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PubMed2002

Conversion of failed hip hemiarthroplasties after femoral neck fractures.

Hemiarthroplasty has been the preferred treatment for fractures of the femoral neck in elderly patients. The objective of the current study was to assess the outcome of revision of failed hemiarthroplasty to total hip arthroplasty in patients with a primary diagnosis of a femoral neck fracture. One hundred thirty-two conversions were done in 108 women and 24 men. One hundred two cemented and 30 uncemented hemiprostheses were revised to 88 cemented, 17 uncemented, and 27 hybrid total hip arthroplasties and the patients were followed up an average of 7.1 years (range, 5.1-15.3 years). Nine hips (6.8%) were revised for loosening and four additional hips (3%) were loose at the last followup. Survivorship free of revision was 96.5% (95% confidence interval, 93%-100%) at 5 years and 92% (95% confidence interval, 86%-98%) at 10 years. Major perioperative complications occurred frequently (45%), including 12 intraoperative femoral fractures (9%) and 13 dislocations (9.8%) Three of 12 (25%) of the intraoperative femoral fractures developed later femoral component loosening and all occurred during conversion of an uncemented Austin-Moore type hemiprosthesis. Conversion of endoprostheses to total hip arthroplasties after femoral neck fractures is fraught with high complication and loosening rates. Careful patient selection for each type of arthroplasty (hemiarthroplasty versus total hip arthroplasty) may help ameliorate the outcome of arthroplasty for patients with femoral neck fractures.

Age Factors↗
PubMed2002

Outcomes of elderly patients with nondisplaced femoral neck fractures.

Seventy patients with nondisplaced femoral neck fractures treated by cannulated screw fixation were followed up prospectively for 6 months. Preinjury Functional Independence Measure scores and comorbidities were recorded as were operative time, type of anesthesia, estimated blood loss, transfusions, and postoperative complications. Functional Independence Measure scores were reassessed at 3 and 6 months. The mean age of the patients was 78 years. The 6-month mortality was 5.7%. The mean overall Functional Independence Measure scores at 3 and 6 months were 86% and 89% of the initial score respectively. Locomotion Functional Independence Measure scores at 3 and 6 months were 73% and 89% of the initial score, respectively. Multiple regression analysis found patient age and initial overall Functional Independence Measure score to be independent predictors of overall, locomotion, and transfer Functional Independence Measure scores at 3 months. At 6 months, only initial Functional Independence Measure score predicted ultimate Functional Independence Measure scores. This suggests that patient age may affect the speed of recovery but not the ultimate functional result. Of comorbidities, only chronic obstructive pulmonary disease significantly affected functional recovery at 3 months, but not at 6 months. Operative time, estimated blood loss, type of anesthesia, and patient gender did not affect functional outcomes. Patients who sustain a nondisplaced femoral neck fracture experience predictable and lasting loss of function. Low initial functional status predicts a poorer outcome. Age and pulmonary comorbidity affect speed of recovery.

Activities of Daily Living↗
PubMed1989

[Significance of the fracture type for treatment of femoral neck fractures].

The authors report on the results obtained with surgical treatment of 470 femoral neck fractures, which they analyzed with reference to the type of break. The found that a fracture line with a zig-zag course signified the best prognosis for both healing and stability, whereas fractures with a posterior fragment had a poorer prognosis. The results support the urgency of the operation and confirm the higher proportion of cases treated for jagged fractures among those with good results.

Aged↗
PubMed1994

An algorithm for assessment of fracture displacement and pin positions in femoral neck fractures.

A method for determination of both the displacement of the femoral head and the position of the fixation device in fixed femoral neck fractures is described. In routine AP and lateral radiographs of the hip, measurements are made of femoral neck-shaft angle, the diameter of the femoral head and neck, the distances from the center of the femoral head to the femoral neck axis and the distances from the femoral neck axis to the fixating screws. From these values the position of the femoral head and the fixating screws are determined by geometric calculations. A computer program in Q-BASIC was devised to perform the calculations and to produce graphic displays of cross-sections of the femoral head and neck, with the displacement of the head and the screw positions indicated. The accuracy of the method was evaluated by a new method using axial radiographs of hip specimens, which were compared with the computer-plotted graphs of the femoral head and neck. The mean error of the method was found to be +/- 5% of the femoral head diameter, approximately 2.5 mm.

Aged↗
PubMed1978

Femoral neck fractures in osteoarthritis of the hip.

Femoral neck fractures seldom occur in hips with a significant degree of osteoarthritis. Experience with three hitherto undescribed fractures around hip nails suggests that the ridge of new bone which forms on the inferior part of the femoral neck in osteoarthritis increases the strength of the neck, thus decreasing the tendency to neck fractures.

Aged↗
PubMed2001

Dynamic magnetic resonance imaging of femoral head perfusion in femoral neck fracture.

A prospective followup study of 36 femoral neck fractures according to the assessment of femoral head perfusion using dynamic magnetic resonance imaging is reported. Patients were divided into three groups based on the dynamic magnetic resonance imaging findings (dynamic curve pattern and relative enhancement ratio) that were conducted within 48 hours of the injury. Traction was used to achieve anatomic reduction and to prevent additional damage to vascularity until minimally invasive internal fixation could be done. The fractures of all 17 patients whose femoral head perfusion was normal (Type A; n = 11) or was impaired but not totally absent (Type B; n = 6) healed without complications. Among the 19 patients whose femoral head perfusion was absent (Type C), 15 had complications (osteonecrosis, n = 10; nonunion, n = 5). Assuming that fractures with a Type A or Type B curve pattern would unite successfully and that those with a Type C curve pattern would not, the sensitivity, specificity, and accuracy of the predictions of successful osteosynthesis of the femoral neck fractures using this method were 81%, 100%, and 89%, respectively. The current classification of femoral neck fractures using dynamic magnetic resonance imaging may be useful in selecting an appropriate treatment method for the fractures.

Adult↗
PubMed1988

Displacement in femoral neck fractures. A numerical analysis of 200 fractures.

We measured the proximal-distal and anterior-posterior displacement of the femoral head in 200 femoral neck fractures. The numerical data were compared with the Garden classification. The average displacement of the Stages I and II fractures were almost equal. Moreover, the displacement of the Stage III fractures did not differ from the displacement of the Stage IV fractures. The Garden Stages I and II fractures displayed a more posterior position of the femoral head than did the normal hips. The femoral heads of Stages III and IV were situated more posterodistally than those of the Stages I and II fractures. Classification of femoral neck fractures into two groups without (Stages I and II) and with (Stages III and IV) proximal displacement is probably sufficient for clinical use.

Aged↗
PubMed2004

[Orthopedic reduction and percutaneous fixation of femoral neck fractures in children].

Fracture of the femoral neck is a rare injury in children but remains difficult problem and challenge with high rate of complications. Having in mind recommendations of the American Academy of Orthopaedic Surgeons, our effort was to improve treatment approach. In the period 1999 to 2004, five patients, aged 5 to 14 years, were treated by closed reduction and percutaneous pinning. All patients sustained high energy trauma and displaced femoral neck fractures, out of which two were transcervical, two cervicotrochanteric and one intertrochanteric. Procedures were performed under image amplifier. Hip decompression was achieved by needle aspiration via a subadductor approach. Three smooth Kirschner wires appeared to be stable and least aggressive fixation device, easy for applying and subsequent removal. We insisted on urgent treatment, anatomic alignment, stabile fixation and hip decompression. Excellent results were obtained in four patients who had undergone immediate treatment. Poor outcome with vascular necrosis in a five-year-old girl was attributed to five-day treatment delay. Suggested treatment, simple and applicable in practice, is aimed at reducing pathologic mechanisms crucial for development of complications.

Adolescent↗
PubMed2003

Nonunion of femoral neck fracture and trochanteric osteotomy after a pinned, slipped capital femoral epiphysis: a case report.

Femoral neck fracture as a complication of slipped capital femoral epiphysis (SCFE) is rare. Even rarer is a femoral neck nonunion as an additional complication. This is the first case reported in the literature of a failed valgus osteotomy for a femoral neck nonunion. A salvage operation involving a step-cut valgus/flexion/internal rotation osteotomy, open reduction and internal fixation, with a blade plate and cannulated screw, placement of an allograft femoral strut, and allograft bone grafting was successfully performed. Femoral neck fractures following SCFE fixation are more difficult to treat because of abnormal femoral neck configuration. Therefore a valgus, flexion, and internal rotation producing osteotomy may need to be initially performed to prevent a femoral neck nonunion.

Adolescent↗
PubMed2004

Non-union of femoral neck fractures with osteonecrosis of the femoral head: treatment with combined free vascularized fibular grafting and subtrochanteric valgus osteotomy.

Femoral neck fractures, frequently complicated by non-union and femoral head osteonecrosis,present a difficult clinical situation, especially when young patients are concerned. Existing treatment options are valgus osteotomy to address the biomechanical factors or bone grafting to address the biologic factor. The authors describe the operative technique and results of combined subtrochanteric valgus osteotomy and free vascularized fibular grafting in management of five young patients with both non-union and avascular necrosis.

Adolescent↗
PubMed1975

Treatment for fixation complications: Femoral neck fractures.

Of 102 hips with femoral neck fracture complications, 75 required major secondary procedures such as total hip replacement, femoral prosthesis, cup arthroplasty, tibial bone grafting, and head and neck resection. The method chosen depended on the specific problem: nonunion, aseptic necrosis, infection, degenerative arthritis, or a failed primary prosthesis. Other factors influencing treatment were the patient's chronological and physiological age, his general health, his life pattern, and the familiarity of the surgeon with the technique and the advantages and disadvantages of the various salvage procedures.

Adult↗
PubMed1990

Cemented arthroprosthesis in femoral neck fractures.

Primary total hip replacement in femoral neck fractures is still controversial. This report presents the findings of a study of 42 femoral neck fractures treated with cemented arthroprosthesis with an average follow-up of five years. The patients were divided into two groups according to the type of prosthesis, the reaming and cementing techniques, and the type of operating room. Each group had positive results in about 80% of the cases, testifying to the fact that arthroprosthesis is a valid method of treatment provided that the following procedures are scrupulously carried out: the preparation of the patient, the choice and implantation of the prosthesis, and the functional and psychological rehabilitation of the patient.

Aged↗
PubMed1991

[Cervico-acetabular impingement after femoral neck fracture].

Six cases of femoral neck-acetabular impingement following fracture of the femoral neck are reported. To our knowledge, this complication has not previously been described in the literature. A bony prominence at the level of the former fracture site following primary or secondary valgus position of the femoral head showed a conflict with the acetabular rim causing pain and limited motion. In four patients this impingement was posterior, between the femoral neck and the acetabulum in extension with external rotation, and in two patients it was anterior in flexion with internal rotation. A detailed description of the symptoms, diagnostic procedures and treatment options is presented.

Acetabulum↗
PubMed1997

Femoral neck fracture fixation. Clinical decision making.

Femoral neck fractures continue to pose significant decision making problems for the busy practitioner. Indirect factors over which the orthopaedic surgeon has little control include the patient's preinjury medical status, metabolic bone quality, and fracture classification. Direct factors that fall on the decision making ability of the surgeon include surgical timing, capsular hematoma, quality of reduction, and mechanics of fixation. Early, rigid anatomic reduction with 6.5-mm compression screws in patients with few comorbidities will achieve the optimum outcomes using fixation techniques. Anterolateral open approaches afford capsular hematoma decompression and anatomic access for fixation in the young or irreducible fracture pattern.

Bone Density↗
PubMed2002

Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women.

Some proximal femur geometry (PFG) parameters, measured by dual-energy X-ray absorptiometry (DXA), have been reported to discriminate subjects with hip fracture. Relatively few studies have tested their ability to discriminate femoral neck fractures from those of the trochanter. To this end we performed a cross-sectional study in a population of 547 menopausal women over 69 years of age with femoral neck fractures (n = 88), trochanteric fractures (n = 93) or controls (n = 366). Hip axis length (HAL), neck-shaft angle (NSA), femoral neck diameter (FND) and femoral shaft diameter (FSD) were measured by DXA, as well as the bone mineral density (BMD) of the nonfractured hip at the femoral neck, trochanter and Ward's triangle. In fractured subjects, BMD was lower at each measurement site. HAL was longer and NSA wider in those with femoral neck fractures. With logistic regression the age-adjusted odds ratio (OR) for a 1 standard deviation (SD) decrease in BMD was significantly associated at each measurement site with femoral neck fracture (femoral neck BMD: OR 1.9, 95% confidence interval (95% CI): 1.4-2.5; trochanter BMD: OR 1.6, 95% CI 1.2-2.0; Ward's triangle BMD: OR 1.7, 95% CI 1.3-2.2) and trochanteric fracture (femoral neck BMD: OR 2.6, 95% CI 1.9-3.6; trochanter BMD: OR 3.0, 95% CI 2.2-4.1; Ward's triangle BMD: OR 1.8, 95% CI 1.4-2.3). Age-adjusted OR for 1 SD increases in NSA (OR 2.2, 95% CI 1.7-2.8) and HAL (OR 1.3, 95% CI 1.1-1.6) was significantly associated with the fracture risk only for femoral neck fracture. In the best predictive model the strongest predictors were site-matched BMD for both fracture types and NSA for neck fracture. Trochanteric BMD had the greatest area (0.78, standard error (SE) 0.02) under the receiver operating characteristic curve in trochanteric fractures, whereas for NSA (0.72, SE 0.03) this area was greatest in femoral neck fractures. These results confirm the association of BMD with proximal femur fracture and support the evidence that PFG plays a significant role only in neck fracture prediction, since NSA is the best predictive parameter among those tested.

Absorptiometry, Photon↗
PubMed2000

Occult hypoxia after femoral neck fracture and elective hip surgery.

The incidence of hypoxia after femoral neck and total hip arthroplasty was investigated. In addition, the incidence of preoperative and postoperative delirium was assessed. Oxygen saturation and mental status were tested before and after surgery in patients undergoing surgery for a femoral neck fracture or total hip arthroplasty. Hypoxia was present before surgery in five of 50 patients who underwent total hip replacement and 17 of 50 patients with femoral neck fractures. On Day 1 after surgery, 20 patients who underwent total hip replacement and 36 with femoral neck fractures had hypoxia; on Day 3 after surgery, 12 patients who underwent total hip replacement and 17 with femoral neck fractures had hypoxia. Respiratory recovery was quicker in patients after total hip replacement with 39 who recovered by Day 3 after surgery, compared with 31 patients with femoral neck fractures. Preoperatively, patients with femoral neck fracture had significantly lower mental test scores than did patients who had undergone total hip replacement, and this continued on Day 1 after surgery. However, by Day 3 after surgery, there was no significant difference between the groups. Although the scores for the patients with femoral neck fractures were lower, delirium developed in only three patients with total hip replacements and six patients with femoral neck fracture. Hypoxia after hip surgery, particularly after femoral neck fracture, is common. The incidence of delirium was much lower than reported previously, and it is suggested that supplemental oxygen, when indicated and monitored by pulse oximetry, was the cause for the reduction in delirium.

Aged↗