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PubMed1993

Clandestine femoral neck fractures with ipsilateral diaphyseal fractures.

We present a protocol for diagnosis of all femoral neck fractures associated with ipsilateral femoral diaphyseal fractures. A 30% incidence of delayed diagnosis has been reported by other investigators. Between 1982 and 1990, we have treated 32 patients with ipsilateral femoral neck and shaft fractures due to blunt trauma. Only 22 femoral neck fractures were diagnosed on prediaphyseal fixation radiographs. This left the 10 patients in this study who had normal prediaphyseal fixation radiographs and were subsequently found to have femoral neck fractures. The ipsilateral femoral neck fractures were found through a retrospective chart and radiographic review of all 555 femoral diaphyseal fractures identified through our trauma and fracture registries. The clinical and radiologic techniques for diagnosing the femoral neck fractures were presented. The time to union of the femoral shaft and neck was determined, and a preliminary radiologic assessment of the vascularity of the femoral head was made. Ten femoral neck fractures (31%) with normal preoperative radiographs were diagnosed after femoral diaphyseal fixation. One patient did not have a post-diaphyseal fixation radiograph. An incidental radiograph at 6 weeks showed a mildly displaced femoral neck fracture in an asymptomatic patient. At 16 weeks the patient became symptomatic, and a repeat radiograph showed the fracture. Five fractures were diagnosed in asymptomatic patients on routine post-femoral fixation radiographs. Two patients had normal post-femoral fixation radiographs, became symptomatic, and had their femoral neck fractures diagnosed on repeat radiographs at 3 and 7 days. One patient had normal pre- and postfixation radiographs, and on a 25-day routine femoral radiograph, the femoral neck fracture was diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Algorithms for the treatment of femoral neck fractures.

Worldwide prevalence of femoral neck fractures is increasing, doubling for patients older than 50 years. Age of the patient, prefracture activity level, and associated comorbidities must be considered when determining treatment. It seems that hemiarthroplasty is best suited for an elderly patient who is a household ambulator with low demands on the prosthesis. Younger patients, and those with minimally displaced fractures, should be treated with internal fixation in an attempt to preserve the natural hip. Proximal femur fractures in the pediatric population are associated with high complication rates. Because of vascular vulnerability, avascular necrosis of the femoral head continues to be the most frequent and serious complication after hip trauma in children. Femoral neck fractures in children also differ from those in adults because a child can tolerate immobilization much more readily than can an adult. As healthcare resources become more limited and their use becomes scrutinized more closely, cost-effective treatment algorithms for femoral neck fractures will dictate orthopaedic treatment. For some fractures, closed treatment is evolving toward interventional approaches to minimize late sequelae. With the availability of viable treatment options, the potential risks and benefits of individual treatment modalities as related to each fracture pattern must be reviewed.

Adult↗
PubMed1996

Femoral neck fracture following intertrochanteric fracture.

Four patients with femoral neck fracture following healed intertrochanteric fracture were evaluated retrospectively. This situation is a rare occurrence with a current literature review documenting only 15 cases. Patient charts and radiographs were retrospectively reviewed to evaluate the period from initial injury to definitive treatment for the femoral neck fracture. Emphasis was placed on associated risk factors and operative techniques. In case 1, the femoral neck fracture appeared to be clearly a traumatic fracture as it occurred 11 years after the intertrochanteric fracture. In cases 2, 3, and 4, multiple factors were believed to play a role in the generation of the femoral neck fractures, which occurred within 6 months of the original fracture. The etiology of such fractures remains speculative. All four patients were elderly, women with substantial medical comorbidities. Osteoporosis may be the most important single contributing factor to these fractures. Because management of this patient subgroup is notably more complex, surgeons need to be aware of the difficulties and prepared to deal with them.

Aged↗
PubMed1981

The treatment of femoral neck fractures with an isoelastic endoprosthesis implanted without bone cement.

We report about our first experiences inserting an "isoelastic" femoral endoprosthesis in cases of a fractured femoral neck. 28 patients have been observed for a period of more than 1 year after surgery. We did not find loosening or incompatibility of the polyacetal-resin material. We believe the implantation of this prosthesis type without cement fixation is especially advantageous. The histologic result of a patient who died 6 weeks after surgery did not reveal any tissue incompatibility. We observed an excellent fixation of the prosthesis by bone growth into the surface indentations of the stem.

Aged↗
PubMed2001

Comparison of logistic and Bayesian classifiers for evaluating the risk of femoral neck fracture in osteoporotic patients.

Femoral neck fracture prediction is an important social and economic issue. The research compares two statistical methods for the classification of patients at risk for femoral neck fracture: multiple logistic regression and Bayes linear classifier. The two approaches are evaluated for their ability to separate femoral neck fractured patients from osteoporotic controls. In total, 272 Italian women are studied. Densitometric and geometric measurements are obtained from the proximal femur by dual energy X-ray absorptiometry. The performances of the two methods are evaluated by accuracy in the classification and receiver operating characteristic curves. The Bayes classifier achieves an accuracy approximately 1% higher than that of the multiple logistic regression. However, the performances of the two methods, evaluated by the area under the curves, are not statistically different. The study demonstrates that the Bayes linear classifier can be a valid alternative to multiple logistic regression in the classification of osteoporotic patients.

Aged↗
PubMed2006

Early return to function in young adults with neglected femoral neck fractures.

Neglected femoral fractures in young adults are a challenge to the orthopaedic surgeon, requiring prolonged treatment and with attendant risks of nonunion. We postulated treatment in this group by accurate reduction, two cannulated screws, and whole free fibular autograft would allow early mobilization and provide good bony union. Thirty-two patients aged 18 to 50 years were treated at our center in this manner. They presented to our center 3 to 6 months after injury, and had Garden's Grade III/IV fractures with varying degrees of neck resorption, but no avascular necrosis. No plaster was applied, and early return to function was encouraged. Bony union was achieved in 29 (90.6%) patients at a mean of 19.2 weeks (range, 16-24 weeks). All patients with union had good function at long-term followup at an average of 6.1 years postoperatively (range, 2-12 years), and the average Harris hip score was 87.1 points (range, 74.5-94 points). Our procedure allows early return of function in young, active patients disabled by old femoral neck fractures compounded by lack of early treatment.

Adolescent↗
PubMed1996

Osteoclast cytomorphometry in patients with femoral neck fracture.

In patients with femoral neck fracture, nutritional deficiencies have been shown to be common. A low calcium diet and/or a reduced vitamin D intake have been suspected to cause secondary hyperparathyroidism responsible for increased bone turn over and bone loss. Parathyroid hormone (PTH) levels are increased in these patients, data which are in accordance with the pronounced changes observed on bone biopsies reflecting a true hyperparathyroidism. We have used a cytomorphometrical approach to characterize PTH-induced changes on the osteoclastic population. Osteoclasts were detected histochemically (by tartrate resistant acid phosphatase staining) on bone biopsies from 10 control subjects, 8 patients with primary hyperparathyroidism and 10 patients with a femoral neck fracture of osteoporotic origin. The maximum Feret's diameter of each osteoclast (Oc.Le) was determined with a semiautomatic image analyzer. In all groups, the frequency distribution of Oc.Le appeared positively skewed. In both hip fractured patients and primary hyperparathyroid patients, the mode of the distribution was higher (25-30 microns) than in controls (20-25 microns). When graphically converted on a probability graph, the osteoclastic populations appeared homogeneous and well described by a lognormal distribution in the three groups. However, osteoclasts appeared similarly enlarged in the groups of patients with primary hyperparathyroidism and with femoral neck fracture. PTH has been shown to increase both the recruitment of mononucleated precursors and their fusion into larger osteoclasts than controls. In the present study, a cytomorphometric method appeared able to identify the border line hyperparathyroidism in the hip fractured patients.

Adult↗
PubMed1995

[Covered osteosynthesis through cannulated screws in medial Garden type I and II femoral neck fractures].

Fracture of the femoral neck is a common problem in elderly patients. In these patients with concomitant illness and medical complications the hip fracture is then often the reason for a long-term institutionalization with serious implications for the outcome. While the treatment of displaced femoral neck fractures Garden's stage III and IV is quite clear, the procedure for impacted or undisplaced fractures Garden's stage I or II is still the subject of controversy. In a retrospective study was shown that conservative treatment of impacted or undisplaced femoral neck fractures is associated with a high complication rate of 30-40%. When these femoral neck fractures were broken down according to Garden's classification the complication rate in cases of Garden's stage II was found to be 1.5 times that in femoral neck fractures in Garden's stage I. With a P-value less than 0.05 this difference was statistically significant (Wilcoxon test). Because of these major problems associated with conservative treatment we changed our current algorithm. Covered internal fixation with cancellous screws is now considered to be indicated for all impacted or undisplaced femoral neck fractures. Between 1990 und 1992, 53 patients (42 female, 11 male) with femoral neck fracture in Garden's stage I (24 patients) or II (29 patients) were treated in our Department of Traumatology with 6.5 mm cancellous screws. In all case early mobilization and weight-bearing were allowed. In this prospective study the average follow-up was 14.3 +/- 2.1 months (range 8-20 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1987

Delayed diagnosis of femoral-neck fractures in the elderly.

A survey of a district population presenting to a trauma unit with fractured femoral necks over a year, showed that, out of a total of 374 elderly patients with this fracture, in 33 the diagnosis was delayed for over 24 hours from the onset of disabling symptoms. This was due to late presentation in eight patients, difficulty in confirming the suspected diagnosis in five, and in 20 to initial failure of doctors to make the diagnosis. By comparing this latter group with controls, it was found that medical error was most likely in patients who were either confused, dependent and subject to falls, or alternatively had suffered a spontaneous fracture which had not displaced.

Accidental Falls↗
PubMed1990

Femoral neck stress fractures.

Femoral neck stress fractures are unusual but not rare athletic injuries. In one large series they accounted for 5% of all stress fractures. Early recognition of the signs and symptoms of this injury is important, as objective findings are often delayed. The potential problems from this fracture are serious. The aetiology includes repeated force above a certain load without internal bone response time. Loss of shock absorption due to muscle fatigue and limitation of ankle motion by boots or splints may also play a role. The diagnosis is based on the finding of groin pain and radiographic testing, which often requires plain films and bone scintigraphy. Regular radiographic findings present in stages progressing from a normal film through sclerosis to a disruption of the cortex and displacement. Bone scintigraphy may be positive 2 or more weeks before plain film changes are present. Classification schemes follow the radiographic changes. A classification system and treatment plan may be based on 3 categories of these fractures--compression side, tension side and displaced femoral neck fracture. Treatment ranges from rest with early symptoms to surgical stabilisation for any widening of cortical cracks and/or displaced fractures. Prompt diagnosis and carefully supervised treatment is the key to preventing displacement. Prolonged disability secondary to pain, nonunion or avascular necrosis is associated with displacement of the femoral neck stress fracture.

Athletic Injuries↗
PubMed2005

Surgical treatment of intertrochanteric hip fractures with associated femoral neck fractures using a sliding hip screw.

OBJECTIVE: The purpose of this study was to report the results of surgical treatment of a subset of intertrochanteric fractures with posteromedial comminution and extension of the fracture line into the femoral neck using a sliding hip screw. DESIGN: Retrospective review. SETTING: Level I county trauma center. PATIENTS: Twenty-nine fractures (8%) with this pattern were identified from 381 intertrochanteric hip fractures treated at a single institution over a 10-year period. Nine patients were excluded (2 died, 7 had incomplete radiographic follow-up), leaving 20 patients for assessment. INTERVENTION: All fractures were treated with a sliding hip screw. MAIN OUTCOME MEASUREMENTS: Radiographs at a mean follow-up of 17 months were recorded as demonstrating: 1) fixation failure; 2) fracture union; or 3) fracture nonunion. The tip-apex distance, amount of lag screw collapse, screw position in the femoral head, and adequacy of reduction were determined. RESULTS: Treatment failed according to these radiographic measures in 5 of 20 (25%) fractures. Failures included fracture nonunion (1 case), lag screw cutout (2 cases), and combined nonunion/lag screw cutout (2 cases). All 5 failures had complete collapse of the lag screw, whereas 4 of the 15 successfully treated fractures had complete collapse. The amount of collapse was significantly greater for the treatment failures (mean, 38 mm) than in the successfully treated hips (mean, 20 mm). There was no significant association between treatment success or failure and tip-apex distance, lag screw position, and adequacy of reduction. CONCLUSION: We conclude that intertrochanteric hip fractures with associated femoral neck fractures should not be managed with a standard sliding hip screw.

Adult↗