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PubMed1984

The effect of early weight-bearing on the stability of femoral neck fractures treated with Knowles pins.

I compared the effects of early weight-bearing on the stability of femoral neck fractures following Knowles-pin fixation with data on a similar group of patients who were studied ten years previously, in which weight-bearing had been delayed until radiographic evidence of fracture-healing was apparent. The results concerning stability were essentially comparable, indicating that early weight-bearing did not adversely affect the stability of a properly reduced and pinned displaced fracture of the femoral neck. Factors that did adversely affect stability following fixation with Knowles pins included the degree of initial displacement of the fracture (Garden Type IV), failure to adequately reduce or fix the fracture, and severe demineralizing bone disease as measured in an iliac-crest biopsy specimen obtained at the time of surgery.

Adult↗
PubMed1977

Recovery and rehabilitation of elderly subjects with femoral neck fractures.

The effects of operative methods and postoperative care were studied in a series of 87 patients with femoral neck fractures. Thirty nine patients were treated with the Thompson endoprosthesis and 48 with internal fixation. Half of the patients in both groups were given the routine postoperative physical therapy of the department and the other half intensive physical therapy. The patients' mean age was 73 years, and 75% of the patients were women. The patients fitted with a prosthesis were mobilised better than patients following internal fixation. The clinical results in the cases who had received intensive physical therapy and those given routine physical therapy did not differ during the postoperative follow-up period of 9 weeks. The patients' age did not influence recovery. Mortality during the 3 months of follow-up was 11.5%. The mean age of the patients who died was higher than that of the other patients. Wound infections occurred in 7%. The morbidity and mortality rates were the same for both groups. Postoperative mobilisation of elderly patients with femoral neck fractures causes a great deal of work to the nursing staff. Intensified physical therapy did not hasten the patients' recovery in this study.

Aged↗
PubMed1993

Hook-pin and compression screw in the treatment of femoral neck fractures. Clinical trial and biomechanical study.

One hundred and two patients with femoral neck fracture underwent combined hook-pin and compression screw fixation. Eighty-five patients were followed up for over 6 months. The fracture was united in 80 patients. The advantages of this method included less trauma, simple technique and firm internal fixation and early postoperative partial weight-bearing. Biomechanical study showed that this method is superior to Smith-Petersen nailing and two hook-pins methods. The sliding and continuous compression of this method promotes impaction and healing of the fracture.

Adolescent↗
PubMed2007

Rating of internal fixation and clinical outcome in displaced femoral neck fractures: a prospective multicenter study.

The influence of precise surgical technique on the clinical outcome of internal fixation for displaced femoral neck fractures is an under-reported and potential confounding factor in randomized studies involving internal fixation as a treatment modality. Two experienced surgeons blindly rated internal fixation techniques on the perioperative radiographs of 102 patients selected for internal fixation in a prospective multicenter 2-year followup study. Overall technical, fracture reduction, and implant positioning ratings were given according to instruction. One or both raters assigned an inadequate overall rating in 25% of patients. There was a correlation with 2-year clinical internal fixation failure for overall technique and fracture reduction rating. Implant positioning did not correlate with 2-year internal fixation failure. Correlation increased if both raters agreed on inadequate technique. One inadequate rating indicated a problem could arise, whereas two inadequate ratings strengthened this problem likelihood. Adjudication of technique by independent rater(s) is useful, may have clinical implications, and should be performed routinely in future studies involving internal fixation in patients with displaced femoral neck fractures.

Aged↗
PubMed2006

Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients.

BACKGROUND: The treatment of displaced femoral neck fractures has long been debated. 14 randomized controlled studies (RCTs) comparing internal fixation with primary arthroplasty may give material for evidence-based decision making. METHODS: Computerized databases were searched for RCTs published between 1966 and 2004. 14 RCTs containing 2,289 patients were included in a metaanalysis regarding complications, reoperations and mortality. The analysis was performed with software from the Cochrane collaboration. RESULTS: Primary arthroplasty leads to significantly fewer major method-related hip complications and reoperations, compared to internal fixation. There was no significant difference in mortality between the two groups at 30 days and 1 year. Most of the studies found better function and less pain after primary arthroplasty. INTERPRETATION: Primary arthroplasty should be used in most patients with displaced femoral neck fracture. The healthy, lucid individual, 70-80 years old, should be given a total hip arthroplasty. The older, impaired or institutionalized patient would benefit from a hemiarthroplasty.

Aged↗
PubMed1989

Fixation of femoral neck fracture. Prospective comparison of von Bahr screws, Gouffon screws, and Hessel pins.

We report a prospective study of 214 patients with femoral neck fractures operated on with multiple pinning. The fractures were randomly allocated to fixation with either von Bahr screws or Hessel pins in 1983 and 1984 or von Bahr or Gouffon screws in 1984 and 1985. After 2 years, the failure rate was one third in the von Bahr and the Gouffon screw groups and one half in the Hessel pin group. We conclude that the nonthreaded Hessel pin is inferior to the von Bahr and Gouffon screws for fixation of femoral neck fractures.

Adult↗
PubMed1981

[Femoral neck fractures in children. About 14 cases (author's transl)].

The authors study 14 femoral neck fractures in children after a four and half years follow up. They point out the scarcity of these fractures in children. They describe their therapeutic methods and results. They corroborate the bad prognosis of this injury (femoral neck necrosis or further growth trouble) and emphasise the importance of a long term follow up to appreciate precisely the sequellar growth trouble. They discuss the responsibility of the femoral neck's vascularisation pattern in the origin of the sequella. They ask two questions : -- Is it useful to treat these fractures in emergency? -- Is the surgical dogma still valid?

Adolescent↗
PubMed1996

Blood transfusion requirements in intracapsular femoral neck fractures.

The blood transfusion requirements of 445 patients undergoing operation for intracapsular fractures of the femoral neck were studied. These requirements were correlated with the type of operation carried out, the existence of pre-operative anaemia, and intra-operative blood loss. A total of 127 patients (29 per cent) were transfused with a total of 321 units.

Adolescent↗