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PubMed1980

Mortality patterns following internal fixation for acute femoral neck fractures in the elderly with special emphasis on potential excess mortality following reoperations.

Mortality patterns and excess mortality have been studied and quantified in 103 patients treated with internal fixation for acute, displaced femoral neck fractures with special emphasis on the potential excess mortality which may follow later operations for capital necrosis, failure of the osteosynthesis, etc. Of 103 patients studied 31 needed one or more reoperations. We have confirmed previously published reports that excess mortality is limited to the first six months after the primary operation. Quantification of the excess mortality which may follow reoperations shows that later operations are not followed by an increased death rate compared with the standard population.

Aged↗
PubMed1991

A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures.

The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay.

Aged↗
PubMed1999

An evaluation of bone loss after total hip arthroplasty for femoral head necrosis after femoral neck fracture: a quantitative CT study in 16 patients.

This study was conducted to determine if bone and muscle loss is reversible in patients who had undergone total hip arthroplasty (THA) owing to necrosis of the femoral head after osteosynthesis for a displaced femoral neck fracture. The cortical bone mineral density (BMD), bone volume, bone mass, and muscle volume of the thigh and the BMD of the distal femur and proximal tibia were measured by quantitative computed tomography in 16 patients. Both extremities were measured just before reoperation. The measurements were repeated 3 and 6 months later. At reoperation, there was a mean 12% relative loss of bone mass and 23% loss of muscle volume in the middle femur on the fractured side compared with the uninjured side. In the distal femur and proximal tibia, there was a relative loss of BMD of 14% and 21% on the fractured side. Six months after reoperation, we found no change in bone mineral at any location on either side. The muscle of the thigh showed a gain in volume of 20% on the reoperated side but no change on the uninjured side. At the time of reoperation, we noted a marked bone and muscle loss on the fractured side. We failed to note any restoration of bone mineral after THA despite remobilization, which is expressed as an increase in muscle volume on the reoperated side. This study indicates that osteopenic bone has difficulties in adapting to patients' improved mobility after reoperation.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Clinical profile of delirium in patients treated for femoral neck fractures.

The incidence of delirium, its predisposing factors, clinical profile, associated symptoms and consequences were investigated in 54 consecutive patients, 19 men and 35 women, mean age 77.1 years, admitted to an 'ortho-geriatric unit' with femoral neck fractures. The incidence of postoperative delirium was 15/54 (27.8%) and a logistic regression model found that dementia and a prolonged waiting time for the operation increased the risk of postoperative delirium. Delirium during the night was most common but in 5 patients the delirium was worst in the morning. Patients with delirium suffered more anxiety, depressed mood, emotionalism, delusions and hallucinations. A larger proportion of patients with delirium could not return to their previous dwelling, and a larger proportion of delirious patients were either dead, wheelchair-bound or bedridden at the 6-month follow-up (p < 0.005). The conclusion is that delirium is common and has a serious impact on the outcome after hip fracture surgery.

Activities of Daily Living↗
PubMed2002

Allele frequency of the G-->T mutation of the col1A1 gene analyzed by an ARMS-PCR in osteoporotic subjects with femoral neck fractures.

The allele frequency of the G-->T mutation of COL1A1 gene (collagen type I alpha 1 gene, GenBank accession n. AF017178) was analyzed by a newARMS-PCR method in 240 osteoporotic subjects bearing a femoral neck fracture. The method is based on the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Normal and mutated alleles were detected by two PCRs, in which a common forward primer (positions 1307 to 1336 of the gene) and two reverse primers (positions 1566 to 1546), differing in the 3'-base (3'-C for the normal Sallele and 3'-A for the mutated sallele) are used. In the SS condition, amplification occurs only in one of the two PCRs, and in the ss condition only in the other. In the Ss condition both reactions give a product. This ARMS-PCR method avoids the use of any restriction enzyme, as described by Grant and colleagues in a previously published method based on a mismatched reverse primer which introduced a restriction site in the T-substituted (s) allele and in a method recently proposed by Vinkanharju and co-workers. In a survey for COL1A1 polymorphism in 240 osteoporotic subjects with femur fractures, here presented, a frequency of 80.6% was found for the G allele and 19.4% for the T allele. There were 66.7% dominant SS subjects, 27.9% Ss heterozygotes and 5.4% ss recessive homozygotes.

Base Sequence↗
PubMed1978

Effect of ozone variation on disease in Great Britain: II. Femoral neck fracture.

During the period 1951-72 ozone variation had produced about a 20% decrease in UV radiation at the wavelengths necessary for the production of vitamin D3 in the human skin. Study of the mortality associated with femoral neck fracture, a symptom now linked to vitamin D deficiency disease, shows similar trends, but of opposite sign, to the trends of skin cancer incidence and mortality over the same period.

Femoral Neck Fractures↗
PubMedDate not supplied

Comparative blood chemical data related to aging, femoral neck fracture and hip osteoarthrosis.

Fifteen blood parameters were studied in 73 men and 97 women divided into four groups: 66 blood donors; 36 aged subjects with various cerebral, cardiovascular or infectious illnesses; 43 patients with femoral neck fracture; 25 patients with severe hip osteoarthrosis. The parameters measured were: serum total proteins, albumin, total, alpha 1, alpha 2, beta and gamma globulins, total calcium, phosphates, alkaline phosphatase, creatinine, bilirubin, hemoglobin, 25 OHD3 and 1.25(OH)2D3. Each group differed significantly from the others, with regard to age and also to pathological conditions. Among the more discriminant variables, albumin was retained as the main parameter reflecting the nutritional status related to skeleton quality. Significantly higher albumin values were found for the hip osteoarthrosis patients (i.e., in a condition associated with well known bone solidity).

Adult↗
PubMed2006

Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons.

A survey was distributed to the American Association of Hip and Knee Surgeons (AAHKS) membership to evaluate surgical treatment preferences for displaced femoral neck fractures (DFNFXs). Of 718 members, 381 (54%) responded to the 16-question survey that was an adjunct to a multicenter, randomized study (funded by AAHKS/OREF) designed to prospectively evaluate efficacy of hemiarthroplasty vs total hip for treatment of DFNFXs. Hemiarthroplasty (85%) was the most preferred treatment option for DFNFXs (reduction with internal fixation 2%, total hip arthroplasty 13%). Prefracture hip pain/osteoarthritis, poor bone quality, and fracture comminution were the main reasons why arthroplasty was chosen over reduction with internal fixation. Ambulatory status and dislocation risk after arthroplasty were the main factors in choosing between unipolar (48%) and bipolar (52%) hemiarthroplasty. Total hip arthroplasty is used by 88% of responders. Dislocation risk and ambulatory status were influential factors against performing total hip arthroplasty. Arthroplasty is the preferred method of surgical intervention for the treatment of DFNFXs for AAHKS members.

Aged↗
PubMed1990

[Pedicle bone grafting in treatment of bone union disorders after femoral neck fracture].

Clinical and radiological assessment of 8 patients operated because of femoral neck pseudoarthrosis or delayed union proved the pedicle bone grafting to be very useful method, especially in young patients. Surgical reconstruction of femoral neck with the use of pedicular graft (Judet--Chacha) resulted in all the patients in absence of pain; satisfactory range of movement has been restored in operated hip. Bone union has been achieved in 7 from the 8 operated patients that is in all the cases of posttraumatic union disorders. However, we failed in total reconstruction of anatomy and the radiographs revealed osteoarthritis of the joint.

Adult↗
PubMed1989

[Impacted femoral neck fractures].

During a period of ten years, from 1975 to 1985, 123 impacted neck fractures were treated at our hospital. In eleven patients (about 10%) secondary dislocation occurred making operative intervention necessary. In this study we wanted to find criteria predicting the stability of the so-called impacted femoral neck fractures.

Aged↗
PubMed1994

Functional recovery after operative treatment of femoral neck fractures in an institutionalized elderly population.

Agreement that hip fracture is best treated surgically stems from the fact that early mobilization of the patient reduces morbidity and mortality. This concept was tested in 54 elderly, institutionalized patients with femoral neck fractures who were operatively treated. The patients were reviewed within 12 months after being injured. Their average age was 81.2 years, and 94% of the patients were women. Seventy-five percent of the study population had neurological disease or heart disease and were thus limited in their motivation or ability to participate in a rehabilitation program. Only 16.7% of the patients regained their overall functional ability and only 12.9% returned to their pre-injury, ambulatory status. The therapeutic concept should be reviewed and the conservative approach be given serious consideration.

Activities of Daily Living↗
PubMed1990

[Alpha 2-plasmin inhibitor plasmin complex in patients undergone surgery in femoral neck fracture].

The alpha 2-plasmin inhibitor-plasmin complex (alpha 2-PI-PM), alpha 2-plasmin inhibitor (alpha 2-PI) and some functions of coagulation and hemostasis were assayed on aged patients who were operated for femoral neck fracture. After the surgery, APTT, PT, fibrinogen, AT-III and platelet counts were in normal range or slightly deviated, which did not match with the DIC diagnostic standard. FDP levels in the operation group (337 +/- 303 ng/ml) were significantly increased compared to the level of the normal aged persons (64 +/- 9.9 ng/ml). The alpha 2-PI-PM in the operation group was 2.92 +/- 3.56 micrograms/ml, which was significantly higher than the alpha 2-PI-PM level (0.76 +/- 0.45 micrograms/ml) in the normal aged persons. Moreover, 3 in 7 operation cases, showed the increase of alpha 2-PI-PM levels over 5 micrograms/ml. The alpha 2-PI-PM in DIC group was 5.29 +/- 5.17 micrograms/ml. These data suggest that the patients are in the pre DIC state after surgery. In titers of FDP and alpha 2-PI, there were no differences between patients treated with and without heparin. alpha 2-PI-PM levels were improved in 5 out of 7 cases with the heparin treatment. On the other hand only one in 6 cases who did not receive heparin therapy showed the improvement of alpha 2-PI-PM level. In some cases without heparin treatment, the alpha 2-PI-PM level increased in the course of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Surgical treatment of undisplaced femoral neck fractures in the elderly.

The study was a retrospective evaluation and comparison. Eighty-four elderly patients (> 60 years) with undisplaced intracapsular femoral neck fractures were treated with osteosynthesis with either dynamic hip screws (DHS) or multiple cannulated screws (MCS). The Singh index was used to evaluate bone quality. All patients were followed up retrospectively for at least 12 months. The clinical results were compared between the DHS and MCS groups. Both groups were similar in respect of injury mechanisms, mean Singh index, injury-surgery interval, gender and age (all p values > or = 0.29). The MCS group had significantly smaller wound incisions, less haemoglobin level drops, lower blood transfusion rates and shorter hospital stays than the DHS group (all p values < or = 0.008). However, the DHS group had a higher rate of overall success when compared to the MCS group (97.5% versus 84.1%, p=0.04). In conclusion, although DHS fixation requires a larger skin incision and more soft tissue dissection, its use in elderly patients with osteoporosis is recommended due to simple, efficacy and high overall success rate.

Aged↗
PubMed2006

Responsiveness of the EuroQol (EQ-5D) and the Nottingham Health Profile (NHP) in elderly patients with femoral neck fractures.

INTRODUCTION: The objective of this study was to evaluate the internal and external responsiveness of the EuroQol (EQ-5D) and the Nottingham Health Profile (NHP) and to evaluate the overlap of change scores from the two instruments. METHODS: Sixty patients with femoral neck fractures treated with internal fixation at a university hospital participated. Internal responsiveness was assessed using a paired t-test and the standardised response mean (SRM) for patients with displaced fractures hypothesised to deteriorate between baseline and the 6-month follow-up. In the analyses of external responsiveness, receiver operator characteristics (ROC) and logistic regression were employed to assess the correspondence between the chosen external criterion (EC) defining fracture displacement, i.e. displaced vs. undisplaced fractures, and the change scores from the EQ-5D and the NHP. The overlap in change scores for the overall scores and comparable subdimensions of the two instruments was evaluated by correlational analyses. RESULTS: The SRM were large and the change in HRQoL over time was statistically significant for both instruments in patients with displaced fractures. A correspondence was found between the EC and change scores for both questionnaires. The correlation coefficients between the change scores for the overall scores and comparable subdimensions of the two instruments ranged from relatively small to moderate. CONCLUSIONS: The results yielded support for the internal and external responsiveness of the EQ-5D and the NHP and indicated an advantage for the EQ-5D. The empirical overlap between change scores from the two instruments was limited.

Aged↗