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PubMed1992

PINTRACE: a computer program for assessment of pin positions in routine radiographs of femoral neck fractures.

A new method for determination of pin positions in internally fixated femoral neck fractures is described. In AP and lateral radiographs of the hip, measurements are made of the cervicofemoral angles, the diameter of the femoral head and neck, and the distances from the central femoral neck axis to each pin. From these values the positions of the fixation pins in defined straight AP and lateral projections are determined by geometric calculations. A computer program in BASIC was developed to perform the calculations and to produce graphic displays of cross-sections of the femoral head and neck with the corrected pin positions indicated. For routine radiographic examinations with unknown inclination angles of the X-ray beams, the error of the method is less than 5% of the femoral head diameter. With conventional methods of determining pin positions the error can exceed 25% of the femoral head diameter.

Algorithms↗

PubMedDate not supplied

Orthopaedic treatment of displaced femoral neck fractures in elderly patients.

PURPOSE AND METHOD: A review article concerning orthopaedic treatment and rehabilitation of displaced femoral neck fractures, focusing on evidence-based knowledge. RESULTS: Properly performed randomized controlled studies comparing internal fixation and primary arthroplasty provides the best basis to decide which method should be used. During the last decade, several such studies have been published, in addition to a few earlier works. After internal fixation with pins, screws or sliding hip screw and plate, the failure rate was 21 - 57% and re-operations were performed in 14 - 53% of all the cases. In the studies using THA, the failure rate was 4 - 11% and the re-operation rate 2 - 8%. The corresponding numbers for hemi-arthroplasty were 3 - 23% and 0 - 24%. A primary arthroplasty tends to result in better function and less pain during the rehabilitation period. CONCLUSION: With support in evidence-based literature, an elderly patient with displaced femoral neck fracture should be treated with a primary arthroplasty. If the individual is healthy, active and mentally intact, a total hip arthroplasty should be performed, otherwise a hemi-arthroplasty. This rationale ensures fewer failures and re-operations, as well as better function and less pain during the rehabilitation.

Arthroplasty, Replacement, Hip↗

PubMed2006

Early results of prosthetic hip replacement for femoral neck fracture in active elderly patients.

PURPOSE: To evaluate the short-term clinical and functional outcomes of total hip arthroplasty performed for physiologically active elderly patients with Garden type-3 or -4 femoral neck fracture. METHODS: Records of 47 consecutive patients (40 female, 7 male) with type-3 or -4 femoral neck fracture (Garden classification) who underwent cemented total hip arthroplasty at our hospital during January 1999 to December 2002 were reviewed. Radiological and clinical (Harris functional hip score and Oxford hip score) assessments of 38 patients were measured with a mean follow-up period of 21 months (range, 4-48 months). RESULTS: The mean age of the 47 patients was 75 years (range, 62-89 years). Records of 9 patients were excluded because of death, lost to follow-up, and development of deep infection that necessitated implant removal and excision arthroplasty. The mean Harris hip score of the 38 patients was 83 (range, 59-97), whereas the mean Oxford hip score was 25.2 (range, 14-33). Pain in the hips was absent in 30 patients, 6 had slight pain occasionally, and 2 patients had mild-to-moderate hip discomfort. No signs of aseptic loosening or change in implant position were noted on radiographic assessment. Two cases of dislocation were reduced by closed reduction. Two patients had deep wound infection and were treated with debridement, implant removal, and conversion to girdle stone. CONCLUSION: This short-term study showed that total hip arthroplasty for femoral neck fracture had good postoperative results in functional hip and pain scores. More attention should be paid to coexisting medical illness (e.g. diabetes mellitus, hypertension, and ischaemic heart disease) and prevention of infection.

Aged↗

PubMed2002

[Does hospital structure influence the outcome of operative treatment of femoral neck fractures?].

UNLABELLED: Data on 32 007 patients suffering from a medial fracture of the femoral neck have been collected between 1993 and 1999 in a database for external quality assurance organized by the chamber of physicians in Westfalia-Lippe. A statistical analysis (ANOVA, chi-square-test) has been performed to find out whether factors like specialization, annual volume or level of the hospital (primary, secondary or tertiary hospital) influence the outcome. RESULTS: Patients with higher preoperative risk-factors are treated more often in primary hospitals. These clinics perform conservative treatment significantly more often than tertiary hospitals (6.5 % vs. 3.8 %). Osteosyntheses are performed more often in departments specialized in traumatology (13 %) or tertiary hospitals (16.8 %). Preoperative length of stay was 0.5-0.7 days shorter in these hospitals. There is no significant difference in postoperative complications all together (23.2-25.6 %), but a significantly lower rate in postoperative complications after osteosynthesis performed by departments specialized in traumatology (11.3 % vs. 18.8 %). A volume load of more than 50 cases per year correlates with a significant decline in postoperative complications (22.5 % vs. 28.2 %). Risk adjusted mortality does not show significant differences among the different levels of hospitals. CONCLUSIONS: There are distinct differences regarding the way of treatment and procedural quality, but not concerning the short-term outcome between hospitals of different levels.

Arthroplasty, Replacement, Hip↗

PubMed1987

Treatment of femoral neck fractures by hemiarthroplasty.

Seventy-five patients with a displaced unstable fracture of the femoral neck were reviewed to evaluate treatment by cemented hemiarthroplasty through a posterior approach. Twenty-three patients were available for follow-up. The mean duration of follow-up was 46.7 months. Twenty-one patients (91%) showed a good clinical result. Sixteen patients (69%) had maintained their preoperative mobility or had deteriorated slightly. Major complications were divided as follows: mortality: six patients (6/75, 8%); early deep infection (3/23.4%) and dislocation (5/23, 7%). In four patients (4/23, 5%) a revision operation was required. Radiological evaluation showed possible loosening in one patient. Protrusion was not observed.

Aged↗

PubMed2001

Heterotopic ossification following internal fixation or arthroplasty for displaced femoral neck fractures: a prospective randomized study.

One hundred hips in 99 patients of 75 years or older, with a displaced femoral neck fracture, were studied for heterotopic ossification (HO). The patients were randomized to either internal fixation or total hip arthroplasty (THA). In the THA group HO was found in 32 of 45 hips compared with 1 of 39 in the internal fixation group (P < 0.0012). The frequency of HO after THA corresponds well with findings in other studies on patients receiving THA for osteoarthrosis. In cervical fractures the surgical procedure of total hip replacement seems to be a prerequisite for HO, indicating that the procedure itself is more important than the patient's age and the diagnosis. Severe symptoms due to HO were found in only one patient. HO following THA for a femoral neck fracture is of little clinical importance and prophylaxis is unnecessary.

Age Distribution↗

PubMed1989

Internal fixation of femoral neck fractures in Parkinson's disease. 32 patients followed for 2 years.

32 patients, suffering from Parkinson's disease, had internal fixation of femoral neck fractures. In 24 displaced fractures, 6 nonunions and 3 segmental collapses were seen; and in 8 undisplaced fractures, 1 case of segmental collapse was diagnosed. Healing complications were thus seen in one third. Total hip replacement for healing complication was performed in 3 of 32 patients. 9 patients died within 2 years. No difference in the rate of healing or mortality was detected compared with hip fracture patients without Parkinson's disease. Our study does not support primary arthroplasty for femoral neck fracture in patients with Parkinson's disease.

Adult↗

PubMed1997

[Outcome of management of femoral neck fractures with cemented bipolar endoprostheses].

In our hospital 334 patients were treated with a bipolar prosthesis for medial femoral neck fracture in the years 1990 and 1991. After an average of 54 months (minimum 48 months) informations about function could be obtained by examination and x-ray from 19 patients (5.7%), from 42 patients (12.6%) a questionnaire was analyzed. No function of the hip was described as poor, 2/3 of the patients had no pain, nearly 50% walked without crutches or other tools. No protrusio acetabuli or acetabular erosion was seen. Together with further follow-up examinations from another 230 patients out of 1365 patients treated with a bipolar prosthesis up to now, these results support the statement that bipolar prostheses play an important role in treatment of medial femoral neck fractures in the elderly.

Aged↗

PubMed1998

Bilateral pathological femoral neck fractures secondary to ectopic parathyroid adenoma.

A rare case of bilateral pathological femoral neck fractures secondary to ectopic parathyroid adenoma is reported. Both hip fractures were treated with closed reduction and internal fixation. The right hip fracture healed uneventfully, whereas the left hip fracture developed non-union that required subtrochanteric osteotomy and internal fixation and eventually healed. Neither hip developed avascular necrosis.

Adenoma↗

PubMed1988

[The femoral neck fracture in childhood].

A retrospective study into fracture of the femoral neck in childhood was compiled from 18 hospitals by the Working Group on Paediatric Traumatology, since conditions of that kind were found to be very rare. Thirty-eight fractures were kept under observation, with follow-up checks being made on 29 of them. An account is first given of peculiarities of the proximal femur in childhood. Results are communicated, and therapeutic approaches are compared. A therapeutic proposal has been derived from these findings as well as from literature data.

Child↗

PubMed1992

[The role of Gardner's classification in the detection of dislocation in femoral neck fractures].

As the literary data are contradictory, authors examined in 489 operated femoral neck fractures the significance of Garden's classification. Based on their material it was found that this classification gives help in the judgement of the single fractures and in the choice of the adequate treatment. For a more exact assessment however they think the consideration of the lateral Roentgenograms also necessary.

Femoral Neck Fractures↗

PubMed2004

[The minimally-invasive screw osteosynthesis of the medial femoral neck fracture in the very old. A prospective clinical study].

Increasing life expectancy has led to an increase of medial femoral neck fractures. Treatment by hip arthroplasty is a major surgical procedure for geriatric patients and imposes high healthcare costs. Manninger developed a cannulated screw system which allows a joint-sparing, less invasive, and stable internal fixation for the management of intracapsular femoral neck fractures. In a prospective study from January 1998 to August 2002, 63 patients older than 70 years with Garden type I to III fractures were treated by closed reduction and internal fixation with two Manninger screws on a traction table within the first 6 h after trauma. Mean time of follow-up was 21.5+/-16 months. Of the patients examined, 88.5% regained their preoperative stage of mobility. Two patients needed secondary hip arthroplasty. Due to low complication and failure rates and less medical expenses compared to treatment by hemiprosthesis the joint-sparing, less invasive internal fixation with two cannulated Manninger screws presents a safe and cost-efficient surgical technique for geriatric patients.

Aged↗

PubMed1987

Prognostic precision in postoperative 99mTc-MDP scintimetry after femoral neck fracture.

A 2-year follow-up regarding healing complications, such as redisplacement, nonunion, and segmental collapse of the femoral head, was performed in 306 patients operated on for femoral neck fracture and examined with 99mTechnetium-MDP scintimetry within 2 weeks postoperatively. Scintimetric evaluation was performed by selecting regions of interest over the femoral head on the fracture side and the intact side and by comparing the uptake. A femoral head ratio fractured/intact side thus was obtained. Of 199 patients with an intact femoral head uptake (ratio greater than or equal to 1.0), 181 showed no signs of healing complications at 2 years, whereas 18 had developed healing complications. Of 107 cases with a deficient femoral-head uptake (ratio less than 1.0), 96 had developed healing complications within 2 years from the operation, while 11 cases had no signs of radiographic complications. We conclude that 99mTc-MDP scintimetry performed within 2 weeks from femoral neck fracture can predict the outcome of the healing course with a prognostic accuracy of 91 per cent.

Adolescent↗

PubMed2002

Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up.

OBJECTIVES: This investigation was undertaken to compare a series of elderly individuals who sustained a displaced femoral neck fracture treated with either a cemented bipolar prosthesis or a cemented modular unipolar prosthesis. DESIGN: A retrospective review of prospectively collected data. SETTING: Hospital-based tertiary care orthopaedic trauma practice. PATIENTS AND PARTICIPANTS: Two hundred eighty-one community dwelling elderly patients sixty-five years of age or older who sustained a displaced femoral neck fracture (Garden Types III-IV) and underwent primary prosthetic replacement. INTERVENTION: One hundred one patients received a cemented bipolar prosthesis and 180 received a cemented modular unipolar prosthesis. MAIN OUTCOME MEASUREMENTS: The study was designed to determine whether there were any significant differences in: (a) the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and (b) the functional outcome, including the incidence of hip pain and recovery of preinjury levels of ambulatory status and activities of daily living, at a minimum of thirty-six months of follow-up. RESULTS: The two groups of patients did not differ in preinjury characteristics (age, sex, American Society of Anesthesiologist rating of operative risk, number of comorbidities, fracture type, activities of daily living, ambulatory status). There were no significant differences in the rates of postoperative medical or wound complications or dislocation. Ninety-two patients died during the period of study. Forty patients were lost to follow-up or refused to participate. Consequently, 149 patients were followed for a minimum of thirty-six months. Functional ability was compared between both groups with regard to recovery of ambulatory status and activities of daily living, as well as the incidence of hip pain at a minimum of thirty-six months of follow-up. No significant differences were found between the unipolar and bipolar groups. CONCLUSION: Based on the results of this study, there does not appear to be any advantage to the use of a bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly. Furthermore, the extra cost of bipolar endoprostheses does not seem to warrant its use.

Aged↗

PubMed1956