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PubMed2003

Costs of internal fixation and arthroplasty for displaced femoral neck fractures: a randomized study of 68 patients.

We included in a prospective, randomized study 68 patients aged 70 years or older, with displaced cervical hip fractures. The patients were randomized to internal fixation with hook-pins (36) or primary arthroplasty (32) (total or hemiarthroplasty due to their prefracture status) and followed for 2 years. Patients with rheumatoid arthritis, mental confusion and/or residence in an institution were excluded. The postoperative stay in hospital, rehabilitation wards or nursing homes were recorded as well as complications and the costs of surgery. The aim of this study was to compare the accumulated costs of each method, during the first 2 years after the fracture. In the internal fixation group, 15/36 were considered failures, as compared to 1/32 in the arthroplasty group. As regards primary treatment of the fracture, the durations of surgery and hospital stay were shorter after internal fixation, but the total need for hospitalization/institutionalization was somewhat longer in these patients. The mean 2-year cost for a patient with internal fixation was USD 21,000 and of one with primary arthroplasty USD 15,000. We conclude that primary arthroplasty is a cost-efficient treatment. Considering the very much higher failure rate after internal fixation--leading to increased suffering for these patients--primary arthroplasty stands out as the best method for displaced fractures of the femoral neck.

Aged↗
PubMed1989

Treatment of bone weakness in patients with femoral neck fracture by fluoride, calcium and vitamin D.

Twenty-three of 46 patients, aged 56 to 95 years, with fracture of the femoral neck (FNF) completed the first trial of 10 months treatment with oral sodium fluoride 60 mg and calcium 1800 mg on alternate days and 1 micrograms of vitamin D1 daily. Pre-treatment and post-treatment biopsy specimens and microradiographs of the iliac crest and metacarpal and spinal radiographs were evaluated together with biopsy material from seven untreated age-matched controls with FNF. In 17 patients the treatment improved the amount and quality of trabecular bone. Cortical thickness increased in nine patients and there were no losses of amount or mineralisation. The treatment was well tolerated by most patients and there were no major side-effects or signs of bone demineralisation. The study also revealed an unexpected rapid post-fracture deterioration of bone tissue in untreated FNF patients; thus there is an increased risk of further fractures which calls for the use of an effective treatment to increase bone mass.

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PubMed1998

Femoral neck fracture fixation: a biomechanical study of two cannulated screw placement techniques.

This biomechanical study evaluated two different methods of femoral neck fracture fixation. Ten pairs of embalmed femora were used. A standardized midcervical osteotomy was performed. One side from each pair was fixed with either conventional (central) or calcar (cortical adjacent) screw placement. The femora pairs then were subjected to cyclic and load to failure biomechanical testing. The results demonstrated significant improved stability, load, stiffness, and displacement in all tested parameters for the group with calcar screw fixation. Grossly, the conventional fixation group tended to fail in an excessively varus position, while the calcar fixation group failed with impaction of the head on the calcar, a potentially stable position.

Aged↗
PubMed1992

Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture.

OBJECTIVE: To evaluate the contribution of specific nutritional deficiencies (as indicated by zinc; vitamin A, C, and E; albumin; and haemoglobin concentrations) to the risk of pressure sores. DESIGN: Observational cohort study. SETTING: St James's University Hospital, Leeds. SUBJECTS: 21 elderly patients presenting consecutively to the orthopaedic unit with femoral neck fracture. MAIN OUTCOME MEASURE: Full thickness epidermal break over a pressure bearing surface. RESULTS: 10 patients (48%) developed a pressure sore during their hospital stay. Indices of zinc status and concentrations of albumin, haemoglobin, and vitamins A and E were similar in patients who developed a pressure sore and those who did not. Mean leucocyte vitamin C concentration, however, was 6.3 (SD 2.2) micrograms/10(8) cells in patients who developed a pressure sore as compared with 12.8 (4.6) micrograms/10(8) cells in patients who did not. CONCLUSIONS: Low concentrations of leucocyte vitamin C appear to be associated with subsequent development of pressure sores in elderly patients with femoral neck fractures.

Aged↗
PubMed1987

Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes.

All patients admitted from their own homes with a femoral neck fracture to 12 hospitals in Stockholm County Council during a three-year period were reviewed six years after the fracture. The outcome of the fractures was related to different types of treatment centers (orthopedic and surgical) and primary treatments (conservative, internal fixation, and hemiarthroplasty [HAP]). The treatment results of the four most common types of internal fixation (von Bahr, Hessel/Nyström, Thornton, and Rydell nails), the experience of the surgeons, and the operative delay were also compared. Of 2418 patients, the majority (93%) were treated with internal fixation. Thirty-three percent of patients sustained complications after conservative treatment, 37% after primary internal fixation, and 15% after primary HAP. Early redisplacement of the fracture was most common when the Thornton nail was used and when less experienced surgeons treated the fractures. Early complications such as redisplacement and nonunion occurred most often in surgical departments, but the total frequency of complications including segmental collapse was equal for different treatment centers. In surgical departments these fractures were operatively treated most often by less experienced surgeons and the Thornton nail was used more frequently than in orthopedic departments. An operative delay of up to one week did not result in more complications. Seventy percent of the complications after primary treatment were reoperated. Only 11% were not reoperated, either because of the presence of only minor symptoms, or because of the patient's poor general condition, which made reoperation too risky. The results of the present study stress the importance of stable fixation of this fracture and of the experience of the surgeon for optimal treatment results.

Adult↗
PubMed2004

Long-term results of total hip arthroplasty for femoral neck fracture nonunion.

BACKGROUND: Hip arthroplasty for the treatment of nonunion at the site of a femoral neck fracture has provided good short-term results. The purpose of the present study was to evaluate the long-term results and complications of total hip arthroplasty for the treatment of femoral neck nonunion. METHODS: The records of ninety-nine patients who had been managed with total hip arthroplasty with use of a cemented Charnley acetabular component and a cemented Charnley monoblock femoral component for the treatment of a femoral neck nonunion were retrospectively reviewed. The average age at the time of the arthroplasty was sixty-eight years. Eighty-four patients (85%) were followed until death, revision, or component removal or for at least two years (mean, 12.2 years) postoperatively. RESULTS: Twelve patients were treated with revision (eleven) or resection arthroplasty (one), eleven were lost to follow-up, and four died less than two years postoperatively. Of the remaining seventy-two unrevised hips that were followed for at least two years, sixty-nine (96%) had no or mild hip pain at the time of the last follow-up. The rate of component survival free of revision or removal for any reason was 93% at ten years and 76% at twenty years. The risk factors that were significantly associated with revision for aseptic loosening included an age of less than sixty-five years at the time of the arthroplasty (p = 0.045), a body-mass index of >/=30 (p < 0.01), and male gender (p = 0.02). The second most common complication after loosening was dislocation, which occurred in nine patients (9%). CONCLUSIONS: Total hip arthroplasty is an effective method for the treatment of nonunion of the femoral neck and provides satisfactory long-term results. However, the rate of implant survival is poorer than that reported in most other studies of Charnley total hip arthroplasty in the general population.

Adult↗
PubMed2002

Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures.

The aim of this study was to establish whether or not to cement the hemiarthroplasty for displaced intracapsular femoral neck fractures in the elderly. Consecutive patients treated by hemiarthroplasty in adjacent hospitals were reviewed. The same monoblock prosthesis was used; in hospital A they were uncemented (121 patients), and in hospital B they were cemented (123 patients). Notes were reviewed retrospectively. Surviving patients (50 and 56 respectively) were assessed prospectively for pain and functional ability using validated scoring systems. Follow-up was 32-36 months. Patient demographics were similar. Fewer of the cemented group had been revised or were awaiting revision ( P=0.036). There was no difference in general complication or mortality rates. There was a highly statistically significant greater deterioration in pain ( P=0.003), walking ability ( P=0.002), use of walking aids ( P=0.003) and activities of daily living ( P=0.009) in the uncemented group. Our findings support the use of cemented hemiarthroplasty in the elderly.

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PubMed2005

[Possibilities of unipolar hip hemiarthroplasty after femoral neck fracture].

Due to osteoporosis and incoordination, elderly people are prone to hip fractures. Hip endoprosthesis is the most rational treatment of such injuries at persons older that 65 years of age. Aim of our work was to analyze long term clinical result at the elderly patients with implanted unipolar partial hip endoprothesis after femoral neck fracture. Inclusion criteria were implantation of unipolar partial hip endoprothesis as the first operative procedure and absence of changes visible an X-ray. Our follow up was at least 18 months and all patients were treated between January 1996 and June 2001 at the Clinic for Orthopedics and Traumatology in Sarajevo according to department protocol. We used Harris hip score (HHS) for clinical evaluation. From basic group of 131 patients, in retroprospective prospective research with average follow up period of 40 months, 32 patients were clinically examined, others passed away or were not reachable. Life expectancy in basic group was 3.5 years and average HHS in examined group was 72,06 points. Our study showed that unipolar partial hip endoprothesis implanted after femoral neck fracture achieves long term fair clinical result. Main factor on a patient's recovery is not type of implanted hip endoprothesis, but general health condition before injury, motivation and early postoperative mobilization.

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PubMed2004

Management of intracapsular femoral neck fractures in the elderly; is it time to rethink our strategy?

We reviewed 100 adult patients who had a traumatic intracapsular femoral fracture internally fixed prior to 1998, with full clinical and radiological data available. End points were complete clinical and radiological union of the fracture, non-union, avascular necrosis or fixation failure. The incidence of non-union and avascular necrosis was found to be 13 and 11%, respectively. The following factors did not influence the development of avascular necrosis or non-union; fracture displacement, screws inserted (two or three), osteoporosis, parallelism of screws, presence of screws in each "quadrant" and the experience or seniority of the surgeon. The factors influencing a poor outcome were the age of the patient at injury, reduction gap at the fracture site, alignment after reduction of the fracture especially on AP view and having all screw threads crossing beyond the fracture site. We conclude that the incidence of non-union and avascular necrosis following fixation of femoral neck fractures in our study is less than generally reported with no statistical difference between displaced and undisplaced fractures. Traditional fixation factors such as screw position and number do not seem to significantly affect the outcome with the quality of reduction being most important. Thus, the majority of patients under the age of 70 with displaced intracapsular fracture should be considered for internal fixation.

Age Factors↗
PubMed2005

Displaced femoral neck fracture in children and adolescents: closed versus open reduction--a preliminary study.

Twenty-six children and adolescents with displaced femoral neck fractures who were treated surgically from 1992 to 2002 were included in this study. Among them, 14 were male and 12 were female. Altogether, 10 of them had a transcervical type of fracture, and the other 16 had a cervicotrochanteric type of fracture. The average age of the patients was 10.8 years (3-17 years). Seventeen were treated by closed reduction and internal fixation (group A), and nine required open reduction and internal fixation (group B). In group A, there were good results in 11 cases (65%), a fair result in one case (6%), and poor results in 5 cases (29%). In group B, there were good results in seven cases (78%) and fair results in the other two cases (22%). The average fracture union times in groups A and B were 12.6 and 10.2 weeks, respectively. Thus, there was a favorable outcome in group B. However, statistical analysis of data in this preliminary study did not reveal any significant difference in the surgical outcome between the two groups.

Adolescent↗
PubMed1985

Evaluation in femoral neck fracture scintimetry: modes of region of interest selection and influence on results.

Different sized ROIs within the femoral head and different modes of calculation were used in [99mTc]MDP scintimetry after femoral neck fracture. In preoperative scintimetry, correction for increased trochanteric uptake gave the best discrimination, whereas in postoperative scintimetry the direct ratio fractured/intact femoral head was superior. The change in ROI size had little influence.

Aged↗
PubMed1988

Internal fixation of femoral neck fracture. No difference between the Rydell four-flanged nail and Gouffon's pins.

Two methods of internal fixation of femoral neck fractures were compared in a prospective randomized study of 223 patients. Radiographic evidence of early redisplacement, nonunion, or late segmental collapse occurred in 45 of 122 patients operated on with the Rydell four-flanged hook nail and in 33 of 101 patients operated on with Gouffon pins. According to the actuarial method of follow-up, the failure rates after 2 years were respectively 41 and 35 percent in the nail and pin groups, which is a nonsignificant difference.

Actuarial Analysis↗
PubMed1979

Internal fixation versus primary prosthetic replacement in acute femoral neck fractures: a prospective, randomized clinical study.

A prospective, randomized clinical study has been performed on 104 patients with an acute femoral neck fracture, comparing internal fixation (von Bahr screws) with primary prosthetic replacement (Christiansen endoprosthesis). Immediate weight bearing was allowed in both groups. The postoperative mortality rate was similar in the two groups. Internal fixation proved to be a less time-consuming operation, gave a shorter hospitalization time and was associated with a significantly reduced morbidity rate compared with prosthetic replacement. No blood transfusion was needed in the internal fixation group. Primary prosthetic replacement was associated with earlier postoperative mobilization, probably gave a more definitive treatment with fewer reoperations, and showed better results at 1-year follow-up.

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PubMed1980

Survival patterns following primary prosthetic replacement for acute femoral neck fractures in the elderly.

Theoretical statistical models have been used to study survival patterns following primary prosthetic replacement for acute femoral neck fractures in the elderly with special emphasis on the nature of the potential excess mortality following trauma and operation. The chances of our patients surviving given periods of time are well below those of the standard population. The excess mortality has been quantified using the proportional hazard model. The high death rate for our patients is limited to the first 4-6 postoperative months, thereafter the death rate is similar to that of the standard population. Similarly we can show that mortality following surgery is primarily dependent on the age of the patient. Survival probability and expected longevity have been calculated for different age groups. The relative longevity expected for patients below the age of 70 is very good compared with a very reduced expected longevity for patients older than 90 years. The practical consequences of our findings are discussed.

Actuarial Analysis↗
PubMed1993

A comparison of modified Knowles pins and cannulated cancellous screws for the treatment of nondisplaced or impacted femoral neck fractures.

A prospective study was performed comparing modified Knowles pins to cannulated cancellous screws for the treatment of nondisplaced and impacted femoral neck fractures. Forty-five impacted or nondisplaced fractures were identified: twenty-five were stabilized with modified Knowles pins and twenty with cannulated cancellous screws. Patient follow-up averaged twenty-four months (range 12 to 46 months) or until reoperation. Six patients (13%) required reoperation; these failures were evenly divided between the two groups. The remainder of patients (twenty-two patients (88%) in the Knowles pin group and seventeen patients (85%) in the cannulated screw group) were comparable with regard to functional outcome.

Activities of Daily Living↗