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PubMedDate not supplied

Bilateral femoral neck fractures after electrical injury: a case report and literature review.

Simultaneous bilateral fractures of the femoral necks are rare injuries, especially when there is no underlying pathologic condition. A review of the literature revealed only 10 cases of this injury as a result of trauma, only one of which was due to accidental electric shock. A second case in which such an injury was caused by accidental electric shock is presented here. It is important to be aware of this injury and to diagnose it early to avoid the increased risk of complications after a delay in diagnosis or treatment.

Adult↗
PubMed1993

[Medial femoral neck fractures treated with hip compression screw. A product control study].

311 medial femoral neck fractures (213 of them displaced) treated with a hip compression screw were studied retrospectively. 90 patients were treated with a primary hemiprosthesis during the same period. Fixation was lost in the case of seven fractures within three months after the operation. Two patients developed pseudarthrosis and 53 late segmental collapse. 54 patients have been reoperated, and given an endoprosthesis. The radiographs of 176 patients (114 displaced fractures) who were accessible for follow-up until failure, or for at least three years, were analysed. The rates of late segmental collapse were particularly high for fractures with a postoperative anterior angulation exceeding 15 degrees. Displacement and time until operation were independently related to late segmental collapse.

Adult↗
PubMed1983

Scintimetric evaluation of nailed femoral neck fractures with special reference to type of osteosynthesis.

With the aid of Tc-MDP-scintimetry 1-2 weeks after nailing of femoral neck fractures, it is possible to distinguish fractures liable to complications. Due to the suspicion that frequent peroperative vascular damage was caused by the four-flanged nail (Rydell), a less traumatizing cylindric nail (Hansson) with an insertion instrument was used. In a prospective investigation in January 1981-February 1982, which included all intracapsular femoral neck fractures, the two above-mentioned methods of osteosynthesis were used randomly. Intravital staining with tetracycline showed the peroperative circulation equivalent in Rydell and Hansson groups. A significant difference in postoperative isotope uptake could be noted between the two groups in 37 patients with undisplaced fractures. In 34 of 45 displaced fractures in the Rydell group evidence of circulatory deficiency appeared in the postoperative scintimetry but in only 23 of 52 of the displaced fractures in the Hansson group, a statistically significant difference. The latter figure corresponds well to the incidence of peroperatively registered severe vascular injury evaluated by tetracycline labelling.

Adult↗
PubMed1982

Biochemical findings in blood of aged patients with femoral neck fractures: a contribution to the detection of occult osteomalacia.

A study was made in Geneva of 44 patients with femoral neck fractures and no risk factor of osteomalacia to determine concentrations of 25OHD3, calcium, phosphorus, alkaline phosphatase, albumin, and globulins in blood. The results were compared with those obtained for control groups of adult and aged subjects, as well as of 21 subjects operated on for hip osteoarthritis. For the detection of occult osteomalacia, femoral head bone tissue from 14 patients with fractures was examined by histomorphometric methods. In more than a third of the cases, 25OHD3 and serum albumin values were lower than those found for adult and even aged control subjects. Some slight histological signs of osteomalacia were observed in 1 patient with a femoral neck fracture, but there was no correlation between the histologic and the blood data. In practice, when dealing with aged people with no obvious risk of osteomalacia, it is important that a systematic antiosteomalacia treatment consisting of large supplements of vitamin D be avoided and that the conditions of diet and living be carefully controlled.

Adult↗
PubMed1984

Treatment of femoral neck fractures with a sliding compression screw and two Knowles pins.

Twenty-one patients with an average age of 65 years had displaced femoral neck fractures treated by a sliding compression screw and two Knowles pins. All patients had either Garden III or Garden IV fractures. One patient healed with a malunion and five developed symptomatic avascular necrosis; all of these patients required reconstructive surgery. There were no nonunions. The sliding compression screw with two Knowles pins gave a 100% rate of union, which was superior to most fixation methods. The incidence of avascular necrosis was 24%, the expected range for displaced femoral neck fractures.

Aged↗
PubMed2006

Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty.

The incidence of femoral neck fracture among the elderly in the United States is expected to increase dramatically because of the anticipated explosion in the population aged 65 years and older, increased life expectancy, and the rising incidence of osteoporosis. The resulting public health implications may be significant, with annual hospital admissions resulting from hip fracture projected to increase to 700,000 by 2050, and with annual spending on hip fracture care expected to exceed 15 billion dollars within a few years. The decision to perform internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA must be based on patient mental status, living arrangement, level of independence and activity, and bone and joint quality.

Aged↗
PubMed2002

[The femoral neck fracture in the elderly patient - cemented or cementless hip arthroplasty?].

This is a report on the treatment results of femoral neck fractures with a cemented (group 1) and cementless (group 2) type of hip prosthesis, resp. 72 patients were enrolled. 35 patients were treated with a cemented hip prosthesis (mean age: 78 years), and 37 patients with a cementless modular hip prosthesis (mean age: 77 years). In the cemented group we observed 5 cases of hypotension during insertion of the prosthesis in the femoral shaft. One of these patients required mechanical resuscitation during surgery. In the second group 3 cases of proximal femur fissure and one case of distal femoral fracture were recorded. One year after surgery 43 patients presented for follow up evaluation (cemented group: n = 24; cementless group: n = 19). Both groups revealed comparable results according to the Harris Hip Score (75 versus 78,3 points). No prosthesis loosening was observed in either group. In our view the cemented hip prosthesis is the treatment of choice for femoral neck fractures among the old and very old, if no stabile osteosynthesis can be performed. Patients with cardiopulmonary risk factors, however, may profit from cementless hip arthroplasty to avoid the well known cardiodepression during surgery.

Aged↗
PubMed1982

[Femoral neck fractures: conservative or operative therapy in view of therapeutic results and rehabilitation].

The analysis of late results of 75 consecutive cases of abduction fractures of the femoral neck gave the following results: One third (24/75) of the patients must be operated because of a secondary dislocation. This secondary dislocation cannot be predicted. All the patients successfully treated conservatively can walk like before the accident. This confirms our therapeutic concept for abduction fractures of the femoral neck: Primary conservative treatment with immediate mobilization and weight bearing. Secondary operation for the cases with varus dislocation (one third).

Adult↗
PubMed2001

Femoral neck fracture after removal of the standard gamma interlocking nail: a cadaveric study to determine factors influencing the biomechanical properties of the proximal femur.

We retrospectively analyzed 1334 patients who were implanted standard gamma interlocking nails (SGN) to stabilize trochanteric femoral fractures over the years 1992-1998. Reoperation to remove the nails was performed in 37 patients, in 9 of them purely because of pain. Three out of these 9 patients with removed SGN suffered femoral neck fractures in the early postoperative course after having been mobilized to full weight-bearing capacity. This complication was not observed with other implant systems and, considering the notoriously high complication rate of femoral neck fractures, severely reduces the value of the SGN concept per se. These findings in combination with other known shortcomings of SGNs prompted us to conduct an experimental study on the fracture force of excavated femurs addressing the hypothesis that the specific design of the SGN is responsible for the occurrence of fatigue fractures of the femoral neck. Eighteen matched pairs of fresh human cadaveric proximal femurs, which were treated by insertion and removal of (i) SGNs or (ii) dynamic hip screws (DHS) or (iii) by excavation in the absence of an implant, were subjected to incremental loading cycles and compared to the untreated contralateral femurs. Overall, the fracture force was found to be significantly lower among the treated than among the untreated bones. However, the fracture force required after removal of the DHS system was still significantly higher than for SGN or excavation alone. In this way, our findings demonstrate that removing relatively big implants such as SGN can cause serious complications such as femoral neck fractures. We therefore recommend to leave this type of device in place even after fracture healing except in cases of deep and chronic infection.

Aged↗
PubMed1996

The value of continuous blockade of the lumbar plexus as an adjunct to acetylsalicyclic acid for pain relief after surgery for femoral neck fractures.

In a randomized, double-blind investigation the analgesic effect of continuous blockade of the lumbar plexus as an adjunct to acetylsalicyclic acid by suppository after surgery for femoral neck fractures under spinal anaesthesia was examined in 20 patients. Before surgery, a catheter was inserted into the femoral nerve sheath. The patients were allocated randomly to receive bupivacaine or saline by bolus and then continuous infusion, started immediately after the operation. No statistically significant differences in additional morphine requirements, visual analogue pain scores or adverse effects were observed between the two treatment groups. It is concluded that continuous blockade of the lumbar plexus as an adjunct to rectal acetylsalicyclic acid offers no major additional pain relief after surgery for femoral neck fractures under spinal anaesthesia.

Administration, Rectal↗
PubMed1976

Femoral-neck fractures in young adults.

Twenty-two young adult patients with femoral-neck fractures fitting the following criteria were evaluated. All patients (1) were between twenty and forty years old, (2) had clinical and follow-up roentgenograms at least twelve months after the injury, (3) incurred fracture of the neck of the femur through normal bone, and (4) did not incur a stress fracture. The incidence of non-union was 59 per cent (thirteen of twenty-two patients) and of avascular necrosis, 86 per cent (nineteen of twenty-two patients). Evaluation of patients and results are discussed.

Adult↗
PubMed2004

[Predictive criterions of unrecognized articular effraction after internal fixation of femoral neck fractures].

On the basis of a retrospective study comprising 91 cases of femoral neck fracture treated by DHS, unrecognized screw articular penetration was observed in 9 cases (9.9%). The coxa valga (Garden I) fractures are the most interested by this complication (7 cases out of 9). With a practical purpose and to avoid remarking each time complex measurements again we found that the distance "d" separating the end of the implant from subchondral bone calculated on antero posterior and lateral views and so the angle measured on the lateral view were two criteria significantly predictive of this technical error with respectively P: 0.005 and P: 0.0005. Thus during the surgical procedure taking these two measurements after the installation of the pin guide would allow attention on the risk incurred. In case of doubt, we have changed the way of this pin before resorting to drilling and tapping.

Bone Nails↗
PubMedDate not supplied

Kirschner wires caused unexpected complications of femoral neck fracture.

OBJECTIVE: To report a unique complication of the surgical treatment of femoral neck fractures. CLINICAL PRESENTATION AND INTERVENTION: A young adult presented with lower abdominal pain and bleeding per rectum caused by rectal transfixion by Kirschner wires (K wires). The wires were used to fix a fracture on the neck of the femur during the Iraqi occupation of Kuwait. A plain X-ray showed an old united fracture of the neck of the left femur with coxa magna, mild coxa vara and mild secondary osteoarthritis of the left hip joint. Limited barium enema disclosed transfixion of the rectum by two radiopaque K wires in the pelvis with rectal track formation around them. The complication necessitated a laparotomy and a major dissection to remove the K wires. CONCLUSION: The K wire provided an immediate solution during a difficult period. However, since it is not normally used for this purpose, it caused subsequent complications that were resolved by laparotomy and a major dissection.

Adult↗
PubMed2002

[Adaptive planing model for osteosynthesis of femoral neck fracture].

To investigate how surgeons can be supported in planning of screws for femoral neck fracture fixation reducing incidents of misplaced screws, a system was developed which makes use of a deformable model to be adapted to the femoral head/neck. The accuracy and usability of the system was checked against planning support systems mimicking the conventional positioning of screws within bi-planar x-rays. All designs were evaluated and compared by N = 7 test user. Checking the rate of misplaced screws a) at the femoral neck yielded rates of 8% or up to 42%, b) at the femoral head yielded rates of 0% or up to 11% for model-based or conventional planning, respectively. It is thus suggested to constrain the planning and navigation space by means of deformable models of the bone.

Bone Screws↗
PubMed1993

Effects of bed rest on bone metabolism in patients with femoral neck fracture.

The effect of continuous 1 week bed rest during traction on bone metabolism were studied in patients with femoral neck fracture. Bone demineralization was assessed by measuring serum calcium (Ca), phosphorus (P), and alkaline phosphatase (AlkP) before, during, and after 1 week-bed rest with skeletal traction. In addition, 24-hour urinary excretion of calcium and phosphorus were measured. Serum Ca did not change significantly before, during, and after bed rest, whereas serum P increased after 1 week bed rest and postoperatively remained significantly elevated. Serum AlkP did not increase with bed rest, but became elevated postoperatively. Urinary Ca excretion increased from 105.8 +/- 15.2 to 138.0 +/- 15.4 mg/24h after 1 week of bed rest, and remained elevated postoperatively. In contrast, urinary P excretion initially increased 495.1 +/- 65.0 to 610.8 +/- 87.7 mg/24h, and subsequently decreased to a level significantly less than the admission level. These results suggest that 1 week bed rest for the patients with femoral neck fracture resulted in bone atrophy and demineralization.

Aged↗
PubMed1988

Axial malalignment in femoral neck fractures. An experimental study.

Varus, valgus, and retroversion-anteversion displacements of femoral neck fractures are easily identified on standard AP and lateral radiographs, but rotational malalignments are frequently overlooked. Alterations of the normal appearance of the trabecular systems will indicate rotatory malalignments. A misleading picture of what seems to be severe osteoporosis may actually be due to malrotation and disappearance of the normal trabecular pattern on radiograph.

Bone Nails↗
PubMed1985

Methylmethacrylate blood levels in patients with femoral neck fracture.

The blood levels of monomeric methylmethacrylate were measured in 20 patients with fracture of the femoral neck, treated with a Thompson prosthesis under spinal anesthesia. Monomeric methylmethacrylate was detected in the blood stream in all patients; the maximum levels (mean 6.44 micrograms/ml, range 0.05-31.89 micrograms/ml) were measured 30 s after insertion of the Thompson prosthesis. A moderate drop in systolic blood pressure and a marked reduction of arterial oxygen tension was noted after cementation and insertion of the prosthesis; the mean maximum drops were 10.1 mm Hg (range 0-32 mm Hg) and 6.1 mm Hg (range 0-13.5 mm Hg) No dose-dependent correlation could be established between the levels of monomeric methylmethacrylate and the drop in arterial blood pressure or arterial oxygen tension.

Aged↗