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PubMed1986

Radionuclide scintigraphy of femoral head specimens removed at arthroplasty for failed femoral neck fractures.

In order to determine the value of scintimetry as a tool for quantitative measurement of femoral head vascularity, the results of postoperative scintigraphic and histologic examination of surgically removed femoral head specimens were compared with those of preoperative radionuclide scintigraphy in 19 failed femoral neck fractures. Following intravenous administration of 600 MBq of Tc-99m MDP before hip replacement, the activity distribution in femoral head sections was recorded with a gamma camera and the area of isotope uptake calculated. A correlation was found between the results of preoperative noninvasive radionuclide scintigraphy and the assessment of isotope uptake in the removed femoral head specimens (r = 0.83, p less than .001) and was confirmed by the results of histologic examination. There is a risk, however, of overestimating the ratio of isotope uptake between the femoral head on the fracture side relative to the contralateral side with respect to quantitative assessment of femoral head vascularity, due to the general increase in isotope owing to accumulation in the injured hip region. The calculations, however, reflect the levels of radionuclide uptake and the varying degrees of femoral head vascularity.

Aged↗
PubMedDate not supplied

[Follow-up analysis of total hip endoprosthesis after femoral neck fracture with and without previous operation].

Damage occurring after joint-preserving surgical treatment of femoral neck--mostly femoral head necrosis of pseudoarthrosis-necessitates endoprosthetic joint replacement. In the case of inferior bone quality and unfavorable fracture forms as well as after failed conservative therapy, surgical treatment consists of implanting a total hip endoprosthesis. Between 1971 and 1989, 120 patients received total hip replacement after suffering fractures of the femoral neck: 61 patients did not have previous surgery, 59 patients had had joint-preserving surgery. Statistical analysis of the results showed that the primary stabilizing operation to preserve the joint did not have a negative influence on the survival probability of the total hip replacement in comparison with primary implantation. If the joint-preserving primary intervention fails, total hip replacement is a good choice for secondary surgery. In the case of complications such as femoral head necrosis or pseudoarthrosis the indication for total hip replacement should therefore be made early on.

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PubMed1983

Femoral head vitality after femoral neck fracture. Comparison between pre- and peroperative tetracycline labeling.

Using fluorescence microscopy, a ratio between tetracycline labeling of the femoral head and of the greater trochanter was calculated for 370 femoral neck fractures. Sixty-three patients were given tetracycline on admission to hospital and 307 on the operating table after closed reduction. The following results were obtained: Visual grading of labeling correlated well to a distribution analysis based on a morphometric point-wave pattern. No significant difference concerning the degree of labeling between the pre- and peroperative groups was found. A redistribution into groups according to fracture displacement (Garden I-IV) did not alter this fact. In the total material, labeling was significantly better for undisplaced than for displaced fractures. No difference was found between different degrees of displacement. For patients less than 50 years of age, labeling values were significantly lower. Intact femoral head vascularization (ratio greater than or equal to 0.90) was found in less than three per cent of the total material.

Adolescent↗
PubMed2004

Osteoporotic femoral neck fractures: management and current controversies.

Osteoporosis is a pervasive disease among the growing elderly population. Femoral neck fractures are often a direct result of osteoporosis and are challenging to treat. Surgical interventions seek to return the patient to preinjury function as quickly as possible, but many obstacles exist. Disruption of the blood supply occurs regardless of the fracture pattern, and in the active elderly population, reduction and fixation should be done as soon as possible to minimize healing problems. Closed reduction with percutaneous cannulated screw instrumentation is currently the fixation method of choice, but even with meticulous technique, moderate complication rates persist. Newer devices and biologic bone augmentation cement show promise in decreasing postoperative fracture collapse. Patients in whom a stable reduction cannot be achieved or who have a limited life expectancy should undergo arthroplasty. Unipolar and bipolar arthroplasty have both been effective in restoring function and have been the standard of care in these patients. Recent evidence suggests that active elderly patients who have acetabular disease or severely displaced fractures may benefit most from primary total hip arthroplasty.

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PubMed1989

[Mineralization status in bones in patients with femoral neck fractures].

The authors present the results of the evaluation of the state of the art of mineralization of the bone in 56 patients over 45 years of age with the fracture of the femoral neck. The state of the art of mineralization was evaluated by means of bone indices. In each patient there were determined 6 values of bone indices and thus they got a more objective picture of the state of the art of bone tissue. They found out that most cases of fractures occurred on the osteporous skeleton. For pathological values corresponding to osteoporosis they considered such values when the bone index according to Barnet-Nordin was less than 45, Garn index less than 67, Singh index equal to the values I, II, III and Kocian index corresponded to normograms. Lower cortico-diaphyseal index on the side of the fracture in comparison with the contralateral side they explain by timely demineralization after the fracture during immobilization. Proceeding from the results achieved they emphasize the necessity of a timely prevention and treatment of osteoporosis.

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PubMed1991

The uncemented bipolar hemiarthroplasty for displaced femoral neck fractures. 6-year follow-up of 171 cases.

We report a study of 168 consecutive patients (171 prostheses) with a displaced femoral neck fracture and a physiologic age older than 75 years who were treated with an uncemented bipolar Monk hard-top hemiarthroplasty. Four prostheses dislocated postoperatively, but none after discharge. Two prostheses were later extracted. Five patients sustained an ipsilateral femoral fracture. Totally, 7 patients (4 percent) were reoperated on. One year after the operation, 22 percent of the patients were dead. An increased mortality rate was recorded during the first 6 months after surgery. At follow-up 6 (3-9) years after the operation, 4 of the 62 patients alive had weight-bearing pain. Three had subsidence of the prosthesis, but none had protrusion of the acetabulum. Ninety-five percent of the patients were free from complications requiring a reoperation or outpatient evaluation.

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PubMed1986

[Phlebography of the femoral head following femoral neck fracture].

The incidence of avascular necrosis (AVN) of the head of the femur after transcervical fracture is 30-60%, depending on the diagnostic methods used. A poor outcome in AVN is not inevitable, since early diagnosis and treatment with prolonged non-weightbearing can produce satisfactory revascularisation without deformity. Nineteen patients with fractures of the femoral neck treated with internal fixation were assessed after operation by per-osseous phlebography. Weightbearing was allowed, irrespective of the state of union of the fracture, only if this test was positive. Of 13 patients who were allowed to bear weight after consolidation of the fracture, only one developed avascular necrosis. A further six patients were treated by non-weightbearing for up to eight months. Only one, in whom the fracture did not unite, developed avascular necrosis. The average time to union was 3.2 months, and the time to weightbearing was 4.1 months. This small difference, taking into account the low incidence of AVN (2 out of 19 or 10.5%, has led us to suggest a fresh approach to fractures of the femur neck in which the indications for immediate arthroplasty are restricted if the patient can tolerate prolonged non-weightbearing. Revascularisation may be assessed with phlebography and weightbearing allowed when this becomes positive. This approach should diminish the incidence of advanced AVN of the femoral head, and widen the indications for internal fixation.

Female↗
PubMed1999

Bilateral femoral neck fractures secondary to hypocalcemic seizures in a skeletally immature patient.

We report the case of an 11-year-old, skeletally immature boy who sustained bilateral femoral neck fractures during seizure activity. These fractures were due to hypocalcemia. Although this condition is a rare complication of seizures, its early recognition and treatment are essential to minimize complications associated with the delayed treatment of intracapsular hip fractures.

Bone Development↗
PubMed1987

Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws.

In a prospective, randomized trial, 104 consecutive patients with displaced femoral neck fractures were allocated either to fixation with a sliding screw plate or 4 ASIF cancellous bone screws. The patients were reexamined at fixed intervals to determine the time of union. The 2-year-cumulated rate of union was 64 per cent in the plate group and 84 per cent in the screw group.

Adult↗
PubMed1999

Vascularized iliac bone graft for displaced femoral neck fractures in young adults.

From November 1989 to September 1994, a total of 26 patients (18 men and 8 women) with acute displaced femoral neck fractures were treated with closed reduction and Knowles pinning combined with vascularized iliac bone grafting. Mean patient age was 37.5 years (range: 24-48 years). The mean time interval from injury to surgery was 3.6 days (range: 1-10 days). One patient experienced loss of the reduction at 6 weeks postoperatively and subsequently went on to hip replacement. Mean follow-up for the remaining 25 patients was 56.2 months (range: 20-78 months). All fractures united within 4 months. The average union time was 3.3 months. Plain radiographs confirmed the presence of avascular necrosis in 2 patients during the final follow-up; 1 of these patients developed systemic lupus erythematous 1 year after the fracture and had been treated with high doses of corticosteroid. Functional and radiographic results were satisfactory in the remaining patients.

Adult↗
PubMed1998

Outcome after hemiarthroplasty for femoral neck fractures in the elderly.

A prospective outcome study was performed on 270 patients, 65 years of age and older, who sustained a femoral neck fracture and underwent hemiarthroplasty. The treatment compared was the use of a noncemented unipolar versus either a cemented or a press fit bipolar prosthesis. The outcome variables assessed included the occurrence of a postoperative complication, length and cost of hospitalization, and function in various quality of life measurements. Patients who underwent bipolar hemiarthroplasty with either a cemented or a press fit prosthesis had better pain relief and function than patients who had a noncemented unipolar prosthesis at a minimum of 24 months after surgery. However, the mean hospitalization cost for patients who had a bipolar prosthesis was $12,290 compared with $8876 for a unipolar prosthesis.

Activities of Daily Living↗
PubMed1987

[Femoral neck fractures after age 65: morbidity, mortality, lethality].

In 1984, in France, 7,916 deaths of persons over 65 yr were due to femoral neck fracture (national statistics of mortality). In the same age group, the annual number of surgical procedures performed for this reason was estimated from a national survey to be 36,300 in 1980. The proportion of deaths and surgical procedures due to this condition increases with age and is always higher in females. The same result is observed concerning the annual incidence of deaths and the incidence of operations (2 p. 1000 in males, 6 p. 1000 in females over 65 yr). Lethality was assessed by relating figures of mortality and surgical morbidity (1 death p. 4.6 operations). It was higher in males (1 death p. 3.5) than in females (1 death p. 4.9). The difference between males and females was more marked in younger age groups (ratio of 3 in the 65-69 yr group) and decreased with age. This excess-lethality in males is partly due to a poorer preoperative condition, and especially to a greater frequency of coexisting respiratory failure.

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