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PubMed2006

Undisplaced femoral neck fractures in children have a high risk of secondary displacement.

Femoral neck fractures in children are rare and known to have a high complication rate (e.g. femoral head necrosis, persistent deformities, and pseudarthrosis). While open reduction and internal fixation is the treatment of choice for displaced fractures, non-operative treatment methods have been proposed if the fracture is undisplaced. Three consecutive patients aged 11, 14 and 16 years with undisplaced femoral neck fractures were seen at our institutions and primarily treated with the recommendation of non-weightbearing and minimal flexion until consolidation. All three cases showed secondary displacement within the first 6 weeks. A second minor indirect trauma caused displacement in one case; in the other two cases, no further trauma had occurred. All three fractures healed uneventfully following reduction and osteosynthesis. Undisplaced femoral neck fractures treated non-operatively evidently bear the risk of secondary displacement. The observations in these patients suggest that primary internal stabilization, even of undisplaced femoral neck fractures in children, should be considered.

Adolescent↗
PubMed1995

[Femoral neck and iliac bone histomorphometry in femoral neck fracture].

Involutional osteoporosis is a risk factor for femoral neck fracture in elderly people. This study was designed to evaluate the bone mass and quality of the femoral neck specimen obtained directly from the femoral neck at the time of hip surgery. An iliac bone biopsy was also performed in some cases. A histomorphometric analysis of the femoral neck was performed in 31 women with a femoral neck fracture, aged 64-104 (mean age 76.2), and in 19 women with osteoarthritis of the hip, aged 50-77 (mean age 64.3) as a control. The cortical thickness of the lateral, anterior and posterior aspects of the femoral neck was significantly less in the fracture group than in the osteoarthritis group. However, there was no significant difference in the medial cortical thickness between the two groups. The fracture group exhibited an increased resorption cavity area and intracortical porosity in the cortical area as well as increases in the eroded surface and osteoclast number in the endocortical envelope. The bone volume in the cancellous envelope of the medial femoral neck was significantly lower in the fracture group. Most parameters of the iliac bone were not correlated with those of the femoral neck in either group. Our findings suggested that a femoral neck fracture was associated with a decreased cortical thickness in the femoral neck. Increased intracortical porosity and a low cancellous bone volume were also critical factors in femoral neck fragility, and an iliac bone biopsy did not necessarily reflect the femoral neck bone status.

Aged↗
PubMed2000

[Femoral neck fracture. Osteosynthesis or which endoprosthesis is indicated?].

Femoral neck fractures are frequent fractures of the elderly. They can be treated by the use of dynamic hip screws, lag screws, bipolar hemi-protheses or total hip replacement. The results are markedly influenced by the timing of the operation and the choice of the implant. Using the Garden classification of femoral neck fracture we demonstrate a different therapeutic approach according to Garden stadium I-IV.

Aged↗
PubMedDate not supplied

Intracapsular pressure and hemarthrosis following femoral neck fracture.

The possibility that intracapsular hemorrhage after femoral neck fracture may contribute to avascular necrosis remains controversial. The intracapsular pressure and the amount of blood aspirated from 12 hip joints with acute femoral neck fractures were measured. The total volume aspirated never exceeded 5 cm3 of blood. The intracapsular pressure varied from 0 to 68 mm Hg (average, 28 mm Hg). These findings suggest that preoperative aspiration of the joint is unlikely to influence the vascularity of the femoral head since the volume of the hemarthrosis is small and the measured pressure in the capsule is well below the diastolic blood pressure level.

Femoral Neck Fractures↗
PubMed1997

Biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures.

OBJECTIVES: The optimal method of internal fixation of basicervical femoral neck fractures is controversial. This area represents a transition zone between the intracapsular femoral neck fracture, usually fixed with multiple cancellous screws, and the extracapsular interochanteric fracture, fixed with a sliding screw device [sliding hip screw (SHS)] and derotation screw (DRS) device. The authors' specific aim was to biomechanically compare these two methods of fixation in a cadaveric model of a basicervical femoral neck fracture with posteromedial comminution. DESIGN: The authors compared the average peak force during cyclic loading and the maximum axial force sustained by matched pairs of specimens stabilized with either fixation and subjected to axial and torsional loading while flexing and extending the hip. The average peak force was defined as the mean of the peak force values measured in each loading cycle with the maximum displacement of the materials tester actuator the same for each cycle (displacement control) as opposed to the maximum force being held constant (load control). RESULTS: The cancellous screw group maintained a significantly lower average peak force, 470 Newtons (SD = 145 Newtons), compared with 868 Newtons (SD = 186 Newtons) for the SHS and DRS composite group (p < 0.01). Similarly, the cancellous screw group demonstrated a lower ultimate load to failure, 1,863 Newtons (SD = 475 Newtons) compared with 3,557 Newtons (SD = 215 Newtons) for the SHS and DRS composite group (p < 0.01). CONCLUSION: The results support the use of an SHS and DHS composite compared with three cancellous screws in the treatment of unstable basicervical femoral neck fractures.

Aged↗
PubMed2006

Delayed osteonecrosis following reduction and internal fixation of a femoral neck fracture.

Osteonecrosis (ON) is a common complication following femoral neck fracture and most studies have reported the incidence of ON after less than 3 years follow-up. Here we report a case of delayed osteonecrosis 7 years after initial treatment for a femoral neck fracture. This example supports the need for continued clinical and radiographic follow-up over an extended period after femoral neck fracture and suggests that 3 years is too short a time to reliably rule out ON as a postoperative complication.

Adult↗
PubMed1991

[Follow-up results of osteosynthesis of medial femoral neck fractures with the dynamic hip screw].

The operative treatment of subcapital femoral neck fractures of stages Garden III and IV in the young patient is still a problem. The current methods of osteosynthesis show a high rate of avascular necrosis of the femoral head. We controlled 24 patients with subcapital femoral neck fracture, who were treated with a dynamic hip screw (DHS). The average age of these patients is 55 years. They were examined after 30-89 months from the operation. All patients were assessed regarding clinical and radiological parameters. All of the six patients with femoral neck fractures of stages Garden I and II had no pain, their clinical results were good. In one of these patients we found a partial avascular necrosis of the femoral head. Four out of the 18 patients with femoral neck fractures of stages Garden III and IV had painful complications, 3 of them needed a reoperation. Fourteen patients of the group with femoral neck fractures of stages Garden III and IV had no pain and wer satisfied with the result. But in this group we found 7 patients with partial avascular necrosis of the femoral head. These results are discussed and compared with data published elsewhere.

Bone Screws↗
PubMed1996

Percutaneous pinning in undisplaced subcapital femoral neck fractures.

Three hundred and five undisplaced subcapital femoral neck fractures managed by pinning in situ with Knowles' pins were evaluated to elucidate the role and effect of such treatment. The protocol of management and follow up, and evaluation, both radiographically and functionally, were set up prospectively. The duration from injury to management was 3.5 (1-14) days, the operation time was 22 (9-48) min and most of the patients were discharged without hospitalization. The follow-up period was 75 (28-136) months. The final results showed 282 (92.5 per cent) fractures united without complications (mean union time: 20 weeks), 14 (4.6 per cent) limbs with non-union, and 9 (2.9 per cent) had implant problems. Twenty-two (7.2 per cent) developed avascular necrosis after union. Percutaneous pinning of undisplaced subcapital femoral neck fractures as day cases is a simple, safe, effective and economic method.

Adult↗
PubMed1993

[Management of femoral neck fractures at the Liestal canton hospital].

The mode of treatment for femoral neck fractures at the Kantonsspital Liestal depends on age primarily. Patients over 70 years of age are treated with a unipolar endoprosthesis. Screws are being used in cases of medial femoral neck fractures, DHS in cases of lateral fractures. Total hip arthroplasty is only indicated in patients with evident osteoarthritis. 78 femoral neck fractures were seen in a 3-year-period. 50 endoprostheses were used in 49 patients. The mean age at time of surgery was 80 years. 70% of the patients have died at a mean survival time of 2 1/4 years. 13 out of a total of 14 surviving patients were investigated. The follow-up of 10 surviving patients reveals radiographically a mild protrusion in one case only. Clinically all 13 surviving patients are not compromised by the endoprosthesis after 5 years. We consider the implantation of a unipolar endoprosthesis in patients with femoral neck fractures at age over 70 years the treatment of choice. There is an acceptably low risk for protrusion as a late complication in regard to a reduced life expectancy.

Aged↗
PubMed1995

[Femoral neck fractures in bicyclists due to clipless pedals].

Femoral neck fractures in healthy young adults caused by a relatively low-energy trauma are uncommon. The cases are presented of four cyclists, men of 37, 42 (n = 2) and 43 years old, with a femoral neck fracture, in which so called clipless pedals played an important part. The shoes of the cyclist are affixed to these pedals, and the patients had been unable to remove their feet quickly when they fell. They were treated by osteosynthesis using screws, but one of them developed intra-articular infection which eventually necessitated implantation of a total hip prosthesis.

Adult↗
PubMed2004

Total hip arthroplasty: optimal treatment for displaced femoral neck fractures in elderly patients.

Although internal fixation is recommended for most nondisplaced fractures of the femoral neck, the optimal treatment for displaced fractures of the femoral neck is controversial. Options for operative treatment of displaced fractures of the femoral neck include: reduction and internal fixation; unipolar hemiarthroplasty; bipolar hemiarthroplasty; and total hip arthroplasty. One hundred eighty-six displaced fractures of the femoral neck in elderly patients were treated surgically with internal fixation (in 120 patients), hemiarthroplasty (in 43 patients), and total hip arthroplasty (in 23 patients). One hundred twenty patients with displaced fractures treated with internal fixation were compared with 66 patients with displaced fractures treated with arthroplasty. Criteria for comparison were reoperation, mortality, hospital discharge disposition, functional outcome, living status, and cost effectiveness. There was no difference in rates of reoperation or mortality, but arthroplasty produced a longer interval to reoperation or death. Arthroplasty was associated with more independent living, and arthroplasty was more cost-effective than internal fixation. Total hip arthroplasty was the best treatment for displaced fractures of the femoral neck in elderly patients in this series.

Age Factors↗
PubMed1989

Consumption versus need of institutional care after femoral neck fracture.

For 137 patients who sustained a femoral neck fracture domiciliary circumstances, ADL functional level and walking ability were recorded during a period of six months in 1983. At the time of injury 71% were living at home or in a so-called service apartment with medical and domestic facilities, and 28% in chronic care institutions (1% were transferred from other acute care units). Of the surviving patients 43% could return directly home or to a service apartment on discharge, 21% were transferred to an orthopedic rehabilitation facility, convalescent home, or other acute care unit, and 36% to chronic care institutions. At the 1-year as well as the 2-year follow-up 39% of the surviving patients were living in chronic care institutions. Analysis of the various parameters for patients having recourse to chronic care facilities at follow-up, showed that almost half of this group might be cared for at home. However, this will only be possible on condition that an extensive and effective home medical care system is developed as a complement to domestic assistance provided by public agencies. It is unrealistic to expect the incidence of patients needing chronic care facilities following femoral neck fracture to subside below a minimum of 20%.

Activities of Daily Living↗
PubMed1975

A long term follow-up of Moore arthroplasty in femoral neck fractures.

Moore arthroplasty was performed for medial femoral neck fractures in 169 patients. The mortality rate was 21.3 per cent within 3 months. The general postoperative complication rate (39.6 per cent) was dominated by cardiopulmonary (17.2 per cent) and thromboembolic (16.0 per cent) events. Of local complications, wound infection was found in 4.7 per cent and osteitis in 3.0 per cent of cases. A total of 60 patients were followed up with a mean observation time of 4.9 years. Of these, 8.3 per cent sustained femoral fractures during this period. The results classified according to the criteria of the American Academy of Orthopedic Surgeons showed 52 per cent excellent or good, 43 per cent fair and 5 per cent poor results. The roentgenological finding of settling or osteolysis along the prosthesis was significantly correlated to reduced hip mobility. Ossification in the prosthetic fenestres gave significantly diminished settling, and was correlated to better hip mobility and less pain. In our opinion, Moore arthroplasty has proved to be an acceptable method for the treatment of femoral neck fractures in elderly patients, as 73 per cent had an acceptable range of motion, 40 per cent managed walking distances of more than 500 m and 70 per cent had minimal or no pain. Although 25 per cent became nursing home patients, this reduction of vitality could be related to the hip arthroplasty in only two cases.

Aged↗
PubMed1990

The late outcome of femoral neck fractures.

The late outcome of 562 consecutive femoral neck fractures is presented; 396 were treated with a Thompson hemiarthroplasty, 121 by internal fixation, 4 by primary total hip replacement, and 41 were treated conservatively. Mortality during the first 30 days was 5%. The incidence of primary and secondary local complications after osteosynthesis was 25%. Further operations were carried out in 10% of the hemiarthroplasties. Seventy-eight patients were evaluated clinically and radiologically 10 years after this operation; 24 had been converted to total hip replacements, and in 23 of the remaining 54 the prosthesis appeared loose on radiographs. There was severe protrusion of the metal head in 25 cases. The clinical result was excellent or good in only 17 of 78 cases. We conclude that osteosynthesis or total hip replacement, rather than a Thompson hemiarthroplasty, should be considered for the treatment of femoral neck fractures if the patient is active and appears to have a life expectancy of several years.

Adult↗
PubMedDate not supplied

Femoral neck fracture secondary to in situ pinning of slipped capital femoral epiphysis: a previously unreported complication.

Two patients developed femoral neck fractures as a complication of in situ pinning for slipped capital femoral epiphysis (SCFE) by surgeons who each used a cannulated screw system. Both patients exhibited recurrent hip pain, femoral neck fracture, and coxa vara after asymptomatic postoperative intervals of 2 and 6 months, respectively. The fracture in one patient healed with weight relief alone: the other persisted, requiring a vascularized pedicle bone graft. Bone biopsy at surgery disclosed avascular necrosis (AVN). Based on preliminary studies of heat production during reaming, we speculate that these fractures developed through areas of AVN secondary to thermal injury.

Adolescent↗