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PubMed1983

Femoral neck fracture fixation: rigidity of five techniques compared.

Artificial cadaveric femoral neck fractures were internally fixed with five different devices and subjected to cyclical loading of 0-1.0 kilonewtons (approximately one body weight) whilst in an anatomical position. Displacement of the proximal fragment was detected by a transducer and charted. Bone strength was assessed by a preliminary control loading phase on the intact bone. Efficiency of each fracture fixator could then be directly compared by the relative movement in each case. Five specimens each were tested with Moore's Pins, Trifin Nail, Garden Screws and a sliding screw-plate (OEC Ltd). By the criteria of the experiment, which put a severe shearing load on the implant, none of these devices reliably bore the representative body weight. An extended barrel-plate, which supported the sliding screw almost up to the fracture line, was then made. This device, employing some of Charnley's concepts, tolerated body weight in four cases out of five.

Aged↗
PubMed1986

Treatment of neglected femoral neck fractures in young adults.

Sixteen young adults with neglected femoral neck fractures were treated from 1974 to 1981. The ages ranged from 16 to 43 years. The periods of delay after fracture were three months to two years. Most of the patients were initially treated by a "Chinese bone setter" with subsequent development of leg shortening, upward displacement of the distal fragment, and a variable degree of absorption of the femoral neck or head. Treatment included skeletal traction followed by open or closed reduction, internal fixation, or angulation osteotomy with or without bone graft. Two to eight years later, there were no cases of nonunion. Four hips developed avascular necrosis with one requiring still further surgical treatment. Thirteen patients (81%) had good to excellent results. Preservation of the patients' own hip joints was worthwhile. A defeatist attitude toward the "unsolved" fracture should be qualified.

Adolescent↗
PubMed1991

Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases.

In a prospective study, 170 impacted femoral neck fractures were treated by early mobilisation and weight-bearing. The overall mortality at one year was 16%. In the 167 patients who were followed up until fracture healing or secondary instability, 143 fractures (86%) united. Instability occurred only in patients over 70 years of age, and in younger patients with a short life expectancy. Stepwise logistic regression analysis indicated that poor general health and old age (over 70 years) were risk factors. None of the other variables, such as the Garden index, Pauwels' type, and time to full weight-bearing had any influence on the development of secondary instability. Delayed operation after secondary instability caused no increase in mortality, nonunion or avascular necrosis. Functional treatment of all patients with impacted femoral neck fractures seems therefore to be justified.

Adolescent↗
PubMed1982

Dislocated femoral neck fractures. A follow-up study of 98 cases treated by multiple AO (ASIF) cancellous bone screws.

A series of 98 dislocated femoral neck fractures were treated by closed reduction and osteosynthesis with multiple AO (ASIF) cancellous bone screws. The patients were followed up for 2 years (or until death). The degree of dislocation did not have a statistically significant influence on the failure rate, which was, however, significantly correlated with poor reduction. Thirty-nine percent of the fractures were complicated by non-union or late segmental collapse. Forty-three of the patients participated in the 2 year follow-up examination. Of these patients, 38 had achieved excellent or good hip function. It was concluded that the reduction was the most important single factor in treatment of these factors.

Adult↗
PubMed2006

[Influence of operation time point on the frequency of early complications after surgical femoral neck fracture treatment].

AIM: The current publication deals with surgically treated medial and lateral femoral neck fracture of patients aged 60 and older. MATERIAL/METHODS: All patients were evaluated who received operative treatment between day of trauma and day 14 after trauma. Therefore, 30,254 patients (77,44%) were included. All early complications observed during hospital treatment were recorded as general and special complications, and we calculated whether the day of operation influenced the occurrence of early complications. Statistically significant differences were gained for revision operations. RESULTS: If the primary operation was performed on days 2 to 3 or 4 to 5 after trauma, fewer revisions necessary. Similar results were gained for revisions due to seroma and haematoma or postoperative bleeding. In these cases, fewer revision operations were performed when primary treatment was achieved on day 2 or 3. CONCLUSIONS: From the data presented, it is postulated that early complications provide no decisive reason for treating femoral neck fracture as an emergency. However, considering late complications such as the rate of femoral head necrosis, treatment for retaining the femoral head should be performed as early as possible. German guidelines suggest early but not emergency treatment in case of operations not saving the femoral head. Emergency operation within 6 h is not mandatory.

Aged↗
PubMed1995

[Epidural anesthesia for the repair of the femoral neck fracture in elderly patients].

For the repair of the femoral neck fracture in the elderly patients, an epidural catheter was inserted immediately after injury and epidural anesthesia was employed to allow radical operation as early as possible. The subjects were 45 patients with a mean age of 81.4 years. Surgical procedures were osteosynthesis and replacement of the femoral cap. The preoperative management of pain included insertion of an epidural catheter at the L2-L4 interspace immediately after injury for injection of 0.25% bupivacaine. The catheter was inserted 1.5 days on average after injury, and surgery was undertaken 1.4 days on average after the insertion. The intraoperative management included epidural anesthesia by injection of 1.5% mepivacaine. The mean duration of anesthesia was 150 min, and the total amount of mepivacaine used during the operation averaged 284 mg. For postoperative management, the epidural catheter was retained for 5 days on average to achieve adequate pain relief. The incidence of postoperative complications was relatively low, and the post operative course was also favorable.

Aged↗
PubMed2006

Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases.

PURPOSE: Avascular necrosis (AVN) is one of the most serious complications of femoral neck fractures in children. Variability in the reported rates of AVN and lack of statistical evidence has minimized the prognostic power of individual studies. The purpose of our study was to review our own cases as well as those from the literature in an effort to identify the risk factors for AVN. METHODS: We conducted a computerized search of medical records to identify all children with femoral neck fractures treated at our institution from 1980 to 2003. Records were reviewed to determine fracture type (Delbet type I to IV), displacement, age, treatment, and incidence of AVN. A structured search of PubMed was also performed to identify all reports published in English, on femoral neck fractures in children, from 1965 to 2003. Hand searches of major orthopedic journals and reference lists of publications identified additional cases. Of the 275 citations initially identified through our computerized search, 47 met the criteria for further evaluation. These citations were reviewed by 2 investigators, and data was abstracted from 20 reports that provided patient-level data and met our criteria for inclusion. RESULTS: Twenty-four patients with 25 femoral neck fractures from our institution were identified including 12 boys and 12 girls with an average age of 8 years (range 1.5 to 16). Over 300 patients who met our study criteria were also identified from the literature, and a total of 360 patients were included in the analysis. Fracture type, displacement, age, and treatment were all statistically significant independent predictors of AVN with P values <or=0.05. With logistic regression analysis, however, fracture type and age were identified as the only significant predictors of AVN. Older children were 1.14 times more likely to develop AVN for each year of increasing age. Type I to III fractures were 15, 6, and 4 times, respectively, more likely to develop AVN than type IV fractures. AVN rate by Delbet class was I=38%, II=28%, III=18%, and IV=5%. CONCLUSION AND SIGNIFICANCE: Although several factors may contribute to the development of AVN, our meta-analysis provides statistical evidence that fracture type and age are the most significant predictors.

Child↗
PubMed1993

Unrecognised joint penetration in treatment of femoral neck fractures.

Screw devices used to treat fractures of the femoral neck are usually positioned under image-intensifier control, using anteroposterior and lateral views. The volume projected by these views is over 27% larger than the femoral head; the tips of screws so placed may be outside the femoral head. This can be avoided by placement within the central two-thirds of the head: we have designed a template which can confirm safe placement.

Anthropometry↗
PubMed1999

Internally fixed femoral neck fractures. Early prediction of failure in 203 elderly patients with displaced fractures.

After internal fixation of a femoral neck fracture, 3 months is the critical time for planning rehabilitation of the patient. Most failures in the elderly occur within this time. In a series of 165 patients, we followed 127 women and 38 men with a median age of 81 (63-97) years from an examination at 3 months to reoperation or survival of the hip. 36 patients had radiographic signs of disturbed healing at the 3-month follow-up--change in fracture position by 10 mm, change in screw position by 5%, backing of the screws by 20 mm, or perforation of the femoral head by the screw. These signs had a high association with local complications and need for a later reoperation. High age and male sex increased this association. Signs of impaired healing made nonunion likely, but did not predict late segmental collapse of the femoral head. Patients with signs of disturbed healing and those closest to them should be informed about the value of early check-ups in case of pain and impaired function.

Age Factors↗
PubMed1987

Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases.

In 300 femoral neck fractures treated with hook-pin internal fixation, no perioperative mortality and no deep infection was seen. Eighty-four patients (28%) died within two years of the date of fracture. At two-year follow-up examination, 56 of 300 cases (19%) had developed radiographic healing complications, i.e., redisplacement, nonunion, or segmental femoral head collapse (26% of the survivors). Three of 85 undisplaced fractures (4%) developed segmental collapse (5% of the survivors) while among displaced fractures, radiographic evidence of malhealing was found in 53 of 215 cases (25%; 35% of survivors) at two-year follow-up examination. In the total series, secondary hip arthroplasty was performed in 34 cases (11%). Atraumatic reduction and internal fixation are recommended as primary treatment in femoral neck fractures.

Adolescent↗
PubMed1990

Redisplacement of nailed femoral neck fractures. 4-year follow-up of 110 cases.

In 110 femoral neck fractures, we measured the articulotrochanteric distance and the anteroposterior position of the femoral head, preoperatively, postoperatively, and at a minimum follow-up of 2 years. In displaced fractures the size of the displacement could not be used to predict future incidence of fracture redisplacement or femoral head necrosis.

Bone Nails↗
PubMed2001

Prediction of osteonecrosis by magnetic resonance imaging after femoral neck fractures.

Thirty-one patients undergoing internal fixation for femoral neck fractures who were examined by magnetic resonance imaging at 2, 6, and 12 months after surgery and who could be followed up more than 2 years were enrolled in the current study. The items investigated were timing of the appearance of the band image on T1 weighted images, magnetic resonance imaging classification, and plain radiographs. Band images were observed 2 months after surgery in eight patients and 6 months in 12 patients (39% of all patients). According to the location and extent of the band image on magnetic resonance imaging, one patient was classified in the B1 Group (lateral type), four patients in the B2 Group (surface type), three patients in the B3 Group (intermediate type), and four patients in the B4 Group (extended type). Band images appeared in all patients in the B4 Group 6 months after surgery. Femoral heads of the patients in the B3 and B4 Groups by magnetic resonance imaging classification all were collapsed. On plain radiographs, osteonecrosis of the femoral head could be diagnosed in eight patients between 11 and 24 months after injury. The interval giving the greatest sensitivity, specificity, and accuracy of the diagnosis of osteonecrosis of the femoral head by magnetic resonance imaging was 6 months after surgery.

Adult↗
PubMed1984

[Femoral neck fractures during the growth period. Treatment principles, results, prognosis].

Therapy and prognosis of femoral neck fractures in children is illustrated by means of 14 patients, treated by us. In adequate treatment, prognosis of fractures type II (medially) and III (laterally) is good. Medical care has to relieve the hip joint emergently, either by operative opening of the joint during osteosynthesis or at least by punction. Because of the tendency to dislocation, it is necessary to make an internal fixation even of little or not dislocated fractures of the neck. Screws are best suited for osteosynthesis. They must not cross the upper femoral epiphysis. To prevent further damage to the epiphyseal plate, the traumatic separation of the upper femoral epiphysis (fracture type I) is stabilized by K-wires. The postoperative treatment in a spica cast is necessary only in unreliable children.

Adolescent↗
PubMedDate not supplied

Internal fixation of femoral neck fractures. A follow-up study of 118 cases.

A retrospective study of 118 femoral neck fractures treated with multiple Knowles pins or with AO (ASIF) cancellous bone screws, and followed for at least 22 months, revealed nonunion in 1/33 undisplaced fractures and in 27/85 displaced fractures. Avascular necrosis was radiographically evident in respectively 2/32 and 19/58 united undisplaced and displaced fractures. Four factors were adversely associated with union: inaccurate reduction, mental confusion, age above 80 years and fixation with less than 6 Knowles pins. Late segmental collapse was not significantly related with any of the 9 analyzed factors. It was concluded that displaced femoral neck fractures in confused patients older than 80 years, or fractures one cannot adequately reduce, should be primarily treated with arthroplasty. Following accurate reduction, internal fixation with less than 6 Knowles pins cannot be recommended.

Adolescent↗
PubMed1990

[Nondisplaced (impacted) femoral neck fracture--conservative or surgical treatment?].

The treatment of undisplaced femoral neck fractures, having been disputed for the past 50 years, is analysed on the basis of 111 observations during the period of 1981 to 1983. Osteosynthesis proved to be advantageous. Fixation with a three-flanged nail did not increase mortality rate, had no negative effect on late complications, while it could prevent dislocation and permitted full loading at an early stage.

Aged↗
PubMed2003

[Femoral neck fractures in the elderly -- bipolar hemiarthroplasty in total hip replacement].

INTRODUCTION: In this study surgical risk and functional outcome of bipolar hemiarthroplasty and total hip replacement in elderly patients with femoral neck fractures were compared. METHODS: In a prospective study 54 patients with femoral neck fractures (median age: 80.5 years) were treated by implanting a total hip replacement (group I). Group II comprised 52 patients with 55 femoral neck fractures (median age: 81 years) who underwent bipolar hemiarthroplsty. Pre- and postoperative mobility and social history, perioperative parameters such as duration of surgery, blood loss, and number of transfused blood units as well as postoperative complications and mortality were compared. Function was ascertained by a scoring system. RESULTS: Duration of surgery, blood loss, and numbers of transfused blood units were significantly lower in group II, and mortality rate was lower. Postoperative mobility and medium-term functional score were comparable, whereas in the longer-term follow-up after 8 years group I had a significantly better functional score. CONCLUSION: In elderly patients with femoral neck fracture and high comorbidity, we recommend the implantation of hemiarthroplasty and in healthy, active patients with longer life expectancy the total hip replacement.

Age Factors↗
PubMed1994

Function after primary hemiarthroplasty and secondary total hip arthroplasty in femoral neck fracture.

Four to 12 years after primary treatment of femoral neck fracture with hemiarthroplasty in a group of Finnish patients and secondary total hip arthroplasty as a salvage procedure for healing complication after primary osteosynthesis in a group of Swedish patients, function was classified and the Nottingham Health Profile questionnaire was applied. The two groups were comparable with regard to age, sex, and social status. The patients with secondary total hip arthroplasty used walking aids to a lesser extent than the patients with hemiarthroplasty and experienced less problems in several aspects of life. Walking ability was considered unchanged, compared to prefracture, to a larger extent in the secondary total hip arthroplasty group. Thus, secondary total hip arthroplasty in patients with healing complication following primary osteosynthesis gives better long-term functional capacity than that obtained with a primary hemiarthroplasty.

Activities of Daily Living↗