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PubMed2006

Factors affecting postoperative mortality of patients with displaced femoral neck fracture.

Displaced femoral neck fractures are known to be associated with high rates of mortality. The purpose of the present study is to investigate pre- and postoperative factors which influence this mortality in a series of 1186 consecutive Danish patients presenting to one hospital's orthopaedic department with Garden type 3-4 fractures. Subsequent mortality data was obtained from the state population register (224 were still alive). The stepwise Cox proportional hazards model was used for multivariate analysis in order to obtain the predictors of postoperative mortality. The median survival of male subjects fell from 5.2 years in an age-matched control population to 1.6 years in the patients. In women survival time fell from 6.6 to 2.8 years. Almost all excess mortality occurred during the first 3 months following hemiarthroplasty. In order of significance, key factors negatively influencing mortality at 3 months were: cardiac complications, dementia, male sex, age, waiting time before operation, stroke and dislocation of the prosthesis and perioperative fracture. Of these, waiting time for surgery and dislocation of the prosthesis could be modified. A number of other studies have confirmed the importance of optimising these factors.

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PubMed1993

[Femoral neck fracture and femoral head necrosis].

In this study we wanted to demonstrate the relationship between the fracture of the femoral neck and femoral head necrosis. For this purpose we reviewed the new literature, the dates of the ASIF documentation and some cases from the Davos Hospital. Head necrosis appears in all types of fractures and is independent of the implant. We can find femoral head necrosis in all age groups but the risk is higher the younger the patient. The necrosis can develop many years after the accident. There are not enough long-term studies to explain this phenomenon.

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PubMedDate not supplied

[A hip fracture bandage for the prevention of femoral neck fractures in the elderly. The femoral neck fracture, a biomechanical problem].

In the industrial countries, the number of hip fractures will double or even triple in the next 20 years. Pathogenetically, it is a complex matter of medical as well as biosocial factors. Gerontoprophylactically, it is more a biomechanical problem. Therefore a light fall on to the hip at the greater trochanter is of the greatest importance. We have constructed an impact neutralizer, also designed as a hip fracture bandage, to absorb the impact forces which act on aged people during a fall. It is made of a special silicone rubber. The impact neutralizer permits an impulse amplification by a factor of approximately two. Also, the critical height of the fall is increased by a factor of three. That means that the number of hip fractures occurring in elderly people can be reduced by 30-50%, depending on the type of fall and assuming that all elderly people liable to fall wear the hip fracture bandage.

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PubMed1995

Femoral neck fracture: a complication of femoral nailing.

A fracture of the shaft of the femur in adults is common after road traffic accidents. Until recently it was not known that a fracture of the femoral neck can occur while fixing the femoral shaft fracture with an intramedullary nail. We report three patients in whom femoral neck fractures occurred during femoral nailing. Fractures of the femoral neck were detected by routine postoperative radiographs of the hip joint. All the three patients were treated non-operatively and the fractures healed without complication. The cause of the femoral neck fracture seems to be forceful use of an awl in the wrong direction or multiple entry points in the trochanteric region which weaken the femoral neck; subsequent hammering of the nail completes the fracture.

Adult↗
PubMed1992

Subtrochanteric fractures following osteosynthesis of femoral neck fractures with the VLC-femoral system.

Twenty-two patients with femoral neck fracture were treated with the VLC (Variable Length Cannulated)-femoral screw system. In four patients, the osteosynthesis had complications with ipsilateral subtrochanteric femoral fractures in relation to the screw holes in the lateral cortex. The problem seemed to be excessive stress on the lateral cortex during insertion of the screws. The method has been abandoned in our department.

Adult↗
PubMed2007

Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol.

BACKGROUND: An ipsilateral fracture of the femoral neck is seen in association with 1% to 9% of femoral shaft fractures, and 20% to 50% of these injuries are missed initially. Recognition of an associated femoral neck fracture prior to stabilization of the femoral shaft fracture is imperative to avoid or minimize complications of displacement and osteonecrosis. METHODS: A protocol to look for a femoral neck fracture in all patients with a femoral shaft fracture was instituted at a single level-I trauma center. This protocol consisted of a dedicated anteroposterior internal rotation plain radiograph, a fine (2-mm) cut computed tomographic scan through the femoral neck, and an intraoperative fluoroscopic lateral radiograph prior to fixation as well as postoperative anteroposterior and lateral radiographs of the hip in the operating room prior to awakening the patient. A chi-square analysis comparing pre-protocol and post-protocol fracture prevalences was used to assess the relative risk of missing an associated femoral neck fracture. RESULTS: Two hundred and sixty-eight consecutive patients with a femoral shaft fracture formed the basis of the study group. Of 254 who were followed for at least two months, sixteen were identified as having an associated ipsilateral femoral neck fracture with use of the protocol. Thirteen associated femoral neck fractures were identified before the patient entered the operating room for definitive fixation, and twelve of them were identified with the fine-cut computed tomographic scan. One fracture was identified intraoperatively. There was one iatrogenic fracture and one delayed diagnosis of a femoral neck fracture. With this protocol, we reduced the delay in diagnosis by 91% as compared with our experience in the year prior to the initiation of the protocol. CONCLUSIONS: In the presence of a femoral shaft fracture, evaluation of the femoral neck with fine-cut computed tomography and dedicated internal rotation hip radiographs significantly improves the ability to diagnose an associated femoral neck fracture.

Adult↗
PubMed2002

Fixation failure in femoral neck fractures.

Fixation of femoral neck fractures is associated with a higher incidence of complications than any other fracture. The rates of nonunion and avascular necrosis with open reduction and internal fixation continue to be unacceptably high. These complications are the main reason for resorting to primary endoprosthetic replacement of the femoral head in the presence of displaced fractures in elderly patients. However, with the increasing life span of the patients with these prostheses, late complications of endoprosthetic replacement of the femoral head are becoming significant. With these complications, it may be argued that the most cost-effective solution to the femoral neck fracture in the majority of patients is open reduction and internal fixation, with elective conversion, when necessary, to total hip arthroplasty in patients who have a complication. Because the literature does not contain a systematic review of reasons for failure of internal fixation, the authors will attempt to review the common means of failure of internal fixation in young and older patients in an attempt to better understand and prevent these complications.

Adult↗
PubMed2006

[Diagnosis and treatment of the femoral shaft fractures combined with ipsilateral occult femoral neck fractures].

OBJECTIVE: To improve the ability of recognizing, diagnosing and treatment for the femoral shaft fractures combined with ipsilateral occult femoral neck fractures, and reduce the rate of loss-diagnosis. METHODS: By retrospective study of 50 patients who sustained ipsilateral femoral shaft and neck fractures from March 1998 to October 2003, 9 cases were femoral shaft fractures combined ipsilateral femoral neck fractures. The neck fractures were diagnosed separately before, during and after operation. Among the 9 cases, 5 cases treated with reconstructive intramedullary nail to fix both shaft and neck fractures; 3 cases were treated with retrograted intramedullary nail to fix shaft fractures and with canulated screws to fix neck fractures; another one was sustained two operations, after the fixation of shaft by intramedullary nail, the neck fracture was found, the neck fracture was fixed with canulated screws anterior and posterior of the nail. RESULTS: Nine cases were followed up for average 20 months. All femoral shaft fractures were united during 6 months; and all neck fractures were united during 3 months. CONCLUSIONS: Femoral shaft fractures combined with ipsilateral occult femoral neck fractures have a high rate of loss-diagnosis during the early stage after injure, the orthopaedic surgeons should consider the femoral neck fracture by analyzing the mechanism of high energy injury patient with femoral shaft fracture. The occult femoral neck fractures can be diagnosed by CT scan before operation. During and after the operation of fixing the femoral shaft fractures, the femoral neck should be observed intensively to identify the exist of fractures.

Adult↗
PubMed1999

Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients.

To screen a potential risk factor for femoral neck fracture, we characterized lumbar vertebral fractures in 120 patients with femoral neck fractures (19 men, 101 women; mean age, 78.7 years) by investigating the frequency of patients with lumbar vertebral fracture, the number of vertebral fractures per patient, and the severity of deformity of the fractured vertebral bodies. These findings were compared with data gathered from a population of age- and sex-matched control patients (20 men, 89 women; mean age, 77.6 years) who had no evidence of femoral neck fracture. The heights of the anterior and posterior walls together with the midpart of the lumbar vertebrae were measured on lateral radiographs to identify fractures. The extent of height loss in the fractured vertebrae was calculated for each group. The incidence of patients with vertebral compression fractures was significantly higher in the femoral neck fracture group than in the control group (65.0% vs 41.1%). In terms of age, the difference in the incidence of vertebral fractures in the two groups was greater in the less aged (60-79 years old) than in the more aged (>80 years old) population. The mean number of lumbar vertebral fractures was also significantly greater in the femoral neck fracture group than in the control group (1.59 +/- 1.39 vs 0.75 +/- 1.19; P < 0.001). The incidence of more deformed vertebral fractures, which were defined as a vertebral height loss of more than 50%, was also significantly higher in the group with femoral neck fracture than in the control group (23.0% vs 7.3%). Based on these results, we concluded that multiple and more severely deformed vertebral fractures might represent a high risk for femoral neck fracture, particularly in patients less than 79 years of age. Care measures that encompass fall prevention and protection of proximal femurs in addition to drug therapy for osteoporosis should be recommended to individuals in this category.

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PubMed1986

Complications of femoral neck fracture in young adults.

Femoral neck fractures are uncommon but serious injuries in young adults, with high rates of nonunion and avascular necrosis reported. This study was undertaken to examine the relationship between the mechanism and severity of injury, anatomic site of fracture, health status, and method of therapy on the incidence of these complications in young adults. The hospital records of 32 skeletally mature patients between the ages of 15 and 50 years (mean, 33) treated for femoral neck fracture between 1975 and 1982 were reviewed, and data analyzed for the 25 patients with a minimum 2-year followup (mean, 61 months). Data pertaining to the cause of injury, fracture pattern, prior health status, overall injury severity, method of fracture treatment, and long-term outcome were analyzed. Nonunion of the fracture site was observed in five (20%); avascular necrosis in nine (36%). Of patients with subcapital fracture 83% developed nonunion or avascular necrosis, compared to 21% with true femoral neck fracture (p = 0.05). There was no difference in cause of injury, overall injury severity, degree of comminution, displacement, method of treatment, or prior health status between those with and without complications. In this study, high rates of nonunion and avascular necrosis were seen after all types of femoral neck fracture in young adults, but were more often associated with subcapital fracture. These complications of hip fracture appeared to be independent of health status, method of treatment, or mechanism or severity of injury.

Adult↗
PubMed2003

[Femoral neck fractures in hemodialysis patients].

Femoral neck fractures are important causes of morbidity and mortality. Patients with end-stage renal diseases are 4,4-fold more likely to sustain a hip fracture that the general population. We present our own experience with treatment of femoral neck fractures in hemodialysis patients. The study included 12 patients (6 females and 6 males), mean age 51 years (range 41-77). They were dialysed for a mean duration of 125 months (range 12-271). The femoral neck fracture was treated by bipolar hip arthroplasty. The follow up was from 3 month to 6 years. We did not observe serious complications after operation. One patient was reoperated after 20 months, because of bipolar prosthesis protrusion. One patient died after 4 years from operation with normal hip function. The cause of death was decompensation of cirrhotic hepatitis. We estimate that severe secondary hyperparathyroidism is a risk factor of femoral neck fractures in hemodialysis patients.

Adult↗