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PubMed1995

Early roentgenological grading of femoral shortening is correlated to the late outcome after femoral neck fractures.

Using orthoradiography, the distance between the centre of the femoral head and the intercondylar notch was assessed at regular intervals in 144 patients who were followed for a 2-year period after osteosynthesis of a femoral neck fracture. Late complications, such as segmental collapse and non-union, occurred in 27% of the patients. The degree of femoral shortening was significantly correlated to the incidence of late complications. At 1 month, femoral shortening of more than 5 mm was observed in 85% of patients who developed late complications, and in only 5% of patients without such complications. Thus, the observation of a shortening of more than 5 mm predicted a greater than 6-fold increase of the incidence of late complications. The prognostic accuracy of this observation 1 month after treatment was 92%.

Adult↗
PubMedDate not supplied

Primary Thompson prosthesis for acute femoral neck fractures.

Two hundred fifty cases of F.R. Thompson endoprosthesis replacement without methylmethacrylate in acute femoral neck fractures between 1969 and 1973 were reviewed. Follow-up evaluation was obtained in 94 patients averaging 4.8 years postoperative utilizing the Harris hip questionnaire. None of the patients were personally examined, but each was interviewed and rated for pain, function, and satisfaction with the hip surgery. The average Harris score was 63 points giving 56% overall satisfactory results. Pain relief was satisfactory in 85% of cases. Functional results were 71% fair or better, and 90% were satisfied with the overall results. Mortality at one year postoperative was 23%. Incidence of deep wound infection was 2% and prosthesis dislocation was 1%. Both infection rate and dislocation rate were higher in posterior exposure compared to anterior lateral surgical approach. The lack of methylmethacrylate cement apparently did not delay postoperative ambulation, as 60% of all patients were discharged within 4 weeks of fracture. The indications for methylmethacrylate with the Thompson endoprosthesis is an unanswered question and requires further investigation.

Acute Disease↗
PubMed2003

Noncontiguous fractures of the femoral neck, femoral shaft, and distal femur.

BACKGROUND: Multifocal fractures of the femur are uncommon injuries and present unique management challenges. Combined ipsilateral fractures of the femoral shaft and femoral neck or the femoral shaft and distal femur have been described. The combination of noncontiguous ipsilateral femoral neck, femoral shaft, and distal femoral articular injuries, however, has not been described. The purposes of this report are to document the incidence and characteristics of this injury and to present a treatment rationale. METHODS: This was a retrospective study conducted at a Level I trauma center. RESULTS: Over a 5-year period, 1639 adult patients with femur fractures were definitively managed at the authors' institution. Five male and two female patients (average age, 43.3 years) sustained ipsilateral, noncontiguous fractures of the femoral neck, femoral shaft, and distal femoral articular surface (0.43%). All femoral neck fractures were vertically oriented. All distal femoral injuries were unicondylar. A variety of fixation methods were used, dependent on individual fracture characteristics. The femoral neck fractures were prioritized in all cases. Stabilization of the distal femoral articular surface was then performed before diaphyseal fixation in patients with sagittally oriented condylar fractures. Patients were followed for an average of 19.3 months. All fractures healed without the need for secondary procedures. CONCLUSION: This injury constellation is rare. Open reduction and internal fixation of the displaced femoral neck fracture should be the primary focus of orthopedic management, followed by stable reduction and fixation of displaced distal femoral articular injuries. The diaphyseal fracture should be treated with a technique that does not jeopardize either the proximal or the distal fractures. Patients who are critically ill can be managed in a similar sequence over the course of several days, depending on their overall condition.

Accidents, Traffic↗
PubMed2006

Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients.

INTRODUCTION: Recent randomized controlled trials have shown that for the active and lucid elderly patient with a displaced femoral neck fracture, a primary total hip replacement (THR) is superior to internal fixation (IF) regarding the need for secondary surgery, hip function and health-related quality of life (HRQoL). Despite the high failure rate for IF, the method is still recommended for this patient cohort by some authors. One argument is that if IF fails, there is always the possibility of performing a secondary salvage THR. The main aim of our study was to determine whether a primary THR, as compared to a secondary THR after failed IF, gives a better outcome after 2 years. METHODS: We compared outcome for 43 patients with a primary THR to the outcome for 41 patients who were treated with a secondary THR after failed IF. All patients (mean age 80 years) were lucid and had a displaced femoral neck fracture. Hip function (Charnley score) and health-related quality of life (HRQoL, EQ5D) were assessed 2 years after the THR procedure. RESULTS: Hip function was better in the primary THR group: the mean Charnley score was 15/18 as compared to 13/18 in the secondary THR group (p < 0.001). The patients with failed IF who later underwent a secondary THR experienced a more pronounced decrease in HRQoL (EQ-5D index score) during the first year of treatment compared to patients in the primary THR group, with a difference of 0.25 in the EQ-5D index score at the 4-month follow-up (p = 0.02). INTERPRETATION: We found that a secondary THR after failed IF results in inferior hip function compared to a primary THR for a displaced femoral neck fracture in the active and lucid elderly patient. Moreover, the patients with failed IF had to undergo at least one re-operation and experienced a significant reduction in HRQoL before the salvage THR.

Activities of Daily Living↗
PubMed2003

Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly?

This prospective randomized trial compared the efficacy of unipolar versus bipolar hemiarthroplasty in elderly patients (> or = 65 years) with displaced femoral neck fractures in terms of quality of life and functional outcomes. One hundred fifteen patients with a mean age of 82.1 years were enrolled in this study and randomized to either unipolar or bipolar hemiarthroplasty. Quality of life and functional outcomes were assessed using the Musculoskeletal Functional Assessment instrument and Short Form-36 health survey. Seventy-eight patients completed 1 year of followup. There were no differences between the groups in estimated blood loss, length of hospital stay, mortality rate, number of dislocations, postoperative complications, or ambulatory status at 1 year. There also were no significant differences between the two groups at either point in postoperative Short Form-36 or Musculoskeletal Functional Assessment instrument scores. Results of this prospective randomized study suggest that the bipolar endoprosthesis provides no advantage in the treatment of displaced femoral neck fractures in elderly patients regarding quality of life and functional outcomes.

Aged↗
PubMed1991

Femoral head blood flow in femoral neck fractures. An analysis using intra-osseous pressure measurement.

We studied 50 patients with fractures of the femoral neck, 33 intracapsular and 17 extracapsular. Intraosseous pressure was measured by a transducer within the bone to quantify blood flow, and intracapsular pressure by a needle introduced into the joint space. The mean intracapsular pressure was lower in the extracapsular fractures. In these, the mean intraosseous pressure in the femoral head was unchanged by aspiration of the joint. However in the intracapsular fractures aspiration produced a significant decrease in intra-osseous pressure and an increase in pulse pressure within the femoral head. The results suggest that aspiration of intracapsular haematoma produced an increase in femoral head blood flow by relieving tamponade.

Femoral Neck Fractures↗
PubMed1975

[Head endoprostheses in femoral neck fractures].

By clinical, radiographic and scintigraphic means we attempted to examine, whether the implantation of a simple head-endoprosthesis after fractures of the femoral neck still has to be considered as an appropriate operating method or whether on principle, primary endoprosthesis should be used. The results prove that in suitable cases and with correct technique the head-endoprosthesis still has justification, especially as the "protrusio acetabuli", known only as complication of pure head-endoprosthesis, is mostly avoidable. Reference to the choice of cases, operating conditions and appropriate methods of examination are given.

Aged↗
PubMed1993

Femoral neck fracture. Factors related to ambulation and prognosis.

A total of 427 elderly patients with femoral neck fractures were studied retrospectively to identify factors that may be correlated with life expectancy and functional prognosis. Gender, age, prefracture activities of daily living (ADL), electrocardiogram ECG), electroencephalogram (EEG), cognitive function, hemoglobin level, total protein level, and type of fracture were evaluated to determine the correlation of each predictive factor with survival time after surgery and three-month postoperative walking recovery rate. The one-year survival rate was found to be 55.9%: 59.1% for women and 52.3% for men. The walking recovery rate was 55.8%. The most important factors affecting life expectancy were prefracture ADL, ECG, EEG, and cognitive function score (Hasegawa's score). Electroencephalogram and Hasegawa's score also were found to be important prognostic factors for postoperative ADL. Preoperative medical conditions are useful indicators for determination of functional prognosis and survival.

Activities of Daily Living↗
PubMed1991

Radiographic prediction of early failure in femoral neck fracture.

We studied the primary radiographs of 56 patients treated with osteosynthesis for a displaced femoral neck fracture. The radiographic findings were subjected to a multiple regression analysis together with the results 3 months postoperatively. A primary fracture displacement of more than 20 mm on the AP film and a defect of the calcar due to fracture comminution were associated with a failed osteosynthesis.

Aged↗
PubMedDate not supplied

Vitamin D and calcitonin treatment in patients with femoral neck fracture: a prospective controlled clinical study.

The effects on general and bone metabolism of femoral neck fracture patients of 0.25 micrograms alpha-calcoid given orally twice daily (n = 9) and 25 micrograms calcitonin given subcutaneously 30 times (n = 10) in 10 weeks were studied against a control (n = 11). Bone histology and histomorphometry showed non-age related osteoporosis in 30% and osteomalacia in 22% of the patients studied. Impaired serum vitamin D status was found in 47-88% of patients, secondary hyperparathyroidism and increased serum parathyroid hormone in 59% and decreased serum calcitonin levels in 69%. On histology, normal findings and non-age related osteoporosis on histology were associated with low serum levels of 25-hydroxyvitamin D3, 1,25- and 24,25-dihydroxyvitamin D3. Very high serum levels of 1,25-dihydroxyvitamin D3 and low levels of 25-hydroxyvitamin D3 occurred in fracture patients with osteomalacia. Calcitonin improved calcium balance, reduced osteoporosis and increased the serum 1,25- and 24,25-dihydroxyvitamin D3 levels but had no effect on osteomalacia. Vitamin D reduced osteomalacia, slightly increased the serum 1,25-dihydroxyvitamin D3 concentration and decreased serum levels of parathyroid hormone. Both treatments gave a similar slight decrease in serum calcitonin concentrations. A mechanism of action for the treatments is suggested.

Aged↗
PubMed1984

Total hip replacement after nailing failure in femoral neck fractures.

Forty patients were treated by means of total hip arthroplasty after nailing of femoral neck fractures had failed. Their average age was 73 years. Thirty-eight patients were still alive after 2 years and were reviewed. Two hips dislocated, but there was no early mortality. The results regarding pain, walking capacity, and function were good, and total hip replacement is considered to be the salvage operation of choice.

Adult↗
PubMed1991

Incidence of femoral neck fractures: senile osteoporosis in Finland in the years 1970-1985.

The number of new femoral neck fractures in Finland doubled between 1970 and 1985. This is a result of the progressive increase in the age of the population as well as of an increase in incidence rates. The former factor predominated in women, while the latter was more characteristic among men. The increase in incidence rates seemed to be based on a cohort effect.

Aged↗
PubMed1985

Morbidity after femoral neck fracture not increased in diabetics.

In a retrospective study the morbidity following surgery for femoral neck fracture was investigated in 81 patients with diabetes mellitus and in 81 non-diabetic matched control patients. Sixteen patients in each group had postoperative complications with no tendency to specific complications in the diabetic patients. Morbidity was equally distributed between patients treated with insulin, antidiabetic agents, and diet. Our results do not support the common belief that there is an increased postoperative risk in diabetic patients.

Aged↗
PubMed1984

[The cementless Moore prosthesis in femoral neck fractures of the aged].

We report on 207 cases of elderly patients suffering from femoral neck fractures treated with cementless Moore-hip prosthesis in the years 1967 to 1979. Low complication rate and good functional results were also confirmed in 29 follow-up examinations 3 years or more after arthroplastic. Loosening of prosthesis, breaking of material or protrusio acetabuli could not be found. The method is easy to be learned and well tolerated by the aged patients. In regard of the contraindications it leads to good results.

Age Factors↗