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PubMed1997

[Magnetic resonance imaging for suspected femoral neck fractures].

Painful hip as a result of injury, with or without a history of trauma, is a common reason for referring elderly patients to the emergency room. The diagnosis of femoral neck fracture requires the combination of a physical examination, X-rays, and in problematic cases, a bone scan. However, even this combination does not always provide a diagnosis. We present 50 patients with painful hip who complained of limp and reduced hip joint motion, but had no evidence of fracture, either on X-ray or bone scan. After conservative treatment, 5 patients with no history of trauma underwent hemiarthroplasty of the hip for displaced subcapital fracture. In addition, we present a case of subcapital fracture which was diagnosed only by MRI, in whom both X-rays and bone scan were considered normal.

Aged↗
PubMed1996

[Fractures of the lower extremity--including femoral neck fractures--in advanced age].

Unstable intertrochanteric and subtrochanteric fractures in elderly patients are still a challenge in orthopedic surgery. The results of the present study show the importance of a rigid fixation to allow early mobilization and immediate weight bearing. The gamma nail has clearly brought an improvement to the treatment of such fractures, although there are complications associated to this implant which need to be reduced by further developments of the implant itself, the instruments, and/or the operative technique.

Aged↗
PubMed2006

Cementless hemiarthroplasty in femoral neck fractures: evaluation of clinical results and measurement of migration by EBRA-FCA.

Aim of the present study was to evaluate migration rates of cementless primary hemiarthroplasty in acute femoral neck fractures. In a longitudinal, prospective study 46 patients were treated by cementless hemiarthroplasty. Clinical follow up was correlated with the EBRA-FCA method. In 30% of all patients stem migration amounted to more than 2 mm; further, these patients were seen to have a high level of activity. A high degree of migration in more than 30% of all patients requires critical scepticism toward further use of the investigated cementless stem as hemiarthroplasty. According to literature, migration of more than 2 mm suggests a high probability of early aseptic loosening. In patients with a low degree of activity good results could be observed; nevertheless, in patients with a high level of activity the combination of the investigated cementless stem with a solid fracture head cannot be recommended.

Aged↗
PubMed2002

Clinical evaluation of aged patients who underwent surgery for femoral neck fractures -- comparative study of clinical results according to age.

The objective was to assess mortality and ambulatory ability for elderly patients over 90 years of age with femoral neck fractures treated surgically. From January 1998 to March 1999, 60 patients aged over 80 years were chosen for the study. The patients had a mean age of 87.1 years. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80-84 years old), group B (85-89 years old) and group C (over 90 years old). The rates of recovered postoperative walking ability were 72.2% (13/18) of group A, 65.2% (15/23) of group B and 84.2% (16/19) of group C. These patients were followed up until death or for at least one year. The overall mortality rates were 11.1% (2/18) of group A, 17.4% (4/23) of group B and 10.5% (2/19) of group C.

Aged↗
PubMed1980

Internal fixation versus endoprosthesis in the treatment of femoral neck fractures in the elderly. A prospective analysis of the comparative costs and the consumption of hospital resources.

The consumption of hospital resources and the costs involved in treating femoral neck fractures in the elderly were studied and a comparison was made between internal fixation (von Bahr screws) and primary prosthetic replacement (Christiansen's endoprosthesis). The 1-year results of screw fixation were excellent or good in 55% of the patients, fair in 17% and poor in 28%, compared with 79% excellent or good results, 13% fair and 8% poor results in the prosthetic group. As regards the initial stay in hospital, prosthetic replacement was found to be associated with 2.4 times higher costs. This difference was reduced, however, by a more expensive follow-up and more frequent readmissions and reoperations in the internal fixation group. Considering the total costs, prosthetic replacement was found to be 1.6 times more expensive than internal fixation.

Aged↗
PubMed1991

Quality of life after primary hemiarthroplasty for femoral neck fracture. 6-year follow-up of 185 patients.

Totally, 185 patients with a mean age of 80 years treated by Austin-Moore cementless hemiarthroplasty for an acute femoral neck fracture were compared with age- and sex-matched nonfracture controls. There were 22 early complications, notably 7 percent dislocation and 4 percent deep infection. Later on, two acetabular protrusions and four loosenings of the prosthesis requiring admission were recorded. Mortality after the fracture was 12 percent above the control level at 3 months, 19 percent at 12 months, and 21 percent at 18 months. The 5-year mortality was about 60 percent in both patients and controls. The average loss of life in the fracture group compared with the control group was 425 days. After a mean follow-up period of 6 years, 24 of the 65 patients still alive and the 49 of the 60 controls were living in their own homes; and 28 of the patients were institutionalized in a hospital unit for chronic care. Half of the patients and most of the controls were able to move about independently. We concluded that Austin-Moore hemiarthroplasty is associated with serious complications that prevent social rehabilitation and function to reach acceptable levels.

Adult↗
PubMed2006

Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: a randomized study of 118 patients.

BACKGROUND: We wanted to evaluate whether augmentation with calcium phosphate cement can improve clinical and functional outcome following internal fixation of displaced femoral neck fractures. PATIENTS: 118 patients aged 60-98 years (95 women) were included. All patients were physically active and ambulatory before the fracture. Patients were randomized to treatment with closed reduction and fixation with two cannulated screws alone (controls: 60 patients) or screws combined with injection of calcium phosphate for augmentation around the screw threads and at the fracture site (augmented: 58 patients). All patients were allowed free weight bearing. Clinical and radiographic examinations were done by a physiotherapist directly after surgery, at 1 and 6 weeks, and at 6, 12 and 24 months. RESULTS: 24 patients, 14 augmented and 10 controls, died during the follow-up. There was 1 deep infection (augmented). Another 34 patients were reoperated with a total arthroplasty (20 in the augmented group and 14 controls) due to loss of reduction, nonunion or avascular necrosis (p = 0.1). There was no difference in pain or muscle strength between groups. Some activities of daily living (ADLs) were slightly better in the augmented patients during the first weeks, while there were no differences between groups later on. INTERPRETATION: Due to a trend towards more reoperations in the augmented group, and only a temporary clinical improvement during the early rehabilitation, augmentation as we used it cannot be recommended.

Activities of Daily Living↗
PubMed1991

[Follow-up of elderly patients with fractures. Results of a catamnestic study of patients with femoral-(neck-)fractures].

A random sampling of n = 30 patients with fractures of the (neck of the) femur was followed up approx. 1 year after surgery, early mobilisation and rehabilitation. The average age was 79 years. The follow-up revealed a noticeable decrease in independence compared to the status at the time of discharge from hospital. This is in part due to health but mainly due to mental, social and organisational factors. The results agree with the assumption that the potential gained during the inpatient treatment period may be relatively invalidated during the subsequent outpatient phase unless measures are taken to ensure long-term quality assurance. This preservation of quality involves, among other factors, in particular satisfactorily exhaustive information and guidance of the patient and his relatives (by giving competent medical advice), clarification of the domestic situation already during the inpatient period, and cooperation with all aftercare institutions including the next of kin.

Aftercare↗
PubMedDate not supplied

[Treatment of femoral neck fractures using carbon implants].

The article generalizes the experience in the use of endoprostheses of carbon materials in fractures of the femoral neck in elderly individuals. Twenty-seven cases are discussed, the average age of the patients was 76 years. Owing to the possibility of forming from carbon materials a device which meets the functional demands of the organs and tissues, such widely encountered complications in endoprosthesis as stretching of the implant's pedicle and destruction of the device were avoided.

Age Factors↗
PubMed2000

The effect of screw insertion site and unused drill holes on stability and mode of failure after fixation of basicervical femoral neck fracture.

The intent of this biomechanical study is to characterize the effect of unused drill holes and cannulated screw insertion site on the fixation stability and mode of failure after fixation of basicervical femoral neck fractures. Fourteen matched pairs of embalmed human cadaver femora were sorted into four groups according to the level of screw insertion along the lateral cortex. Screws inserted at higher positions along the lateral cortex afforded higher rigidity, thus decreasing the amount of motion at the fracture site. In addition, higher insertion positions reduced the rate of permanent displacement, thus better maintaining reduction. Although all specimens failed at the neck, post-failure inspection revealed upward translation of the inferior screw head when inserted 20 mm below the lesser trochanter. Unused drill holes and guidepin holes had no observed affect on stability or failure mode.

Biomechanical Phenomena↗
PubMed1991

[Indications for bipolar prosthesis in femoral neck fractures. A retrospective study of the prognosis in geriatric patients with bipolar prostheses with reference to the preoperative health status].

In Germany the decision to implant a bipolar prosthesis in patients with femoral neck fracture depends mainly on the patient's age and general condition. Taking into account the clinical results to date, however, these criteria alone appear not to be adequate. In our hospital 182 patients were provided with a bipolar prosthesis between January 1986 and February 1989 after traumatic hip fracture. By June 1990, the end of this investigation, 56% had died. In a retrospective study of the 67 surviving patients 25 (6-48) months postoperatively, we found that the results obtained with this bipolar prosthesis were comparable to those seen with total hip endoprostheses according to the Harris hip function score and to radiological findings regarding the frequency of loose stems and protrusion. We also employed a standardized system to evaluate the clinical condition of each patient preoperatively as well as the intra- and postoperative complications. These clinical data were compared with the postoperative survival and the Harris hip score. We found: (1) Good to excellent results in 45% (greater than 80 points), satisfactory results in 52% (51-80 points) and poor results in 3% after a period of up to 48 months. Good to excellent functional results were frequently obtained in healthy older patients. (2) Life expectancy in our group of 182 patients was shorter than in the normal population of the same age. (3) The reduced life expectancy was not attributable to the fracture trauma or the operation but rather to preexisting unrelated causes. In fact the fracture trauma itself often appeared to be a result of the patient's preexisting bad health.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2003

Functional comparison between uncemented Austin-Moore hemiarthroplasty and osteosynthesis with three screws in displaced femoral neck fractures--a matched-pair study of 168 patients.

There is no consensus as to whether osteosynthesis (OS) or hemiarthroplasty (HA) should be used as the primary treatment of displaced femoral-neck fracture. In a prospective matched-pair study, we compared 84 patients treated with OS with three screws and 84 patients treated with uncemented Austin-Moore HA focusing on functional parameters, reoperations and mortality. At 4 months after the fracture, functional recovery was not significantly different between the study groups. However, OS patients tended to have slightly better functional ability than HA patients, as more of them were able to walk out of doors (45.2% versus 39.2%), more were able to walk without walking aids (23.7% versus 16.7%), and more returned to live in their own homes (80%versus 72.9%). OS patients used slightly but not significantly less painkillers and had less hip pain than HA patients. OS patients had had 15.4% more reoperations by 4 months and 14.2% more by 1 year compared to the HA group. The 4-month and 1-year mortality rates of the study groups were of the same order. Functional recovery was slightly better after OS with three screws than after uncemented HA, although no significant differences were seen in a sample of this size. On the other hand, OS was associated with a higher reoperation rate.

Aged↗
PubMedDate not supplied

Peptide YY (PYY) is increased in elderly patients with femoral neck fractures: a prospective cohort study.

BACKGROUND: Peptide YY (PYY), a gut peptide, has recently been shown to inhibit appetite. The role of this peptide in elderly nutritionally-compromised patients with femoral neck fracture (FNF) has not been investigated. In this study, we investigated the longitudinal pattern of PYY levels during hospital stay and investigated the postprandial PYY response to a standard meal in patients with FNF and matched controls. METHODS: Fasting plasma concentrations of the PYY were measured on days 1, 4, 7, 14, 21 and 28 or on discharge from the hospital in 17 white patients with FNF. On the second week of stay, 13 patients with FNF consumed a standard breakfast following an overnight fasting. One fasting sample and one 45-minute postmeal sample were collected. A control group was made up of 17 matched healthy elderly patients. RESULTS: PYY concentrations were increased significantly over the length of hospital stay. Results of the test breakfast suggested a significant and exaggerated post-prandial PYY response, despite a smaller energy intake being consumed. CONCLUSIONS: This study shows PYY concentrations are increased during hospitalization and their post-prandial release exaggerated in this group of vulnerable patients, and suggests a role in the etiology of reduced appetite in this patient group.

Aged, 80 and over↗
PubMedDate not supplied

Energy balance in elderly patients after surgery for a femoral neck fracture.

To study energy and protein balances in elderly patients after surgery, spontaneous energy and protein intake and resting energy expenditure (REE) were measured in 20 elderly female patients with a femoral neck fracture (mean age 81 +/- 4, SD, range 74-87 years; weight 53 +/- 8, range 42-68 kg) during a 5-6 day period following surgery. REE, measured over 20-40 min by indirect calorimetry using a ventilated canopy, averaged 0.98 +/- 0.15 kcal/min on day 3 and decreased to 0.93 +/- 0.15 kcal/min on day 8-9 postsurgery (p less than 0.02). REE was positively correlated with body weight (r = 0.69, p less than 0.005). Mean REE extrapolated to 24 hr (24-REE) was 1283 +/- 194 kcal/day. Mean daily food energy intake measured over the 5-day follow-up period was 1097 +/- 333 kcal/day and was positively correlated with 24-REE (r = 0.50, p less than 0.05). Daily energy balance was -235 +/- 351 kcal/day on day 3 (p less than 0.01 vs zero) and -13 +/- 392 kcal/day on day 8-9 postsurgery (NS vs zero) with a mean over the study period of -185 +/- 289 kcal/day (p less than 0.01 vs zero). When an extra 100 kcal/day was allowed for the energy cost of physical activity, mean daily energy balance over the 5-day study period was calculated to be -285 +/- 289 kcal/day (p less than 0.01 vs zero). Measurements of total 24-hr urinary nitrogen (N) excretion were obtained in a subgroup of 14 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Superselective angiography of the circumflex arteries in preoperative evaluation of femoral neck fractures].

The study of arterial vascularity in the head and neck of the femur is performed as an emergency exploration of femoral neck fractures by means of selective catheterization. The systematization of vascular lesions thus obtained is compared with the anatomical types of fractures. The posteromedial circumflex artery is not injured definitively as a rule, so that conservative osteosynthesis can be preferred to arthroplasty.

Angiography↗
PubMed1998

Cannulated screws for fixation of femoral neck fractures. No difference between Uppsala screws and Richards screws in a randomized prospective study of 268 cases.

We compared 2 types of cannulated hip screws in a randomized prospective study of 268 femoral neck fractures. Complications were defined as penetration of the screw into the joint, early redisplacement, nonunion or segmental collapse. During the first year, complications were noted in 31 of 130 patients treated with 3 Richards screws and in 34 of 138 patients treated with 2 Uppsala screws. Secondary arthroplasty was performed in 17 cases in the Richards group and in 16 cases in the Uppsala group. Clinical outcome did not differ between the groups.

Activities of Daily Living↗