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PubMed1978

Deyerle treatment for femoral neck fractures.

Thirty-eight displaced intracapsular fractures of the femoral neck treated by the Deyerle method of internal fixation have been added to the previously reported series of sixty-three cases from the Walter Reed Army Medical Center Orthopaedic Service. A significant change in the incidence of non-union was found. In the over-all series of 101 patients, the incidence of non-union was 13.8 per cent and the incidence of segmental collapse due to avascular necrosis was 13.8 per cent. The roentgenographic and functional over-all end results were rated excellent in 67.7 per cent and poor in 32.3 per cent of the fractures. Some difficulties arising from the multiple-pin and plate technique and the associated morbidity are discussed. We now think that Deyerle method produces no better results than other methods of internal fixation of displaced intracapsular fractures.

Bone Nails↗
PubMed2007

Interpreting preoperative radiographs in displaced femoral neck fractures: observer variability in evaluating signs of poor outcome.

OBJECTIVE: To evaluate the reproducibility of four preoperative radiographic signs thought to be associated with negative prognosis in dislocated femoral neck fractures when treated with internal fixation. SETTING: University Hospital. DESIGN: Standard hip radiographs of ten patients with displaced subcapital femoral neck fractures were studied by five orthopaedic surgeons. The radiographs were studied twice; the second time on average 3 months after the first reading. Inter- and intra-observer reliability of four radiological parameters was estimated. RESULTS: Poor intra- and inter-observer reproducibility of all four signs tested was observed. CONCLUSIONS: The decision to treat an intracapsular femoral neck fracture with either prosthesis or internal fixation has to be based on other variables than the preoperative radiographic signs evaluated in this study.

Aged↗
PubMed1980

A nutrient survey in elderly women with femoral neck fractures.

This survey was undertaken to study the nutrition of elderly women following surgical treatment for a femoral neck fracture. The voluntary food intake of 19 patients was measured 3, 7 and 14 days after operation. When the nutrient content was calculated and compared with DHSS recommended values for healthy women of the same age, only the intakes of vitamin A and calcium were adequate. The mean intake of protein, energy, vitamin D, riboflavin, vitamin C, thiamin and niacin fell short of the recommendation. The evidence suggests that whilst adequate food intake may be provided in hospital, the actual nutrient intake of elderly female patients recovering from a femoral neck fracture is often inadequate.

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PubMed1993

Screw positions in femoral neck fractures. Comparison of two different screw positions in cadavers.

To evaluate the influence of different screw positions on the stability of fixation in femoral neck fractures, 30 cadaveric proximal femora were osteotomized and fixed with 2 cannulated screws. The proximal screw was placed either with a posterior cortical support in the femoral neck or centrally, supported only by cancellous bone. The distal screw rested on the femoral calcar. The specimens were tested in bending, using the force at 2 and 5 mm deflection at the osteotomy site and at fracture, as an expression of the stability of fixation. The test sequences were recorded on a x-y plotter and on videotape. Bone density measurements were made at the femoral neck, Ward's triangle, and the trochanter region. Our findings indicate that a posterior position with cortical support for the proximal screw, compared to a central screw position with only cancellous bone support, increases the stability of femoral neck fractures.

Aged↗
PubMed2001

[Bone screw osteosynthesis of medial femoral neck fracture in elderly patients].

This study evaluated the complication rate and surgical outcome following cannulated screw fixation of femoral neck fractures in elderly patients. Between 1.6.97 and 31.12.98 we operated on 110 patients with 112 fractures. The mean age was 78.4 years (range 25-96 years). Mean follow up was 6.8 months (range 3-16 months). The mortality rate was 22.7% (25/110). 60 patients with 61 fractures could be evaluated for complications, reoperations, pain and walking ability. 68.9% of the fractures healed. Avascular necrosis developed in 18%. Non-union rate was 8.2% and redislocation rate 4.9%. 18 patients needed a second operation, two thirds received an arthroplasty and one third had implant removal or replacement. In 81.6% of the patients (the patients with secondary arthroplasty excluded) pain relief was good. Insufficient reduction and malposition of the screws are the most common causes for failure of cannulated screw fixation of femoral neck fractures in the elderly.

Adult↗
PubMed1979

Clinical study on internal fixation of femoral neck fractures.

A clinical study on the results of internal fixation of femoral neck fractures treated by multiple Knowles pinning was undertaken and correlated with the results of an experimental study. Experimentally, failures were produced by downwards migration of the Knowles pins. This phenomenon accounts for the settling of the femoral head on the neck and the frequency of non-union or malunion in patients with subcapital fractures. The type of fracture, type of reduction and age correlate with failure rate. This has to be explained by biomechanical considerations based upon the mode of failure of the internal fixation. A Garden stage III and IV, a varus or anatomical reduction of the fracture and an old age predispose to failure of the internal fixation and consequent non-union.

Age Factors↗
PubMed1999

The preoperative prevalence of deep vein thrombosis in patients with femoral neck fractures and delayed operation.

Out of 61 consecutive patients admitted for femoral neck fracture 21 patients had a delay to operation for more than 48 h from the time of injury. We studied these patients prospectively for the presence of deep-vein thrombosis (DVT). 13 (62%) had venographic evidence of thrombosis. All occurred in the broken limb. Five patients had bilateral thrombosis. The delay alone seems to be the major risk factor for thrombosis irrespective of age, fracture type, premorbid mobility and coexisting illness. The prevalence of preoperative DVT 48 h after injury approaches the reported postoperative incidence of DVT, which suggests that DVT will occur in a high proportion of patients regardless of treatment and prophylaxis. We recommend that those patients, in whom operation is delayed, should be routinely investigated for the presence of thrombosis preoperatively and a prophylactic vena cava filter should be considered when major deep vein thrombosis occurred.

Aged↗
PubMed1986

Acetabular protrusion and the Monk Duopleet prosthesis in subcapital femoral neck fractures.

A total of 166 patients with acute, displaced subcapital fractures of the femoral neck were treated over a 5-year period with the Monk Duopleet bi-articular prosthesis. The average age at operation was 77.8 years. 81 patients were available for review at an average of 37.1 months after surgery. Radiographic evidence of acetabular protrusion was found in 3 patients (3.7 per cent). This incidence of protrusion is considerably lower than that normally reported for one-piece prostheses such as the Austin Moore or Thompson. The causes of acetabular protrusion are discussed.

Acetabulum↗
PubMed1990

Bateman bipolar hip arthroplasty for femoral neck fractures. A five- to ten-year follow-up study.

Displaced femoral neck fractures in 128 patients were treated with cemented Bateman universal proximal femoral bipolar hemiarthroplasties. The follow-up period ranged from five to ten years. In the surviving 49 cases, the average follow-up period was seven years and five months. Seventy-nine percent of surviving patients had no or slight pain after their primary procedure. None of these patients developed acetabular protrusio. Ten percent of the survivors required late revision; 88% of the unrevised hips had no or slight pain. When compared with studies of noncemented Moore and Thompson fixed-head prostheses, the cemented Bateman bipolar prosthesis had decreased protrusio and less pain.

Aged↗
PubMed1978

[Vitamin D deficiency in femoral neck fractures (author's transl)].

In a therapeutic trial 20 patients with femoral neck fractures (FNF) were treated alternatively without supplemental vitamin D, calcium and phosphate or with 15 000 I.U. vitamin D2, 500 mg Ca++ and 560 mg of phosphate daily. Within two weeks, 25-OH-D in serum increased in patients with supplementary therapy. It is concluded that in the German Federal Republic, vitamin D deficiency is frequently found in the elderly during the winter months and that vitamin D deficiency could be important for the development of FNF.

Aged↗
PubMed1988

Raised serum albumin in hip osteoarthrosis: a comparative study in women of some blood chemical parameters in aging and in cases of femoral neck fractures, osteoporotic vertebral crush fractures, and hip osteoarthrosis.

Twelve blood parameters were studied in five groups of women totalling 120 subjects--group I: 26 blood donors (average age 45.2 years, range 23-66); group II: 18 patients with various cerebral, cardiovascular, or infectious illnesses (average age 79.9 years, range 66-92); group III: 28 patients with femoral neck fractures (average age 79.4 years, range 56-95); group IV: 12 patients with hip osteoarthrosis (average age 71.7 years, range 60-87); group V: 36 patients with vertebral crush fractures associated with postmenopausal and involutional osteoporosis (average age 63.0 years, range 51-75). The parameters measured were total proteins, albumin, total, alpha 1, alpha 2, beta, and gamma globulins, total calcium, phosphates, alkaline phosphatase, bilirubin, and haemoglobin. Statistical analysis showed that each group differed from the others even with adjustment for age. Among the discriminant parameters, serum albumin had a distinctive position. Significantly high concentrations of serum albumin in the group with osteoarthrosis raise the question of the possible existence of a population prone to osteoarthrosis in whom the serum albumin level may reflect a special nutritional state associated with the well known bone density in subjects with hip osteoarthrosis. Albumin values in patients with femoral neck fractures are lower than normal but non-significantly. The difference between the group with vertebral crush fractures and that with femoral neck fractures seems to be due to age.

Adult↗
PubMed2005

Hemiarthroplasty for femoral neck fracture in the elderly surgeon and hospital volume-related outcomes.

The elderly patient with a displaced femoral neck fracture is commonly treated via hemiarthroplasty. The objectives of this study were to: 1) determine the rates of in-hospital mortality, complications, and prolonged length of stay (LOS) in such patients; 2) elucidate the patient characteristics that predict these occurrences; and 3) investigate the influence of surgeon and hospital volumes on these outcomes. Using the Nationwide Inpatient Sample (NIS), 173,508 cases of hemiarthroplasty for femoral neck fracture were identified in patients > or =65 years of age. Univariate and multivariate analysis demonstrated that hospitals with low caseload volumes were associated with increased patient risk for prolonged LOS, pulmonary embolism, urinary tract infection, and pneumonia. Surgeons with low caseload volumes were associated with increased risk for mortality and prolonged LOS. Quality-improvement initiatives would benefit from consideration of these factors.

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PubMed1980

Replacement with the Christiansen endoprosthesis in acute femoral neck fractures. A 5 year follow-up study.

Patients with acute femoral neck fractures, treated with prosthetic replacement (Christiansen's trunnion bearing endoprosthesis), were followed up at 15 months and again at 67 months postoperatively, and the results of the two examinations have been compared. The patients' personal opinion of the results of the operation did not change between the time of the first and second follow-up examinations. However, the objective results showed a deterioration in function (according to Stinchfield's hip assessment scheme) with increasing follow-up time. This deterioration in rating was mostly caused by reduced walking ability. X-ray study of the hips showed an increasing frequency of acetabular protrusion, and settling and loosening of the prosthetic stem. No clear correlation between X-ray findings and clinical results could be found. We conclude that the serviceability of the prosthetic operation is apparently good despite the objective evidence of progressive deterioration both in the grading of the results and in the X-ray findings.

Acute Disease↗
PubMed1991

Drugs and femoral neck fracture: a case-control study.

Two hundred consecutive patients with femoral neck fractures (FNF) and 200 controls matched by age, sex, nursing home residency and number of admissions within the last 2 years, were interviewed about recent drug use. The matching criteria were chosen to achieve case and control groups that were comparable with regard to overall physical disability. Thus a preliminary study had shown FNF to be strongly associated with nursing home residency and to be correlated with the number of recent hospital admissions. FNF was found to be negatively associated with use of coronary drugs (OR = 0.27; 95% CI = 0.11-0.70) and positively associated with drug use in general (OR = 2.00; 95% CI = 1.04-3.05). The OR for the various classes of psychotropic drugs was consistently greater than 1., although this was not statistically significant. An inherent problem in interpreting such findings is that underlying disease may predispose the subject to both FNF and drug use, thus creating a non-causal relationship.

Aged↗
PubMed2002

Variations in treatment of femoral neck fractures in Alberta.

OBJECTIVES: To examine, in the province of Alberta, temporal trends, regional variations in treatment options and in-hospital death rates after a femoral neck fracture. DESIGN: A retrospective cohort study. PATIENTS: Six years' data were abstracted from the Alberta Morbidity File, the Alberta Health Stakeholder File and the Alberta Health Care Claims File. Patients were included if they were Alberta residents, aged 65 years or older, had sustained a femoral neck fracture and had undergone internal fixation, hemiarthroplasty or total hip arthroplasty. MAIN OUTCOME MEASURES: Death rates, arthroplasty rates and hospital stay. RESULTS: In-hospital death rates were similar across hospitals, with risks being higher for men, patients aged 80 years or older and those with more comorbid conditions. Arthroplasty rates varied from 58% to 77% among hospitals, and hospital stays associated with arthroplasty were significantly longer than those associated with internal fixation. The chance of undergoing arthroplasty varied from hospital to hospital by gender and by the number of comorbid conditions. CONCLUSION: Regional variations suggest lack of agreement among Alberta's surgeons as to how best to treat femoral neck fractures.

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PubMed1986

Internal fixation of femoral neck fractures: a prospective study.

To determine the adequacy of reduction and the soundness of the technique of primary internal fixation, the authors studied prospectively 96 femoral neck fractures over 6 1/2 years. Patients were followed up for an average of 11 months. The mean patient age was 70 years. Both clinical and radiologic data were collected at 3-month intervals for 6 months and then annually. Radiologic indices recorded included the Garden classification and index, shear angle, Western Infirmary Glasgow angle, lateral angle, nail placement, occurrence of bony union and presence of avascular necrosis. The fixation devices included sliding compression screw and side plate, multiple Knowles pins and a 130 degrees AO blade plate. A high rate of varus reduction, excessive ante- or retroversion and poor nail placement were all noted. Twenty-three patients required a total of 36 reoperations. There were six deaths in the first 6 months after operation. Eighty-five patients (mean age 79 years) with femoral neck fractures treated by hemiarthroplasty (71) or total hip replacement (14) during the same period were also reviewed. Follow-up averaged 8 months. Two patients required reoperation. The general morbidity was similar to that of the group treated by internal fixation, but there were eight deaths. Femoral neck fractures, if treated by internal fixation, demand accurate reduction and fixation for optimum results. Primary prosthetic replacement should be reserved for elderly patients with poor bone stock.

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PubMed1991

[Traumatology in the elderly. Problems exemplified by femoral neck fractures].

The most frequent complications in response to a fracture of the femoral neck, a typical injury of the elderly, are necrosis of the head of femur and pseudoarthrosis of the femoral neck. Only the around dressed down fracture can be conveyed to conservative treatment. The classification of AO takes these problems into consideration. One possibility to preserve the femur head is by operative insertion of a dynamic hip screw (DHS). Specific problems of the diverse types of fracture and their surgical details are taken into special account.

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