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PubMed1995

Percutaneous osteosynthesis with two screws in treating femoral neck fractures.

In a consecutive, retrospective study, 182 patients were followed 1 year after surgical treatment of a fractured femoral neck. The patients were admitted on alternate days to the neighboring departments of orthopedic surgery O and phi, respectively. In Department O, the patients were submitted to sliding screw-plate (SSP) osteosynthesis, while patients in Department phi were treated with two percutaneously introduced screws. Our results showed that double-screw osteosynthesis can be performed significantly quicker and with less blood loss than application of SSP. Healing of the fractures in the two groups did not differ significantly, nor did the cumulative rate of failure or the frequency of secondary surgical procedures. We find that, judged from these parameters, percutaneously introduced double-screw osteosynthesis is at least as effective as SSP osteosynthesis.

Aged↗
PubMed1995

Femoral nerve block in extracapsular femoral neck fractures.

We randomised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone. A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity.

Aged↗
PubMed2004

Neck fracture femoral heads for impaction bone grafting: evolution of stiffness and compactness during impaction of osteoarthrotic and neck-fracture femoral heads.

BACKGROUND: The need for safe bone allografts is increasing and preservation of femoral heads from patients being operated on with hip arthroplasty should be encouraged. However, should we preserve femoral heads from patients operated on for neck fracture as tissue mechanical quality may not be satisfactory? MATERIAL AND METHODS: We compared the evolution of stiffness and compactness of fresh-frozen morselized bone obtained from osteoarthrotic femoral heads and those from neck fractures. Both materials were also compared after freeze-drying and irradiation. We used 6 osteoarthrotic and 6 neck-fracture femoral heads to prepare 4 batches of morselized bone. 18 samples from each batch were impacted in a contained cylinder. Frozen bone grafts were tested after thawing at room temperature for 2 hours and freeze-dried grafts were tested after 30 minutes of rehydration. RESULTS: The stiffness of fresh-frozen neck fracture bone was lower than that of fresh-frozen osteoarthrotic bone at 150 impactions. The stiffness of freeze-dried irradiated bone was higher than that of the fresh-frozen bone and did not differ between osteoarthrotic and neck-fracture bone. INTERPRETATION: Solvent-treated freeze-dried bone from femoral heads procured during arthroplasty for sub-capital hip fractures represents a valuable source of material for allografts, addressing concerns regarding serological testing, medical history and bone quality.

Aged↗
PubMed2000

[Anesthetic management of the elderly patients with femoral neck fracture by sevoflurane and femoral nerve block].

Fracture of the femoral neck (FNF) is a significant cause of morbidity and mortality in the elderly, and the elderly with FNF are often high-risk patients for anesthesia. We studied 15 patients above 80 years of age with severe physical status (ASA III-IV). After femoral nerve block (for the pain of fracture) and lateral femoral cutaneous nerve block (for the cutting pain), surgical procedure was performed under general anesthesia by laryngeal mask airway under spontaneous ventilation. After the operation, morphine 2 mg was administered subcutaneously. In our experience, the majority of 15 patients cardiovascular status of remained stable, except one patient who needed ephedrine for hypotension and another patient who needed diclofenac sodium for post-operative pain relief.

Aged↗
PubMed1985

[Bilateral shoulder dislocation fractures, femoral neck and vertebral fractures: a remarkable combination of injuries during an epileptic seizure].

Fracture complications of convulsions are reported occasionally, e.g.: mono- or bilateral posterior shoulder luxations and luxation fractures, central dislocations of the hip as well as fractures of the femoral neck or compression fractures of vertebrae. A case is reported where the patient sustained four such lesions simultaneously. The epileptic seizure occurred following the sudden interruption of a neurotropic therapy with Carbamazepin (Tegretal). A general osteodystrophy was not found. The simultaneous presence of four such lesions following one convulsion has never before been reported and appears to be very uncommon. The frequency and problems of post-epileptic fractures are discussed and the operative treatment of the lesions briefly described.

Adult↗
PubMed1999

Femoral neck fracture complicating intramedullary nailing of femoral shaft.

Intramedullary nailing of the femur is now established as a routine treatment for femoral shaft fractures. A recognised complication of this technique is the occasional jamming of the intramedullary reaming device within the femoral canal although surprisingly we could not find any reports in the literature. We describe a case in which the removal of such a reamer resulted in an iatrogenic intracapsular fracture of the femoral neck, a serious complication of this problem not previously described in the English literature. This resulted in an intraoperative decision to change the fixation device to accommodate this.

Adult↗
PubMed1998

[Occult fracture of the femoral neck fractures of the proximal femur].

Bone scintigraphy is a highly sensitive method for the detection of fractures. In case a trauma and clear clinical signs are evident, but the radiography is inconspicuous, bone scintigraphy may lead to the final diagnosis. In the present case of an occult fracture in the proximal femur only scintigraphy indicated the fracture, which then was proved topographically by magnetic resonance imaging.

Aged↗
PubMed1976

[25-OH-vitamin D in the serum of patients with femoral-neck fractures].

In 10 women with femoral neck fracture, 10 with fracture(s) evolved from accidents (mainly traffic accidents) and 10 without disease (controls) in January and July, the 25-OH-vitamin D levels in serum were measured by a competitive protein binding assay. Patients with femoral neck fractures exhibited significantly (p less than 0.05) lower 25-OH-vitamin D levels than the other groups. Additionally, in patients with femoral neck fractures calcium x phosphate product in serum was subnormal (below 25). In Germany, prophylactic dietary supplementation of vitamin D seems feasible.

Aged↗
PubMed1987

Sequential scintimetry in prediction of healing rate after femoral neck fracture.

Thirty-one femoral neck fractures which united without complications (nonunion or late segmental collapse) were included in a prospective sequential scintimetric study. Roentgenologically, three subgroups with different healing rates could be distinguished: rapid union, normal union, and delayed union. All fractures showed a rapid increase in relative femoral head radionuclide uptake after the 1-week scintimetry, followed by a gradual decline after 6 weeks-3 months. However, both the initial rise in activity and the time for maximal uptake tended to differ between the three groups. For rapid union and normal union the peak activity was registered at 6 weeks and for delayed union at 3 months. It is concluded that sequential scintimetric assessment of femoral head uptake can identify different healing rates and that this difference can be partly explained by a transient impairment of vascular supply to the femoral head in fractures with delayed healing.

Adult↗
PubMed1996

Femoral neck fracture following avascular necrosis of the femoral head.

Four cases of femoral neck fracture following avascular necrosis of the femoral head were studied histologically. All four patients were women who had received steroid therapy, three of them for systemic lupus erythematosus and the other for idiopathic thrombocytopenic purpura. Two types of fracture were found according to the site and the mechanism of fracture. One was at the junction between the necrotic bone and the repairing bone, and it can thus be regarded as a stress fracture. The other type of fracture commenced at the superior portion of the junction between the femoral head and neck, which was weak due to the repair reaction. The fracture line extended to the inferior cortex of the femoral neck, as often occurs in the elderly. In one patient, the femoral neck fracture was the first sign of avascular necrosis of the femoral head.

Adrenal Cortex Hormones↗
PubMed2004

Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment?: A pilot study of hip BMD and biochemical bone markers in patients with femoral neck fractures.

The incidence of nonunion is high after a femoral neck fracture. If reliable predictors were available, fractures that heal well could be subjected to internal fixation while fractures that do not could undergo an arthroplasty. In this pilot study of 28 patients, those with a low hip BMD on admission had a higher risk of developing non-union.

Absorptiometry, Photon↗
PubMed1992

[A study of risk factor in osteoporosis, femoral neck fracture and colles' fracture].

This work studied risk factors of osteoporosis, femoral neck fracture and Colles' fracture. The results were compared with those of a healthy group. Milk intake was frequent in the healthy group, but rare in the femoral neck fracture or Colles' fracture group. Most of osteoporosis and femoral neck fracture group were bed ridden, or stayed indoors for a long time before injury. They weighed less and were thin as compared to the healthy group. Decrease of activities of daily living and less body weight were risk factors of osteoporosis and femoral neck fracture, but these risk factors were more predominant in the femoral neck fracture than osteoporosis group. In this study, 74.4% of the patients with femoral neck fracture also had osteoporosis and 33.3% with Colles' fracture had osteoporosis. Colles' fracture was related to injury force and femoral neck fracture was found to be closely related to osteoporosis.

Activities of Daily Living↗
PubMed1988

Hemarthrosis after femoral neck fracture fixation.

In 34 femoral neck fractures, CT was performed within 1-32 days after internal fixation. All the cases except one showed an increased distance between the femoral neck and the anterior aspect of the joint capsule as compared with the intact side, indicating varying degrees of hip joint effusion and/or synovitis. Hip joint aspiration in 11 patients revealed increased intracapsular pressure varying between 10 and 112 mmHg and volumes of aspirated joint effusion up to 23 ml. Pain relief and increased joint motion after drainage of the intracapsular effusion was observed in 3 patients whose postoperative mobilization was facilitated.

Aged↗
PubMed2002

Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation.

OBJECTIVE: To determine differences in outcome between undisplaced (Garden I and II) and displaced (Garden III and IV) femoral neck fractures in elderly patients treated with internal fixation. SETTING: University hospital. DESIGN: Prospective clinical study. PATIENTS: Ninety patients with an acute femoral neck fracture after a fall. The inclusion criteria were age older than sixty-five years, absence of severe cognitive dysfunction, independent living, and unhindered walking capability preoperatively. The mean follow-up was twenty-six months. INTERVENTION: The patients were treated with closed reduction and percutaneous internal fixation with two cannulated screws. MAIN OUTCOME MEASUREMENTS: Fracture healing complications, pain (visual analogue scale), walking capability, activities of daily living, and quality of life according to EuroQol. RESULTS: The rate of fracture healing complications in displaced femoral neck fractures in patients available at the final follow-up was 36 percent compared with 7 percent in patients with undisplaced fractures. The quality of life, according to EuroQol, of patients with uneventfully healed fractures was significantly lower in patients with primarily displaced fractures (0.51) than in patients with undisplaced ones (0.76). CONCLUSION: There was a major difference in outcome on comparing undisplaced and displaced femoral neck fractures in elderly patients treated with internal fixation. The rate of fracture healing complications in patients with undisplaced fractures was low, and patients with healed fractures regained their prefracture quality of life level. The rate of fracture healing complications and reoperations in patients with displaced fractures was high, and even in patients with uneventfully healed fractures, there was a substantial decrease in the quality of life.

Age Factors↗
PubMed1975

Primary prosthetic replacement for femoral neck fractures.

Treatment of displaced femoral neck fractures remains a problem. Routine prosthetic replacement is controversial. Review of 100 patients treated at the Campbell Clinic from 1957 to 1966 suggests that 60% long-term good results can be anticipated at a cost of 5% mortality and 25% morbidity. We believe prosthetic replacement probably should be restricted to (1) those patients admitted for treatment late or those in whom previous internal fixation has failed, (2) elderly patients whose fracture cannot be reduced closed, and (3) patients with special circumstances such as pathologic fractures, seizure disorders, Parkinsonism, and so on.

Age Factors↗
PubMed1991

[Emergency screw osteosynthesis of femoral neck fractures].

27 patients with femoral neck fractures have been treated by ORIF with 3 or 4 large cancellous bone screws. The operation has been performed as an emergency intervention within 5 1/2 hours after accident. Anterior arthrotomy in direction of the long axis of the neck for evacuation of the intraarticular hematoma has been performed as a routine. Personal follow-up with X-ray documentation after 18 to 106 months (mean 29.5 months) showed complete rehabilitation in 22 patients and 2 femoral head necroses (7.4%). We conclude that these good results are due to the short interval between accident and operation as well as to the evacuation of the intraarticular hematoma, together with a stable internal fixation and functional rehabilitation.

Adolescent↗