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PubMed1991

Femoral neck fractures. 121 cases treated by Knowles pinning.

The femoral neck fracture remains one of the unsolved fractures. It is a fracture with a high incidence of nonunion and avascular necrosis. One hundred twenty-one mostly young adult patients with femoral neck fractures were treated by Knowles pins internal fixation. Patients were observed for an average of 32 months following surgery. Union occurred in all Garden Stage I and II undisplaced fractures, and the incidence of nonunion was 14% in Garden Stage III and IV displaced fractures. The incidence of avascular necrosis was 5.9% in undisplaced fractures and 34.5% in displaced fractures. There was no significant difference in avascular necrosis rates among age groups. Nonunion and avascular necrosis occurred mainly in displaced fractures. Knowles pinning offers the advantages of few technical failures, early weight bearing, high union rate, and low complication rate.

Adolescent↗
PubMed2006

The role of preoperative bone scan for determining the treatment method for femoral neck fracture.

To evaluate the role of preoperative bone scintigraphy in determining the operative treatment method for femoral neck fracture, we reviewed the data of 83 patients who underwent preoperative bone scanning after femoral neck fracture. Fractures were classified using the Garden staging system. Radioisotope uptake in femoral heads was evaluated visually. Of 28 patients with Garden stage I or II, radioactivity of the femoral head was normal in 26, partially reduced in one, and generally reduced in one patient. Twenty-seven patients were treated by closed reduction and multiple pinning, and one patient was treated by bipolar hemiarthroplasty. Of 55 patients with Garden stage III or IV, femoral-head radioactivity was normal in three, partially reduced in seven and generally reduced in 45 patients. Fifty-four patients were treated by bipolar hemiarthroplasty or total hip arthroplasty, and one patient was treated by closed reduction and multiple pinning. In only one of the 83 cases was the operative method changed because of bone scan findings. Isotope uptake of the femoral head after femoral neck fracture generally corresponded with the degree of fracture displacement. Preoperative bone scans appear to have no significant role to play in determining the operative treatment method for femoral neck fracture.

Adolescent↗
PubMed1979

Intertrochanteric displacement osteotomy in the treatment of femoral neck fractures.

A total of 51 patients with displaced femoral neck fractures of Garden grade III or IV was treated by intertrochanteric displacement osteotomy. Of these, 42 patients had complete follow-up and 31 fractures (73.8%) united. The results were satisfactory in 66.6% and poor in 33.4%. The poor results were mainly due to non-union, chronic osteomyelitis and stiffness of the hip or knee. A high intertrochanteric osteotomy with adequate displacement is recommended in fresh, displaced femoral neck fractures.

Adult↗
PubMed2007

Incidence of fracture-healing complications after femoral neck fractures.

What is the relationship between the age or gender of the patient and the incidence of fracture-healing complications after internal fixation of intracapsular fractures? We aimed to determine the association between the age of the patient and fracture nonunion and also to establish if the gender of the patient had any influence on the occurrence of fracture nonunion. We prospectively studied 1133 patients with intracapsular fractures of the femoral neck treated by internal fixation. The overall incidence of nonunion was 19.3%. Fracture nonunion was less common for undisplaced fractures than for displaced fractures (48 of 565 [8.5%] versus 171 of 568 [30.1%]) and in men than in women (35 of 271 [12.9%] versus 184 of 862 [21.3%]). The incidence of nonunion progressively increased with age from one of 17 (5.9%) in patients younger than 40 years to 84 of 337 (24.9%) in patients in their 70s. For patients in their 80s, the incidence of nonunion began to decrease, but if patients who died within 1 year after injury were excluded, the incidence continued to increase. Our study showed an increased risk for intracapsular hip fractures developing nonunion with older age and in females.

Adolescent↗
PubMed2006

Sliding compression screw fixation for delayed union/non-union of femoral neck fracture: is it a viable option.

Femoral neck fracture non-unions often present with significant difficult treatment decision as regards to surgical options and the risk of complication. We present three cases of femoral neck non-union treated with double screw stabilization technique using sliding compression hip screw and anti-rotational screw. The rationale for opting to these simple implants in our setting is discussed.

Adult↗
PubMed2005

Treatment of undisplaced femoral neck fractures in the elderly.

BACKGROUND: While the treatment for displaced femoral neck fractures in the elderly (Garden types III and IV) is quite clear, the procedure for impacted or undisplaced femoral neck fractures (Garden types I and II) is still a subject of controversy. METHODS: Thirty-seven (all >80 years old) patients with undisplaced femoral neck fractures were treated with osteosynthesis by cannulated screws fixation. The clinical outcomes were followed up retrospectively for at least two years. RESULTS: The overall union rate was 94.59% (35 patients) at 6 months after primary internal fixation. The overall success rate was 83.78% (31 patients), and the overall failure rate was 16.22% (6 patients). CONCLUSIONS: Osteosynthesis with cannulated screws fixation is a simple, safe, economical, and reasonably effective procedure for the treatment of undisplaced femoral neck fractures in patients older than 80 years.

Aged↗
PubMed2003

Dementia after delirium in patients with femoral neck fractures.

OBJECTIVES: To investigate whether delirium in older patients with femoral neck fractures is associated with an increased risk of developing dementia and a higher mortality rate. DESIGN: A 5-year prospective follow-up study. SETTING: Department of Orthopedic Surgery at the University Hospital in Umeå, Sweden. PARTICIPANTS: Seventy-eight nondemented patients aged 65 and older operated on for femoral neck fractures were followed for 5 years. MEASUREMENTS: The patients were assessed using the Organic Brain Syndrome (OBS) Scale pre- and postoperatively. Medical and social data were collected from the patients, their caregivers, and medical records, and the survivors were visited and assessed with the OBS Scale and the Mini-Mental State Examination in their homes 5 years after the fracture. RESULTS: Thirty of 78 (38.5%) nondemented patients with a femoral neck fracture developed dementia within a 5-year period. Twenty of 29 (69%) who were delirious postoperatively developed dementia, compared with 10 of 49 (20%) who were not delirious during their hospital stay (P <.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years, compared with 17 of 49 (34.7%) of those who remained lucid postoperatively (P =.001). CONCLUSION: Delirium in nondemented femoral neck fracture patients is associated with the development of dementia and a higher mortality rate. Patients with preoperative or postoperative delirium should therefore be assessed not only for the etiology of the delirium but also for any underlying organic brain disorder. Questions that remain unanswered are whether postoperative delirium is a marker of undetected dementia and whether postoperative delirium contributes to the development of dementia.

Aged↗
PubMed2007

Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center.

Femoral neck fractures in children are severe injuries associated with the potentially disastrous complication of femoral head osseous necrosis. Our primary goal was to identify what factors contribute to the occurrence of femoral head osteonecrosis in skeletally immature patients with femoral neck fractures. We evaluated a large consecutive series of pediatric patients with femoral neck fractures. Between 1970 and 2000, 20 patients with a mean age of 11 years (range, 4-15 years) with femoral neck fractures were identified. All traumatic epiphyseal, transcervical, and basicervical (Types I, II, and III) fractures were included. There were 14 male patients and six female patients. The mean followup was 7 years (range, 1-28 years). Timing of surgery, type of fixation, and quality of reduction were analyzed with respect to the primary outcome measure-radiographic evidence of femoral head osteonecrosis. Eighteen of 20 hip fractures healed without complication; all had good or excellent reductions. Two patients had osteonecrosis develop; both had fair or poor reductions. Five patients were treated more than 48 hours after injury, including the two patients who had osteonecrosis develop. The mean time to fixation for the remaining patients was 12 hours. There was no relationship between capsular decompression and osteonecrosis development. Quality of reduction and timing of reduction influenced the risk of osteonecrosis.

Adolescent↗
PubMedDate not supplied

[Treatment of femoral neck fractures with endoprostheses in the aged].

A primary prosthetic replacement is advocated for all elderly patients with displaced fractures of the femoral neck. The aim of the study was to determine the effectiveness of this method of treatment. Patients admitted to the Department of Orthopedics, University Hospital Firule, Split, from 1977 through 1989 were analyzed. Over this period, a total of 350 hip joint endoprostheses were implanted (233 hemiarthroplasties, 38 total hip arthroplasties and 79 biarticular endoprostheses). Postoperative complications occurred in 10.85% of cases [infections (1.43%), luxations of endoprostheses (4.28%), loosening of the femoral component (2%), intrahospital mortality (1.43%), perforations of the femur (0.86%), lesions of the sciatic nerve (0.57%) and fractures of the endoprosthetic stem (0.28%)]. Fifty patients were followed. Using the clinical and radiologic criteria, functional results were evaluated. Excellent results were reported in thirty-seven (74%), good results in eight (16%), and poor results in five patients (10%). All arthroplasties carry a certain risk which could be diminished by the improvement of both fundamental characteristics of endoprostheses and surgical techniques. In summary, we feel this is the best method to be utilized in elderly patients with the femoral neck fractures.

Adult↗
PubMed1994

Cancellous screw fixation for subcapital femoral neck fractures.

Experience in treating 80 subcapital femoral neck fractures by AO/ASIF cancellous screws is reported. Immediate full-weight bearing was allowed routinely. The mean follow-up was 28 months. Non-union occurred in 2% and late segmental collapse in 12% of patients with undisplaced fractures. Non-union occurred in 16.7% and late segmental collapse in 30% of patients for displaced fractures. Regression of screws occurred in 30% of patients, all of which were detected within the first month after the operation. It was associated with a significantly higher risk of non-union and late segmental collapse for both undisplaced (P < 0.01) and displaced (P < 0.001) fractures.

Adult↗
PubMed1985

Early fixation failure in displaced femoral neck fractures.

A study of 76 displaced femoral neck fractures treated by reduction and Knowles pins or AO (ASIF) cancellous bone screws was carried out. Fixation failure within 3 months occurred in 17 cases (22%). Advanced age, inaccurate reduction, a poor mental state of the patient, the number of Knowles pins used, and the preinjury functional ability of the patient are significant risk factors for fixation failure. Neurological disease, the type of fracture according to Garden, delay before operation, and the method of fixation are not significantly related to fixation failure.

Adolescent↗
PubMed1993

Types and complications of femoral neck fractures in children.

This multicenter collaborative study was undertaken to review the types and complications of femoral neck fractures in children. It is a retrospective clinical and radiological review of 108 femoral neck fractures. Cases originated from four different pediatric hospitals. All the patients had plain radiographs. Fractures occurred at all ages (one day to 18 years), and 63% of the patients were boys. Forty-nine fractures were traumatic; 37 were pathologic, 19 were insufficiency fractures; and three were fatigue fractures. Unless the underlying bone was abnormal, significant high velocity trauma, fall from a height or other severe violence was required to fracture the femoral neck. A unicameral bone cyst was the underlying lesion in 40% of pathologic femoral neck fractures and malignancy in 35%. Osteoporosis as in myelodysplasia, osteogenesis imperfecta and from other causes was responsible for 52% of insufficiency fractures. Because of the unique osseous and vascular anatomy of the femoral head and neck in the growing child, these fractures have a high incidence of complications. Complications included avascular necrosis 13%, premature closure of the epiphyseal plate 12%, varus deformity 8.3%, and nonunion 3.7%. Unless there is a clear history of significant violence, a cause for a femoral neck fracture should be sought, e.g. an underlying bone lesion or a metabolic bone disease. These fractures are rare, but are serious injuries since their complications may lead to a life-long disability.

Adolescent↗
PubMed1988

Consumption of hospital resources for femoral neck fracture.

In 1,673 patients with femoral neck fracture, the utilization of hospital and rehabilitation resources following primary operations and necessary reoperations was assessed in relation to type of treatment center and outcome of the fracture. All the patients were admitted from their homes to either orthopedic or general surgery departments, urban or rural. The fractures were treated by one of four osteosynthesis methods and followed for 6 years postoperatively. About 30 per cent of the fractures developed healing complications. Patients treated in surgical departments utilized more acute and rehabilitation bed days than those treated in orthopedic departments. The patients stayed longer in city surgical departments than in rural surgical departments. The Thornton osteosynthesis used by general surgical specialists resulted in 29 percent, mainly early complications, whereas the Rydell osteosynthesis used by orthopedic specialists had 24 percent, mainly late complications. This difference resulted in more than 40 percent higher consumption of bed days by the Thornton-nailed patient. In sum, a fracture without complications consumed, on an average, 31 cost standardized bed days compared with 101 bed days for fracture with complications. Thus, every fracture with complications was SEK 112,000 more expensive than the complication-free one.

Aged↗
PubMed1975

Primary internal fixation of femoral neck fractures.

The principles in treatment of femoral neck fractures by primary internal fixation have been reviewed. In the rare, undisplaced stress or fatigue fracture, early internal fixation with threaded pins is recommended. Impacted fractures should be treated by primary internal fixation in patients who do not follow orders and patients whose general condition is poor and would require early weight bearing. Displaced fractures may be treated by primary internal fixation at any age and regardless of the patient's general condition. The following principles are emphasized: early operation, anatomical reduction and slight valgus in some cases, compression and impaction of fragments, and firm immobilization of fragments with a device that has a sliding mechanism and provides lateral cortical fixation.

Bone Nails↗
PubMed1998

Predicting the mechanical outcome of femoral neck fractures fixed with cancellous screws: an in vivo study.

OBJECTIVE: The goal of this project was to determine, by using a retrospective cohort analysis, the relative importance of fracture geometry, bone density, and quality of fracture reduction in predicting redisplacement of femoral neck fractures fixed with multiple cancellous screws in a patient population. DESIGN: A retrospective analysis of quantitative geometric and bone density data from forty-seven patients with femoral neck fractures fixed with cancellous screws was performed. SETTING: Radiographs retrieved after analysis of a statewide hospital database were digitized and analyzed quantitatively. INTERVENTION: Quantitative data from radiographs included estimates of femoral neck bone density, fracture surface orientation and location, degree of comminution, prefixation displacement, initial reduction position of the fractured component, and final displacement of the fracture after fixation. MAIN OUTCOME MEASUREMENTS: Angular rotation and inferior displacement of the fracture component after fixation. RESULTS: Femoral neck bone density can be correlated to femoral cortical thickness and can be used as a measure of bone density from plain x-rays. Significant relative risk of redisplacement of a femoral neck fracture is correlated with initial inferior offset of the fracture component and varus angulation. Relative risks of other variables, including valgus reduction, Garden Stage 3 and 4 position of the femoral head, low bone density, presence of inferior comminution, a more vertical fracture surface angle, and fracture position, were not significant. CONCLUSIONS: When compared with other geometric and mechanical variables, nonanatomic reduction of a femoral neck fracture, with either inferior offset or varus angulation, is the strongest predictor of postfixation redisplacement of the fracture.

Absorptiometry, Photon↗
PubMed1996

[Reasonably good results of Hansson's pins in elderly patients with a medial femoral neck fracture].

OBJECTIVE: To establish the result of treatment of medial femoral neck fractures in patients aged 70 years and older using Hansson pins introduced percutaneously. DESIGN: Descriptive. SETTING: Department of Surgery, University Hospital Utrecht, the Netherlands. METHOD: Ninety-two patients aged 70 years and older with a medial femoral neck fracture were treated in the period 1986-1994 with osteosynthesis using Hansson pins. The case histories and X-rays of these patients were analysed. All fractures were classified according to Garden and Pauwels, with Singh classification of bone quality. The result of the operation was evaluated with the aid of postoperative X-rays. RESULTS: The patients' mean age was 80 years. There were 16 non-dislocated Garden grades I or II and 71 dislocated Garden III and IV fractures. Four patients died within 30 days after the operation. At the time of the follow-up (after an average of 4.5 years), 45 patients had died. Thirty-three patients in all developed a fracture-related complication; 27 of them underwent reoperations during which 19 (21%) were fitted with a head-neck prosthesis or a total hip prosthesis. All reoperations which included implantation of a prosthesis were performed in dislocated Garden grades III and IV fractures. In fractures of this type in which postoperative repositioning proved inadequate, more reoperations were performed than in the Garden grades III and IV fractures with correct posture. CONCLUSION: Treatment of a medial femoral neck fracture in elderly patients by means of internal fixation with percutaneously introduced Hansson pins gives results similar to those of other types of internal fixation. This is a good operation for Garden grades I and II fractures, whereas in Garden grades III and IV fractures in which repositioning is impossible, internal fixation should be refrained from and a head-neck prosthesis should be implanted in one session.

Aged↗