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PubMed1984

[Osteosynthesis of femoral neck fractures with 3 curved elastic nails].

The authors have treated 56 cases of fracture of the femoral neck using an original method. Three curved elastic nails were introduced into the head and neck through the greater trochanter. The results appear to be encouraging. The main advantage of the technique is minimal disturbance of the intra osseous vascular system of the head resulting in a low rate of avascular necrosis. The stability of the fixation has been studied from the biomechanical point of view. In many cases, the reduction obtained is improved immediately preceding the nailing.

Adult↗
PubMed1994

Bateman bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures. Uncemented versus cemented.

Four hundred forty-seven patients with 451 displaced fractures of the femoral neck were treated with Bateman bipolar hemiarthroplasty (190 cemented and 261 uncemented) between 1985 and 1990 in the authors' institution. During a follow-up period of at least two years, the authors found less thigh pain (13% versus 46.2%) and higher Harris hip scores (86 versus 79) in the cemented group in comparison with the uncemented group. Radiographic examination showed less radiolucent zones and subsidence in the cemented group. Heterotopic ossification was more common in the cemented group. Despite the fact that the cemented group had longer operative times (average, 20 minutes) and more blood loss (average, 160 ml) during the operation, there was no significant difference in the early mortality rate observed between these two groups. The cemented prostheses provided better functional and radiographic results and fewer failures in the early stage. In addition, the cemented prostheses did not lead to more complications and higher mortality rates. Thus, for elderly patients who need early ambulation and functional recovery, the cemented Bateman bipolar prosthesis appears to be a better choice than the uncemented Bateman prosthesis.

Aged↗
PubMed1988

[Femoral neck fractures--treatment and results at a general surgery department].

This is a report about 50 fractures of the femoral neck, treated in a ward for general surgery. Impacted valgus fractures generally do not need surgery. Osteosynthesis only with Böhler nail have no good results. Hemiprosthesis of femoral head on elderly patients is a good method and generally not followed by protrusio acetabuli.

Adult↗
PubMed2004

Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage among patients with femoral neck fractures: implication for antibiotic prophylaxis.

Fifteen (8.4%) of 179 patients admitted with femoral neck fractures carried MRSA. Among 96 patients admitted from their homes, only 2 (2%) were carriers, whereas 13 (15.6%) of 83 patients from nursing or residential homes or long-term-care facilities were colonized (P = .001). Routine prophylaxis with vancomycin is recommended in the latter group.

Aged↗
PubMed2006

Inpatient falls and injuries in older patients treated for femoral neck fracture.

A prospective inpatient study was performed at the Orthopedic and Geriatric Departments at the Umeå University Hospital, Sweden, to study inpatient falls, fall-related injuries, and risk factors for falls following femoral neck fracture surgery. Ninety-seven patients with femoral neck fracture aged 70 years or older were included, background characteristics, falls, injuries, and other postoperative complications were assessed and registered during the hospitalization. There were 60 postoperative falls among 26/97 patients (27%). The postoperative fall event rate was 16.3/1000 Days (95% CI 12.2-20.4). Thirty two percent of the falls resulted in injuries, 25% minor, and 7% serious ones. In multiple regression analyses, delirium after Day 7, HRR 4.62 (95% CI 1.24-16.37), male sex 3.92 (1.58-9.73), and sleeping disturbances 3.49 (1.24-9.86), were associated with inpatient falls. Forty-five percent of the patients were delirious the day they fell. Intervention programs, including prevention and treatment of delirium and sleeping disturbances, as well as better supervision of male patients, could be possible fall prevention strategies. Improvement of the quality of care and rehabilitation, with the focus on fall prevention based on these results, should be implemented in postoperative care of older people.

Accidental Falls↗
PubMed2001

Noncemented Cathcart elliptical head endoprosthesis for displaced femoral neck fractures.

A total of 93 patients (95 hips) undergoing unipolar noncemented elliptical head endoprosthetic replacement for an acute displaced femoral neck fracture were reviewed clinically and radiographically at an average follow-up of 28 months. The 12-month mortality rate was 22%. The medical complication rate was 15%, and the surgical complication rate was 19%. At most recent follow-up, 66% of patients used an assist device for ambulation or were nonambulatory. Of patients, 64% required full-time nursing care. Radiographically, subsidence of the component was identified in 66% of the hips and acetabular erosion in 29%. More than half of these patients had complaints of either thigh or groin pain. Hips with evidence of subsidence had a statistically significant greater length of follow-up (36 months) compared with hips that did not show subsidence (18 months; P = .014). Noncemented unipolar replacement for displaced femoral neck fractures is an accepted form of treatment. In this group of predominantly male patients, noncemented elliptical head unipolar replacement was associated with a high medical and surgical complication rate as well as poor clinical and radiographic results.

Aged↗
PubMed2006

[Propofol to facilitate spinal anesthesia in the lateral position in patients with femoral neck fracture].

PURPOSE: The aim of this study was to assess the feasibility and efficacy of propofol before positioning elderly patients with a femoral neck fracture in the lateral decubitus position, to perform a spinal anesthetic. METHODS: In this prospective and descriptive study, 79 consecutive patients, > 75 yr old, with a femoral neck fracture were included. Propofol, 0.5 mg x kg(-1), was administered. If loss of consciousness was not obtained (Ramsay score < or = 3/6), then additional doses of 0.25 mg x kg(-1) were given until a Ramsay score of 4 or 5 was attained. Then, the patient was turned to the lateral decubitus position, the fractured side up. The efficacy of propofol was assessed by observing a grimace during positioning and asking the patients if they had recall of pain. Hemodynamic data and oxygen saturation were collected. RESULTS: Forty-three patients required a single injection, 34 required two injections and only two patients required three injections. No grimace and no recall of pain were recorded during the study. There was no desaturation (SpO(2) < 92 %), and hypotension, defined as a systolic blood pressure decrease > 30% from baseline, was observed. CONCLUSION: Propofol is a simple and efficacious means of providing comfort while positioning elderly patients with a femoral head fracture before performing spinal anesthesia.

Aged↗
PubMed2002

Bipolar hemiarthroplasty for treatment of femoral neck fractures in geriatric patients--surgical technique and outcome.

Fractures of the femoral neck are frequent in the elderly population. The reduced general health status and presence of concomitant diseases, in many cases, make the treatment of these patients demanding. Early mobilization is mandatory to avoid secondary infections, which were often lethal in the past. Surgical intervention has become the standard treatment for these patients. Only a few patients with stable fracture-types allow early mobilization without operation.

Aged↗
PubMed2000

Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients.

BACKGROUNDS AND AIMS: There are no randomised trials comparing internal fixation and hemiarthroplasty for a displaced intracapsular femoral neck fracture in relation to mental state. MATERIAL AND METHODS: To establish what should be the treatment of first choice, a prospective randomised clinical study was performed on 60 demented patients with displaced intracapsular femoral neck fractures, comparing internal fixation (n = 31) with hemiarthroplasty (n = 29). RESULTS: There was no significant difference in the mortality rate of both groups. Hemiarthroplasty was associated with significantly more loss of blood and more wound complications. Reoperation for secondary displacement of the fracture after internal fixation occurred in four patients. Although not-statistically significant, failure of internal fixation seemed to be higher after an inadequate osteosynthesis. CONCLUSION: Postoperative mortality is high and the chance of successful rehabilitation very small for both types of treatment in this group of patients. In our opinion, demented patients should not be treated with a major surgical procedure like hemiarthroplasty. Internal fixation should be considered the treatment of choice, because it is a smaller operation than prosthetic replacement, with less morbidity. If adequate reduction can not be achieved, a primary hemiarthroplasty should be performed.

Activities of Daily Living↗
PubMed1983

Bone scintigraphy in Moore hemiarthroplasty with and without cement following femoral neck fractures. A controlled study.

In a controlled clinical trial patients with acute femoral neck fractures were allocated into two groups of treatment. One group (14 patients) had a Moore hemiarthroplasty cemented with methyl methacrylate, and the other (15 patients) a noncemented prosthesis. Bone scanning with 99m-Tc-MDP was performed 6 weeks, 3 months, 6 months and 12 months after the operation. Increased activity without time-trend was found at the operated side during the entire observation period in both groups. The activity was equally increased in the two groups. No correlation was found between the scintigraphic activity and the functional hip assessment according to Merle d'Aubigné. Bone scintigraphy is of no diagnostic value in the evaluation of a hemiarthroplasty, cemented or without cementation, during the first year postoperatively, as an increased activity might be expected through the entire period.

Aged↗
PubMed1987

Postoperative confusion after anesthesia in elderly patients with femoral neck fractures.

Fifty-seven patients, all over the age of 64, with femoral neck fracture were randomized to receive epidural or halothane anesthesia to see if the anesthetic technique influenced the incidence of postoperative confusion. All patients were lucid on admission. Using the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) as criteria for confusion, we found that 44% of the patients developed confusion that correlated closely to a history of mental depression (P less than 0.01) and to the use of drugs with anticholinergic effect (P less than 0.005). There was no difference in the incidence of confusion between the two anesthetic groups. In patients given halothane, however, early postoperative hypoxemia was associated with confusion (P less than 0.05). Patients with confusion had significantly more postoperative complications and almost four times longer hospitalization times. It is concluded that anticholinergic medication and a history of mental depression are predominant risk factors for development of postoperative confusion and in this respect are more important than the anesthetic technique.

Aged↗
PubMedDate not supplied

[Epidemiologic study of femoral neck fractures in the province of Parma (1980-1992)].

Fractures of the femoral neck are one of the most important and severe complications of osteoporosis. To obtain up-to-date estimates on the frequency of these fractures in the province of Parma, a city of northern Italy, a retrospective study on the incidence of hip fractures has been carried out examining the operative records of all the orthopedic departments serving the whole province. Between January 1980 and December 1992, 3774 operations for hip fractures were performed, with a marked prevalence in women (2830 women and 944 men) and an exponential increase with age in both sexes. The incidence of extracapsular hip fractures was slightly higher and in women increased more rapidly with age than intracapsular fractures. Approximately 3 fractures out of 4 in women and 2 out of 3 in men occurred after the age of 75. Between 1980 and 1992, the age-adjusted annual incidence rose significantly by 7.1 cases per 100,000 per year in women and by 2.7 cases per 100,000 per year in men. When compared to other populations, these estimates indicate that the incidence of hip fractures in this province of Northern Italy is lower than that reported in other countries, especially in Northern Europe.

Aged↗
PubMedDate not supplied

Is a certain degree of osteomalacia involved in femoral neck fractures of the elderly? Histological approach to the problem and practical applications.

A study was made in Geneva of 14 patients with femoral neck fractures (7 subcapital and 7 trochanteric) to determine whether a certain degree of osteomalacia might be involved (group I). No patients with risks factors for osteomalacia were used. For ethical reasons, double tetracycline labelling was not possible and osteomalacia criteria were based on osteoid tissue values determined in a histomorphometric study directly on cancellous bone samples of the femoral head. A comparison was made with femoral head bone tissue taken from 12 patients with hip osteoarthritis at a distance from the remodelled territory (group II) and with iliac crest bone tissue taken from 6 patients with clinically and biochemically determined osteomalacia (group III). The patients were part of a larger group of subjects used for a biochemical blood study in which levels of albumin, calcium and 25 OHD3 as an index of vitamin D content were determined. Based on the data of the literature and the results obtained for group II, slight signs of osteomalacia were diagnosed for only one case (group I), although 25 OHD3 deficiency was found in more than a third of the subjects in that group as well as in some subjects of group II and in some of the aged controls. Skeletal aging must be considered not only in terms of unavoidable physiological factors but also within the context of living conditions. Hence the necessity of controlling calcium and vitamin D intake in the elderly, and of a histological examination for signs of osteomalacia in surgical specimens from patients with femoral neck fractures.

Aged↗
PubMed2005

[Large variation in indications for internal fixation or arthroplasty in displaced femoral neck fracture; results of a questionnaire distributed among general surgeons in 20 hospitals].

OBJECTIVE: To describe the treatment protocols for displaced femoral neck fractures in all 8 university hospitals (UH) and 12 general hospitals (GH). DESIGN: Descriptive; questionnaire. METHOD: Questionnaires were distributed to general surgeons who also perform traumatology surgery. They were requested to give succinct answers to questions about local protocol for the maximum permissible time interval between hip trauma and operation, indications for internal fixation and arthroplasty, operative technique and postoperative degree of weight-bearing in patients over 60 years of age with a displaced femoral neck fracture. RESULTS: Internal fixation and arthroplasty were performed within 24 and 48 hours respectively in 95% of all hospitals. A biological upper age limit of between 65 and 80 years old was the most commonly quoted indication for internal fixation in 70% of all hospitals. In 83% of GH dementia was considered an indication for arthroplasty as opposed to 0% in UH. Poor bone quality, immobility, comminution and inadequate reduction were incidentally quoted indications for arthroplasty. Rheumatoid arthritis, arthrosis and pathological fracture were contra-indications for internal fixation in all hospitals. Operative techniques for internal fixation and arthroplasty were similar in both UH and GH. After internal fixation, full weight-bearing was recommended in all UH and partial weight-bearing in 7 (58%) of GH. Following arthroplasty all protocols prescribed full weight-bearing. CONCLUSION: The variation in indications for internal fixation or arthroplasty reflects the lack of studies that demonstrate clearly which patient can be treated optimally with which treatment modality. There were few differences in the operative techniques of internal fixation and arthroplasty between the hospitals.

Age Factors↗
PubMed2004

The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures.

Although it is widely accepted that aspirin will increase the risk of intra- and post-operative bleeding, clinical studies have not consistently supported this assumption. We aimed to assess the effect of pre-operative aspirin on blood loss and transfusion requirements in patients undergoing emergency fixation of femoral neck fractures. A prospective case-control study was undertaken in patients presenting with femoral neck fractures. Parameters recorded included intra-operative blood loss, post-operative blood loss, transfusion requirements and peri-operative reduction in haemoglobin concentration. Of 89 patients presenting with femoral neck fractures 32 were on long-term aspirin therapy. Pre-operative aspirin ingestion did not significantly affect peri-operative blood loss, or change in haemoglobin concentration or haematocrit. However those patients taking aspirin pre-operatively had a significantly lower haemoglobin concentration and haematocrit and were more likely to be anaemic at presentation than those who were not receiving aspirin. Patients taking aspirin were also more likely to receive blood transfusion post-operatively.

Aged↗
PubMed1991

[Management of femoral neck fracture with an intermediate (dual head) prosthesis in geriatric surgery].

Between 1980 and 1989 in 195 elderly patients with fractures of the femoral neck a duo-cup endoprosthesis was inserted. The average age was 78 years, most of them were high risk patients with sometimes more than 2 preexisting diseases. The hospital mortality after hip replacement was 9.7%, specific complications like protrusio acetabuli and shaft fractures were not observed. In 2 cases immediate postoperative luxation required reintervention. The incidence of infection was significantly reduced to 2.4% after antibiotic therapy. When discharged from hospital, 86% had a good functional result. We regard hemiarthroplasty with duo-cup endoprosthesis as an acceptable alternative to total hip replacement in elderly patients with fractures of the femoral neck.

Aged↗
PubMed1998

Hemarthrosis and hip joint pressure in femoral neck fractures.

In a prospective clinical study the intraarticular pressure of 55 patients with intracapsular femoral neck fractures was measured intraoperatively with the hip in different positions. Intraarticular hemarthrosis was quantified by a preoperative sonography examination. In 75% of the patients, increased intraarticular pressure caused by the hemarthrosis was found. The spontaneous median pressure increased significantly from 22 mm Hg with extension (28 mm Hg) and internal rotation of the hip joint (56 mm Hg). The lowest pressure was found in 70 degrees flexion (15 mm Hg). The median pressures increased within the first 24 hours after injury from 26 mm Hg in the first 6 hours to 46 mm Hg from 7 to 24 hours. Even in the first and second weeks after trauma, increased median pressures were detected (8.5 mm Hg and 13 mm Hg, respectively). No significant difference was found between undisplaced and displaced fracture types. Because increased joint pressure in other studies correlates with reduced perfusion of the femoral head, it can be deduced that reduction maneuvers without capsulotomy can compromise the circulation of the femoral head. Capsulotomy and osteosynthesis of the femoral neck at the earliest time possible is the best prophylaxis of tamponade. If the osteosynthesis is delayed, a preoperative sonography after admission and a control sonogram after 6 hours is recommended. In the event of relevant hemarthrosis, immediate therapeutic drainage is suggested for patients who will receive joint conserving osteosynthesis.

Adult↗