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PubMed1995

[Femoral neck fractures in adults: joint sparing operations. I. Results of an AO collective study with 328 patients].

In a multi-center study in 14 trauma hospitals 328 patients with fractures and osteosyntheses of the femoral neck were investigated with reference to time between accident and operation implants used, early and late complications, and results in the years from 1974 to 1987. A follow-up examination was possible in 266 patients a mean of 46.7 months after their accidents. General postoperative complications were recorded in 12.2% and local complications in 11.6%. In 9.8% pseudarthrosis was observed, in 26% an aseptic femoral head necrosis and in 2.4% deep infections. Functional results were excellent to fair in 75%. The best results (significantly better than in other groups) were obtained in patients who were operated on early (< 24 h after trauma) (P < 0.05) and those in whom dynamic hip screws (DHS) were used (P < 0.01). Of all cases of aseptic necrosis 70% were seen within 3 years and 86% within 6 years after trauma. The rate was dependent on the degree of dislocation of the fracture (Garden III and IV), the time from trauma to operation, and the implant used (130 degrees blade plate 30.5%, DHS 9.2%).

Adolescent↗
PubMed1988

[Complications following osteosynthesis management of femoral neck fractures with spongiosa locking screws].

Osteosynthesis under pressure using two perforating cancellous bone screws in medial and lateral fractures of the neck of the femur and in some cases also in pertrochanteric fractures of the femur has proved successful, in our opinion, in surgery aimed at preserving the head of the femur, as has been confirmed at our hospital by follow-up studies. A striking fact that came to light during follow-up was that there was a higher percentage of incidence of necroses of the femoral head following Pauwels-I-type fractures. However, in our case it was only one necrosis of the head of the femur in a total of five Pauwels-I-type fractures treated by osteosynthesis. A final judgment can surely be passed only by studying a larger number of cases for a longer period of time. We will, therefore, follow up the fractures of the neck of the femur a few years later by re-examination. As a matter of principle, the aim of surgery in osteosynthesis of a medial femoral neck fracture can be attained by means of the cancellous bone screws. A very important aspect which is most essential for successful surgery is the accurate and controlled introduction of the screws via the guide wire. The infection risk is reduced by the small operative approach. In view of the fact that the follow-up examinations revealed more than 72% well-healed fractures of the neck of the femur, we do not think it necessary to effect any changes in our surgical procedure at the present time.

Bone Screws↗
PubMedDate not supplied

Osteoporosis of the spine, pelvis and hand. A comparative study in a femoral neck fracture series.

In a comparative study of the degree and prevalence of osteoporosis in the hand, pelvis and spine of a group of femoral neck fractures in the elderly, it was noted that spinal osteoporosis was much more frequent and appeared much earlier than pelvic osteoporosis. Similarly, a one way correlation existed between osteoporosis of the hand and spine. No relationship was noted between osteoporosis of the pelvis as measured by our criteria and by the Singh technique.

Adult↗
PubMed1997

Decrease in bone mineral density and muscle mass after femoral neck fracture. A quantitative computed tomography study in 25 patients.

We performed a prospective, longitudinal, quantitative computed tomography (QCT) study of bone mineral density (BMD), cortical bone volume, bone mass and muscle volume in 25 patients who were operated on with osteosynthesis because of a displaced femoral neck fracture. Both legs were scanned within 3 days after the fracture, and 3 and 6 months after the operation. The measurements were performed by a computer tomograph equipped for bone mineral densitometry. We found some side differences among the patients at the time of fracture, but none of the differences was statistically significant. After 6 months, we found reductions in BMD in the distal femur and proximal tibia on the fractured side of 11% and 19%, respectively, as well as a reduction in BMD of 7% in the proximal tibia on the uninjured side. We found no changes in cortical bone mass, either on the fractured femur or on the uninjured femur. The muscles of the thigh showed a loss of 9% on the fractured side, but a gain of 12% on the uninjured side. The findings of a bone loss in the distal femur and proximal tibia of the fractured leg and in the proximal tibia of the healthy leg, but no cortical bone loss in the middle femur on any side 6 months after the fracture, indicate that the cancellous bone is more sensitive to osteopenia. Moreover, this bone loss is interpreted as mainly a posttraumatic effect, since we also found a decrease in bone mineral on the uninjured side, despite a gain in muscle volume on that side, an overuse which was not sufficient to counteract the posttraumatic effect on the bone of the uninjured side.

Bone Density↗