[2-Pfeiler acetabulum fracture with central hip dislocation and ipsilateral femoral neck fracture in epileptic seizure].
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Acetabulum↗
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Results for “FEMORAL NECK FRACTURES”
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The use of quadratus femoris muscle pedicle bone graft for the treatment of displaced femoral neck fractures.
In 1974, Meyers et al advocated the use of the quadratus femoris muscle pedicle bone graft with screw fixation to treat displaced femoral neck fractures. In 1979 he quoted a 95% union rate in 144 patients and a 5% incidence of late segmental collapse. Most authors quote a 60% to 80% union rate and a 25% to 30% incidence of late segmental collapse of the femoral head. From 1974 to 1980 at the University of Rochester, there were 13 patients, ages 20 to 60 years, who underwent the Meyers procedure for displaced femoral neck fractures. Twelve patients were done acutely and one was delayed. Followup averaged 38 months. Average time to bony union was five months. One patient had a nonunion secondary to inadequate fixation. Four patients showed radiographic evidence of late segmental collapse despite fracture union. These patients were between 20 and 28 years old. They had moderate to severe symptoms including pain, limitation of motion, and a limp. Subsequently two of them had total hip replacements and one a valgus osteotomy. To date few if any reports have reaffirmed the results obtained by Meyers et al. Although our series is small, the rate of union was 85% and the rate of late segmental collapse was 23%. These results are the same as or worse than those achieved by several authors using internal fixation alone or in combination with autogenous bone graft.
Adult↗
Differences in proximal femur geometry distinguish vertebral from femoral neck fractures in osteoporotic women.
Bone mineral density (BMD) is generally used to predict the risk of fracture in osteoporotic subjects. However, femoral neck BMD and spine BMD have been reported not to be significantly different among patients with hip or vertebral fractures, suggesting that other risk factors are needed to determine the different fracture types. Proximal femur geometry (PFG) parameters, such as hip axis length (HAL), femoral neck-shaft angle (NSA) and femoral neck diameter (FND) have also been shown to predict the risk of hip fracture. These parameters are statistically different in spine fractures compared with both types of hip fractures (trochanteric and femoral neck) when considered together. We wanted to assess the difference in these parameters by comparing spine fractures with a homogeneous group of hip fractures, i.e. femoral neck fractures. 807 post-menopausal women were divided into three groups; those with vertebral fractures (182), those with femoral neck fractures (134) and a control group without fractures (491). Dual X-ray absorptiometry (DXA) scans of the spine and hip were carried out to measure BMD and define the PFG parameters of the hip. Data were statistically analysed. In agreement with other authors, we found that women with femoral neck fractures had longer HAL, wider FND and larger NSA than controls, whereas there were no statistically significant differences in PFG between women with spine fractures and controls. Logistic regression showed HAL and NSA could predict the risk of femoral neck but not vertebral fracture. These data indicate specificity of some PFG parameters for hip fracture risk.
Aged↗
Nonunion of subcapital femoral neck fractures.
One hundred forty-one patients were reviewed following osteosynthesis of their femoral neck fractures. All cases had been pinned using three or four short threaded 6.5 mm AO screws. It was found that those fractures with a vertical configuration, particularly in the males, showed a high rate of nonunion. It is concluded that simple pin fixation is not adequate for this specific group of patients.
Adult↗
Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures.
AIM: To evaluate the effects of a protein-rich liquid supplementation, alone or in combination with the anabolic steroid nandrolone decanoate, on body composition, activities of daily living (ADL) status and the health-related quality of life (HRQoL) after a femoral neck fracture. METHODS: Sixty women, aged 83 +/- 5 years (mean +/- SD), BMI < 24 kg/m2 (20.4 +/- 2 kg/m2 ) and capable of co-operating, with a femoral neck fracture treated with internal fixation, were randomised to open treatment during 6 months with a protein-rich liquid formula alone (PR, Fortimel, 200 ml/day, 20 g protein/day) or in combination with nandrolone decanoate (PR/N, Deca-Durabol 25 mg i.m./3 weeks) or to a control group (C). The patients were re-examined after 6 and 12 months regarding body weight (BW), lean body mass (LBM, DXA), ADL status according to Katz, HRQoL according to EQ 5-D and fracture healing. RESULTS: LBM decreased in the C (-1.2 +/- 2 kg) and PR groups (-1.2 +/- 1 kg) but remained the same in the PR/N group (0.3 +/- 1 kg) (P < 0.05 between groups). ADL remained at a high level in the two intervention groups but declined significantly in the C group (P < 0.005 between groups). The decline in HRQoL was least pronounced in the PR/N group at 6 months (P < 0.05 between groups). Patients with fracture healing complications lost more BW (P < 0.05) and LBM (P < 0.01) than patients with uneventful fracture healing. CONCLUSION: Protein-rich liquid supplementation in combination with nandrolone given for 6 months to lean elderly women after a femoral neck fracture may positively affect LBM, ADL and HRQoL.
Activities of Daily Living↗
Regional survey of femoral neck fractures.
In the South-west Thames Region 2619 patients (2105 women and 514 men) were discharged with a diagnosis of femoral neck fracture in 1974. The equivalent of a 250-bedded hospital was occupied throughout the year. The incidence, average length of stay, and mortality rate rose with increasing age and there were differences in these indices in the five health areas. These results confirm the enormous burden placed on the hospital service by patients with fracture of the femoral neck but suggest that differences in practice in the five areas may contribute to the size of the problem.
Age Factors↗
Garden's classification of femoral neck fractures. An assessment of inter-observer variation.
Radiographs of 100 randomly chosen femoral neck fractures were assessed by eight observers using Garden's classification. The radiographs were classified identically by all eight in only 22 cases. Another 45 cases were classified by some observers as undisplaced fractures (Stages 1 and 2) and by others as displaced fractures (Stages 3 and 4). Between the different observers the number of displaced fractures varied from 63 to 89. These results show that observers had a relatively poor ability to delineate the various stages of Garden's classification.
Femoral Neck Fractures↗
Nailing versus prosthesis for femoral-neck fractures. A critical review of long-term results in two hundred and thirty-nine consecutive private patients.
In a follow-up study of 239 consecutive patients with fractures of the femoral neck treated by six surgeons in one hospital by Pugh nailing, Austin Moore prosthesis, or Knowles pinning, 96 per cent could be followed for a minimum of two years or until a definitve result had been reached. The incidence of unsatisfactory results was 39.3 per cent after Pugh nailing, 18.2 per cent after prosthetic replacement, and 14.2 per cent after Knowles pinning (mostly undisplaced or impacted fractures). Thirty-five unsatisfactory results following Pugh nailing were due to: aseptic necrosis which was definite in eighteen cases and probable in two; early mechanical failure in twelve cases; infection in one; and late non-union in two. Eight poor results followed prosthetic replacement and were due to erosion of the acetabulum in six and dislocation in two. The four poor results that followed Knowles pinning were due to aseptic necrosis in three and to pain, probably the results of aseptic necrosis, in another. From this study it was concluded that aseptic necrosis was more influenced by the original displacement than by the accuracy of reduction or fixation, and that in displaced femoral-neck fractures in the elderly, prosthetic replacement gave a more reliable result.
Age Factors↗
[LONG-TERM EXPERIENCES WITH THE SURGICAL TREATMENT OF FEMORAL NECK FRACTURES].
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Bronchopneumonia↗
The stability of femoral neck fractures and its influence on healing.
We measured the stability of fixation in femoral neck fractures treated with von Bahr screws, investigated the influence of impaction and correlated peroperative stability with the clinical results. Stability was measured at operation using a metal probe fitted with strain gauges. Its tip was anchored in the subchondral bone of the femoral head and its lateral end was fixed in the lateral femoral cortex. The shearing force produced by longitudinal compression applied to the foot of the operated leg was recorded. The results in 41 consecutive patients all followed for 30 months, showed that fractures with early loosening or nonunion had all had significantly poorer stability than the fractures that had healed. Impaction improved stability in only 23 out of the 41 fractures; in the others stability had deteriorated or was unchanged.
Aged↗
Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases.
We present a series of 247 undisplaced femoral neck fractures, of which 122 were primarily treated non-operatively, and 125 with primary operative stabilization. The background parameters did not differ significantly in the two groups. The length of hospitalization was 1 week shorter in the operatively treated group. They started to walk bearing full weight at an average of 11 days earlier. Two-thirds of the operatively treated but only one-quarter of the non-operatively treated patients were able to walk alone when they left hospital. General complications were recorded in 19 of the non-operatively and in four of the operatively treated patients during their hospitalization. Early displacement (within 6 weeks) was noted in 20 per cent of the non-operatively treated patients who required late operation. However, there was no early displacement in the operatively treated group. We therefore recommend primary operative stabilization of undisplaced femoral neck fractures.
Adult↗
An algorithm for the management of femoral neck fractures.
The choice of total hip arthroplasty should probably be reserved for those rare patients with preexisting osteoarthritis of the hip in the setting of a subcapital hip fracture. Additionally, relative indications for total hip arthroplasty may include the presence of contralateral hip disease; the presence of metabolic bone disease, which may controvert internal fixation or reasonable results with endoprosthetic replacement; and those patients with high activity expectations or life expectancy greater than 5 years. Given the diminished performance of hemiarthroplasty with time and activity, it may be argued that the most cost effective solution to the subcapital hip fracture in the majority of patients may be the reduction and internal fixation pathway, with elective conversion, when necessary, of the approximately 25% of patients who suffer avascular necrosis to total hip arthroplasty. It appears that hemiarthroplasty is best suited for the elderly household ambulator, whereas total hip arthroplasty is the better alternative either as the elective solution to failed internal fixation of femoral neck fractures or in the occasional community ambulator with high activity expectations and irreducible femoral neck fractures. Younger patients, and those with minimally displaced fractures, should be treated with internal fixation in an attempt to preserve the natural hip joint.
Algorithms↗
[3-phase bone scintigraphy: perfusion and vitality of the femur head after media femoral neck fracture and osteosynthesis].
UNLABELLED: Perfusion and Vitality of the Femoral Head after Medial Neck Fracture and Osteosynthesis. AIMS: to analyse with regard to necrosis the perfusion and vitality of the femoral head after medial neck fracture and repair by placement of a dynamic hip screw. PATIENTS AND METHODS: Twenty-one patients were examined by scintigraphy immediately following operation as well as at 3 and 6 months postoperative for evaluation of dysfunctions of perfusion and mineralization. RESULTS: Complete perfusion and mineralization defects with a tendency for revascularization at 3 months will be normal at 6 months. Persisting dysfunctions at 3 and 6 months will progress to femoral head necrosis irrespective of the fracture staging. CONCLUSIONS: Three-phase skeletal scintigraphy is a highly sensitive, non-invasive method for evaluating perfusion and revascularization of the femoral head after femoral neck fracture and repair by means of a dynamic hip screw. When perfusion of the femoral head is observed one week after the trauma, femoral head necrosis will not arise. Immobilization is necessary after partial or complete perfusion and mineralization dysfunctions until the scintigraphic findings return to normal. The present results may serve as a recommendation for loading after fracture repair with a dynamic hip screw.
Adult↗
[Treatment of femoral neck fractures with bipolar hemiarthroplasty].
The aim of the study was determine the effectiveness of treatment with bipolar prosthesis in elderly patients with the femoral neck fractures. Patients admitted from 1980 through 1994 were analysed. Over this period, a total of 152 hip joint bipolar prostheses were implanted. Postoperative complications occurred in 9.2% of cases (luxations of endoprostheses 2.63%, loosening of the femoral component 1.31%, infections 2.63%, intrahospital mortality 1.31%, fractures of the endoprosthetic stem 0.65% and fracture of the polyethylene cup 0.65%). Ten (6.5%) hips required revision surgery. Twenty eight patients were followed-up. Excellent results were reported in twenty-three patients (82.1%), good results in four (14.3%), and fair results in one patient (3.6%). There were no poor results. In summary, we feel that bipolar hemiarthroplasty is the method of choice in elderly patients with femoral neck fractures.
Adult↗
Acute femoral neck fracture in children--preliminary report.
Nineteen children, aged 3-15 years, with acute femoral neck fracture were treated. The follow-up period ranged from 2 years to 6 years, 9 months (avg. 54.8 +/- 14.5 months). The clinical and radiological assessments were carried out according to the assessment system of Ratliff. Undisplaced fractures and all intertrochanteric fractures were treated conservatively and displaced ones by reduction and multiple pinning. The outcomes reveal 14 (79%) with good results, 2 (10.5%), fair and 3 (15.8%), poor. Four hips (21%) developed avascular necrosis with 2 requiring secondary surgical procedures. Both of them also had leg length discrepancy. Another 3 hips (15.8%) developed coxa vara, one of them had mild leg length discrepancy.
Acute Disease↗
Treatment of femoral neck fractures with a cancellous screw and fibular graft.
Twenty-six patients with femoral neck fractures were treated by open reduction, cancellous screw fixation and free fibular grafting. The patients were between 14 and 50 years of age. There were 16 old and 10 fresh fractures. Four patients had radiological signs of avascular necrosis before the treatment was instituted. Bony union was achieved in all patients except one, where the failure occurred because of a technical error. The patients were followed up for at least two years. No new case of avascular necrosis was detected after treatment, and there was clinical and radiological improvement in all four patients with pre-operative avascular necrosis.
Adolescent↗
[Moore hemiarthroplasty of the hip for treatment of femoral neck fracture].
A series of 158 hemiarthroplasties of the hip with the use of Moore prosthesis has been performed in patients with recent femoral neck fractures or its complication (nonunion, necrosis) between 1980 and 1992. From 73 patients operated between 1986 and 1990 32 showed up for clinical assessment, 11 responded in writing to the questionnaire. In 26 cases the result was rated good, in 9 fair and 8 results were poor. Twenty-five patients died. The authors explain small number of patients who reported themselves for evaluation by high mortality rate due to the old age and general medical problems. Authors' findings supported by the literature indicate, that hemiarthroplasty of the hip remains as a useful mode of treatment for femoral neck fracture or its complications.
Aged↗
Failure of internal fixation of displaced femoral neck fractures in rheumatoid patients.
We reviewed the records and radiographs from 10 hospitals to identify 50 patients with rheumatoid arthritis (RA) who had sustained 52 femoral neck fractures. Most patients were female (88%), elderly (mean age 66 years) and had had severe polyarticular disease for a mean duration of 16 years. Over half had taken systemic corticosteroids, nearly all were severely osteopenic but few had rheumatoid changes in the hip. Of the 20 fractures treated by internal fixation 12 had complications including nonunion (5), osteonecrosis (5), infection (1), and intertrochanteric fracture (1). Only one of the nine undisplaced fractures required reoperation, but seven of the 11 displaced fractures had revision surgery. Twenty fractures were treated by primary total hip arthroplasty with only one early complication. The other 12 fractures had been treated by hemiarthroplasty (9), hip excision (1) or non-operatively (2). Our results suggest that, in elderly rheumatoid patients, severely displaced femoral neck fractures should be treated by total hip replacement.
Adult↗