SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In a series of over 1000 elderly patients with femoral neck fracture, who were routinely screened by iliac crest bone biopsy, a 2% prevalence of osteomalacia was found. This low figure suggests that osteomalacia is not a significant predisposing factor in the development of these fractures and that routine screening is not cost-effective.
This study evaluated the relationship of the disposition and outcome of patients with displaced femoral neck fractures with the type of surgical treatment. From 1993 to 1996, 186 patients with displaced femoral neck fractures who were 65 years of age or older were treated at one hospital. One hundred and twenty fractures were treated with reduction and internal fixation; 66 were treated with arthroplasty. The time interval from fracture to death and to repeat surgery was significantly less for the internal fixation group than for the arthroplasty group. The possibility of nursing home residence is increased in patients who were treated with reduction and internal fixation compared with patients who were treated with arthroplasty.
Using roentgen stereophotogrammetric analysis, the postoperative stability of femoral neck fractures was measured in 16 patients. During the first day after internal fixation, before weight bearing, the center of the femoral head moved on an average 1.5 mm (total translation) in six undisplaced fractures and 3.7 mm in 10 displaced fractures, which was about one third of the fracture movement during the first postoperative month. Three undisplaced fractures displayed a rotatory instability, mainly after weight bearing had begun. Five of the displaced fractures showed maximal rotatory displacement during the first postoperative day. The recorded fracture movements before weight bearing may question the rationale of peroperative mechanical compression.
Explore the source record for details and available documents.
The influence of three different fixation devices on late healing complications after femoral neck fractures was studied in a large patient group from three different hospitals. Except for the choice of device, which was unique to each hospital, all other factors having a potential influence on the late outcome, such as sex and age of the patients, initial degree of fracture dislocation and quality of surgical reduction were similar among the three groups. Within a 2-year observation period the incidence of late segmental collapses (14%-19%) was not related to choice of device, but a higher number of non-unions (27%-30%) occurred after adaptive non-rigid methods using screws (von Bahr) or a flanged nail (Rydell) than after a more rigid osteosynthesis (8%, Deyerle). Using such a rigid fixation, the complication rate could be reduced by one-third and the need for revision surgery halved. A device providing stable fixation should be preferred for treatment of femoral neck fractures in the elderly to prevent the healing complications related to insufficient stabilization.
Explore the source record for details and available documents.
OBJECTIVE: To study appetite and food choices in lean elderly women at the time of a femoral neck fracture and after 6 months of nutritional and anabolic intervention. SUBJECTS AND METHODS: Forty-five nondemented women >70 years of age (mean +/- SD: 83 +/- 5 years) with a recent hip fracture and body mass index <24 kg/m2 (mean: 20.5 +/- 2.3) were interviewed about their appetite and dietary habits prior to fracture. The patients were randomized to treatment with a protein-rich liquid supplement (PR; 200 kcal and 20 g protein day(-1)) alone or in combination with nandrolone decanoate injections (PR/N) 25 mg i.m. every third week or to a control group (C). A second interview was conducted 6 months later. RESULTS: Reduced appetite before the fracture was reported by 60%. Half of the patients did not have dessert with any of their daily meals, one-third used low-fat margarines and one-third drank water with their meals. The estimated mean daily energy intake was 6.4 +/- 1.2 MJ (1541 +/- 304 kcal) indicating that three of four subjects did not meet their energy needs. At 6 months, 40% reported reduced appetite. There was no difference in the change of appetite between the three randomized groups. Still, half of the subjects appeared to not meet their energy needs. Protein intake increased in the PR and PR/N groups, in contrast to the controls (P = 0.002). CONCLUSION: Reduced appetite and insufficient energy intake was recorded in lean elderly women with a femoral neck fracture. Nutritional supplementation alone or in combination with an anabolic steroid increased protein intake without adversely affecting appetite.
This study was performed to assess mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures in relation to mental state. Between 1991 and 1995, 202 consecutive patients over 70 years of age were followed for at least two years or until death. Thirty-nine patients were known with senile dementia at the time of admission. The four-month mortality rate was 11.7% for the mentally normal patients and 33.3% for the mentally impaired patients. After one year the mortality rate was 19. 6% for the mentally normal patients and 43.6% for the mentally impaired patients. This difference is statistically significant (p<0. 001). Of the 141 surviving mentally normal patients, who had been mobile before operation, 16 (11.3%) were not mobile four months after operation. Of the 24 surviving mentally impaired patients, who had been mobile before operation, 18 (75.0%) were not mobile four months after operation. This difference is statistically significant (p<0.001). The conclusion of our study is that mental state has a statistically significant effect on mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures. For demented patients, hemi-arthrplasty is a too major operation and less invasive methods of internal fixation should be considered.
Sixty fractures of the femoral neck were fixed by a Descamps-Kerner compression screw and followed up for an average of 6.5 years. The functional results were estimated on the Merle d'Aubigné scale. Three cases had to be operated on again because of early displacement and seven did not unite. There were eleven necroses of the femoral head. The authors have made an attempt to compare the results with other series in the literature. The overall results were satisfactory in 86% of cases. It is concluded that the technique of treatment should be improved, possibly by the use of microsurgery.
We investigated perioperative blood gas changes in 26 patients scheduled for surgical correction of femoral neck fracture under epidural anesthesia. Arterial blood gases during spontaneous air respiration were measured eight times during the femoral neck prosthetic replacements (n = 16), and four times during osteosynthesis (n = 10). In the patients who received femoral neck replacements using bone cement (n = 8), arterial oxygen tension decreased significantly four hours after insertion of prosthesis, and did not recover during two postoperative days. In contrast, in the patients who received cementless femoral neck replacements (n = 8), arterial oxygen tension tended to decrease but not significantly, and returned to normal on the second postoperative day. In the patients who received osteosynthesis, arterial oxygen tension did not change. We suspected that the causes of delayed hypoxia in the femoral neck replacements were vascular endothelial cell injury in the lung by free fatty acid originating from fat embolism, and/or microthrombosis resulting from activated coagulation system. Bone cement was thought to intensify fat embolism because of elevated intramedullary pressure in the femur.
OBJECTIVE: To compare the results of femoral head replacement (FHR) and total hip replacement (THR) in treatment of subcapital femoral neck fractures (SFNF). METHODS: Between May 1987 and July 1998, 56 elderly patients (6 5-90 years; average 73.5 years) with SFNF were treated with prosthetic replacement. Six cases were treated with unipolar FHR, 18 cases with Bateman bipolar FHR, and 32 cases with Bateman bipolar THR. All domestic prostheses were installed with cement. RESULTS: There was no significant difference between the 2 groups in operating time and blood transfusion. Forty-nine patients were followed-up for an average of 5 years and 10 months. No wound infection or death was related to surgery. Complications in Group FHR were significantly higher than that i n Group THR. CONCLUSIONS: Since FHR is difficult to fit the bony acetabulum, it is only indicated for senile cases with poor conditions. However, the bi polar THR installed with cement is indicated for most elderly patients. Since th e femoral head and acetabulum can fit each other completely, it is more stable for taking weight-bearing earlier with less complications.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
An elderly patient presenting with severe tetany secondary to hypocalcaemia causing bilateral fractures of the femoral necks, was proved to have coeliac disease. Severe muscle pains, an organic mental syndrome and personality changes are rare complications of coeliac disease and are reversible with treatment.
In a comparative biomechanical study of the stability of experimentally produced femoral neck fractures fixed with Knowles pins or with 6.5-mm cancellous screws, 12 matched pairs of anatomic specimen femurs were divided into four groups of standardized osteotomies. One member of each matched pair was fixed with three or four 6.5-mm cancellous screws, whereas the other member was fixed with the same number of Knowles pins. Mechanical testing was performed on an Instron testing machine. There was no statistically significant difference in maximum load to failure or in fixed stiffness between the two methods of fixation. When examining maximum load to failure, three of either device provided fixation equivalent to four. Although there was a difference in absolute fixed stiffness between specimens fixed with three Knowles pins compared to four, when stiffness was expressed as a percentage of intact stiffness, there was no difference between any fixation group. From an analysis of the observed modes of failure and from calculations of the flexural rigidity provided by the devices, it is proposed that the quality of the trabecular bone of the femoral neck is a major factor in the experimental fixation of femoral neck fractures.
The blood transfusion requirements of a consecutive series of 249 unselected patients with femoral neck fracture were studied retrospectively. A total of 339 Units of blood were transfused (a mean of 1.36 Units per patient). Blood transfusion occurred in 132 patients (53.0%), with each receiving a mean of 2.57 Units. Patients aged 80 years and above as a group were transfused significantly more blood than those aged less than 80 years: 1.64 vs 0.94 Units, X2 = 12.09, p < 0.001. Patients with intertrochanteric fractures were transfused significantly more blood than those with intracapsular fractures (1.74 vs 1.00 Units: X2 = 13.4, p < 0.001).
In successive series of displaced subcapital femoral neck fractures in the elderly, we operated on 75 cases with three Gouffon screws, 94 with three Mecron screws, and 75 with two von Bahr screws. Redisplacement within 3 months occurred in 20 Gouffon cases, 11 Mecron cases, and 12 von Bahr cases. Poor reduction contributed to the failures in all the groups. Although the reduction results in the three groups were similar, the Mecron group had better fixation and better social recovery than the Gouffon group. We concluded that, in addition to good reduction of the fracture, solid screws also contributed to the stability of the bone-implant construct.
Between January 1, 1987, and December 31, 1992, 140 community-dwelling geriatric patients > or = 65 years of age with a displaced femoral neck fracture (Garden III-IV) underwent primary prosthetic replacement and were followed prospectively for a minimum of 1 year. Overall, 92 patients received a cemented bipolar prosthesis and 48 patients received a cemented modular unipolar prosthesis. There were no statistically significant differences between the two groups with respect to preinjury characteristics (age, sex, and number and severity of medical comorbidities) and functional ability. There were no statistically significant differences between the two groups with regard to the number of postoperative complications, length of stay, and 1 year mortality rate. An in-depth functional evaluation was obtained as follows: level of ambulation, independence in basic activities of daily living (feeding, bathing, dressing, toileting), and independence in instrumental activities of daily living (food shopping, food preparation, banking, laundry, housework, and use of public transportation). At 1 year follow-up, no statistically significant differences in functional ability were identified between the unipolar and bipolar groups. Furthermore, at a minimum of 1 year follow-up, there were no statistically significant differences between the two groups with regard to the need for revision surgery or the incidence hip pain. Based on the results of this study, there does not appear to be any advantage to the use of bipolar endoprosthesis for the treatment of femoral neck fractures in the elderly patient. The lower cost of modular unipolar prostheses compared with bipolar prostheses provides additional support for their use.