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PubMed2000

The effect of implant design and bone density on maximum torque and holding power for femoral neck fracture devices.

BACKGROUND AND AIMS: Displacement of internally fixed femoral neck fractures due to implant migration is a common problem. This in vitro study was performed to compare maximum torque and holding power for five different implants. MATERIAL AND METHODS: Synthetic porous material with low, medium or high density was used to simulate cancellous bone. The tested implants included three conventional screws (AO, Olmed, Hansson), one screw with threads and a barb (Hybrid), and a pin with a hook (LIH). RESULTS: The Hansson screw provided higher maximum torque in low and medium density blocks when compared with the other implants (p < 0.0001) followed by LIH, Hybrid, Olmed, and AO. For high-density blocks there was no significant difference between Hansson and Hybrid screws, both with significantly higher torque than the other implants. The maximal pullout in low-density blocks differed significantly between all five implants with the Hansson screw providing the highest holding power. For medium and high-density blocks the conventional screws had significantly higher pullout resistance compared with the Hybrid and LIH. CONCLUSION: The in vitro model used seemed to provide reproducible and clinically relevant results. There was a good correlation between material density and holding power for all implants. Screws inserted without predrilling provided higher maximal torque while maximal pull out load seemed less affected by predrilling being used or not.

Bone Density↗
PubMed1994

[Total endoprosthesis or dual head prosthesis in endoprosthetic management of femoral neck fractures?].

From 1.1.1984 to 31.12.1992, a total of 363 femoral neck fractures were treated by primary hip arthroplasty, with 213 total hip endoprostheses (58.7%) and 150 bipolar endoprostheses (41.3%). The average age of the 51 (14.0%) male and 312 (86.0%) female patients was 80.3 (+/- 8.9) years. While only 15.8% of all patients were treated with alloarthroplasty in 1984, the proportion treated in this way increased to 88.9% in 1992. In the same period, the percentage of patients with total hip arthroplasty who were above 80 years rose from 15.6% to 54.5% (p < 0.05), and the percentage in this group with multiple concomitant diseases rose from 28.1% to 48.2% (p < 0.05). General postoperative complications occurred after 43.5% of the operations (total arthroplasty 38.0%, bipolar prosthesis 51.3%, p < 0.01), with no substantial change during the observation period (1984-1986, 43.6%; 1990-1992, 43.2%). Surgical complications were observed in 9.1% of all cases (total arthroplasty 11.7%, bipolar prosthesis 5.6%, p < 0.05), decreasing slightly from 11.7% in 1984-1986 to 8.1% in 1990-1992. The postoperative mortality was 3.3% (total arthroplasts 1.9%, bipolar prosthesis 5.3%, p > 0.05). The higher rate of general complications and the insignificantly higher mortality after insertion of bipolar endoprostheses cannot be attributed to the endoprosthetic technique itself; they are probably due to the higher age and poorer general condition of patients in whom hemiarthroplasty was performed. Although there has been an increasing frequency of total hip replacement even in older and sicker patients in recent years, no significant changes in morbidity and mortality were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Internal fixation of femoral neck fractures. Compression screw compared with nail plate fixation.

In a prospective, randomized study of femoral neck fracture operations, a newly developed compression-screw device was compared with the McLaughlin nail-plate. One hundred and twenty-eight fractures were treated with the compression screw and 127 with a nail plate. The patients were followed up for 3 years. All undisplaced fractures healed in both groups. Eleven per cent of displaced Garden 3 and 4 fractures did not heal in the compression-screw group compared to 25 per cent in the nail-plate group. Late segmental collapse occurred in 15 per cent of the healed displaced fractures in the compression-screw group, compared to 21 per cent in the nail-plate group. Fixation of femoral neck fractures using the new compression-screw device gave fewer failures without concomitant disadvantages compared to nail plate fixation.

Aged↗
PubMed1999

Subcapital femoral neck fracture after closed reduction and internal fixation of an intertrochanteric hip fracture: a case report and review of the literature.

A subcapital femoral neck fracture in a healed intertrochanteric fracture treated by an open reduction and internal fixation is a rare, but catastrophic, event. We present the case of an 86-year-old woman, a community ambulator, who sustained a displaced right intertrochanteric hip fracture during a fall. She was treated with closed reduction and internal fixation with a dynamic compression hip screw and side plate. Four months later, she was noted to have a displaced subcapital femoral neck fracture and underwent hip screw and side plate hardware removal and cemented bipolar hemiarthroplasty. Both postoperative recoveries were uncomplicated, and she was discharged to a rehabilitation facility able to ambulate with minimal assistance. This devastating complication in patients with osteoporosis may be prevented by deeper placement of the dynamic hip compression lag screw to within 5 mm to 8 mm of the subchondral bone, which may decrease the stress forces in the subcapital femoral neck.

Aged↗
PubMed2005

[A new model of comprehensive data linkage--evaluation of its application in femoral neck fracture].

Aim of the project was a comprehensive assessment of short- and middle-term outcome of femoral neck fracture by linkage and analysis of available data from routine care. For this purpose, a generic model of data linkage was developed, agreed with the data security officer, and practically applied. Included were all patients of the AOK Westphalia-Lippe, who were treated in a general or trauma surgery hospital in 1995/1999 for a femoral neck fracture (ICD-9: 820). For these patients, the linkage was based on the following sources: the data regarding the initial hospital stay were provided by the office of quality assurance of the chamber of physicians of Westphalia-Lippe; the administrative data were provided by the AOKWestphalia-Lippe; and the data evaluating the nursing needs were obtained from the Medical Services of the Health Insurance of Westphalia-Lippe (MDK). This paper presents the model of data linkage and describes its practical implementation; it also presents medical data demonstrating that femoral neck fractures are associated with high mortality and increase of nursing needs in the course of disease. The benefit of the new model is manifold and can be easily extended to other clinical questions.

Aged↗
PubMed1995

Outcomes in surgical treatment of femoral neck fracture: analysis of failures secondary to osteonecrosis.

We analyzed failures of surgical treatment of femoral neck fractures due to osteonecrosis in a consecutive series of 26 patients with an average age of 31 (range, 10 to 49 years). These patients were referred for treatment of osteonecrosis that developed after internal fixation of a fracture of the femoral neck. The average Harris hip score at the time of referral was 59. The length of time from fracture treatment to the development of osteonecrosis averaged 22.5 months (range, 5 months to 13 years). All patients were symptomatic at the time of presentation. Internal fixation used at the time of the initial trauma included a variety of cannulated and noncannulated screws and sliding hip screws. Of the 27 fractures, 7 (26%) were nondisplaced, 20 (74%) were displaced, and 2 (7%) were open and displaced. Fifteen patients had previously had removal of hardware, making magnetic resonance imaging of the femoral head possible. Of those patients, 2 had involvement of 25% or less of the femoral head, 7 had involvement of 25% to 50%, 5 had involvement of 50% to 75%, and 1 patient appeared to have complete involvement of the femoral head. Among the displaced fractures, 30% (6/20) had a radiographically evident malreduction. Radiographs were adequate for evaluation of hardware placement in 78% (21/27) of the fractures. Central placement of the hardware was noted in only 9% (2/21). Superolateral positioning of the hardware within the femoral head was most frequently noted.

Adolescent↗
PubMed1983

Classification of femoral neck fractures in the elderly as pathologic fractures.

The following distinctions can be made between fractures of the femoral neck in elderly persons and similar fractures in younger patients: They are much more common in the elderly. They are more frequent in females than in males. There is a much higher incidence in the white than in the black population. Fractures of the opposite hip are more common in the elderly. Associated medical conditions in the elderly may make the patient more susceptible to falls and may increase the degree of osteopenia. There is a high rate of mortality in elderly patients within 1 year of the fracture. Minor trauma causes many of the fractures in elderly patients whereas severe trauma is usually the mechanism in younger ones. Osteopenia is more common in elderly women and places them at higher risk for fracture. Microfractures of the femoral head and neck may add to the high incidence of fracture in elderly persons. The anatomic configuration of the fracture is different in elderly patients, with impacted and displaced subcapital fractures more common. The incidence of union of the fracture is the same in older and younger patients, but in the older patient multiple pin fixation is necessary for impacted and nondisplaced fractures; also, in displaced fractures a device with side plate fixation is necessary to maximize fracture healing. The incidence of avascular necrosis is approximately the same in older and younger individuals, but revascularization of the avascular segment in older patients is a limited process. On the basis of these observations, fractures of the femoral neck in the elderly should be classified as pathologic fractures. There is a need for improved methods of reducing and treating nonunion and avascular necrosis, but also there is a need to obtain more data concerning factors related to the patient and to the quality of bone. Thus, it is hoped, some of these fractures can be prevented and better treatment can be provided.

Adolescent↗
PubMed2004

[Evaluation of the postoperative quality of life in the elderly over 80 years old who underwent hip hemiarthroplasty for femoral neck fracture].

OBJECTIVE: To evaluate the postoperative quality of life of aged patients (> 80 years old) who underwent hip hemiarthroplasty for femoral neck fracture one year ago. METHODS: From February 1995 to February 2001, 52 elderly patients (> 80 years old) underwent the hip hemiarthroplasty after femoral neck fractures. There were 28 males and 24 females, with the average age of 84.2 years old (ranged from 80 - 95 years old). The fracture type was Garden III or IV, and all the patients underwent the hip hemiarthroplasty of domestic prosthesis. Before the operation, most of them were accompanied with pre-existed diseases. Harris hip score including symptoms and the ability of daily life at the one year after operation was adopted for the follow-up. Postoperative A-P and lateral X-ray of hip joint in different phase were also assayed. RESULTS: Forty-six patients (88.46%) were free of pain and satisfied their operations, only 6 patients (11.54%) complained about slight pain. Twenty-four patients (46.2%) were able to walk without any assistant, 24 patients (46.2%) managed to walk by walker, 4 patients (7.7%) could only lie on the bed or move by wheel chair. Postoperatively, patients with neurological diseases such as Parkinson dementia, Senile dementia, cerebrovascular diseases got poor result of the quality of life. However, the other comorbid diseases such as cardiovascular diseases, diabetes mellitus, chronic renal failure, chronic bronchitis did not affect the result. Thirty-eight patients had the postoperative X-ray when they were followed up. Postoperatively, the X-ray were taken from 3 months to 5 years and 6 months, averaged 54.2 months. Sclerotic line were discovered around the shaft of prosthesis only in 3 patients. No complications such as femoral head central dislocation or hip osteoarthritis were found. CONCLUSION: Operative treatment could be actively adopted for aged femoral neck fracture patients without surgical contraindication, which can contribute to obtain the motion ability, reduce complication caused by lying in bed, and keep a good quality of life.

Aged↗
PubMed2003

Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial.

The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery. We have studied 102 patients of mean age 80 years, with an acute displaced fracture of the femoral neck. They were randomly placed into two groups, treated either by internal fixation (IF) with two cannulated screws or total hip replacement (THR). None showed severe cognitive dysfunction, all were able to walk independently, and all lived in their own home. They were reviewed at four, 12 and 24 months after surgery. Outcome measurements included hip complications, revision surgery, hip function according to Charnley and the health-related quality of life (HRQoL) according to EuroQol (EQ-5D). The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications (36% and 4%, respectively; p < 0.001), and the number of revision procedures (42% and 4%, p < 0.001). Hip function was significantly better in the THR group at all follow-up reviews regarding pain (p < 0.005), movement (p < 0.05 except at 4 months) and walking (p < 0.05). The reduction in HRQoL (EQ-5D index score) was also significantly lower in the THR group than in the IF group, comparing the pre-fracture situation with that at all follow-up reviews (p < 0.05). The results of our study strongly suggest that THR provides a better outcome than IF for elderly, relatively healthy, lucid patients with a displaced fracture of the femoral neck.

Aged↗
PubMed1984

Osteosynthesis of femoral neck fracture. The sliding-screw-plate with or without compression.

In a prospective study of 220 displaced femoral neck fractures treated with a sliding-screw-plate, the cases were allocated to osteosynthesis with or without compression. In surviving patients followed for at least 1 year, union occurred in 57/85 with compression and 58/71 without compression. At 2 years, necrosis was radiographically evident in 9/37 and 7/36 united fractures. Thus, compression cannot be recommended when displaced femoral neck fractures are treated with a sliding-screw-plate.

Adult↗
PubMed1986

Hip joint pressure after femoral neck fracture.

The hip joint pressure in 40 patients with intracapsular femoral neck fractures was measured on the fracture table prior to surgery. All but 1 patient had pressures well below 20 mmHg with the hip unreduced. When the hip was extended and internally rotated, the pressure rose to values exceeding the normal arteriolar pressure in most patients, with a peak pressure of 135 mmHg. In nine of 22 Garden IV fractures, the pressure remained low despite extension and inward rotation. Injection of contrast medium in three of these hips indicated a rupture of the joint capsule. The pressure response to extension and internal rotation was less marked in fractures older than 72 hours. The findings do not support the hypothesis that a hip-joint tamponade is a common etiologic factor for the development of femoral head necrosis following fracture. However, prolonged reduction maneuvers with the hip joint in extension and internal rotation can create intracapsular pressures high enough to temporarily jeopardize the circulation of the femoral head.

Aged↗
PubMed1999

[Pre- and postoperative complications of elderly patients with femoral neck fractures--a report of 525 cases].

Pre- and postoperative complications of 525 cases of femoral neck fractures in elderly patients were studied. The mean age was 81.5 years. Preoperative complications were found in 94.5% of the patients. Circulatory and respiratory complications were 68.4% and 29.7%, respectively. Dementia was present in 55.6% of the patients. Operations for fractures were performed under spinal anesthesia only or under both spinal and epidural anesthesia. We tried to avoid hypotension and hypoxia during operations and postoperative periods under pulse oximeteric monitoring. In the postoperative period, circulatory and respiratory diseases exacerbated or newly developed in 4.4% and 5.7% of all cases, respectively. Postoperative mortality within a month was 1.0%, and it was 3.6% within a year. Many elderly patients with femoral neck fractures had preoperative complications, but postoperative complications could be avoided by careful management during pre- and postoperative periods.

Aged↗
PubMed2004

Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years.

BACKGROUND: There is a paucity of data on the treatment of femoral neck fractures in young patients. The purpose of the present study was to review the results and complications associated with the treatment of femoral neck fractures with internal fixation in a large consecutive series of young patients. METHODS: Between 1975 and 2000, eighty-three femoral neck fractures in eighty-two consecutive patients who were between fifteen and fifty years old were treated with internal fixation at our institution. Two patients died, and eight were lost to follow-up. Seventy-three fractures were followed until union, until conversion to hip arthroplasty, or for a minimum of two years; the mean duration of follow-up was 6.6 years. Fifty-one of the seventy-three fractures were displaced, and twenty-two were nondisplaced. The results and complications of treatment were retrospectively reviewed, and the effects of fracture displacement, reduction quality, and capsular decompression on outcome were evaluated. Function was assessed by evaluating pain, walking capacity, and the need for gait aids. The mean duration of follow-up for the fifty-seven patients (fifty-eight fractures) who had not undergone early conversion to arthroplasty was 8.1 years. RESULTS: Fifty-three (73%) of the seventy-three fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. Osteonecrosis developed in association with seventeen fractures (23%), and a nonunion developed in association with six (8%). Four of the six nonunions later healed after a secondary procedure. At the time of the final follow-up, thirteen patients had had a conversion to a total hip arthroplasty because of osteonecrosis (eleven), nonunion (one), or both (one). Five (9.8%) of the fifty-one displaced fractures were associated with the development of nonunion, and fourteen (27%) were associated with the development of osteonecrosis. Three (14%) of the twenty-two nondisplaced fractures were associated with the development of osteonecrosis, and one (4.5%) was associated with the development of nonunion. Eleven (24%) of the forty-six displaced fractures with a good to excellent reduction were associated with the development of osteonecrosis, and two (4%) were associated with the development of nonunion. Four of the five displaced fractures with a fair or poor reduction were associated with the development of osteonecrosis, nonunion, or both. CONCLUSIONS: The ten-year survival rate of the native femoral head free of conversion to total hip arthroplasty was 85%. Osteonecrosis was the main reason for conversion to total hip arthroplasty, but not all patients with osteonecrosis required further surgery. The results of treatment were influenced by fracture displacement and the quality of reduction.

Adolescent↗
PubMed2001

Femoral neck fracture--the cause of death of Emperor Charles IV.

We present the oldest documented case of femoral neck fracture of a particular person in the history of orthopaedic surgery. Examination of the skeleton of Charles IV, the King of Bohemia and Roman Emperor living in XIVth century has revealed a fracture of the left femoral neck. This fracture was most probably an indirect cause of his death as it resulted in pneumonia, the immediate cause of death. This fact has been confirmed by contemporary chronicles.

Czechoslovakia↗
PubMed1992

Coxarthrosis and femoral neck fracture.

A retrospective cross-sectional study of the roentgenograms of 300 hip fracture patients and 300 age- and gender-matched controls was performed to determine the relationship between fracture type, femoral neck trabecular bone integrity (as measured by the Singh index), osteoarthrosis, and age. Coxarthrosis was associated with a low incidence of intracapsular fracture but unchanged rates of extracapsular fracture. Singh grade declined with age in all groups of patients, although the rate of decline was reduced in control female patients with coxarthrosis compared with other diagnostic groups. When the coxarthrosis patients were included, the mean Singh grade for the female fracture patients was significantly reduced in patients compared with controls with or without age adjustment (3.88 versus 4.17). When patients with coxarthrosis were excluded from the analysis, this effect disappeared. It is suggested that the differences in Singh grades observed previously between femoral fracture patients and controls may have resulted from an undetected negative association between coxarthrosis and retention of trabecular integrity with aging.

Aged↗
PubMed1989

Changes in osteocalcin after femoral neck fracture.

In a group of elderly patients with osteoporosis and femoral neck fracture, osteocalcin concentrations rose significantly in the first week after fracture fixation. The changes in osteocalcin correlated well with the changes in plasma 1,25-dihydroxycholecalciferol (P less than 0.001).

Aged↗
PubMed1986

Internal fixation of ununited femoral neck fractures combined with muscle-pedicle bone grafting.

Fifty-six patients with ununited intracapsular fractures of the femoral neck were treated by internal fixation and muscle-pedicle bone grafting. All had some absorption of the femoral neck, and many had avascular necrosis of the femoral head. At operation the sclerosed surfaces of the fractures were freshened, the avascular femoral head was decompressed and the muscle-pedicle graft was fixed with silk thread wrapped around pins. Satisfactory union occurred in 42 patients (75%), and delayed union in seven, of whom four (7%) eventually united without further treatment and three united after osteotomy. Non-union occurred in five patients and technical failure in two.

Adolescent↗