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PubMed1981

[The experimental measurement of torque and axial force of 6.5 mm ASIF lag screws in fixation of femoral neck fractures (author's transl)].

An experimental study was undertaken to evaluate the torque and axial force of the 6.5 mm ASIF lag screw implanted in the femoral neck after a subcapital osteotomy. The experiments were carried out on autopsied bones of more than 60 years of age. The average torque was 204 cmN, the screws in the upper half of the femoral head showing a higher torque than those in the lower half. The axial tension was measured by strain gauge transducer. Depending on the length of the thread of the screw (16 or 32 mm) the average tension reaches 1162 N or 1960 N. By tightening the screw until the impression of optimum fit is obtained, 70% of the maximum axial force is reached. It can therefore be estimated that at the beginning an interfragmentary pressure of 4000 to 8000 N is exerted on a medial femoral neck fracture fixed by four ASIF lag screws.

Biomechanical Phenomena↗
PubMed1990

The architecture of cancellous and cortical bone in femoral neck fracture.

The architecture of cancellous bone as well as quantity and quality is considered important in maintaining mechanical integrity. To determine whether abnormalities of architecture occur in femoral neck fracture we measured trabecular width and number in iliac crest bone biopsies of 68 women with femoral fracture and compared them with data from a postmortem series of age-matched women without known bone disease. Cortical thickness was measured in 27 of the fracture patients and 17 controls. After exclusion of ten biopsies with increased osteoid surface no significant difference was seen in mean trabecular width or number between fracture patients and subjects without fracture. Both thinning of trabeculae and loss of trabeculae contributed to low bone volume in femoral fracture patients. Direct measurements of trabecular number correlated with calculated mean trabecular plate density (P less than 0.001), and the percentage of trabeculae at any one of a range of trabecular widths in the fracture biopsies was similar to that in non-fracture subjects. No difference was seen in the architecture of cancellous bone with age, fracture trauma or between subcapital and intertrochanteric fracture in fracture subjects. Cortical thickness, however, was related to age in both fracture and control subjects (P less than 0.05). There was no difference in cortical thickness between age-matched fracture and control subjects. Patients with intertrochanteric fracture had lower cortical thickness (P less than 0.02) and were older (P less than 0.01) than patients with subcapital fracture.

Aged↗
PubMed2005

[Correlation between the content of transforming growth factor-beta 1, interleukin-1 beta and collagenase activity in proximal femur bone samples obtained from patients with femoral neck fracture].

The aim of this study was to determine correlations between the content of TGF-beta1, IL-1beta and collagenase activity in bone samples of the femoral neck obtained from patients with femoral neck fracture. The material consisted of 42 samples of cancellous bone of femoral neck collected during hemiarthroplasty or total hip replacement procedure. 24 samples of cancellous bone from patients with osteoarthritis of the hip harvested during total hip replacement served as a control group. The content of TGF-beta1, IL-1beta was measured using ELISA and collagenase activity was measured with spectrofluorometry. In patients with fracture there was found a distinct inversely proportional correlation between the content of TGF-beta1 and IL-1beta. This correlation was not observed in the control group. In addition, a directly proportional relation between the content of TGF-beta1 and IL-1beta was discovered. These results confirm mutual correlations between examined cytokines in bone.

Adult↗
PubMed1984

Comparison between hemiarthroplasty and total hip replacement following failure of nailed femoral neck fractures focused on dislocations.

The frequency of and the factors causing dislocations of 71 total hip replacements and 59 hemiarthroplasties following failure of nailed femoral neck fractures were investigated. Dislocations were frequent and occurred in four (6%) and seven (l2%) hips respectively. Malposition of the components increased the risk for dislocation. A well-positioned total hip replacement was more stable than a hemiarthroplasty.

Aged↗
PubMed1997

Spontaneous subcapital femoral neck fracture after healed trochanteric fracture.

Two hundred thirty-three patients with an unstable trochanteric hip fracture were randomized prospectively for stabilization with a fixed angle blade plate or a compression hip screw. Twenty patients had the implant removed after the fracture was healed (average, 20.5 months; range, 12-42 months). In seven of these 20 patients, a spontaneous fracture of the femoral neck occurred at an average of 19 days after implant removal. Four of the seven patients had been treated with the fixed angle blade plate and three with the sliding screw plate. The histologic examination of three specimens was inconclusive. The authors have not observed subcapital fracture among patients whose implants were not removed. The mechanism behind this complication is unknown.

Aged↗
PubMed1987

Sliding of the compression hip screw in femoral neck fractures.

Backing out of the compression screw in the sliding screw-plate hip osteosynthesis was analyzed in a series of 71 hips with medial femoral neck fractures during an observation period of 12-42 months, with a median of 26 months. In addition to the compression screw device, a parallel cranial lag screw was used. A postoperative primary diastasis in the fracture space of 1-5 mm in 11 cases did not predispose to major sliding of the screws or to healing problems. Thirteen of 27 fractures with late screw telescoping of 4 mm or more showed healing disturbances, 11 late segmental collapses, and 2 nonunions, compared with 7 disturbances, 6 late segmental collapses, and 1 nonunion among 39 cases with screw gliding of 3 mm or less. The difference was significant (p less than 0.05, Mann-Whitney). Five early mechanical failures were excluded from this analysis.

Adolescent↗
PubMed1993

Osteoarthritis protects against femoral neck fracture: the MEDOS study experience.

The relationship between osteoarthritis and osteoporosis (hip fracture) was studied using the data from the MEDOS study, a large prospective epidemiological study of femoral neck fracture patients and age-matched controls in the Mediterranean area. Osteoarthritis was found to be protective against hip fracture in both men and women, with a significant reduction of the relative risk factor for osteoporosis (relative risk = 0.48 and 0.68, respectively, p < 0.001). The age-adjusted relative risk factor for osteoporosis remains even after adjustment for body mass index, indicating that body mass index and osteoarthritis are independent relative risk factors for hip fracture. The mean age of the group with co-existent osteoarthritis and hip fracture was significantly higher for both men and women, compared to the group with osteoporosis alone. This indicates that if osteoarthritic subjects develop osteoporotic fracture, they do so at a later age. The osteoarthritic cases compared to controls and hip fracture cases were significantly smaller in stature in both sexes, and women had a significantly higher body weight and body mass index. Extra-capsular hip fracture was significantly more frequent in cases with concomitant osteoarthritis. These findings confirm earlier observations that osteoarthritis and osteoporosis are two distinct diseases and not phenomena related solely to aging.

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PubMed2004

Cancellous screw fixation for femoral neck fractures: one hundred and sixteen patients.

INTRODUCTION: This paper evaluates the efficacy and safety of the use of cancellous screw fixation in the treatment of intracapsular femoral neck fractures in our local population. MATERIALS AND METHODS: A retrospective analysis of the results of 116 cases that were performed in Singapore General Hospital and Changi General Hospital over a 2-year period was undertaken. The minimum period of follow-up was 2 years. RESULTS: The median age of the study group was 71 years and approximately two-thirds were females. There were 104 (90%) cases of undisplaced (Garden 1 and 2) fractures and 12 (10%) displaced (Garden 3 and 4) fractures. The specific complication rate was much higher in the displaced group of patients. At 2 years' postoperation, 85% returned to their premorbid level of ambulation and 90% reported good pain relief. The 1-year mortality rate was 7%. CONCLUSION: Cancellous screw fixation is a relatively safe and useful operation. It achieved our aim of returning most patients to their pre-fracture level of ambulation and providing good pain relief.

Adult↗
PubMed1997

A case of spontaneous femoral neck fracture associated with multicentric reticulohistiocytosis: oversecretion of interleukin-1beta, interleukin-6, and tumor necrosis factor alpha by affected synovial cells.

We describe a case of left femoral neck fracture associated with multicentric reticulohistiocytosis (MR). Biopsy specimens from a skin nodule and from synovial tissue showed histiocytic multinucleated giant cells (MR cells) that are characteristic of MR. A surgical specimen from the resected femoral head revealed that multinucleated giant cells and mononuclear cells invaded the marginal subchondral bone, without evident pannus. These cells also infiltrated into the fracture site, with bone resorption by activated osteoclasts. Immunohistochemical studies of synovium from the left hip joint showed positive staining for interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor alpha, and abundant cytokine production by cultured synovial cells was demonstrated. These findings suggest that the subchondral invasion and intramedullary infiltration by MR cells caused articular destruction and/or fracture as a result of oversecretion of the cytokines.

Aged↗
PubMed1986

Supplement feeds and nitrogen and calorie balance following femoral neck fracture.

A 10 day study of nitrogen and calorie balance has been undertaken in 61 women patients aged 65-96 years (mean age 81 years) with femoral neck fractures. All underwent fracture surgery with an inhalation anaesthetic lasting from 45 min to 2 h. Intake of ward food varied widely but was always low with a mean of 127 mg N kg-1 and 17 kcal kg-1 daily. Daily nitrogen production was 85-250 mg N kg-1 (mean 158 mg N kg-1) and calorie expenditure was 17-48 kcal kg-1 (mean 32 kcal kg-1). These were greatest in trochanteric fracture patients. Of the 61 patients, 90 per cent were in negative nitrogen balance with a mean 8 day deficit of 411 mg N kg-1 and all in negative calorie balance, mean 141 kcal kg-1. The deficits were greatest in trochanteric fracture patients. Sip feeding with supplementary enriched drinks raised protein and calorie intake substantially. Both nitrogen and calorie balance were significantly improved, but large calorie deficits remained; intolerance of the supplements proved to be a handicap in correcting the deficits in many patients.

Aged↗
PubMed2006

[Analysis of health insurance costs in cases of patients under 60 years old with medial femoral neck fracture treated primarily with screw fixation or hip replacement].

AIM: The aim of the study is to analyse the cost of patients under the age of 60 with medial femoral neck fracture up to 2 years follow up after the primary treatment including cost of acute and chronic inpatient care, outpatient care, sickness pay and changes in ability to work according to the most frequently used surgical methods and Garden classification. PATIENTS AND METHODS: Patients were identified from the financial database of the National Health Insurance Fund Administration and a questionnaire was used for further analysis. The costs of patients were analysed in three groups I) all patients, (II.) patients with further treatment because of complications, and (III.) patients cured by one primary treatment. RESULTS: Altogether 518 patients were included into the study: 413 (79.7%) with primary screw fixation and 48 (9.3%) with hip replacement. The average cost for all patients (I) for the 2 years follow up was 582.181 Hungarian Forint (HUF) with screw fixation and 545.300 HUF with hip replacement. The average cost per patients in the group with one primary surgical treatment (II) was (N = 337, 81.6%) 441.466 HUF with screw fixation and (N = 44, 91.6%) 561.027 HUF with hip replacement. The average cost per patients in the subgroup with further hospitalization because of complications (II) was (N = 76, 18.4%) 1.005.578 HUF with screw fixation and (N = 4, 8.4%) 775.640 HUF with hip replacement. The costs according to Garden classification (I-IV.) were as follows: patients without complications from 436.681 HUF to 659.160 HUF and patients with complications from 628.323 HUF to 1.192.564 HUF. CONCLUSION: The results suggest that patients (N = 76, 18.4%) having displaced fractures with screw fixation receiving further treatment should be treated - knowing the vitality of femoral head - with stable osteosynthesis or hip replacement in order to reduce further reoperations and finally, health insurance expenditures and patients' burden.

Adult↗
PubMed1990

Factors predisposing to healing complications after internal fixation of femoral neck fracture. A stepwise logistic regression analysis.

A stepwise logistic regression analysis was made to assess the influence of various factors on the rate of healing complications after femoral neck fracture. A prospective series comprising 101 patients with fresh fractures treated by closed reduction and internal fixation was included in a roentgenographic follow-up study. The single most important factor was the quality of reduction, followed by the type of fracture, and the position of the internal fixation material. Age, gender, and type of internal fixation device (three screws or three nails) were not found to influence the healing complication rate. The predicted probability of a healing complication for different combinations of the three most important factors ranged from 0.05 to 0.99. The highest value was found for the combination Garden Type IV fracture, which had unacceptable reduction and position of the internal fixation material. The results show that failure to achieve adequate reduction should be a strong argument in favor of primary hip arthroplasty.

Adult↗
PubMed1992

Femoral neck fracture fixation with hook-pins. 2-year results and learning curve in 626 prospective cases.

We performed a prospective 2-year follow-up study of 626 consecutive femoral neck fractures treated with closed reduction and hook-pin fixation in all cases. The woman:man ratio was 2.9:1, the displaced:undisplaced fracture ratio 2.6:1. Mean patient age was 78 (18-100) years. The first 476 fractures were operated on by one of six surgeons with special interest in the technique, while the remaining operations were performed by any of the 35 surgeons in the department, all specialists in orthopedic surgery. Mortality within two years was 31 percent. Healing complications (redisplacement, nonunion or segmental femoral head collapse) in the total material/survivors only were for undisplaced fractures 5/7 percent, for displaced fractures 30/41 percent and for the total material 23/32 percent. According to life-table analysis, the complication rate in the total material at two years was 24 percent. The rate of secondary arthroplasty for healing complications was 13/19 percent. For displaced fractures, as well as for the total material, the group of specially interested surgeons had better results than the department as a whole.

Adolescent↗
PubMed2002

Percutaneous pin fixation of a femoral neck fracture complicated by deep infection in a 12-year-old boy.

Avascular necrosis with or without resultant limb-length discrepancy and problems with bony union is not uncommon after femoral neck fractures in the pediatric population. This rare case of infection after closed reduction and percutaneous pinning of an intracapsular fracture of the hip in a child illustrates the treatment difficulties posed by joint sepsis and the value of modern scanning techniques.

Bone Nails↗
PubMed1989

Fixation of femoral neck fractures. Comparison of the Uppsala and von Bahr screws.

In a prospective randomized study, a newly developed so-called Uppsala technique for internal fixation of femoral neck fractures was compared with the von Bahr technique. The series consisted of 222 consecutive patients, 167 women and 55 men, with a mean age of 80 years. Half of the patients were randomized to each treatment group. During the first postoperative year, 18 failures occurred in the Uppsala group, compared with 39 in the von Bahr group (P less than 0.01). Of 128 patients without pain at 4 months, 9 developed failures, compared with 29 of the 37 that had pain at this time (P less than 0.001). We conclude that the new technique gives better results during the first postoperative year and that most failures occur among those with pain at 4 months. Follow-up radiography is indicated only in patients with pain at 4 months.

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