatment of femoral neck fractures. The 100-year anniversary].

Fractures of the neck of the femur, and especially operative treatment of such, are seldom described in the older medical literature. Sir Astley Cooper (1768-1841) was the first surgeon to describe, in 1822, the two most common fractures of the upper end of the femur, medial fracture and pertrochanteric fracture. However, like many other surgeons of his time, he believed that such fractures would not heal. B. von Langenbeck (1810-1887), a German surgeon, was the first to propose operative treatment of a fracture of the femoral neck and actually did one operation, but the patient died. In 1897 and 1899, J. Nicolaysen (1831-1911), Professor of Surgery at the National Hospital, Oslo, published first his technique and then the results of closed nailing of fractures of the femoral neck in his material of 21 patients. He performed his first operation in July 1894, one hundred years ago. Fracture of the femoral neck was not as common in the 1890s as it is today. It is now one of the most frequent kinds of fracture and presents a major challenge to surgical and orthopaedic departments. Professor Nicolaysen is recognized in the international professional literature as a pioneer in the operative treatment of fracture of the femoral neck. His publications are reviewed in this article, to mark the hundredth anniversary of the first systematic nailing of a fracture of the neck of the femur.

Femoral Neck Fractures↗
PubMed1981

Healing of femoral neck fractures; influence of fracture reduction and age.

In the present study, the influence on healing of femoral neck fractures of reduction of the fracture and the age of the patients were investigated in 446 consecutive cases treated by internal fixation. If the fracture was reduced in valgus position anteroposteriorly, 90% of the cases healed, and if anatomical reduction was achieved the figure was 77%. However, if the fracture remained in varus position bone union was obtained in only 63%. After a good lateral reduction internal fixation resulted in failures in 22% of cases, if a satisfactory in 26%, but poor lateral reduction was followed by failure in 49% of cases. There was correlation to reduction position in all Garden's Stages. With regard to the healing of the fracture, reduction in lateral as well as anteroposterior views were of equal importance. The patient's age did not influence the failure rate in 22% of cases. With increasing age progressive decrease of healing was encountered. The number of patients attending for follow-up until bony union decreased also due to a high mortality rate in these patients. Internal fixation was found to be the treatment of choice in femoral neck fractures, provided that a satisfactory reduction could be obtained.

Adolescent↗
PubMed1998

An algorithm for preoperative prediction of reoperation risk after internal fixation of femoral neck fractures.

An algorithm was designed for preoperative prediction of the risk for reoperation, and the mortality risk, after internal fixation of femoral neck fractures. Out of 51 reviewed studies of femoral neck fractures, eight met specified inclusion criteria such as low dropout rates, a minimum of ten surgeons performing the surgery, a minimum of 2 years follow-up, and a standard age, sex, and Garden class distribution. Five of these studies were used for the construction of the algorithm, and the remaining three for testing the specificity and sensitivity of the algorithm. A separate analysis of the influence of age on the reoperation rate was also performed. In the analysis of 399 reviewed cases of femoral neck fractures, the specificity for the algorithm in predicting the risk for reoperation was 96%, and the sensitivity was 51%. The positive predictive value for the algorithm in predicting the risk for reoperation was 77%, which was three times higher compared to the commonly used predictors age and Garden class (positive predictive value 25%). For prediction of the mortality risk the positive predictive value for-the algorithm was 57%.

Aged↗
PubMed2003

Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures.

INTRODUCTION: There have been a number of non-randomized studies comparing arthroplasty with internal fixation in patients with femoral neck fractures. However, there remains considerable debate about whether the results of non-randomized studies are consistent with the results of randomized, controlled trials. Given the economic burden of hip fractures, it remains essential to identify therapies to improve outcomes; however, whether data from non-randomized studies of an intervention should be used to guide patient care remains unclear. We aimed to determine whether the pooled results of mortality and revision surgery among non-randomized studies were similar to those of randomized trials in studies comparing arthroplasty with internal fixation in patients with femoral neck fractures. MATERIALS AND METHODS: We conducted a Medline search from 1969 to June 2002, identifying both randomized and non-randomized studies comparing internal fixation with arthroplasty in patients with femoral neck fractures. Additional strategies to identify relevant articles included Cochrane database, SCISEARCH, textbooks, annual meeting programs, and content experts. We abstracted information on mortality and revision rates in each study and compared the pooled results between non-randomized and randomized studies. In addition, we explored potential reasons for dissimilar results between the two study designs. RESULTS: We identified 140 citations that addressed the general topic of comparison of arthroplasty and internal fixation for hip fracture. Of these, 27 studies met the eligibility criteria, 13 of which were non-randomized studies and 14 of which were randomized trials. Mortality data was available in all 13 non-randomized studies ( n=3108 patients) and in 12 randomized studies ( n=1767 patients). Non-randomized studies overestimated the risk of mortality by 40% when compared with the results of randomized trials (relative risk 1.44 vs 1.04, respectively). Information on revision risk was available in 9 non-randomized studies ( n=2764 patients) and all 14 randomized studies ( n=1901 patients). Both estimates from non-randomized and randomized studies revealed a significant reduction in the risk of revision surgery with arthroplasty compared with internal fixation (relative risk 0.38 vs 0.23, respectively). The reduction in the risk of revision surgery with arthroplasty compared with internal fixation was 62% for non-randomized studies and 77% for randomized trials. Thus, non-randomized studies underestimated the relative benefit of arthroplasty by 19.5%. Non-randomized studies with point estimates of relative risk similar to the pooled estimate for randomized trials all controlled for patient age, gender, and fracture displacement in their comparisons of mortality. We were unable to identify reasons for differences in the revision rate results between the study designs. CONCLUSIONS: Similar to other reports in medical subspecialties, non-randomized studies provided results dissimilar to randomized trials of arthroplasty vs internal fixation for mortality and revision rates in patients with femoral neck fractures. Investigators should be aware of these discrepancies when evaluating the merits of alternative surgical interventions, especially when both randomized trials and non-randomized comparative studies are available.

Arthroplasty, Replacement, Hip↗
PubMed1997

An orthopedic surgeon survey on the treatment of displaced femoral neck fracture: opposing views.

OBJECTIVE: To examine the reasons for practice variation in the treatment of displaced femoral neck fractures. DESIGN: A survey, asking surgeons to choose either hemiarthroplasty or internal fixation for 2 different female patients with a displaced femoral neck fracture. SETTING: The Canadian Orthopaedic Association Meeting, Halifax, May 1995. PATIENTS: The scenario in the first patient was of an independent 70-year-old woman with no pre-existing medical conditions. The scenario in the second patient was of a housebound 84-year-old woman with co-morbidity. MAIN OUTCOME MEASURES: Proportion of surgeons choosing either hemiarthroplasty or internal fixation for each case scenario. Distribution of reasons to explain the treatment decision. RESULTS: Ninety-nine surgeons responded. For the case of the 70-year-old woman, 47% chose hemiarthroplasty and 53% chose internal fixation (p = 0.60), and for the 84-year-old woman, 96% chose hemiarthroplasty. These findings were consistent within the subgroups of teaching surgeons and community practice surgeons. Surgeons with 10 years or less of practice tended to favour hemiarthroplasty whereas those with more than 15 years' practice favoured internal fixation. Important reasons for treatment choice were avoidance of reoperation in the hemiarthroplasty group (85%) and better hip function in the fixation group (83%), durability (83%) and ease of revision (77%). CONCLUSION: The surgeon's interpretation of the importance of reoperation and function underlies the differences in treatment decision regarding the management of femoral neck fractures in elderly patients.

Aged↗
PubMed2005

[Osteosynthesis of intracapsular femoral neck fractures].

PURPOSE OF THE STUDY: To evaluate outcomes of internal fixation of intracapsular femoral neck fractures. MATERIAL AND METHODS: Between the beginning of 1998 and end of 2002 the authors performed internal fixation of intracapsular fracture of the femoral neck in 47 patients (21 women, 26 men). The average age of patients was 56 years, range, 17 to 86 years (men 54.5 years, women 58.2 years). Forty patients (18 women, 22 men) went through the follow-up at the minimal interval of 1 year after the surgery. Their average age was 56 years. The remaining 7 patients were lost to follow-up. In 21 patients the case was Garden 1 and 2 fractures, in 19 patients Garden 3 and 4 displaced fractures. Internal fixation by three lag screws was performed in 16 cases, fixation by DHS with antirotational screw in 24 cases. RESULTS: The fracture healed in 70% of cases, non-union occurred 3times and avascular necrosis developed 9times. Garden 1 and 2 fractures were associated with 14.3% and Garden 3 and 4 fractures with 47.4% of complications. Of fractures treated by lag screws, 71% of cases healed, while in those treated by DHS the percentage was 69%. Both duration of surgery and x-ray exposure was in lag screws by 50% longer than in DHS. In terms of the development of avascular necrosis, the study did not prove any advantage of a shorter interval between the injury and surgery. However, development of avascular necrosis was influenced also by other factors and therefore the significance of urgent surgery within 6 hours after injury should not be questioned. CONCLUSION: Garden 3 and 4 displaced fractures have a worse prospect than Garden 1 and 2 fractures. Duration of surgery and x-ray exposure in DHS is shorter than in lag cancellous screws with the same percentage of good results. Of great importance is an exact reduction of the fracture in both projections, a correct position of implants and evacuation of intracapsular haematoma as a prevention of avascular necrosis of the femoral head.

Adolescent↗
PubMed1980

Evaluation of femoral neck fracture healing in man by serial 99mTc-diphosphonate scintimetry.

99mTc-diphosphonate uptake was measured in thirty-four patients with intracapsular fractures of femoral neck and in sixteen patients with trochanteric fractures during their healing process. A peak value in count ratio was recorded in all patients 4 to 6 weeks after fractures. Fifty patients were classified into a normal healing group and a delayed or non-union group. Namely, 99mTc-diphosphonate uptake was significantly higher in the delayed or non-union group than in the normal healing union group 10 weeks after injury. The application of 99mTc-diphosphonate scintimetry seems to make it possible to differentiate objectively the normal healing union from the delayed or non-union.

Adult↗
PubMed1991

Central fracture-dislocation of the hip with ipsilateral femoral neck fracture: case report.

Central fracture dislocation of the hip with associated fracture of the femoral neck is rare. Treatment of choice consists of open reduction of the displacement and internal fixation of both fractures. Nevertheless, inadequate reduction of the burst fracture of the acetabulum may lead to hip arthritis, and the surgical approach to the femoral neck jeopardizes its vitality. In elderly patients early full motion and prompt physical rehabilitation can be achieved by total hip arthroplasty after fusion of the displaced femoral head to the acetabular wall.

Accidents, Traffic↗
PubMed1976

[Ways of reduction of mortality in femoral neck fractures].

267 patients with fractures of the femoral neck were observed by the authors. A total mortality was 16.1%. In patients with medial fractures--12.2%, in trochanteric fractures--20.3%. Among patients operated upon during the first two days the mortaliity made 8.5%.

Adult↗