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At least 433 records · Page 24Linked to original sources
PubMed2003

Minimally displaced intra-capsular femoral neck fractures in the elderly--comparison of multiple threaded pins and sliding compression screws surgical techniques.

PURPOSE: To determine the outcome of treatment for minimally displaced femoral neck fractures using multiple threaded pins versus sliding compression screws for internal fixation. METHODS: The medical records of 62 consecutive elderly patients with minimally displaced intra-capsular femoral neck fractures who underwent internal fixation of the fracture (37 with multiple threaded pins, and 25 with sliding compression screws) were reviewed. Clinical and radiological assessment of fracture healing at follow-up visits were noted. RESULTS: In the 55 patients seen for follow-up at 3 months, 21.9% (n=7) of those treated by pinning demonstrated non-union of the fracture, and 0% of fractures treated with sliding compression screws (p=0.02). 46 patients were seen for follow-up at one year, with 10% (n=2) of those treated with sliding compression screws found to have osteonecrosis of the femoral head. The 2 fractures in the group treated by pinning demonstrating non-union at 3 months failed to unite by one year (p=0.11). 34 patients were seen for follow-up for at least 2 years, with no additional complications noted. CONCLUSION: Using sliding compression screws to treat minimally displaced femoral neck fractures can achieve a higher union rate than using pinning. The reason may be the better stability in the osteoporotic bone. However, osteonecrosis of the femoral head may occur with use of sliding compression screws because of greater intramedullary vascular damage as a result of wider reaming.

Aged↗
PubMed2002

The effect of augmentation with resorbable or conventional bone cement on the holding strength for femoral neck fracture devices.

OBJECTIVES: To compare maximum extraction torque and pull-out load for femoral neck fracture implants inserted with standard technique or after augmentation with polymethylmethacrylate (PMMA) or calcium phosphate cement (Norian SRS). DESIGN: Biomechanical study using synthetic bone. INTERVENTION: Implants were inserted in foam blocks with three different densities for simulation of normal bone or slight or severe osteoporosis. Tested implants included three screws (AO, Olmed, Hansson), one screw with both threads and a barb (Hybrid), and one pin with a hook (LIH hook-pin). Implants were inserted by standard technique and after augmentation with PMMA or Norian SRS. MAIN OUTCOME MEASUREMENT: The effect of (a) density of the synthetic bone (low, medium, high), (b) augmentation (none, PMMA, SRS), and (c) type of implant (AO, Olmed, Hansson, Hybrid, LIH) on the maximum extraction torque and pull-out load was determined using a material testing machine. Analysis of variance with Fisher's PLSD post hoc test was used to determine statistical differences. RESULTS: PMMA significantly increased maximum torque and pull-out load for all implants and block densities when compared without cement (p < 0.0001), whereas enhancement with SRS was far less pronounced and most obvious in low density blocks. For screws normally inserted without predrilling (Olmed and Hansson) the use of SRS in high density blocks caused a significant reduction in maximum torque (p < 0.0001) and pull-out load (p < 0.0001). SRS-augmented specimens failed through the cement at the periphery of the threads, whereas PMMA-augmented specimens failed between the cement and the synthetic bone. CONCLUSION: This study suggests that augmentation with PMMA around femoral neck fracture implants will increase the holding power significantly when compared with standard insertion technique as well as augmentation with calcium phosphate cement. Augmentation with calcium phosphate cement like SRS will increase the holding characteristics mainly in low density bone, whereas in high density bone it might even reduce the maximum torque because of the need for predrilling when using the cement for augmentation.

Biomechanical Phenomena↗
PubMed1989

[Participation of osteoporosis in femoral neck fracture--bone mineral measurement of proximal femur using quantitative computed tomography].

Quantitative computed tomography (QCT) was used to measure bone mineral contents of the proximal femur. First, 62 specimens of cancellous bones of the proximal femur obtained at operation were burnt for mineral determination after preoperative QCT measurement to evaluate the relationship between QCT values and ash weight. The findings indicated that QCT measurement of proximal femur was as useful as that of the lumbar spine. Next, 10 groups of 50 men and 50 women ranging in age from the 5th to the 9th decade were tested to define the control mean and range of QCT mineral content of proximal femur, to compare with 32 cases of femoral neck fracture. In women with femoral neck fracture, QCT values of the femoral neck were less than those of the same normal age group except for cases of medial fracture in the 9th decade. This measurement might provide an index for fracture risk.

Aged↗
PubMed1989

[The problem of femoral neck fracture in multiple sclerosis].

CASE REPORT: In a female MS-patient with severe osteoporosis a fracture of the femoral neck occurred while doing neurophysiological exercises. A lawsuit for damages followed and ended in settlement. The risk of femoral fracture in MS and an expert report are discussed.

Female↗
PubMed1998

Unstable femoral neck fractures in young adults: treatment with the AO 130-degree blade plate.

OBJECTIVE: To evaluate the clinical outcome of the treatment of unstable femoral neck fractures using the AO 130-degree blade plate. DESIGN: Between 1980 and 1994, thirty-four consecutive patients younger than age fifty years with an unstable intracapsular femoral neck fracture (Garden Types III-IV) were treated with internal fixation. SETTING: University Hospital Gasthuisberg, Leuven, Belgium. INTERVENTION: The AO 130-degree blade plate with an antirotation, 6.5-millimeter, partially threaded cancellous lag screw was used. RESULTS: Nineteen (63.3 percent) patients had an excellent result, seven (23.3 percent) had a good result, three (10 percent) had a fair result, and one (3.3 percent) had a poor result. Delayed union was observed in one case, and avascular necrosis was observed in two cases. Two implants perforated the subchondral bone. CONCLUSION: Stable fixation with the AO 130-degree blade plate avoids damage to the adjacent blood supply to the femoral head and appears to guarantee a good final outcome of unstable intracapsular femoral neck fractures in young adults.

Adult↗
PubMed2002

A survey of the treatment of displaced intracapsular femoral neck fractures in the UK.

A survey was undertaken to investigate the treatment of displaced intracapsular femoral neck fractures across the UK. The usual practice at 223 hospitals was recorded for two groups of patients, active and frail. Management of stereotyped fractures, in similar patients, varied between hospitals. There was also variation between specialists within some hospitals: two or more of the alternative methods of treatment were in routine use for active patients at 22% of hospitals and for frail patients at 27%. Overall, for active patients, bipolar hemiarthroplasty was undertaken at 41% of hospitals, internal fixation at 37%, unipolar hemiarthroplasty at 32% and total hip replacement at 16%. Cemented prostheses were used in 74% of arthroplasties for active patients. For frail patients, hemiarthroplasty with an Austin Moore or Thompson prostheses was undertaken at 94% of hospitals; bipolar prostheses were used at 8%; internal fixation was undertaken at 1%. Cement was used in 46% of hemiarthroplasties. These findings indicate a lack of consensus in aspects of the treatment of displaced intracapsular femoral neck fractures and are likely to reflect difficulties in determining "best practice."

Aged↗
PubMed2006

Two cannulated hip screws for femoral neck fractures: treatment of choice or asking for trouble?

INTRODUCTION: Undisplaced intracapsular fractures are predominantly treated with a minimally invasive fixation technique, whereas the standard treatment for displaced intracapsular fractures is still a subject of discussion. The purpose of this study was to identify the determinants influencing the outcome of intracapsular femoral neck fractures, treated with two cannulated hip screws. PATIENTS AND METHODS: From January 1998 through December 2002 data of all consecutive patients with an intracapsular femoral fracture, treated with two cannulated screws, were documented. Consolidation was chosen as the primary endpoint, mortality and a reoperation for replacement of osteosynthesis were defined secondary endpoints. RESULTS: One hundred and twelve patients were included in the study. Fifty six percent of the intracapsular fractures healed within 1 year. Consolidation was accomplished in 95% of the stable fractures. Consolidation rates were negatively influenced by unstable fractures and inadequate anatomical reduction. The position of the screws did not influence consolidation rates. Reintervention rates were related to the number of local complications and the fracture type. CONCLUSION: In conclusion, the results of this study show that in case of operative treatment, undisplaced femoral neck fractures can be adequately fixated by two cannulated hip screws. Unstable, anatomically reduced femoral neck fracture (Garden III/IV) may be treated with a more stable implant (e.g. DHS) to avoid redisplacement. If adequate reduction cannot be achieved, endoprosthetic replacement is recommended.

Adult↗
PubMed2006

[Treatment of femoral neck fractures with compressed screw and sartorius bone flap in youth or middle age].

OBJECTIVE: To study the application and the curative effect of compressed screw and sartorius bone flap in treating femoral neck fractures in youth or middle age. METHODS: From February 1996 to December 2004, 86 patients with femoral neck fracture were treated by open reduction compressed screw and sartorius bone flap, aging from 21 to 49 years. Fracture was caused by traffic accident in 35 cases, fall from height in 27 cases and fall in 24 cases. According to Garden classification, 23 cases were type II, 25 cases were type III, and 15 cases were type IV. We analyzed fracture healing and evaluate function by observation of the postoperative X-ray films. RESULTS: Of the 86 patients, 62 were followed up 6 months to 7 years (2 years and 5 months on average). According to Weijie's criterion for nonunion and necrosis of femoral head, nonunion occurred in 4 cases; the healing rate of fracture was 93.5%. In healed patients, necrosis of femoral head occurred in 7 cases (11.3%) after 3 years. The results of hip joint function evaluation were excellent in 44 cases, good in 8 cases, fair in 6 cases and poor in 4 cases; and the excellent and good rate was 83.9%. CONCLUSION: Compressed screw and sartorius bone flap was simple and effective for femoral neck fractures in youth or middle age.

Adult↗
PubMed1991

[Primary valgisation osteotomy in femoral neck fractures].

Technique and results after primary valgisation osteotomy in 41 patients with femoral neck fractures are described. 2 non unions and 9 avascular femoral head necroses were observed. The primary valgisation most probably does not influence the rate of necrosis. When performed by accurate technique it lowers the incidence of non union of the femoral neck. Postoperative leg lengthening is always evident. The most current avoidable mistake is an external rotational deformity. The procedure requires proper preoperative planning.

Adult↗
PubMed2006

[Relation of bone microdamage and mineralization to the risk of femoral neck fracture].

Increased microdamage accumulation and decreased degree of mineralization have been observed in the patients with femoral neck fracture. This may indicate that increased microdamage production caused by osteopenia such as cortical or trabecular thinning, stimulate bone remodeling to repair damage and decrease degree of mineralization of bone. Appropriate regulation of bone remodeling is a key to prevent the impaired bone quality and to reduce a risk of femoral neck fracture.

Aged↗
PubMed1998

[Treatment of old femoral neck fracture with implantation of a vascularized fibular graft].

OBJECTIVE: To investigate the healing of old femoral neck fracture treated with transplantation of vascularized fibula graft accompanied with lag screw, and rehabilitation of and precaution against ischemic necrosis of femoral head. METHOD: Vascularized fibula autograft was transplanted to the anterolateral side of the femoral neck with an internal fixator of lag screw. Fibular artery and vein were anastomosed with lateral circumflex artery and vein. RESULT: 186 of 229 cases subjected to systemic X-ray films and function follow-up (3 to 15 years). The percentage of fracture healing was 93.0% the sulass rate 86.5%. CONCLUSION: Fibula with blood supply and compressed screw have a combined fixation effect of the old femoral neck fracture. Fibula is solid enough for supporting the femoral head and preventing it from collapse. Vascularized fibular grafting provides blood supply to the affected femoral head and neck, promoting femoral head restoration and reconstruction.

Adolescent↗
PubMed2001

Delirium before and after operation for femoral neck fracture.

OBJECTIVES: The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures. DESIGN: A prospective clinical assessment of patients treated for femoral neck fractures. SETTING: Department of orthopedic surgery at Umeå University Hospital, Sweden. PARTICIPANTS: One hundred one patients, age 65 and older admitted to the hospital for treatment of femoral neck fractures. MEASUREMENTS: The Organic Brain Syndrome (OBS) Scale. RESULTS: Thirty patients (29.7%) were delirious before surgery and another 19 (18.8%) developed delirium postoperatively. Of those who were delirious preoperatively, all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, had been treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium, and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and had more postoperative complications such as infections. Male patients were more often delirious both preoperatively and postoperatively. Patients with preoperative delirium were more often discharged to institutional care and had poorer walking ability both on discharge and after 6 months than did patients with postoperative delirium only. CONCLUSIONS: Because preoperative and postoperative delirium are associated with different risk factors it is necessary to devise different strategies for their prevention.

Aged↗
PubMed1994

Prediction of fracture union after internal fixation of intracapsular femoral neck fractures.

This study was based on a series of 470 patients with an intracapsular proximal femoral fracture treated by internal fixation; the characteristics of those patients with non-union were contrasted with those of patients in which union occurred, to determine which variables would predict bony union of the fracture. Radiological factors studied included measurements of fracture displacement, anatomical site and degree of osteoporosis. Patient characteristics studied were age, sex, prefracture mobility and mental state. Patient age and pre-operative fracture displacement were found to be of the greatest value in predicting non-union.

Age Factors↗
PubMed1995

[Femoral neck fracture in the elderly--differential procedure].

Recent investigations and new devices allow specific regimens in the management of dislocated femoral neck fractures. Very old, immobile patients with a bad prognosis should be treated with a femoral head prosthesis. Patients with either arthritis, osteopenia, dysplasia or rheumatoid arthritis should receive a total hip prosthesis. The remaining population (age > 65 years) with dislocated femoral neck fractures and intact acetabulum should be managed with a bipolar hemialloarthroplasty. The protrusion rate is not significant.

Aged↗
PubMed2000

Femoral structure and stiffness in patients with femoral neck fracture.

Bone morphological characteristics may relate to the risk of hip fracture. We applied finite element modeling to radiologic data for two groups of women in vivo to address two questions: (a) Do individuals who have just sustained a femoral neck fracture exhibit reduced three-dimensional structural stiffness? and (b) Are victims of hip fracture disproportionately more susceptible to loads sustained in a fall than to stance-type loads? Ten white women (age: 64-76 years) who had just sustained a femoral neck fracture and 18 female volunteers (age: 65-76 years), matched as groups for race, age. and body mass index, were evaluated. From quantitative computed tomography scans, femoral morphometric and volumetric cancellous density measurements were obtained and a finite element model was constructed. Two load conditions were simulated: single-stance phase and lateral fall. Global stiffness values were determined for each model. The cancellous bone density was significantly lower at the femoral neck and the femoral neck and head diameters were significantly larger in the women in the fracture group than in those in the control group. The stiffness of the proximal femur did not differ significantly between the groups for either load condition. An apparently linear relationship was found for stiffness at stance load compared with stiffness at fall load (r = 0.84, p < 0.001). and slopes did not differ significantly between the groups. Although cancellous density was reduced at the fracture site in patients with femoral neck fractures. this did not result in a reduction in the predicted bone stiffness. Previous studies have established a very strong relationship between the stiffness and strength of bone. Since these modeling methods were thoroughly validated ex vivo, we conclude that although decreased bone density at the femoral neck may predict where fracture initiates, the risk of hip fracture per se may be more strongly dependent on issues such as the risk of falling and fall biomechanics than on the structural characteristics of bone.

Accidental Falls↗
PubMed2002

A biomechanical study of femoral neck fracture fixation with the VHS Vari-Angle Hip Fixation System.

Femoral neck fracture fixation with a new device, the VHS Vari-Angle Hip Fixation System (Biomet Orthopaedics Inc, Warsaw, IN), was studied in 14 fresh-frozen cadaver femurs. A Pauwels class III fracture was simulated in these femurs. Seven femurs were fixed by placing the screw at a high (150 degrees) angle to the femoral axis; the other 7 femurs were fixed by placing the screw at a low (135 degrees) angle to the femoral axis. Mean compressive failure load was found to be significantly higher for the high-angle group than for the low-angle group. We concluded that compared with a low-angle screw placement (135 degrees), high-angle screw placement (150 degrees) results in a biomechanically stronger fixation.

Aged↗
PubMed2026

Robot-assisted versus freehand cannulated-screw fixation for femoral neck fractures: a systematic review of technical, clinical and adoption outcomes.

Robot-assisted guidance may improve the technical precision of percutaneous cannulated-screw fixation for femoral neck fractures. Whether these procedural advantages translate into better clinical outcomes remains uncertain. We compared robot-assisted and conventional freehand fixation in adults with femoral neck fractures. MEDLINE, Embase and CINAHL were searched from inception to 15 July 2026 without language restrictions. Google Scholar was used only as a supplementary search source, together with forward and backward citation searching. Comparative studies of robot-assisted versus freehand fluoroscopy-guided cannulated-screw fixation were included. Risk of bias was assessed using RoB 2 and ROBINS-I, with the Newcastle-Ottawa Scale used as a complementary appraisal of non-randomised studies. Random-effects meta-analyses included prediction intervals and prespecified sensitivity analyses. The protocol was registered prospectively (PROSPERO CRD420261465038). Sixteen comparative studies involving 1,293 participants were included. Of these, 597 underwent robot-assisted fixation and 696 underwent freehand fixation. Two studies reporting random allocation and 14 non-randomised studies were included in the study. Robot-assisted fixation was associated with fewer guide-wire manipulations, greater screw-placement accuracy and 13.9 fewer fluoroscopic acquisitions per procedure (95% confidence interval [CI] -20.3 to -7.5). Earlier radiographic healing and modestly higher final Harris Hip Scores were also observed. Pooled estimates suggested lower risks of union failure, avascular necrosis and composite complications. Fluoroscopy duration, overall operative time and reoperation did not differ significantly. Heterogeneity was substantial for several continuous outcomes, with prediction intervals crossing the null for several estimates, indicating that the magnitude of benefit varied considerably between studies. Some clinical associations were also sensitive to eligibility-restricted analyses. Robot-assisted cannulated-screw fixation improves technical execution compared with freehand fixation. Patient-important clinical superiority and economic value have not been established, and evidence concerning learning curves, operator acceptability and system reliability remains insufficient. Current evidence does not support routine widespread adoption; adequately powered multicentre randomised trials incorporating economic and implementation evaluation are required.

Humans↗