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PubMed1994

[Femoral neck fractures: position of the implant, unrecognized articular penetration and its consequences].

INTRODUCTION: Only two dimensions of a three dimensional object are visible on plain roentgenograms. Therefore, on gross inspection of antero-posterior and lateral roentgenograms, a screw may project as being safely within the head of the femur even though penetration has occurred. This region may be referred to as a "blind zone". MATERIAL AND METHODS: Unrecognized screw penetration into the hip joint during internal fixation of femoral neck fractures was researched on intra operative roentgenograms of 30 patients. Unrecognized pin penetration through the posterior part of the neck was also analyzed on the same X Rays. RESULTS: Unrecognized screw penetration into the hip joint was observed in 20 per cent and penetration at the posterior part of the neck was observed in 10 per cent of cases. DISCUSSION: Several methods of determining screw position are described and discussed in this study.

Bone Nails↗

PubMed1982

Humeral cortical thickness in female Bantu--its relationship to the incidence of femoral neck fracture.

Measurements of the humeral cortical thickness demonstrate that generalised osteoporosis in female Bantu commences in the fifth decade and gradually increases until, in the ninth decade, all subjects are osteoporotic. The combined cortical thickness (CCT) of the humerus in young adults is very similar to that found previously in a white London population and the loss of cortex with age is very similar. It is concluded that the known low incidence of femoral neck fracture in Bantu is not due to a lower incidence of generalised osteoporosis but to environmental factors. The chief environmental factor postulated is the greater amount of physical work performed by the Bantu. A more careful mode of walking is suggested as a subsidiary cause.

Adolescent↗

PubMed1987

Stability of fixation in femoral neck fractures. Comparison of four fixation devices in vivo and in cadavers.

On human cadaveric femora, internal fixation of cervical osteotomies was performed with four different devices. With the use of a lever, a static force was applied through the acetabulum to the osteotomy site. Motion at the osteotomy site was measured by two strain gauges. The compression force necessary to inhibit motion at the osteotomy site during the fixation procedure was measured. This force was lower with a hook pin than with the other devices. During surgery in 12 patients with displaced femoral neck fractures, the forces holding the fracture surfaces together were measured with a dynamometer. The force at which widening of the fracture gap was observed by fluoroscopy was recorded. In seven fractures, the mean compression force was 110 (60-170) N. The remaining five fractures did not open up when pressures of up to 200 N were applied. These forces were always greater than the hook pin forces measured in the cadaver experiments, but often less than the forces obtained with the other devices.

Aged↗

PubMed1992

Management of childhood femoral neck fractures.

Forty-three children with displaced transcervical femoral fractures were reviewed at a mean follow-up of 7.2 years and results were assessed using Ratliff's criteria. Of 22 patients treated by internal fixation alone, 10 had good, 6 had fair and 6 had poor results. The results in 21 children treated by internal fixation along with primary transverse intertrochanteric undisplaced osteotomy were: 14 good, 5 fair and 2 poor, but none improved to a statistically significant level (P = 0.139). However, the osteotomy improved the fracture union significantly and no delayed union or non-union was noted in this group (P = 0.05). There were no complications related to the osteotomy itself.

Adolescent↗

PubMed2000

The Charnley-Hastings bipolar prosthesis in femoral neck fractures - a study of dynamic motion.

Fourteen patients who had a Charnley-Hastings bipolar prosthesis inserted for a fracture of the neck of the femur underwent a fluoroscopic assessment of the prosthesis while walking on a treadmill at an average of 24 months (range 8-48 months) post-insertion. This motion was compared with static weight-bearing and non-weight-bearing motion. The area of interest was the motion at the interprosthetic junction. Previous studies of this and similar prostheses had suggested that interprosthetic motion lessened with time, as the inner bearing stiffened up. However, in this study it was found that although the interprosthetic motion during non-weight-bearing abduction was in the region of 20-30% of total abduction, the interprosthetic motion during flexion and extension in gait accounted for 70-80% of motion. We suggest this can be explained by considering the biomechanical effect of sliding friction at the metal-acetabular bone junction during weight-bearing gait, as well as the impingement of the neck on the prosthetic socket during extremes of movement. The reported superior long term results of the bipolar prosthesis over its unipolar counterparts in femoral neck fracture treatment can be explained by the delayed acetabular wear due to reduced motion, and shear forces, at the prosthetic-bone interface.

Aged↗

PubMed1974