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Sample records for femoral neck bone

  1. Femoral head-neck junction reconstruction, after iatrogenic bone resection.

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    Guevara-Alvarez, Alberto; Lash, Nicholas; Beck, Martin

    2015-07-01

    Arthroscopic over-resection of the head-neck junction during the treatment of a cam deformity can be a devastating complication and is difficult to treat. Large defects of the femoral head-neck junction (FHNJ) increase the risk of femoral neck fracture and can also affect hip biomechanics. We describe a case of an iatrogenic defect of the FHNJ due to excessive bone resection, and a previously non-described treatment using iliac crest autograft to restore femoral head-neck sphericity and hip joint stability. After protecting the femoral neck with an angled blade plate, the large anterior FHNJ defect was reconstructed using autogenous iliac crest bone graft; sphericity was restored by contouring the graft using spherical templates. Clinical and radiographic follow-up was performed up to 2 years. Results at 2 years showed no residual groin pain and normal range of motion. The Oxford Hip Score was 46/48, rated as excellent. Computed tomography (CT) scanning showed union of bone graft without resorption, and CT arthrogram indicating retained sphericity of the FHNJ without evidence of degenerative changes in the articular surface. This novel surgical technique can be used to restore the structural integrity and contour of the FHNJ that contains a significant anterior defect.

  2. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

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    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  3. Femoroacetabular impingement: bone marrow oedema associated with fibrocystic change of the femoral head and neck junction

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    James, S.L.J. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom) and Department of Radiology, Royal Orthopaedic Hospital, Birmingham (United Kingdom)]. E-mail: jamesslj@email.com; Connell, D.A. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom); O' Donnell, P. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom); Saifuddin, A. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom)

    2007-05-15

    Aim: To describe the association of bone marrow oedema adjacent to areas of fibrocystic change at the femoral head and neck junction in patients with femoroacetabular impingement. Materials and methods: The clinical and imaging findings in six patients with bone marrow oedema adjacent to an area of fibrocystic change at the femoral head and neck junction are presented. There were five males and one female (age range 19-42 years, mean age 34.5 years). Three patients were referred with a clinical suspicion of femoroacetabular impingement, two with suspected osteoid osteoma and one with a clinical diagnosis of sciatica. The volume of bone marrow oedema (grade 1: 0-25%, grade 2: 26-50%, grade 3: 51-75% and grade 4: 76-100% of the femoral neck width), presence of labral and articular cartilage abnormality, joint effusion, and femoral head and neck morphology were recorded. Results: Magnetic resonance imaging (MRI) identified fibrocystic change in the anterolateral aspect of the femoral head and neck junction in all cases (mean size 9 mm, range 5-14 mm, three multilocular and three unilocular cysts). The volume of oedema was variable (one grade 1, two grade 2, one grade 3 and two grade 4). All patients had abnormality of the anterosuperior labrum with five patients demonstrating chondral loss. An abnormal femoral head and neck junction was identified in five patients. Conclusion: The radiological finding of fibrocystic change at the anterosuperior femoral neck with or without bone marrow oedema should prompt the search for femoroacetabular impingement. Bone marrow oedema may rarely be identified adjacent to these areas of cystic change and should be considered in the differential diagnosis of bone marrow oedema in the femoral neck.

  4. Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research

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    Jia-zuo SHEN, Jian-fei YAO, Da-sheng LIN, Ke-jian LIAN, Zhen-qi DING, Bin LIN, Zhi-min GUO, Ming-hua ZHANG, Qiang LI, Lin LI, Peng QI

    2012-01-01

    Full Text Available Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise.Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS and standard dynamic hip screws (DHS in an animal model.Design: Testing of specifically designed fixation devices in a pig animal model.Interventions/Methods: We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each. Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively.Results: There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P < 0.05. There were also significant differences between the Hb-DHS and DHS groups in postmortem visually assessed indicators of bone healing at both 8 and 16 weeks postoperatively.Conclusions: The Hb-DHS device promotes femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.

  5. Bone mineral density of the femoral neck in resurfacing hip arthroplasty

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    Penny, Jeannette Østergaard; Ovesen, Ole; Brixen, Kim

    2010-01-01

    Resurfacing total hip arthroplasty (RTHA) may preserve the femoral neck bone stock postoperatively. Bone mineral density (BMD) may be affected by the hip position, which might bias longitudinal studies. We investigated the dependency of BMD precision on type of ROI and hip position....

  6. Maintenance of bone mineral density after implantation of a femoral neck hip prosthesis

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    Zurstegge Matthias

    2008-01-01

    Full Text Available Abstract Background Stress shielding of the proximal femur has been observed in a number of conventional cementless implants used in total hip arthroplasty. Short femoral-neck implants are claiming less interference with the biomechanics of the proximal femur. The goal of this study was to investigate the changes of bone-mineral density in the proximal femur and the clinical outcome after implantation of a short femoral-neck prosthesis. Methods We prospectively assessed the clinical outcome and the changes of bone mineral density of the proximal femur up to one year after implantation of a short femoral neck prosthesis in 20 patients with a mean age of 47 years (range 17 to 65. Clinical outcome was assessed using the Harris Hip Score. The WOMAC was used as a patient-relevant outcome-measure. The bone mineral density was determined using dual energy x-ray absorptiometry, performed 10 days, three months and 12 months after surgery. Results The Harris Hip Score improved from an average preoperative score of 46 to a postoperative score at 12 months of 89 points, the global WOMAC index from 5,3 preoperatively to 0,8 at 12 months postoperatively. In contrast to conventional implants, the DEXA-scans overall revealed a slight increase of bone mineral density in the proximal femur in the 12 months following the implantation. Conclusion The short femoral neck stem lead to a distinct bone reaction. This was significantly different when compared to the changes in bone mineral density reported after implantation of conventional implants.

  7. Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities.

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    Hreshchyshyn, M M; Hopkins, A; Zylstra, S; Anbar, M

    1988-08-01

    The relationships between parity, breast-feeding, and the use of birth control pills and the bone densities of the lumbar spine and the femoral neck, measured by dual-photon densitometry, were studied in normal women. Femoral neck density was found to decrease by 1.1% per live-birth, whereas lumbar spine density showed no significant association with parity. Breast-feeding was found to increase lumbar spine density by 1.5% per breast-fed child, whereas femoral neck density was not significantly correlated. No significant relationships between the use of birth control pills and the bone densities were found.

  8. Bone mineral density aspects in the femoral neck of hip fracture patients.

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    Guerado, Enrique; Cruz, Encarnacion; Cano, Juan Ramon; Crespo, Pascual Vicente; Alaminos, Miguel; Sánchez-Quevedo, Maria del Carmen; Campos, Antonio

    2016-01-01

    Elderly people, due to neurological conditions and muscular atrophy, present a greater propensity to falls and thus are very susceptible to hip fractures. Other variables, such as osteoporosis, may also be related to the etiopathogenesis of hip fractures, although osteoporosis is in fact a concurrent disease, and merely a coadjutant cause. Nonetheless, osteoporosis can make fracture patterns more severe and interfere with osteosynthesis. Osteoporosis is the radiological image of osteopenia, a pathological concept meaning a smaller quantity of bone per unit of volume. The radiological expression of osteopenia is therefore that of bone tissue with a lower radiological density than normal. In the context of hip fractures, bone mineral density and bone architecture of the femoral neck together with protein expression profiles and cross-links of this anatomical area are of special interest which is reviewed in the current paper. Spatial variations in bone mineral density in the femoral neck were found in the literature with increased porosity from the periosteal to the endosteal region and also from the distal to the proximal part of the femoral neck. Furthermore, increased crystal size, increased cortical porosity, reduced osteocyte lacunar density and an increased Ca/P ratio associated with higher concentrations of Ca and P were described in hip fracture patients compared to control patients. Osteocalcin/collagen type 1 expression ratio and enzymatic cross-link content in high-density bone was found to be significantly lower in hip fractures compared to controls. In conclusion, further research in bone mineral density and associated parameters are of interest to deepen the understanding of osteoporotic hip fractures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. The recent prevalence of Osteoporosis and low bone mass in the United States based on bone mineral density at the Femoral Neck or Lumbar Spine

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    The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral ...

  10. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

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    D D Baksi

    2016-01-01

    Full Text Available Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8-30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG were excluded. Thus, out of 244 patients, 208 (85.3% untreated nonunion and 36 (14.7% following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN femoral head was found histologically in 135 (54.3% and radiologically in 48 (19.7% patients. The patients were operated by open reduction of fracture

  11. Melatonin improves bone mineral density at the femoral neck in postmenopausal women with osteopenia

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    Amstrup, Anne Kristine; Sikjaer, Tanja; Heickendorff, Lene

    2015-01-01

    Melatonin is known for its regulation of circadian rhythm. Recently, studies have shown that melatonin may have a positive effect on the skeleton. By increasing age, the melatonin levels decrease, which may lead to a further imbalanced bone remodeling. We aimed to investigate whether treatment...... with melatonin could improve bone mass and integrity in humans. In a double-blind RCT, we randomized 81 postmenopausal osteopenic women to 1-yr nightly treatment with melatonin 1 mg (N = 20), 3 mg (N = 20), or placebo (N = 41). At baseline and after 1-yr treatment, we measured bone mineral density (BMD) by dual...... X-ray absorptiometry, quantitative computed tomography (QCT), and high-resolution peripheral QCT (HR-pQCT) and determined calciotropic hormones and bone markers. Mean age of the study subjects was 63 (range 56-73) yr. Compared to placebo, femoral neck BMD increased by 1.4% in response to melatonin...

  12. A Novel Method for Estimation of Femoral Neck Bone Mineral Density Using Forearm Images from Peripheral Cone Beam Computed Tomography

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    Kwanmoon Jeong

    2016-04-01

    Full Text Available The main goal of osteoporosis treatment is prevention of osteoporosis-induced bone fracture. Dual-energy X-ray absorptiometry (DXA and quantitative computed tomographic imaging (QCT are widely used for assessment of bone mineral density (BMD. However, they have limitations in patients with special conditions. This study evaluated a method for diagnosis of osteoporosis using peripheral cone beam computed tomography (CBCT to estimate BMD. We investigated the correlation between the ratio of cortical and total bone areas of the forearm and femoral neck BMD. Based on the correlation, we established a linear transformation between the ratio and femoral neck BMD. We obtained forearm images using CBCT and femoral neck BMDs using dual-energy X-ray absorptiometry (DXA for 23 subjects. We first calculated the ratio of the cortical to the total bone area in the forearm from the CBCT images, and investigated the relationship with the femoral neck BMDs obtained from DXA. Based on this relationship, we further investigated the optimal forearm region to provide the highest correlation coefficient. We used the optimized forearm region to establish a linear transformation of the form to estimate femoral neck BMD from the calculated ratio. We observed the correlation factor of r = 0.857 (root mean square error = 0.056435 g/cm2; mean absolute percentage error = 4.5105% between femoral neck BMD and the ratio of the cortical and total bone areas. The strongest correlation was observed for the average ratios of the mid-shaft regions of the ulna and radius. Our results suggest that femoral neck BMD can be estimated from forearm CBCT images and may be useful for screening osteoporosis, with patients in a convenient sitting position. We believe that peripheral CBCT image-based BMD estimation may have significant preventative value for early osteoporosis treatment and management.

  13. Lumbar spine degenerative disease : effect on bone mineral density measurements in the lumbar spine and femoral neck

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    Juhng, Seon Kwan [Wonkwang Univ. School of Medicine, Iksan (Korea, Republic of); Koplyay, Peter; Jeffrey Carr, J.; Lenchik, Leon [Wake Forest Univ. School of Medicine, Winston-salem (United States)

    2001-04-01

    To determine the effect of degenerative disease of the lumbar spine on bone mineral density in the lumbar spine and femoral neck. We reviewed radiographs and dual energy x-ray absorptiometry scans of the lumbar spine and hip in 305 Caucasian women with suspected osteoporosis. One hundred and eight-six patient remained after excluding women less than 40 years of age (n=18) and those with hip osteoarthritis, scoliosis, lumbar spine fractures, lumbar spinal instrumentation, hip arthroplasty, metabolic bone disease other than osteoporosis, or medications known to influence bone metabolism (n=101). On the basis of lumbar spine radiographs, those with absent/mild degenerative disease were assigned to the control group and those with moderate/severe degenerative disease to the degenerative group. Spine radiographs were evaluated for degenerative disease by two radiologists working independently; discrepant evaluations were resolved by consensus. Lumbar spine and femoral neck bone mineral density was compared between the two groups. Forty-five (24%) of 186 women were assigned to the degenerative group and 141 (76%) to the control group. IN the degenerative group, mean bone mineral density measured 1.075g/cm? in the spine and 0.788g/cm{sup 2} in the femoral neck, while for controls the corresponding figures were 0.989g/cm{sup 2} and 0.765g/cm{sup 2}. Adjusted for age, weight and height by means of analysis of variance, degenerative disease of the lumbar spine was a significant predictor of increased bone mineral density in the spine (p=0.0001) and femoral neck (p=0.0287). Our results indicate a positive relationship between degenerative disease of the lumbar spine and bone mineral density in the lumbar spine and femoral neck, and suggest that degenerative disease in that region, which leads to an intrinsic increase in bone mineral density in the femoral neck, may be a good negative predictor of osteoporotic hip fractures.

  14. Reliability of using DXA around RTHAs. Bone Mineral Density of the femoral neck in resurfacing hip arthroplasty

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    Penny, Jeannette Østergaard; Ovesen, Ole; Brixen, Kim;

    2010-01-01

      Background and purpose: Resurfacing Total Hip Arthroplasty (RTHA) may preserve the femoral neck bone-stock post-operatively. Bone Mineral Density (BMD), could theoretically be affected by the hip-position, and bias longitudinal studies. We aimed to investigate BMD precision dependency on type...... of ROI and position of hip. Method: We DXA scanned the femoral neck of 15 resurfacing patients twice with the hip in 3 different rotations; 15° internal, neutral, and 15° external. For each position BMD was analyzed with 3 different surface area models. One model measured BMD in the total femoral neck......, the second model divided the neck in two and the third model had 6 divisions. Results: When all hip positions were pooled a mean Coefficient of variation (CV) of 3.1%, 3.6% and 4.6% was found in the 1, 2 and 6-region models, respectively, The external rotated hip position was less reproducible. When the hip...

  15. Relationship between change in femoral neck bone mineral density and hip fracture incidence during treatment with strontium ranelate.

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    Bruyère, O; Roux, C; Badurski, J; Isaia, G; de Vernejoul, M C; Cannata, J; Ortolani, S; Slosman, D; Detilleux, J; Reginster, J-Y

    2007-12-01

    Strontium ranelate (SR) increases bone mineral density (BMD) in postmenopausal osteoporotic women and reduces vertebral and non-vertebral fracture incidence. Hip fracture reduction has also been observed during 3-year treatment with SR in osteoporotic women at high risk of hip fracture. The objective of this study is to analyse the association between BMD changes and hip fracture incidence during treatment with SR. In this post-hoc analysis, 465 women aged over 74 years with low BMD at the femoral neck (T-score TROPOS). BMD was assessed at the femoral neck at baseline and after a follow-up of 3 years. Hip fractures were reported by study investigators. After adjusting for age, body mass index, femoral neck BMD at baseline and number of prevalent vertebral fractures, we found that for each 1% increase in femoral neck BMD observed after 3 years, the risk to experience a hip fracture after 3 years decreased by 7% (95% CI: 1-14%) (p = 0.04). In patients experiencing a hip fracture over 3 years of treatment with SR, femoral neck BMD increased by (mean [SE]) 3.41 (1.02)% compared to 7.23 (0.81)% in patients without hip fracture (p = 0.02). In this post-hoc analysis of women undergoing 3 years of SR treatment, an increase in femoral neck BMD is associated with a decrease in hip fracture incidence.

  16. Internal fixation and muscle pedicle bone grafting in femoral neck fractures

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    Gupta A

    2008-01-01

    Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

  17. Treatment of femoral neck fracture with muscle-bone flap of both tensor fasciae latae and sartorius

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    刘国平; 康斌; 曾晖; 唐嫄科; 唐新宇; 熊奡; 解笑宸; 黄伟

    2003-01-01

    Objective: To evaluate the effect of muscular pedicle bone grafts with sartorius or tensor fasciae latae and sartorius in fresh transcervical or subcapital fractures of the femoral neck. Methods: Thirty cases of fresh transcervical and subcapital fractures of the femoral neck were treated by the tail breakable screws and sartorius pedicle bone grafts (single muscular pedicle, SMP group). The other 23 cases were treated by cannulated pressure screws and bone grafts with the muscular pedicles of both sartorius and tensor fasciae latae (double muscular pedicles, DMP group). Results: Fifty-two cases were followed up for 3 to 5 years (mean, 4 years). In SMP group, ten cases showed poor therapeutic results. Excellent therapeutic effects were achieved in all cases of DMP group. Conclusions: The transcervical or subcapital fractures of the femoral neck can be treated by double muscular pedicles bone graft. The bone graft with double muscular pedicles is more effective than single sartorius muscular pedicles for fresh transcervical and subcapital fractures of the femoral neck during short and medium terms.

  18. The variation of cancellous bones at lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep.

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    Zhang, Yongqiang; Li, Yongfeng; Gao, Qi; Shao, Bo; Xiao, Jianrui; Zhou, Hong; Niu, Qiang; Shen, Mingming; Liu, Baolin; Hu, Kaijin; Kong, Liang

    2014-07-01

    This study aimed to compare the variation of cancellous bones at four skeletal sites: lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep. Sixteen adult sheep were randomly divided into two groups: eight sheep were ovariectomized served as experimental group; the other eight untreated sheep were served as control group. Bone mineral density was assessed by dual-energy X-ray absorptiometry on lumbar vertebrae at baseline and twelve months after ovariectomy. After 12 months, lumbar vertebrae L3 and L4, femoral necks, mandibular angles and the fourth ribs were harvested for micro-CT scanning, histological analysis and biomechanical test. The results showed that bone mineral density of lumbar vertebra decreased significantly in twelfth month (pCT showed that the bone volume/total volume decreased by 45.6%, 36.1% 21.3% and 18.7% in lumbar vertebrae, femoral necks, mandibular angles and ribs in experimental group (psheep was site-specific on a pattern as follows: lumbar vertebra, femoral neck, mandibular angle and rib.

  19. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

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    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  20. Radiographic bone texture analysis is correlated with 3D microarchitecture in the femoral head, and improves the estimation of the femoral neck fracture risk when combined with bone mineral density

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    Ollivier, Matthieu [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Le Corroller, Thomas, E-mail: Thomas.LeCorroller@ap-hm.fr [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Radiology Department, 13009 Marseille (France); Blanc, Guillaume [APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Parratte, Sébastien [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Champsaur, Pierre [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Radiology Department, 13009 Marseille (France); Chabrand, Patrick [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); Argenson, Jean-Noël [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France)

    2013-09-15

    Purpose: Femoral neck fracture is a major public health problem in elderly persons, representing the main source of osteoporosis-related mortality and morbidity. In this study, we aimed at comparing radiographic texture analysis with three-dimensional (3D) microarchitecture in human femurs, and at evaluating whether bone texture analysis improved the assessment of the femoral neck fracture risk other than that obtainable by bone mineral density (BMD). Materials and methods: Thirteen osteoporotic femoral heads from patients who fractured their femoral neck and twelve non-fractured femoral heads from osteoarthritic patients were studied using respectively (1) a new high-resolution digital X-ray device (BMA™, D3A Medical Systems) allowing for bone texture analysis with fractal parameter Hmean, and (2) a micro-computed tomograph (CT) for 3D microarchitecture. BMD was measured postoperatively by DXA in all patients in the contralateral femur. Results: In these femoral heads, we found that fractal parameter Hmean was correlated with 3D microarchitecture parameters: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular separation (Tb.Sp) and fractal dimension (FD) respectively (p < 0.05). Then, fractal parameter Hmean was significantly lower in the femoral heads from the fractured group than from the non-fractured group (p < 0.01). Finally, multiple regression analysis showed that combining bone texture analysis and total hip BMD significantly improved the estimation of the femoral neck fracture risk from adjusted r{sup 2} = 0.46 to adjusted r{sup 2} = 0.67 (p < 0.05). Conclusion: Radiographic bone texture analysis was correlated with 3D microarchitecture parameters in the femoral head, provided accurate discrimination between the femoral heads from the fractured and non-fractured groups, and significantly improved the estimation of the femoral neck fracture risk when combined with BMD.

  1. Development of new criteria for cortical bone histomorphometry in femoral neck: intra- and inter-observer reproducibility.

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    Tong, Xiao-Yu; Malo, Markus; Tamminen, Inari S; Isaksson, Hanna; Jurvelin, Jukka S; Kröger, Heikki

    2015-01-01

    Histomorphometry is commonly applied to study bone remodeling. Histological definitions of cortical bone boundaries have not been consistent. In this study, new criteria for specific definition of the transitional zone between the cortical and cancellous bone in the femoral neck were developed. The intra- and inter-observer reproducibility of this method was determined by quantitative histomorphometry and areal overlapping analysis. The undecalcified histological sections of femoral neck specimens (n = 6; from men aged 17-59 years) were processed and scanned to acquire histological images of complete bone sections. Specific criteria were applied to define histological boundaries. "Absolute cortex area" consisted of pure cortical bone tissue only, and was defined mainly based on the size of composite canals and their distance to an additional "guide" boundary (so-called "preliminary cortex boundary," the clear demarcation line of density between compact cortex and sparse trabeculae). Endocortical bone area was defined by recognizing characteristic endocortical structures adjacent to the preliminary cortical boundary. The present results suggested moderate to high reproducibility for low-magnification parameters (e.g., cortical bone area). The coefficient of variation (CV %) ranged from 0.02 to 5.61 in the intra-observer study and from 0.09 to 16.41 in the inter-observer study. However, the intra-observer reproducibility of some high-magnification parameters (e.g., osteoid perimeter/endocortical perimeter) was lower (CV %, 0.33-87.9). The overlapping of three histological areas in repeated analyses revealed highest intra- and inter-observer reproducibility for the absolute cortex area. This study provides specific criteria for the definition of histological boundaries for femoral neck bone specimens, which may aid more precise cortical bone histomorphometry.

  2. Bone density in relation to failure in patients with osteosynthesized femoral neck fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Lauritsen, Jens;

    Background The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still......,2 (75,4-79,0). Failure is defined as revision surgery or new fracture. Results 69 patients had a t-score (total hip) below -2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,5 % (44,7 %), at 2 years 45,4 % (60,0 %) and at end of follow-up 49,6 % (62...

  3. Bone density in relation to failure in patients with osteosynthesized femoral neck fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Lauritsen, Jens;

    2011-01-01

    Background The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still......,1 (75,3-78,9). Failure is defined as revision surgery or new fracture. Results 69 patients had a t-score (total hip) below -2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,3 % (44,2 %), at 2 years 45,1 % (59,4 %) and at end of follow-up 49,2 % (62...

  4. Panoramic-Based Mandibular Indices and Bone Mineral Density of Femoral Neck and Lumbar Vertebrae in Women

    Directory of Open Access Journals (Sweden)

    M. Imanimoghaddam

    2010-06-01

    Full Text Available Objective: The aim of this cross-sectional analytic study was to evaluate the diagnostic efficacy of panoramic-based indices of the mandible (Mental Index-MI, Mandibular Cortical Index-MCI and Panoramic Mandibular Index-PMI and to determine their correlationwith bone mineral density (BMD of the femoral neck and lumbar vertebrae (L2-L4 in order to assess the possibility of using these parameters as indicators of osteoporosis.Materials and Methods: The mandibular indices of 67 women over 35 years old were measured from panoramic radiographs, and bone densitometry was performed in the femoral neck and lumbar vertebrae (L2-L4, using DXA (Dual Energy X-ray Absorptiometrytechnique. The patients were divided into three categories of normal, osteopenic andosteoporotic in each skeletal region. One-way ANOVA and ROC curve analyses were applied.The results were considered statistically significant when the P-value was less than 0.05.Results: Comparing the mean BMD in the femoral neck in women between C1 and C3 subgroups of MCI, a significant difference was detected (P=0.04. The mean PMI in the three skeletal subgroups was not different according to the skeletal region (P>0.05. We found a significant difference in mean MI between normal and osteopenic subgroups in the femoral neck (P=0.042.Conclusion: Using radiomorphometric indices of the mandible (MCI-MI may be useful in determining the skeletal status of the patients, but is not sufficient for precise evaluation.

  5. Dual-energy X-ray absorptiometric densitometry in osteoarthritis of the hip. Influence of secondary bone remodeling of the femoral neck

    Energy Technology Data Exchange (ETDEWEB)

    Preidler, K.W. [Dept. of Radiology, Veterans Administration Medical Center and Univ. of California, San Diego, CA (United States); White, L.S. [Dept. of Radiology, Veterans Administration Medical Center and Univ. of California, San Diego, CA (United States); Tashkin, J. [Dept. of Radiology, Veterans Administration Medical Center and Univ. of California, San Diego, CA (United States); McDaniel, C.O. [Dept. of Radiology, Veterans Administration Medical Center and Univ. of California, San Diego, CA (United States); Brossmann, J. [Dept. of Radiology, Veterans Administration Medical Center and Univ. of California, San Diego, CA (United States); Andresen, R. [Dept. of Radiology, Veterans Administration Medical Center and Univ. of California, San Diego, CA (United States); Sartoris, D. [Dept. of Radiology, Veterans Administration Medical Center and Univ. of California, San Diego, CA (United States)

    1997-07-01

    Purpose: The aim of this study was to evaluate the influence of buttressing on bone densitometry measurements in the femoral neck, in Ward`s triangle, and in the greater trochanter. In addition, we attempted to establish the length of the femoral axis (FAL) and the true length of the femoral neck (FNL) as potential correlates with osteoarthritis (OA) or with buttressing. Material and Methods: Our study comprised 101 hips in 68 adult patients. Conventional radiographs of the hip joints were obtained in order to assess the presence and extent of OA by means of the 6-step grading system introduced in 1990 by CROFT et al., and in order to measure the cortical thickness at the medial aspect of the femoral neck. In addition, FAL and FNL were measured. All patients underwent dual energy X-ray absorptiometry so that bone density could be assessed in the femoral neck, in Ward`s triangle, and in the greater trochanter. The Spearman rank correlation was used to compare the measurements. Results: Statistical analysis showed a significant positive correlation between cortical thickness and bone density in the femoral neck and in Ward`s triangle. No correlation was found between cortical thickness and bone density in the greater trochanter, nor between cortical thickness and OA, FNL, and FAL, nor between OA and bone density, FNL, and FAL. (orig.).

  6. Bone scanning after muscle-pedicle bone graft for femoral neck fracture, (1). Preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Yutaka; Nabeshima, Kazuo; Okazaki, Takeyuki; Dogo, Akihiko; Kurihara, Makoto; Tsai, Yeong-Nan (Kawasaki Steel Corp., Kobe (Japan))

    1982-04-01

    sup(99m)Tc-MDP bone scintigraphy was performed on patients who received muscle-pedicle bone graft. In each of the bone head and the bone graft, a time-activity curve was obtained. In this muscle-pedicle bone graft, active revascularization and marked osteogenesis, which suggested rapid bone repairing, were observed. The bone scintigraphy was considered to be useful in observing the result of bone grafts, blood circulation, and time of bone fusion, and of value for early detection of secondary changes.

  7. Bone density in relation to failure in patients with osteosynthesized femoral neck fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Lauritsen, Jens

    Background The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still...... of Orthopaedic Surgery and Traumatology, 175 patients with femoral neck fractures accepted DEXA –scanning of the hip and lumbar spine assessing BMD. Final follow-up were 01.08.2010 and 141 patients with IF comprised the final cohort. The cohort consisted of 105 females and 36 males with a mean (CI) age of 77......,2 (75,4-79,0). Failure is defined as revision surgery or new fracture. Results 69 patients had a t-score (total hip) below -2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,5 % (44,7 %), at 2 years 45,4 % (60,0 %) and at end of follow-up 49,6 % (62...

  8. Bone density in relation to failure in patients with osteosynthesized femoral neck fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Lauritsen, Jens

    2011-01-01

    Background The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still...... of Orthopaedic Surgery and Traumatology, 177 patients with femoral neck fractures accepted DEXA –scanning of the hip and lumbar spine assessing BMD. Final follow-up were 01.08.2010 and 142 patients with IF comprised the final cohort. The cohort consisted of 106 females and 36 males with a mean (CI) age of 77......,1 (75,3-78,9). Failure is defined as revision surgery or new fracture. Results 69 patients had a t-score (total hip) below -2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,3 % (44,2 %), at 2 years 45,1 % (59,4 %) and at end of follow-up 49,2 % (62...

  9. Dual photon absorptiometry in patients with Paget disease (bone mineral contents of lumbar spine and femoral neck)

    Energy Technology Data Exchange (ETDEWEB)

    Talbot, J.N.; Piketty, C.; Kiffel, T.; Coutris, G.; Milhaud, G.

    1988-01-01

    The bone mineral contents (BMC) of the lumbar spine (84 cases) and of one femoral neck (53 cases) were measured by dual photon absorptiometry (DPA) in patients suffering from Paget's disease of bone. The BMC of the patients and of 53 controls were compared, taking into account the occurrence of a scintigraphic hyperfixation, in each patient. A hyperfixation of the technetium labelled diphosphonate in the lumbar spine, more frequent in males, was associated with an elevated mean BMC value. The difference versus controls was significant in men but not in women. A hyperfixation of the femoral neck was associated with an elevated mean BMC value in both sexes. BMC values greater than the mean BMC of controls + 2 SD were observed in 83 per cent of these male patients and 50 per cent of the females. In contrast, BMC values lower than in controls were observed in non-pagetic areas. DPA allows the quantification of these abnormalities which cannot be evidenced by bone scintigraphy even if alkaline phosphatases levels are assayed.

  10. Biomechanics Significance of Femoral Head and Neck of Grafting-bone Group After Femoral Neck Fracture-healing%股骨颈骨折愈合后钉道植骨的生物力学意义

    Institute of Scientific and Technical Information of China (English)

    唐洪涛; 仝允辉; 杨茹萍; 朱太永; 张美超; 赵卫东

    2011-01-01

    Objective To study biomechanical performance of fracture-healing femoral head and neck after the hollow compressionb screws are taken out in ungrafting-bone group, grafting-bone group, normal group, and provide theoretical basis for the treatment of necrosis of the femoral head by bone grafting in the channel of screws. Methods Nine femurs fixed and preserved by formalin were used in this test. They were randomly divided into three groups: normal group, ungrafting-bone group, grafting-bone group. According to inversed-triangle, at the range of physiological load, it tested the defixed bias-value of three group femoral head at different load. The data were collected and analyzed. The three-dimension finite element model of the femoral head and neck was calculated. Nodal solution of stress value and max-offset was calculated at area of femoral head and neck, then the data were compared and analyzed.Results Compared with the mean of load-offset about the femoral head and neck, biomechanical capability of ungrafting-bone group was lowest with regard to other two groups , the influence was very hard, P <0.05. But there was no singnificant difference between normal group and graflng-bone group, P >0.05. Analysis of the three-dimension finite element model showed that the massive stress was concentrated at weight loading region of ungrafting-bone group's femoral head, it was an dangerous chance to lead to femoral head collapse. Conclusion For the treatment of femur neck fractures with cannulated compression screws, bone grafting in the channel of screw should be used to improve biomechanical integrity after fracture healed and cannulated compression screws are taken out. This is of benefit to loading in early stage and to preventing the collapse of femoral head, etc.%目的 探讨股骨颈骨折愈合后取出空心加压螺钉遗留钉道不植骨、植骨及正常的股骨头颈部的生物力学特性,为临床提供实验依据.方法 收集9付股骨标本测量

  11. Combined with Bone Marrow-Derived Cells and rhBMP-2 for Osteonecrosis after Femoral Neck Fractures in Children and Adolescents: A case series

    Science.gov (United States)

    Gao, Fuqiang; Sun, Wei; Guo, Wanshou; Wang, Bailiang; Cheng, Liming; Li, Zirong

    2016-01-01

    Osteonecrosis of the femoral head (ONFH) following femoral neck fractures is a rare, yet severe, disorder in children and adolescents. This study evaluated the effectiveness of core decompression (CD) combined with implantation of bone marrow–derived cells (BMDC) and rhBMP-2 for osteonecrosis of femoral head (ONFH) after femoral neck fractures in children and adolescents. This study included 51 patients, aged 11.4–18.1 years, with ARCO stages I–III ONFH after femoral neck fractures between 2004 and 2010. The hips were divided into two groups based on whether the lateral pillar of the femoral head (LPFH) was preserved: LPFH and non-LPFH groups. All patients were followed up clinically and radiographically for a minimum of 5 years. 44 patients (86.3%) had improved clinical outcome. Radiologically, 9 of the 51 hips (17.6%) exhibited collapse onset or progression of the femoral head or narrowing of the hip joint space, and one patient in the non-LPFH group required hip arthroplasty due to the worsened syndrome. The technique provided an effective therapeutic option for children and adolescents with ONFH following femoral neck fractures. It relieves hip pain and prevents the progression of osteonecrosis in young patients lasting more than 5 years after surgery. PMID:27477836

  12. Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Overgaard, Søren;

    2014-01-01

    Background and purpose - Internal fixation (IF) in femoral neck fractures has high reoperation rates and some predictors of failure are known, such as age, quality of reduction, and implant positioning. Finding new predictors of failure is an ongoing process, and in this study we evaluated...... the importance of low bone mineral density (BMD). Patients and methods - 140 consecutive patients (105 females, median age 80) treated with IF had a dual-energy X-ray absorptiometry (DXA) scan of the hip performed median 80 days after treatment. The patients' radiographs were evaluated for fracture displacement......, or new hip fracture). A stratified Cox regression model on fracture displacement was applied and adjusted for age, sex, quality of reduction, implant positioning, comorbidity, and walking disability. Results - 49 patients had a T-score below -2.5 (standard deviation from the young normal reference mean...

  13. Results of bone regenerate study after osteosynthesis with bioinert and calcium phosphate-coated bioactive implants in experimental femoral neck fractures (experimental study

    Directory of Open Access Journals (Sweden)

    K. S. Kazanin

    2015-01-01

    Full Text Available Objective - to analyze the results of X-ray, cytomorphometric and immunohistochemistry experimental studies of bone regenerates after osteosynthesis with bioinert and calcium phosphate-coated bioactive implants. Material and methods. The study was conducted on experimental femoral neck fractures in rabbit males. Reparative osteogenesis processes were studied in groups of bioinert titanium implant osteosynthesis and calcium phosphate-coated bioactive titanium implant osteosynthesis. The animals were clinically followed-up during the postoperative period. X-ray, cytomorphometric and immunohistochemistry studies of samples extracted from femoral bones were conducted over time on days 1, 7, 14, 30 and 60. The animal experiments were kept and treated according to recommendations of international standards, Helsinki Declaration on animal welfare and approved by the local ethics committee. All surgeries were performed under anesthesia, and all efforts were made to minimize the suffering of the animals. Results. In the animal group without femoral neck fracture osteosynthesis, femoral neck pseudoarthrosis was observed at the end of the experiment. The results of cytomorphometric and immunohistochemistry studies conducted on day 60 of the experiment confirmed that the cellular composition of the bone regenerate in the group of calcium phosphate-coated bioactive titanium implants corresponded to a more mature bone tissue than in the group of bioinert titanium implants. Conclusion. The results of the statistical analysis of cytomorphometric and immunohistochemistry data show that the use of calcium phosphate-coated bioactive titanium implants allows to achieve significantly earlier bone tissue regeneration.

  14. New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures.

    Science.gov (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu

    2017-01-01

    Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm(3)), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be

  15. Assessment of volumetric bone mineral density of the femoral neck in postmenopausal women with and without vertebral fractures using quantitative multi-slice CT

    Institute of Scientific and Technical Information of China (English)

    Sheng-yong WU; Hui-hui JIA; Didier HANS; Jing LAN; Li-ying WANG; Jing-xue LI; Yue-zeng CAI

    2009-01-01

    Objective: To demonstrate the validity and reliability of volumetric quantitative computed tomography (vQCT) with multi-slice computed tomography (MSCT) and dual energy X-ray absorptiometry (DXA) for hip bone mineral density (BMD) measurements, and to compare the differences between the two techniques in discriminating postmenopausal women with osteoporosis-related vertebral fractures from those without. Methods: Ninety subjects were enrolled and divided into three groups based on the BMD values of the lumbar spine and/or the femoral neck by DXA. Groups 1 and 2 consisted of postmenopausal women with BMD changes <-2SD, with and without radiographically confirmed vertebral fracture (n=11 and 33, respectively).Group 3 comprised normal controls with BMD changes ≥-1SD (n=46). Post-MSCT (GE, LightSpeed16) scan reconstructed images of the abdominal-pelvic region, 1.25 mm thick per slice, were processed by OsteoCAD software to calculate the following parameters: volumetric BMD values of trabecular bone (TRAB), cortical bone (CORT), and integral bone (INTGL) of the left femoral neck, femoral neck axis length (NAL), and minimum cross-section area (mCSA). DXA BMD measurements of the lumbar spine (AP-SPINE) and the left femoral neck (NECK) also were performed for each subject. Results: The values of all seven parameters were significantly lower in subjects of Groups 1 and 2 than in normal postmenopausal women (P<0.05, respectively).Comparing Groups 1 and 2, 3D-TRAB and 3D-INTGL were significantly lower in postmenopausal women with vertebral fracture(s) [(109.8±9.61) and (243.3±33.0) mg/cm3, respectively] than in those without [(148.9±7.47) and (285.4±17.8) mg/cm3,respectively] (P<0.05, respectively), but no significant differences were evident in AP-SPINE or NECK BMD. Conclusion: the femoral neck-derived volumetric BMD parameters using vQCT appeared better than the DXA-derived ones in discriminating osteoporotic postmenopausal women with vertebral fractures from

  16. The application of closed reduction internal fixation and iliac bone block grafting in the treatment of acute displaced femoral neck fractures.

    Directory of Open Access Journals (Sweden)

    Zhiyong Li

    Full Text Available OBJECTIVE: This study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting. METHODS: From December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females with a mean age of 44.8 years (range, 20-64 years. There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females with a mean age of 46.3 years (range, 23-64 years. There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting. RESULTS: In study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months. All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100. In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months. The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68 and 16.2% (11/68, respectively, significantly higher than those in study group (both P<0.05. The mean Harris score in control group was 83.8 (41-100, significantly lower than that in study group (P<0.05. CONCLUSION: Acute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.

  17. Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius pedicle bone grafting in neglected femoral neck fracture in physiologically active patients

    Directory of Open Access Journals (Sweden)

    Pankaj Kumar Mishra

    2014-01-01

    Full Text Available Background: Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture. Materials and Methods: This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction. Results: 14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4% patients. All patients were within the age group of 15-51 years (average 38 years with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks. Conclusion: Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients.

  18. Bilateral nonunited femoral neck fracture in a child with osteopetrosis.

    Science.gov (United States)

    Steinwender, G; Hosny, G A; Koch, S; Grill, F

    1995-01-01

    We report a case of osteopetrosis with bilateral nonunited femoral neck and coxa vara in a 7-year-old boy. There was a history of traumatic transcervical left femoral neck fracture unsuccessfully treated by internal fixation. We performed a bilateral subtrochanteric valgus osteotomy. K-Wire fixation failed on the right side due to hardness of the bone. Finally, internal fixation with an angular plate after predrilling of the femoral neck offered stability. Bone union was achieved on both sides, resulting in full recovery of normal physical activity.

  19. Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement: two-year results from a randomised study.

    Science.gov (United States)

    Penny, J O; Brixen, K; Varmarken, J E; Ovesen, O; Overgaard, S

    2012-08-01

    It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into two groups to receive either a resurfacing or a THR and were followed for two years. One patient's resurfacing subsequently failed, leaving 19 patients in each group. Resurfaced replacements maintained proximal femoral BMD and, compared with THR, had an increased bone mineral density in Gruen zones 2, 3, 6, and particularly zone 7, with a gain of 7.5% (95% confidence interval (CI) 2.6 to 12.5) compared with a loss of 14.6% (95% CI 7.6 to 21.6). Resurfacing replacements maintained the BMD of the medial femoral neck and increased that in the lateral zones between 12.8% (95% CI 4.3 to 21.4) and 25.9% (95% CI 7.1 to 44.6). On the acetabular side, BMD was similar in every zone at each point in time. The mean BMD of all acetabular regions in the resurfaced group was reduced to 96.2% (95% CI 93.7 to 98.6) and for the total hip replacement group to 97.6% (95% CI 93.7 to 101.5) (p = 0.4863). A mean total loss of 3.7% (95% CI 1.0 to 6.5) and 4.9% (95% CI 0.8 to 9.0) of BMD was found above the acetabular component in W1 and 10.2% (95% CI 0.9 to 19.4) and 9.1% (95% CI 3.8 to 14.4) medial to the implant in W2 for resurfaced replacements and THRs respectively. Resurfacing resulted in a mean loss of BMD of 6.7% (95% CI 0.7 to 12.7) in W3 but the BMD inferior to the acetabular component was maintained in both groups. These results suggest that the ability of a resurfacing hip replacement to preserve BMD only applies to the femoral side.

  20. Prediction of femoral neck and spine bone mineral content from the BMC of the radius or ulna and the relationship between bone strength and BMC

    Science.gov (United States)

    Wilson, C. R.

    1974-01-01

    The bone mineral content (BMC) is extensively used to provide information about the status of an entire skeleton. Changes in BMC are employed to evaluate the effect of various drugs, disease states, weightlessness, exercise, renal dialysis and others on the skeleton. Clinical and functional information is discussed that may be derived from the BMC of a limited region of the skeleton. In particular there is a fairly high degree of correlation between the BMC of the radius or ulna and that of the femoral neck, r about 0.85 and a somewhat lower relationship between the BMC of the radius or ulna and the thoracic vertebrae, r about 0.65. Also the BMC is highly related to the strength of bone at that scan site.

  1. Reliability of using DXA around RTHAs. Bone Mineral Density of the femoral neck in resurfacing hip arthroplasty. Precision biased by region of interest and rotation of the hip

    DEFF Research Database (Denmark)

    Penny, Jeannette Østergaard; Varmarken, Jens-Erik; Ovesen, Ole;

    2009-01-01

      Introduction:  Resurfacing Total Hip Arthroplasty (RTHA) may preserve the femoral neck bone-stock post-operatively. Bone Mineral Density (BMD), could theoretically be affected by the hip-position, and bias longitudinal studies. We aimed to investigate BMD precision dependency on type of ROI...... and position of hip.   Method and Materials  We DXA scanned the femoral neck of 15 resurfacing patients twice with the hip in 3 different rotations; 15° internal, neutral, and 15° external. For each position BMD was analyzed with 3 different surface area models. One model measured BMD in the total femoral neck......, the second model divided the neck in two and the third model had 6 divisions.   Results  When all hip positions were pooled a mean Coefficient of variation (CV) of 3.1%, 3.6% and 4.6% was found in the 1, 2 and 6-region models, respectively, The external rotated hip position was less reproducible. When...

  2. Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement

    DEFF Research Database (Denmark)

    Penny, J O; Brixen, K; Varmarken, J E;

    2012-01-01

    It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into ...

  3. Brodie's abscess of the femoral neck simulating osteoid osteoma.

    Science.gov (United States)

    Gulati, Yash; Maheshwari, Aditya V

    2007-10-01

    Subacute osteomyelitis (Brodie's abscess) is essentially a problem of diagnosis, and there may be considerable difficulty in distinguishing it from other benign and malignant bone lesions. Though reported in the metaphyseal region of the femur, Brodie's abscess is rarer in the femoral neck. The authors present a case of Brodie's abscess in the femoral neck, which clinico-radiologically simulated an osteoid osteoma. Retrospectively, the presence of a cortical sinus tract should have aroused suspicion.

  4. Salvage of failed osteosynthesis of an intracapsular fracture of the femoral neck using two cannulated compression screws and a vascularised iliac crest bone graft.

    Science.gov (United States)

    Xiaobing, Y; Dewei, Z

    2015-07-01

    We evaluated the outcome of treatment of nonunion of an intracapsular fracture of the femoral neck in young patients using two cannulated screws and a vascularised bone graft. A total of 32 patients (15 women and 17 men, with a mean age of 36.5 years; 20 to 50) with failed internal fixation of an intracapsular fracture were included in the study. Following removal of the primary fixation, two cannulated compression screws were inserted with a vascularised iliac crest bone graft based on the ascending branch of the lateral femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved in 27 hips (84%). A total of five patients with a mean age of 40.5 years (35 to 50) had a persistent nonunion and underwent total hip arthroplasty as also did two patients whose fracture united but who developed osteonecrosis of the femoral head two years post-operatively. Statistical analysis showed that younger patients achieved earlier and more reliable union (p 45 years (p osteosynthesis of a displaced intracapsular fractures of the femoral neck has failed.

  5. Changes in bone mineral density and femoral neck narrowing in the proximal femur three to five years after hip resurfacing versus conventional total hip arthroplasty.

    Science.gov (United States)

    Gerhardt, Davey M J M; Smolders, José M H; Rijnders, Ton A J M; Hol, Annemiek; van Susante, Job L C

    2015-02-01

    We studied whether bone mineral density (BMD) is preserved without significant femoral neck narrowing (FNN) after hip resurfacing (RHA) (n=42) versus small diameter metal-on-metal total hip arthroplasty (MoM THA) (n=40). In this three to five year randomized trial BMD was measured in the calcar with dual energy absorptiometry (DXA) preoperatively, at three and six months, one, two, three and five years postoperatively. Four additional BMD regions of interest (ROIs) and femoral neck narrowing (FNN) were measured after RHA. BMD in the calcar increased to 107% (P<0.001) at one year and remained stable. Additional ROIs in the femoral neck and trochanter-area BMD changes fluctuated between 99.9% and 104.1%. FNN was minimal with a mean of 1.3% at three years. After THA BMD decreased in the calcar to 80% at one year (P<0.001) and stabilized. This bone stock preserving nature of RHA must be weighed against potential disadvantages caused by specific metal-on-metal bearing problems.

  6. THE RESULTS OF THE CLINICAL USE OF A NEW METHOD OF OSTEOSYNTHESIS WITH NON-FREE BONE AUTOPLASTY AT THE MEDIAL FEMORAL NECK FRACTURES

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2013-01-01

    Full Text Available Objective - to improve treatment outcomes in patients with medial fractures of the femoral neck through the development and introduction into clinical practice a new method of fixation with non-free plastic by the autograft from the iliac crest on a permanent muscular-vascular pedicle. Materials and methods. A comparative analysis of short- and long-term results of surgical treatment of 57 patients with medial fractures of the femoral neck, which were divided into primary and control groups. The study group included 24 patients who have undergone an osteosynthesis with cannulated screws with additional autoplasty with vascularized graft from the iliac crest. The control group consisted of 33 patients who underwent fixation with cannulated screws for the traditional method. Results. The use of non-free bone autoplasty in the main group of patients provided the best short- and long-term outcomes: fracture healing occurred in all cases in a period of 6 to 8 months. The long-term results of treatment of 22 patients after 2-6 years after the operation showed comparatively better anatomical functional outcomes. Conclusions. The indications for the clinical use of the fixation with the non-free bone autotransplantation are prognostically unfavorable for the union medial fractures of the femoral neck (II-III types by Pauwels or III-IV types by Garden in patients aged under 60 years with no signs of deforming arthrosis II-III stages.

  7. Nano-structural, compositional and micro-architectural signs of cortical bone fragility at the superolateral femoral neck in elderly hip fracture patients vs. healthy aged controls.

    Science.gov (United States)

    Milovanovic, Petar; Rakocevic, Zlatko; Djonic, Danijela; Zivkovic, Vladimir; Hahn, Michael; Nikolic, Slobodan; Amling, Michael; Busse, Bjoern; Djuric, Marija

    2014-07-01

    To unravel the origins of decreased bone strength in the superolateral femoral neck, we assessed bone structural features across multiple length scales at this cortical fracture initiating region in postmenopausal women with hip fracture and in aged-matched controls. Our combined methodological approach encompassed atomic force microscopy (AFM) characterization of cortical bone nano-structure, assessment of mineral content/distribution via quantitative backscattered electron imaging (qBEI), measurement of bone material properties by reference point indentation, as well as evaluation of cortical micro-architecture and osteocyte lacunar density. Our findings revealed a wide range of differences between the fracture group and the controls, suggesting a number of detrimental changes at various levels of cortical bone hierarchical organization that may render bone fragile. Namely, mineral crystals at external cortical bone surfaces of the fracture group were larger (65.22nm±41.21nm vs. 36.75nm±18.49nm, pfracture group. Fracture cases showed nearly 35% higher cortical porosity and showed significantly reduced osteocyte lacunar density compared to controls (226±27 vs. 247±32#/mm(2), p=0.05). Along with increased crystal size, a shift towards higher mineralization and a tendency to increased cortical porosity and reduced osteocyte lacunar number delineate that cortical bone of the superolateral femoral neck bears distinct signs of fragility at various levels of its structural organization. These results contribute to the understanding of hierarchical bone structure changes in age-related fragility. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Femoral neck radiography: effect of flexion on visualization

    Energy Technology Data Exchange (ETDEWEB)

    Garry, S.C. [Univ. of Alberta, Dept. of Radiology and Diagnostic Imaging, Walter C Mackenzie Health Sciences Centre, Edmonton, Alberta (Canada); Jhangri, G.S. [Univ. of Alberta, Dept. Public Health Sciences, Edmonton, Alberta (Canada); Lambert, R.G.W. [Univ. of Alberta, Dept.of Radiology and Diagnostic Imaging, Walter C Mackenzie Health Sciences Centre, Edmonton, Alberta (Canada)]. E-mail: rglamber@cha.ab.ca

    2005-06-15

    To determine whether flexion improves radiographic visualization of the femoral neck when the femur is externally rotated. Five human femora, with varying neck-shaft and anteversion angles, were measured and immobilized. Degree of flexion required to bring the femoral neck horizontal was measured, varying the rotation. Next, one bone was radiographed in 16 positions, varying rotation in 15{sup o} and flexion in 10{sup o} increments. Radiographs were presented in randomized blinded fashion to 15 staff radiologists for scoring of femoral neck visualization. Following this, all 5 bones were radiographed in 4 positions of rotation and at 0{sup o} and 20{sup o} flexion, and blinded randomized review of radiographs was repeated. Comparisons between angles and rotations were made using the Mann-Whitney test. The flexion angle required to bring the long axis of the femoral neck horizontal correlated directly with the degree of external rotation ({rho} < 0.05). Visualization of the femoral neck in the extended position progressively deteriorated from 15{sup o} internal rotation to 30{sup o} external rotation ({rho} <0.01). However, when 20{sup o} flexion was applied to bones in external rotation, visualization significantly improved at 15{sup o} ({rho} <0.05) and 30{sup o} ({rho} <0.01). Flexion of the externally rotated femur can bring the femoral neck into horizontal alignment, and a relatively small amount (20{sup o}) of flexion can significantly improve radiographic visualization. This manoeuvre could be useful for radiography of the femoral neck when initial radiographs are inadequate because of external rotation of the leg. (author)

  9. Effect of beta-blockers on bone mass and biomechanical parameters of the femoral neck in males with acute myocardial infarction.

    Science.gov (United States)

    Pérez-Castrillón, José L; Vega, Gemma; Abad, Laura; Sanz, Alberto; Mendo, Marcelino; Porrero, Miguel García; Dueñas, Antonio

    2007-05-01

    Evaluate the effect of cardioselective beta-blockers on bone mass and biomechanical properties of the femoral neck in males with acute myocardial infarction. Forty males with acute myocardial infarction were studied during one year. Seventy-five percent of the patients (30 patients) were treated with cardioselective beta-blockers and 10 were not similarly treated. A hip densitometry was performed upon release and one year later. The BMD was measured in the femoral neck and in biomechanical elements obtained by DXA. Both groups had similar clinical conditions at the beginning of the study and after a one-year follow-up. No differences in the BMD (0.934+/-0.12 vs. 0.921+/-0.14) were observed in the group without beta-blockers or in the group with beta-blockers (0.980+/-0.12 vs. 0.977+/-0.12). No differences were observed in the measured structural parameters. The cardioselective beta-blockers do not modify bone mass or the structural bone parameters in males with acute myocardial infarction.

  10. Biogeometry of femoral neck for implant placement

    Directory of Open Access Journals (Sweden)

    Patwa J

    2006-01-01

    Full Text Available Background : Treatment of fracture neck femur with three cannulated cancellous screws in an apex proximal configuration is practised in many parts of the world. Methods : Dimensions of femoral neck at the middle of transcervical neck using CT scan (live neck and vernier caliper (dry cadeveric neck in 20 subjects respectively were measured. Results : Inferior half of the neck is narrower than superior half. Conclusion : Biogeometry of the neck of femur does not accomodate two inferior screws and thus fixation of fracture neck femur with three canulated cancellous screws in an apex distal configuration is recommended.

  11. Sexual dimorphism of femoral neck cross-sectional bone geometry in athletes and non-athletes: a hip structural analysis study.

    Science.gov (United States)

    Hind, Karen; Gannon, Lisa; Whatley, Emma; Cooke, Carlton

    2012-07-01

    The characterisation of bone geometry in male and female athletes may increase our understanding of how physical loading may enhance bone strength in both sexes. This study investigated sexual dimorphism in hip geometry of athletes and age- and sex-matched non-athletes. Dual energy X-ray absorptiometry of the left proximal femur was performed in 62 male (n = 31; 30.2 ± 4.6 years) and female (n = 31; 27.9 ± 5.2 years) competitive endurance runners, and 36 male (n = 18; 28.7 ± 5.8 years) and female (n = 18; 29.1 ± 5.3 years) non-athletes. The hip structural analysis programme determined areal bone mineral density (aBMD), bone area (BA), hip axis length, cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) of the femoral neck. Strength indices were derived from the femoral strength index (FSI) (Yoshikawa et al., J Bone Miner Res 9:1053-1064, 1994). Despite similar size-adjusted aBMD, sexual dimorphism was apparent for BA, CSA and CSMI, with superior values in men compared to women (P < 0.01). FSI was greater in male and female athletes than non-athletes (P < 0.01). From all groups, results in male athletes inferred greatest resistance to axial (CSA) and bending loads (FSI). Estimates of bone strength (FSI) were greater in female athletes than male and female non-athletes, supporting the osteogenic value of regular loading of the hip.

  12. 股骨颈骨折愈合后钉道植骨应力分布的有限元分析%Finite element analysis of the stress distribution in femoral head and neck of bone grafting in nail path after femoral neck fracture heating

    Institute of Scientific and Technical Information of China (English)

    唐洪涛; 仝允辉; 张美超; 赵卫东

    2011-01-01

    Objective:To investigate the rationality of bone grafting in nail path after femoral neck fracture healing and internal fixator was removed so as to provide theoretical support for clinical therapy. Methods: Two three - dimensional finite element models of the femoral head and neck region were reconstructed after femoral neck fracture healing and internal fixator was removed,one undergone bone grafting.Both of the models were simulated under the load of body weight,and the stress and shift on the femoral head and neck were calculated and compared. Results: Analysis of the three - dimension finite element model showed that the massive stress concentrated on weight loading region of femoral head without bone grafting,while the massive stress concentrated on the region of calcar femorale of grafting- bone model.The max - stress value (0.482 E + 8) in the weight loading region of femoral head without bone grafting was far higher than the max - stress value(0.295 E +8) of ungrafting - bone model. In the nail path shift test,value of shift in the region of femoral head of the ungrafting -bone model (0.391 E - 0.3 ) significantly exceeded that of grafting - bone model (0.352 E - 0.3 ). Conclusion: For the treatment of femoral neck fracture with hollow compression screws, bone grafting in the channel of screw should be used to improve biomechanical integrity of femoral head and neck after fracture healed and hollow compression screws were taken out. This is of benefit to preventing the collapse of femoral head owing to excessive stress concentration on femoral head.%目的:探讨股骨颈骨折经空心加压螺钉固定,骨折愈合后取出螺钉遗留的钉道内是否应予植骨,为临床选择治疗方法提供依据.方法:重建人体股骨头颈部的三维有限元仿真模型,模拟钉道不植骨与钉道植骨的股骨头颈部,对模型进行虚拟加栽和仿真计算.比较2种模型在同一载荷下的应力分布及位移情况.结果:不植骨模型的

  13. Magnetic Resonance Imaging of the Femoral Neck Cortex

    Energy Technology Data Exchange (ETDEWEB)

    Sievaenen, H.; Karstila, T.; Apuli, P.; Kannus, P. [Bone Research Group, UKK Inst., Tampere (Finland)

    2007-04-15

    Purpose: To determine the in vivo precision and accuracy of magnetic resonance imaging (MRI) in evaluating the thin (emm) femoral neck cortex. Material and Methods: Hip regions of 30 volunteers were scanned with standard 1.5T MRI twice with repositioning, and the images of the narrow-neck cross-sections were obtained. Two radiologists independently delineated periosteal and endosteal cortical boundaries, and several structural variables were determined. For precision, 95% limits of agreement and coefficients of variation were calculated. Accuracy was determined with phantoms. Results: In vivo precision of the directly delineated measurements varied from 0.9% (periosteal circumference) to 1.6% (total area), while the precision of the calculated variables remained poorer, from 7.3% (cortical to total area ratio) to 15.1% (torsional rigidity). The root-mean-square error of the cortical thickness measurement was 0.15 mm. Conclusion: Thin cortical bone at the narrowest location of the femoral neck can be delineated precisely and accurately with a standard clinical 1.5T MRI device. MRI provides a feasible tool for the assessment of mechanically important cortical bone at the femoral neck and may be of clinical utility in assessing hip fragility. Keywords Bone densitometry, bone fragility, bone strength, osteoporosis, precision.

  14. The use of recombinant human bone morphogenetic protein-2 for the treatment of a delayed union following femoral neck open-wedge osteotomy

    Directory of Open Access Journals (Sweden)

    Axel W.A. Baltzer

    2012-03-01

    Full Text Available Although the clinical potential of bone morphogenetic proteins (BMPs has been known for decades, their use in humans has only been approved for a limited number of orthopaedic conditions. Promising results in animals demonstrate the utility of BMP-2 in regional bone repair without using osteoconductors. To our knowledge, no comparable human case has been described. We report the case of a 50- year-old who suffered a femoral neck fracture. After 9 months of extensive treatment, he was still not pain-free. The following open-wedge osteotomy resulted in a therapy-resistant delayed union. We therefore conducted 4 computer tomography-guided injections of recombinant human (rh BMP-2 into the bone gap. No osteoconductor was employed. Six weeks later, there was a 55-60% defect filling. Followup examination showed a complete union of the bone defect. Our case report shows that in a complicated delayed union rhBMP-2 can be successfully used to induce bone formation without any osteoconductor.

  15. Cortical Marrow Ratio in Plain X-rays of Femoral Neck Fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Severin Gråe Harbo, Frederik; Ryg, Jesper

    2016-01-01

    Objectives: The purpose of this study is to evaluate Cortical Marrow Ratio (CMR) for reliability and relation to low Bone Mineral Density (BMD) in patients with femoral neck fractures. Methods: A total of 132 consecutive femoral neck fracture patients (median age 81.2 years, IQR 70.6-86.1) were a...

  16. The Association of Femoral Neck Stress Fractures with Femoral Acetabular Impingement

    Science.gov (United States)

    Safran, Marc R.; Goldin, Michael; Anderson, Christian; Fredericson, Michael; Stevens, Kathryn J.

    2013-01-01

    Objectives: To determine if there is an increased incidence of femoral acetabular impingement (FAI) in patients presenting with stress fractures of the femoral neck. Methods: After IRB approval, the imaging studies of 25 athletes (22 females, 3 males, mean age 26, range 19 - 39 years) with femoral neck stress injuries were assessed for the presence of features suggesting FAI, including acetabular retroversion, coxa profunda, abnormal femoral head-neck junction, fibrocystic change, os acetabulae, labral tear and chondral injury. All subjects had to have an adequate AP Pelvis radiograph, a lateral radiograph of the affected hip, and an MRI of the affected hip. The alpha angle, anterior offset ratio, and center to edge (CE) angle were measured on radiographs. The grade of stress injury was determined on MR images. All images and measurements were made by a musculoskeletal fellowship trained radiologist, a fellowship trained orthopaedic surgeon, an orthopaedic sports medicine fellow and a physical medicine and rehabilitation resident. Charts were reviewed to determine treatment of the stress fracture, outcome and final follow up, as well as to determine if the patient had any further treatment for their hip. Results: Of the 25 hips (18 right, 7 left) with femoral neck stress reactions, 9 were grade 2 (bone marrow edema), 5 were grade 3 (high T2 and low T1 marrow signal), and 11 were grade 4 (stress fracture). Twenty patients (80%) had coxa profunda - where the floor of the cotyloid fossa touches or extends beyond the ilioischial line (incidence in general population is 15.2% of males, and 19.4% of females). Coxa profunda, defined by the floor of the cotyloid fossa touching or extending beyond the ilioischial line and a center edge angle of more than 35o, was present in 28% of subjects. Acetabular retroversion as assessed by the crossover sign was present in 42% (normal incidence is 5% of population). Center edge angle was greater than 35o in 20% and greater than 40 o

  17. Ipsilateral femoral neck and trochanter fracture

    Directory of Open Access Journals (Sweden)

    Devdatta S Neogi

    2011-01-01

    Full Text Available Ipsilateral fractures in the neck and trochanteric region of the femur are very rare and seen in elderly osteoporotic patients. We present a case of a young man who presented with ipsilateral fracture of the femoral neck and a reverse oblique fracture in the trochanteric region following a motor vehicle accident. A possible mechanism, diagnostic challenge, and awareness required for identifying this injury are discussed.

  18. Hip resurfacing femoral neck fracture influenced by valgus placement.

    Science.gov (United States)

    Anglin, Carolyn; Masri, Bassam A; Tonetti, Jérôme; Hodgson, Antony J; Greidanus, Nelson V

    2007-12-01

    Femoral neck fracture is the most common short-term concern after hip resurfacing arthroplasty. Currently, there is little basis to decide between neutral and valgus placement. We loaded 10 notched cadaveric femur pairs to failure; one side was implanted at 0 degrees relative to the femoral neck and the other at 10 degrees valgus. All 20 were dual-energy X-ray absorptiometry-scanned. Failure load correlated with bone mineral density. Valgus placement increased the fracture load by an average of 28% over neutral for specimens with normal bone mineral density but had no effect on fracture load in specimens with low bone mineral density. For specimens with normal bone mineral density (typical of patients undergoing resurfacing arthroplasty), neutral-valgus placement had a greater effect than bone mineral density, explaining 54% of the fracture load variance. Component placement greater than 10 degrees valgus is likely undesirable because this can lead to an increase in component size and a greater likelihood of notching. To reduce fracture risk, we recommend placing the femoral component in valgus and selecting patients with higher bone mineral density.

  19. Cortical and trabecular load sharing in the human femoral neck.

    Science.gov (United States)

    Nawathe, Shashank; Nguyen, Bich Phuong; Barzanian, Nasim; Akhlaghpour, Hosna; Bouxsein, Mary L; Keaveny, Tony M

    2015-03-18

    The relative role of the cortical vs trabecular bone in the load-carrying capacity of the proximal femur-a fundamental issue in both basic-science and clinical biomechanics-remains unclear. To gain insight into this issue, we performed micro-CT-based, linear elastic finite element analysis (61.5-micron-sized elements; ~280 million elements per model) on 18 proximal femurs (5M, 13F, ages 61-93 years) to quantify the fraction of frontal-plane bending moment shared by the cortical vs trabecular bone in the femoral neck, as well as the associated spatial distributions of stress. Analyses were performed separately for a sideways fall and stance loading. For both loading modes and across all 18 bones, we found consistent patterns of load-sharing in the neck: most proximally, the trabecular bone took most of the load; moving distally, the cortical bone took increasingly more of the load; and more distally, there was a region of uniform load-sharing, the cortical bone taking the majority of the load. This distal region of uniform load-sharing extended more for fall than stance loading (77 ± 8% vs 51 ± 6% of the neck length for fall vs. stance; mean ± SD) but the fraction of total load taken by the cortical bone in that region was greater for stance loading (88 ± 5% vs. 64 ± 9% for stance vs. fall). Locally, maximum stress levels occurred in the cortical bone distally, but in the trabecular bone proximally. Although the distal cortex showed qualitative stress distributions consistent with the behavior of an Euler-type beam, quantitatively beam theory did not apply. We conclude that consistent and well-delineated regions of uniform load-sharing and load-transfer between the cortical and trabecular bone exist within the femoral neck, the details of which depend on the external loading conditions.

  20. Genetic predisposition for femoral neck stress fractures in military conscripts

    OpenAIRE

    Barral Sandra; Sahi Timo; Ruohola Juha-Petri; Solovieva Svetlana; Pihlajamäki Harri; Hartikka Heini; Korvala Johanna; Ott Jürg; Ala-Kokko Leena; Männikkö Minna

    2010-01-01

    Abstract Background Stress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures. Results Eight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5...

  1. Longitudinal study on physical fitness parameters influencing bone mineral density reduction in middle-aged and elderly women: bone mineral density in the lumbar spine, femoral neck, and femur.

    Science.gov (United States)

    Iida, Tadayuki; Ikeda, Hiromi; Shiokawa, Michihisa; Aoi, Satomi; Ishizaki, Fumiko; Harada, Toshihide; Ono, Yuichiro

    2012-06-01

    The prolongation of the average life span of women has been associated with the rapidly aging society. However, serious problem have arisen as a result, such as an increase in the number of bed-ridden elderly patients with osteoporosis-associated femoral neck fracture. As preventive measures against osteoporosis for middle-aged to elderly women, 10,000 steps per day and intense exercise have been reported to inhibit bone mineral density (BMD) reduction. However, only a few studies have concretely reported on the type of physical fitness that is effective for BMD in particular parts of the body. In this study, a one-year longitudinal survey was performed involving generally healthy postmenopausal women to investigate physical fitness parameters influencing BMD in the lumbar spine, femoral neck, and femur. The subjects were 38 female residents of M City, aged 49-73 years. As physical fitness parameters, sit-ups, anteflexion in a sitting position, grip strength, mean amount of exercise (kcal), and area of outer body sway on standing straight with the eyes closed (m2) were measured. The BMD was measured in the lumbar spine (L2-L4), femoral neck, and femur. Logistic regression analysis was performed regarding the physical fitness parameters as explanatory variables and groups with and without BMD reduction over one year as those with and without risk as dependent variables. The number of sit-ups (odds ratio: 0.76, 95% CI: 0.61-0.96, p=0.022) was a preventive factor against BMD reduction of the lumbar spine, and ante flexion in a sitting position was a preventive factor against BMD reduction of the femoral neck (odds ratio: 0.88, 95% CI: 0.78-0.99, p=0.029). Regarding BMD reduction of the femur, the area of outer body sway on standing straight with the eyes closed tended to be not significant to the risk. It is suggested that physical fitness and local muscle strength are associated with BMD reduction in the lumbar spine, femoral neck, and femur.

  2. Association and linkage analysis of COL1A1 and AHSG gene polymorphisms with femoral neck bone geometric parameters in both Caucasian and Chinese nuclear families

    Institute of Scientific and Technical Information of China (English)

    Hui JIANG; Shu-feng LEI; Su-mei XIAO; Yuan CHEN; Xiao SUN; Fang YANG; Li-ming LI; Shun WU; Hong-wen DENC

    2007-01-01

    Aim: To simultaneously investigate the contribution of the alpha 1 chain of col-lagen type 1 (COL1A1) and alpha2-HS-glycoprotein (AHSG) genes to the varia-tion of bone geometric parameters in both Caucasians and Chinese. Methods: Six hundred and five Caucasian individuals from 157 nuclear families and 1228 Chi-nese subjects from 400 nuclear families were genotyped at the AHSG-Sacl, COL1A1-PCOL2 and Sp1 polymorphisms using polymerase chain reaction (PCR)-restric-tion fragment length polymorphism (RFLP). 5 FN bone geometric parameters were calculated based on bone mineral density and bone area of femoral neck (FN)measured by dual energy X-ray absorptiometry. Population stratification, total family association, within-family association, and linkage tests were performed by the quantitative transmission disequilibrium test program. Results: The t-test showed the significant differences of all bone geometric phenotypes (except ED)between Caucasians and Chinese in the offspring using both unadjusted and adjusted (by age, height, weight, and gender) data. In Caucasians, we found significant within-family association results between the COL1A1-Sp1 polymor-phism (rs1800012) and cross sectional area (CSA), cortical thickness (CT),endocortical diameter (ED), buckling ratio (BR) (P=0.018, 0.002, 0.023, and 0.001,respectively); the COL1A1-Sp1 polymorphism also detected significant linkage with BR (P=0.039). In the population of China, the within-family associations between the COL1A1-PCOL2 polymorphism (rs1107946) and CT, BR were signifi-cant (P=0.012 and 0.008, respectively). Furthermore, evidence of linkage were observed between the AHSG-SacI polymorphism (rs4918) and CT, BR (P--0.042 and 0.014, respectively) in Caucasians, but not in Chinese. Conclusion: Our results suggest that the COL1A1 gene may have significantly association with bone geometry in both Caucasians and Chinese, and the AHSG gene may be linked to bone geometry in Caucasians, but not in Chinese. This study

  3. Ipsilateral Acetabular and Femoral Neck and Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Hideto Irifune

    2015-01-01

    Full Text Available Floating hip injuries and ipsilateral femoral neck and shaft fractures are rare. Additionally, the simultaneous occurrence of these injuries is extremely rare, and only one case report of the simultaneous occurrence of these injuries has been published. Here, we report the case of a patient with ipsilateral acetabular and femoral neck and shaft fractures following a suicide attempt. The patient experienced nonunion of the femoral neck and shaft after the initial operation and therefore underwent reconstruction using a femoral head prosthesis with a long stem and interlocking screws. Our procedure may be used in primary and/or secondary reconstruction for ipsilateral acetabular and femoral neck and shaft fractures.

  4. Simultaneous bilateral femoral neck fractures after electrical shock injury: a case report

    Institute of Scientific and Technical Information of China (English)

    Harminder Singh Sohal; Darsh Goyal

    2013-01-01

    Simultaneous bilateral fractures of the femoral necks are rare injuries,especially when there is no underlying pathological condition.We report a 20-year-old man who sustained bilateral femoral neck fractures resulting from an accidental electric shock with 440 Ⅴ direct current.Simultaneous bilateral femoral neck fractures after electrical shock injury without falling from a height are rather uncommon in clinic.The main cause of the fracture may be muscle contraction.This case highlights that even in the absence of primary and secondary bone disease,bilateral fractures of the femoral necks can occur following electric shock injury.We successfully managed this case with bilateral cannulated screw fixation without bone grafting.Surgeons caring for patients with electrical injury should be aware of the possibility of skeletal injuries which can go unnoticed,leading to delay in diagnosis and increased risk of complications.

  5. Aneurysmal femoral neck cyst: Report of a paediatric case and review of literature

    Directory of Open Access Journals (Sweden)

    Oumar Ndour

    2016-01-01

    Full Text Available The aneurysmal bone cyst (ABC is a benign tumour of children and young adults. It represents approximately 1-2% of all bone tumours. The ABC may develop on all skeletal bones, but the proximal end of the femur is the most common location. The authors report a ABC femoral neck in a child of 13 years. This location is pretty special. Indeed, the fragility of the femoral neck due partly to the pathology itself and secondarily curettage requires a judicious attitude surgical (excisional curettage + bone graft + screw to prevent the risk of high local recurrence and pathological fracture.

  6. Redox Status in Patients with Femoral Neck Fractures

    Directory of Open Access Journals (Sweden)

    Pesic Goran

    2016-09-01

    Full Text Available The femur transfers the body weight from the pelvic bone to the shinbone. Femur fractures are a significant cause of morbidity and mortality among the group of locomotor apparatus injuries, especially in the elderly population. Considering that oxidative stress occurs as a result of increased production of free radicals that damage cell function and cause numerous pathological conditions and diseases, the aim of this study was to investigate oxidative stress parameters in older patients with femoral neck fractures. This clinical study included 70 patients, of which 35 had femoral neck fractures (26 males and 9 females, while the other half of the patients formed the matched control group. Markers of oxidative stress (NO2−, TBARS, H2O2 and O2- and anti-oxidative enzymes (SOD, CAT, and GSH were measured. Results showed that the levels of O2- increased, while levels of NO2-, H2O2 and all the antioxidative enzymes decreased in patients with femoral neck fractures. These findings indicate that fractures cause oxidative stress, probably because of the reduced activity of osteoblasts and the increased activity of osteoclasts.

  7. Differences in the trajectory of bone mineral density change measured at the total hip and femoral neck between men and women following hip fracture.

    Science.gov (United States)

    Rathbun, Alan M; Shardell, Michelle; Orwig, Denise; Hebel, J Richard; Hicks, Gregory E; Beck, Thomas; Hochberg, Marc C; Magaziner, Jay

    2016-01-01

    Research has not examined changes in bone mineral density (BMD) between men and women following hip fracture. The aim was to evaluate sex differences in BMD following hip fracture. Men experienced significant declines in BMD, while not statistically greater than women, underscoring the necessity for better osteoporosis care in men. Each year in the USA, approximately 260,000 older adults experience a hip fracture. Women experiencing hip fracture have excess decline in BMD in the year following fracture compared to expected decrements due to aging, but few studies have assessed sex differences in the sequelae of hip fracture. Thus, our objective was to examine sex differences in BMD change in the year after hip fracture. The sample (n = 286) included persons enrolled in the Baltimore Hip Studies 7th cohort, a study that matched (1:1) men and women experiencing hip fracture. Weighted estimating equations that accounted for missing data and selective survival were used to estimate sex differences in 12-month total hip (TH) and femoral neck (FN) BMD changes. Men had larger average adjusted percent decline in TH and FN BMD. Adjusted 12-month decreases at the FN showed a statistically significant decline of -4.60% (95% confidence interval [CI] -7.76%, -0.20%) in men and an insignificant change of -1.62% (95% CI -4.57%, 1.32%) in women. Yet, the difference in change between men and women was not statistically significant (P = 0.17). The estimated sex differences for TH BMD loss were smaller in magnitude. There is evidence of significant BMD loss among men at the FN in the year after hip fracture. Although not statistically greater than women, these clinically significant findings highlight the need for improved osteoporosis care among men prior to and after hip fracture.

  8. Differential influence of physical activity on lumbar spine and femoral neck bone mineral density in the elderly population.

    Science.gov (United States)

    Vuillemin, A; Guillemin, F; Jouanny, P; Denis, G; Jeandel, C

    2001-06-01

    This study investigates the relationship between lifetime physical activity and bone mineral density (BMD) at various sites in 129 healthy men and women aged 72.1 +/- 6.5 years. BMD was measured by dual energy x-ray absorptiometry, and physical activity was assessed by using the QUANTAP system (Quantification de l'Activité Physique), a standardized and structured computer-assisted interview tool designed to assess lifetime physical activity. Linear regression models controlling for age, gender, height, body mass, lean mass, and smoking habits were performed. Higher levels of sporting activity during youth were associated with greater lumbar spine BMD ( p construction and bone aging taking place at the time.

  9. Short-term Results of Muscle-Pedicle Bone Grafting with Tensor Fascia Lata for Delayed Femoral Neck Fractures; Case Series and Literature Review

    Directory of Open Access Journals (Sweden)

    Kuldip Salgotra

    2016-04-01

    Full Text Available Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7% men and 1 (14.3% women among the patients. Overall 5 (71.5% patients had transcervical and 2 (28.5% had subcapital fractures. At the end of 6 months, 6 (85.7% patients were pain free and on plain radiographs fracture union was noted. One (14.3% patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures.

  10. Genetic predisposition for femoral neck stress fractures in military conscripts

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    Barral Sandra

    2010-10-01

    Full Text Available Abstract Background Stress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures. Results Eight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5, IL-6 were examined in 72 military conscripts with a femoral neck stress fracture and 120 controls. The risk of femoral neck stress fracture was significantly higher in subjects with low weight and body mass index (BMI. An interaction between the CTR (rs1801197 minor allele C and the VDR C-A haplotype was observed, and subjects lacking the C allele in CTR and/or the C-A haplotype in VDR had a 3-fold higher risk of stress fracture than subjects carrying both (OR = 3.22, 95% CI 1.38-7.49, p = 0.007. In addition, the LRP5 haplotype A-G-G-C alone and in combination with the VDR haplotype C-A was associated with stress fractures through reduced body weight and BMI. Conclusions Our findings suggest that genetic factors play a role in the development of stress fractures in individuals subjected to heavy exercise and mechanical loading. The present results can be applied to the design of future studies that will further elucidate the genetics of stress fractures.

  11. MR evaluation of femoral neck version and tibial torsion

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)

    2012-01-15

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  12. Bilateral impacted femoral neck fracture in a renal disease patient

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    Pramod Devkota

    2013-01-01

    Full Text Available Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

  13. Treatment of the femoral neck peudoarthrosis in childhood: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5­year­old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X­ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit®. Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow­up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X­ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults can prevent the occurrence of femoral neck pseudoarthrosis.

  14. Hip Hemiarthroplasty for Femoral Neck Fractures Using the Modified ...

    African Journals Online (AJOL)

    The patients had good hip abduction postoperatively. In addition ... Key words: Femoral neck fractures, hip hemiarthroplasty, ... the overall blood loss at surgery and morbidity after surgery, ... Their clinical and demographic features were noted.

  15. Ipsilateral femoral neck and shaft fractures: An overlooked association

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA)); Riemer, B.L.; Butterfield, S.L. (Dept. of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA))

    1991-05-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG).

  16. A case of stress fracture of the femoral neck; Przypadek przeciazeniowego zlamania szyjki kosci udowej

    Energy Technology Data Exchange (ETDEWEB)

    Walenczak, K.; Widawski, T. [Szpital MSW, Lodz (Poland)

    1993-12-31

    A case of 28 years-old male with stress fracture of the femoral neck is presented. Heterogeneous clinical picture is blamed for diagnostic problems in the initial stage of the disease. Bone scintigraphy aids in the early diagnosis. The use of low frequency electromagnetic field had unquestionable effect on shortening of the treatment time in the case reported. (author). 10 refs, 1 fig.

  17. Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients

    Directory of Open Access Journals (Sweden)

    Bhava RJ Satish

    2013-01-01

    Conclusion: Closed reduction and cannulated cancellous screw fixation gives satisfactory functional results in large group of elderly patients. The four quadrant parallel peripheral (FQPP screw fixation technique gives good stability, allows controlled collapse, avoids fixation failure and achieves predictable bone healing in displaced femoral neck fracture in patients ≥50 years of age.

  18. Effects of ground and joint reaction force exercise on lumbar spine and femoral neck bone mineral density in postmenopausal women: a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Kelley George A

    2012-09-01

    Full Text Available Abstract Background Low bone mineral density (BMD and subsequent fractures are a major public health problem in postmenopausal women. The purpose of this study was to use the aggregate data meta-analytic approach to examine the effects of ground (for example, walking and/or joint reaction (for example, strength training exercise on femoral neck (FN and lumbar spine (LS BMD in postmenopausal women. Methods The a priori inclusion criteria were: (1 randomized controlled trials, (2 exercise intervention ≥ 24 weeks, (3 comparative control group, (4 postmenopausal women, (5 participants not regularly active, i.e., less than 150 minutes of moderate intensity (3.0 to 5.9 metabolic equivalents weight bearing endurance activity per week, less than 75 minutes of vigorous intensity (> 6.0 metabolic equivalents weight bearing endurance activity per week, resistance training g was calculated for each FN and LS BMD result and pooled using random-effects models. Z-score alpha values, 95%confidence intervals (CI and number-needed-to-treat (NNT were calculated for pooled results. Heterogeneity was examined using Q and I2. Mixed-effects ANOVA and simple meta-regression were used to examine changes in FN and LS BMD according to selected categorical and continuous variables. Statistical significance was set at an alpha value ≤0.05 and a trend at >0.05 to ≤ 0.10. Results Small, statistically significant exercise minus control group improvements were found for both FN (28 g’s, 1632 participants, g = 0.288, 95% CI = 0.102, 0.474, p = 0.002, Q = 90.5, p I2 = 70.1%, NNT = 6 and LS (28 g’s, 1504 participants, g = 0.179, 95% CI = −0.003, 0.361, p = 0.05, Q = 77.7, p I2 = 65.3%, NNT = 6 BMD. Clinically, it was estimated that the overall changes in FN and LS would reduce the 20-year relative risk of osteoporotic fracture at any site by approximately 11% and 10%, respectively. None of the mixed

  19. fibular osteosynthesis of neglected femoral neck fracture in a young ...

    African Journals Online (AJOL)

    Where there are no facilities for microvascular surgery, non- ... fixation of a neglected femoral neck fracture associated with aseptic necrosis of femoral head in ... After a follow-up of two years, he had a Harris hip ... applied on the fifth postoperative day and patient was ... radiographic features that suggested aseptic necrosis.

  20. Osteoid Osteoma of the Femoral Neck in Athletes: Two Case Reports Differentiating From Femoral Neck Stress Injuries.

    Science.gov (United States)

    Cordova, Christopher B; Dembowski, Scott C; Johnson, Michael R; Combs, John J; Svoboda, Steven J

    2016-01-01

    The diagnosis of an intra-articular osteoid osteoma can be a challenging and lengthy process, with reports of delayed diagnosis of greater than 2 years. In the young, athletic patient with an atraumatic onset of groin pain, an overuse injury or muscle strain is the most likely etiology. However, an overuse injury of femoral neck stress fracture must be identified because of the potentially disastrous outcome of fracture completion. The similar clinical presentation of a femoral neck stress fracture and intra-articular osteoid osteoma of the femoral neck can further delay the diagnosis of the osteoid osteoma. In a patient with these differential diagnoses that do not improve with a period of nonweightbearing activity, a more intensive workup must ensue. The purpose of this case report is to describe the initial presentations, subsequent follow-up, and imaging findings leading to the diagnosis of osteoid osteoma as well as to differentiate an osteoid osteoma from femoral neck stress injuries.

  1. Effects of Salmon Calcitonin on Bone Metabolism of Osteoporotic Femoral Neck Fracture and Bone Mineral Density%鲑鱼降钙素对骨质疏松性股骨颈骨折骨代谢及骨密度的影响

    Institute of Scientific and Technical Information of China (English)

    刘卓; 孙琪

    2014-01-01

    To investigate the effect of salmon calcitonin on bone metabolism of osteoporotic femoral neck fracture and bone mineral density.Methods:86 cases of femoral neck fracture patients were randomly divided into two groups:treatment group and control group,All patients were performed with surgical treatment,The treatment group used the salmon calcitonin combined calcium,Control group simply used calcium.Results:Blood calcium of treatment group increased,urine HOP declined obviously,femoral neck was a significant increase in the density,there was a significant difference compared with control group (P<0.05).Conclusion:Salmon calcitonin on bone metabolism in blood calcium,urine HOP and femoral neck bone mineral density has significant effect.%目的:探讨鲑鱼降钙素对骨质疏松性股骨颈骨折骨代谢及骨密度的影响。方法:选取86例股骨颈骨折患者,随机分为两组:治疗组和对照组,两组患者均采用手术治疗,治疗组采用鲑鱼降钙素联合钙剂治疗,对照组单纯使用钙剂治疗。结果:治疗组血钙值增加,尿HOP明显下降,股骨颈密度较治疗前显著增加,与对照组相比有显著差异(P<0.05)。结论:鲑鱼降钙素对骨代谢中血钙、尿HOP及股骨颈骨密度有显著影响。

  2. Three-dimensional measurement of femoral neck anteversion and neck shaft angle.

    Science.gov (United States)

    Sangeux, Morgan; Pascoe, Jessica; Graham, H Kerr; Ramanauskas, Fiona; Cain, Tim

    2015-01-01

    We present a three-dimensional measurement technique for femoral neck anteversion and neck shaft angles which do not require alignment of the femoral and scanner axes. Two assessors performed the measurements on 11 patients (22 femurs). Repeatability between assessors was 2.7 degrees for femoral neck anteversion and 4.8 degrees for neck shaft angle. Measurements compared with an alternative single slice method were different by 2 degrees (3 degrees) in average. The method was repeatable and appropriate for clinical practice.

  3. Negative magnetic resonance imaging in femoral neck stress fracture with joint effusion: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Nobutoshi; Okuyama, Koichiro; Kamo, Keiji; Chiba, Mitsuho [Akita Rosai Hospital, Department of Orthopedic Surgery, Odate, Akita (Japan); Shimada, Yoichi [Akita University School of Medicine, Department of Orthopedic Surgery, Akita (Japan)

    2016-06-15

    Femoral neck stress fracture (FNSF) is well documented in the orthopedic literature and is generally associated with strenuous activities such as long-distance running and military training. The diagnostic yield of magnetic resonance imaging (MRI) for FNSF was reported to be 100 %, and early MRI is recommended when this fracture is suspected. We encountered a 16-year-old male long-distance runner with FNSF in whom the left femoral neck showed no signal changes on MRI although an effusion was detected in the left hip joint. One month later, roentgenograms revealed periosteal callus and oblique consolidation of the left femoral neck, confirming the diagnosis of compression FNSF. Because FNSF with a normal bone marrow signal on MRI is very rare, this patient is presented here. (orig.)

  4. Femoral revision surgery with impaction bone grafting

    NARCIS (Netherlands)

    B.L.E.F. ten Have (Bas); R.W. Brouwer (Reinoud); F.C. van Biezen (Frans); J.A.N. Verhaar (Jan)

    2012-01-01

    textabstractThe purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all

  5. Fibular grafting with cannulated hip screw fixation in late femoral neck fracture in young adults

    Directory of Open Access Journals (Sweden)

    Goyal R

    2006-01-01

    Full Text Available Background: We reviewed the operative results of fibular bone graft with cannulated hip screw fixation in femoral neck fracture in young adults. Method: Sixteen young adults with femoral neck fracture were treated by fibular bone graft with cannulated hip screw fixation. All the fractures were more than 3 weeks old. Results: Results were assessed in 15 patients while one patient died due to complications not related to surgery. Union occurred in all 15 patients. One patient had intra-operative complication in the form of screw cut out with graft in the joint space. The average fallow up was 24.4 months. Out of 15 patients assessed clinico-radiologically 11 showed good results, 3 had fair while 1 had poor result. Conclusion: We conclude that this is a simple and cost effective procedure for late femoral fleck fracture in young adults with good results.

  6. Femoral Neck Shaft Angle in Men with Fragility Fractures

    Directory of Open Access Journals (Sweden)

    S. P. Tuck

    2011-01-01

    Full Text Available Introduction. Femoral neck shaft angle (NSA has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric, symptomatic vertebral (91, and distal forearm (67 fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately, nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P=0.001, but larger in those with distal forearm fractures (129.8° versus 128.5°: P=0.01. Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  7. Biomechanics study on the femoral neck with side hole hollow nail combined with bone cement%股骨颈带侧孔空心钉添加骨水泥的生物力学实验探究

    Institute of Scientific and Technical Information of China (English)

    闫作

    2014-01-01

    objective To study the healing effects by applying femoral neck with side hole hollow nail combined with bone cement for the promotion of fracture.Methods 58 adult femoral neck specimens were seletced based on the maximum axial pull output (F-Max) in experimental group, 12 femoral neck in bored after the hollow screw directly into the center of the axial, the other 12 femoral neck in the center of the axial drilling will polymethacrylate again after infusion of bone cement into side holes with hollow screw. To pull out the experiment, the hollow nail pulling power of the maximum axial and screw in the process of cycle resistance to bending experiment in loose could withstand the maximum load were determined.Results In PMMA bone cement injection hole hollow nail was signiifcantly higher than that of the maximum axial force ,which was higher than pure hollow nail maximum axial pull output, the difference was statistically signiifcant (P<0.05). Conclusion For hip osteoporosis fracture, the side holes by using methyl methacrylate hollow nail ifxed the fracture end, can signiifcantly reduce the risk of femoral head loose, falling off, and improve the stability of the ifxed the fracture end, accelerate fracture healing.%目的:探讨股骨颈带侧孔空心钉添加骨水泥对骨折愈合的促进效果。方法选取58具成人尸体股骨颈标本,依据最大轴向拔出力(F-max)进行实验分组,12个股骨颈在轴向正中钻孔后将空心钉直接置入,另12个股骨颈在轴向正中钻孔将聚甲基丙烯酸酯骨水泥输注后再置入带侧孔空心钉。进行拔出实验,对空心钉最大轴向的拔出力及周期抗屈实验过程中螺钉在松动时所能承受的最大负荷进行测定。结果注入PMMA骨水泥侧孔空心钉最大轴向力显著高于高于单纯空心钉最大轴向拔出力,对比差异有统计学意义(P<0.05)。结论对于髋部骨质疏松骨折来说,采用加入聚甲基丙烯酸甲酯侧孔

  8. A case report of missed femoral neck stress fracture

    Directory of Open Access Journals (Sweden)

    Onibere Oruaro Adebayo

    2015-01-01

    Full Text Available Femoral neck stress fracture (FNSF is an uncommon but potentially serious orthopaedic problem. This is a case report on missed femoral neck stress fracture in a 62-year-old female who was initially treated as early-onset coxarthrosis. She later presented to us with a displaced intra-capsular neck of left femur fracture and underwent total hip replacement. This case illustrates that causes other than osteoarthritis should be taken into consideration in patients presenting with anterior hip pain where symptoms are disproportionate to clinical and radiological findings. More advanced investigations such as MRI scan or regular follow up with plain radiographs should be performed. A delay in diagnosis can lead to secondary displacement of the femoral neck stress fracture.

  9. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by post-operative SPECT/CT

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sang Won; Oh, Min Young; Yoon, Seok Ho; Kim, Jin Soo; Chang, Jae Suk; Ryu, Jin Sook [Asan Medical CenterUniversity of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Ji Wan [Dept. of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-03-15

    Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2–10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

  10. Chondroblastoma: a rare cause of femoral neck fracture in a teenager.

    Science.gov (United States)

    Paloski, Michael D; Griesser, Michael J; Jacobson, Mark E; Scharschmidt, Thomas J

    2011-09-01

    Chondroblastomas usually present in the epiphyseal region of bones in skeletally immature patients. These uncommon, benign tumors are usually treated with curettage and use of a bone-void filler. Here we report a case of a hip fracture secondary to an underlying chondroblastoma in a 19-year-old woman. Open biopsy with intraoperative frozen section pointed toward a diagnosis of chondroblastoma. Extended curettage was performed, followed by cryotherapy with a liquid nitrogen gun and filling of the defect with calcium phosphate bone substitute. The femoral neck fracture was stabilized with a sliding hip screw construct. The patient progressed well and continued to regain functional status. A final pathology report confirmed the lesion to be a chondroblastoma. Clinicians should have heightened awareness of a pathologic lesion in a young person presenting with a femoral neck fracture and should consider the uncommon differential diagnosis that the lesion is located in the greater trochanter apophysis.

  11. Chondroblastoma of the femoral neck as a cause of hip synovitis.

    Science.gov (United States)

    Kaneko, Hiroshi; Kitoh, Hiroshi; Wasa, Junji; Nishida, Yoshihiro; Ishiguro, Naoki

    2012-03-01

    Chondroblastoma is a rare benign chondroid bone tumor, which typically arises from the epiphysis of a long tubular bone. We present a 13-year-old girl with persistent hip synovitis caused by a chondroblastoma that arose from the femoral neck (metaphysis) and uniquely extended extraosseously into the hip joint. Computed tomography scan clearly demonstrated a tumoral lesion of the left femoral neck and a periosteal reaction along the anterior cortex of the femur, distal to the legion. Magnetic resonance imaging showed reactive synovitis with marked joint effusion of the hip and an extensive edema in the proximal femur and the surrounding soft tissues. Aneurysmal bone cysts formation secondary to chondroblastoma was confirmed by histologic examinations of the excised specimens. Complete relief of pain and an improvement in the range of movement of the hip joint was obtained after surgical resection of the tumor.

  12. Logistic regression in estimates of femoral neck fracture by fall

    Directory of Open Access Journals (Sweden)

    Jaroslava Wendlová

    2010-04-01

    Full Text Available Jaroslava WendlováDerer’s University Hospital and Policlinic, Osteological Unit, Bratislava, SlovakiaAbstract: The latest methods in estimating the probability (absolute risk of osteoporotic fractures include several logistic regression models, based on qualitative risk factors plus bone mineral density (BMD, and the probability estimate of fracture in the future. The Slovak logistic regression model, in contrast to other models, is created from quantitative variables of the proximal femur (in International System of Units and estimates the probability of fracture by fall.Objectives: The first objective of this study was to order selected independent variables according to the intensity of their influence (statistical significance upon the occurrence of values of the dependent variable: femur strength index (FSI. The second objective was to determine, using logistic regression, whether the odds of FSI acquiring a pathological value (femoral neck fracture by fall increased or declined if the value of the variables (T–score total hip, BMI, alpha angle, theta angle and HAL were raised by one unit.Patients and methods: Bone densitometer measurements using dual energy X–ray absorptiometry (DXA, (Prodigy, Primo, GE, USA of the left proximal femur were obtained from 3 216 East Slovak women with primary or secondary osteoporosis or osteopenia, aged 20–89 years (mean age 58.9; 95% CI: −58.42; 59.38. The following variables were measured: FSI, T-score total hip BMD, body mass index (BMI, as were the geometrical variables of proximal femur alpha angle (α angle, theta angle (θ angle, and hip axis length (HAL.Statistical analysis: Logistic regression was used to measure the influence of the independent variables (T-score total hip, alpha angle, theta angle, HAL, BMI upon the dependent variable (FSI.Results: The order of independent variables according to the intensity of their influence (greatest to least upon the occurrence of values of the

  13. The Femoral Neck Mechanoresponse to Hip Extensors Exercise: A Case Study

    Directory of Open Access Journals (Sweden)

    Saulo Martelli

    2017-01-01

    Full Text Available Physical activity is recommended to prevent age-related bone loss. However, the proximal femur mechanoresponse is variable, possibly because of a muscle-dependant mechanoresponse. We compared the proximal femur response with the femoral strain pattern generated by the hip extensor muscles. A healthy participant underwent a six-month unilateral training of the hip extensor muscles using a resistance weight regularly adjusted to the 80% of the one-repetition maximum weight. DXA-based measurements of the areal Bone Mineral Density (aBMD in the exercise leg were adjusted for changes in the control leg. The biomechanical stimulus for bone adaptation (BS was calculated using published models of the musculoskeletal system and the average hip extension moment in elderly participants. Volumetric (ΔvBMD and areal (ΔaBMD BMD changes were calculated. The measured and calculated BMD changes consistently showed a positive and negative effect of exercise in the femoral neck (ΔaBMD = +0.7%; ΔvBMD = +0.8% and the trochanter region (ΔaBMD = −4.1%; ΔvBMD = −0.5%, respectively. The 17% of the femoral neck exceeded the 75th percentile of the spatially heterogeneous BS distribution. Hip extensor exercises may be beneficial in the proximal femoral neck but not in the trochanteric region. DXA-based measurements may not capture significant aBMD local changes.

  14. The Femoral Neck Mechanoresponse to Hip Extensors Exercise: A Case Study

    Science.gov (United States)

    Mokhtarzadeh, Hossein; Pivonka, Peter; Ebeling, Peter R.

    2017-01-01

    Physical activity is recommended to prevent age-related bone loss. However, the proximal femur mechanoresponse is variable, possibly because of a muscle-dependant mechanoresponse. We compared the proximal femur response with the femoral strain pattern generated by the hip extensor muscles. A healthy participant underwent a six-month unilateral training of the hip extensor muscles using a resistance weight regularly adjusted to the 80% of the one-repetition maximum weight. DXA-based measurements of the areal Bone Mineral Density (aBMD) in the exercise leg were adjusted for changes in the control leg. The biomechanical stimulus for bone adaptation (BS) was calculated using published models of the musculoskeletal system and the average hip extension moment in elderly participants. Volumetric (ΔvBMD) and areal (ΔaBMD) BMD changes were calculated. The measured and calculated BMD changes consistently showed a positive and negative effect of exercise in the femoral neck (ΔaBMD = +0.7%; ΔvBMD = +0.8%) and the trochanter region (ΔaBMD = −4.1%; ΔvBMD = −0.5%), respectively. The 17% of the femoral neck exceeded the 75th percentile of the spatially heterogeneous BS distribution. Hip extensor exercises may be beneficial in the proximal femoral neck but not in the trochanteric region. DXA-based measurements may not capture significant aBMD local changes. PMID:28168080

  15. Risk of pelvic injury from femoral neck guidewires.

    Science.gov (United States)

    Feeney, M; Masterson, E; Keogh, P; Quinlan, W

    1997-01-01

    Many of the devices used in the internal fixation of femoral neck fractures are cannulated and require the initial placement of one or more guidewires for accurate positioning. These wires are occasionally advanced inadvertently through the hip joint and the acetabulum. Pelvic visceral damage may follow. To assess this risk, we inserted three guidewires to a depth of 16 cm into each femoral neck of ten cadavers and explored the pelvis during autopsy. Thirty-two of the 60 guidewires had penetrated a pelvic organ. The literature on intrapelvic injuries associated with hip surgery is reviewed, and suggestions are offered on the avoidance of pelvic penetration during hip fracture fixation.

  16. Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

    Science.gov (United States)

    Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

    2008-03-01

    Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

  17. Proximal femoral bone geometry in osteoporotic hip fractures in Thailand.

    Science.gov (United States)

    2015-01-01

    A number of different bone geometries have been reported to be correlated with osteoporosis, bone mineral density and fractures. Those correlations are used for diagnosis, treatment and prediction of fracture risk in osteoporosis cases. However there have been no studies of significant bone parameters predicting osteoporosis and hip fracture in Thailand To evaluate the correlation between geometric parameters of the proximal femur and both the Singh index and bone mineral density as well as to investigate the relationship between those two metrics and osteoporotic hip fracture in the Thai population. Forty-four Thai patients with osteoporotic hip fractures andforty-five healthy Thai people matched for age and gender were included in the present study. Bone mineral density and bone geometry from plain hip radiographs of non-fracture sites in the fracture group and proximal femur radiographs of the same site in the healthy group were measured That data were analyzed to determine levels of correlation. Bone geometries were also analyzed to determine hip fracture predictive capacity. Correlation between the Singh index and bone mineral density was significant (p hip fracture (p = 0.014 and p = 0.035, respectively). Each 1 mm reduction in the width of the femoral medial neck cortex increased the osteoporotic hip fracture risk by a factor of 2.7 (OR = 0.37, 95% CI = 0.15-0.93). In the Thai population, bone geometry from plain radiographs can help predict the risk of osteoporotic hip fracture. Osteoporosis is correlated with a low Singh index value. The width of the femoral medial neck cortex is a reliable predictor of hip fracture risk.

  18. 激素性股骨头坏死与股骨头、颈部骨髓脂肪含量关系的MRI研究%Relationship between bone marrow fat content of femoral head-neck and femoral head osteonecrosis in corticosteroid-treated pa-tients

    Institute of Scientific and Technical Information of China (English)

    陈兴灿; 邬亚军; 潘永青; 张永强; 刘淼; 何东

    2014-01-01

    Objective To investigate the relationship between bone marrow fat content of femoral head- neck and femoral head osteonecrosis in corticosteroid- treated patients. Methods Twenty seven patients aged above 18 years, with rheumatoid arthritis (n=12), ankylosing spondylitis (n=10) or renal transplantation (n=5), who had no history of hip disorders and previous corticosteroid treatment, underwent corticosteroid treatment. MRI examinations were performed before and 25, 50 weeks after the initiation of corticosteroid therapy. The bulk T1 signal intensity values were measured by GE/AW4.2 work station. If MRI showed femoral head osteonecrosis, the pathology examination was fol owed. t test was used (P<0.05) for statistical analysis. Results Four patients developed lateral femoral head osteonecrosis (2 in right and 2 in left)at week 25. The mean base T1 value of femoral head- neck before corticosteroid treatment was significantly shorter in femoral head osteonecrosis than that in normal femoral head (P<0.05). Conclusion The development of corticosteroid associated femoral head osteonecrosis is correlated with a high fat content in the marrow of femoral head- neck before corticosteroid therapy.%目的:通过MRI检查研究激素性股骨头坏死与股骨头、颈部骨髓脂肪含量的关系。方法对18周岁以上,无任何髋关节疾病及糖皮质激素治疗病史的27例患者(其中类风湿性关节炎12例,强直性脊柱炎10例,肾移植5例),在正规糖皮质激素治疗前后作MRI检查并进行随访,包括糖皮质激素治疗前基础MRI检查及糖皮质激素治疗后(基础MRI检查后)25、50周共2次随访MRI检查。采用GE/AW4.2工作站提供的T1信号值测量软件对基础MRI检查的股骨头、颈部骨髓进行T1信号值测量;MRI显示股骨头坏死者均经活检病理检查证实。结果4例发生股骨头坏死(左右侧各2例)。所有患者左右侧股骨头、颈部大范围平均T1信号值均无

  19. Collagen fiber orientation in the femoral necks of apes and humans: do their histological structures reflect differences in locomotor loading?

    Science.gov (United States)

    Kalmey, J K; Lovejoy, C O

    2002-08-01

    Human hip joint anatomy differs substantially from that in other primates. Humans modulate pelvic tilt during walking with a highly developed abductor apparatus, but other primates (such as chimpanzees) clearly lack such an apparatus (they exhibit a Trendelenburg gait during bipedal progression). Because the primate femoral neck is cantilevered whenever it supports body mass, it must be consistently subjected to substantial bending at the neck/shaft interface during stance phase in quadrupedal or bipedal locomotion. It has been argued, however, that the powerful abduction during the single support phase in humans results in almost entirely compressive stress on the human femoral neck. We examined collagen fiber orientation in human and chimpanzee femoral neck cortices using circularly polarized light, which has been shown to be a strong correlate of bone loading patterns. Chimpanzee superior femoral neck cortex was shown to be largely nonbirefringent (dark), but the inferior cortex was strongly birefringent. Human femoral necks showed strong birefringence both superiorly and inferiorly. These results are consistent with loading patterns suggested from anatomical structure, and provide corroborative evidence of bone's ability to preferentially orient collagen fibers during extracellular matrix deposition.

  20. [Spontaneous disappearance of herniation pit on the femoral neck].

    Science.gov (United States)

    Lerais, J M; Jacob, D; Thibaud, J C; Fourrer, C; Cercueil, J P; Krause, D; Laredo, J D; Baudrillard, J C

    1995-09-01

    The authors present a case of a 39 years old patient who had a herniation pit of the left femoral neck, 5 years ago. This lesion disappeared spontaneously. To our knowledge, no report of healing of a herniation pit has been previously described.

  1. Internal Fixation of Femoral Neck Fractures : Treatment and effects

    NARCIS (Netherlands)

    S.M. Zielinski (Stephanie)

    2015-01-01

    markdownabstract__Abstract__ This thesis consists of three parts. Part 1 described aspects of the organization of trauma related trials. Part 2 analyzed the uniformity of current femoral neck fracture treatment and adherence to the Dutch guideline on hip fracture treatment. The implications of

  2. Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly

    Directory of Open Access Journals (Sweden)

    SKS Marya

    2011-01-01

    Conclusion: Cementless bipolar hemiarthroplasty for femoral neck fractures in the very elderly permits early return to premorbid life and is not associated with any untoward cardiac event in the perioperative period. It can be considered a treatment option in this select group.

  3. Lentivirus-TAZ Administration Alleviates Osteoporotic Phenotypes in the Femoral Neck of Ovariectomized Rats

    Directory of Open Access Journals (Sweden)

    Zhanhai Yin

    2016-01-01

    Full Text Available Background: Osteoporosis is characterized by impairment of bone mass, strength, and microarchitecture, leading to the susceptibility to fragility fractures, especially in femoral neck region. Transcriptional coactivator with PDZ-binding motif (TAZ facilitates osteogenesis while suppressing adipogenesis via regulation of transcriptional activities of runt-related transcription factor 2 and peroxisome proliferator-activated receptor γ. Here, we validated the role of TAZ in vivo using an ovariectomized (OVX rat model of osteoporosis. Methods: Serum alkaline phosphatase, triglyceride, cholesterol and urinary hydroxyproline were measured on an automatic analyzer using diagnostic reagent kits. Serum OCN and C-terminal cross-linked telopeptides of type I collagen were measured using ELISA. Bone mineral density was measured using dual-energy X-ray scanner. Mechanical parameters were detected by three-point bending assays. Bone volume per tissue volume (BV/TV, trabecular thickness (Tb. Th, trabecular number (Tb. No, and trabecular separation (Tb. Sp were measured by MicroCT. The mRNA and protein levels were quantified by Realtime PCR and Western Blotting respectively. Results: After injections of lentivirus overexpressing TAZ into the femoral neck region, bone mineral density, ultimate force, stiffness, BV/TV, Tb. Th, and Tb. No were significantly increased, whereas Tb. Sp was dramatically decreased. In the TAZ-overexpression region in the femoral neck of OVX rats, the mRNA levels of Runx2 and osteocalcin were obviously elevated, whereas that of PPARγ and adipocyte protein 2 were downregulated. Conclusion: Lentivirus-mediated TAZ gene therapy alleviated the osteoporotic phenotypes in the femoral neck of OVX rats, providing an alternative strategy for the treatment of postmenopausal osteoporosis and prevention of osteoporotic fracture.

  4. Malignant pleural mesothelioma with osseous metastases and pathologic fracture of femoral neck.

    Science.gov (United States)

    Lester, Todd; Xu, Haodong

    2008-10-01

    Malignant mesotheliomas occur in the pleura, peritoneum, pericardium, and tunica vaginalis. The majority of tumors are pleural in origin. The typical pattern of spread is usually contiguous or via implantation. Hematogenous or lymphatic metastasis is not uncommon; however, metastasis to bone has rarely been well documented. This is a case report of malignant pleural mesothelioma metastatic to the femur with a pathologic fracture of femoral neck.

  5. Factors affecting the aluminium content of human femoral head and neck.

    Science.gov (United States)

    Zioła-Frankowska, Anetta; Dąbrowski, Mikołaj; Kubaszewski, Łukasz; Rogala, Piotr; Frankowski, Marcin

    2015-11-01

    Tissues for the study were obtained intraoperatively during hip replacement procedures from 96 patients. In all the cases, the indication for this treatment was primary or secondary degenerative changes in the hip joint. The subject of the study was the head and neck of the femur, resected in situ. Aluminium concentrations measured in femoral head and neck samples from patients aged between 25 and 91 were varied. Statistical methods were applied to determine the variations in relation to the parameters from the background survey. Significant differences in the aluminium content of femoral head samples were observed between patients under and over 60 years of age. Based on the results, it was confirmed that the aluminium accumulates in bones over a lifetime. The study showed that the content of aluminium in the head and neck of the femur depends on the factors such as: type of medicines taken, contact with chemicals at work, differences in body anatomy and sex. The study on the levels of aluminium in bones and the factors affecting its concentration is a valuable source of information for further research on the role of aluminium in bone diseases. Based on the investigations, it was found that the GF-AAS technique is the best analytical tool for routine analysis of aluminium in complex matrix samples. The use of femoral heads in the investigations was approved by the Bioethics Committee of the University of Medical Sciences in Poznań (Poland). Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Unstable femoral neck fractures in children - A new treatment option

    Directory of Open Access Journals (Sweden)

    Pruthi K

    2006-01-01

    Full Text Available Background : Femoral neck fractures in children are an uncommon but difficult situation. The aim of our study was to evaluate clinical results of closed reduction internal fixation and primary valgus osteotomy fixed with a tension band wire loop in high angled pediatric femoral neck fractures. Methods : In a prospective nonrandomized study conducted at 2 centres, sixteen children and adolescents with a Pauwel type 2/3 fracture neck femur were taken as participants. The femoral neck fractures were stabilized using closed reduction and internal fixation (6.5 mm noncannulated screw and a primary valgus osteotomy fixed with a tension band wire loop preferably within 24-36 hours of injury. Patients were evaluated to determine complications, clinical and radiological outcome. Results : At a mean post operative follow up of 5 years, union was achieved in all cases. Three patients had AVN and one developed coxavara. Results were evaluated using IOWA hip scores. Thirteen patients had an excellent result while 3 patients had a good result. Conclusion : Use of this technique holds promise in treating these difficult unstable fractures. Although results from a larger series are still awaited yet the use of this technique can safely be extended to stable fractures also, to minimize the incidence of complications as nonunion and AVN.

  7. An analysis of factors affecting the mercury content in the human femoral bone.

    Science.gov (United States)

    Zioła-Frankowska, A; Dąbrowski, M; Kubaszewski, Ł; Rogala, P; Kowalski, A; Frankowski, M

    2017-01-01

    The study was carried out to determine the content of mercury in bone tissue of the proximal femur (head and neck bone) of 95 patients undergoing total hip replacement due to osteoarthritis, using CF-AFS analytical technique. Furthermore, the investigations were aimed at assessing the impact of selected factors, such as age, gender, tobacco smoking, alcohol consumption, exposure to chemical substance at work, type of degenerative changes, clinical evaluation and radiological parameters, type of medications, on the concentration of mercury in the head and neck of the femur, resected in situ. Mercury was obtained in all samples of the head and neck of the femur (n = 190) in patients aged 25-91 years. The mean content of mercury for the whole group of patients was as follows: 37.1 ± 35.0 ng/g for the femoral neck and 24.2 ± 19.5 ng/g for the femoral head. The highest Hg contents were found in femoral neck samples, both in women and men, and they amounted to 169.6 and 176.5 ng/g, respectively. The research showed that the mercury content of bones can be associated with body mass index, differences in body anatomy, and gender. The uses of statistical analysis gave the possibility to define the influence of factors on mercury content in human femoral bones.

  8. Dual fibular grafting - A new technique of fixation of the femoral neck fractures

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    Yadav S

    2005-01-01

    Full Text Available Background: To achieve osteosynthesis of femoral neck fractures is a challenge to the treating surgeon. Plethora of devices and methods has been described. Method: A new technique of achieving union of femoral neck fractures by dual-fibular fixation has been reported in 150 patients. The age of the patients ranged from 6-75 years. Results: Nearly two-third of these were Garden type II and III with an average follow-up of 120 months. In this series 67% had good to excellent long term results. Conclusion: Two fibular struts provide autologous bone, filling the whole of the osteopenic femoral neck and prevent the rotational forces. Since the total fixation is biologically active, the technique has proved advantageous even when stable / desirable reduction is not possible and adequate fixation is not achieved, because of posterior communition at the fracture site or due to osteoporosis. Being autologous bone, the twin-fibular graft is advantageous even when there is ′subsequent loss of reduction′ of the fracture. It is, therefore, suggested that this simple, inexpensive and biological technique has many advantages over the existing methods of fixation of these fractures.

  9. Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia

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    Dhammapal Sahebrao Bhamare

    2013-01-01

    Full Text Available Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.

  10. Microvascular medial femoral condylar flaps in 107 consecutive reconstructions in the head and neck.

    Science.gov (United States)

    Brandtner, Christian; Hachleitner, Johannes; Bottini, Gian Battista; Buerger, Heinz; Gaggl, Alexander

    2016-07-01

    We have assessed the role of the medial femoral condylar flap in 107 patients who had reconstructions of the head and neck. We retrospectively reviewed their medical records for indications, complications, and outcomes. The flap was primarily used for coverage of alveolar ridge defects (n=67), secondly for defects of the facial bone, calvaria, or skull base (n=35), and thirdly for partial laryngeal defects (n=5). Two flaps were lost. One patient fractured a femur 5 weeks postoperatively. The duration of follow up ranged from 6 months to 12 years. The medial femoral condylar flap is well-suited to individual reconstructions of the alveolar ridge, midface, calvaria, skull base, and part of the larynx with poor recipient sites. The flap does not replace other wellknown flaps, but offers new solutions for solving special problems in head and neck surgery.

  11. Effectiveness of Selected Fitness Exercises on Stress of Femoral Neck using Musculoskeletal Dynamics Simulations and Finite Element Model.

    Science.gov (United States)

    Qian, Jing-Guang; Li, Zhaoxia; Zhang, Hong; Bian, Rong; Zhang, Songning

    2014-06-28

    The purpose of the study was to establish a dynamics model and a three-dimensional (3D) finite element model to analyze loading characteristics of femoral neck during walking, squat, single-leg standing, and forward and lateral lunges. One male volunteer performed three trials of the five movements. The 3D kinematic data were captured and imported into the LifeMOD to establish a musculoskeletal dynamics model to obtain joint reaction and muscle forces of iliacus, gluteus medius, gluteus maximus, psoas major and adductor magnus. The loading data LfeMOD were imported and transformed into a hip finite-element model. The results of the finite element femur model showed that stress was localized along the compression arc and the tension arc. In addition, the trabecular bone and tension lines of the Ward's triangle also demonstrated high stress. The compact bone received the greatest peak stress in the forward lunge and the least stress in the squat. However, the spongy bone in the femoral neck region had the greatest stress during the walk and the least stress in the squat. The results from this study indicate that the forward lunge may be an effective method to prevent femoral neck fractures. Walking is another effective and simple method that may improve bone mass of the Ward's triangle and prevent osteoporosis and femoral neck fracture.

  12. Effectiveness of Selected Fitness Exercises on Stress of Femoral Neck using Musculoskeletal Dynamics Simulations and Finite Element Model

    Directory of Open Access Journals (Sweden)

    Qian Jing-Guang

    2014-07-01

    Full Text Available The purpose of the study was to establish a dynamics model and a three-dimensional (3D finite element model to analyze loading characteristics of femoral neck during walking, squat, single-leg standing, and forward and lateral lunges. One male volunteer performed three trials of the five movements. The 3D kinematic data were captured and imported into the LifeMOD to establish a musculoskeletal dynamics model to obtain joint reaction and muscle forces of iliacus, gluteus medius, gluteus maximus, psoas major and adductor magnus. The loading data LfeMOD were imported and transformed into a hip finite-element model. The results of the finite element femur model showed that stress was localized along the compression arc and the tension arc. In addition, the trabecular bone and tension lines of the Ward's triangle also demonstrated high stress. The compact bone received the greatest peak stress in the forward lunge and the least stress in the squat. However, the spongy bone in the femoral neck region had the greatest stress during the walk and the least stress in the squat. The results from this study indicate that the forward lunge may be an effective method to prevent femoral neck fractures. Walking is another effective and simple method that may improve bone mass of the Ward's triangle and prevent osteoporosis and femoral neck fracture.

  13. MR findings in cases of suspected impacted fracture of the femoral neck

    Energy Technology Data Exchange (ETDEWEB)

    Stiris, M.G.; Lilleaas, F.G. [Aker Hospital, Oslo (Norway). Dept. of Diagnostic Radiology

    1997-09-01

    Purpose: To evaluate MR imaging of the hip in patients with a clinically suspected impacted fracture of the femoral neck in cases where conventional plain films show negative or equivocal findings. Material and Methods: Twenty-seven such patients were prospectively examined by MR imaging with a 1.0 T unit, within 24 hours of admittance to hospital. A coronal T1-weighted turbo spin-echo sequence (n=27), and a coronal STIR sequence (n=25) or a coronal T2-weighted turbo spin-echo fast saturation sequence (n=2) were used. The evaluations were made by 2 radiologists with experience in musculoskeletal radiology. Results: There were 6 patients with a petrochanteric fracture, 2 without and 4 with slight displacement. Five patients had an impacted fracture of the femoral neck, and 3 had a fracture of the superior pubic bone. Of 2 patients with advanced arthrosis, i had an impacted femoral neck fracture and the other a nondisplaced intertrochanteric fracture. There was 1 patient who had sustained a nondisplaced acetabular fracture with increased joint fluid and muscle contusions. Three patients had muscle contusions only. Two patients had bone marrow contusions only, while 2 others with advanced coxarthrosis had increased joint fluid only. Three patients showed normal findings. Our findings led to emergency surgery in 13 cases, and conservative measures directed to the specific MR findings in 14 patients. Conclusion: MR imaging should be the first modality of choice in examining patients with a clinically suspected impacted fracture of the femoral neck where conventional films show negative or equivocal findings. (orig.).

  14. Femoral neck non-union treatment by valgus intertrochanteric osteotomy

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT OBJECTIVE : The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union. METHODS : Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS : Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis). CONCLUSIONS : Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study. PMID:27057146

  15. Bilateral Simultaneous Femoral Neck Fracture Mimicking Abdominal Pain in a Cerebral Palsy Patient

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    P. Mariani

    2014-01-01

    Full Text Available Simultaneous bilateral femoral neck fractures are unusual lesions, generally associated with an underlying condition which causes impaired bone mineralization, triggered by an increased bone stress. We present a 24-year-old cerebral palsy patient, who was previously evaluated in another institution due to inability to walk, interpreted as abdominal pain. No alteration in blood analysis or abdominal X-rays was found. As no response to treatment was observed, a new abdominal X-ray was taken, which incidentally depicted bilateral medial femoral neck fracture. He was referred to our practice after a resection arthroplasty was offered in another institution. After admission, bilateral one-stage THA was performed. Several reports emphasize bone disease as a major precipitating factor, and there is an increased incidence of hip fractures in chronic epilepsy, renal osteodystrophy, and chronic steroid use. Femoral head resection has been proven to be effective in immobilized patients, whereas this was not a reasonable option in this patient who presented walking ability. Despite the treatment election, primary care physicians should be aware of and alert to the possibility of fractures in patients with neurological disorders and calcium metabolism alterations. Late diagnosis of orthopedic injuries in this type of patients may lead to permanent disability.

  16. Transfracture abduction osteotomy: A solution for nonunion of femoral neck fractures

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    Jairamchander Pingle

    2014-01-01

    femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO. Materials and Methods: Over a period of 35 years (1974-2008, 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008, All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years. Results were analyzed in terms of radiological union at six months. Average followup was five years and six months. Results: Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°. Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore′s pins. These were reopened and cancellous screws were inserted in the same tracks. Conclusions: Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.

  17. Treatment of femoral neck fracture with muscle-bone flap of both musculus tensor fasciae latae and musculus sartorius%阔筋膜张肌缝匠肌骨瓣移植治疗股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    刘国平; 康斌; 曾辉

    2001-01-01

    Objective To evaluate the effects of bone grafts with muscular pedicles of both musculus tensor fasciae latae and musculus sartorius in treating fresh transcervical or subcapital fractures of femoral neck (TSFFN). Methods 30 cases of TSFFN were treated by tail breakable screws and sartorius muscular pedicles bone grafts. The other 23 cases were treated by hollow pressure screws and bone grafts with muscular pedicles of both musculus tensor fasciae latae and musculus sartorius. Results 52 cases were followed up for 3 to 5 years, 4 years on average. In sartorius muscular pedicles, 8 cases showed the poor therapeutic results. The excellent therapeutic effects were achieved in all cases of musculus sartorius. Conclusion TSFFN can be treated by double muscular pedicles bone graft. The double muscular pedicles bone graft is more effective than single sartorius muscular pedicles in treating TSFFN of short-mid-term.%目的观察阔筋膜张肌和缝匠肌联合双肌蒂骨瓣移植治疗新鲜股骨颈头下型和经颈型骨折的疗效。方法缝匠肌蒂组30例用可折螺钉固定加缝匠肌蒂骨瓣移植;双肌蒂组23例采用可折螺钉或空心加压螺钉固定加阔筋膜张肌和缝匠肌双肌蒂骨瓣移植。结果随访52例,时间3~5年,平均4年,缝匠肌蒂组8例疗效较差,双肌蒂组均愈合良好。结论联合双肌蒂骨瓣治疗股骨颈头下型和经颈型骨折,其近期和中期疗效均较缝匠肌单肌蒂骨瓣移植好。

  18. Difference in the trajectory of change in bone geometry as measured by hip structural analysis in the narrow neck, intertrochanteric region, and femoral shaft between men and women following hip fracture.

    Science.gov (United States)

    Rathbun, Alan M; Shardell, Michelle; Orwig, Denise; Hebel, J Richard; Hicks, Gregory E; Beck, Thomas J; Magaziner, Jay; Hochberg, Marc C

    2016-11-01

    Prior studies have shown that women have declines in bone structure and strength after hip fracture, but it is unclear whether men sustain similar changes. Therefore, the objective was to examine sex differences in proximal femur geometry following hip fracture. Hip structural analysis was used to derive metrics of bone structure and strength: aerial bone mineral density, cross-sectional bone area (CSA), cortical outer diameter, section modulus (SM), and buckling ratio (BR) from dual-energy x-ray absorptiometry scans performed at baseline (within 22days of hospital admission), two, six, or twelve months after hip fracture in men and women (n=282) enrolled in the Baltimore Hip Studies 7th cohort. Weighted estimating equations were used to evaluate sex differences at the narrow neck (NN), intertrochanteric (IT), and femoral shaft (FS). Men had significantly different one year NN changes compared to women in CSA: -6.33% (-12.47, -0.20) vs. 1.37% (-3.31, 6.43), P=0.049; SM: -4.98% (-11.08, 1.10) vs. 3.94% (-2.51, 10.42), P=0.042; and BR: 7.50% (0.65, 14.36) vs. -1.20% (-6.41, 4.00), P=0.044. One year IT changes displayed similar patterns, but the sex differences were not statistically significant for CSA: -4.07% (-10.83, 2.67) vs. 0.41% (-3.41, 4.24), P=0.252; SM: -4.78% (-12.10, 5.53) vs. -0.31 (-4.74, 4.11), P=0.287; and BR: 4.59% (-0.65, 9.84) vs. 1.52% (-4.23, 7.28), P=0.425. Differences in FS geometric parameters were even smaller in magnitude and not significantly different by sex. Women generally experienced non-significant increases in bone tissue and strength following hip fracture, while men had structural declines that were statistically greater at the NN region. Reductions in the mechanical strength of the proximal femur after hip fracture could put men at higher risk for subsequent fractures of the contralateral hip. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Accuracy and the influence of marrow fat on quantitative CT and dual-energy X-ray absorptiometry measurements of the femoral neck in vitro

    NARCIS (Netherlands)

    J.W. Kuiper; C. van Kuijk (Cornelis); J.L. Grashuis (Jan); A.G.H. Ederveen (Antwan); H.E. Schütte (Henri)

    1996-01-01

    markdownabstractAbstract Bone mineral measurements with quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) were compared with chemical analysis (ChA) to determine (1) the accuracy and (2) the influence of bone marrow fat. Total bone mass of 19 human femoral necks in

  20. The curative effect evaluations of 46 Bone cement type artificial bipolar femoral head replacement for femoral neck fracture in the elderly patients%骨水泥型人工双极股骨头置换治疗老年人股骨颈骨折46例疗效分析

    Institute of Scientific and Technical Information of China (English)

    张庆凯; 李忠义; 马也

    2014-01-01

    目的:探讨骨水泥型人工双极股骨头置换治疗老年人股骨颈骨折的疗效。方法:我院2009-12至2012-12共收治并采用骨水泥型人工双极股骨头置换治疗老年人股骨颈骨折患者46例,其中,男性15例,女性31例,年龄在65—91岁之间,平均78.8岁;左侧19例,右侧27例,均为单侧股骨颈骨折;致伤原因:摔伤所致35例,交通事故所致11例。骨折按Garden分型:Ⅲ型33例,Ⅳ13例。通过手术时间,出血量及术后肢体功能Harris评分等,评价手术效果。结果:46例患者全部获得随访,随访时间为6-36个月,平均20.5个月。假体松动2例,肺内感染2例,股骨头脱位1例,并发症发生率为:11%;经处理后,患者痊愈。所有患者肢体功能恢复良好。术前Harris评分:43.2±8.3分,术后6个月及12个月分别为91.4±3.2分93.2±4.6分,较置换前明显提高,P<0.01,差异有统计学意义。结论:骨水泥型人工双极股骨头置换治疗老年人股骨颈骨折具有固定牢固,返修率小,术后并发症少,肢体功能恢复良好等优点,是治疗该类疾病一种较为良好的选择。%Objective:To report and discuss The curative effect of surgical treatment with Bone cement type artificial bipolar femoral head replacement for Femoral neck fracture in the elderly patients.Method:From December 2009 to December 2012,46 cases with Femoral neck fractures in the elderly patients were treated with Bone cement type artificial bipolar femoral head replacement in our hospital, Including 15 males and 31 females ,with an average of 78.8 years old .(range,65 to 91 years old).19 cases in the left,27 cases in the right. And al the cases were unilateral fractures. The causes of injury:35 cases were related to fal ing ,11 cases were related to traffic accident. According to Garden classification ,33 cases were of typeⅢ, 14 cases were of typeⅣ. Evaluate the curative effect by the

  1. Positive effects of a chicken eggshell powder-enriched vitamin-mineral supplement on femoral neck bone mineral density in healthy late post-menopausal Dutch women

    NARCIS (Netherlands)

    Schaafsma, A; van Doormaal, JJ; Muskiet, FAJ; Hofstede, GJH; Pakan, [No Value; van der Veer, E

    2002-01-01

    Although bone metabolism is largely under genetic control, the role of nutrition is considerable. The present study evaluates the effects of chicken eggshell powder, a new source of dietary Ca, and purified CaCO3 on bone mineral density (BMD) of the lumbar spine and hip. Besides BMD we also looked a

  2. The effect of femoral neck osteotomy on femoral component position of a primary cementless total hip arthroplasty.

    Science.gov (United States)

    Dimitriou, Dimitris; Tsai, Tsung-Yuan; Kwon, Young-Min

    2015-12-01

    The aim of this study was to quantify the femoral canal diameter and version at different femoral neck osteotomy locations, and to investigate the effect of the osteotomy plane on femoral component position in total hip arthroplasty (THA). Preoperative and postoperative three-dimensional models were reconstructed in 15 patients (19 hips) who underwent primary cementless THA with tapered non-anatomical femoral stem. On the pre-operative models, the osteotomy plane was simulated at different levels (-5, 0, 5, and 10 mm from the femoral saddle [piriformis fossa]) and angles (30, 40, 50, and 60° from the femoral anatomical axis). Medullary canal version and mediolateral diameter were measured on the osteotomy surfaces. On the postoperative models, the femoral neck osteotomy plane, stem anteversion and alignment were measured. The average canal diameter ranged from 22.8 to 26.3 mm at different osteotomy levels and from 20.8 to 29.0 mm at different osteotomy angles. The average canal version ranged from 11.4 to 23.2° at different resection levels and from 12.8 to 21° at different resection angles. The femoral stem anteversion was correlated with neck osteotomy angle (R = 0.72), whereas stem alignment in frontal plane (varus/valgus) was correlated with neck osteotomy level (R = 0.87). The femoral neck osteotomy plane in THA affects the postoperative stem position due to the complex morphology of the proximal femoral medullary canal, suggesting that both femoral neck resection level and angle should be considered in optimizing femoral component alignment in THA patients.

  3. Treatment of Femoral Neck Fractures: Unipolar Versus Bipolar Hemiarthroplasty

    Directory of Open Access Journals (Sweden)

    Somashekar

    2013-07-01

    Full Text Available BACKGROUND AND OBJECTIVE: Intracapsular femoral neck fractures are common in the elderly population. To avoid the poor outcome of internal fixation and for early mobilization, hemiarthroplasty is performed. However, there is inadequate evidence to support the choice between unipolar or bipolar hemiarthroplasty. The aim of this study was to compare the outcome of unipolar with the bipolar prosthesis in geriatric patients. METHODS: Forty-one patients above 60 years of age and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar hemiarthroplasty, in the Department of Orthopaedics, between September 2009 and October 2012. Functional outcome was assessed and compared using Harris hip score and radiological parameters with a follow-up of one year. RESULTS: The two groups of patients with mean age of 67.3 in bipolar group and 75.6 in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. The mean Harris hip score in bipolar and unipolar groups was 86.18±12.18 and 79.79±15.55, respectively (p=0.183; range of motion was 210.63±28.39 and 181.58±37(p=0.015 with bipolar and unipolar groups, respectively. Functional activities were better in the bipolar group. Complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion were encountered in unipolar prostheses. CONCLUSION: The use of bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.

  4. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  5. Effect of semisynthetic extracellular matrix-like hydrogel containing hepatocyte growth factor on repair of femoral neck defect in rabbits.

    Science.gov (United States)

    Liu, Pengfei; Guo, Lin; Huang, Lanfeng; Zhao, Dewei; Zhen, Ruixin; Hu, Xiaoning; Yuan, Xiaolin

    2015-01-01

    Using tissue engineering technology research to develop organized artificial bone, then repair bone defect. This work aims to investigate the role of semisynthetic extracellular matrix-like hydrogel (sECMH) containing hepatocyte growth factor (HGF) on repair of femoral neck defect in rabbits. 18 New Zealand rabbits were used in this study. According to autologous paired comparison method, the left and right sides of rabbit were used as control and experimental side, respectively. The models of bilateral femoral neck bone defect were established. In experimental side, sECMH containing HGF was implanted in the defect area. In control side, no material was implanted in the defect area. At the 2nd, 4th and 8th week after surgery, the gross observation, histological examination and molybdenum target (Mo-target) X-ray examination were performed on the specimens to study the repair of femoral neck defect. In gross observation, there was no macroscopic difference of femoral neck specimen between the 2nd and 4th postoperative week. At the 8th week, the defect orifice was closed with immature cortical bone, with unblocked marrow cavity. HE staining results showed that, at the 4th week, there were more new vessels in defect area of experimental side, compared with control side. At the 8th week, in experimental side there was immature cortical bone connecting the fracture end in defect area, with visible bone marrow cells. Mo-target X-ray examination found that, at the 8th week, the bone tissue repair in experimental side was better than control side. As a new drug delivery system, sECMH containing HGF has good application prospect in bone tissue repair.

  6. Subtalar Distraction Arthrodesis with Fresh Frozen Femoral Neck Allograft: A Retrospective Case Series.

    Science.gov (United States)

    Monaco, Spencer J; Brandao, Roberto A; Manway, Jeffrey M; Burns, Patrick R

    2016-10-01

    Subtalar joint distraction arthrodesis has been well reported with use of structural iliac crest or local autologous bone graft for malunited calcaneal fractures. Early reports for structural allograft did not yield good, consistent results, leading to a subsequent lack of recommendation in previous literature. Newer studies have had promising results utilizing femoral allograft as an alternative to autogenous bone graft. We performed a retrospective chart review on 10 patients (12 feet) undergoing subtalar joint distraction arthrodesis with femoral neck allograft for malunited calcaneal fractures. The primary aim of this study was to report on successful union rates and, in addition, outline any consistent complications. Twelve of the 12 procedures (100%) yielded successful fusion with a mean final follow-up of 7.7 months (range = 2.2-35.1 months). The mean increase in talocalcaneal height was 4 mm (range = 2-6 mm). The overall complication rate was 16.6%, including one superficial wound complication that healed uneventfully and one hardware removal. In conclusion, the current study reports a 100% successful fusion rate with interpositional structural femoral neck allograft in treatment for malunited calcaneal fractures. Therapeutic, Level IV: Case series. © 2016 The Author(s).

  7. Subtrochanteric femur fracture after removal of screws for femoral neck fracture in a child.

    Science.gov (United States)

    Song, Kwang Soon; Lee, Si Wook

    2015-01-01

    Displaced femoral neck fractures are rare in children and are associated with a high rate of complications. Subtrochanteric fractures after cannulated screw fixation of femoral neck fractures in adults are well recognized, and there are several reports on the topic. However, there are no reports on complications related to hardware or subtrochanteric fractures after removal of the screws in the treatment of femoral neck fractures in children. Here we report the case of a 10-year-old boy who sustained a subtrochanteric fracture after the screw removal and healing that followed a femoral neck fracture.

  8. Spontaneous fracture of the femoral neck in preexisting avascular necrosis of femoral head in sickle cell disease

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya

    2012-01-01

    Avascular necrosis of the femoral head is a known complication of femoral neck fracture but on the contrary,femoral neck fracture in a case of preexisting avascular necrosis is a very rare phenomenon.We present a case study of a 47 year old Iraqi male who developed spontaneous ipsilateral subcapital femoral neck fracture under the condition of preexisting sickle cell disease and avascular necrosis of the femoral head.The fracture was unnoticed for a few months.The patient was managed successfully by uncemented total hip arthroplasty.Postoperative recovery was uneventful and he was discharged 4 days after surgery.At 1 year's follow-up,the patient had normal gait and hip function,with no sign of loosening or any other complications on radiograph.

  9. Effects of anticoagulants on outcome of femoral neck fracture surgery.

    Science.gov (United States)

    Ginsel, Bastiaan L; Taher, Ahmad; Whitehouse, Sarah L; Bell, Jack J; Pulle, Chrys R; Crawford, Ross W

    2015-04-01

    To review records of 330 patients who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy. Medical records of 235 women and 95 men aged 48 to 103 years (mean, 81.6; standard deviation [SD], 13.1) who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy were reviewed. 30 patients were on warfarin, 105 on aspirin, 28 on clopidogrel, and 167 were controls. The latter 3 groups were combined as the non-warfarin group and compared with the warfarin group. Hospital mortality, time from admission to surgery, length of hospital stay, return to theatre, and postoperative complications (wound infection, deep vein thrombosis, and pulmonary embolism) were assessed. The warfarin and control groups were significantly younger than the clopidogrel and aspirin groups (80.8 vs. 80.0 vs. 84.2 vs. 83.7 years, respectively, preturned to theatre for surgery: one in the warfarin group for washout of a haematoma, 2 in the aspirin group for repositioning of a mal-fixation and for debridement of wound infection, and one in the control group for debridement of wound infection. The warfarin group did not differ significantly from non-warfarin group in terms of postoperative complication rate (6.7% vs. 2.7%, p=0.228) and the rate of return to theatre (3.3% vs. 1%, p=0.318). It is safe to continue aspirin and clopidogrel prior to surgical treatment for femoral neck fracture. The risk of delaying surgery outweighs the peri-operative bleeding risk.

  10. Bilateral subcapital femoral neck fractures secondary to transient osteoporosis during pregnancy: a case report.

    Science.gov (United States)

    Emami, Mohammad Jafar; Abdollahpour, Hamid Reza; Kazemi, Ali Reza; Vosoughi, Amir Reza

    2012-08-01

    Transient osteoporosis during pregnancy is a rare, self-limiting disease. We report on a 36-year-old woman who had bilateral subcapital femoral neck fractures during the 6th month of pregnancy. The diagnosis was made 4 days after delivery, because radiography was declined by the patient for fear of radiation. Fixation was not feasible owing to bone resorption, and 2-stage bipolar hemiarthroplasty was therefore performed. Magnetic resonance imaging is the best non-invasive investigative tool for pregnant women with hip pain. Early detection can prevent complications and resorting to major surgeries.

  11. Successful management of simple fractures of the femoral neck with femoral head and neck excision arthroplasty in two free-living avian species.

    Science.gov (United States)

    Burgdorf-Moisuk, Anne; Whittington, Julia K; Bennett, R Avery; McFadden, Mike; Mitchell, Mark; O'Brien, Robert

    2011-09-01

    A red-tailed hawk (Buteo jamaicensis) and a Canada goose (Branta canadensis) were evaluated for unilateral pelvic limb lameness. Physical examination findings and results of diagnostic imaging revealed femoral neck fractures in both birds. Both birds were treated with a femoral head and neck excision arthroplasty. The affected legs were not immobilized, and the birds were encouraged to use the legs immediately after surgery to encourage formation of a pseudoarthrosis. Within 2 weeks, both birds were using the affected limb well enough to be either successfully released or transferred to a wildlife rehabilitation facility. Femoral head and neck excision arthroplasty without immobilization of the limb is recommended for managing avian femoral neck fractures, especially in free-ranging species in which a rapid and complete or near complete return to function is vital for survival in the wild.

  12. Variations of relative anteversion of the femoral neck during walking.

    Science.gov (United States)

    Quesnel, T

    1998-01-01

    Based on the geometric model developed by Netter [11], we determined the different positions of the femoral neck during monopodal support in walking in relation to a fixed frontal plane of reference (relative anteversion). This "relative anteversion" ranges on average from 24 degrees of retroversion at the beginning of support to 15 degrees of anterversion at the end if loading. We then studied the relations possibly existing between relative anteversion and acetabular orientation on the one hand, and the orientation of the resultant of the articular stresses on the other (both being variables during monopodal support in walking). The results showed that relative anteversion is well correlated with variations of position of the acetabulum since, at most, the deviation between the respective axes did not exceed the anatomic deviation due to absolute anteversion of the femoral neck and acetabulum. Lastly, analysis of the relations obtained with the orientation of the resultant of the articular stresses allowed a better comprehension of the functional distribution of forces.

  13. EVALUATION OF NECK SHAFT ANGLE OF FEMUR ON DRY BONES

    Directory of Open Access Journals (Sweden)

    Radha

    2015-04-01

    Full Text Available BACKGROUND: Evaluation of the neck shaft angle of femur helps to understand clinical relevance in bio mechanics of the hip joint. It helps for the better treatment of different pathological conditions of hip and femur and also to design prosthesis. Femoral neck shaft angle is important to convey the information regarding the race to which they belong. Hence the present study was under taken to determine the neck shaft angle of femur in humans. OBJECTIVE: 1. To correct the different types of deformity and to have a normal good walking Mechanism. 2. To know the recent methodology and attempt to evaluate the range of normal Angles of femora and their sex differences. METHODS: ANTHROPOMETRIC: 100 Adult dry bones were studied and analyzed . The neck shaft angle of femur was measured by tracing outlines of contours of all femora. RESULTS: The neck shaft angle of the femur have revealed that there is no much difference in between males and females. There was slightly higher 0.2° in females. INTERPRETATION & CONCLUSION: There was no significant gender difference in neck shaft angle. The Knowledge of knowing the neck shaft angle helps to understand the Biomechanics of the hip joint and also for better treatment of pathological condition of hip and femur.

  14. Short-term Results of Muscle-Pedicle Bone Grafting with Tensor Fascia Lata for Delayed Femoral Neck Fractures; Case Series and Literature Review

    Science.gov (United States)

    Salgotra, Kuldip; Kohli, Sarabjeet; Vishwakarma, Nilesh

    2016-01-01

    Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft) and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG) using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7%) men and 1 (14.3%) women among the patients. Overall 5 (71.5%) patients had transcervical and 2 (28.5%) had subcapital fractures. At the end of 6 months, 6 (85.7%) patients were pain free and on plain radiographs fracture union was noted. One (14.3%) patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures. PMID:27331067

  15. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    Science.gov (United States)

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  16. Dislocation and spontaneous reduction of the femoral implant against the femoral neck in an infected metal on metal hip resurfacing with complex collection

    Energy Technology Data Exchange (ETDEWEB)

    Tins, Bernhard, E-mail: Bernhard.Tins@rjah.nhs.uk [Department of Radiology, RJAH Orthopaedic Hospital, Oswestry, Shropshire, SY 107 AG (United Kingdom)

    2011-07-15

    Metal on metal resurfacing hip implants are known to have complications unique to this type of implant. The case presented adds a further previously not described complication, the dislocation and spontaneous reduction of the pin of the femoral component against the femoral neck. The radiographic and CT findings are demonstrated. The dislocation was aided by bone loss due to an infection with a large periarticular collection. Periarticular collections in hip resurfacings are often due to a hypersensitivity type reaction to metal debris. However in the case presented it was due to infection. MRI was not able to discern the infection from a sterile collection. CT demonstrated bone loss and periosteal reaction suggestive of infection. In addition calcification of the pseudocapsule was seen, this is not a recognized feature of sterile collections.

  17. Nonunion of the femoral neck: Possibilities and limitations of the various treatment modalities

    Directory of Open Access Journals (Sweden)

    Raaymakers Ernst

    2008-01-01

    Full Text Available Nowadays in cases of nonunions of the femoral neck, the surgeon is tempted to perform prosthetic replacement of the hip, more so if there is also evidence of avascular necrosis of the head of femur. This provides rapid pain relief and allows early mobilization. However, long-term results of hip arthroplasties, especially in younger people and in the presence of osteopenia, are not always as expected; and a less radical approach is worth considering. The intertrochanteric valgization osteotomy, described by Pauwels, is an excellent alternative for healthy patients up to 65 years of age with a nonunion of the femoral neck. A union rate of 80-90% of the nonunion is described by most authors. Leg length inequallity, rotational and angular deformities can be corrected at the same time. During the period 1973-1995, we performed valgization osteotomy according to Pauwels in 66 patients of, 18-72 years old (mean 49.5 years. 24 (37% of our patients died 4 months to 24 years (mean: 9.5 years after the operation. Union of the femoral neck was achieved in 58 (88% of the 66 patients; union of the osteotomy in 65 patients (99%. A good or excellent result was achieved in 62% (23 uneventful and 13 with healed, necrosis/arthrosis without need for further treatment of our patients. However, the method has its limits. We feel if there is too little bone stock inside the femoral head, a valgization osteotomy does not give good result. The radiographic signs of avascular necrosis in patients over 30 years of age is considered a contraindication for an osteotomy. However our results show that it is worthwhile trying to save the joint of young patients even in case of a segmental collapse. In the race between revascularization and collapse, often revascularization is the winner. We deliberately give nature its chance and don′t rely on the result of bleeding from drill holes in the head, nuclear scans and other methods to estimate vascularity. A secondary total hip

  18. Accuracy and the influence of marrow fat on quantitative CT and dual-energy X-ray absorptiometry measurements of the femoral neck in vitro.

    Science.gov (United States)

    Kuiper, J W; van Kuijk, C; Grashuis, J L; Ederveen, A G; Schütte, H E

    1996-01-01

    Bone mineral measurements with quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) were compared with chemical analysis (ChA) to determine (1) the accuracy and (2) the influence of bone marrow fat. Total bone mass of 19 human femoral necks in vitro was determined with QCT and DXA before and after defatting. ChA consisted of defatting and decalcification of the femoral neck samples for determination of bone mineral mass (BmM) and amount of fat. The mean BmM was 4.49 g. Mean fat percentage was 37.2% (23.3%-48.5%). QCT, DXA and ChA before and after defatting were all highly correlated (r > 0.96, p defatting the QCT values were on average 0.35 g less than BmM and the DXA values were on average 0.65 g less than BmM. After defatting, all bone mass values increased; QCT values were on average 0.30 g more than BmM and DXA values were 0.29 g less than BmM. It is concluded that bone mineral measurements of the femoral neck with QCT and DXA are highly correlated with the chemically determined bone mineral mass and that both techniques are influenced by the femoral fat content.

  19. Corrosion at the head-neck interface of current designs of modular femoral components: essential questions and answers relating to corrosion in modular head-neck junctions.

    Science.gov (United States)

    Osman, K; Panagiotidou, A P; Khan, M; Blunn, G; Haddad, F S

    2016-05-01

    There is increasing global awareness of adverse reactions to metal debris and elevated serum metal ion concentrations following the use of second generation metal-on-metal total hip arthroplasties. The high incidence of these complications can be largely attributed to corrosion at the head-neck interface. Severe corrosion of the taper is identified most commonly in association with larger diameter femoral heads. However, there is emerging evidence of varying levels of corrosion observed in retrieved components with smaller diameter femoral heads. This same mechanism of galvanic and mechanically-assisted crevice corrosion has been observed in metal-on-polyethylene and ceramic components, suggesting an inherent biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers clinicians and researchers must understand regarding corrosion of the taper, and its relevance to current orthopaedic practice. Cite this article: Bone Joint J 2016;98-B:579-84.

  20. MULTICENTRIC GIANT CELL TUMOR OF IPSILATERAL ACETABULUM AND FEMORAL HEAD WITH PATHOLOGICAL FRACTURE OF FEMORAL NECK: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Jayant

    2015-02-01

    Full Text Available INTRODUCTION: Multicentric Giant Cell Tumor is extremely rare; here we are presenting a case of pathological neck femur fracture in case of multicentric giant cell tumor involving ipsilateral acetabulum along with femoral head and neck. CASE PRESENTATION: 24 years old male presented with pain in groin region and inability to walk after he fell down while walking. He had pain in left groin on weight bearing for last six months. Radiological examination shows pathological trans - cervical femoral neck fracture with sub - articular lytic lesion in femoral head and neck suggestive of Giant cell tumor. MRI has been done to define the extent of involvement and to rule out soft tissue infiltration. Fine needle aspiration cytology which was done through anterior route was inconclusive. After review of literature, patient has been planned for excisional biopsy and un - cemented total hip arthroplasty. Intra - operatively, frozen section confirms the giant cell tumor and surprisingly acetabulum was found to be involved which was curetted and hydrogen - peroxide treated. Post - operatively, patient was pain - free with good range of movements at hip. CONCLUSION: Giant cell tumor involving femoral head and neck with pathological fracture though uncommon, but may present as multicentric with acetabular involvement.

  1. Fixed treatment for femoral neck fracture of young adults by bone flap M. sartorious transplanting and hollow pulling nails%缝匠肌骨瓣移植空心拉力钉固定治疗青壮年股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    蔡明; 白金广

    2000-01-01

    目的:通过采用缝匠髂骨瓣移植、空心拉力钉固定治疗青壮年股骨颈骨折,获得更好的疗效。方法:自1992年1月~1999年12月,采用缝匠肌骨瓣移植桥接与空心拉力钉固定治疗青壮年股骨颈骨折,随访时间1~5年,平均4年。结果:73例新鲜骨折中1例骨折不愈合,股骨头坏死,1例骨折愈合股骨头坏死;27例移位型陈旧骨折中3例骨折不愈合,股骨头坏死,2例骨折愈合后股骨头坏死。骨折愈合率96%,股骨头坏死率7%。结论:缝匠肌骨瓣移植可改善股骨头血供并使植骨以"活骨骨折愈合"的方式完成,陈旧性骨折股骨颈吸收的可重建股骨颈,并有一定的强度支撑防止股骨头坏死应力塌陷,与空心拉力钉有协同支撑固定作用。三根空心拉力钉固定创伤小而连接控制面积大是理想的内固定物。%Objective: To achieve better effects through the application of bone flap M. Sartorious transplanting and hollowpulling nails for the treatment of the femoral neck fracture of young adults. Methods: From 1,1992 to 12, 1999, We treatedfemoral neck fracture of young adults by bone flap M. Sartorious transplanting and hollow pulling nails with one to five yearsfollow-up,averaging 4 years. Results: Among 73 fresh (new) fracture 1 not healed up,femoral head necrosis, 1 healed up, withtemoral head necrosis;27 transferred old fractures, 3 not healed up, femoral head necrosis, 2 healed up, femoral head necrosis.Fracture healing rate was 96 percent, femoral head necrosis rate was 7 percent. Conclusion: That the bone flap M. Sartorioustransplanting can improve femoral blood supply, finish bone transplanting in a way of"live bone fracture healing up", rebuildfemoral neck for old fracture and together with hollow pulling nails prevent femora from necrosis. Three hollow pulling forcenails make little wound and large joined controlling area. They are the ideal inner fixed objects.

  2. Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis

    Institute of Scientific and Technical Information of China (English)

    Zhao Wenbo; Liu Lei

    2014-01-01

    Objective:To discuss the curative effect of the dynamic hip system blade (DHS-blade) on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods:A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of (66.8±3.2) years.According to the Singh Index Classification,all the patients' Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results:All patients were followed up for 12-17 months (mean 14 months).No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months (average 3.5 months).According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively (P<0.05).Conclusion:DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis.

  3. Correlation study between 25-OH-D2, 25-OH-D3, and the bone mineral density of the femoral neck%25-OH-D2、25-OH-D3与股骨颈骨密度的相关性研究

    Institute of Scientific and Technical Information of China (English)

    宋红

    2014-01-01

    Objective To investigate the correlation between the content of the 25-hydroxyvitamin D2 ( 25-( OH ) D2 ) and 25-hydroxyvitamin (25-(OH)D3) and the bone mineral density of the femoral neck (femoral neck BMD).Methods The femoral neck BMD of 205 patients was detected using dual energy X-ray absorptiometry.The serum levels of 25-( OH) D2 and 25-( OH) D3 were determined using high performance liquid chromatography.The correlation between Vitamin D ( Vit D) content and the femoral neck BMD was analyzed.Results In patients younger than 50 years old, no correlation between the VitD (25-(OH)D2 and 25-(OH)D3) content and the femoral neck BMD was observed (P>0.05).But in patients elder than 50 years old, a positive linear correlation was observed (P<0.05 or P<0.01).This existed both in men and women.Conclusion In patients elder than 50 years old, the serum Vit D level decreases along with the increase of age, which may cause a decline in the femoral neck BMD.%目的:研究人体内25羟维生素D2(25-OH-D2)、25羟维生素D3(25-OH-D3)含量与股骨颈骨密度的相关性。方法利用双能X线骨密度测量法检测205例患者股骨颈骨密度,同时用高效液相色谱法检测其血清中25-OH-D2及25-OH-D3的含量,并根据维生素D(VitD)含量分析VitD与骨密度的关系。结果人体内VitD(25-OH-D2+25-OH-D3)含量与50岁以下者的股骨颈骨矿含量无相关性(P>0.05),与50岁以上者呈正向直线相关(P<0.05或P<0.01),男女性别均一致。结论对于50岁以上者,随着年龄的增长,其体内血清VitD的含量降低很可能会导致其股骨颈骨矿含量下降。

  4. Hip dislocation following the treatment of femoral neck fracture: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2010-01-01

    Full Text Available Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.

  5. Patterns of osteocytic endothelial nitric oxide synthase expression in the femoral neck cortex: differences between cases of intracapsular hip fracture and controls.

    Science.gov (United States)

    Loveridge, N; Fletcher, S; Power, J; Caballero-Alías, A M; Das-Gupta, V; Rushton, N; Parker, M; Reeve, J; Pitsillides, A A

    2002-06-01

    Evidence indicates that extensive amalgamation of adjacent resorbing osteons is responsible for destroying the microstructural integrity of the femoral neck's inferior cortex in osteoporotic hip fracture. Such osteonal amalgamation is likely to involve a failure to limit excessive resorption, but its mechanistic basis remains enigmatic. Nitric oxide (NO) inhibits osteoclastic bone destruction, and in normal bone cells its generation by endothelial nitric oxide synthase (eNOS, the predominant bone isoform) is enhanced by mechanical stimuli and estrogen, which both protect against fracture. To determine whether eNOS expression in osteocytes reflects their proposed role in regulating remodeling, we have examined patterns of osteocyte eNOS immunolabeling in the femoral neck cortex of seven cases of hip fracture and seven controls (females aged 68-96 years). The density of eNOS+ cells (mm(-2)) was 53% lower in the inferior cortex of the fracture cases (p bone.

  6. Atypical femoral neck stress fracture in a marathon runner: a case report and literature review.

    LENUS (Irish Health Repository)

    2012-02-01

    BACKGROUND: Femoral neck stress fractures are relatively rare and may present as sports-related injuries. The presentation is variable, and prompt diagnosis facilitates the earliest return to pre-morbid functional activity levels. Delayed detection may precipitate femoral non-union or avascular necrosis, resulting in long-term functional deficit. AIMS: We present the case of a basicervical femoral neck stress fracture occurring in a 23-year-old marathon runner. The pathophysiology and practical management issues related to this unusual injury pattern are discussed. CONCLUSION: The growing interest in amateur athletic activities should raise the index of suspicion for stress fractures of the femoral neck in healthy adults with atypical hip pain. Increased levels of patient education and physician awareness can reduce the incidence of long-term morbidity in cases of this unusual sports-related injury.

  7. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report.

    Science.gov (United States)

    Okamoto, Shinichi; Arai, Yuji; Hara, Kunio; Tsuzihara, Takashi; Kubo, Toshikazu

    2010-03-05

    This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad.

  8. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report

    Directory of Open Access Journals (Sweden)

    Okamoto Shinichi

    2010-03-01

    Full Text Available Abstract This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad.

  9. The role of acetabulum geometry and femoral head-neck ratio in the development of osteoarthritis in young men

    DEFF Research Database (Denmark)

    Halle, B; Halle, D M; Torfing, T;

    2007-01-01

    We studied the role of acetabulum geometry and head neck ratio in the development of osteoarthritis of the hip in young men. Contrary to previous studies we evaluated the significance of the anterior, posterior and total coverage of the femoral head, the influence of the femoral neck and the cons......We studied the role of acetabulum geometry and head neck ratio in the development of osteoarthritis of the hip in young men. Contrary to previous studies we evaluated the significance of the anterior, posterior and total coverage of the femoral head, the influence of the femoral neck...

  10. Mechanical properties of femoral trabecular bone in dogs

    Directory of Open Access Journals (Sweden)

    Nolte Ingo

    2005-03-01

    Full Text Available Abstract Background Studying mechanical properties of canine trabecular bone is important for a better understanding of fracture mechanics or bone disorders and is also needed for numerical simulation of canine femora. No detailed data about elastic moduli and degrees of anisotropy of canine femoral trabecular bone has been published so far, hence the purpose of this study was to measure the elastic modulus of trabecular bone in canine femoral heads by ultrasound testing and to assess whether assuming isotropy of the cancellous bone in femoral heads in dogs is a valid simplification. Methods From 8 euthanized dogs, both femora were obtained and cubic specimens were cut from the centre of the femoral head which were oriented along the main pressure and tension trajectories. The specimens were tested using a 100 MHz ultrasound transducer in all three orthogonal directions. The directional elastic moduli of trabecular bone tissue and degrees of anisotropy were calculated. Results The elastic modulus along principal bone trajectories was found to be 11.2 GPa ± 0.4, 10.5 ± 2.1 GPa and 10.5 ± 1.8 GPa, respectively. The mean density of the specimens was 1.40 ± 0.09 g/cm3. The degrees of anisotropy revealed a significant inverse relationship with specimen densities. No significant differences were found between the elastic moduli in x, y and z directions, suggesting an effective isotropy of trabecular bone tissue in canine femoral heads. Discussion This study presents detailed data about elastic moduli of trabecular bone tissue obtained from canine femoral heads. Limitations of the study are the relatively small number of animals investigated and the measurement of whole specimen densities instead of trabecular bone densities which might lead to an underestimation of Young's moduli. Publications on elastic moduli of trabecular bone tissue present results that are similar to our data. Conclusion This study provides data about directional elastic

  11. Efficacy Evaluation for the Treatment of Subcapital Femoral Neck Fracture in Young Adults by Capsulotomy Reduction and Closed Reduction

    Institute of Scientific and Technical Information of China (English)

    Cong Liu; Meng-Ting Liu; Peng Li; Hong-Hai Xu

    2015-01-01

    Background:Subcapital femoral neck fracture in young adults has many complications,and the incidence is increasing year-by-year.The selection of the proper operation method to avoid them is an ambiguous matter.This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and intemal fixation in young adults.Methods:From March 2003 to February 2010,65 young patients with subcapital femoral neck fractures were treated,including 39 males and 26 females with average age of 34.5 years (range,19-50 years); 29 cases of the left side and 36 cases of the right side.They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting.The two groups had no significant differences in sex,age,body mass index and preoperative Harris Hip Score.The observation criteria involved the length of the incision,blood loss,operation time,nonunion rate,avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score.Results:Four of 65 patients were lost follow-up,and the follow-up rate was 93.8%,the average follow-up time was 38.7 months (range,33-47 months).In Group A,the incision length was 5.1 ± 2.2 cm,blood loss was 84.0 ± 13.2 ml,and operation time was 52.9 ± 10.2 min.In Group B,the incision length was 15.4 ± 4.6 cm,blood loss was 396.0 ± 21.3 ml,and operation time was 1 16.5 ± 15.3 min.Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B.ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B.Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B.The above index of two groups was considered statistically significant (P < 0.05).Conclusions:Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing,reduce ANFH

  12. Subchondral bone density distribution in the human femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Wright, David A.; Meguid, Michael; Lubovsky, Omri; Whyne, Cari M. [Sunnybrook Research Institute, Orthopaedic Biomechanics Laboratory, Toronto, Ontario (Canada)

    2012-06-15

    This study aims to quantitatively characterize the distribution of subchondral bone density across the human femoral head using a computed tomography derived measurement of bone density and a common reference coordinate system. Femoral head surfaces were created bilaterally for 30 patients (14 males, 16 females, mean age 67.2 years) through semi-automatic segmentation of reconstructed CT data and used to map bone density, by shrinking them into the subchondral bone and averaging the greyscale values (linearly related to bone density) within 5 mm of the articular surface. Density maps were then oriented with the center of the head at the origin, the femoral mechanical axis (FMA) aligned with the vertical, and the posterior condylar axis (PCA) aligned with the horizontal. Twelve regions were created by dividing the density maps into three concentric rings at increments of 30 from the horizontal, then splitting into four quadrants along the anterior-posterior and medial-lateral axes. Mean values for each region were compared using repeated measures ANOVA and a Bonferroni post hoc test, and side-to-side correlations were analyzed using a Pearson's correlation. The regions representing the medial side of the femoral head's superior portion were found to have significantly higher densities compared to other regions (p < 0.05). Significant side-to-side correlations were found for all regions (r {sup 2} = 0.81 to r {sup 2} = 0.16), with strong correlations for the highest density regions. Side-to-side differences in measured bone density were seen for two regions in the anterio-lateral portion of the femoral head (p < 0.05). The high correlation found between the left and right sides indicates that this tool may be useful for understanding 'normal' density patterns in hips affected by unilateral pathologies such as avascular necrosis, fracture, developmental dysplasia of the hip, Perthes disease, and slipped capital femoral head epiphysis. (orig.)

  13. Factors affecting health-related quality of life in patients after femoral neck fracture.

    Science.gov (United States)

    Valavičienė, Rasa; Smailys, Alfredas; Macijauskienė, Jūratė; Hommel, Ami

    2010-01-01

    Quality of life in patients with femoral neck fracture is an issue frequently discussed in the literature. There is ongoing research on identifying factors that have an impact on quality of life in this particular group of patients. A great variety of factors affecting quality of life and lack of information on their importance encouraged us to perform a systematic literature review analyzing quality of life of patients who sustained femoral neck fracture. The search was performed in the PubMed and Medline databases according to the selected key words. In our systematic review, we included clinical and clinical randomized trials investigating patients with femoral neck fracture and their quality of life. Our analysis showed that treatment of femoral neck fracture with hip replacement was superior to osteosynthesis with regard to patients' quality of life. The data regarding the impact of different rehabilitation programs on quality of life were controversial; a few reports showed that special rehabilitation programs were associated with better health-related quality life. However, other studies did not report any differences in patients' quality of life when different rehabilitation programs were applied. Patient's nutrition may be an important factor affecting the quality of life in patients with femoral neck fractures; however, data supporting this fact are insufficient.

  14. Bone Mineral Densities and Mechanical Properties of Retrieved Femoral Bone Samples in relation to Bone Mineral Densities Measured in the Respective Patients

    Directory of Open Access Journals (Sweden)

    Yvonne Haba

    2012-01-01

    Full Text Available The bone mineral density (BMD of retrieved cancellous bone samples is compared to the BMD measured in vivo in the respective osteoarthritic patients. Furthermore, mechanical properties, in terms of structural modulus (Es and ultimate compression strength (σmax of the bone samples, are correlated to BMD data. Human femoral heads were retrieved from 13 osteoarthritic patients undergoing total hip replacement. Subsequently, the BMD of each bone sample was analysed using dual energy X-ray absorptiometry (DXA as well as ashing. Furthermore, BMDs of the proximal femur were analysed preoperatively in the respective patients by DXA. BMDs of the femoral neck and head showed a wide variation, from 1016±166 mg/cm2 to 1376±404 mg/cm2. BMDs of the bone samples measured by DXA and ashing yielded values of 315±199 mg/cm2 and 347±113 mg/cm3, respectively. Es and σmax amounted to 232±151 N/mm2 and 6.4±3.7 N/mm2. Significant correlation was found between the DXA and ashing data on the bone samples and the DXA data from the patients at the femoral head (r=0.85 and 0.79, resp.. Es correlated significantly with BMD in the patients and bone samples as well as the ashing data (r=0.79, r=0.82, and r=0.8, resp..

  15. bone mineral densities and mechanical properties of retrieved femoral bone samples in relation to bone mineral densities measured in the respective patients.

    Science.gov (United States)

    Haba, Yvonne; Skripitz, Ralf; Lindner, Tobias; Köckerling, Martin; Fritsche, Andreas; Mittelmeier, Wolfram; Bader, Rainer

    2012-01-01

    The bone mineral density (BMD) of retrieved cancellous bone samples is compared to the BMD measured in vivo in the respective osteoarthritic patients. Furthermore, mechanical properties, in terms of structural modulus (E(s)) and ultimate compression strength (σ(max)) of the bone samples, are correlated to BMD data. Human femoral heads were retrieved from 13 osteoarthritic patients undergoing total hip replacement. Subsequently, the BMD of each bone sample was analysed using dual energy X-ray absorptiometry (DXA) as well as ashing. Furthermore, BMDs of the proximal femur were analysed preoperatively in the respective patients by DXA. BMDs of the femoral neck and head showed a wide variation, from 1016 ± 166 mg/cm(2) to 1376 ± 404 mg/cm(2). BMDs of the bone samples measured by DXA and ashing yielded values of 315 ± 199 mg/cm(2) and 347 ± 113 mg/cm(3), respectively. E(s) and σ(max) amounted to 232 ± 151 N/mm(2) and 6.4 ± 3.7 N/mm(2). Significant correlation was found between the DXA and ashing data on the bone samples and the DXA data from the patients at the femoral head (r = 0.85 and 0.79, resp.). E(s) correlated significantly with BMD in the patients and bone samples as well as the ashing data (r = 0.79, r = 0.82, and r = 0.8, resp.).

  16. Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vande Berg, Bruno C. [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium)]. E-mail: vandeberg@rdgn.ucl.ac.be; Gilon, Raphael [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Malghem, Jacques [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Lecouvet, Frederic [Radiology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Depresseux, Genevieve [Rheumatology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium); Houssiau, Frederic A. [Rheumatology Department, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels (Belgium)

    2006-06-15

    Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p = 0.0298). Conclusion: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy.

  17. 生物型与骨水泥型人工股骨头置换治疗高龄股骨颈骨折%Biotype and bone cement-type artificial femoral head replacement for the treatment of femoral neck fracture in elderly patients

    Institute of Scientific and Technical Information of China (English)

    史建国; 邱南海

    2013-01-01

      BACKGROUND: With the maturity and development of artificial joint materials, processes and technology, artificial femoral head replacement has been widely used for the treatment of femoral neck fracture, especial y the elderly patients with displaced femoral neck fracture. OBJECTIVE: To observe the clinical efficacy of biotypes and cementless artificial femoral head replacement for the treatment of elderly femoral neck fracture combined with heart disease. METHODS: Thirty-five elderly femoral neck fracture patients with heart disease treated in the Department of Orthopedic Center, Tianjin Nursing Home from January 2004 to December 2009 were selected, including 16 cases of coronary heart disease combined with angina pectoris, eight cases of myocardial infarction coronary heart disease, eight cases of asymptomatic coronary heart disease and three cases of ischemic cardiomyopathy and coronary heart disease. And 18 cases were treated with biotypes artificial femoral head replacement, 17 cases were treated with cementless artificial femoral head replacement. RESULTS AND CONCLUSION: One of the 35 patients was dead in the surgery, other 34 cases were fol owed-up for 8 to 36 months. Three cases of complications occurred in surgery were belongs to cementless group, and one patient died during surgery, two cases had to drop in blood pressure and suffered from difficulty breathing in surgery, whose life characteristics returned to normal after efforts to save. In the fol ow-up process, part of the prosthesis implanted in the two cases of patients with severe osteoporosis appears sinking in the biotype group, the excel ent rate of biotype group was 89%(16/18), and the cementless group was 94%(16/17). It suggests that biotype artificial femoral head replacement is suitable for the patients with severe heart disease, while the cementless artificial femoral head replacement is suitable for osteoporosis patients.%  背景:随着人工关节材料、工艺及技术的

  18. Design and validation of automated femoral bone morphology measurements in cerebral palsy.

    Science.gov (United States)

    Park, Noyeol; Lee, Jehee; Sung, Ki Hyuk; Park, Moon Seok; Koo, Seungbum

    2014-04-01

    Accurate quantification of bone morphology is important for monitoring the progress of bony deformation in patients with cerebral palsy. The purpose of the study was to develop an automatic bone morphology measurement method using one or two radiographs. The study focused on four morphologic measurements-neck-shaft angle, femoral anteversion, shaft bowing angle, and neck length. Fifty-four three-dimensional (3D) geometrical femur models were generated from the computed tomography (CT) of cerebral palsy patients. Principal component analysis was performed on the combined data of geometrical femur models and manual measurements of the four morphologic measurements to generate a statistical femur model. The 3D-2D registration of the statistical femur model for radiography computes four morphological measurements of the femur in the radiographs automatically. The prediction performance was tested here by means of leave-one-out cross-validation and was quantified by the intraclass correlation coefficient (ICC) and by measuring the absolute differences between automatic prediction from two radiographs and manual measurements using original CT images. For the neck-shaft angle, femoral anteversion, shaft bowing angle, and neck length, the ICCs were 0.812, 0.960, 0.834, and 0.750, respectively, and the mean absolute differences were 2.52°, 2.85°, 0.92°, and 1.88 mm, respectively. Four important dimensions of the femur could be predicted from two views with very good agreement with manual measurements from CT and hip radiographs. The proposed method can help young patients avoid instances of large radiation exposure from CT, and their femoral deformities can be quantified robustly and effectively from one or two radiograph(s).

  19. 前外侧和外侧联合入路的股骨颈肿瘤刮除植骨及内固定术%Surgical technique of combined anterior-lateral and lateral approach in the management of bone tumor of femoral neck

    Institute of Scientific and Technical Information of China (English)

    伦登兴; 胡永成; 黄洪超; 夏群; 苗军; 于金虎

    2011-01-01

    Objective To explore surgical procedure of combined anterior-lateral and lateral approach for the treatment of bone tumors of femoral neck. Methods Forty patients with bone tumors of femoral neck treated in Tianjin Hospital were included from July 2005 to August 2009. Of the patients, 12 who were treated with curettage and bone graft through combined anterior-lateral and lateral incision were analyzed in this study. There were 7 males and 5 females with an average age of 34 years ranging from 17 to 68 years. 4 patients were diagnosed as chondroblastoma, 2 giant cell tumor, 3 fibrous dysplasia, and 3 single bone cysts. 7 patients suffered from pathologic fractures, and 5 had presented thin cortical bone because of tumor involvement. There were 1 tumor located in H1 zone, 4 in H2 zone and 7 in H1,2 zone according to ISOLS femoral neck classification. All patients were treated by curettage and bone graft via anterior-lateral approach, 10 cases underwent internal fixation with anatomical plate, and 2 cases with canulated screws with lateral approach. Results The follow-up time ranged from 10 to 68 months with an average of 35 months.Pain disappeared in all patients, and there were not recurrence of tumor, pathologic fractures and avascular necrosis. One case had complained of lateral femoral skin numbness which may be caused by injures of femoral lateral nerves. One case had difficulties in the valgus of hip joint. The mean MSTS score was 29.2 points ranging from 27 to 30 points. Conclusion Anterior approaches of "SP" incision is helpful to thorough curettage which decrease the risk of recurrence due to good visualization and intemal fixation is easy to perform via lateral approaches. The result suggested that combined anterior-lateral "SP" and lateral incision is liable option in treatment of bone tumors of femoral neck.%目的 探讨前外侧和外侧联合入路肿瘤刮除植骨重建治疗股骨颈骨肿瘤的疗效.方法 2005年7月至2009年8月采用前外侧

  20. Perioperative treatment of femoral neck fracture with deep venous thrombosis: A case report

    Institute of Scientific and Technical Information of China (English)

    Ming Liu; Lei Liu; Fuguo Huang; Yue Fang; Gang Zhong; Zhou Xiang

    2015-01-01

    Deep venous thrombosis (DVT) is an important cause of disability and mortality after major orthopedic surgery.The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice.Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery.Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken.The condition of the patient was stable during the perioperative period and the surgery was successful.Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory.Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.

  1. Pertrochanteric osteotomy and distraction femoral neck lengthening for treatment of proximal hip ischemic deformities in children.

    Science.gov (United States)

    Teplenky, Mikhail; Mekki, Waleed

    2016-02-01

    Proximal femoral ischemic deformities in the pediatric population is a challenging pathological situation. Many surgical techniques have been proposed to treat this problem, with variable reported results. We believe that a C-shaped pertrochanteric osteotomy plus neck lengthening utilizing distraction osteogenesis principles would restore the femoral anatomical ratios between neck, shaft, and the head, and redress the biomechanics of the proximal femur with resultant sufficient containment of the femoral head within the acetabulum. We reviewed the results of 19 patients divided into two groups with proximal femoral ischemic deformities. Between 2002 and 2009, preoperative and postoperative clinical examination and radiographs were assessed measuring the neck-shaft angle (NSA), neck-epiphyseal angle (NEA), articulo-trochanteric distance (ATD), lateralization of the greater trochanter (LT), the angle of Wiberg (CEA), index of lateral head displacement by Reimers (IM), and lateral angle of displacement (LDA). All patients were followed prospectively. Clinical outcome was assessed using Colton's criteria, which showed average good improvement in function (58.9 %). Radiological indicators were assessed using Kruczynski's criteria. For group I, the postoperative NSA, NEA, and CEA showed significant change (p < 0.01, p < 0.001, and p < 0.001, respectively). For group II, the postoperative NSA, NEA, and CEA showed significant change (p < 0.001, p < 0.001, and p < 0.001, respectively). The midterm functional results are favorable for the implementation of pertrochanteric osteotomy and distraction osteogenesis to treat proximal femoral ischemic deformities in the pediatric population.

  2. Forum. Femoral neck surgery using a local anaesthetic technique.

    Science.gov (United States)

    Howard, C B; Mackie, I G; Fairclough, J; Austin, T R

    1983-10-01

    Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.

  3. Comparison of cementless and bone-cement protheses in total hip arthroplasty for osteoporotic femoral neck fracture in elderly patients%生物型和骨水泥型股骨假体全髋关节置换术治疗老年骨质疏松性股骨颈骨折的临床效果对比

    Institute of Scientific and Technical Information of China (English)

    王华国; 叶劲; 邹仲兵; 白波

    2014-01-01

    Objective To compare the therapeutic effects of bone-cement stem and cementless stem used in the total hip arthroplasty ( THA) for treating the osteoporotic fracture of the femoral neck in the senile patients .Methods A retrospective study was carried out to analyse 100 cases of osteoporotic femoral neck fracture in the elderly patients who underwent THA in our hospital .The patients were divided into two groups by the operation methods:group A, 60 cases applied bone-cement stem in THA;group B, 40 cases applied cementless stem in THA .The hip joint function , the motion range of the joint , the imaging characteristics of the hip and posoperative pain were all compared between the two groups . Results Therewere significant differences in the clinical therapeutic effects between the two groups ( P<0.05).Conclusions The postoperative effects of the bone-cement stem is much better than the cementless stem in THA for the osteoporotic femoral neck fracture in elderly , but it may cause the risks of deep venous thromboembolism and bone cement crisis .%目的:对比老年骨质疏松股骨颈骨折使用生物型股骨假体柄与骨水泥型股骨假体柄行全髋关节置换术治疗效果。方法对本组进行老年骨质疏松股骨颈骨折100例(100髋)进行的全髋关节置换术根据手术方式分为A组(股骨假体柄骨水泥型全髋关节置换术,60髋), B组(股骨假体柄生物型全髋关节置换术,40髋)。对比两组髋关节功能、关节活动度、髋关节影像学特点及术后疼痛情况。结果老年骨质疏松股骨颈骨折行全髋关节置换术,采用生物型股骨假体柄与骨水泥型股骨假体柄的全髋关节置换术临床疗效对比差异显著( P<0.05)。结论对于老年骨质疏松股骨颈骨折行全髋关节置换术,应用骨水泥型者股骨假体柄术后近期疗效明显优于生物型,但它有诱发深静脉血栓栓塞和骨水泥危象的风险。

  4. EVALUATION OF NECK SHAFT ANGLE OF FEMUR ON DRY BONES

    OpenAIRE

    Radha; Ravi Shankar; Naveen; Roopa

    2015-01-01

    BACKGROUND: Evaluation of the neck shaft angle of femur helps to understand clinical relevance in bio mechanics of the hip joint. It helps for the better treatment of different pathological conditions of hip and femur and also to design prosthesis. Femoral neck shaft angle is important to convey the information regarding the race to ...

  5. 不同角度植骨和空心钉固定股骨颈骨折的生物力学研究%Biomechanical study of femoral neck fracture fixed by cannulated screws and iliac bone graft at different angles

    Institute of Scientific and Technical Information of China (English)

    李智勇; 张奇; 张英泽; 王娟; 田帅; 秦士吉; 刘跃驹; 许斌

    2015-01-01

    Objective To investigate the biomechanical stability of iliac bone grafts at different angles with three cannulated screws for fixation of femoral neck fractures in order to provide scientific basis for clinical application.Methods The nine pairs of proximal femora and ipsilateral iliac bone grafts with lateral and upper surface retaining cortex were harvested from nine cadavers fixed in formalin,which were randomly divided into two groups: cannulated screw with medial bone graft fixation group ( CMB group) ,cannulated screw with cross bone graft fixation group ( CCB group) .The specimens were cut with power saw to create a standardized midcervical osteotomy perpendicular to the cervical neck.The fracture was then reduced and fixed with three parallel 7.3mm cannulated screws and an iliac bone graft.The cannulated screws were placed triangularly with one screw superior and two inferior.In the CMB group,the bone graft was in the middle of three cannulated screws and parallel with it,however,in the CCB group,the bone graft was made an angle of 30°with the screws on postero-anterior position.All the bone grafts were passed across the fracture line about 1.5cm.Every specimen was detected by Electroforce 3520-AT biomechanical machine.Results When femoral head was rotated to 3°and 5°, the torque values in CCB group were significantly higher than those in CMB group ( P <0.05) ,however,during axial displacement at the load of 700N and 1000N, the displacement values in CCB group were significantly lower than those in CMB group ( P <0.05).All the specimens underwent cycling compression test at 700N compression force successfully,without fatigue fracture or screw failure.The mean ultimate load in CMB group and CCB group was (2112.689 ±186.913)N and (2360.811 ±204.340)N,respectively,there was a significant difference between two groups ( P <0.05).Conclusion The biomechanical stability of fixation of femoral neck fracture with three cannulated screws in CCB group is

  6. The societal costs of femoral neck fracture patients treated with internal fixation

    NARCIS (Netherlands)

    Zielinski, S.M.; Bouwmans, C.A.; Heetveld, M.J.; Bhandari, M.; Patka, P.; Lieshout, E.M. van; Kampen, A. van

    2014-01-01

    SUMMARY: The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are compa

  7. Bilateral femoral neck fractures due to transient osteoporosis of pregnancy: a case report

    OpenAIRE

    Willis-Owen, Charles A; Daurka, Jas S; Chen, Alvin; Lewis, Angus

    2008-01-01

    We describe a case of bilateral femoral neck fractures secondary to transient osteoporosis of pregnancy, which were diagnosed after delivery due to the desire to avoid ionising radiation. These fractures were presumed to be secondary to transient osteoporosis of pregnancy and were treated successfully with internal fixation despite delayed presentation. We discuss the role of MRI in the evaluation of hip pain in pregnancy.

  8. The societal costs of femoral neck fracture patients treated with internal fixation

    NARCIS (Netherlands)

    Zielinski, S.M.; Bouwmans, C.A.; Heetveld, M.J.; Bhandari, M.; Patka, P.; Lieshout, E.M. van; Kampen, A. van

    2014-01-01

    SUMMARY: The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are

  9. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    DEFF Research Database (Denmark)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistic...

  10. Clinical, Radiologic and scintigraphic evaluation of the results of A. Moore and Thompson prostheses in the management of femoral neck fractures

    OpenAIRE

    Kiran, Ugur; Orhan, Zafer; Parmaksizoglu, Atilla Sancar; Ozkaya, Ufuk; Yalaman, Okan; Yazıcı, Nüzhet

    2004-01-01

    140 patients had been operated due to femoral neck fractures in the Ortopaedics and Traumatology CIinic Taksim State Hospital during the period of 1985 to 1991 and of this group, 42 patient's results were clinically, radiologically and scintigraphically evaluated. We evaluated the technical criteria used in the A.Moore type and the Thompson type endoprostheses, and tried to emphasize the significance of Tc-99 bone scanning in assesment of the results of prosthetic replacement. In this study, ...

  11. Application of left femoral neck radioactive uptake ratio in 99Tcm-MDP bone scan for evaluation of osteoporosis%99Tcm-MDP骨显像左侧股骨颈放射性计数比值评价骨质疏松的价值

    Institute of Scientific and Technical Information of China (English)

    朱宝; 邵科晶; 杨丹; 袁航; 朱蕙; 浦晓佳; 王菲

    2013-01-01

    Objective To evaluate the value of 99Tcm-MDP uptake by left femoral neck for diagnosing osteopomsis.Methods A total of 58 cases (23 males,35 females,mean age:(66.15±8.45) years) with spondyloarthmpathies from May to December of 2012 were selected.Serum concentrations of type Ⅰ collagen telopeptide (sCTX-1) and bone ALP (BALP) were determined.All patients underwent dual-energy X-ray absorptiometry (DXA) to detect bone mineral density (BMD).According to the T scores,patients were divided into 2 groups:normal group (NG) (T>-1.0) and osteoporosis group (OG) (T≤-2.5).99TcmMDP bone scan was further performed.The average radioactive ratio of the left femoral neck to the medial soft tissue of left femur (T/N) was measured.Data differences between the 2 groups were compared by twosample t test and Pearson correlation analysis.Results According to BMD,13 patients (7 males,6 females) were included in NG and 28 patients (10 males,18 females) were included in OG.The mean ages of OG and NG were significantly different ((68.82± 10.41) years vs (62.46± 11.77) years; t =3.560,P<0.05).The BMD of left femoral neck in OG was significantly lower than that in NG ((0.67±0.08) g/cm2 vs (0.91±0.10) g/cm2 ; t=9.917,P<0.01).Although BALP level of OG was significantly higher than that of NG ((35.92±11.58) U/L vs (22.38±6.34) U/L; t=-3.397,P<0.05),no significant difference was observed on sCTX-1 between the 2 groups (t=-0.463,P>0.05).T/N ratio of OG (11.63±6.22) was higher than that of NG (9.74±4.44) (t =-3.027,P< 0.05).There were significant correlations between the T/N ratio of the left femoral neck and the sCTX-1 and BALP concentrations (r=0.376,0.483,both P<0.01).No correlations between the T/N ratio of the left femoral neck and age,BMI and BMD were observed (r=-2.031,-0.017,0.134,all P>0.05).Conclusion The uptake ratio of the left femoral neck in 99Tcm-MDP bone scan could evaluate the metabolism of bone,and it is useful for the early diagnosis of osteoporosis

  12. Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management

    Directory of Open Access Journals (Sweden)

    Narender Kumar Magu

    2014-01-01

    Full Text Available Background: Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term "small head or inadequate size femoral head" objectively for its prognostic significance. Materials and Methods: 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. Results: The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm. Proximal fragment volume of >43 cu cm was termed adequate size (type I and of ≤43 cu cm as small femoral head (type II. Fractures which united (n = 54 had a relatively large average head size (59 cu cm when compared to fractures that did not (n = 16, which had a small average head size (49 cu cm and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05. Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05. Conclusion: Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective

  13. Osteonecrosis of the femoral head after bone marrow transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Jun, Jeong Su; Park, Chang Suk; Kim, Yong Sik; Kwon, Soon Yong; Kim, Yoo Jin; Kim, Chun Choo [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2003-07-01

    To retrospectively review findings of osteonecrosis of the femoral head after bone marrow transplantation. We reviewed the clinical and MR findings of osteonecrosis of the femoral head in 23 of 1112 patients who underwent marrow transplantation during a five-year follow-up period lasting from 1996 to 2000. Mean age at the time of diagnosis was 31 (range, 20-47) years, and the mean time from transplant to diagnosis was 17 months. All patients developed variable graft-versus-host disease and seventeen were treated with high-dose prednisolone and/or cysclosporin for severe acute or extensive chronic graft versus host disease. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allowed early detection of disease assessment of its stage. At the time of diagnosis, 15 hips were at stage I, 28 at stage II, two at stage III, and none at stage IV, according to the international ARCO classification system. Osteonecrosis of femoral diaphyses, the lower lumbar spine, or pelvic bones in the MR field was also found to have occurred in 11 patients. Initial treatment was conservative: 21 hips underwent surgery [core decompression (n=10), vascularized fibular bone graft (n=5), and joint replacement (n=6)]. In patients receiving high-dose steroids for the treatment of graft-versus-host disease, MR screening might help detect osteonecrosis at an early stage.

  14. Review of a single contemporary femoral neck fracture fixation method in young patients.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-03-01

    An intracapsular femoral neck fracture in a young patient is a rare and difficult injury to manage. The occurrence of complications following fixation is multifactorial. Initial displacement and timing and accuracy of reduction are the key factors affecting outcome. The severities of the trauma to the hip and the impact of the intracapsular hematoma also play a role, the importance of which remains poorly understood. The purpose of this study was to evaluate the high incidence of femoral neck fractures treated in our institution over a 7-month period, to record the long-term outcome of these patients, all of whom were treated with contemporary methods of internal fixation, and to highlight the reasons for this injury being termed an "orthopedic emergency" and its differences from the same injury in the elderly population. We performed a retrospective analysis of 12 cases of intracapsular femur neck fracture in patients younger than 50 years treated over 7 months in a regional trauma center. All patients underwent satisfactory reduction and fixation. Nine of the 12 patients had a good outcome at a mean follow-up of 29 months. One patient developed a nonunion of the femoral head requiring total hip arthroplasty, one developed avascular necrosis of the femoral head, and one developed partial avascular necrosis. This compares favorably with other studies.

  15. Fixation of intracapsular femoral neck fractures: Effect of trans-osseous capsular decompression

    Directory of Open Access Journals (Sweden)

    Elsayed Ibraheem Elsayed Massoud

    2010-06-01

    Full Text Available Objectives: Intracapsular femoral neck fractures have been found as associated with hemarthrosis. The fluid in the intact capsule elevates the intracapsular pressure to a level could tamponades the vascular supply of the femoralhead. Therefore, capsular decompression seems necessaryto salvage the femoral head circulation. Negative impact of the capsular incision also has been reported. Therefore, we hypothesize that creation of a trans-osseousportal can decompress the capsule as well as not threaten the capsular related blood vessels.Materials and methods: In present study, 27 patients with intracapsular femoral neck fractures were included. Coinciding with closed reduction and internal fixation we made a trans-osseous portal for capsular decompression. Patients were followed-up prospectively for a mean periodof 43.1 months.Results: All fractures united. However, one patient 17 years-old who was nursed preoperatively in skin traction developed osteonecrosis of the femoral head.Conclusion: Our results supported that the trans-osseous capsular decompression has evacuated the intracapsular haematoma and has not threatened the capsular integrity. Preoperative traction of the injured limb particularly in the young patient may play a role in development of osteonecrosisof the femoral head.

  16. Unusual Foreign Bone Fragment in Femoral Open Fracture

    Science.gov (United States)

    Sadoni, Hanon; Arti, Hamidreza

    2016-01-01

    Introduction: Femoral shaft fracture is one of the typical bone fractures due to high energy trauma and may occur as an open fracture. Some foreign materials may enter the fracture site such as sand, cloth particles and so on. Case Presentation: A 28-year-old motorcycle riding military member and his collaborator were received in the hospital because of multiple traumas due to a fall in a hollow during a surveillance mission. His collaborator died because of head trauma and multiple severe open fractures. When fixing the patients femoral fracture, a large femoral butterfly fragment was removed from the patient’s thigh as a foreign segment. The patient’s femur was fixed with a plate and screws. No femoral defect was detected during surgery or post-operative X-rays and CT scan. The removed segment was not a part of the patient’s femur. Conclusions: Surgical and post-surgical findings showed that this segment was not related to the patient’s femur. The foreign segment may have belonged to the other victim of this trauma. PMID:27218050

  17. Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

    National Research Council Canada - National Science Library

    Patel, Kushal V; Brennan, Kindyle L; Brennan, Michael L; Jupiter, Daniel C; Shar, Adam; Davis, Matthew L

    2014-01-01

    .... Specifically we examined: (1) Is there an association of a modified frailty index with 1- and 2-year mortality rates in patients aged 60 years and older who sustain a low-energy femoral neck fracture? (2...

  18. Study of the anatomical position of the femoral nerve by magnetic resonance imaging in patients with fractured neck of femur: relevance to femoral nerve block.

    LENUS (Irish Health Repository)

    Mehmood, Shehzad

    2012-01-31

    STUDY OBJECTIVE: To determine the anatomical location of the femoral nerve in patients who have sustained fracture of the neck of femur, and its relevance to femoral nerve block technique. DESIGN: Prospective, observational clinical study. SETTING: Orthopedic and Radiology departments of a regional hospital. SUBJECTS: 10 consecutive adult ASA physical status II and III patients (mean age, 78.5 yrs) and 4 adult healthy volunteers. INTERVENTIONS: A T1 magnetic resonance imaging scan was performed of both upper thighs in patients and healthy volunteers successfully. MEASUREMENTS: The distance (mm) between the midpoint of the femoral artery and the midpoint of the femoral nerve, and the distance of the femoral nerve from the skin was measured at the mid-inguinal ligament, the pubic tubercle, and at the mid-inguinal crease. Data are shown as means (SD). Differences between both sides were compared using paired Student\\'s t-tests. P < 0.05 was significant. MAIN RESULTS: In patients the mean distance (mm) between the midpoint of the femoral nerve from the midpoint of femoral artery at the mid-inguinal crease on the fractured and non-fractured sides was 10.7 and 11.0, respectively (P = 0.87). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the mid-inguinal ligament on the fractured and non-fractured sides was 9.64 and 12.5, respectively (P = 0.03). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the pubic tubercle on the fractured and non-fractured sides was 8.74 and 10.49, respectively (P = 0.18). CONCLUSIONS: Blockade of the femoral nerve may be easier to perform at the mid-inguinal crease in patients with fractured neck of femur.

  19. Computer-assisted three-dimensional correlation between the femoral neck-shaft angle and the optimal entry point for antegrade nailing.

    Science.gov (United States)

    Anastopoulos, George; Chissas, Dionisios; Dourountakis, Joseph; Ntagiopoulos, Panagiotis G; Magnisalis, Evaggelos; Asimakopoulos, Antonios; Xenakis, Theodore A

    2010-03-01

    Optimal entry point for antegrade femoral intramedullary nailing (IMN) remains controversial in the current medical literature. The definition of an ideal entry point for femoral IMN would implicate a tenseless introduction of the implant into the canal with anatomical alignment of the bone fragments. This study was undertaken in order to investigate possible existing relationships between the true 3D geometric parameters of the femur and the location of the optimum entry point. A sample population of 22 cadaveric femurs was used (mean age=51.09+/-14.82 years). Computed-tomography sections every 0.5mm for the entire length of femurs were produced. These sections were subsequently reconstructed to generate solid computer models of the external anatomy and medullary canal of each femur. Solid models of all femurs were subjected to a series of geometrical manipulations and computations using standard computer-aided-design tools. In the sagittal plane, the optimum entry point always lied a few millimeters behind the femoral neck axis (mean=3.5+/-1.5mm). In the coronal plane the optimum entry point lied at a location dependent on the femoral neck-shaft angle. Linear regression on the data showed that the optimal entry point is clearly correlated to the true 3D femoral neck-shaft angle (R(2)=0.7310) and the projected femoral neck-shaft angle (R(2)=0.6289). Anatomical parameters of the proximal femur, such as the varus-valgus angulation, are key factors in the determination of optimal entry point for nailing. The clinical relevance of the results is that in varus hips (neck-shaft angle shaft angle between 120 degrees and 130 degrees , the optimal entry point lies just medially to the trochanter tip (at the piriformis fossa) and the use of stiff implants is safe. In hips with neck-shaft angle over 130 degrees the anatomical axis of the canal is medially to the base of the neck, in a "restricted area". In these cases the entry point should be located at the insertion of the

  20. Is surgeons' experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture?

    OpenAIRE

    Turgut, Ali; Kumbaracı, Mert; Kalenderer, Önder; İlyas, Gökhan; Bacaksız, Tayfun; Karapınar, Levent

    2017-01-01

    Purpose: To evaluate whether surgeons' experience affect inter- and intra-observer reliability among mostly used classification systems for femoral neck fractures. Material and Methods: A power point presentation was prepared with 107 slides which were antero-posterior radiographs of each femoral neck fracture. 5 residents, 5 orthopaedic surgeons and 5 senior orthopaedic surgeons reviewed this presentation and classified the fractures according to Garden, Pauwels and AO classifications. ...

  1. Free fibular strut graft in neglected femoral neck fractures in adult

    Directory of Open Access Journals (Sweden)

    Azam Md Quamar

    2009-01-01

    Full Text Available Background: Neglected femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula. The aim of this study was to assess outcome of nonvascularized fibular strut graft and cancellous screw fixation in neglected femoral neck fractures in the younger age group. Materials and Methods: Medical records of 32 patients of neglected femoral neck fracture, in the age group of 22-45 years (mean 37.8 years, operated between May 1994 to December 2001, were retrospectively reviewed. After the application of inclusion and exclusion criteria, 28 patients having three years minimum follow-up (mean 4.6 years were included. Delay between injury and operation varied from four weeks to 42 weeks (mean 16.4 weeks. Closed reduction was achieved in 17 patients; open reduction through Watson-Jones anterolateral approach was performed in the remaining 15 patients in whom closed reduction failed. The fracture was transfixed with three parallel guide wires. Appropriate sized cannulated lag screw (7 mm was then inserted in two of the wires. Selection of the third guide wire for fibula depended on the space available in both anteroposterior and lateral view. Results: Satisfactory bony union was obtained in 25 patients, of whom in four cases, the union occurred in 10-20° (mean 15° of varus. Nonunion occurred in three patients (9.37%, and aseptic necrosis occurred in another six patients (18.75%. Of the 25 patients where union was achieved, five patients showed excellent results; 14 good and six had poor functional result, as evaluated using modified Anglen criteria. Conclusion: Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative procedure for neglected femoral neck fractures in young adults. Fibula

  2. Case Reports: Treatment of Subtrochanteric and Ipsilateral Femoral Neck Fractures in an Adult with Osteopetrosis

    OpenAIRE

    2008-01-01

    We describe a patient with autosomal-dominant osteopetrosis, a subtrochanteric fracture, and an ipsilateral femoral neck fracture treated with a hip spica cast Although the fracture united with coxa vara and external rotation deformities, the patient successfully returned to his normal activities of daily living. Operative fracture treatment in patients with osteopetrosis is difficult, and our patient provides evidence that with nonoperative treatment these patients can return to a functional...

  3. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly.

    Science.gov (United States)

    Panteli, Michalis; Rodham, Paul; Giannoudis, Peter V

    2015-03-01

    Femoral neck fractures represent a relatively uncommon injury in the non-elderly population often resulting from high-energy trauma. The cornerstone of their management is anatomic reduction and stable internal fixation of the femoral neck in an attempt to salvage the femoral head. Complications including avascular necrosis of the femoral head, non-union and post-traumatic osteoarthritis are not uncommon. The clinical outcomes of these patients can be improved with good pre-operative planning, optimization of surgical procedures and introduction of new improved implants and techniques. In the herein study, we attempt to describe the biomechanical properties of the hip and compare the performance of the most commonly used devices. Experimental evidence suggests that in Pauwels type III fracture patterns a cephalomedullary nail was significantly stronger in axial loading. Moreover, in unstable basicervical patterns cannulated screws (triangular configuration) demonstrated a lower ultimate load to failure, whereas in subcapital or transervical patterns both the cannulated screws (triangular configuration) and the sliding hip screw demonstrated no compromise in fixation strength. The fracture pattern appears to be the major determinant of the ideal type of implant to be selected. For a successful outcome each patient needs to be considered on an individual basis taking into account all patient and implant related factors.

  4. Using biomechanics to improve the surgical technique for internal fixation of intracapsular femoral neck fractures.

    Science.gov (United States)

    Wu, Chi-Chuan

    2010-01-01

    Despite advances in science and technology, the success rate for the treatment of displaced intracapsular femoral neck fractures in high-energy injuries remains disappointing. The blood supply system in the femoral head of humans does not favor recovery from these fractures. Once these fractures occur, osteonecrosis and nonunion rates may be as high as 30%, even if the newest technique is used. There are some surgical techniques used to supplement internal fixation to reestablish the blood supply in the femoral head, but none have been evidently successful. After analysis of related studies, the author concludes that immediate surgical treatment using improved techniques incorporating the principles of biomechanics can improve the success rate of treatment of these fractures. Using these principles, the fracture site can achieve sufficient stability. Consequently, the blood supply in the femoral head and neck can be reestablished earlier and loss of reduction of fragments during treatment can be minimized. Thus, the chance of full recovery from these complicated fractures can be maximized. In this study, the biomechanical characteristics of these fractures and the principles associated with the surgical techniques used for treating them are reviewed and clarified. Finally, a surgical technique which is ideal from the author's viewpoint is presented. The author believes that the recommended surgical technique may become the best method for treating these complicated fractures.

  5. Comparison of effects of different screw materials in the triangle fixation of femoral neck fractures.

    Science.gov (United States)

    Gok, Kadir; Inal, Sermet; Gok, Arif; Gulbandilar, Eyyup

    2017-05-01

    In this study, biomechanical behaviors of three different screw materials (stainless steel, titanium and cobalt-chromium) have analyzed to fix with triangle fixation under axial loading in femoral neck fracture and which material is best has been investigated. Point cloud obtained after scanning the human femoral model with the three dimensional (3D) scanner and this point cloud has been converted to 3D femoral model by Geomagic Studio software. Femoral neck fracture was modeled by SolidWorks software for only triangle configuration and computer-aided numerical analyses of three different materials have been carried out by AnsysWorkbench finite element analysis (FEA) software. The loading, boundary conditions and material properties have prepared for FEA and Von-Misses stress values on upper and lower proximity of the femur and screws have been calculated. At the end of numerical analyses, the best advantageous screw material has calculated as titanium because it creates minimum stress at the upper and lower proximity of the fracture line.

  6. Preoperative Use of Clopidogrel Does Not Affect Outcomes for Femoral Neck Fractures Treated With Hemiarthroplasty.

    Science.gov (United States)

    Ghanem, Elie S; Richard, Raveesh D; Wingert, Nathaniel C H; Gotoff, James R; Graham, Jove H; Bowen, Thomas R

    2017-07-01

    The antiplatelet effect of clopidogrel on blood loss and perioperative complications after surgical intervention remains ambiguous. The purpose of this study was to determine if patients on clopidogrel before hemiarthroplasty for femoral neck fracture are predisposed to greater surgical bleeding and perioperative complications compared with those not taking clopidogrel before surgery. We conducted a review of our electronic medical record from 2006-2013 and identified 602 patients who underwent 623 hemiarthroplasty procedures for displaced femoral neck fracture, of which 54 cases (9%) were taking clopidogrel before hospital admission. Patient demographics and comorbidities, operative and surgical variables, and perioperative complications at 90 days were compared between the clopidogrel and nonclopidogrel user groups. The 2 groups of patients had similar baseline characteristics, but patients taking clopidogrel preoperatively were sicker with higher American Society of Anesthesiologists scores (P = .049) and age-adjusted Charlson index (P = .001). They also had a greater incidence of cerebrovascular disease (P = .01), chronic obstructive pulmonary disease (P = .03), diabetes (0.03), and malignancy (P postoperative medical readmissions (P = .85), surgical readmissions (P = .26), infection (P = .99), and mortality (P = .89). Patients taking clopidogrel who present with a displaced femoral neck fracture can safely undergo a hemiarthroplasty while actively on clopidogrel without an increase in medical or surgical complications and mortality. We do not recommend delaying surgical intervention until the antiplatelet effects of clopidogrel subside. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures.

    LENUS (Irish Health Repository)

    Manning, Brian J

    2012-02-03

    Although it is widely accepted that aspirin will increase the risk of intra- and post-operative bleeding, clinical studies have not consistently supported this assumption. We aimed to assess the effect of pre-operative aspirin on blood loss and transfusion requirements in patients undergoing emergency fixation of femoral neck fractures. A prospective case-control study was undertaken in patients presenting with femoral neck fractures. Parameters recorded included intra-operative blood loss, post-operative blood loss, transfusion requirements and peri-operative reduction in haemoglobin concentration. Of 89 patients presenting with femoral neck fractures 32 were on long-term aspirin therapy. Pre-operative aspirin ingestion did not significantly affect peri-operative blood loss, or change in haemoglobin concentration or haematocrit. However those patients taking aspirin pre-operatively had a significantly lower haemoglobin concentration and haematocrit and were more likely to be anaemic at presentation than those who were not receiving aspirin. Patients taking aspirin were also more likely to receive blood transfusion post-operatively.

  8. Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck - 10 year study

    Directory of Open Access Journals (Sweden)

    Maini P

    2006-01-01

    Full Text Available Background : One of the most common treatments of displaced fracture of femoral neck in elderly is bipolar hemiarthroplasty. Method : Two hundred and seventy patients of displaced fracture of femoral neck were treated by bipolar hemiarthroplasty. The Mean age of the patients at the time of surgery was 69.80 years. Results : Follow up ranged between 12 months and 120 months. There were 8 cases each of acetabular erosion and protrusion with 10 cases of femoral stem loosening. Eight cases had post operative dislocation requiring open reduction. Eighteen patients got revision surgery to total hip replacement. The overall incidence of DVT/PE was 9.9% which declined after regular use of low molecular weight heparin. Eleven patients had post operative infection. There were 54.2 % excellent results, 21.0 % good results, 10.7 % fair and 3.7% poor results. Conclusion : Elderly patients with displaced fracture of neck femur are able to ambulate early after Cemented bipolar hemi arthroplasty. The complication rate is low, the component survival long and pre injury functional status is restored in majority of patients.

  9. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review

    Directory of Open Access Journals (Sweden)

    Sujit Kumar Tripathy

    2016-01-01

    Full Text Available Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%. Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

  10. Multiple Small Diameter Drillings Increase Femoral Neck Stability Compared with Single Large Diameter Femoral Head Core Decompression Technique for Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Brown, Philip J; Mannava, Sandeep; Seyler, Thorsten M; Plate, Johannes F; Van Sikes, Charles; Stitzel, Joel D; Lang, Jason E

    2016-10-26

    Femoral head core decompression is an efficacious joint-preserving procedure for treatment of early stage avascular necrosis. However, postoperative fractures have been described which may be related to the decompression technique used. Femoral head decompressions were performed on 12 matched human cadaveric femora comparing large 8mm single bore versus multiple 3mm small drilling techniques. Ultimate failure strength of the femora was tested using a servo-hydraulic material testing system. Ultimate load to failure was compared between the different decompression techniques using two paired ANCOVA linear regression models. Prior to biomechanical testing and after the intervention, volumetric bone mineral density was determined using quantitative computed tomography to account for variation between cadaveric samples and to assess the amount of bone disruption by the core decompression. Core decompression, using the small diameter bore and multiple drilling technique, withstood significantly greater load prior to failure compared with the single large bore technique after adjustment for bone mineral density (pcore decompression techniques. When considering core decompression for the treatment of early stage avascular necrosis, the multiple small bore technique removed less bone volume, thereby potentially leading to higher load to failure.

  11. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  12. OUTCOME OF UNCEMENTED UNIPOLAR HEMIARTHROPLASTY IN FRACTURE NECK OF FEMUR, IN GERIATRIC PATIENTS IN RELATION TO BONE QUALITY

    Directory of Open Access Journals (Sweden)

    Mehraj Din

    2015-09-01

    Full Text Available BACKGROUND: Osteoporosis plays an important role in pathogenesis of fracture neck of femur in mobile elderly. Hemiarthroplasty is most common mode of management of femoral neck fractures in elderly in developing world. We report the outcome of uncemented hemiarthropl asty in elderly patients with a femoral neck fracture in relation to bone quality of patient as estimated by Dual energy x ray absorptiometry (DEXA scan. MATERIALS AND METHODS: 75 uncemented hemiarthroplasties for femoral neck fractures were performed in elderly patients more than 70 years of age between August 2008 and April 2012. The clinical, radiological results and bone mineral density of 65 hips in 65 patients who could be followed up were analyzed. For all cases Austin Moore prosthesis was implanted . RESULTS: The mean age of the patients was 79.96±7.21 years ( 7 1 to 96 years. 44 patients were women and 21 were men. Average duration of follow - up was 18.59±11.53 months ( R ange 4 to 44 months. The mean Harris Hip Score in patients with osteopenia was 80 .29±13.29 and in patients with osteoporosis it was 79.96 ± 11.67 at the time of the last follow - up. There was no significant difference in mean Harris hi p score in osteoporotic and non - osteoporotic patient’s p value 0.923. Out of 65 patients whose results were assessed in our study 48 patients (73.8% had osteoporosis and 17 patients (26.1% had Osteopenia. None of the patients in our study had a normal bone density. The mean T Score as measured on DEXA scan was - 3.74±1.57. CONCLUSION: Uncemented hemiarthro plasty for elderly patients more than 70 years of age with a femoral neck fracture showed satisfactory short - term results with no relationship to the bone quality

  13. The direct anterior approach in hemiarthroplasty for displaced femoral neck fractures.

    Science.gov (United States)

    Schneider, Kerstin; Audigé, Laurent; Kuehnel, Stefanie-Peggy; Helmy, Naeder

    2012-09-01

    Hip replacement is the most common treatment for displaced femoral neck fractures in the elderly, and minimally invasive surgery is popular in the field of orthopaedic surgery. This study evaluated the outcome of monopolar hemiarthroplasty by the direct anterior approach over a postoperative period up to 2.5 years. A total of 86 patients with displaced femoral neck fractures were included (mean age of 86.5 years). Surviving patients were reviewed three months (retrospectively) and one to 2.5 years (prospectively) after surgery. One-year mortality was 36 %. For all stems, implant positioning with respect to stem alignment, restoration of leg length and femoral offset was correct. Acetabular protrusion was observed in 55 % of the patients one to 2.5 years postoperatively. Subsidence and intraoperative periprosthetic fractures occurred in three patients (3 %) each. All revision stems for postoperative periprosthetic fractures could be implanted using the initial surgical technique without extension of the previous approach. The mean Harris hip score was 85 points at the one to 2.5-year follow-up; 85 % of the patients were satisfied with their hip and 57 % returned to their preoperative level of mobility. Based on these findings, hemiarthroplasty for hip fractures can be performed safely and effectively via the direct anterior approach with good functional outcome and high patient satisfaction.

  14. Minimally invasive positioning robot system of femoral neck hollow screw implants based on x-ray error correction

    Science.gov (United States)

    Zou, Yunpeng; Xu, Ying; Hu, Lei; Guo, Na; Wang, Lifeng

    2017-01-01

    Aiming the high failure rate, the high radiation quantity and the poor positioning accuracy of femoral neck traditional surgery, this article develops a set of new positioning robot system of femoral neck hollow screw implants based on X-rays error correction, which bases on the study of x-rays perspective principle and the Motion Principle of 6 DOF(degree of freedom) series robot UR(Universal Robots). Compared with Computer Assisted Navigation System, this system owns better positioning accuracy and more simple operation. In addition, without extra Equipment of Visual Tracking, this system can reduce a lot of cost. During the surgery, Doctor can plan the operation path and the pose of mark needle according to the positive and lateral X-rays images of patients. Then they can calculate the pixel ratio according to the ratio of the actual length of mark line and the length on image. After that, they can calculate the amount of exercise of UR Robot according to the relative position between operation path and guide pin and the fixed relationship between guide pin and UR robot. Then, they can control UR to drive the positioning guide pin to the operation path. At this point, check the positioning guide pin and the planning path is coincident, if not, repeat the previous steps, until the positioning guide pin and the planning path coincide which will eventually complete the positioning operation. Moreover, to verify the positioning accuracy, this paper make an errors analysis aiming to thirty cases of the experimental model of bone. The result shows that the motion accuracy of the UR Robot is 0.15mm and the Integral error precision is within 0.8mm. To verify the clinical feasibility of this system, this article analysis on three cases of the clinical experiment. In the whole process of positioning, the X-rays irradiation time is 2-3s, the number of perspective is 3-5 and the whole positioning time is 7-10min. The result shows that this system can complete accurately

  15. Bilateral synchronous parathyroids cancer and femoral neck fracture as the complications of tertiary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    A F Romanchishen

    2013-12-01

    Full Text Available In the paper has presented the first in Russia observation of bilateral synchronous parathyroids cancer in patient with urolithiasis complicated by chronic pyelonephritis, renal insufficiency with tertiary hyperparathyroidism and femoral neck fracture. During observation of the patient in our hospital were found hyperparathyroid osteodystrophy, medial right femoral neck fracture, very high level of parathormone (1969,0 pg/ml, tumorous of right (16,0 × 17,0 mm and left (23,0 × 17,0 mm parathyroid glands located behind of inferior thyroid poles during ultrasound research. Surgical exploration has found bilateral whitish parathyroid tumorous with invasion to right recurrent laryngeal nerve. Were performed right hemithyroidectomy, left thyroid lobe resection and central neck dissections. Parathormone level has decreased to 3.5 times (up to 582 pg/ml. 20 minutes later after bilateral inferior parathyroidectomies. The regular hemodialysis was restore and six months later was successfully undertaken the hip prosthetics. Two year later after the surgery signs of parathyroid cancer relapses were no found.

  16. Bilateral stress fractures of femoral neck in non-athletes: a report of four cases

    Directory of Open Access Journals (Sweden)

    Naik Monappa A

    2013-04-01

    Full Text Available 【Abstract】Femoral neck stress fractures (FNSFs are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers with-out underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and sub-trochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular ne-crosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in pa-tients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation. Key words: Fractures, stress; Femoral neck fractures; Coxa vara; Osteotomy

  17. High Reliability of a Scoring System for Implant Position in Undisplaced Femoral Neck Fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Bartholin, Marie-Louise L; Weber, Kolja;

    2016-01-01

    OBJECTIVES: The aim of this study was to evaluate the intra-rater and inter-rater reliability of a scoring system for internal fixation (SIFA) in undisplaced femoral neck fractures (FNF). DESIGN: A reproducibility study with a historical consecutive cohort. SETTING: The patients were all treated...... of the screw position in femoral head had the largest difference of acceptable positioning, when comparing visual assessment with the measured. CONCLUSIONS: The SIFA scoring system demonstrates substantial intra-rater and inter-rater reliability (kappa (0.51-0.78), when raters make measurements of radiographs......, but lower reliability (kappa 0.13-0.78) when raters visually assess the radiographs without measuring. The SIFA scoring system should be assessed on a large cohort for correlation with clinical evaluation....

  18. Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Tao Li

    Full Text Available OBJECTIVE: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 70 years old. METHODS: We searched PUBMED, EMBASE, Cochrane Library, CNKI and VIP Database from inception to December 2012 for relevant randomized controlled trials (RCTs. Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR and weighted mean differences (WMD from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies. RESULTS: 7 RCTs involving 1,125 patients (1,125 hips were eligible for meta-analysis. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31-0.76; P = 0.002, lower residual pain (OR = 0.43, 95%CI, 0.29-0.64; P<0.0001, less implant-related complications (OR = 0.15, 95%CI, 0.09-0.26; P<0.00001 and longer operation time (WMD = 7.43 min, 95% CI, 5.37-9.49 min; P<0.00001. No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss. CONCLUSIONS: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.

  19. Management of neglected femoral neck fracture in above knee amputated limb: A case report

    Institute of Scientific and Technical Information of China (English)

    Umesh Meena; Ramesh Meena; Balaji S; Sahil Gaba

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a challenging situation for both the orthopedic surgeon and the rehabilitation team.These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy.We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected.

  20. Delayed fixation of displaced type II and III pediatric femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Azam Md

    2009-01-01

    Full Text Available Background: Time from injury to fixation of femoral neck fractures has been postulated as a vital determinant for rate of complications; however, no prospective study is available in the English literature. Delay, unfortunately, is inevitable in developing countries. The aim of the present study is to retrospectively review the outcome after delayed fixation of displaced type II and III femoral neck fractures in children. Materials and Methods: Using a standard assessment chart, we retrospectively reviewed medical records of all pediatric patients having femoral neck fractures presenting to our institution from June 1999 to May 2006. Inclusion criteria were children between 5 and 15 years of age sustaining displaced Delbet type II and III femoral neck fractures having a complete follow-up of at least 2 years. Patients with known metabolic disease, poliomyelitis or cerebral palsy, were excluded from the study. After application of inclusion and exclusion criteria, 22 patients having 22 fractures (13 type II and 9 type III were studied. Surgery could be performed after a mean delay of 11.22 days (ranging from 2 to 21 days. Closed reduction was achieved in 14 cases and 8 cases required open reduction through anterolateral approach. Result: Osteonecrosis was noted in eight patients (36.37% who included two of nine patients (22.22% operated in the first week, three of eight patients (37.51% operated in the second week, and three of five patients (60% operated in the third week of injury. Nonunion was seen in four (18.18% cases, and two of them were associated with failure of implants. One was treated by valgus osteotomy and the other by Meyer′s procedure. Fractures united in both children but the latter developed avascular necrosis. Functional results, as assessed using Ratliff′s criteria, were good in 14 (63.63%, fair in 2 (9%, and poor in 6 (27.27% patients. Conclusion: Delay in fixation, type of fracture, and ability to achieve and maintain

  1. Femoral stiffness after osteosynthesis of a subcapital osteotomy in osteoporotic bone: an in-vitro comparison of nine fixation methods.

    Science.gov (United States)

    Hernefalk, L; Messner, K

    1995-01-01

    Restitution of normal bone mechanics after osteosynthesis of a proximal femoral fracture in the elderly is assumed to be a prerequisite for optimal healing. To find the most appropriate fixation device for this purpose, the stiffness of 79 cadaver femora from donors with a history of osteoporosis was measured during axial loading before and after a subcapital osteotomy stabilized with one of nine different osteosynthesis devices. Only an osteotomy stabilized with an experimental device consisting of 2 von Bahr screws (Ericsson AB, Göteborg, Sweden) supported by acrylic cement gave similar mean values as the intact femur. A femur stabilized with the Deyerle device (Biomet, Bridge End, Wales, U.K.), with cannulated screws type Uppsala (Olmed AB, Uppsala, Sweden), or with von Bahr screws had an approximately 20-30% lower stiffness than tested intact. However, these devices provided a higher femoral stiffness than the hook-pin technique type LiH (Söderström AB, Gothenburg, Sweden), cannulated screws (Smith & Nephew, Memphis, TN, U.S.A.), a sliding screw plate (Smith & Nephew), a compression screw with variable length (Biomet), or an experimental screw providing expansion and compression. Despite attempted compression of the osteotomy by some of the devices, all of the commercially available devices resulted in a decrease of femoral stiffness after fixation, which may adversely influence the healing of femoral neck fractures in the elderly. Only a combination of screws and bone cement resulted in normal femoral stiffness, probably because of better device anchorage in the osteoporotic cancellous bone. However, this combination might have the potential risk of vascular damage.

  2. Sinusoidal electromagnetic fields promote bone formation and inhibit bone resorption in rat femoral tissues in vitro.

    Science.gov (United States)

    Zhou, Jian; Ma, Xiao-Ni; Gao, Yu-Hai; Yan, Juan-Li; Shi, Wen-Gui; Xian, Cory J; Chen, Ke-Ming

    2016-01-01

    Effects of sinusoidal electromagnetic fields (SEMFs) on bone metabolism have not yet been well defined. The present study investigated SEMF effects on bone formation and resorption in rat femur bone tissues in vitro. Cultured femur diaphyseal (cortical bone) and metaphyseal (trabecular bone) tissues were treated with 50 Hz 1.8 mT SEMFs 1.5 h per day for up to 12 days and treatment effects on bone formation and resorption markers and associated gene expression were examined. Treatment with SEMFs caused a significant increase in alkaline phosphatase (ALP) activity and inhibited the tartrate-resistant acid phosphatase (TRACP) activity in the femoral diaphyseal or metaphyseal tissues. SEMFs also significantly increased levels of mRNA expression of osterix (OSX), insulin-like growth factor (IGF-1) and ALP in the bone tissues. SEMF treatment decreased glucose content and increased lactic acid contents in the culture conditioned medium. In addition, treatment with SEMFs decreased mRNA expression levels of bone resorption-related genes TRACP, macrophage colony stimulating factor (M-CSF) and cathepsin K (CTSK) in the cultured bone tissues. In conclusion, the current study demonstrated that treatment with 1.8 mT SEMFs at 1.5 h per day promoted bone formation, increased metabolism and inhibited resorption in both metaphyseal and diaphyseal bone tissues in vitro.

  3. Octogenarian with an untreated femoral neck fracture: upright position during the postoperative course after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    M. Polastri

    2015-06-01

    Full Text Available We describe a patient with a femoral neck fracture undergoing an aortic valve replacement. The study design was a case report. An 82-year-old female with an untreated right femoral neck fracture, and a severe aortic valve stenosis was admitted to a cardiac surgery department for surgical treatment of the valve disease. She underwent aortic valve replacement with a sutureless biological valve prosthesis through a partial sternotomy. At an early stage, the patient was instructed to make postural changes in the standing position. As a result, she was able to perform body movements associated with either a sitting or standing position. This case shows that appropriate early mobilization of a patient with a femoral neck fracture is feasible after aortic valve replacement, even though this does not necessarily mean that the patient needs to walk.

  4. Simultaneous bilateral fractures of the femoral neck caused by high energy:A case report and literature review

    Institute of Scientific and Technical Information of China (English)

    You-Shui Gao; Zhen-Hong Zhu; Chang-Qing Zhang

    2015-01-01

    Simultaneous bilateral fractures of the femoral neck are rare injuries,which are reportedly induced by low-speed energy with predisposing factors including systemic diseases,medications and eclamptic seizures.Those caused by high energy are even rarer.High energy-induced bilateral fractures of the femoral neck conceive of high incidence of mortality and present great challenges in the early management.We report one case of a 52-year-old man with simultaneous bilateral fractures of the femoral neck which resulted from a motor pedestrian accident.One-stage closed reduction and internal fixation was done following the emergent resuscitation and neurosurgical management for concomitant brain injuries.The fractures united.There was no pain in the hips,and they had a normal range of motion.The treatment protocol,mechanism of the injury and possible postoperative complications were discussed to expand a comprehensive understanding about these infrequent types of fractures.

  5. The effect of osteoarthritis on functional outcome following hemiarthroplasty for femoral neck fracture: a prospective observational study.

    Science.gov (United States)

    Boese, Christoph Kolja; Buecking, Benjamin; Bliemel, Christopher; Ruchholtz, Steffen; Frink, Michael; Lechler, Philipp

    2015-10-16

    The influence of pre-existing radiographic osteoarthritis on the functional outcome of elderly patientents with displaced intracapsular fractures of the femoral neck treated by hemiarthroplasty is unclear. We prospectively examined the impact of pre-existing osteoarthritis on the functional outcome of 126 elderly patients with displaced intracapsular fracture of the femoral neck treated by hemiarthroplasty. The mean age of the cohort was 82.7 years. At 12 months, we observed no statistically significant differences in the Harris hip score (p = 0.545), the timed up and go test (p = 0.298), the Tinetti test (p = 0.381) or the Barthel Index (p = 0.094) between patients with Kellgren and Lawrence grades 3 or 4 osteoarthritis, and patients with grades 0 to 2 changes. Furthermore, there were no differences in complication or revision rates. Our findings challenge the hypothesis that pre-existing osteoarthritis is a contraindication to hemiarthroplasty in elderly patients with femoral neck fracture.

  6. Subtrochanteric fracture: a rare but severe complication after screw fixation of femoral neck fractures in the elderly.

    Science.gov (United States)

    Jansen, Hendrik; Frey, Soenke P; Meffert, Rainer H

    2010-12-01

    Cannulated screw fixation is a minimal invasive technique to treat undisplaced femoral neck fractures. It is the preferred method in elderly patients who often suffer co-morbidities. There is scarce literature on subtrochanteric femoral fracture as a complication of cannulated screw fixation of a femoral neck fracture. This complication occurred, without an adequate trauma, in two of 35 patients (5.7%) in this retrospective study of patients older than 65 years (mean age: 77 years) who were treated with cannulated screws for an undisplaced femoral neck fracture between 2004 and 2009. We reviewed the literature for the incidence of this complication and possible predisposing factors. The overall incidence reported in literature is 2.4-4.4% (mean: 2.97%). Despite a broad use of this type of osteosynthesis, the literature does not provide clear biomechanical or clinical indications for optimal screw placement to avoid this complication. Considering the literature and our personal results, surgeons should be aware of this severe complication; they may opt for a different implant in the very old, osteoporotic patient with an undisplaced femoral neck fracture.

  7. Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures: diagnostic features on bone scan.

    Science.gov (United States)

    Probst, Stephan; Rakheja, Rajan; Stern, Jerry

    2013-05-01

    A 69-year-old woman presented with a spontaneous right subtrochanteric hip fracture. Pan-imaging following orthopedic repair failed to identify a primary malignancy to explain the presumed pathologic basis for this fracture. The patient then underwent bone scintigraphy and SPECT/CT which showed mild uptake in multifocal endosteal thickening of the lateral left femoral diaphysis, diagnostic of bisphosphonate-associated femoral shaft stress fractures, but no evidence of metastatic bone disease. Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures have a fairly specific appearance on bone scintigraphy, and nuclear medicine physicians should be aware of this relatively infrequent emerging pathology.

  8. Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement?

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Ah; Park, Ji Seon; Ryu, Kyungnam [Kyung Hee University, Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Jin, Wook [Kyung Hee University, Department of Radiology, East-West Neo Medical Center, Seoul (Korea, Republic of)

    2011-02-15

    The purpose was to assess the significance of herniation pits in the femoral neck for radiographic diagnosis of femoroacetabular impingement (FAI). Eighty hips in 62 patients (bilateral in 18) with neutral pelvic orientation were enrolled. Herniation pits were diagnosed when they were located at the anterosuperior femoral neck, close to the physis, and with a diameter of >3 mm. The five radiographic signs of FAI were used: lateral center edge angle (LCE) >39 , acetabular index (AI) {<=}0, extrusion index (EI) <25%, acetabular retroversion, and pistol-grip deformity. Patients with radiographs suggesting FAI were retrospectively correlated with their clinical symptoms. Positive radiographic signs were observed in 7 hips with LCE, 7 with AI, and 80 with EI criteria. Only 3 hips out of 80 (3.8%) showed all of the signs. The acetabular retroversion and pistol-grip deformity were seen in 12/80 and 3/80 hips, respectively. The total number of hips that met radiographic criteria for FAI, including pincer type and cam type, was 18 (23%). However, none of these hips were clinically diagnosed with FAI. All symptomatic hips (11/80) presented only with nonspecific pain, and 2 hips out of 11 showed radiographic signs of FAI. The low frequency of positive radiographic signs suggesting FAI with related symptoms among patients with herniation pits suggests that herniation pits have limited significance in the diagnosis of FAI. Therefore it can be concluded that an incidental finding of herniation pits does not necessarily imply a correlation with FAI. (orig.)

  9. Trochanter/calcar preserving reconstruction in tumors involving the femoral head and neck

    Science.gov (United States)

    Cho, Hwan Seong; Lee, Young-Kyun; Ha, Yong-Chan; Koo, Kyung-Hoi

    2016-01-01

    AIM: To evaluate the results of hip reconstruction with extensive excision for tumor confined to the femoral head and neck. METHODS: We designed a resection preserving the greater trochanter and lower portion of calcar femorale, and utilized conventional total hip prosthesis. We retrospectively reviewed 7 patients, who underwent a wide resection and reconstruction using conventional hip prosthesis. There were 3 men and 4 women and their mean age was 42.5 years (22 to 65 years). The histologic diagnosis of each patient was low-grade osteosarcoma, diffuse large B-cell lymphoma, liposclerosing myxofibroma, intraosseous lipoma, chondroblastoma, giant cell tumor and focal intramedullary fibrosis. RESULTS: One patient with lymphoma died due to disease dissemination at 10 mo postoperatively and the remaining 6 patients were followed for a mean of 4.7 years (3 to 6 years). All patients were able to return to their daily activities and no patient had local recurrence. No radiographic signs of loosening, wear, and osteolysis were found at the last follow-up. CONCLUSION: Trochanter/calcar-preserving resection of the proximal femur and reconstruction using conventional total hip prosthesis, is a satisfactory treatment for tumors confined to the femoral head and neck. PMID:27458555

  10. Prosthetic replacement in treatment of subcapital femoral neck fractures in the elderly

    Institute of Scientific and Technical Information of China (English)

    徐莘香; 刘一; 刘建国; 李印良

    2002-01-01

    Objective: To compare the results of femoral head replacement (FHR) and total hip replacement (THR) in treatment of subcapital femoral neck fractures (SFNF).   Methods: Between May 1987 and July 1998, 56 elderly patients (65-90 years; average 73.5 years) with SFNF were treated with prosthetic replacement. Six cases were treated with unipolar FHR, 18 cases with Bateman bipolar FHR, and 32 cases with Bateman bipolar THR. All domestic prostheses were installed with cement.   Results: There was no significant difference between the 2 groups in operating time and blood transfusion. Forty-nine patients were followed-up for an average of 5 years and 10 months. No wound infection or death was related to surgery. Complications in Group FHR were significantly higher than that in Group THR.   Conclusions: Since FHR is difficult to fit the bony acetabulum, it is only indicated for senile cases with poor conditions. However, the bipolar THR installed with cement is indicated for most elderly patients. Since the femoral head and acetabulum can fit each other completely, it is more stable for taking weight-bearing earlier with less complications.

  11. Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients

    Directory of Open Access Journals (Sweden)

    Moretti Lorenzo

    2011-02-01

    Full Text Available Abstract Background Total hip replacement is considered the best option for treatment of displaced intracapsular fractures of the femoral neck (FFN. The size of the femoral head is an important factor that influences the outcome of a total hip arthroplasty (THA: implants with a 28 mm femoral head are more prone to dislocate than implants with a 32 mm head. Obviously, a large head coupled to a polyethylene inlay can lead to more wear, osteolysis and failure of the implant. Ceramic induces less friction and minimal wear even with larger heads. Methods A total of 35 THAs were performed for displaced intracapsular FFN, using a 32 mm alumina-alumina coupling. Results At a mean follow-up of 80 months, 33 have been clinically and radiologically reviewed. None of the implants needed revision for any reason, none of the cups were considered to have failed, no dislocations nor breakage of the ceramic components were recorded. One anatomic cementless stem was radiologically loose. Conclusions On the basis of our experience, we suggest that ceramic-on-ceramic coupling offers minimal friction and wear even with large heads.

  12. A mountain among molehills: removing an impinging large femoral neck osteochondroma in a man with hereditary multiple exostoses.

    LENUS (Irish Health Repository)

    Fitzgerald, Conall W R

    2014-01-01

    A 31-year-old man with a history of hereditary multiple exostoses (HME) presented with persistent right groin pain and reduced hip range of movement. Examination demonstrated a positive FADIR (flexion, adduction and internal rotation) test suggesting femoroacetabular impingement (FAI). Investigations showed multiple sessile osteochondromata of the right femur with a dominant anterolateral femoral neck osteochondroma causing flexion block. The patient underwent an uncomplicated proximal femoral exostectomy. Six-week postoperative pain, range of movement and daily activity had greatly improved. This case highlights that even in the setting of multiple osteochondromata, excellent impingement relief can be achieved following selective proximal femoral exostectomy.

  13. Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages

    Directory of Open Access Journals (Sweden)

    Souza AD

    2015-07-01

    Full Text Available Precise anatomical assessment of femoral neck anteversion (FNA and the neck shaft angles (NSA would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. The present study was undertaken on 48 fetal femurs to calculate the NSA and FNA in fetuses digitally. End on images of upper end of the femurs were taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t test showed the FNA and NSA of femur did not vary significantly during the third trimester.

  14. Adaptive Bone Remodeling of the Femoral Bone After Tumor Resection Arthroplasty With an Uncemented Proximally Hydroxyapatite-Coated Stem

    DEFF Research Database (Denmark)

    Andersen, Mikkel R; Petersen, Michael M

    2015-01-01

    Loss of bone stock and stress shielding is a significant challenge in limb salvage surgery. This study investigates the adaptive bone remodeling of the femoral bone after implantation of a tumor prosthesis with an uncemented press fit stem. We performed a prospective 1 yr follow-up of 6 patients ...

  15. A transepiphyseal fracture of the femoral neck in a child with 2 widely displaced Salter-Harris III fragments of the capital femoral epiphysis.

    Science.gov (United States)

    Lee, Dae-Hee; Park, Jong-Woong; Lee, Soon-Hyuck

    2010-02-01

    To our knowledge, this is the first report of a transphyseal fracture of the femoral neck with a fracture of the capital femoral epiphysis involving 2 widely displaced Salter-Harris III fragments in a child. Preoperative surgical lateral radiographs of the hip of a 14-year-old boy clearly showed an anteriorly dislocated femoral head fragment. However, the overlapping ischium, soft tissue, and an anteriorly dislocated femoral head fragment caused a posteriorly dislocated fragment of the split femoral head to be overlooked on the radiographs. The emergent nature of the injury resulted in the performance of an open reduction without further imaging studies. Based on the initial evaluation, an anterior iliofemoral approach was chosen, which made it difficult to locate the posteriorly dislocated main fragment of the split femoral head. This case highlights that plain radiographs do not always provide adequate information for such injuries. Computed tomography or magnetic resonance imaging should be employed to enable accurate diagnosis and appropriate treatment for fracture-dislocations of the pediatric hip.

  16. 活血补肾中药联合植骨支撑治疗非创伤性股骨头坏死%Combined treatment of HUOXUEBUSHEN Decoction and bone impaction grafting for nontraumatic osteonecrosis of the femoral head

    Institute of Scientific and Technical Information of China (English)

    韦标方; 孙丙银

    2014-01-01

      结果与结论:治疗组患者Harris总分、疼痛程度、关节活动范围分值均显著高于对照组(P 0.05);治疗组患者疗效优良率显著高于对照组(88%,74%,χ2=4.54, P OBJECTIVE:To investigate clinical efficacy of combined treatment of HUOXUEBUSHEN decoction and bone impaction grafting through a femoral neck window at high location for non-traumatic osteoporosis of the femoral head. METHODS:This study is a prospective control ed trial. The patients with non-traumatic osteoporosis of the femoral head were divided into two groups:treatment group (n=52, 60 hips) and control group (n=51, 60 hips). The treatment group was given a combined treatment of HUOXUEBUSHEN decoction and bone impaction grafting through a femoral neck window (the decoction was prepared in People’s Hospital of Linyi, China). The control group underwent simple bone impaction grafting through a femoral neck window. Al the involved patients were fol owed up for 12 months, Harris hip score and the excellent-good rate at the last fol ow-up were used to evaluate clinical efficacy. RESULTS AND CONCLUSION:The Harris score, pain degree, and joint range of motion scores in the treatment group were higher than that in control group (P0.05). The excellent-good rate in the treatment group was significantly higher than that in control group (88%, 75%;χ2=4.91, P<0.05). The combined treatment of HUOXUEBUSHEN decoction and bone impaction grafting through a femoral neck window at high location is effective in the treatment of non-traumatic osteonecrosis of the femoral head, and is better than simple bone impaction grafting at al eviating pain and improving joint range of motion.

  17. A randomised controlled trial of cemented and cementless femoral components for metal-on-metal hip resurfacing: a bone mineral density study.

    Science.gov (United States)

    Tice, A; Kim, P; Dinh, L; Ryu, J J; Beaulé, P E

    2015-12-01

    The primary purpose of this study of metal-on-metal (MoM) hip resurfacing was to compare the effect of using a cementless or cemented femoral component on the subsequent bone mineral density (BMD) of the femoral neck. This was a single-centre, prospective, double-blinded control trial which randomised 120 patients (105 men and 15 women) with a mean age of 49.4 years (21 to 68) to receive either a cemented or cementless femoral component. Follow-up was to two years. Outcome measures included total and six-point region-of-interest BMD of the femoral neck, radiological measurements of acetabular inclination, neck-shaft and stem-shaft angles, and functional outcome scores including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index and the University of California at Los Angeles activity scale. In total, 17 patients were lost to follow-up leaving 103 patients at two years. There were no revisions in the cementless group and three revisions (5%) in the cemented group (two because of hip pain and one for pseudotumour). The total BMD was significantly higher in the cementless group at six months (p < 0.001) and one year (p = 0.01) than in the cemented group, although there was a loss of statistical significance in the difference at two years (p = 0.155). All patient outcomes improved significantly: there were no significant differences between the two groups. The results show better preservation of femoral neck BMD with a cementless femoral component after two years of follow-up. Further investigation is needed to establish whether this translates into improved survivorship.

  18. 股骨干骨折合并同侧股骨颈或股骨髁上骨折漏诊的诊治%Analysis of misdiagnoses for femoral shaft fracture with ipsilateral femoral neck or femoral fractures

    Institute of Scientific and Technical Information of China (English)

    李守民; 朱晨; 孔荣; 夏睿; 方诗元; 张光平

    2010-01-01

    Objective To analyze the misdiagnoses of femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures.Methods Over the past six years,eight misdiagnosed cases of ipsilateral femoral neck or femoral fractures missed patients,aged 25 to 59 years old(mean:41.7),were treated at our department.An initial diagnosis of femoral shaft fracture was later revised as ipsilateral femoral shaft with supra-condylar fracture of femoral neck or femur.Femoral shaft fracture was fixed with armor plate,3-screw hollow compression fixation of femoral neck;two cases of femoral condylar fractures of distal femoral condyle with anatomical plate fixation and 1 case of intraoperative change into the retrograde femoral intramedullary nail fixation.Results The mean post-operative follow-up was 3.5 years.All fractures healed with excellent hip and knee functions.Conclusion For those with a strong reverse and torsional violence,femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures may be easily misdiagnosed.A preoperative conventional hip-knee X-ray film is an effective way to avoid a misdiagnosis.%目的 对股骨干骨折合并同侧股骨颈或股骨髁上骨折漏诊的治疗进行分析.方法 2002年12月至2008年12月安徽医科大学附属省立医院骨科收治8例股骨干合并同侧股骨颈或股骨髁上骨折漏诊患者,年龄25~59岁,平均41.7岁,初步诊断为股骨干骨折,后修正为股骨干合并同侧股骨颈或股骨髁上骨折.股骨干骨折行钢板内固定.股骨颈骨折行3枚空心加压螺丝钉内固定;股骨髁上骨折2例行股骨远端外髁解剖钢板的内固定,1例术中更改行逆行股骨交锁髓内钉内固定.结果 术后平均随访3.5年,骨折均愈合,髋膝关节功能良好.结论 凡强大暴力及有扭转暴力者股骨干合并同侧股骨颈或股骨髁上骨折易漏诊,术前常规髋膝摄片是避免漏诊的有效方法.

  19. Burnei's technique of femoral neck variation and valgisation by using the intramedullary rod in Osteogenesis imperfecta.

    Science.gov (United States)

    Georgescu, I; Gavriliu, Șt; Nepaliuc, I; Munteanu, L; Țiripa, I; Ghiță, R; Japie, E; Hamei, S; Dughilă, C; Macadon, M

    2014-01-01

    Varus or valgus deviations of the femoral neck in osteogenesis imperfecta have been an ignored chapter because the classic correction procedures were applied in medical practice with unsatisfying results. Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially corrected, which required an extensive use of the wheel chair or bed immobilization of the patient. The concomitant correction of the complex deformities, coxa vara/valga and femoral integrated configuration, have been a progress which allowed the patients to walk with or without support. The purpose of this study is to present the Burnei's technique, a therapeutic alternative in deformity corrections of the varus or valgus hip in children with osteogenesis imperfecta. The paper is about a retrospective study done in a single center, which analyses Burnei technique and other procedures described in literature. The content of the article is based on a 12 years experience on a batch of 51 patients with osteogenesis imperfecta from which 10 patients (13 hips) presented frontal plane deviations of the femoral neck. All the patients with osteogenesis imperfecta who presented coxa vara or valga were submitted to investigations with the purpose of measuring blood loss, the possibility of extending the surgical intervention to the leg, the association of severe deformities of the proximal extremity of the femur and the necessity of postoperative intensive care. Burnei's technique: The operation was first performed in 2002. A subtrochanteric osteotomy was made in an oblique cut, from the internal side to the external side and from proximal to distal for coxa vara, or by using a cuneiform resection associated with muscular disinsertions. Only telescopic rods were used for osteosynthesis. There are a few articles in literature, which approach corrections of vara or valgus deviations in osteogenesis imperfecta

  20. Press-fit Femoral Fixation in ACL Reconstruction using Bone-Patellar Tendon-Bone Graft

    Directory of Open Access Journals (Sweden)

    Kaseb Mohammad Hasan

    2009-05-01

    Full Text Available Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86 preoperatively and 91.88(73-100 at the latest follow up (P < 0.005. No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.

  1. Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients?

    Directory of Open Access Journals (Sweden)

    Yurdakul E

    2015-06-01

    Full Text Available Emre Yurdakul,1 Fatih Karaaslan,2 Murat Korkmaz,2 Fuat Duygulu,3 Ali Baktir41Department of Orthopedics and Traumatology, Osmaniye State Hospital, 2Department of Orthopedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, 3Department of Orthopedics and Traumatology, Kayseri Training Hospital, 4Department of Orthopedics and Traumatology, Modern Dünyam Hospital, Kayseri, TurkeyObjectives: Controversy exists regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients.Methods: This study included 133 patients over 65 years of age admitted to our clinics from 2006 to 2012 for the surgical treatment of a displaced femoral neck fracture. All patients were treated via hemiarthroplasty. The patients (66 males, 67 females; mean age: 78.16 years; range: 60–110 years were followed-up regularly. All patients were divided into one of two groups: group A was treated with cement; and group B without. Both groups were compared in terms of preoperative features (demographics and associated diseases, pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. Hospitalization time, average surgical duration, and time from fracture to operation were also recorded. Mean follow-up duration was 30.9 (range: 5–51 months.Results: We found no significant between-groups differences in terms of length of hospital stay, Harris Hip Score, complications, or follow-up mortality rates. Walking ability and pain scores were better in the cemented group in the early follow-up period. Duration of surgery and perioperative mortality rates were somewhat lower in the cementless group, but the difference was not statistically significant.Conclusion: The use of cement during hip hemiarthroplasty in patients over 65 years of age had

  2. Quantification of Femoral Neck Exposure Through a Minimally Invasive Smith-Petersen Approach

    Science.gov (United States)

    2010-06-01

    2004; 429:248 255. 9. Jacobs MA, Goytia RN, Bhargava T. Hip resurfacing through an anterolateral approach: surgical description and early review. J...neck blood supply than the posterior approach during hip resurfacing . J Bone Joint Surg (Br). 2007;89-B: 1293 1298. 11. Swiontkowski MF, Thorpe M, Seiler...approach to the hip . Methods: Ten fresh frozen hemipelves were dissected using a minimally invasive Smith Petersen approach. Upon completion of the

  3. Large diameter metal on metal total hip replacement for femoral neck fractures with neurological conditions A retrospective assessment

    Directory of Open Access Journals (Sweden)

    Jia Li

    2014-01-01

    Conclusion: We believe the use of L-MoM can diminish the rate of instability or dislocation, after operation. The L-MoM is an option for patients with Parkinson′s disease and poliomyelitis with femoral neck fracture.

  4. Variation of the anterior aspect of the femoral head-neck junction in a modern human identified skeletal collection

    DEFF Research Database (Denmark)

    Radi, Nico; Mariotti, Valentina; Riga, Alessandro

    2013-01-01

    of this study is to analyze the variability of the anterior aspect of the femoral neck through a new scoring method taking into account three main traits: Poirier's facet, plaque, and cribra (including the Allen's fossa). This method has been applied to a sample of 225 adult individuals of both sexes coming...

  5. Assessment of interobserver variation in Garden classification and management of fresh intracapsular femoral neck fracture in adults

    Institute of Scientific and Technical Information of China (English)

    Amit Aggarwal; Mahipal Singh; Aditya N Aggarwal; Shuchi Bhatt

    2014-01-01

    Objective:To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior (AP) view and also assess if the addition of lateral view changes the classification and management plan.Methods:Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan.Then the same films were reshown in conjunction with their lateral view after 10 days.Results were compared with respect to the classification and management plan between two groups.Interobserver agreement was calculated using Fleiss' kappa.Results:There was only a fair interobserver agreement (kappa value 0.39) on Garden classification on AP view only which improved to moderate agreement (kappa value 0.52) after adding a lateral view.While there was only a slight improvement in the interobserver agreement on the management plan on AP view only (kappa value 0.50) and AP combined with lateral views (kappa value 0.52).Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases.Conclusion:We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.

  6. Variation of the anterior aspect of the femoral head-neck junction in a modern human identified skeletal collection

    DEFF Research Database (Denmark)

    Radi, Nico; Mariotti, Valentina; Riga, Alessandro

    2013-01-01

    The effectiveness of the so-called skeletal markers of activity as functional indicators is widely debated. Among them, certain morphological features of the anterior aspect of the femoral head-neck junction (Poirier's facet, cervical fossa of Allen, etc.) have been considered in relation to some...

  7. Analysis of prosthetic replacement in treatment of femoral neck fracture on the hemiplegia side in the elderly

    Institute of Scientific and Technical Information of China (English)

    冯明利; 沈惠良; 胡怀健; 雍宜民; 曹立; 王玮

    2004-01-01

    Objective: To study the effect of prosthetic replacement in treatment of femoral neck fractures on the hemiplegia side in the elderly.Methods: From May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement in my hospital. Twenty-nine hemiplegia patients, who suffered from stroke previously,had Garden type Ⅲ and type Ⅳ femoral neck fractures on the hemiplegia side. Thirty non-hemiplegia patients were chosen randomly. The two groups were followed-up for 27-98 months (average: 59 months). The age, hospitalization days, operating time, blood loss, blood transfusion,complications during perioperative period and long-term complications were compared between the two groups and the results of femoral head replacement and total hip replacement in the hemiplegia group were also compared.Results: All the patients of the two groups survived the perioperative period. No significant difference was found in the age, hospitalization days, operation time,blood loss and blood transfusion and long-term complications between the two groups ( P > 0.05 ). However there was significant difference in complications during perioperative period between the two groups ( P < 0.05 ).Five patients died in the hemiplegia group with the mortality of 17.2% and two died in the non-hemiplegia group with the mortality of 6.7 % 11 months to 5 years after operation. There was significant difference in long-term complications between the femoral head replacement and the total hip replacement in the hemiplegia group (P <0.05). The result of the total hip replacement was better than that of the femoral head replacement.Conclusions: Prosthetic replacement is a reliable method in treatment of Garden type Ⅲ and type Ⅳfemoral neck fractures on the hemiplegia side in the elderly,and patients are safe during perioperative period. More complications during perioperative period occur in the hemiplegia group, and long-term complications are

  8. Glutamine repeat variants in human RUNX2 associated with decreased femoral neck BMD, broadband ultrasound attenuation and target gene transactivation.

    Directory of Open Access Journals (Sweden)

    Nigel A Morrison

    Full Text Available RUNX2 is an essential transcription factor required for skeletal development and cartilage formation. Haploinsufficiency of RUNX2 leads to cleidocranial displaysia (CCD a skeletal disorder characterised by gross dysgenesis of bones particularly those derived from intramembranous bone formation. A notable feature of the RUNX2 protein is the polyglutamine and polyalanine (23Q/17A domain coded by a repeat sequence. Since none of the known mutations causing CCD characterised to date map in the glutamine repeat region, we hypothesised that Q-repeat mutations may be related to a more subtle bone phenotype. We screened subjects derived from four normal populations for Q-repeat variants. A total of 22 subjects were identified who were heterozygous for a wild type allele and a Q-repeat variant allele: (15Q, 16Q, 18Q and 30Q. Although not every subject had data for all measures, Q-repeat variants had a significant deficit in BMD with an average decrease of 0.7SD measured over 12 BMD-related parameters (p = 0.005. Femoral neck BMD was measured in all subjects (-0.6SD, p = 0.0007. The transactivation function of RUNX2 was determined for 16Q and 30Q alleles using a reporter gene assay. 16Q and 30Q alleles displayed significantly lower transactivation function compared to wild type (23Q. Our analysis has identified novel Q-repeat mutations that occur at a collective frequency of about 0.4%. These mutations significantly alter BMD and display impaired transactivation function, introducing a new class of functionally relevant RUNX2 mutants.

  9. The management of femoral bone stock in THA revision: indications and techniques.

    Science.gov (United States)

    Bianchi, Luca; Galante, Claudio; Zagra, Luigi

    2014-10-02

    Following the increasing number of total hip arthroplasties, the amount of hip revision procedures continue to rise. Careful patient selection and bone loss evaluation is crucial for a correct management of femoral revision procedures. The key point in femoral revision is to obtain a reliable primary stability of the stem, with the least invasive implant as possible, to preserve and if possible to restore the bone stock. In this article we present the indications and the techniques for the femoral revisions most commonly used in Europe, referring to the evidence in the literature and our personal experiences.

  10. In peripubertal girls, artistic gymnastics improves areal bone mineral density and femoral bone geometry without affecting serum OPG/RANKL levels.

    Science.gov (United States)

    Maïmoun, L; Coste, O; Mariano-Goulart, D; Galtier, F; Mura, T; Philibert, P; Briot, K; Paris, F; Sultan, C

    2011-12-01

    Peripubertal artistic gymnasts display elevated areal bone mineral density at various bone sites, despite delayed menarche and a high frequency of menstrual disorders, factors that may compromise bone health. The concomitant improvement in femoral bone geometry and strength suggested that this type of physical activity might have favourable clinical impact. The purpose of this study is to evaluate the effect of artistic gymnastics (GYM) on areal bone mineral density (aBMD), femoral bone geometry and bone markers and its relationship with the osteoprotegerin (OPG)/rank-ligand (RANKL) system in peripubertal girls. Forty-six girls (age 10-17.2 years) were recruited for this study: 23 elite athletes in the GYM group (training 12-30 h/week, age at start of training 5.3 years) and 23 age-matched (± 6 months; leisure physical activity ≤ 3 h/week) controls (CON). The aBMD at whole body, total proximal femur, lumbar spine, mid-radius and skull was determined using dual-X-ray absorptiometry. Hip structural analysis (HSA software) was applied at the femur to evaluate cross-sectional area (CSA, cm(2)), cross-sectional moment of inertia (CSMI, cm(4)), and the section modulus (Z, cm(3)) and buckling ratio at neck, intertrochanteric region and shaft. Markers of bone turnover and OPG/RANKL levels were also analysed. GYM had higher (5.5-16.4%) non-adjusted aBMD and adjusted aBMD for age, fat-free soft tissue and fat mass at all bone sites, skull excepted and the difference increased with age. In the three femoral regions adjusted for body weight and height, CSA (12.5-18%), CSMI (14-18%), Z (15.5-18.6%) and mean cortical thickness (13.6-21%) were higher in GYM than CON, while the buckling ratio (21-27.1%) was lower. Bone markers decreased with age in both groups and GYM presented higher values than CON only in the postmenarchal period. A similar increase in RANKL with age without OPG variation was observed for both groups. GYM is associated not only with an increase in aBMD but

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

    Energy Technology Data Exchange (ETDEWEB)

    Bloom, R.A.; Pogrund, H.

    1982-03-01

    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.

  12. A method for the measurement of dispersion curves of circumferential guided waves radiating from curved shells: experimental validation and application to a femoral neck mimicking phantom.

    Science.gov (United States)

    Nauleau, Pierre; Minonzio, Jean-Gabriel; Chekroun, Mathieu; Cassereau, Didier; Laugier, Pascal; Prada, Claire; Grimal, Quentin

    2016-07-07

    Our long-term goal is to develop an ultrasonic method to characterize the thickness, stiffness and porosity of the cortical shell of the femoral neck, which could enhance hip fracture risk prediction. To this purpose, we proposed to adapt a technique based on the measurement of guided waves. We previously evidenced the feasibility of measuring circumferential guided waves in a bone-mimicking phantom of a circular cross-section of even thickness. The goal of this study is to investigate the impact of the complex geometry of the femoral neck on the measurement of guided waves. Two phantoms of an elliptical cross-section and one phantom of a realistic cross-section were investigated. A 128-element array was used to record the inter-element response matrix of these waveguides. This experiment was simulated using a custom-made hybrid code. The response matrices were analyzed using a technique based on the physics of wave propagation. This method yields portions of dispersion curves of the waveguides which were compared to reference dispersion curves. For the elliptical phantoms, three portions of dispersion curves were determined with a good agreement between experiment, simulation and theory. The method was thus validated. The characteristic dimensions of the shell were found to influence the identification of the circumferential wave signals. The method was then applied to the signals backscattered by the superior half of constant thickness of the realistic phantom. A cut-off frequency and some portions of modes were measured, with a good agreement with the theoretical curves of a plate waveguide. We also observed that the method cannot be applied directly to the signals backscattered by the lower half of varying thicknesses of the phantom. The proposed approach could then be considered to evaluate the properties of the superior part of the femoral neck, which is known to be a clinically relevant site.

  13. Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly Has a Low Conversion Rate.

    Science.gov (United States)

    Grosso, Matthew J; Danoff, Jonathan R; Murtaugh, Taylor S; Trofa, David P; Sawires, Andrew N; Macaulay, William B

    2017-01-01

    Hemiarthroplasty (HA) has been a mainstay treatment for displaced femoral neck fractures for many years. The purpose of this study was to report the conversion rate of HA to total hip arthroplasty (THA) for displaced femoral neck fractures and compare outcomes between implant constructs (bipolar vs unipolar), fixation options (cemented vs cementless stems), and age groups (fractures at our institution between 1999 and 2013 with a minimum of 2-year follow-up. The overall component revision rate, including conversion to THA, revision HA, revision with open reduction internal fixation, and Girdlestone procedure, was 5.6% (39/686). Seventeen patients (2.5%) were converted from HA to THA at an average of 1.9 years after index procedure. A significantly lower conversion rate of 1.4% (7/499 patients) was found in the older patient cohort (≥75 years old) compared to 5.3% (11/187) in the younger cohort. The most common causes for conversion surgery to THA were acetabular wear (5 patients), aseptic loosening (4 patients), and periprosthetic fracture (3 patients). There was a significantly lower rate of periprosthetic fracture (0.4% vs 2.5%, P value .025) in the cemented implant group compared to the cementless group. We observed a higher rate of dislocations in the bipolar vs unipolar group (3.8% vs 1%, P value .02) and no other significant differences between these groups. We observed a low reoperation rate for this cohort of patients, relatively higher conversion rates for the younger population, fewer periprosthetic fractures with the use of cemented stems, and no advantage of bipolar over unipolar prostheses. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis.

    Science.gov (United States)

    Silverton, Craig D; Jacobs, Joshua J; Devitt, Jeffrey W; Cooper, H John

    2014-09-01

    Modular neck femoral stems have a higher-than-anticipated rate of failure in registry results, but large single-center cohort studies are lacking. This is a retrospective cohort of 152 hips implanted with a single titanium stem with a modular titanium neck, presenting clinical, radiographic, and metal ion results at a mean 4.5-year follow-up. Five hips were revised during the study period, for an overall Kaplan-Meier survival of 0.894 at 8 years. There was one modular neck fracture (0.66%), but others demonstrated corrosion or adverse tissue reaction. Serum metal levels demonstrated wide variability. Despite good clinical results in the majority of patients, we confirmed an increased rate of femoral revision at mid-term follow-up, and therefore urge caution in the use of this particular stem design.

  15. The effect of patulin on femoral bone structure in male rabbits

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    Veronika Kováčová

    2015-05-01

    Full Text Available A lot of kinds of crops are susceptible to fungal attack, leading to considerable financial losses and damage the health of humans and animals. Patulin, a toxic fungal metabolite, can be found mainly in apple and apple products, with much less frequent contamination in other food products. Because of its high incidence and harmful health effects, patulin belongs to a class of mycotoxins, which are strictly monitored. However, its effect on bone structure is still unknown. This study was designed to investigate the impact of patulin on femoral bone structure in adult male rabbits. Four month-old male rabbits were randomly divided into two groups of three animals each. Rabbits from the experimental group (group A, n=3 were intramuscularly administered with patulin at dose 10 μg.kg-1 body weight (b.w. twice a week for 4 weeks. The second group without patulin administration served as a control (group B, n=3. At the end of the experiment, body weight, femoral weight and length, cortical bone thickness and histological structure of femoral bones from all rabbits were determined. The results did not show any significant differences in body weight, femoral weight and length between experimental and control groups of rabbits. On the other hand, intramuscular application of patulin induced a significant increase in cortical bone thickness (p <0.05 and considerable changes in qualitative histological characteristics of compact bone in adult male rabbits. In patulin-intoxicated males, the primary vascular longitudinal bone tissue was absent near endosteal border. On the other hand, this tissue occurred near periosteum and also in the middle part of the femoral bone in these rabbits. The values for the primary osteons' vascular canals were significantly lower (p <0.05 in males exposed to patulin as compared to the control group. Based on these findings we can conclude that intramuscular patulin administration demonstrably influences cortical bone thickness

  16. Bilateral stress fractures of femoral neck in non-athletes:a report of four cases

    Institute of Scientific and Technical Information of China (English)

    Monappa A Naik; Premjit Sujir; Sujit Kumar Tripathy; Sandeep Vijayan; Shamsi Hameed; Sharath K Rao

    2013-01-01

    Femoral neck stress fractures (FNSFs) are rare,constituting only 5% of all stress fractures in young adults.These fractures are usually seen in athletes,military recruits and patients with underlying metabolic diseases.The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure.We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers without underlying bony disorders.Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation.One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and subtrochanteric valgus osteotomy on the other side.The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation.All the fractures healed without any complications.No evidence of avascular necrosis or arthritis was noted in our series.Subtrochanteric valgus osteotomy restores normal neck-shaft angle in patients suffering from FNSFs combined with coxa vara deformity.Moreover,it helps to bring the forces acting around the hip to normal biomechanical levels,leading to fracture union and better results.Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation.

  17. Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Nitesh Gahlot; Sameer Aggarwal; Vijay Goni

    2013-01-01

    Objective:Surgical management options for femoral shaft fracture and ipsilateral proximal femur fracture vary from single-implant to double-implant fixation.Cephalomedullary fixation in such fractures has relative advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation.However,the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation.The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture.Methods:Sixteen cases (10 males and 6 females with a mean age of 41.8 years) ofipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India.The fractures were classified according to AO classification.An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients.ResuRs:The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients.The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients.Four of the AO B2.1 and 2 of the AO B2.3 fractures required open reduction with Watson-Jones approach.The mean operative time was around 78 minutes,which tended to decrease as the surgical experience increased.There was only one case of malreduction,which required revision surgery.Conclusion:Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult fracture pattern for trauma surgeons.Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications.Surgery is technically demanding with a definite learning curve.Nevertheless,a majority of these fractures can be surgically managed by singleimplant cephaiomedullary

  18. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis.

    Science.gov (United States)

    Wang, Weiguo; Wei, Junjie; Xu, Zhanwang; Zhuo, Wenkun; Zhang, Yuan; Rong, Hui; Cao, Xuecheng; Wang, Pingshan

    2014-05-22

    A meta-analysis was performed to assess the association between healing rate, avascular necrosis (AVN) of femoral head and two reductions-open reduction internal fixation (ORIF) and closed reduction internal fixation (CRIF) for femoral neck fracture. A literature-based search was conducted to identify all relevant studies published before September 10, 2013. The odd ratio (OR) and 95% confidence interval (CI) were used for estimating the effects of the two reduction methods. Data were independently extracted by two investigators who reached a consensus on all of the items. The heterogeneity between studies was examined by χ2-based Q statistic. Egger's regression analysis was used to evaluate publication bias. Statistical analysis was performed by Stata 10.0 software. We examined 14 publications. The results of the present meta-analysis showed that AVN of femoral head were significant associated with the two reductions (CRIF vs. ORIF, OR=1.746, 95% CI 1.159-2.628, p=0.008), while the healing rate were not (CRIF vs. ORIF, OR=0.853, 95% CI 0.573-1.270, p=0.433). The present meta-analysis indicated the risk of AVN of femoral head was significant higher after CRIF fixation compared with ORIF, but no association between the healing rate and the two reductions for femoral neck fracture.

  19. Necrosis avascular de cabeza y cuello de fémur en un paciente con sida Avascular osteonecrosis of femoral head and neck in an AIDS patient

    Directory of Open Access Journals (Sweden)

    María F. Villafañe

    2004-04-01

    Full Text Available La osteonecrosis avascular (ONA es una complicación que se describe con frecuencia creciente en pacientes infectados por el virus de la inmunodeficiencia humana tipo-1 (HIV-1. En su localización más común compromete la cabeza y cuello del fémur con dolor e impotencia funcional, en una o ambas caderas. Su etiología es multifactorial y la terapia antirretroviral de alta eficacia (HAART con inhibidores de proteasa (IP puede estar relacionada con la patogenia. En su evolución puede requerir el reemplazo total de la cadera con la colocación de una prótesis. Se presenta un paciente hemofílico, HIV-1 seropositivo, que desarrolló una ONA bilateral de cabeza y cuello de fémur mientras se encontraba bajo HAART.Avascular osteonecrosis (AON has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1. The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART with protease inhibitors (PI is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.

  20. In Vivo Quantitative Ultrasound Image Analysis of Femoral Subchondral Bone in Knee Osteoarthritis

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    Jana Podlipská

    2013-01-01

    Full Text Available A potential of quantitative noninvasive knee ultrasonography (US for detecting changes in femoral subchondral bone related to knee osteoarthritis (OA was investigated. Thirty-nine patients referred to a knee arthroscopy underwent dynamic noninvasive US examination of the knee joint. The subchondral bone was semiautomatically segmented from representative US images of femoral medial and lateral condyles and intercondylar notch area. Subsequently, the normalized mean gray-level intensity profile, starting from the cartilage-bone interface and extending to the subchondral bone depth of ~1.7 mm, was calculated. The obtained profile was divided into 5 depth levels and the mean of each level, as well as the slope of the profile within the first two levels, was calculated. The US quantitative data were compared with the arthroscopic Noyes’ grading and radiographic Kellgren-Lawrence (K-L grading. Qualitatively, an increase in relative subchondral bone US gray-level values was observed as OA progressed. Statistically significant correlations were observed between normalized US mean intensity or intensity slope especially in subchondral bone depth level 2 and K-L grading (r=0.600, P<0.001; r=0.486, P=0.006, resp. or femoral arthroscopic scoring (r=0.332, P=0.039; r=0.335, P=0.037, resp.. This novel quantitative noninvasive US analysis technique is promising for detection of femoral subchondral bone changes in knee OA.

  1. Effect of morselized bones on binding of the canine hydroxyapatite-coated femoral stem

    Institute of Scientific and Technical Information of China (English)

    SONG Ke-guan; MA De-sheng; HOU Jian-wen; WANG Huan; YAN Jing-long; YU Zhan-ge; LIANG Zhi-zhong

    2010-01-01

    Background Non-cement femoral stems are recognized in clinical use, but there are still some problems. The aim of this research was to make non-cement femoral stems to be press-fit with the medullary cavity. Methods Twenty-four healthy adult mongrel dogs were randomly divided into experimental and control groups. In the right hip joint, an artificial femoral bone replacement surgery was conducted. For the experimental group, the replacement surgery of hydroxyapatite (HA)-coated femoral stems was done, while autogeneous morselized bone was implanted into the medullary cavity. For the control group, morselized bone was not implanted. At postoperative 1, 3, 6 months, a test for interfacial shear characteristics was conducted in the MTS810 Tester. The comparison between the two groups' bone-prostheses in shear strength for their interface from shearing destruction was made. A histological observation to check prosthesis-bone interface contact ratios and bone growth was carried out. Results For the experimental group, shear strength was 0.317 MPa in 1 month, 1.447 MPa in 3 months, and 1.621 MPa in 6 months. For the control group, shear strength was 0.195 MPa in 1 month, 1.023 MPa in 3 months, and 1.483 MPa in 6 months. The difference was statistically significant. Stereomicroscope-based observation showed that the number of trabecular bones in the experimental group was larger than that of the control group, and bone growth of the former group was better than that of the latter group. Inverted microscopic observation showed that the binding degree between the prosthesis and trabecular bone of the experimental group was higher than that of the control group. Comparatively, the experimental group's trabecular bone had more stromal cells. Conclusions The morselized bones can effectively improve the biological bonding strength and bone-contact ratios in the short term for the HA-coated femoral stem and accelerate the bonding process. The use of morselized autogenous bones

  2. Ansys nonlinear buckling analysis for prediction of femoral neck fracture%股骨颈骨折预测的Ansys非线性屈曲分析

    Institute of Scientific and Technical Information of China (English)

    张国栋; 林海滨; 陈宣煌; 郑锋; 陈国立; 陶圣祥

    2012-01-01

    目的 实施10例股骨颈骨折的Ansys非线性屈曲分析,模拟与生物力学实验一致的股骨颈骨折实验全程.方法 采用10个股骨上段标本进行有限元建模,以十字坐标轴及绘图辅助软件TweakWindow实施精确的载荷施加及条件约束,进行特征值屈曲分析及非线性屈曲分析.结果 实现可控制的股骨颈骨折预测的Ansys非线性屈曲分析的载荷施加及条件约束;全部分析在达到结构崩溃时自动终止,发生股骨颈骨折的极限载荷为( 12 324.07±4439.733)N,最大位移为(7.6067 ±2.2716) mm,截取载荷-位移曲线;通过应力等值线图可判断股骨颈骨折位置.结论 非线性屈曲分析是一种适用于骨折预测的有限元算法;通过十字坐标轴及绘图辅助软件可以实现精确可控制的载荷施加及条件约束,实现与生物力学实验一致的条件设置.%Objective To simulate the whole femoral neck fractures experimental processes which were consistent with the biomechanical experiments by executing 10 cases of ansys nonlinear buckling analysis of femoral neck fracture.Methods 10 femoral superior segment specimens were used for finite element modeling.A cross axis as well as tweakwindow,which was a drawing auxiliary software,were used to execute the define loads and displacement procedures accurately,then the linear and nonlinear buckling analysis were executed successively.Results A controllable define loads and displacement in ansys nonlinear buckling analysis of prediction for femoral neck fracture; All analysises stop automatically when structural collapse happened.The ultimate load results of femoral neck fracture were (12 324.07 ±4439.73) N,the maximum displacement results were (7.6067 ± 2.2716) mm.The load-displacement curves were harvested; The positions of femoral neck fracture could be judged easily by stress contour plots.Conclusion The nonlinear buckling analysis was a suitable finite element calculation method for

  3. Bone marrow mesenchymal stem cell transplantation combined with core decompression and bone grafting in the repair of osteonecrosis of femoral head

    Institute of Scientific and Technical Information of China (English)

    Zhang Yang; Wang Nan; Yang Li-feng; Ma Ji; Li Zhi

    2015-01-01

    BACKGROUND: Core decompression alone for osteonecrosis of femoral head easily causes fovea of femoral head and colapse of inner microstructure. Therefore, autologous bone is needed for filing and supporting. Moreover, bone marrow stem cel transplantation can decrease the incidence of femoral head colapse. OBJECTIVE:To discuss the clinical effects of core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels for osteonecrosis of femoral head. METHODS: A total of 33 patients were treated by core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels in the Fourth Department of Bone Surgery, Central Hospital Affiliated to Shenyang Medical Colege in China from December 2012 to May 2013. RESULTS AND CONCLUSION:After the treatment by core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels, Harris hip function score increased and pain disappeared in patients with osteonecrosis of femoral head. They could do various labors. Radiographs or CT examination displayed normal femoral head in 30 hips, accounting for 79%. Pain significantly reduced. Normal or slight limp walking was found in 15 hips, accounting for 40%. There were 35 hips in patients, whose walking distance was extended, accounting for 92%. 24 hips dysfunction was improved markedly, accounting for 63%. Al results suggested that core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels improved the local blood supply of femoral head, and played a positive role in promoting the necrotic bone absorption and bone repairing.

  4. The correlation between preoperative levels of albumin and tlc and mortality in patients with femoral neck fracture.

    Science.gov (United States)

    Niccolai, F; Parchi, P D; Vigorito, A; Pasqualetti, G; Monzani, F; Lisanti, M

    2016-01-01

    A femoral neck fracture in an elderly patient often represents a major challenge for the orthopaedic surgeon who has to face not only the fracture, but also all the multiple issues related to age. Among others, malnutrition has been recognised as an important factor associated with severe aggravation in these patients. One-hundred-and-forty-seven patients were enrolled to investigate the use of two markers of patient nutritional status, i.e. serum albumin level and total leukocyte count (TLC), as predictors of mortality in the elderly patient suffering from proximal femur fracture. We found that low preoperative values of serum albumin and TLC proved to be directly related to worse outcomes. Therefore, these exams can be useful to identify patients with a femoral neck fracture that have higher risk of malnutrition and consequent higher mortality and that can benefit from some measures, such as albumin or protein nutritional supplement.

  5. Periprosthetic femoral bone loss in total hip arthroplasty: systematic analysis of the effect of stem design.

    Science.gov (United States)

    Knutsen, Ashleen R; Lau, Nicole; Longjohn, Donald B; Ebramzadeh, Edward; Sangiorgio, Sophia N

    2017-02-21

    Periprosthetic bone loss may lead to major complications in total hip arthroplasty (THA), including loosening, migration, and even fracture. This study analysed the influence of femoral implant designs on periprosthetic bone mineral density (BMD) after THA. The results of all previous published studies reporting periprosthetic femoral BMD following THA were compiled. Using these results, we compared percent changes in bone loss as a function of: femoral stem fixation, material, and geometry. The greatest bone loss was in the calcar region (Gruen Zone 7). Overall, cemented stems had more bone loss distally than noncemented stems, while noncemented stems had more proximal bone loss than cemented stems. Within noncemented stems, cobalt-chromium (CoCr) stems had nearly double the proximal bone loss compared to titanium (Ti) alloy stems. Finally, within noncemented titanium alloy group, straight stems had less bone loss than anatomical, tapered, and press-fit designs. The findings from the present study quantified percent changes in periprosthetic BMD as a function of fixation method, alloy, and stem design. While no one stem type was identified as ideal, we now have a clearer understanding of the influence of stem design on load transfer to the surrounding bone.

  6. Bilateral Pseudarthrosis of the Femoral Neck in a 25-Year-Old Male with Hereditary Hypophosphatemic Rickets

    Directory of Open Access Journals (Sweden)

    Joris Anthonissen

    2014-01-01

    Full Text Available Hereditary hypophosphatemic rickets (HHR is a rare disorder of renal phosphate wasting and the most common form of heritable rickets. Here, we report a case of an active 25-year-old male with HHR showing atraumatic bilateral femoral neck pseudarthrosis after 4 years of consecutive knee pain. A conservative therapy was administered, taking into account both the risks of surgical treatment and the little impairment even in the sport activities which the patient experienced.

  7. The quality of life after a femoral neck fracture in elderly patients: a comparative study between internal fixation and arthroplasties

    Directory of Open Access Journals (Sweden)

    Dennis Sansanovicz

    2017-01-01

    Full Text Available Introduction: The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surgery in these cases. Conclusion: Further studies are needed to define which is the best surgical treatment option.

  8. Extracapsular wide resection of a femoral neck osteosarcoma and its reconstruction using a pasteurized autograft-prosthesis composite: A case report.

    Science.gov (United States)

    Yasuda, Taketoshi; Hori, Takeshi; Suzuki, Kayo; Hachinoda, Jun; Matsushita, Isao; Ito, Yoshiaki; Kanamori, Masahiko; Kimura, Tomoatsu

    2013-10-01

    The requirement for an extracapsular resection is indicated for malignant bone tumors that have disseminated intracapsularly. Extracapsular resections are often performed for malignant tumors arising from the knee joint, but there are relatively few studies that have described an extracapsular resection of a tumor arising from the hip joint. The present study describes a case of extracapsular wide resection of the hip joint using rotational acetabular osteotomy. The patient was a 17-year-old female and the diagnosis was an osteoblastic osteosarcoma with a pathological fracture of the femoral neck. The joint was reconstructed using an allograft-implant composite graft and total hip arthroplasty. Although the patient presented a slight Trendelenburg gait, no recurrence or metastases were identified during a follow-up period of 3 years. The clinical features and surgical procedure of the case are described.

  9. Sustained Release of Vancomycin from Polyurethane Scaffolds Inhibits Infection of Bone Wounds in a Rat Femoral Segmental Defect Model

    Science.gov (United States)

    2010-04-09

    a one shot two component reaction between the triisocyanate and the hardener comprising polyester triol, water, TEGOAMIN33 tertiary amine catalyst ...Sustained release of vancomycin from polyurethane scaffolds inhibits infection of bone wounds in a rat femoral segmental defect model Bing Li a,b...2010 Keywords: Polyurethane Vancomycin Sustained release Infection control Rat femoral segmental defect Bone tissue engineering Infection is a common

  10. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset.

    Science.gov (United States)

    Ito, K; Minka, M A; Leunig, M; Werlen, S; Ganz, R

    2001-03-01

    We have observed damage to the labrum as a result of repetitive acetabular impingement in non-dysplastic hips, in which the femoral neck appears to abut against the acetabular labrum and a non-spherical femoral head to press against the labrum and adjacent cartilage. In both mechanisms anatomical variations of the proximal femur may be a factor. We have measured the orientation of the femoral neck and the offset of the head at various circumferential positions, using MRI data from volunteers with no osteoarthritic changes on standard radiographs. Compared with the control subjects, paired for gender and age, patients showed a significant reduction in mean femoral anteversion and mean head-neck offset on the anterior aspect of the neck. This was consistent with the site of symptomatic impingement in flexion and internal rotation, and with lesions of the adjacent rim. Furthermore, when stratified for gender and age, and compared with the control group, the mean femoral head-neck offset was significantly reduced in the lateral-to-anterior aspect of the neck for young men, and in the anterolateral-to-anterior aspect of the neck for older women. For patients suspected of having impingement of the rim, anatomical variations in the proximal femur should be considered as a possible cause.

  11. [Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure].

    Science.gov (United States)

    Kazimoğlu, Cemal; Yağdi, Serhan; Karapinar, Hasan; Sener, Muhittin

    2007-01-01

    Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.

  12. Scaling in Theropod Dinosaurs: Femoral Bone Strength and Locomotion II

    Science.gov (United States)

    Lee, Scott

    2015-01-01

    In the second paper of this series, the effect of transverse femoral stresses due to locomotion in theropod dinosaurs of different sizes was examined for the case of an unchanging leg geometry. Students are invariably thrilled to learn about theropod dinosaurs, and this activity applies the concepts of torque and stress to the issue of theropod…

  13. Bilateral vascularized femoral bone transplant: a new model of vascularized bone marrow transplantation in rats, part I.

    Science.gov (United States)

    Agaoglu, Galip; Carnevale, Kevin A; Zins, James E; Siemionow, Maria

    2006-06-01

    We present a new model of vascularized bone marrow transplantation-bilateral vascularized femoral bone (BVFB) isograft transplant based on abdominal aorta and inferior vena cava. A total of 7 BVFB isograft transplants were performed between Lewis (RT1) rats. In the donor, both femoral bones were harvested based on the abdominal aorta and inferior vena cava. In the recipient, the harvested isograft transplants were transferred into the inguinal region (in 3 animals) and into the abdominal cavity (in 4 animals). The mean operation time was 3 hours and 35 minutes. The mean warm ischemic time was 35 minutes. The vascular pedicles of the transplants that were transferred into the inguinal region were thrombosed at day 7 posttransplantation. The vascular pedicles of transplants into the abdominal cavity were patent and the bones were viable during the follow-up period of 63 days posttransplant. We have confirmed the feasibility of BVFB transplantation based on abdominal aorta and inferior vena cava.

  14. Nerve Tissue Prefabrication Inside the Rat Femoral Bone: Does It Work?

    Science.gov (United States)

    Ozbek, Zuhtu; Kocman, Atacan Emre; Ozatik, Orhan; Soztutar, Erdem; Ozkara, Emre; Kose, Aydan; Arslantas, Ali; Cetin, Cengiz

    2017-01-01

    To investigate whether nerve regeneration can be induced in the tubular bone between distal and proximal cut nerve ends. Twenty adult Wistar rats were used for the study. Rats were divided into three groups; femoral bone conduit group, nerve transection group, sham group. The sciatic nerve was surgically cut and from both ends inserted into the adjacent femoral bone tunnel in the femoral bone conduit group. The sciatic nerve was cut transversely in the nerve transection group. In the Sham group, only sciatic nerve exploration was performed, without a nerve cut. The groups were evaluated functionally and morphologically. All results showed that axonal growth existed through the osseous canal. To the best of our knowledge, this is the first study to evaluate neural regeneration inside the bone. We can speculate that the bone marrow provides a convenient microenvironment for peripheral nerve regeneration. In addition to prefabricating peripheral nerves, this novel model may help to establish further strategies for engineering of other tissues in the bone marrow.

  15. Periprosthetic bone density changes after MiniHipTM cementless femoral short stem: one-year results of dual-energy X-ray absorptiometry study

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    Ercan Ahmet

    2016-01-01

    Full Text Available Introduction: The purpose of the current study was to investigate the reaction of the femur to the implantation of the MiniHipTM in terms of: (1 bone density change during one year; (2 correlations between stem length, CCD (caput-collum-diaphyseal, femoral offset, T-value, and bone density; (3 other co-variables that influence the change of bone density. Patients and methods: MiniHipTM implant was performed for 62 patients. The age range of the patients who underwent treatment was 25–78 years. Periprothestic bone density was determined within two weeks postoperatively, after three, six, and twelve months utilizing the DEXA scan. Results: The highest change was observed in the first three months post-implantation, while significant decrease in density was recorded at proximal Gruen zones 1, 2, and 7, and at distal Gruen zone 4. The decrease in density reached a plateau between the third and sixth months after operation. Afterwards, bone density recovered up to the 12th postoperative month. The correlation analysis showed significant difference between Gruen zone 1 and stem size and CCD. The same significant trend was not reached for Gruen zone 7. Femoral offset showed no correlation. Covariance analysis was unable to establish connection of the results with diagnosis, pairings, or gender. Discussion: MiniHipTM densitometric results are promising and comparable to good results of the other representatives of the femoral neck partially-sustaining short stem prostheses with a lower proximal bone density reduction. Periprosthetic bone resorption is a multifactorial process where stem size, CCD angle, and patient-specific variables such as T-value have an impact on the periprosthetic bone remodeling. In particular, this applies to Gruen zone 1.

  16. Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index

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    Gross Thomas P

    2012-01-01

    Full Text Available Abstract Background The importance of appropriately selecting patients based on factors such as bone mineral density, body mass index, age, gender, and femoral component size has been demonstrated in many studies as an aid in decreasing the rate of revisions and improving the outcomes for patients after hip resurfacing arthroplasty (HRA; however, there are few published studies quantitatively specifying the potential risk factors that affect early femoral component failures. Therefore, the purpose of this study was to investigate the specific causes of early femoral component failures in hip resurfacing separately and more carefully in order to develop strategies to prevent these failures, rather than excluding groups of patients from this surgical procedure. Methods This retrospective study included 373 metal-on-metal HRAs performed by a single surgeon using the vascular sparing posterior minimally invasive surgical approach. The average length of follow-up was 30 ± 6 months. In order to understand the causes of early femoral failure rate, a multivariable logistic regression model was generated in order to analyze the effects of bone mineral density (T-score, gender, diagnosis, body mass index, femoral implant fixation type, age, and femoral component size. Results The average post-operative Harris hip score was 92 ± 11 points and the average post-operative UCLA score was 7 ± 2 points. There were three revisions due to femoral neck fracture and two for femoral component loosening. These occurred in two female and three male patients. In the multi-variable regression model, only T-score and body mass index showed significant effects on the failure rate of femoral components. Patients with a lower T-score and a higher body mass index had a significantly increased risk of early femoral component failure. Conclusion We recommend that dual energy x-ray absorptiometry scan T-score tests should be routinely performed on all hip resurfacing patients

  17. Osteosynthesis ­of ­femoral ­neck ­fracture ­with­ cannulated ­screws. Prognostic ­factors ­and­ results ­in ­93 ­cases

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    Sebastián Pereira

    2014-03-01

    Full Text Available Abstract Background: Reduction and osteosynthesis with cannulated screws in femoral neck fracture is a valid therapeutic option. Our objective is to identify prognostic factors and risk groups. Methods: We studied retrospectively 93 femoral neck fractures treated with internal fixation with cannulated screw between June 1995 and March 2011 (71 non-displaced and 22 displaced. Results: In 82 of the 93 cases we observed bone consolidation of the fracture. Eleven patients presented complications (5 non-union and 6 avascular necrosis. Consolidation rates were 95.8% and 63.6% in the non-displaced group and the displaced group of fractures. If the displaced fractures presented conminution, consolidation rate was 50% and 71.4% in the group without conminution. The consolidation index was 46.1% with closed reduction and 88% with open reduction. Conclusion: Closed reduction and internal fixation with cannulated screws in non-displaced femoral neck fractures, regardless of the patient’s age, is a successful method. In displaced fractures, on the other hand, necrosis free consolidation is less predictable, so its indication must be evaluated carefully.

  18. Factors Associated With Psycho-Cognitive Functions in Patients With Persistent Pain After Surgery for Femoral Neck Fracture.

    Science.gov (United States)

    Kitayama, Atsushi; Hida, Mitsumasa; Takami, Hidenobu; Hirata, Naoki; Deguchi, Yuko; Miyaguchi, Kazuya; Nakazono, Masako; Nakagawa, Rie; Fukumoto, Noriyuki; Hamaoka, Katsumi

    2017-09-01

    The aim of the study was to address issues arising from fracture of the femoral neck in elderly individuals, the prevalence of which continues to increase in Japan. The prevalence is increasing in Japan and there have been many reports on physical functions such as prevention of a fall. However, there have been a few studies that focus on psycho-cognitive functions. We must examine factors in patients with fractured femur necks to develop methods to assist affected patients. The current study aimed to examine factors associated with psycho-cognitive functions after surgery for fractured femoral neck in the Japanese elderly. In this study, we examined the relationships among sex, age, fracture site, operative procedure, body mass index, lifestyle, psycho-cognitive functions, and types of pain in 142 patients, performed multiple regression analysis using the mini-mental state examination (MMSE) and the Montgomery-Asberg depression rating scale (MADRS) scores as dependent variables, and created MMSE and MADRS models. Analysis of MMSE and MADRS models identified night pain and the number of family members as factors that affected mental function in a population with persistent pain for 1 week after surgery for fractured femoral neck. In addition, the number of family members was identified in multiple regression analysis models as a factor associated with psycho-cognitive functions. Pain, and night pain in particular, affect psycho-cognitive functions. We speculated that emotional changes were associated with number of family members. Patients living with family members maintained psycho-cognitive functions better than did those living alone, even when they experienced pain in their daily lives.

  19. Isolated Femoral Muscle and Bone Metastases Rarely Encountered in Testicular Seminoma

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    Serkan Degirmencioglu

    2013-01-01

    Full Text Available Isolated muscle and bone metastases are rarely encountered in patients with testicular seminomas. In the present study, a patient who was admitted with pain, loss of motion, and swelling in the right leg 20 months following surgery for stage I seminoma was presented. Hypermetabolic lesion was detected in the right femoral muscle and bone via positron emission tomography. After the presence of metastasis from seminoma was confirmed by biopsy, bleomycin, cisplatin, and etoposide, combination chemotherapy was administered to the patient.

  20. Assessment of femoral bone quality using co-occurrence matrices and adaptive regions of interest

    Science.gov (United States)

    Fritscher, Karl David; Schuler, Benedikt; Grünerbl, Agnes; Hänni, Markus; Schwieger, Karsten; Suhm, Norbert; Schubert, Rainer

    2007-03-01

    The surgical treatment of femur fractures, which often result from osteoporosis, is highly dependent on the quality of the femoral bone. Unsatisfying results of surgical interventions like early loosening of implants may be one result of altered bone quality. However, clinical diagnostic techniques to quantify local bone quality are limited and often highly observer dependent. Therefore, the development of tools, which automatically and reproducibly place regions of interest (ROI) and asses the local quality of the femoral bone in these ROIs would be of great help for clinicians. For this purpose, a method to position and deform ROIs automatically and reproducibly depending on the size and shape of the femur will be presented. Moreover, an approach to asses the femur quality, which is based on calculating texture features using co-occurrence matrices and these adaptive regions, will be proposed. For testing purposes, 15 CT-datasets of anatomical specimen of human femora are used. The correlation between the texture features and biomechanical properties of the proximal femoral bone is calculated. First results are very promising and show high correlation between the calculated features and biomechanical properties. Testing the method on a larger data pool and refining the algorithms to further increase its sensitivity for altered bone quality will be the next steps in this project.

  1. Total hip arthroplasty for femoral neck fractures as an urgent procedure

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    Radoičić Dragan

    2017-01-01

    Full Text Available Background/Aim. Total hip arthroplasty (THA is one of the most widely accepted operative methods for femoral neck fracture (FNF in elderly. However, the data on the early THA for FNF are very limited. The aim of this study to determine if there were differences in postoperative complications and functional outcomes between an urgent and delayed THA following FNF. Methods. This prospective study included a total of 244 patients who had THA following FNF from January 2010 to January 2013. In the first group 41 FNF patients were treated with THA within less than 12 hours of admission. A total of 203 FNF patients were operated in delayed settings, of whom 162 required prolonged preoperative processing and comorbidities correction. The group II consisted of 41 FNF patients who were fit for the early surgery at admission, but the operation was delayed due to institution related reasons. Main outcome measurements included mortality, functional outcome assessement, cardiological and pulmonary complications, pressure ulcers, dislocations, infections, length of hospitalization and revisions. Results. There were no differences in terms of age, gender, type of implants, neither in mortality, nor complications. There were differences in hospital length of stay [t (51.72 = -10.25, p < 0.001]. The patients operated within less than 12 hours of admission, had significantly better scores at all three time points of functional outcome assessment: at discharge t (80 = 2.556, p < 0.012; one month t (80 = 4.731, p < 0.001; three months t (80 = 5.908, p < 0.001. Conclusion. THA for FNF as an urgent procedure is not a widely accepted concept. Our findings indicate that the early operative treatment, does not worsen clinical outcomes, and our results give an advantage to the policy of the early THA for FNF.

  2. Study of proximal femoral locking compression plate in extra capsular fracture neck of femur

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    Ravi G.O.

    2015-12-01

    Results: In our study of 21 cases, cases 13 cases were intertrochanteric fracture and remaining 8 were subtrochanteric fracture with the mean age was 51.47 years. Minimum age was 19 years and maximum age was 85 years. 14 patients (67% were males and 7 patients (33% were females, 13 IX patients (62% had right-sided fracture and 8 patients (38% had left-sided fracture. with right side being more common side affected. The average duration of stay in the hospital was 25.31 days. The average follow up was 18 months [11 to 23 months]. Out of 21 patients in our study 16 patients (76% are able to sit cross-legged and can squat on ground without any problem. The functional results were graded according to Harris Hip Scoring, In our study, 10 patients (48%had excellent results, 8 patients (38%had good results, 2 patients (10%had poor result, and 1 failed case (5% as she is an elderly female of 85 years with limited activity both preoperatively due to physiological age and general weakness. Conclusions: In conclusion the potentiality of the Proximal Femoral Locking Compression Plate (PF-LCP in varied indications, shows its versatility. Although not free of complications our study has demonstrated excellent results. The procedure offers, faster mobilization, rapid return to activities of daily living, improves the quality of life and gave a long term solution in patients with extracapsular fracture neck of femur. Larger studies with longer follow up will further validate the procedure. [Int J Res Med Sci 2015; 3(12.000: 3726-3733

  3. 股骨干骨折合并同侧股骨颈骨折的外科治疗分析%Analysis of the surgical treatment on Femoral fracture merge ipsilateral with femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    赵钦福; 李云; 汪琪; 朱兰高; 王文

    2013-01-01

    Objective To explore clinical characteristics,misdiagnos reasons,clinical curative effect of the femoral fracture with lateral femoral neck fracture. Methods 22 cases of ipsilateral femoral with lateral femoral neck fracture treatment, 6 patients w ith hollow nail and AO plate fixed, 5 cases of DHS device fixed, 11 cases of femoral reconstruction nail fixed. Results femoral fracture healing time 6-16 months, femoral neck fracture healing 12~24 months. 3 cases of femoral fractures of lower section steel plate fracture delayed healing; 15 cases femoral neck fracture primary healing ,7 patients ischemic necrosis of femoral head ,according to Friedman evaluation criteria good in 15 cases, seven patients (misdiagnosis 5 cases).Conclusion femoral fracture with femoral neck fracture patients should be taken acetabulum X ray film,early diagnosis,early surgical treatment.%  目的探讨股骨干骨折合并同侧股骨颈骨折的临床特点、漏诊原因、临床疗效。方法22例同侧股骨干合并股骨颈骨折患者中6例采用空心钉加 AO 钢板固定,5例采用动力髋螺钉(DHS)装置固定,11例采用股骨重建钉固定。结果股骨干骨折愈合时间为6个月~16个月,股骨颈骨折愈合时间为12个月~24个月;有3例股骨干中下段骨折钢板断裂延迟愈合;股骨颈骨折Ⅰ期愈合15例,股骨头缺血坏死7例,按 Friedman评定标准优良15例,差7例(漏诊5例)。结论股骨干骨折患者应摄髋臼 X 线片,早期确诊,早期行手术治疗。

  4. Scaling in Theropod Dinosaurs: Femoral Bone Strength and Locomotion

    Science.gov (United States)

    Lee, Scott

    2015-01-01

    In our first article on scaling in theropod dinosaurs, the longitudinal stress in the leg bones due to supporting the weight of the animal was studied and found not to control the dimensions of the femur. As a continuation of our study of elasticity in dinosaur bones, we now examine the transverse stress in the femur due to locomotion and find…

  5. Use of Femoral Head and Neck Ostectomy and Physical Therapy to Manage Osteoarthritis in a Rhesus Macaque (Macaca mulatta).

    Science.gov (United States)

    Uchihashi, Mayu; Hampel, Joseph A; Nemzek, Jean A; Saccone, Phillip A; Eaton, Kathryn A; Nowland, Megan H

    2015-06-01

    Osteoarthritis is associated with pain and immobility in both humans and animals. However, available resources for osteoarthritis management in captive NHP are limited. This case report describes a novel management strategy for a 10-y-old male macaque with unilateral hindlimb lameness, prominent muscle wasting, and severely limited range of motion. Radiographs of the affected limb showed lytic lesions of the femoral head. To relieve pain and improve mobility, femoral head and neck ostectomy (FHO) was performed, and multiple pharmacotherapies were initiated. The macaque also received a unique method of physical therapy that required no sedation, acted as enrichment, and was implemented by using a conventional caging system. The response to therapy was monitored by measuring thigh circumference in the operated and nonoperated limbs, which demonstrated improvement in both legs. The unique physical therapy in conjunction with surgery and pharmacotherapy benefited the macaque with osteoarthritis by reducing discomfort and improving mobility.

  6. Total hip arthroplasty using TRI-LOCK® DePuy bone preservation femoral stem: our experience.

    Science.gov (United States)

    Sperati, G; Ceri, L

    2014-09-24

    In this study we report our 3-years experience (from January 2010 to December 2013) of 101 total hip arthroplasties using Tri-Lock® DePuy bone preservation femoral stem, all performed in our clinic. 101 patients (F54-M47; median age around 69 yrs, range 42-84 yrs). 51 arthroplasties were implanted on the right side whereas 50 on the left side. The average follow-up was 27,3 months. All the arthroplasties were coupled with Pinnacle® polyethylene acetabular cup system; 98 prostheses were implanted cementless whereas cement was used in 3 cases. The Tri-Lock® femoral stem allows both soft tissues and bone stock preservation, leading to greater trochanter maintenance, less spongy bone removal and distal cavity bone tissue conservation. In our experience, we were able to implant the Tri-Lock® femoral stem even in osteoporotic and overweight patients using Gription® porous coating. This allowed for commencing an intensive rehabilitation program with stable load from the following day, without observing any early complications or loosening. According to us, this device is solid and safe, providing remarkable sparing of both soft tissues and bone stock.

  7. Bone marrow edema of the femoral head and transient osteoporosis of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Bruno C. van de [Department of Radiology and Medical Imaging, Universite Catholique de Louvain, University Hospital St Luc, 10 Avenue Hippocrate 1200, Brussels (Belgium)], E-mail: bruno.vandeberg@uclouvain.be; Lecouvet, Frederic E.; Koutaissoff, Sophie; Simoni, Paolo; Malghem, Jacques [Department of Radiology and Medical Imaging, Universite Catholique de Louvain, University Hospital St Luc, 10 Avenue Hippocrate 1200, Brussels (Belgium)

    2008-07-15

    The current article of this issue aims at defining the generic term of bone marrow edema of the femoral head as seen at MR imaging. It must be kept in mind that this syndrome should be regarded, not as a specific diagnosis, but rather as a sign of an ongoing abnormal process that involves the femoral head and/or the hip joint. We aim at emphasizing the role of the radiologists in making a specific diagnosis, starting from a non-specific finding on T1-weighted images and by focusing on ancillary findings on T2-weighted SE or fat-saturated proton-density weighted MR images.

  8. Herniation pits and cystic-appearing lesions at the anterior femoral neck: an anatomical study by MSCT and {mu}CT

    Energy Technology Data Exchange (ETDEWEB)

    Panzer, Stephanie; Esch, Ulrich [Trauma Center Murnau, Department of Radiology, Murnau (Germany); Abdulazim, Ahmed Nabil; Augat, Peter [Paracelsus University Salzburg and Trauma Center Murnau, Biomechanics Laboratory, Murnau (Germany)

    2010-07-15

    To determine distinguishing features between herniation pits (HPs) and other cystic-appearing lesions at the anterior femoral neck in multi-slice computed tomography (MSCT) and micro-computed tomography (microCT) examinations. Institutional review board approval was obtained to examine 37 proximal femora of 23 cadaveric specimens (mean age available in 19 cadavers, 83 years; range 68-100 years; 9 female, 8 male, 6 unknown). All 37 femora were investigated by MSCT. 23 femora, which revealed cystic-appearing lesions at the anterior femoral neck in MSCT examinations, were additionally examined by microCT. Cystic-appearing lesions were categorized by their location, sclerotic margin, demarcation and shape in MSCT with assessment of inter-observer agreement. Detailed cortical and trabecular properties were evaluated in microCT examinations. There were seven HPs in three femora. There were a number of abnormalities potentially imitating HPs, including focal osteoporosis (13 in 13 femora), degenerative changes (5 in 4 femora) and trabecular restructuring (5 in 4 femora) at the anterior femoral neck. HPs were differentiated on the basis of their subchondral/subcortical location, completely surrounding sclerosis, clear demarcation and round-to-oval shape in MSCT. Because of their location and their microscopic appearance, HPs seem to resemble intra-osseous ganglia at the anterior femoral neck. HPs have to be differentiated from other cystic appearing lesions at the anterior femoral neck to avoid overestimation of their incidence in the context of diagnosis of femoroacetabular impingement. (orig.)

  9. Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric

    Directory of Open Access Journals (Sweden)

    Tânia Maria da Silva Mendonça

    2008-01-01

    Full Text Available OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years, 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36 at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.

  10. Do physical examination and CT-scan measures of femoral neck anteversion and tibial torsion relate to each other?

    Science.gov (United States)

    Sangeux, Morgan; Mahy, Jessica; Graham, H Kerr

    2014-01-01

    Informed clinical decision making for femoral and/or tibial de-rotation osteotomies requires accurate measurement of patient function through gait analysis and anatomy through physical examination of bony torsions. Validity of gait analysis has been extensively studied; however, controversy remains regarding the accuracy of physical examination measurements of femoral and tibial torsion. Comparison between CT-scans and physical examination measurements of femoral neck anteversion (FNA) and external tibial torsion (ETT) were retrospectively obtained for 98 (FNA) and 64 (ETT) patients who attended a tertiary hospital for instrumented gait analysis between 2007 and 2010. The physical examination methods studied for femoral neck anteversion were the trochanteric prominence angle test (TPAT) and the maximum hip rotation arc midpoint (Arc midpoint) and for external tibial torsion the transmalleolar axis (TMA). Results showed that all physical examination measurements statistically differed to the CT-scans (bias(standard deviation): -2(14) for TPAT, -10(12) for Arc midpoint and -16(9) for TMA). Bland and Altman plots showed that method disagreements increased with increasing bony torsions in all cases but notably for TPAT. Regression analysis showed that only TMA and CT-scan measurement of external tibial torsion demonstrated good (R(2)=57%) correlation. Correlations for both TPAT (R(2)=14%) and Arc midpoint (R(2)=39%) with CT-scan measurements of FNA were limited. We conclude that physical examination should be considered as screening techniques rather than definitive measurement methods for FNA and ETT. Further research is required to develop more accurate measurement methods to accompany instrumented gait analysis. Copyright © 2013. Published by Elsevier B.V.

  11. Femoral impaction bone grafting in revision hip arthroplasty: 705 cases from the originating centre.

    Science.gov (United States)

    Wilson, M J; Hook, S; Whitehouse, S L; Timperley, A J; Gie, G A

    2016-12-01

    Femoral impaction bone grafting was first developed in 1987 using morselised cancellous bone graft impacted into the femoral canal in combination with a cemented, tapered, polished stem. We describe the evolution of this technique and instrumentation since that time. Between 1987 and 2005, 705 revision total hip arthroplasties (56 bilateral) were performed with femoral impaction grafting using a cemented femoral stem. All surviving patients were prospectively followed for a mean of 14.7 years (9.8 to 28.3) with no loss to follow-up. By the time of the final review, 404 patients had died. There were 76 further revisions (10.8%) involving the stem; seven for aseptic loosening, 23 for periprosthetic fracture, 24 for infection, one for malposition, one for fracture of the stem and 19 cement-in-cement exchanges of the stem during acetabular revision. The 20-year survival rate for the entire series was 98.8% (95% confidence interval (CI) 97.8 to 99.8) with aseptic loosening as the endpoint, and 87.7% (95% CI 82.8 to 92.6) for revision for any reason. Survival improved with the evolution of the technique, although this was not statistically significant due to the overall low rate of further revision. This is the largest series of revision total hip arthroplasties with femoral impaction grafting, and the results support the continued use of this technique. Cite this article: Bone Joint J 2016;98-B:1611-19. ©2016 The British Editorial Society of Bone & Joint Surgery.

  12. Early detection of femoral head avascular necrosis by bone SPECT compared to MRI in renal allograft recipients

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    Kang, Do Young; Yang, Seoung Oh; Lee, Hee Kyung; Han, Duck Jong; Shin, Myung Jin [Asan Mecical Center, Seoul (Korea, Republic of)

    1997-07-01

    The prevalence of avascular necrosis (AVN) of femoral head in patients who receive immunosuppresive agents after renal transplantation is reported to be 4-29%. Among patients who develop AVN after renal transplantation, 80% become symptomatic within 2 years after transplantation. As the number of renal transplantation has been increased recently, early detection of femoral head AVN is very important because early surgical core decompression of femoral head can prevent collapse of the head. MRI is known to be very sensitive to diagnose femoral head AVN. However in three cases we report here, bone SPECT showed early changes of femoral head AVN, whereas MRI showed no specific abnormality. Case 1. A 53-year-old female received an allograft kidney transplantation in 1994. Preoperative bone scan was normal. She complained of both hip pain on Mar. 18 1997. Bone SPECT showed cold defect in both femoral heads but MRI showed no abnormality. After 3 months, bone SPECT and MRI showed AVN of both femoral heads. She underwent bilateral total hip replacement arthroplasty. AVN of femoral heads was confirmed by microscopic examination. Case 2. A 38-year-old female received an allograft kidney transplantation in Feb. 27 1997. Preoperative bone scan was normal. She ran a fever and creatinine was elevated from 1.2 to 2.8 mg/dL. She took high dose methylprednisolone therapy for acute reanl rejection. After two days, she complained pain in both hip joints and knee joints. Bone SPECT showed cold defects in both femoral heads but MRI showed no abnormality. A follow-up bone SPECT and MRI 20 days later revealed AVN of both femoral heads. Case 3. A 50-year-old male received an allograft kidney transplantation on Jul. 12 1995. Preoperative bone scan was normal. He complained of right hip pain on Jul, 26 1995. His bone SPECT showed cold defects in both femoral heads while MRI showed only minimal hip joint effusion. He also complained of left hip pain on Oct. 2 1995. He was admitted on Mar 17

  13. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Overgaard, Søren; Lauritsen, Jens;

    2013-01-01

    treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up. Methods 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1...... an uncemented hydroxyapatite-coated Furlong HA. Data were retrieved from patient files, from the region-based patient administrative system, and from the National Registry of Patients at the end of 2010. We performed survival analysis with adjustment for comorbidity, age, and sex. Results Cemented HA had...

  14. Preparation of the Femoral Bone Cavity for Cementless Stems

    DEFF Research Database (Denmark)

    Hjorth, Mette H; Kold, Søren; Søballe, Kjeld;

    2016-01-01

    BACKGROUND: Short-term experimental and animal studies have confirmed superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone. METHODS: Forty-four hips in 42 patients (19 men) were randomly operated using cementless hydroxyapatite-coated Bi......-Metric stems. Patients were followed with radiostereometric analysis at baseline, 6 and 12 weeks, 1, 2, and 5 years, and measurements of periprosthetic bone mineral density at baseline, 1, 2, and 5 years. Complications during the study period and clinical outcome measures of Harris Hip Score were recorded...... follow-ups (P > .13). The compaction group had significantly less bone loss than the broaching group in Gruen zone 3 (distal-lateral to the stem) at 1 and 5 years. No further differences in bone mineral density changes were found between groups up to 5 years after surgery. Complications throughout...

  15. Multiple bony lesions other than femoral heads on {sup 99m}Tc-MDP bone scan in patients with avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yun Young; Yang, Seoung Oh; Moon, Dae Hyuk; Ryu, Jin Sook; Weon, Young Cheol; Shin, Myung Jin; Lee, Soo Ho; Lee, Hee Kyung [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Chun, Hae Kyung [St. Francisco Hospital, Seoul (Korea, Republic of)

    1997-03-01

    To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. One hundred and seventy three patients with clinical diagnosis of avascular necrosis of the emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of in volvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8%); the location of 79 lesions was other than the femoral head. This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to aveid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.

  16. Can local Erythropoietin administration enhance bone regeneration in osteonecrosis of femoral head?

    Science.gov (United States)

    Bakhshi, Hooman; Rasouli, Mohammad R; Parvizi, Javad

    2012-08-01

    Osteonecrosis of femoral head (ONFH) is a challenging disease. Regardless of underlying causes, the ultimate result in all cases is disruption of femoral head blood supply. Once the disease starts, it is progressive in 80% of cases. Since the majority of the affected individuals are young, every effort should be focused on preserving the patients own femoral head. These years, the role of angiogenic growth factors has been investigated with promising results in animal models of ONFH. Erythropoietin (EPO) is a well known hormone that has been used in treatment of chronic anemia for many years with few side effects. Considering the angiogenic properties of EPO, we hypothesize that local delivery of recombinant human EPO during core decompression will enhance bone regeneration in ONFH. In this way we also can avoid systemic side effects of EPO.

  17. [Paralysis of the femoral nerve complicating ilio-psoas hemorrhage after iliac bone transplantation (author's transl)].

    Science.gov (United States)

    Mestdagh, H

    1982-03-11

    The author reported an unusual complication of iliac bone transplantation for grafting of a tibial pseudarthrosis. In a patient having anticoagulant therapy, a large iliac haematoma developed in the donor site and extended deep to the iliacus muscle and through the osteomuscular gap into the retroperitoneal space. Moreover it spread downwards and entrapped the femoral nerve as it lies behind the iliac fascia, above the inguinal ligament. Both a paralytic ileus and a femoral nerve injury commanded surgical exploration through an oblique iliac approach; emptying of the clotted haematoma, section of the inguinal ligament and liberation of the femoral nerve enable to avoid definitive sequelae to the quadriceps but the time required is varying: three years after the accident, recovery is not complete in the operated patient probably owing to delayed surgery (three weeks).

  18. Planning for corrective osteotomy of the femoral bone using 3D-modeling. Part I

    Directory of Open Access Journals (Sweden)

    Alexey G Baindurashvili

    2016-09-01

    Full Text Available Introduction. In standard planning for corrective hip osteotomy, a surgical intervention scheme is created on a uniplanar paper medium on the basis of X-ray images. However, uniplanar skiagrams are unable to render real spatial configuration of the femoral bone. When combining three-dimensional and uniplanar models of bone, human errors inevitably occur, causing the distortion of preset parameters, which may lead to glaring errors and, as a result, to repeated operations. Aims. To develop a new three-dimensional method for planning and performing corrective osteotomy of the femoral bone, using visualizing computer technologies. Materials and methods. A new method of planning for corrective hip osteotomy in children with various hip joint pathologies was developed. We examined the method using 27 patients [aged 5–18 years (32 hip joints] with congenital and acquired femoral bone deformation. The efficiency of the proposed method was assessed in comparison with uniplanar planning using roentgenograms. Conclusions. Computerized operation planning using three-dimensional modeling improves treatment results by minimizing the likelihood of human errors and increasing planning and surgical intervention  accuracy.

  19. Estimated lean mass and fat mass differentially affect femoral bone density and strength index but are not FRAX independent risk factors for fracture.

    Science.gov (United States)

    Leslie, William D; Orwoll, Eric S; Nielson, Carrie M; Morin, Suzanne N; Majumdar, Sumit R; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A

    2014-11-01

    Although increasing body weight has been regarded as protective against osteoporosis and fractures, there is accumulating evidence that fat mass adversely affects skeletal health compared with lean mass. We examined skeletal health as a function of estimated total body lean and fat mass in 40,050 women and 3600 men age ≥50 years at the time of baseline dual-energy X-ray absorptiometry (DXA) testing from a clinical registry from Manitoba, Canada. Femoral neck bone mineral density (BMD), strength index (SI), cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) were derived from DXA. Multivariable models showed that increasing lean mass was associated with near-linear increases in femoral BMD, CSA, and CSMI in both women and men, whereas increasing fat mass showed a small initial increase in these measurements followed by a plateau. In contrast, femoral SI was relatively unaffected by increasing lean mass but was associated with a continuous linear decline with increasing fat mass, which should predict higher fracture risk. During mean 5-year follow-up, incident major osteoporosis fractures and hip fractures were observed in 2505 women and 180 men (626 and 45 hip fractures, respectively). After adjustment for fracture risk assessment tool (FRAX) scores (with or without BMD), we found no evidence that lean mass, fat mass, or femoral SI affected prediction of major osteoporosis fractures or hip fractures. Findings were similar in men and women, without significant interactions with sex or obesity. In conclusion, skeletal adaptation to increasing lean mass was positively associated with BMD but had no effect on femoral SI, whereas increasing fat mass had no effect on BMD but adversely affected femoral SI. Greater fat mass was not independently associated with a greater risk of fractures over 5-year follow-up. FRAX robustly predicts fractures and was not affected by variations in body composition.

  20. Mid term results of Furlong LOL uncemented hip hemiarthroplasty for fractures of the femoral neck.

    Science.gov (United States)

    Chandran, Prakash; Azzabi, Mohammed; Burton, Dave J C; Andrews, Mark; Bradley, John G

    2006-08-01

    We report the mid-term results of hemiarthroplasty with the Furlong hydroxyapatite coated bipolar prosthesis for displaced (Garden type III and IV) intracapsular hip fracture in 480 patients operated between 1989 and 2000. Three hundred sixty eight (77%) patients were lost to follow-up due to death, dementia or movement away from the area. In the patients followed up there was an 8% reoperation rate for infection, aseptic loosening, periprosthetic fracture and acetabular erosion. One hundred and twelve patients with a mean follow-up of 4 years (3-14) were studied. Eighty eight percent had no or slight pain, 77% could mobilise outdoors and 89% needed either no aid or a single walking stick to mobilise. Radiographic assessment revealed a stable implant with visible osseointegration in 91%. We conclude that hemiarthroplasty with the hydroxyapatite coated bipolar Furlong LOL prosthesis for displaced intracapsular fracture of the neck of the femur gives good mid term results in elderly patients for return to mobility, use of mobility aids and freedom from pain. It avoids the need for cement and provides satisfactory incorporation into the host bone. The use of a modular head makes revision to total hip replacement easier.

  1. Relationship between mechanical properties and bone mineral density of human femoral bone retrieved from patients with osteoarthritis.

    Science.gov (United States)

    Haba, Yvonne; Lindner, Tobias; Fritsche, Andreas; Schiebenhöfer, Ann-Kristin; Souffrant, Robert; Kluess, Daniel; Skripitz, Ralf; Mittelmeier, Wolfram; Bader, Rainer

    2012-01-01

    The objective of this study was to analyse retrieved human femoral bone samples using three different test methods, to elucidate the relationship between bone mineral density and mechanical properties. Human femoral heads were retrieved from 22 donors undergoing primary total hip replacement due to hip osteoarthritis and stored for a maximum of 24 hours postoperatively at + 6 °C to 8 °C.Analysis revealed an average structural modulus of 232±130 N/mm(2) and ultimate compression strength of 6.1±3.3 N/mm(2) with high standard deviations. Bone mineral densities of 385±133 mg/cm(2) and 353±172 mg/cm(3) were measured using thedual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT), respectively. Ashing resulted in a bone mineral density of 323±97 mg/cm(3). In particular, significant linear correlations were found between DXA and ashing with r = 0.89 (p < 0.01, n = 22) and between structural modulus and ashing with r = 0.76 (p < 0.01, n = 22).Thus, we demonstrated a significant relationship between mechanical properties and bone density. The correlations found can help to determine the mechanical load capacity of individual patients undergoing surgical treatments by means of noninvasive bone density measurements.

  2. [ANATOMICAL PLATE COMBINED WITH CORTICAL BONE PLATE ALLOGRAFTS FOR TREATMENT OF COMMINUTED FRACTURES OF FEMORAL CONDYLES].

    Science.gov (United States)

    Guo, Zhimin; Gong, Xingxing; Li, Yanwei; Qiu, Xiaochun; Zhang, Meng; Shangguan, Tiancheng; Ao, Qingfang; Liu, Qiang

    2015-01-01

    To summarize the effectiveness of anatomical plate combined with cortical bone plate allografts in the treatment of comminuted fractures of the femoral condyles. Between January 2008 and December 2012, 18 patients with comminuted fractures of the femoral condyles were treated, including 13 males and 5 females with an average age of 45 years (range, 23-65 years). Fractures were caused by traffic accident in 11 cases, by falling from height in 4 cases, and by the other in 3 cases. The locations were the left side in 7 cases and the right side in 11 cases. Of 18 fractures, 12 were open fractures and 6 were closed fractures. The mean time from injury to operation was 6 days (range, 4-15 days). The fixation was performed by anatomical plate combined with cortical bone plate allografts, and autograft bone or allogeneic bone grafting were used. Superficial local skin necrosis occurred in 1 case, and was cured after skin graft, and other incisions achieved primary healing. All patients were followed up 12-36 months (mean, 23 months). X-ray films showed that bone union was achieved within 3-12 months (5.6 months on average). No related complication occurred, such as fixation loosening, refracture, infection, or immunological rejection. According to Merchan et al. criteria for knee joint function evaluation, the results were excellent in 7 cases, good in 9 cases, fair in 1 case, and poor in 1 case at last follow-up; the excellent and good rate was 88.9%. Anatomical plate combined with cortical bone plate allograft fixation is a good method to treat comminuted fractures of the femoral condyles. This method can effectively achieve complete cortical bone on the inside of the femur as well as provide rigid fixation.

  3. Femoral shaft fracture fixed with intramedullary nailing in a child resulting in femoral neck narrowing deformity and fracture

    Institute of Scientific and Technical Information of China (English)

    WAN Lin; ZHAO Lin; LIU Yan-qing; WANG Xu; LIU Jing-sheng

    2008-01-01

    @@ Treatment of factures in children is different from that of adults because improper internal fixation,including selection of internal fixation device and epiphysis approaching,may cause epiphysis injury,which may result in a series of secondary lesions in bone development,such as growth arrest,limb length discrepancy, osteonecrosis, and other deformities.

  4. Effects of Materials of Cementless Femoral Stem on the Functional Adaptation of Bone

    Institute of Scientific and Technical Information of China (English)

    He Gong; Wei Wu; Juan Fang; Xin Dong; Meisheng Zhao; Tongtong Guo

    2012-01-01

    The objective of this paper is to identify the effects of materials of cementless femoral stem on the functional adaptive behaviors of bone.The remodeling behaviors of a two-dimensional simplified model of cementless hip prosthesis with stiff stem,flexible 'iso-elastic' stem,one-dimensional Functionally Graded Material (FGM) stem and two-dimensional FGM stem for the period of four years after prosthesis replacement were quantified by incorporating the bone remodeling algorithm with finite element analysis.The distributions of bone density,von Mises stress,and interface shear stress were obtained.The results show that two-dimensional FGM stem may produce more mechanical stimuli and more uniform interface shear stress compared with the stems made of other materials,thus the host bone is well preserved.Accordingly,the two-dimensional FGM stem is an appropriate femoral implant from a biomechanical point of view.The numerical simulation in this paper can provide a quantitative computational paradigm for the changes of bone morphology caused by implants,which can help to improve the design of implant to reduce stress shielding and the risk of bone-prosthesis interface failure.

  5. Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005-2008

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Osteoporosis or Low Bone Mass at the Femur Neck ... Survey, 2005–2008. What is the prevalence of osteoporosis or low bone mass at the femur neck ...

  6. Longitudinal femoral shaft due to bone insufficiency. A review of three cases.

    Science.gov (United States)

    Maraval, Anne; Grados, Franck; Royant, Valérie; Damade, Richard; Boulu, Gilles; Fardellone, Patrice

    2003-12-01

    We report three new cases of longitudinal femoral shaft fracture due to bone insufficiency and review the eight cases reported in the literature. The typical patient is a woman older than 65 years of age who present with mechanical pain in the thigh and/or groin. Palpation of the thigh may reproduce the pain. The diagnosis is often made late because the radiographs are normal initially. However, an early and consistent finding is increased radionuclide uptake along the femoral shaft. The fracture line is readily evidenced by computed tomography but may be difficult to see on magnetic resonance imaging. Use of crutches for 6 weeks to protect the bone from weight bearing ensures healing of the fracture.

  7. The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis.

    Science.gov (United States)

    Boese, Christoph Kolja; Frink, Michael; Jostmeier, Janine; Haneder, Stefan; Dargel, Jens; Eysel, Peer; Lechler, Philipp

    2016-01-01

    Background. The femoral neck-shaft angle (NSA) is of high importance for the diagnostics and treatment of various conditions of the hip. However, rotational effects limit its precision and applicability using plain radiographs. This study introduces a novel method to measure the femoral NSA: the modified NSA (mNSA), possibly being less susceptible against rotational effects compared to the conventional NSA. Patients and Methods. The method of measurement is described and its applicability was tested in 400 pelvis computed tomography scans (800 hips). Age- and gender-dependent reference values are given and intra- and interrater reliability are analyzed. Results. The mean age of all 400 patients (800 hips) was 54.32 years (18-100, SD 22.05 years). The mean mNSA was 147.0° and the 95% confidence interval was 146.7°-147.4°. Differences of the mNSA between sexes, age groups, and sides were nonsignificant. The absolute difference between NSA and mNSA was 16.3° (range 3-31°; SD 4.4°); the correlation was high (0.738; p < 0.001). Overall, the intra- and interrater reliability were excellent for the mNSA. Interpretation. We introduced a novel concept for the analysis of the neck-shaft angle. The high reliability of the measurement has been proven and its robustness to hip rotation was demonstrated.

  8. Subtrochanteric femoral fractures due to simple bone cysts in children.

    Science.gov (United States)

    Vigler, Mordechai; Weigl, Daniel; Schwarz, Michael; Ben-Itzhak, Ilan; Salai, Moshe; Bar-On, Elhanan

    2006-11-01

    Seven children were treated surgically as a result of a pathologic fracture through a simple bone cyst in the subtrochanteric region of the proximal femur. Average age at surgery was 10.6 years. Six children were treated primarily. One child was operated for a refracture through a persistent cyst and malunion of a previous fracture that had been treated nonoperatively. Surgery included curettage of cysts in all patients. The cysts were filled with autologous bone graft in five patients and Osteoset bone substitute in two patients. The fracture was stabilized using a blade plate in three patients, a screw and side plate in three patients and an external fixator in one. At average follow-up of 4.7 years, all fractures had healed uneventfully. The cyst was fully obliterated in five patients and partially obliterated in two patients. One patient had a relative lengthening of 2 cm on the affected side. All patients were asymptomatic, fully active and had full range of motion.

  9. Extraction of 3D Femur Neck Trabecular Bone Architecture from Clinical CT Images in Osteoporotic Evaluation: a Novel Framework.

    Science.gov (United States)

    Sapthagirivasan, V; Anburajan, M; Janarthanam, S

    2015-08-01

    The early detection of osteoporosis risk enhances the lifespan and quality of life of an individual. A reasonable in-vivo assessment of trabecular bone strength at the proximal femur helps to evaluate the fracture risk and henceforth, to understand the associated structural dynamics on occurrence of osteoporosis. The main aim of our study was to develop a framework to automatically determine the trabecular bone strength from clinical femur CT images and thereby to estimate its correlation with BMD. All the 50 studied south Indian female subjects aged 30 to 80 years underwent CT and DXA measurements at right femur region. Initially, the original CT slices were intensified and active contour model was utilised for the extraction of the neck region. After processing through a novel process called trabecular enrichment approach (TEA), the three dimensional (3D) trabecular features were extracted. The extracted 3D trabecular features, such as volume fraction (VF), solidity of delta points (SDP) and boundness, demonstrated a significant correlation with femoral neck bone mineral density (r = 0.551, r = 0.432, r = 0.552 respectively) at p TEA method would be useful for spotting women vulnerable to osteoporotic risk.

  10. [Epithelioid hemangioendothelioma of bone complicated by femoral fracture].

    Science.gov (United States)

    Charfi, L; Mrad, K; Karray, S; Sassi, S; Driss, M; Abbes, I; Ben Romdhane, K

    2005-12-01

    A 54-year-old man was seen with a fracture of the left femur. Plain radiographs revealed a 40-mm lytic centromedullary lesion. Magnetic resonance T1- and T2-weighted sequences showed high and low signals. After stabilization of the fracture, the tumor was removed followed by reconstruction with a vascularized fibula. The pathological examination demonstrated proliferation of non atypical CD34 and CD31 positive epithelioid cells with few lumens, accompanied by abundant fibrous stroma, sometimes masking tumor cells. Satisfactory motion was achieved with no recurrence at 20 months follow-up. Bone hemangioendothelioma can simulate metastasis and must be distinguished by immunohistochemistry. Prognosis is a subject of debate as the tumor is considered to exhibit intermediate malignancy by some authors while other consider it to be a malignant tumor.

  11. Femoral cortical index: an indicator of poor bone quality in patient with hip fracture.

    Science.gov (United States)

    Feola, M; Rao, C; Tempesta, V; Gasbarra, E; Tarantino, U

    2015-10-01

    Osteoporosis is a common disease in elderly, characterized by poor bone quality as a result of alterations affecting trabecular bone. However, recent studies have described also an important role of alterations of cortical bone in the physiopathology of osteoporosis. Although dual-energy X-ray absorptiometry (DXA) is a valid method to assess bone mineral density, in the presence of comorbidities real bone fragility is unable to be evaluated. The number of hip fractures is rising, especially in people over 85 years old. The aim is to evaluate an alternative method so that it can indicate fracture risk, independent of bone mineral density (BMD). Femoral cortical index (FCI) assesses cortical bone stock using femur X-ray. A retrospective study has been conducted on 152 patients with hip fragility fractures. FCI has been calculated on fractured femur and on the opposite side. The presence of comorbidities, osteoporosis risk factors, vitamin D levels, and BMD have been analyzed for each patient. Average values of FCI have been 0.42 for fractured femurs and 0.48 at the opposite side with a statistically significant difference (p = 0.002). Patients with severe hypovitaminosis D had a minor FCI compared to those with moderate deficiency (0.41 vs. 0.46, p hip fractures has been found. FCI could be a useful tool to evaluate bone fragility and to predict fracture risk even in the normal and osteopenic BMD patients.

  12. Postoperative start compared to preoperative start of low-molecular-weight heparin increases mortality in patients with femoral neck fractures

    Science.gov (United States)

    Leer-Salvesen, Sunniva; Dybvik, Eva; Dahl, Ola E; Gjertsen, Jan-Erik; EngesæTer, Lars B

    2017-01-01

    Background and purpose — Controversies exist regarding thromboprophylaxis in orthopedic surgery. Using data in the nationwide Norwegian Hip Fracture Register (NHFR) with postoperative death and reoperation in the first 6 months after surgery as endpoints in the analyses, we determined whether the thromboprophylaxis in patients who undergo hemiarthroplasty for femoral neck fracture should start preoperatively or postoperatively. Patients and methods — After each operation for hip fracture in Norway, the surgeon reports information on the patient, the fracture, and the operation to the NHFR. Cox regression analyses were performed with adjustments for age, ASA score, gender, type of implant, length of surgery, and year of surgery. Results — During the period 2005–2014, 25,019 hemiarthroplasties as treatment for femoral neck fractures were reported to the registry. Antithrombotic medication was given to 99% of the patients. Low-molecular-weight heparin predominated with dalteparin in 57% of the operations and enoxaparin in 41%. Only operations with these 2 drugs and with known information on preoperative or postoperative start of the prophylaxis were included in the analyses (n = 20,241). Compared to preoperative start of thromboprophylaxis, postoperative start of thromboprophylaxis gave a higher risk of death (risk ratio (RR) = 1.13, 95% CI: 1.06–1.21; p < 0.001) and a higher risk of reoperation for any reason (RR =1.19, 95% CI: 1.01–1.40; p = 0.04), whereas we found no effect on reported intraoperative bleeding complication or on the risk of postoperative reoperation due to hematoma. The results did not depend on whether the initial dose of prophylaxis was the full dosage or half of the standard dosage. Interpretation — Postoperative start of thromboprophylaxis increased the mortality and risk of reoperation compared to preoperative start in femoral neck fracture patients operated with hemiprosthesis. The risks of bleeding and of reoperation due to

  13. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

    NARCIS (Netherlands)

    P.T.P.W. Burgers (Paul); M. Hoogendoorn (Martine); E.A.C. Van Woensel; R.W. Poolman (Rudolf); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)

    2016-01-01

    textabstractSummary: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awar

  14. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

    NARCIS (Netherlands)

    P.T.P.W. Burgers (Paul); M. Hoogendoorn (Martine); E.A.C. Van Woensel; R.W. Poolman (Rudolf); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)

    2016-01-01

    textabstractSummary: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost

  15. Dynamic condylar screw or hip joint(spanning)external fixator for treatment of pathological fractures of femoral neck and trochanter secondary to benign lesions

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chun-lin; ZENG Bing-fang; DONG Yang; Daria brooks Terrell; Martin M.Malawer

    2008-01-01

    @@ The treatment of pathological fractures of the femoral neck and trochanteric region secondary to benign lesions can be a challenge for orthopaedic surgeons because of the size and nature of the lesions,the resulting bony defect,the risk of recurrence,the possible associated defortuities,and the risk of osteonecrosis.

  16. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-Analysis and systematic review of randomized trials

    NARCIS (Netherlands)

    P.T.P.W. Burgers (Paul); A.R. van Geene (Arnoud); M.P.J. van den Bekerom (Michel); E.M.M. van Lieshout (Esther); B. Blom (Bastiaan); I.S. Aleem (Ilyas); M. Bhandari (Mohit); R.W. Poolman (Rudolf)

    2012-01-01

    textabstractPurpose Displaced femoral neck fractures in healthy elderly patients have traditionally been managed with hemiarthroplasty (HA). Recent data suggest that total hip arthroplasty (THA) may be a better alternative. Methods A systematic review of the English literature was conducted.

  17. Cumulative incidence and treatment of non-simultaneous bilateral femoral neck fractures in a cohort of one thousand two hundred and fifty patients.

    NARCIS (Netherlands)

    Burgers, P.T.; Zielinski, S.M.; Mailuhu, A.K.; Heetveld, M.J.; Verhofstad, M.H.J.; Roukema, G.R.; Patka, P.; Poolman, R.W.; Lieshout, E.M. van; Biert, J.

    2014-01-01

    PURPOSE: In the Netherlands, over 20,000 patients sustain a hip fracture yearly. A first hip fracture is a risk factor for a second, contralateral fracture. Data on the similarity of the treatment of bilateral femoral neck fractures is only scarcely available. The objectives of this study were to

  18. Cumulative incidence and treatment of non-simultaneous bilateral femoral neck fractures in a cohort of one thousand two hundred and fifty patients

    NARCIS (Netherlands)

    P.T.P.W. Burgers (Paul); S.M. Zielinski (Stephanie); A.K.E. Mailuhu (Adinda); M.J. Heetveld (Martin); M.H.J. Verhofstad (Michiel); G.R. Roukema (Gert); P. Patka (Peter); R.W. Poolman (Rudolf); E.M.M. van Lieshout (Esther)

    2014-01-01

    textabstractPurpose In the Netherlands, over 20,000 patients sustain a hip fracture yearly. A first hip fracture is a risk factor for a second, contralateral fracture. Data on the similarity of the treatment of bilateral femoral neck fractures is only scarcely available. The objectives of this study

  19. Finite Element Analysis for Prediction of Shear and Stress Concentration & Distribution in Femoral Bone

    Science.gov (United States)

    Suhendra, N.; Gustiono, D.; Nugroho, E. A.; Masmui; Yuliani, H.

    2017-02-01

    The effect of micromotion on the shear shielding and size of yielding region in the bone asperity in contact with metal of femoral stem was investigated. The main objective of this work was to gain an understanding of bone wear particleformation mechanism from the two-dimensional finite element model of cementless femoral stem type. To assess the influence of the parameters of interest, different friction coefficients and sliding distance (micromotion)were used in the numerical simulations. Results from the finite element analysis showed that the increase ofthe yielding region is strongly influenced by the rise in sliding distance (micromotion), which is related to the generation of bone wear particle formations. Finite element bone wearparticle formation model, based on strain discontinuities, was therefore proposed for further works. The results obtained in this study can lead to the development of an accurate finite element wearparticle formation mechanism model that would be of use in the assessment of an artificial implant performance and their development.

  20. 骨髓间充质干细胞增殖能力与皮质类固醇性骨坏死%Proliferation ability of bone marrow mesenchymal stem cells in corticosteroid-induced osteonecrosis of femoral head

    Institute of Scientific and Technical Information of China (English)

    王佰亮; 李铁军; 岳德波; 孙伟

    2014-01-01

    背景:皮质类固醇激素性骨坏死是造成髋关节功能丧失的主要病因之一。近年研究表明,激素性股骨头坏死可能与激素引起的骨髓间充质干细胞增殖能力有关。  目的:检测皮质类固醇性骨坏死患者骨髓间充质干细胞的增殖活性,为建立自体骨髓干细胞移植治疗股骨头坏死的合理性寻求证据。  方法:选取皮质类固醇性股骨头坏死病例设为股骨头坏死组,按取材部位不同再分为股骨头坏死股骨头组、股骨头坏死髂骨组,同时选取无股骨头坏死、无激素应用的拟行人工关节置换的股骨颈骨折患者设为对照组。用密度梯度离心法分离各组骨髓间充质干细胞,再经贴壁筛选法筛选,选取第3代细胞进行实验。  结果与结论:MTT结果显示,股骨头坏死股骨头组增殖能力明显弱于其他2组,其骨髓间充质干细胞在培养后1-7d为生长滞留期,第8天达到对数生长期,以后进入到平台期,而其他2组较病例组生长曲线明显前移,并且峰值增高。流式细胞仪测定的细胞周期结果显示,股骨头坏死股骨头组中G0/G1细胞比例明显增高,而S+G2/M期细胞比例降低,细胞增殖指数较其他2组降低(P OBJECTIVE:To detect the proliferation and differentiation ability of bone marrow mesenchymal stem cells isolated from patients with steroid-induced osteonecrosis of femoral head, providing rational evidences for treatment of corticosteroid-induced osteonecrosis of femoral head with the transplantation of autologous bone marrow containing bone marrow mesenchymal stem cells into the necrotic area of femoral head. METHODS:Bone marrow mesenchymal stem cells from the femoral heads were col ected from patients with corticosteroid-induced osteonecrosis of femoral head, and new femoral neck fractures without osteonecrosis who were scheduled for total hip arthroplasty. In another group, bone marrow

  1. Temporal gene expression profiling during rat femoral marrow ablation-induced intramembranous bone regeneration.

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    Joel K Wise

    Full Text Available Enhanced understanding of differential gene expression and biological pathways associated with distinct phases of intramembranous bone regeneration following femoral marrow ablation surgery will improve future advancements regarding osseointegration of joint replacement implants, biomaterials design, and bone tissue engineering. A rat femoral marrow ablation model was performed and genome-wide microarray data were obtained from samples at 1, 3, 5, 7, 10, 14, 28, and 56 days post-ablation, with intact bones serving as controls at Day 0. Bayesian model-based clustering produced eight distinct groups amongst 9,062 significant gene probe sets based on similar temporal expression profiles, which were further categorized into three major temporal classes of increased, variable, and decreased expression. Osteoblastic- and osteoclastic-associated genes were found to be significantly expressed within the increased expression groups. Chondrogenesis was not detected histologically. Adipogenic marker genes were found within variable/decreased expression groups, emphasizing that adipogenesis was inhibited during osteogenesis. Differential biological processes and pathways associated with each major temporal group were identified, and significantly expressed genes involved were visually represented by heat maps. It was determined that the increased expression group exclusively contains genes involved in pathways for matrix metalloproteinases (MMPs, Wnt signaling, TGF-β signaling, and inflammatory pathways. Only the variable expression group contains genes associated with glycolysis and gluconeogenesis, the notch signaling pathway, natural killer cell mediated cytotoxicity, and the B cell receptor signaling pathway. The decreased group exclusively consists of genes involved in heme biosynthesis, the p53 signaling pathway, and the hematopoietic cell lineage. Significant biological pathways and transcription factors expressed at each time point post

  2. Bilateral femoral neck fractures resulting from a grand mal seizure in an elderly man with Down syndrome

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    Jonathan P. Marsh

    2010-03-01

    Full Text Available Simultaneous bilateral hip fractures are exceedingly rare and usually occur following a seizure. To our knowledge, only 22 cases of such injuries have been reported in the literature during the past forty years and the majority of fractures are treated with open reduction and internal fixation. We present a case of a 66-year old man with Down syndrome and severe dementia who was diagnosed with bilateral displaced femoral neck fractures following an epileptic seizure. He was treated with single staged bilateral uncemented monopolar hemi-arthroplasties through lateral Hardinge approaches. The treatment choice was governed by fracture displacement, the lack of pre-existing osteoarthritis, length of time to diagnosis, the patient’s age, ambulatory status and mental impairment, with the intention to minimize post-operative complications such as avascular necrosis, non-union and hip dislocation.

  3. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement?

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    Simmen Hans-Peter

    2010-10-01

    Full Text Available Abstract Background Femoral neck fractures in the elderly are frequent, represent a great health care problem, and have a significant impact on health insurance costs. Reconstruction options using hip arthroplasty include unipolar or bipolar hemiarthroplasty (HA, and total hip arthroplasty (THA. The purpose of this review is to discuss the indications, limitations, and pitfalls of each of these techniques. Methods The Pubmed database was searched for all articles on femoral neck fracture and for the reconstruction options presented in this review using the search terms "femoral neck fracture", "unipolar hemiarthroplasty", "bipolar hemiarthroplasty", and "total hip arthroplasty". In addition, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were then reviewed with regard to the different techniques, outcome and complications of the distinct reconstruction options. Results THA yields the best functional results in patients with displaced femoral neck fractures with complication rates comparable to HA. THA is beneficially implanted using an anterior approach exploiting the internervous plane between the tensor fasciae latae and the sartorius muscles allowing for immediate full weight-bearing. Based on our findings, bipolar hemiarthroplasty, similar to unipolar hemiarthroplasty, cannot restorate neither anatomical nor biomechanical features of the hip joint. Therefore, it can only be recommended as a second line of defense-procedure for patients with low functional demands and limited live expectancy. Conclusions THA is the treatment of choice for femoral neck fractures in patients older than 60 years. HA should only be implanted in patients with limited life expectancy.

  4. Changes in spinal and femoral bone mineral density due to pelvic irradiation following oophorectomy

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    Chen, Jui-Tung; Hirai, Yasuo; Seimiya, Yumiko; Hasumi, Katsuhiko; Masubuchi, Kazumasa (Japanese Foundation for Cancer Research, Tokyo (Japan). Hospital); Shiraki, Masataka

    1991-10-01

    Since radiation therapy has been known to be a cause of bone atrophy (radiation osteopathy), it could be important whether postoperative radiotherapy in patients who have undergone oophorectomy further promotes bone mineral loss or not. Nineteen patients with stage Ib to IIb cervical cancer were studied. Eleven of the 19 patients received only surgical treatment and 8 received postoperative radiotherapy (50 Gy to the pelvis and 40 Gy to the lumber spine), because of the presence of advanced lesions or positive lymphnodes. A significant increase in FSH and decrease in E{sub 2} (p<0.01) compared to before treatment were observed in both groups. A significant increase in serum alkaline phosphatase activities (p<0.01), urine-calcium/creatinine ratio (p<0.05) and urine-hydroxyproline/creatinine ratio (p<0.01), which indicated high bone turnover, compared to before treatment in both groups also appeared. Although these chemical parameters in both groups changed coincidentally, the decline in spinal bone mineral density in the irradiated group was delayed at 12 months after the treatment. On the other hand, there was no difference in the changes in femoral bone mineral density in the two groups. These results suggest that radiotherapy might inhibit the bone mineral loss at the irradiated bone site even when there was an estrogen lack. (author).

  5. Effect of boundary conditions on yield properties of human femoral trabecular bone.

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    Panyasantisuk, J; Pahr, D H; Zysset, P K

    2016-10-01

    Trabecular bone plays an important mechanical role in bone fractures and implant stability. Homogenized nonlinear finite element (FE) analysis of whole bones can deliver improved fracture risk and implant loosening assessment. Such simulations require the knowledge of mechanical properties such as an appropriate yield behavior and criterion for trabecular bone. Identification of a complete yield surface is extremely difficult experimentally but can be achieved in silico by using micro-FE analysis on cubical trabecular volume elements. Nevertheless, the influence of the boundary conditions (BCs), which are applied to such volume elements, on the obtained yield properties remains unknown. Therefore, this study compared homogenized yield properties along 17 load cases of 126 human femoral trabecular cubic specimens computed with classical kinematic uniform BCs (KUBCs) and a new set of mixed uniform BCs, namely periodicity-compatible mixed uniform BCs (PMUBCs). In stress space, PMUBCs lead to 7-72 % lower yield stresses compared to KUBCs. The yield surfaces obtained with both KUBCs and PMUBCs demonstrate a pressure-sensitive ellipsoidal shape. A volume fraction and fabric-based quadric yield function successfully fitted the yield surfaces of both BCs with a correlation coefficient [Formula: see text]. As expected, yield strains show only a weak dependency on bone volume fraction and fabric. The role of the two BCs in homogenized FE analysis of whole bones will need to be investigated and validated with experimental results at the whole bone level in future studies.

  6. Gene Expression Changes in Femoral Head Necrosis of Human Bone Tissue

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    Bernadett Balla

    2011-01-01

    Full Text Available Osteonecrosis of the femoral head (ONFH is the result of an interruption of the local circulation and the injury of vascular supply of bone. Multiple factors have been implicated in the development of the disease. However the mechanism of ischemia and necrosis in non-traumatic ONFH is not clear. The aim of our investigation was to identify genes that are differently expressed in ONFH vs. non-ONFH human bone and to describe the relationships between these genes using multivariate data analysis. Six bone tissue samples from ONFH male patients and 8 bone tissue samples from non-ONFH men were examined. The expression differences of selected 117 genes were analyzed by TaqMan probe-based quantitative real-time RT-PCR system. The significance test indicated marked differences in the expression of nine genes between ONFH and non-ONFH individuals. These altered genes code for collagen molecules, an extracellular matrix digesting metalloproteinase, a transcription factor, an adhesion molecule, and a growth factor. Canonical variates analysis demonstrated that ONFH and non-ONFH bone tissues can be distinguished by the multiple expression profile analysis of numerous genes controlled via canonical TGFB pathway as well as genes coding for extracellular matrix composing collagen type molecules. The markedly altered gene expression profile observed in the ONFH of human bone tissue may provide further insight into the pathogenetic process of osteonecrotic degeneration of bone.

  7. Nontraumatic femoral head necrosis. Classification of bone scintigraphic findings and diagnostic value of SPECT following planar imaging

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    Minoshima, Satoshi; Uchida, Yoshitaka; Anzai, Yoshimi; Uno, Kimiichi; Arimizu, Noboru (Chiba Univ. (Japan). School of Medicine)

    1994-09-01

    This study was conducted to determine bone scintigraphic findings in nontraumatic femoral head avascular necrosis and diagnostic value of SPECT imaging following a conventional planar imaging. Forty-three femoral heads in twenty-six cases with idiopathic femoral head necrosis (n=2), systemic lupus erythematosus (n=22), aplastic anemia (n=1), and renal transplantation (n=1) were studied. The diagnosis for femoral head necrosis was based on magnetic resonance imaging as well as other diagnostic studies in all cases. Scintigraphic findings of planar and SPECT images were classified into six categories: normal (N); cold or decrease (C); partial increase with cold or decrease (PH+C); ring-like increase with a cold center (RH+C); partial increase (PH); diffuse and/or irregular increase (DH). Avascular necrosis was confirmed in twenty-four femoral heads, in which planar and SPECT images showed scintigraphic findings of N (n=3, 2), C (n=1, 3), PH+C (n=2, 8), RH+C (n=2, 3), PH (n=9, 2), and DH (n=7, 6), respectively. Femoral heads without avascular necrosis demonstrated planar and SPECT findings of N (n=16, 12), C (n=0, 6), and DH (n=3, 1), respectively. When considering C, PH+C, and RH+C as diagnostic findings for avascular necrosis, sensitivities of planar and SPECT images were 21% and 58%, and specificities were 100% and 68%, respectively. In nineteen femoral heads with normal planar findings (N), SPECT correctly identified avascular necrosis in two femoral heads and misidentified six normal femoral heads as avascular necrosis. In nineteen femoral heads with nondiagnostic abnormalities (PH, DH), SPECT correctly identified avascular necrosis in seven femoral heads and showed no false positive. Diagnostic planar findings in five femoral heads were concordant with SPECT diagnosis. These results indicate that SPECT imaging is most valuable when planar images show nondiagnostic abnormalities based on the proposed classification of scintigraphic findings. (author).

  8. Preoperative factors and early complications associated with hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures.

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    Miller, Christopher P; Buerba, Rafael A; Leslie, Michael P

    2014-06-01

    Displaced femoral neck fractures are common injuries in the elderly individuals. There is controversy about the best treatment with regard to total hip arthroplasty (THA) versus hemiarthroplasty. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to evaluate the preoperative risk factors associated with the decision to perform THA over hemiarthroplasty. We also evaluate the risk factors associated with postoperative complications after each procedure. Patients older than 50 years undergoing hemiarthroplasty or THA after fracture in the NSQIP database from 2007 to 2010 were compared to each other in terms of preoperative medical conditions, postoperative complications, and length of stay. Multivariate logistic regression models were used to adjust for preoperative risk factors for undergoing a THA versus a hemiarthroplasty and for complications after each procedure. In all, 783 patients underwent hemiarthroplasty and 419 underwent THA for fracture. Hemiarthroplasty patients had longer hospital stays. On multivariate logistic regression, the only significant predictor for having a THA after fracture over hemiarthroplasty was being aged 50 to 64 years. The patient characteristics/comorbidities that favored having a hemiarthroplasty were age >80 years, hemiplegia, being underweight, having a dependent functional status, being on dialysis, and having an early surgery. High body mass index, American Society of Anesthesiologists (ASA) class, gender, and other comorbidities were not predictors of having one procedure over another. Disseminated cancer and diabetes were predictive of complications after THA while being overweight, obese I, or a smoker were protective. High ASA class and do-not-resuscitate status were significant predictors of complications after a hemiarthroplasty. This study identified clinical factors influencing surgeons toward performing either THA or hemiarthroplasty for elderly patients

  9. The Timed Up and Go test is an early predictor of functional outcome after hemiarthroplasty for femoral neck fracture.

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    Laflamme, George Y; Rouleau, Dominique M; Leduc, Stéphane; Roy, Louis; Beaumont, Eric

    2012-07-03

    The ability to predict the long-term physical function and prognosis of hip fracture patients during the early postoperative period is essential for surgeons and physical therapists as well as for patients and their families. The purpose of this study was to determine whether early functional assessment correlated with and/or predicted long-term function after surgery to treat a displaced femoral neck fracture. Sixty-two patients undergoing hemiarthroplasty for a displaced femoral neck fracture were evaluated prospectively; a minimum follow-up of two years was required. Validated functional assessments, including the Lower Extremity Measure and the Timed Up and Go test, were utilized, and scores were analyzed with respect to patient baseline data. The functional level of patients decreased significantly after the injury, with the mean Lower Extremity Measure score decreasing from 87.7 to 62.4 and the need for a walking aid increasing from 36% to 54% at two years postoperatively (p Timed Up and Go test scores at four days and three weeks postoperatively were significantly higher in patients who needed a walking aid at two years compared with independently walking patients (p Timed Up and Go test scores revealed that the optimal threshold for predicting the need for a walking aid at two years was fifty-eight seconds at four days postoperatively and twenty-six seconds at three weeks. Also, the need for a walking aid at two years was ninetyfold higher when the Timed Up and Go test score at three weeks postoperatively exceeded the twenty-six seconds threshold. The Timed Up and Go test was an early clinical indicator of future physical function in patients with a hip fracture treated with hemiarthroplasty. Innovative clinical approaches to anticipate future function will contribute to increasing the efficiency of overall management of this growing set of patients.

  10. Osteomalacia and coxa vara. An unusual co-existence for femoral neck stress fracture

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    Kerim Sariyilmaz

    2015-01-01

    Conclusion: Joint and bone pain without any trauma should be investigated and bone metabolism disorders should be kept in mind. There might be co-existing factors related with stress fractures, and they must be treated simultaneously.

  11. Intravenous transplantation of allogeneic bone marrow mesenchymal stem cells and its directional migration to the necrotic femoral head

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    Zhang-hua Li, Wen Liao, Xi-long Cui, Qiang Zhao, Ming Liu, You-hao Chen, Tian-shu Liu, Nong-le Liu, Fang Wang, Yang Yi, Ning-sheng Shao

    2011-01-01

    Full Text Available In this study, we investigated the feasibility and safety of intravenous transplantation of allogeneic bone marrow mesenchymal stem cells (MSCs for femoral head repair, and observed the migration and distribution of MSCs in hosts. MSCs were labeled with green fluorescent protein (GFP in vitro and injected into nude mice via vena caudalis, and the distribution of MSCs was dynamically monitored at 0, 6, 24, 48, 72 and 96 h after transplantation. Two weeks after the establishment of a rabbit model of femoral head necrosis, GFP labeled MSCs were injected into these rabbits via ear vein, immunological rejection and graft versus host disease were observed and necrotic and normal femoral heads, bone marrows, lungs, and livers were harvested at 2, 4 and 6 w after transplantation. The sections of these tissues were observed under fluorescent microscope. More than 70 % MSCs were successfully labeled with GFP at 72 h after labeling. MSCs were uniformly distributed in multiple organs and tissues including brain, lungs, heart, kidneys, intestine and bilateral hip joints of nude mice. In rabbits, at 6 w after intravenous transplantation, GFP labeled MSCs were noted in the lungs, liver, bone marrow and normal and necrotic femoral heads of rabbits, and the number of MSCs in bone marrow was higher than that in the, femoral head, liver and lungs. Furthermore, the number of MSCs peaked at 6 w after transplantation. Moreover, no immunological rejection and graft versus host disease were found after transplantation in rabbits. Our results revealed intravenously implanted MSCs could migrate into the femoral head of hosts, and especially migrate directionally and survive in the necrotic femoral heads. Thus, it is feasible and safe to treat femoral head necrosis by intravenous transplantation of allogeneic MSCs.

  12. Using smooth particle hydrodynamics to investigate femoral cortical bone remodelling at the Haversian level.

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    Fernandez, J W; Das, R; Cleary, P W; Hunter, P J; Thomas, C D L; Clement, J G

    2013-01-01

    In the neck of the femur, about 70% of the strength is contributed by the cortical bone, which is the most highly stressed part of the structure and is the site where failure is almost certainly initiated. A better understanding of cortical bone remodelling mechanisms can help discern changes at this anatomical site, which are essential if an understanding of the mechanisms by which hips weaken and become vulnerable to fracture is to be gained. The aims of this study were to (i) examine a hypothesis that low strain fields arise because of subject-specific Haversian canal distributions causing bone resorption and reduced bone integrity and (ii) introduce the use of a meshless particle-based computational modelling approach SPH to capture bone remodelling features at the level of the Haversian canals. We show that bone remodelling initiated by strain at the Haversian level is highly influenced by the subject-specific pore distribution, bone density, loading and osteocyte density. SPH is shown to be effective at capturing the intricate bone pore shapes that evolved over time.

  13. Bone-femoral component interface gap after sagittal mechanical axis alignment is filled with new bone after cementless total knee arthroplasty.

    Science.gov (United States)

    Kuriyama, Shinichi; Hyakuna, Katsufumi; Inoue, Satoshi; Kawai, Yasutsugu; Tamaki, Yasuyuki; Ito, Hiromu; Matsuda, Shuichi

    2017-02-14

    This study retrospectively evaluated the fate of mismatch between an uncemented femoral component and each femoral cut surface (i.e., wedge-shaped gap) relative to sagittal mechanical alignment in total knee arthroplasty (TKA). Primary TKA was performed on 99 consecutive knees. The femoral components were aligned to the sagittal mechanical axis with CT-based navigation. All patients were assessed with postoperative true lateral radiographs. Bone-side surfaces of the uncemented femoral component were divided into five zones: anterior flange, anterior chamfer, posterior chamfer, posterior part, and distal part, which were defined as zones 1 to 5, respectively. Bone filling of wedge-shaped gaps in each zone was evaluated after 1 year. Femoral anterior notching did not occur. However, wedge-shaped gaps were observed in at least one zone in 23 of 99 knees (23%), most frequently in zone 5 (18%). There were 9 and 7 gaps in zones 1 and 2, respectively. The femoral component showed malpositioning of approximately 3° of flexion in cases with wedge-shaped gaps in zones 2 and/or 5. After one year, 67% (6/9) of zone 1, 100% (7/7) of zone 2, and 94% (17/18) of zone 5 wedge-shaped gaps were filled in with new bone. Femoral alignment relative to sagittal mechanical axis caused wedge-shaped gaps due to unstable anterior bone cutting through hard bone, but the small gaps were not clinically significant and filled in within one year. Sagittal setting of the femoral component should aim for the anatomical axis rather than the mechanical axis. IV.

  14. Grafting of iliac bone flap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis and long dated hip joint function observation%旋髂深血管髂骨瓣移植治疗中青年股骨头缺血性坏死远期髋关节功能观察

    Institute of Scientific and Technical Information of China (English)

    奉成斌; 杜全印

    2002-01-01

    Objective To retrospect the long dated curative effect of grafting of iliac bone flap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis.Methods 79 cases of femoral head ischemic necrosis treated by promoted Smith Petersen incision, neck of femur notch, focus cleaning decompression,grafting of iliac bone flap with deep iliac circumflex vessel and screw fixation. 13 cases treated by transplanting granular bone after decompression. Results Grafting of iliac bone flap with deep iliac circumflex vessel treatment group were followed up from 3 to 9 years,the planting bone healed 3 to 6 months averagely.Two cases suffered femoral head ischemic necrosis continuously.Other cases received good results.Transplanting granular bone after decompression group were followed up 3 to 9 years, 3 cases suffered femoral head ischemic necrosis continuously, hip joint function was limited,patients received hip replacement finally. Conclusion Place of iliac bone flap with deep iliac circumflex vessel is fixed, curative effects are credible, which can become the first choice therapy to femoral head ischemic necrosis of middle age and young people (Ficat I~ III stage).

  15. The topologic and chronologic patterns of hematopoietic cell seeding in host femoral bone marrow after transplantation.

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    Askenasy, Nadir; Stein, Jeremiah; Yaniv, Isaac; Farkas, Daniel L

    2003-08-01

    The early stages of homing, seeding, and engraftment of hematopoietic stem and progenitor cells are poorly characterized. We have developed an optical technique that allows in vivo tracking of transplanted, fluorescent-tagged cells in the host femurs. In this study we used fluorescence microscopy to monitor the topologic and chronologic patterns of hematopoietic cell seeding in the femoral bone marrow (BM) of mice. PKH-labeled cells homed to the femur within minutes after injection into a peripheral vein. Most cells drifted within the marrow space and gradually seeded in clusters close to the endosteal surface of the epiphyseal cortex. Three days after transplantation 85% to 94% (14%) of PKH-labeled cells in the femoral marrow were located within 100 microm of the epiphyseal bone surface (P <.001 versus the more central cells), whereas labeled cells were absent in the femoral diaphysis. Primary seeding of juxtaendosteal, epiphyseal marrow occurred independently of recipient conditioning (myeloablated and nonconditioned hosts), donor-recipient antigen disparity, or the phenotype of the injected cells (whole BM and lineage-negative cells) and was consistently observed in secondary recipients of BM-homed cells. Seeding in regions close to the epiphyseal bone was also observed in freshly excised femurs perfused ex vivo and in femurs assessed without prior placement of optical windows, indicating that the site of primary seeding was not affected by surgical placement of optical windows. Four to 5 days after transplantation, cellular clusters appeared in the more central regions of the epiphyses and in the diaphyses. Centrally located cells showed decreased PKH fluorescence, suggesting that they were progeny of the seeding cells, and brightly fluorescent cells (quiescent first-generation seeding cells) were observed close to the bone surface for as long as 24 days after transplantation. These data indicate that the periphery of the femoral marrow hosts primary seeding

  16. Individualized surgical treatment of femoral neck fracture with strategy andoutcome%股骨颈骨折个体化手术治疗策略与结果

    Institute of Scientific and Technical Information of China (English)

    戢良超; 谌刚; 李世林; 徐映明; 周平

    2012-01-01

    Objective To discuss the Individualized surgical treatment of fresh femoral neck fracture with strategy and outcome. Methods From January 2005 to January 2011 ,admitted femoral neck fracture and a complete follow-up information on 86 cases,they were 47 men and 39 women, age from 18 to 65 in 18 cases,from 66 to 86 in 38 cases. By Garden classification, type Ⅰ were 23 cases, type Ⅱ were 25 cases, type Ⅲ were 26 cases, type Ⅳ were 12 cases . 48 cases were used open reduction. Of 22 cases with cannulated cancellous bone screws , 26 cases with dynamic hip screws. Hemi-hip replacement were 30 cases . Total hip replacement were 8 cases. Results 86 cases were followed up for 1 ~6 years, with an average of 3. 1 years. Internal fixation group 48 cases, the healing time 17 ~ 24 weeks ( an average of 20. 5 weeks) , the varus deformity of hip in 5 cases, avascula r necrosis of femoral head in 3 cases, and the excellent and good rate was 79. 2%. Hip joint replacement group 38 cases, early dislocation in 2 cases,incision infection in 1 case, and the excellent and good rate was 84. 2%. Conclusion With the age, bone density activity ability and fracture type of the patients to choose personalized surgical treatment plan, can gel good curative effect.%目的 探讨新鲜股骨颈骨折个体化手术治疗策略与结果.方法 2005年1月~2011年1月,收治新鲜股骨颈骨折并获得完整随访资料者86例,男47例,女39例,年龄18 ~ 65岁48例,66 ~ 86岁38例,骨折按Garden分型:Ⅰ型23例,Ⅱ型25例,Ⅲ型26例,Ⅳ型12例;分别采用切开复位空心松质骨螺钉内固定22例,动力髋螺钉内固定26例,半髋关节置换30例,全髋关节置换8例.结果 获得1~6年(平均3.1年)随访,内固定组48例,骨折愈合时间17~24周(平均20.5周),髋内翻5例,股骨头缺血坏死3例,优良率79.2%.关节置换组38例,早期脱位2例,切口感染1例,优良率84.2%.结论 根据股骨颈骨折患者年龄、活动能力、骨

  17. Independent measurement of femoral cortical thickness and cortical bone density using clinical CT.

    Science.gov (United States)

    Treece, G M; Gee, A H

    2015-02-01

    The local structure of the proximal femoral cortex is of interest since both fracture risk, and the effects of various interventions aimed at reducing that risk, are associated with cortical properties focused in particular regions rather than dispersed over the whole bone. Much of the femoral cortex is less than 3mm thick, appearing so blurred in clinical CT that its actual density is not apparent in the data, and neither thresholding nor full-width half-maximum techniques are capable of determining its width. Our previous work on cortical bone mapping showed how to produce more accurate estimates of cortical thickness by assuming a fixed value of the cortical density for each hip. However, although cortical density varies much less over the proximal femur than thickness, what little variation there is leads to errors in thickness measurement. In this paper, we develop the cortical bone mapping technique by exploiting local estimates of imaging blur to correct the global density estimate, thus providing a local density estimate as well as more accurate estimates of thickness. We also consider measurement of cortical mass surface density and the density of trabecular bone immediately adjacent to the cortex. Performance is assessed with ex vivo clinical QCT scans of proximal femurs, with true values derived from high resolution HRpQCT scans of the same bones. We demonstrate superior estimation of thickness than is possible with alternative techniques (accuracy 0.12 ± 0.39 mm for cortices in the range 1-3mm), and that local cortical density estimation is feasible for densities >800 mg/cm(3).

  18. 小儿急性化脓性股骨颈骨髓炎的早期诊断%The Early Diagnosis of Acute Suppurative Osteomyelitis of Femoral Neck in Children

    Institute of Scientific and Technical Information of China (English)

    胡月光; 蒋映兰; 彭素华; 杨小红; 汪从秀; 褚先秋

    1996-01-01

    Objective:To discuss early diagnosis of acute suppurative osteomyelitis of the femoral neck and the differential diagnosis from acute pyogenic arthritis of the hip.Method:28 children with acute femoral suppurative osteomyelitis were studied basing on the clinical presentation,isotopic bone scan and exploration findings.Results:Swelling and tenderness were found in the greater trochanter region in addition to the regions anterior and posterior to the hip,and thin seepage was obtained by arthrocentesis.The uptake of radioisotope was concentrated in affected femoral neck.Conclusion:Early diagnosis of acute suppurative osteomyelitis of the femoral neck can be made by careful clinical examination and isotopic bone scan.Surgical exploration should he performed on difficult cases to achieve an early diagnosis and treatment.%为了研讨小儿急性化脓性股骨颈骨髓炎的早期诊断和与化脓性髋关节炎的鉴别诊断,通过28例小儿急性化脓性股骨颈骨髓炎的临床观察和核医学等检查,以及手术中发现,小儿急性化脓性股骨颈骨髓炎早期除髋关节前后压痛外,股骨大粗隆附近亦有肿胀和压痛,髋关节腔穿刺液体为稀薄的渗出液体.同位素股骨颈扫描,可见患侧同位素吸收增多.因此,经过仔细的临床检查和同位素检查,可以早期作出诊断.对诊断困难,临床高度怀疑的病例应行手术探查,以达到早期诊断和早期治疗.

  19. The Effect of Pulsed Electromagnetic Therapy on Femoral Bone Micro-Structure in Ovariectomized Rats

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    Sarah Hojjati

    2016-05-01

    Full Text Available Background and Aim: Osteoporosis is a metabolic bone disease that can result from cytokines activity such as TNFɑ. The aim of this study was to evaluate the effect of pulsed electromagnet therapy on  femoral strength and bone microstructure in ovariectomized rats. Materials and Methods: In this experimental study, 30 rats were randomly divided into control, experimental1 (ovariectomized and two experimental groups; namely ovariectomized and undergoing pulsed electromagnet groups.  The control and experimental1 groups were kept under controlled conditions, while the two experimental groups were treated with pulsed electromagnet (2.4 mT from 12 postoperative weeks for 30min, 3days a week, for 10 weeks. Then, the subjects were sacrificed and their femoral bones were removed to determine the strength and the bone microstructure  parameters (the trabecular and cortical thicknesses and trabecular distances. In order to determine bone microstructures, the sections were prepared and stained with H&E. Then, Haworth method was used to measure. One-way ANOVA, repeated measurements, and Scheffe post- hoc tests were applied to analyze the obtained data. Statistical analyses were performed using SPSS software (version 16; Chicago,IL. Results: Despite equal initial weight of the subjects (P=0.15, they significantly gained weight after12 and also 22 postoperative weeks (P<,0.001. Cortical and trabecular thicknesses, and femoral strength respectively and significantly decreased in the experimental group 1 .X=220.80±5.90,P<0.001; X=90.34±5.73,P=0.001; X=5.15±1.07,P=0.002. In the experiment. group 2, decrease was .X=255.40±6.02,P<0.001; X=113.50±3.43, P=0.008; X=8.00±1.11,P=0.015; respectively, comparing with the control group (X=232.36±5.13, X=100.50±5.06, X=6.95±1.16. Cortical and trabecular thicknesses, and bone strength significantly increased in the experimental group 2, compared to the experimental  group 1(P<0.001.  There was also a

  20. Functional integrative analysis of the human hip joint: the three-dimensional orientation of the acetabulum and its relation with the orientation of the femoral neck.

    Science.gov (United States)

    Bonneau, Noémie; Baylac, Michel; Gagey, Olivier; Tardieu, Christine

    2014-04-01

    In humans, the hip joint occupies a central place in the locomotor system, as it plays an important role in body support and the transmission of the forces between the trunk and lower limbs. The study of the three-dimensional biomechanics of this joint has important implications for documenting the morphological changes associated with the acquisition of a habitual bipedal gait in humans. Functional integration at any joint has important implications in joint stability and performance. The aim of the study was to evaluate the functional integration at the human hip joint. Both the level of concordance between the three-dimensional axes of the acetabulum and the femoral neck in a bipedal posture, and patterns of covariation between these two axes were analysed. First, inter-individual variations were quantified and significant differences in the three-dimensional orientations of both the acetabulum and the femoral neck were detected. On a sample of 57 individuals, significant patterns of covariation were identified, however, the level of concordance between the axes of both the acetabulum and the femoral neck in a bipedal posture was lower than could be expected for a key joint such as the hip. Patterns of covariation were explored regarding the complex three-dimensional biomechanics of the full pelvic-femoral complex. Finally, we suggest that the lower degree of concordance observed at the human hip joint in a bipedal posture might be partly due to the phylogenetic history of the human species.

  1. MRI of the femoral bone marrow in the assessment of aplastic anemia

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Osamu; Matsuura, Katsuhiko; Ichikawa, Tamaki; Kobayashi, Yasuyuki; Nagai, Jun; Takagi, Shojiro [Jichi Medical School, Saitama (Japan) Omiya Medical Center

    1995-11-01

    MR imaging of the femoral bone marrow was performed in 12 patients with untreated aplastic anemia and six patients with hypoplastic myelodysplastic syndrome (MDS). The MRI appearance was classified into four patterns; fatty marrow faint signal, nodular pattern and heterogeneous infiltration. The MRI patterns of aplastic anemia were evaluated and compared with those of hypoplastic MDS. In spite of hypocellular biopsies, MRI of the femoral marrow showed unexpected abnormal signal intensities in aplastic anemia; nodular pattern in five and heterogeneous infiltration pattern in two patients. Completely fatty marrow was depicted in four patients mainly with severe aplastic anemia. The nodular pattern with a background of fatty marrow was commonly seen in moderate or severe cases, while the heterogeneous infiltration pattern was noted in mild cases of the disease. Compared with hypoplastic MDS, asymmetrical nodular pattern suggesting patchy hematopoiesis was thought to be a characteristic finding of aplastic anemia. One patient clinically diagnosed as aplastic anemia, who had shown heterogeneous infiltration pattern, evolved to acute myeloid leukemia. We concluded that MRI of the femoral marrow could be useful in the assessment of aplastic anemia and detection of myelodysplastic or leukemic transformation. (author).

  2. Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

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    Meizer Roland

    2009-01-01

    Full Text Available Background: Bone marrow edema (BME is a common cause of hip pain. The aim of the study was to assess the efficacy of the vasoactive drug iloprost in the treatment of BME of femoral head. Materials and Methods: We reviewed 27 patients (19 male, 8 female with BME of the femoral head. Their mean age was 53.7 ± 10.8 years. All patients were treated with iloprost, a vasoactive drug that dilates arterioles and venules, reduces capillary permeability and suppresses platelet aggregation. The therapy comprised a series of five infusions with 20 to 50 μg iloprost over 6 h on 5 consecutive days each. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. Pain at rest as well as under stress was assessed with a semi quantitative scale from before and 4 months after therapy. MRI investigations were done before and repeated 4 months after therapy. Results: At the clinical follow up of four months after therapy, the pain level at rest had diminished by a mean of 58.3% ( P < 0.0001. Pain under stress decreased by a mean of 41.9% ( P < 0.0001. On MRI, 20 patients had a significant reduction of BME size or complete normalization and 4 showed no change. Worsening of the MRI pattern was found in 3 patients. Conclusion: The authors conclude that the use of parenteral iloprost might be a viable method in the treatment of BME of femoral head.

  3. Novel in Vitro Modification of Bone for an Allograft with Improved Toughness Osteoconductivity

    Science.gov (United States)

    2015-06-01

    Yeni, and T.L. Norman, Fracture toughness is dependent on bone location--a study of the femoral neck , femoral shaft, and the tibial shaft. J Biomed...bone: evaluation by R-curves. Bone, 2004. 35(6): p. 1240-6. 18. Reddy, G.K., Glucose-mediated in vitro glycation modulates biomechanical integrity of

  4. Diet-induced Obesity Alters Bone Remodeling Leading to Decreased Femoral Trabecular Bone Mass in Mice

    Science.gov (United States)

    Body mass derived from an obesity condition may be detrimental to bone health but the mechanism is unknown. This study was to examine changes in bone structure and serum cytokines related to bone metabolism in obese mice induced by a high-fat diet(HFD). Mice fed the HFD were obese and had higher ser...

  5. Biopolymer augmentation of the lag screw in the treatment of femoral neck fractures - a biomechanical in-vitro study

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    Paech A

    2010-04-01

    Full Text Available Abstract The cut-out of the sliding screw is one of the most common complications in the treatment of intertrochanteric fractures. The reasons for the cut-out are: a suboptimal position of the hip-screw in the femoral head, the type of fracture and poor bone quality. The aim of this study was to reproduce the cut-out event biomechanically and to evaluate the possible prevention of this event by the use of a biopolymer augmentation of the hip screw. Concerning the density and compression force of osteoporotic femoral bone polyurethane foam according to the terms of the Association for Standard Testing Material (ASTMF 1839-97 was used as test material. The polyurethane foam Lumoltan 200 with a compression force of 3.3 Mpa and a density of 0.192 g/cm3 was used to reproduce the osteoporotic bone of the femoral fragment (density 12 lbm/ft3. A cylinder of 50 mm of length and 50 mm of width was produced by a rotary splint raising procedure with planar contact. The axial load of the system was performed by a hydraulic force cylinder of a universal test machine type Zwick 1455, Ulm, Germany. The CCD-angle of the used TGN-System was preset at 130 degrees. The migration pattern of the hip screw in the polyurethane foam was measured and expressed as a curve of the distance in millimeter [mm] against the applied load in Newton [N] up to the cut-out point. During the tests the implants reached a critical changing point from stable to unstable with an increased load progression of steps of 50 Newton. This unstable point was characterized by an increased migration speed in millimeters and higher descending gradient in the migration curve. This peak of the migration curve served as an indicator for the change of the hip screw position in the simulated bone material. The applied load in the non-augmented implant showed that in this group for a density degree of 12 (0,192 g/cm3 the mean force at the failure point was 1431 Newton (± 52 Newton. In the augmented

  6. The apparent elastic modulus of the juxtarticular subchondral bone of the femoral head.

    Science.gov (United States)

    Brown, T D; Vrahas, M S

    1984-01-01

    An experiment was undertaken to obtain approximate values for the intrinsic elastic modulus of subchondral bone. Shallow spherical caps, with uniform and incrementally controlled thickness, were machined from subchondral bone in the weight-bearing regions of 11 fresh-frozen normal femoral head autopsy specimens. Under application of polar point loads, the measured deflections were compared with a corresponding analytical shell solution, thus allowing back-calculation of the apparent modulus. Analogous tests were performed on similarly shaped specimens of stock Plexiglas of known modulus in order to estimate the precision of the testing method. The aggregate results for subchondral bone showed that its intrinsic stiffness correlated inversely with nominal shell thickness, but even the thinnest (1.0 mm thick) of these shells had an apparent modulus (mean = 1.372 GN/m2, SD = 414 MN/m2) well below that generally accepted for "pure" cortical bone (about 14 GN/m2). This stiffness deficit was very likely due to the presence of histologically evident marrow spaces. However, the low apparent modulus values measured in this study may not be fully representative of complex in vivo behavior, because in the testing of excised shells there is no radial compressive stress transfer to underlying cancellous bone.

  7. Disparities in correlating microstructural to nanostructural preservation of dinosaur femoral bones

    Science.gov (United States)

    Kim, Jung-Kyun; Kwon, Yong-Eun; Lee, Sang-Gil; Lee, Ji-Hyun; Kim, Jin-Gyu; Huh, Min; Lee, Eunji; Kim, Youn-Joong

    2017-01-01

    Osteohistological researches on dinosaurs are well documented, but descriptions of direct correlations between the bone microstructure and corresponding nanostructure are currently lacking. By applying correlative microscopy, we aimed to verify that well-preserved osteohistological features correlate with pristine fossil bone nanostructures from the femoral bones of Koreanosaurus boseongensis. The quality of nanostructural preservation was evaluated based on the preferred orientation level of apatite crystals obtained from selected area electron diffraction (SAED) patterns and by measuring the “arcs” from the {100} and {002} diffraction rings. Unlike our expectations, our results revealed that well-preserved microstructures do not guarantee pristine nanostructures and vice versa. Structural preservation of bone from macro- to nanoscale primarily depends on original bioapatite density, and subsequent taphonomical factors such as effects from burial, pressure, influx of external elements and the rate of diagenetic alteration of apatite crystals. Our findings suggest that the efficient application of SAED analysis opens the opportunity for comprehensive nanostructural investigations of bone. PMID:28358033

  8. Case of femoral diaphyseal stress fracture after long-term risedronate administration diagnosed by iliac bone biopsy

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    Nagai T

    2013-04-01

    Full Text Available Takashi Nagai, Keizo Sakamoto, Koji Ishikawa, Emi Saito, Takuma Kuroda, Katsunori Inagaki Department of Orthopaedic Surgery, Showa University School of Medicine, Shinagwa-ku, Tokyo, Japan Abstract: Bisphosphonate excessively inhibits bone resorption and results in pathological fracture of the femur or ilium. The subject of this study was administered risedronate for 7 years; we suspected an easy fracture of the femoral diaphysis. In this study, we report the results of this patient's bone biopsy and bone morphometric analysis. A 76-year-old female patient presented with right femoral pain. Bone mineral density of the anteroposterior surface of the 2nd to 4th lumbar vertebrae (L2-L4 was decreased and levels of bone turnover markers were high. Therefore, we initiated treatment with risedronate. As she continued the medication, urinary levels of cross-linked N-terminal telopeptides of type I collagen and alkaline phosphatase (bone-type isozyme were found to be within the normal ranges. After 7 years of administration, the patient experienced pain when she put weight on the right femur and right femoral pain while walking. Plain radiographic examination revealed polypoid stress fracture-like lesions on the right femoral diaphysis and on the slightly distal-lateral cortical bone. Similar lesions were observed on magnetic resonance imaging and bone scintigraphy. We suspected severely suppressed bone turnover. Bone biopsy was obtained after labeling with tetracycline, and bone morphometric analysis was performed. On microscopic examination, slight double tetracycline labeling was observed. The trabeculae were narrow, and the numbers of osteoblasts and osteoclasts were decreased. Further, rates of bone calcification and bone formation were slow. Hence, we diagnosed fracture as a result of low turnover osteopathy. Risedronate was withdrawn, and Vitamin D3 was administered to improve the bone turnover. At 6 months, abnormal signals on magnetic resonance

  9. Long-term implant-bone fixation of the femoral component in total knee replacement.

    Science.gov (United States)

    Cristofolini, L; Affatato, S; Erani, P; Leardini, W; Tigani, D; Viceconti, M

    2008-04-01

    Success of total knee replacement (TKR) depends on the prosthetic design. Aseptic loosening of the femoral component is a significant failure mode that has received little attention. Despite the clinical relevance of failures, no protocol is available to test long-term implant-bone fixation of TKR in vitro. The scope of this work was to develop and validate a protocol to assess pre-clinically the fixation of TKR femoral components. An in vitro protocol was designed to apply a simplified but relevant loading profile using a 6-degrees-of-freedom knee simulator for 1,000000 cycles. Implant-bone inducible micromotions and permanent migrations were measured at three locations throughout the test. After test completion, fatigue damage in the cement was quantified. The developed protocol was successfully applied to a commercial TKR. Additional tests were performed to exclude artefacts due to swelling or creep of the composite femur models. The components migrated distally; they tilted towards valgus in the frontal plane and in extension in the sagittal plane. The migration patterns were consistent with clinical roentgen-stereophotogrammetric recordings with TKR. Additional indicators were proposed that could quantify the tendency to loosen/stabilize. The type and amount of damage found in the cement, as well as the migration patterns, were consistent with clinical experience with the specific TKR investigated. The proposed pre-clinical test yielded repeatable results, which were consistent with the clinical literature. Therefore, its relevance and reliability was proved.

  10. CT analysis of the upper end of the femur: the asterisk sign and ischaemic bone necrosis of the femoral head.

    Science.gov (United States)

    Dihlmann, W

    1982-01-01

    In computed tomography (CT) of the head of the femur, a star-shaped structure can be seen which we refer to as the asterisk or asterisk sign. The asterisk is formed by thickened weight-bearing bone trabeculae. It can be shown by CT that the asterisk exhibits a characteristic change in ischaemic bone necrosis of the femoral head, even when the disease is in an early stage. CT of the hip joint is therefore an important examination for early diagnosis of ischaemic disease of the femoral head.

  11. Walking function follow up in near future after treatment of senile femoral neck fracture with bony cemented artificial hip replacement%骨水泥型人工髋关节置换治疗老年股骨颈骨折术后近期行走功能随访

    Institute of Scientific and Technical Information of China (English)

    胡明鉴; 郑晨希; 张玉鑫; 石化洋; 陈伶; 马红兵; 刘强; 龚文斌; 蒋伟

    2002-01-01

    Objective To investigate the effect of cemented artificial hip replacement in the treatment of senile femoral neck fracture.Method Follow up the 18 patients with senile femoral neck fracture who received bony cemented artificial hip replacement during January 1999 to September 2001.Mean following- up duration:15.7 months(3~ 23).Result Harris score:15 cases got excellent result,3 cases got good result,none got fair result.Total X ray plain film:Position of prothesis was normal with no loosing,heterotopic ossification or dislocation. Conclusion (1)Variant cemented artificial hip replacements all have satisfying effect in near future.(2)It is feasible for patients with poor economic condition to choose native prothesis in arthroplasty.(3)Di- polar artificial thigh bone replacement is a better choice for weak patient with great age.

  12. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Meier, Reinhard; Schaeffeler, Christoph; Waldt, Simone; Rummeny, Ernst J.; Woertler, Klaus [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Diagnostic and Interventional Radiology, Munich (Germany); Kraus, Tobias M. [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Orthopaedics, Munich (Germany); Berufsgenossenschaftliche Unfallklinik Tuebingen, Department of Trauma and Orthopaedics, Tuebingen (Germany); Torka, Sebastian [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Orthopaedics, Munich (Germany); Berufsgenossenschaftliche Unfallklinik Murnau, Department of Trauma and Orthopaedics, Murnau (Germany); Schlitter, Anna Melissa; Specht, Katja [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institute of Pathology, Munich (Germany); Haller, Bernhard [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institute of Medical Statistics and Epidemiology, Munich (Germany); Rechl, Hans [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Orthopaedics, Munich (Germany)

    2014-09-15

    To test the hypothesis that bone marrow oedema (BME) observed on MRI in patients with avascular necrosis (AVN) of the femoral head represents an indicator of subchondral fracture. Thirty-seven symptomatic hips of 27 consecutive patients (53 % women, mean age 49.2) with AVN of the femoral head and associated BME on magnetic resonance (MR) imaging were included. MR findings were correlated with computed tomography (CT) of the hip and confirmed by histopathological examination of the resected femoral head. Imaging studies were analysed by two radiologists with use of the ARCO classification. On MR imaging a fracture line could be identified in 19/37 (51 %) cases, which were classified as ARCO stage 3 (n = 15) and stage 4 (n = 4). The remaining 18/37 (49 %) cases were classified as ARCO stage 2. However, in all 37/37 (100 %) cases a subchondral fracture was identified on CT, indicating ARCO stage 3/4 disease. The extent of subchondral fractures and the femoral head collapse was graded higher on CT as compared to MRI (P < 0.05). Histopathological analysis confirmed bone necrosis and subchondral fractures. In patients with AVN, BME of the femoral head represents a secondary sign of subchondral fracture and thus indicates ARCO stage 3 disease. circle BME on MRI in AVN of femoral head indicates a subchondral fracture. (orig.)

  13. Quercetin-induced changes in femoral bone microstructure of adult male rabbits

    Directory of Open Access Journals (Sweden)

    Ramona Babosová

    2016-06-01

    Full Text Available Flavonoids are a group of plant metabolites with antioxidant effects. One of the most abundant flavonoids in the human diet is quercetin. It is found widely in fruits, vegetables and has a lot of beneficial effects on human health. Quercetin has a positive pharmacological effect on bone metabolism and it prevents the organism against bone loss. However, its impact on the size of basic structural units of the compact bone is still unknown. Therefore, the aim of present study was to investigate the impact of the quercetin on femoral bone microstructure in 5-month-old male rabbits. Five rabbits of Californian broiler line were randomly divided into two groups. In the experimental group (E group; n=3, animals were intramuscularly injected with quercetin at dose 1000 μg.kg-1 body weight (bw for 90 days, 3 times per week. Two rabbits without quercetin administration served as a control group (C group. According to our results, intramuscular application of quercetin had an insignificant effect on cortical bone thickness in male rabbits. In these rabbits, changes in qualitative histological characteristics were present in the middle part of the compacta, where primary vascular longitudinal bone tissue was present and expanded there from the periosteum. Also, a lower number of secondary osteons was found in these animals. From the histomorphometrical point of view, significantly decreased sizes of primary osteons' vascular canals and secondary osteons (p <0.05 were found in rabbits administered by quercetin. Our findings indicate that subchronic administration of quercetin at the dose used in our study had considerable impact on both qualitative and quantitative histological characteristics of the compact bone in adult male rabbits.

  14. 股骨颈骨折七例误漏诊原因分析%Causes of Misdiagnosis and Missed Diagnosis in 7 Patients with Femoral Neck Fractures

    Institute of Scientific and Technical Information of China (English)

    阳波; 杨静

    2016-01-01

    Objective To investigate clinical features, causes of misdiagnosis and missed diagnosis of femoral neck fractures and prevention measures. Methods Clinical data of 7 patients with femoral neck fractures between October 2013 and October 2015 was retrospectively analyzed. Results The 7 patients visited doctors for hip joint pain caused by traffic ac-cidents, falls, sprain, falls from heights and so on. Two patients were misdiagnosed as having left hip contusion;2 patients were misdiagnosed as having soft tissue contusion;2 patients were diagnosed as having middle left femoral transverse fractures, and femoral neck fractures were missed diagnosised;1 patient was diagnosed as having middle femoral transverse fractures, and femoral neck fractures were missed diagnosised. Misdiagnosis and missed diagnosis time was 2-7 d. Femoral neck frac-tures were confirmed by X ray or CT examination for the 7 patients, and the patients were treated with surgeries by titanium cannulated compression screw. During postoperative 1 year of follow-up, all fractures healed, and the healing time was 3. 0-4. 5 (3. 75 ± 0. 54) months. Harris score of hip joint was performed 1 year after operation, and excellent and good rate of Har-ris score in the 7 patients was 85. 71%. Conclusion Femoral neck fracture is easy to be misdiagnosed or missed diagnosed due to various causes. Patients with continuous hip pain and obvious tenderness without abnormalities by X-ray should be high-ly suspected femoral neck fracture, and CT examination should be performed early to avoid misdiagnosis or missed diagnosis.%目的 探讨股骨颈骨折的临床特点及误漏诊原因、防范措施.方法 对遂宁市中心医院2013年10月—2015年10月诊治的曾误漏诊的股骨颈骨折7例的临床资料进行回顾性分析.结果 本组7例因交通事故、跌倒、扭伤、高处跌落等原因导致髋关节疼痛就诊.2例误诊为左髋部挫伤,2例误诊为左膝部软组织挫伤,2例仅诊断左股

  15. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome.

    Science.gov (United States)

    Papakostidis, Costas; Panagiotopoulos, Andreas; Piccioli, Andrea; Giannoudis, Peter V

    2015-03-01

    The aim of the present study was to evaluate the effect of timing of internal fixation of intracapsular fractures of the neck of femur on the development of late complications, particularly osteonecrosis of femoral head (ONFH) and non-union. We undertook a systematic review of the literature adhering to the PRISMA guidelines. There were 7 eligible reports for the final analysis. The methodological quality of component studies was assessed with the Coleman Methodology Score (CMS). Each included study was assigned a score independently by the two reviewers. The final score of each individual study constituted the average value of the scores given by the two reviewers. The agreement between the two assessors was tested with intraclass correlation coefficient (ICC). The CMS ranged from 37 to 64 within component studies (mean: 46.5, SD: 10.8, median: 41). The ICC was 0.94 (95% CI: 0.69-0.99), implying a nearly perfect agreement between the two assessors. Based on the available data regarding the timing of operative fixation of the femoral neck fractures, 4 discreet pairs of comparison groups could be created: (1) fractures fixed within 6h from injury versus fractures fixed after 6h from injury; (2) fractures fixed within 12h versus after 12h; (3) fractures fixed within 24h versus after 24h; and (4) fractures fixed within 6h versus after 24h. Outcome measures were analyzed within each one of the above pairs of treatment groups. The following subgroups analyses were a priori decided: (1) initial fracture displacement (displaced vs. undisplaced fractures); (2) fixation method (cannulated screws vs. sliding hip screw); (3) quality of reduction (anatomic vs non-anatomic reduction). This study failed to prove any essential association between timing of NOF fracture internal fixation and incidence of AVN. With respect to non-union though, it indicated that delay of internal fixation of more than 24h could increase substantially the odds of non-union. Copyright © 2015 Elsevier

  16. Fibular Allograft and Demineralized Bone Matrix for the Treatment of Slipped Capital Femoral Epiphysis.

    Science.gov (United States)

    Murray, Travis; Morscher, Melanie A; Krahe, Amy M; Adamczyk, Mark J; Weiner, Dennis S

    2016-05-01

    Previous studies documented the use of fibular allograft in the treatment of slipped capital femoral epiphysis (SCFE) with bone graft epiphysiodesis (BGE). This study describes the results of using a 10-mm diameter premilled fibular allograft packed with demineralized bone matrix placed across the physis in an open surgical approach under image intensification. A review identified 45 cases of BGE using fibular allograft and demineralized bone matrix in 34 patients with a diagnosis of SCFE performed by a single surgeon during an 8-year period. Thirty-four cases (25 patients) had at least 1 year of follow-up and were included in the study. Medical records were reviewed for complications, subsequent surgeries, and time to physeal closure. Of the 34 cases included, there were no cases of acute chondrolysis. Complications included 1 case of bone graft extrusion that required surgical replacement and 1 re-slip requiring surgical stabilization. Five cases of avascular necrosis (AVN) were encountered (1 unstable slip with total head AVN, and 4 stable slips with 3 total head and 1 partial head AVN). In 1 patient, small loose bony fragments were noted on postoperative radiographs that appeared outside of the articular surface of the hip and were asymptomatic. Two patients encountered wound healing issues that resolved with appropriate wound care. In light of the occurrence of AVN in stable cases, BGE with autogenous corticocancellous graft is preferable to BGE with autologous fibular graft for the treatment of SCFE. [Orthopedics. 2016; 39(3):e519-e525.].

  17. Deproteinized bone with VEGF gene transfer to facilitate the repair of early avascular necrosis of femoral head of rabbit

    Institute of Scientific and Technical Information of China (English)

    CAO Kai; HUANG Wei; AN Hong; JIANG Dian-ming; SHU Yong; HAN Zhi-min

    2009-01-01

    Objective: To explore a new method for early avascular necrosis of femoral head (AVNFH) therapy.Methods: Sixty-nine AVNFH New Zealand adult rabbits were randomly divided into three groups with equal number. In Group A, deproteinized bone (DPB) that absorbed with recombinant plasmid pcDNA3.1-hVEGF165 was implanted into the drilled tunnel of necrotic femoral head. In Group B, only DPB was implanted. In Group C, only tunnel was drilled without DPB or plasmid implanted. Femoral head specimens were obtained at postoperative 1, 2, 4, 8, 16 weeks. The expression of VEGF165 and collagen I was detected by immunohistochemistry. Bone formation was detected generally by X-ray. Angiogenesis and the repair of the femoral head were observed histologically.Results: The expression of VEGF 165 could be detected 2 weeks after implantation in Group A, but it was not observed in other groups. The result of collagen I expression had a significantly difference 2, 4 and 8 weeks after operation in Group A from those in other groups (P<0.01).X-ray results indicated that there was more bone formation in Group A than in other groups. The regenerated capillary vessels staining result of necrotic femoral head in Group A was significantly different from those in other groups at postoperative 2 and 4 weeks (P<0.01).Conclusions: Transfection ofhVEGF165 gene enhances local angiogenesis and DPB-VEGF compound improves the repair of necrotic femoral head. Deproteinized bone grafting with VEGF gene transfer provides a potential method for the treatment of osteonecrosis.

  18. A prospective randomised study of periprosthetic femoral bone remodeling using four different bearings in hybrid total hip arthroplasty

    DEFF Research Database (Denmark)

    Zerahn, Bo; Borgwardt, Lotte; Ribel-Madsen, Søren

    2011-01-01

    Abstract: We performed a study to assess whether different bearing materials have an impact on femoral bone remodeling within the first four years after a hybrid total hip arthroplasty. 205 of 300 patients were available for 4 years follow-up after being randomly allocated to four prosthetic...... 1, 6, and 7.Bone remodeling after total hip arthroplasty may depend on the composition of bearing materials, but age, height, weight, and stem size are also related to changes in BMD....

  19. Bilateral atypical femoral subtrochanteric fractures in a premenopausal patient receiving prolonged bisphosphonate therapy: evidence of severely suppressed bone turnover.

    Science.gov (United States)

    Kondo, Naoki; Yoda, Takuya; Fujisawa, Junichi; Arai, Katsumitsu; Sakuma, Mayumi; Ninomiya, Hiroshi; Sano, Hiroshige; Endo, Naoto

    2015-01-01

    We report a case of bilateral atypical femoral fractures that occurred in a patient who had been taking bisphosphonate long-term. A 36-year-old premenopausal female diagnosed with systemic lupus erythematosus and dermatomyositis had been treated with glucocorticoid and alendronate (5 mg/day) to prevent glucocorticoid-induced osteoporosis. She was taken to our hospital because she could not walk immediately after falling down from the standing position. A plain radiograph showed a subtrochanteric fracture of the left femur. Four months later, she fell again and sustained a contralateral subtrochanteric fracture. For each fracture, a femoral intramedullary nail was inserted. Delayed union was detected in both sides, and revision surgery with an iliac bone graft was required for implant breakage in the right side. Histomorphometric findings for the ilium revealed remarkably decreased osteoid volume with no osteoclasts and a minimally eroded surface, suggesting that bone turnover was severely suppressed. However, histology of the delayed union site revealed callus formation and some osteoclast appearance, suggesting that fracture healing was occurring. In total, it took 29 months (left) and 24 months (right) until fracture healing was achieved, showing delayed union. This case is extremely rare in that patient who presented with atypical femoral fractures in spite of her premenopausal status. The bone histomorphometric findings from this case suggest that severely suppressed bone turnover is associated with atypical femoral subtrochanteric fracture and can cause delayed union in patients treated with alendronate long-term.

  20. Progression of a fracture site impaction as a prognostic indicator of impacted femoral neck fracture treated with multiple pinning.

    Science.gov (United States)

    Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p articulo-trochanteric distance index between 6 weeks and 3 months (p articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.

  1. Numerical simulation of thermal bone necrosis during cementation of femoral prostheses.

    Science.gov (United States)

    Mazzullo, S; Paolini, M; Verdi, C

    1991-01-01

    The implant of a femoral prosthesis is a critical process because of the relatively high temperature values reached at the bone/cement interface during the cementation of the infibulum. In fact, the cement is actually a polymer that polymerizes in situ generating heat. Moreover, the conversion of monomer into polymer is never 100%; this is dangerous because of the toxicity of the monomer. In this paper, we present a 3-D axisymmetric mathematical model capable of taking into account both the geometry of the implant and the chemical/physical properties of the cement. This model, together with its numerical simulation, thus represents a useful tool to set up the optimal conditions for the new materials developed in this orthopaedic field. The real complex geometry is assumed to be a bone/cement/metallic system having cylindrical symmetry, thus allowing the model to be reduced to two space variables. The cementation process is described by the Fourier heat equation coupled with a suitable polymerization kinetics. The numerical approximation is accomplished by semi-implicit finite differences in time and finite elements in space with numerical quadrature. The full discrete scheme amounts to solve linear positive definite symmetric systems preceded by an elementwise algebraic computation. We present various numerical simulations which confirm some critical aspects of this orthopaedic fixing technique such as thermal bone necrosis and the presence of unreacted residual monomer.

  2. Atypical subtrochanteric femoral shaft fractures: role for mechanics and bone quality.

    Science.gov (United States)

    van der Meulen, Marjolein C H; Boskey, Adele L

    2012-08-29

    Bisphosphonates are highly effective agents for reducing osteoporotic fractures in women and men, decreasing fracture incidence at the hip and spine up to 50%. In a small subset of patients, however, these agents have recently been associated with 'atypical femoral fractures' (AFFs) in the subtrochanteric region or the diaphysis. These fractures have several atypical characteristics, including occurrence with minimal trauma; younger age than typical osteoporotic fractures; occurrence at cortical, rather than cancellous sites; early radiographic appearance similar to that of a stress fracture; transverse fracture pattern rather than the familiar spiral or transverse-oblique morphologies; initiation on the lateral cortex; and high risk of fracture on the contralateral side, at the same location as the initial fracture. Fracture is a mechanical phenomenon that occurs when the loads applied to a structure such as a long bone exceed its load-bearing capacity, either due to a single catastrophic overload (traumatic failure) or as a result of accumulated damage and crack propagation at sub-failure loads (fatigue failure). The association of AFFs with no or minimal trauma suggests a fatigue-based mechanism that depends on cortical cross-sectional geometry and tissue material properties. In the case of AFFs, bisphosphonate treatment may alter cortical tissue properties, as these agents are known to alter bone remodeling. This review discusses the use of bisphosphonates, their effects on bone remodeling, mechanics and tissue composition, their significance as an effective therapy for osteoporosis, and why these agents may increase fracture risk in a small population of patients.

  3. Reference point indentation study of age-related changes in porcine femoral cortical bone.

    Science.gov (United States)

    Rasoulian, Ramin; Raeisi Najafi, Ahmad; Chittenden, Michael; Jasiuk, Iwona

    2013-06-21

    The reference point indentation (RPI) method is a microindentation technique involving successive indentation cycles. We employed RPI to measure average stiffness (Ave US), indentation distance increase (IDI), total indentation distance (TID), average energy dissipated (Ave ED), and creep indentation distance (CID) of swine femoral cortical bone (mid-diaphysis) as a function of age (1, 3.5, 6, 14.5, 24, and 48 months) and loading directions (longitudinal and transverse). The Ave US increases with animal age, while the IDI, TID, Ave ED, and CID decrease with age, for both longitudinal (transverse surface) and transverse (periosteal surface) loading directions. Longitudinal measurements generally give higher Ave US and lower IDI and TID values compared to transverse measurements. The RPI measurements show similar trends to those obtained using nanoindentation test, and ash and water content tests.

  4. Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly patients

    Institute of Scientific and Technical Information of China (English)

    WANG Gang; GU Gui-shan; LI Dan; SUN Da-hui; ZHANG Wei; WANG Tie-jun

    2010-01-01

    Objective: To compare the clinical outcome of anterolateral minimally invasive approach versus conventional posterior approach for total hip replacement against femoral neck fractures in elderly patients.Methods: The retrospective study was carried out on 42 patients who suffered from displaced femoral neck fractures (19 cases of Garden type Ⅲ, 23 cases of Garden type Ⅳ) treated by total hip replacement via anterolateral minimally invasive approach or conventional posterior approach by the same experienced surgeon. The average age of the patients was 78.1 years (range: 65-89 years). They were divided into anterolateral mini-invasive group (22 cases) and posterior group (20 cases). The mean time of follow-up was 13 months (range: 6-36 months). The anterolateral approach described by Hardinge goes through between anterior 1/3 and posterior 2/3 of the gluteus medius muscle, reaching the femoral neck from anterior capsule. The traditional posterior approach described by Moore (Southern incision) goes through the insertions of short external rotation muscles,reaching the femoral neck from posterior capsule. The related variables under observation were length of incision,operation time, postoperative limp, length of hospital stay and bed stay and dislolcation rate.Results: The length of the skin incision varied between 7 cm and 12 cm with the anterolateral minimally invasive technique, compared to 15-22 cm in the conventional procedure. It took less time (average 15 minutes) to complete the anterolateral minimally invasive approach (72 min±15 min), compared with the conventional approach (87 min±10 min). The average Harris hip score was 91.23±10.20 inanterolateral approach, 90.03±11.05 in the posterior approach. The average length of hospital stay for patients with the anterolateral approach was (6.4±2.2) days (range:4-9 days), while that in posterior approach was (9.2 ±3.1)days (range: 6-13 days). The average length of bed stay was (3.4±1.1) days (range: 2

  5. Development of neck filters for reducing artifact in cervical bone SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kikkawa, Nobutada; Kimura, Shigeo [Kyoto Minami Hospital (Japan)

    2001-01-01

    In cervical bone scintillation SPECT studies using triple energy window (TEW) and ordered subject-expection maximization (OS-EM) methods, we have observed an artifact that may interfere with evaluation of the image; higher accumulation in cervical vertebra compared with in the head and thoracic vertebra. As the neck is smaller in diameter than in the thorax and head, gamma ray absorption is lower. In addition, as the distance between the neck and the detector is greater, scattered gamma rays are increased, interfering with imaging and causing artifact. To overcome these problems, we have developed special absorbers (neck filter) to make the relative absorption level of the neck comparable to that of the head and thorax and have employed these cervical filters in bone scintillation SPECT studies in combination with TEW scatter correction and OS-EM method. Our results showed that artifacts were significantly reduced and satisfactory images were obtained. (author)

  6. Do post-operative changes of neck-shaft angle and femoral component anteversion have an effect on clinical outcome following uncemented total hip arthroplasty?

    Science.gov (United States)

    Müller, M; Abdel, M P; Wassilew, G I; Duda, G; Perka, C

    2015-12-01

    The accurate reconstruction of hip anatomy and biomechanics is thought to be important in achieveing good clinical outcomes following total hip arthroplasty (THA). To this end some newer hip designs have introduced further modularity into the design of the femoral component such that neck-shaft angle and anteversion, which can be adjusted intra-operatively. The clinical effect of this increased modularity is unknown. We have investigated the changes in these anatomical parameters following conventional THA with a prosthesis of predetermined neck-shaft angle and assessed the effect of changes in the hip anatomy on clinical outcomes. In total, 44 patients (mean age 65.3 years (standard deviation (SD) 7); 17 male/27 female; mean body mass index 26.9 (kg/m²) (SD 3.1)) underwent a pre- and post-operative three-dimensional CT scanning of the hip. The pre- and post-operative neck-shaft angle, offset, hip centre of rotation, femoral anteversion, and stem alignment were measured. Additionally, a functional assessment and pain score were evaluated before surgery and at one year post-operatively and related to the post-operative anatomical changes. The mean pre-operative neck-shaft angle was significantly increased by 2.8° from 128° (SD 6.2; 119° to 147°) to 131° (SD 2.1; 127° to 136°) (p = 0.009). The mean pre-operative anteversion was 24.9° (SD 8; 7.9 to 39.1) and reduced to 7.4° (SD 7.3; -11.6° to 25.9°) post-operatively (p neck-shaft angles was found with a significant decrease of the post-operative anteversion and slight increase of the neck-shaft angles, but without any impact on clinical outcome.

  7. Effect of the high femoral osteotomy upon the vascularity and blood supply of the hip joint

    Energy Technology Data Exchange (ETDEWEB)

    Day, B.; Shim, S.S.; Leung, G.

    1984-05-01

    This investigation was done to study the effects of high femoral osteotomy upon the vascularity and blood supply of the hip and to further our knowledge of its physiologic basis. We have used established methods of study, including bone scans, microangiography, isotope clearance and perosseous venography, and based upon the results of these studies, we have reached certain conclusions. First, high femoral osteotomy increases the blood flow and vascularity in the hip joint, the femoral head and neck and the great trochanter. Second, bone scanning techniques using /sup 99m/Tc labeled diphosphonate have shown increased uptake in the femoral head and neck after high femoral osteotomy. The localization was done using a Digital Gamma III computer, and the activity on the osteotomy side at two weeks was 3.5 times as great as on the control side. By 16 weeks postoperatively, there was still two times as much activity on the osteotomy side. Third, microangiography showed increased vascularity both at the osteotomy site and in the femoral head and neck and the greater trochanter on that side. Such an increase in vascularity first became evident two weeks after osteotomy and persisted during the four month period studied. Fourth, the results of the /sup 99m/Tc diphosphonate clearance study showed a 25 per cent increase in femoral head blood flow on the operative side. Fifth, perosseous venography of the femoral head and neck showed a marked increase in venous drainage through the osteotomy site in the immediate postosteotomy stage.

  8. External fixation of femoral defects in athymic rats: Applications for human stem cell implantation and bone regeneration

    Directory of Open Access Journals (Sweden)

    Terasa Foo

    2013-01-01

    Full Text Available An appropriate animal model is critical for the research of stem/progenitor cell therapy and tissue engineering for bone regeneration in vivo. This study reports the design of an external fixator and its application to critical-sized femoral defects in athymic rats. The external fixator consists of clamps and screws that are readily available from hardware stores as well as Kirschner wires. A total of 35 rats underwent application of the external fixator with creation of a 6-mm bone defect in one femur of each animal. This model had been used in several separate studies, including implantation of collagen gel, umbilical cord blood mesenchymal stem cells, endothelial progenitor cells, or bone morphogenetic protein-2. One rat developed fracture at the proximal pin site and two rats developed deep tissue infection. Pin loosening was found in nine rats, but it only led to the failure of external fixation in two animals. In 8 to 10 weeks, various degrees of bone growth in the femoral defects were observed in different study groups, from full repair of the bone defect with bone morphogenetic protein-2 implantation to fibrous nonunion with collagen gel implantation. The external fixator used in these studies provided sufficient mechanical stability to the bone defects and had a comparable complication rate in athymic rats as in immunocompetent rats. The external fixator does not interfere with the natural environment of a bone defect. This model is particularly valuable for investigation of osteogenesis of human stem/progenitor cells in vivo.

  9. Osteonecrosis Mimicking Bone Metastasis in Femoral Head on {sup 18F} FDG PET/CT: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Kyu Ho; Oh, Jin Kyoung; Kim, Sung Hoon; Yoo, Ik Dong; Choi, Eun Kyoung; Han, Eun Ji [The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2011-03-15

    A 77 year old woman underwent chemotherapy, radiotherapy, and brachytherapy for cervical cancer 9 years ago. On a follow up {sup 18F} fluorodeoxyglucose (FDG) PET/CT image, focal FDG uptake was noted in a focal osteolytic lesion in the right femoral head. During magnetic resonance imaging, this lesion showed subchondral dark signal intensity rim on T1 weighted image and double line sign on T2 weighted image, suggestive of osteonecrosis. The lesion was pathologically confirmed as osteonecrosis after surgery. This case demonstrates that osteonecrosis of the femoral head may demonstrate focal FDG uptake mimicking bone metastasis.

  10. Analgesic efficacy of continuous femoral nerve block commenced prior to operative fixation of fractured neck of femur

    LENUS (Irish Health Repository)

    Szucs, Szilard

    2012-06-27

    AbstractBackgroundPeripheral nerve blocks are effective in treating acute pain, thereby minimizing the requirement for opiate analgesics. Fractured neck of femur (FNF) is a common, painful injury. The provision of effective analgesia to this cohort is challenging but an important determinant of their functional outcome. We investigated the analgesic efficacy of continuous femoral nerve block (CFNB) in patients with FNF.MethodsFollowing institutional ethical approval and with informed consent, patients awaiting FNF surgery were randomly allocated to receive either standard opiate-based analgesia (Group 1) or a femoral perineural catheter (Group 2). Patients in Group 1 received parenteral morphine as required. Those in Group 2 received a CFNB comprising a bolus of local anaesthetic followed by a continuous infusion of 0.25% bupivacaine. For both Groups, rescue analgesia consisted of intramuscular morphine as required and all patients received paracetamol regularly. Pain was assessed using a visual analogue scale at rest and during passive movement (dynamic pain score) at 30 min following first analgesic intervention and six hourly thereafter for 72 hours. Patient satisfaction with the analgesic regimen received was recorded using verbal rating scores (0-10). The primary outcome measured was dynamic pain score from initial analgesic intervention to 72 hours later.ResultsOf 27 recruited, 24 patients successfully completed the study protocol and underwent per protocol analysis. The intervals from recruitment to the study until surgery were similar in both groups [31.4(17.7) vs 27.5(14.2) h, P = 0.57]. The groups were similar in terms of baseline clinical characteristics. For patients in Group 2, pain scores at rest were less than those reported by patients in Group 1 [9.5(9.4) vs 31(28), P = 0.031]. Dynamic pain scores reported by patients in Group 2 were less at each time point from 30 min up to 54 hours [e.g at 6 h 30.7(23.4) vs 67.0(32.0), P = 0

  11. Analgesic efficacy of continuous femoral nerve block commenced prior to operative fixation of fractured neck of femur

    Directory of Open Access Journals (Sweden)

    Szucs Szilard

    2012-06-01

    Full Text Available Abstract Background Peripheral nerve blocks are effective in treating acute pain, thereby minimizing the requirement for opiate analgesics. Fractured neck of femur (FNF is a common, painful injury. The provision of effective analgesia to this cohort is challenging but an important determinant of their functional outcome. We investigated the analgesic efficacy of continuous femoral nerve block (CFNB in patients with FNF. Methods Following institutional ethical approval and with informed consent, patients awaiting FNF surgery were randomly allocated to receive either standard opiate-based analgesia (Group 1 or a femoral perineural catheter (Group 2. Patients in Group 1 received parenteral morphine as required. Those in Group 2 received a CFNB comprising a bolus of local anaesthetic followed by a continuous infusion of 0.25% bupivacaine. For both Groups, rescue analgesia consisted of intramuscular morphine as required and all patients received paracetamol regularly. Pain was assessed using a visual analogue scale at rest and during passive movement (dynamic pain score at 30 min following first analgesic intervention and six hourly thereafter for 72 hours. Patient satisfaction with the analgesic regimen received was recorded using verbal rating scores (0-10. The primary outcome measured was dynamic pain score from initial analgesic intervention to 72 hours later. Results Of 27 recruited, 24 patients successfully completed the study protocol and underwent per protocol analysis. The intervals from recruitment to the study until surgery were similar in both groups [31.4(17.7 vs 27.5(14.2 h, P = 0.57]. The groups were similar in terms of baseline clinical characteristics. For patients in Group 2, pain scores at rest were less than those reported by patients in Group 1 [9.5(9.4 vs 31(28, P = 0.031]. Dynamic pain scores reported by patients in Group 2 were less at each time point from 30 min up to 54 hours [e.g at 6 h 30.7(23.4 vs 67

  12. 股骨颈骨折34例临床分析%The Clinical Analysis of 34 Cases of Femoral Neck Fracture

    Institute of Scientific and Technical Information of China (English)

    张仁忠

    2015-01-01

    目的:探讨股骨颈骨折患者手术治疗方法疗效。方法选取2013年1月~2014年6月收治的股骨颈骨折患者34例手术治疗资料进行分析。结果经手术治疗所有患者骨折均顺利愈合,优16例,良15例,差2例,优良率94.1%。结论若因某种原因不能采取手术治疗,则一旦疼痛缓解可尽量使患者早期活动,造成的骨折不愈合存在明显症状时可在晚期进行处理。手术包括内固定或一期关节成形术,一般对年轻患者应尽可能保留股骨头。%Objective The surgical treatment ef iciency of patients with femoral neck fracture is to be investigated. Methods Analyze the surgical treatment data selected from 34 patients with femoral neck fracture who are treated in hospital from January 2013 to June 2014. Results Al of patients with femoral neck fracture get healed after surgical treatment,including 16 cases of excel ence,15 cases of goodness and 2 cases of poorness,the excel ence and good incidence is up to 94.1%. Conclusion For the patients who are not available for surgical treatment due to some reason,once the pain is relieved,they are able to do some activities in early time and the symptoms caused by unhealed fracture can be treated in later stage of treatment. The surgical treatment of femoral neck fracture includes fixation and one-stage arthroplasty,in general, should be retained as far as possible the Femoral Head in younger patients.

  13. Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly: Systematic Review and Meta-analysis of Short- and Long-term Effectiveness

    Institute of Scientific and Technical Information of China (English)

    Chen-Yi Ye; An Liu; Ming-Yuan Xu; Nwofor Samuel Nonso; Rong-Xin He

    2016-01-01

    Background:There is conflicting evidence as to whether the femoral head should be preserved or replaced in elderly patients with displaced intracapsular femoral neck fractures.In this article,we performed a systematic review and meta-analysis to compare the short-and long-term effectiveness of arthroplasty (AR) and internal fixation (IF).Methods:PubMed,Embase,and the Cochrane Library were searched systematically up to January 2016.All randomized controlled trials directly comparing the effectiveness of AR and IF for displaced intracapsular fracture were retrieved with no limitation on language or publication year.Results:In total,eight prospective randomized studies involving 2206 patients were included.The results of our study showed that patients in the AR group reported significantly lower complication (risk ratio:0.56,95% confidence interval [CI] =0.38-0.80),re-operation (risk ratio:0.17,95% CI =0.13-0.22),revision rates (risk ratio:0.11,95% CI:0.08-0.16),and better function compared with their IF counterparts,and they were less likely to suffer postoperative pain.No statistically significant differences for the rates of mortality,infection,and/or deep vein thrombosis between AR and IF were found.Conclusions:Based on our analysis,we recommend that AR should be used as the primary treatment for displaced intracapsular femoral neck fractures in the elderly.However,IF may be appropriate for those who are very frail.

  14. Femoral neck anteversion, acetabular anteversion and combined anteversion in the normal Indian adult population: A computed tomographic study

    Directory of Open Access Journals (Sweden)

    Maheshwari Aditya

    2010-01-01

    Full Text Available Background: Abnormal femoral neck anteversion (FNA and/or acetabulum anteversion (AA have long been implicated in the etiogenesis of hip osteoarthritis (OA, developmental dysplasia of the hip (DDH, and impingement, instability and wear in total hip arthroplasty (THA. Since studies on the Indian population are sparse on this topic, the purpose of this study was to report the normal values of FNA, AA and the combined anteversion (CA= FNA+ AA in Indian adults. Materials and Methods: FNA, AA and CA were prospectively measured in 172 normal hips in 86 Indian adults using standardized computed tomographic (CT methods and this data was compared with the established Western values. Results: The median values and interquartile ranges were 8 o (6.5-10.0 o for FNA, 19 o (16.0-22.0 o for AA and 27 o (23.5-30.0 o for CA. AA and CA values were significantly (P< 0.05 lower in males, and there was also a trend towards lower FNA in males. Although a negative correlation was observed between the FNA and AA, this was not strong and may not be clinically relevant. Conclusion: When compared with the Western data, the FNA values were 3-12 o lower and the CA values were 3-5 o lower in Indian adults. The AA values were comparable, but were skewed towards the higher side. Further studies are needed to assess the clinical relevance of our basic science data in pathogenesis of OA, and to validate it in relation to hip surgeries like corrective osteotomies and THA.

  15. Perioperative Treatment of Elderly Patients With Femoral Neck Fracture With Diabetes Mellitus%老年股骨颈骨折伴糖尿病患者围手术期的治疗研究

    Institute of Scientific and Technical Information of China (English)

    王玉金

    2016-01-01

    Objective Analysis of therapeutic intervention for elderly patients with femoral neck fracture and diabetes mellitus during perioperative period, and make a summary.Methods 50 cases of elderly patients with femoral neck fracture associated with diabetes in our hospital from July 2014 to July 2015 were randomly selected as the main research subjects, in view of the treatment plan, which is accepted in the perioperative period to carry on the inquisition.ResultsAll patients underwent a complete follow-up, the mean length of follow-up time was 6 months. 50 patients who were no deaths and cases of infection occur, and patients are to achieve the therapeutic effect of bone healing; discharge length were between 5~18 days, the average number is (7.43±1.25) days.Conclusion In the perioperative phase, and femoral neck fractures in elderly patients with diabetes to appropriate therapeutic intervention, can make them more successful completion of the surgery, reducing the risk of infection.%目的:针对股骨颈骨折且伴有糖尿病的老年患者在围术期阶段接受的治疗干预展开分析,并且作以总结。方法随机选取2014年7月~2015年7月于我院就诊的50例股骨颈骨折伴有糖尿病的老年患者作为主要的研究对象,针对其围术期接受的治疗方案进行探究。结果全部患者均接受了完整随访,随访时长平均为6个月。50例患者中均没有死亡以及发生感染的病例,且患者术后均实现骨性愈合的治疗效果;住院时长5~18 d,平均住院时长(7.43±1.25)d。结论围术期阶段,对股骨颈骨折并且伴有糖尿病的老年患者行以适当的治疗干预,能够令其更顺利地完成手术,降低发生感染的隐患。

  16. Bipolar femoral head replacement for the treatment of femoral neck fractures in elder Parkinson's disease patients%双极人工股骨头治疗老年帕金森患者股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    庄泽; 曾春; 曾花; 王昆

    2012-01-01

    BACKGROUND: Due to the muscle imbalance outcomes, Parkinson's patients are easy to fall and have a high risk of femoral neck fracture. OBJECTIVE: To explore the treatment outcomes of bipolar femoral head replacement for the femoral neck fractures in elder Parkinson's patients METHODS: A retrospective analysis was carried out on the clinical data of the 14 Parkinson's disease patients of femoral neck fractures, a total of 14 hips, who were treated with bipolar femoral head replacement. The patients were divided into three phases by Hoehn-Yahr classification, 3 cases in I phase, 4 cases in II phase, 5 cases in III phase and 2 cases in IV phase. The average surgery age was 62 to 83 years old. The Harris score, Fugl-Meyer scale and Unified Parkinson's Disease Rating Scale score were used as follow-up judgment. RESULTS AND CONCLUSION: The average follow-up time was 1 to 6 years. Harris score of 14 patients was postoperatively 85.4 better than preoperatively 22.3 (P < 0.05), Fugl-Meyer score was postoperatively 81.6 better than preoperatively 52.5 (P < 0.05). There was no significant difference of Unified Parkinson's Disease Rating Scale score before and after operation, and the Parkinson's disease controlled stable. No prosthesis loosening, dislocation or other complications. Early and mid-term follow-up showed under the effective medical control of the neurology drugs, bipolar femoral head replacement is a safe and effective treatment of femoral neck fracture for Hoehn-Yahr I -IV Parkinson's patient. There is relationship between the hip joint function and the control of the Parkinson's disease after replacement.%背景:帕金森患者由于肌力不平衡等原因更容易跌倒,发生股骨颈骨折的风险高.目的:观察双极人工股骨头置换对老年帕金森病合并股骨颈骨折患者的治疗效果.方法:回顾分析14例帕金森病合并股骨颈骨折行双极人工股骨头置换患者的临床资料,共14髋,Hoehn-Yahr分级Ⅰ期3例,Ⅱ期4

  17. Salmonella Levels in Turkey Neck Skins, Drumstick Bones, and Spleens in Relation to Ground Turkey.

    Science.gov (United States)

    Cui, Yue; Guran, Husnu S; Harrison, Mark A; Hofacre, Charles L; Alali, Walid Q

    2015-11-01

    The objective of this study was to determine Salmonella levels (presence and numbers) in turkey drumstick bone, spleen, and neck skin samples in relation to Salmonella contamination levels in ground turkey at the flock level. Over a 10-month period, a total of 300 samples of each turkey part (i.e., neck skin, spleen, and drumstick) from 20 flocks were collected at a commercial turkey processing plant after the evisceration step. Turkey flocks included in this study were classified as "targeted" and "nontargeted" based on the company's historical ground turkey contamination data. A flock that originated from a turkey farm that had previously produced one or more flocks with ≥20% Salmonella prevalence in ground turkey was labeled as a targeted flock (n = 13). The remaining seven flocks with Salmonella presence and numbers by using most-probable-number and selective enrichment methods. Further genotypic analysis (pulsed-field gel electrophoresis) of the isolates was performed. Ground turkey samples were collected and analyzed for Salmonella levels by the cooperating turkey company. The outside surface of bone and spleen were sterilized prior to Salmonella analysis. The overall Salmonella prevalence in neck skin, drumstick bone, spleen, and ground turkey samples was 42.0, 9.3, 6.7, and 14.5%, respectively. Salmonella prevalence in neck skin, spleen, drumstick bone, and ground turkey from the targeted flocks was significantly (P Salmonella presence in neck skin (when most probable numbers were ≥2 log) and Salmonella-positive ground turkey lot. Based on our findings, Salmonella was detected internally in drumstick bones and spleens at low levels, whereas Salmonella presence at higher levels in neck skin may indicate a flock with greater potential for Salmonella contamination of ground turkey.

  18. [Stress reactions--stress fracture of the upper femoral neck in endurance sports].

    Science.gov (United States)

    Schultz, W; Stinus, H; Schleicher, W; Hess, T

    1991-06-01

    Stress reactions of the musculoskeletal system may be interpreted as possible precursors of stress fractures. Biological material, in contrast to artificial products, can react in numerous and complex ways. This can not only lead to a continual weakening of the tissue, but also to adaptation phenomena in response to overuse. The causes of such stress reactions are still unclear in many respects. For example, it is unknown to what extent a predisposition to these stress symptoms is created by mechanical stress alone or whether other factors such as physical condition, nutrition or even hormone balance come into play. Early diagnosis considerably reduces the healing process and, the later the diagnosis of the stress reaction, the more drawn out is the healing process and the extent of the athlete's absence from training. In this connection may be discussed whether the stress reaction can be the represent as the precursor of the stress fracture. In light of the need for taking special care in obtaining anamnestic data and determining the predisposition of an athlete, it appears to be justified to perform whole body bone scanning in the initial stages and particularly after an innocuous radiological finding. To what extent more current methods (e. g. MRI) can be applied without exposing the athlete to undue radiation cannot be conclusively judged at present. The treatment of a stress reaction should, at least at the beginning, be the same as for a diagnosed stress fracture.

  19. 加长螺旋刀片股骨抗旋髓内钉治疗股骨干合并同侧股骨颈骨折16例%Lengthened proximal femoral nail antirotation for femoral shaft fractures combined with ipsilateral femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    李山珠; 赵宏谋; 袁锋; 朱辉; 俞光荣

    2012-01-01

    Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82%. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis

  20. Comparison of Compositions and Structural Characterizations of Synthetic Nano-hydroxyapatite and Mineral Phase from Porcine Femoral Bone

    Institute of Scientific and Technical Information of China (English)

    Zhang Li(张利); Li Yubao; Wang Xuejiang; Peng Xuelin; Zuo Yi; Han Jimei

    2004-01-01

    In the paper, nano-hydroxyapatite was synthesized by hydrothermal treatment. The crystal morphology and compositions of the synthetic HA were investigated using TEM, IR, XRD and XPS techniques and were compared with those of porcine femoral bone apatite. The results showed that the synthetic HA is nanometer rod crystal similar to the bone apatite, and the average crystal sizes calculated by Scherrer equation for the four samples (HA dried at 80℃, unburned bone apatite, HA calcined at 750℃ and bone apatite calcined at 750℃) are 20.6, 21.7, 22.5 and 27.6nm, respectively. Moreover, the essential compositions for the synthetic HA and bone apatite are almost the same.

  1. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

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    Sampat S Dumbre Patil

    2016-01-01

    Full Text Available Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN or surface implants like Dynamic Condylar Screw (DCS are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years and mean followup period was 52.1 months (range 27-72 months. Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  2. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    Science.gov (United States)

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion. PMID:27512218

  3. 老年股骨颈骨折术后谵妄的护理对策%Elderly Femoral Neck Fractures of Postoperative Delirium Nursing Countermeasures

    Institute of Scientific and Technical Information of China (English)

    徐云

    2014-01-01

    目的:探讨老年股骨颈骨折术后谵妄的原因,进而提出护理对策。方法比较股骨颈骨折手术后24例出现谵妄患者的手术前后血红蛋白变化,同时对这些患者睡眠情况、年龄及术后出现谵妄持续时间等进行分析,并给予相应护理。结果患者术后谵妄的因素包括高龄、环境因素、贫血、疼痛、睡眠不足、药物毒性等。经治疗护理,24例均痊愈出院。结论术前、术中、术后给予针对性的全程护理措施,可以减少老年患者股骨颈骨折术后谵妄的发生。%Objective To study the elderly femoral neck fracture reasons of postoperative delirium,put forward nursing countermeasures. Methods To compare the 24 cases of femoral neck fracture surgery in delirium in patients with hemoglobin before and after surgery,sleep in those patients, age, and at the same time appear postoperative delirium duration,etc were analyzed,and and giving corresponding nursing. Results The patients of postoperative delirium factors including age,environmental factors,anemia,pain,sleep deprivation,drug toxicity,etc. After care,24 cases were recovered discharge. Conclusion Preoperative,intraoperative and postoperative give pertinent nursing measures al the way,can reduce the happening of the elderly patients with femoral neck fractures of postoperative delirium.

  4. 骨水泥阻塞兔骨干髓腔后远侧骨干骨内压和骨血流的改变%Changes in intraosseous pressure and bone blood flow of the distal femoral shaft after femoral medullary canal blocking with bone cement

    Institute of Scientific and Technical Information of China (English)

    李宏宇; 安洪; 梁斌; 李荣祝; 田文; 韦敏克

    2008-01-01

    BACKGROUND: Implantation of artificial joint of bone cement can result in long-term blocking of recipient site medullary canal and blood vessel lesion, and lead to changes in intraosseous pressure and bone blood flow of distal femoral shaft.OBJECTIVE: To explore the changes in the intraosseous pressure and bone blood flow of distal femoral shaft after blockage of the proximal and middle femoral medullary canal by bone cement.DESIGN: Controlled observation.SETTING: People's Hospital of Guangxi Zhuang Autonomous Region.MATERIALS: The experiment was performed at the Experimental Animal Center of Chongqing Medical University between July 2002 and April 2003. Thirty-two healthy adult New Zealand rabbits were selected and randomly divided into model group (n=24) and control group (n=8). Polymethyl methacrylate (PMMA) TJ bone cement was provided by Tianjin Synthetic Materials Research Institute.METHODS: The rabbit model was established by infusing femoral medullary canal of left side with PMMA. The lateral greater trochanter of anesthetized rabbits were resected below the third trochanter through spatium intermusculare by posterior lateral femur approach, but the neck of femur was remained to expose intertrochanteric fossa and entry of medullary canal following by intramedullary reaming to 1/2 length of femur. The wound was washed repeatedly to remove the destroyed myeioid tissues, and was dried with gauze. Bone cement was prepared by manually stirring powder with solution at a ratio of 2:1, until dough shape formed. A small piece of dough-shaped bone cement was filled in middle femoral stenosis as cavity blocker. Ten minutes later, the solidified bone cement was re-blended until dough shape and implanted into medullary canal fully. When the bone cement was completely solidified, the incision was sutured. The 24-modeled rabbits were randomly divided into 4 subgroups according to the following observation time points (n=6): postoperative 0 day (T0),4th week (T4), 8th week

  5. Influence of bone mineral density and hip geometry on the different types of hip fracture.

    Science.gov (United States)

    Li, Yizhong; Lin, Jinkuang; Cai, Siqing; Yan, Lisheng; Pan, Yuancheng; Yao, Xuedong; Zhuang, Huafeng; Wang, Peiwen; Zeng, Yanjun

    2016-01-01

    The aim of this study was to assess the influence of bone mineral density and hip geometry on the fragility fracture of femoral neck and trochanteric region. There were 95 menopausal females of age ≥ 50 years with fragility fracture of hip, including 55 cases of femoral neck fracture and 40 cases of trochanteric fracture. Another 63 non-fractured females with normal bone mineral density (BMD) were chosen as control. BMD, hip axis length, neck-shaft angle and structural parameters including cross surface area, cortical thickness and buckling ratio were detected and compared. Compared with control group, the patients with femoral neck fracture or trochanteric fractures had significantly lower BMD of femoral neck, as well as lower cross surface area and cortical thickness and higher buckling ratio in femoral neck and trochanteric region. There were no significant differences of BMD and structural parameters in the femoral neck fracture group and intertrochanteric fracture group. Hip axis length and neck-shaft angle were not significantly different among three groups. The significant changes of BMD and proximal femur geometry were present in the fragility fracture of femoral neck and trochanteric region. The different types of hip fractures cannot be explained by these changes.

  6. In-vivo assessment of femoral bone strength using Finite Element Analysis (FEA based on routine MDCT imaging: a preliminary study on patients with vertebral fractures.

    Directory of Open Access Journals (Sweden)

    Hans Liebl

    Full Text Available To experimentally validate a non-linear finite element analysis (FEA modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD measurements as gold standard.One fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects.In-vitro simulations showed good correlation with the experimentally measured strains both in stance (R2 = 0.963 and fall configuration (R2 = 0.976. The simulated maximum stress overestimated the experimental failure load (4743 N by 14.7% (5440 N while the simulated maximum strain overestimated by 4.7% (4968 N. The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366, but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028.FEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our data suggests, that MDCT

  7. The Bone Regeneration Using Bone Marrow Stromal Cells with Moderate Concentration Platelet-Rich Plasma in Femoral Segmental Defect of Rats

    Science.gov (United States)

    Yamakawa, Junichi; Hashimoto, Junichi; Takano, Mitsuo; Takagi, Michiaki

    2017-01-01

    Background: Platelet-rich plasma (PRP) can provide an assortment of growth factors, but how PRP effects bone regeneration is still unknown. The aim of the study was to explore an optimal method of using PRP and bone marrow stromal cells (BMSCs). Methods: An in vitro experiment was first conducted to determine an appropriate quantity of PRP. BMSCs were cultured with PRP of different concentrations to assess cell proliferation and osteogenic differentiation. Following the in vitro study, a rat femoral segmental defect model was used. Five collagen mixtures consisting of different concentrations of PRP and BMSCs were prepared as follows, i) BMSCs and PRP (platelet 20 x 104/µl), ii) BMSCs and PRP (platelet 100 x 104/µl), iii) BMSCs and PRP (platelet 500 x 104/µl), iv) BMSCs, and v) PRP group (platelet 100 x 104/µl), were used to fill defect. New bone formation was evaluated by soft X-ray and histologic analyses were performed at 2, 4, 6 and 8 weeks postoperatively. Results: The cell proliferation increased PRP concentration-dependently. Cellular alkaline phosphatase activity was higher in moderate concentration than high or low concentration group’s in vitro study. In vivo study, the bone fill percentage of newly formed bone in BMSCs and PRP (platelet 100 x 104/µl) was 46.9% at 8 weeks and increased significantly compared with other groups. Conclusion: BMSCs with moderate level of PRP significantly enhanced bone formation in comparison with BMSCs or PRP transplant in a rat femoral defect model. PMID:28217215

  8. The micro-architecture of human cancellous bone from fracture neck of femur patients in relation to the structural integrity and fracture toughness of the tissue

    Directory of Open Access Journals (Sweden)

    C. Greenwood

    2015-12-01

    Full Text Available Osteoporosis is clinically assessed from bone mineral density measurements using dual energy X-ray absorption (DXA. However, these measurements do not always provide an accurate fracture prediction, arguably because DXA does not grapple with ‘bone quality’, which is a combined result of microarchitecture, texture, bone tissue properties, past loading history, material chemistry and bone physiology in reaction to disease. Studies addressing bone quality are comparatively few if one considers the potential importance of this factor. They suffer due to low number of human osteoporotic specimens, use of animal proxies and/or the lack of differentiation between confounding parameters such as gender and state of diseased bone. The present study considers bone samples donated from patients (n = 37 who suffered a femoral neck fracture and in this very well defined cohort we have produced in previous work fracture toughness measurements (FT which quantify its ability to resist crack growth which reflects directly the structural integrity of the cancellous bone tissue. We investigated correlations between BV/TV and other microarchitectural parameters; we examined effects that may suggest differences in bone remodelling between males and females and compared the relationships with the FT properties. The data crucially has shown that TbTh, TbSp, SMI and TbN may provide a proxy or surrogate for BV/TV. Correlations between FT critical stress intensity values and microarchitecture parameters (BV/TV, BS/TV, TbN, BS/BV and SMI for osteoporotic cancellous tissue were observed and are for the first time reported in this study. Overall, this study has not only highlighted that the fracture model based upon BMD could potentially be improved with inclusion of other microarchitecture parameters, but has also given us clear clues as to which of them are more influential in this role.

  9. Biomechanical factors in the design of new femoral neck screw in children%新型儿童股骨颈螺钉设计中的生物力学因素

    Institute of Scientific and Technical Information of China (English)

    黄煊怀; 廖瑛; 范伟杰; 陈志伟

    2013-01-01

    BACKGROUND:As the epiphyseal plate has an important role in the growth and development of femur, the design of internal fixation should avoid the damage to the epiphyseal plate. Therefore, the positioning of pediatric femoral epiphyseal plate is particularly important. OBJECTIVE:To investigate the biomechanical property of the new femur neck screw internal fixation in treatment of children femoral neck fracture. METHODS:Twelve femurs were col ected from six fresh children cadavers provided by Dissecting Room of University of South China. After exclusion of bone disease with X-ray film, three new children femoral neck screws and three Kirschner wires with the diameter of 2.0 mm were used for fixation. The biomechanical tests were conducted to detect the axial compression and torsion stiffness. RESULTS AND CONCLUSION:In the children femoral neck screw group, the axial compression stiffness and torsion stiffness under the torsional torque of maximum 3 N?m were (190.74±20.88) N/mm and (0.18±0.045) N?m/° respectively;(138.95±15.19) N/mm and (0.120±0.036) N?m/° respectively in the Kirschner wire group;there were significant differences in the axial compression stiffness and torsion stiffness between two groups (P  目的:探讨新型儿童股骨颈螺钉固定儿童股骨颈骨折的生物力学性能。  方法:由南华大学解剖室提供的6具儿童尸体上取下股骨12根,X射线排除骨病后,分别采用3枚新型儿童股骨颈螺钉固定;3枚2.0 mm克氏针固定。分别进行生物力学实验,测试其轴向压缩、扭转刚度。  结果与结论:轴向压缩刚度及最大3 N?m 的扭转力矩下扭转刚度,儿童股骨颈螺钉分别为(190.74±20.88) N/mm、(0.18±0.045) N?m/(°),克氏针为(138.95±15.19) N/mm、(0.120±0.036) N?m/(°),两者比较差异均有显著性意义(P<0.05);显示儿童股骨颈螺钉的抗压能力和抗扭能力上明显强于克氏针。实验说明儿童股骨颈螺钉是一

  10. Laser Doppler flowmetry for bone blood flow measurement: correlation with microsphere estimates and evaluation of the effect of intracapsular pressure on femoral head blood flow

    Energy Technology Data Exchange (ETDEWEB)

    Swiontkowski, M.F.; Tepic, S.; Perren, S.M.; Moor, R.; Ganz, R.; Rahn, B.A.

    1986-01-01

    Laser Doppler flowmetry (LDF) was used to measure bone blood flow in the rabbit femoral condyles. To correlate the LDF output signal blood cell flux to in vivo blood flow, simultaneous measurements using LDF and /sup 85/Sr-labeled microspheres were made in an adult rabbit model. There was no correlation between the two methods for blood flow in the femoral condyles and the correlation between the two methods for blood flow in the femoral head does not achieve statistical significance. An LDF signal of 0.4 V was approximately equal to a microsphere measured flow rate of 0.4 ml blood/g bone/min. The strength of the correlation in the latter case may have been affected by (a) large arteriovenous shunts, (b) inadequate mixing of the microspheres with a left ventricular injection, and (c) insufficient numbers of microspheres present in the bone samples. When LDF was used to evaluate the effect of elevated intracapsular pressure on femoral head blood flow in skeletally mature rabbits, femoral head subchondral bone blood flow declined with increasing intracapsular pressure from a baseline value of 0.343 +/- 0.036 to a value of 0.127 +/- 0.27 at 120 cm of water pressure. The decline in femoral head blood flow was statistically significant at pressures of 40 cm of water or higher (p less than 0.001), and evaluation of sections of the proximal femora made from preterminal disulphine blue injections confirmed these findings. Intracapsular tamponade has an adverse effect on femoral head blood flow beginning well below central venous pressure and should be considered in the pathophysiology of posttraumatic and nontraumatic necrosis of the femoral head. Laser Doppler flowmetry was easy to use and appears to be a reproducible technique for evaluating femoral head blood flow, offering distinct advantages over the microsphere technique for measuring bone blood flow.

  11. [Cementless total hip arthroplasty after acute femoral neck fracture in active patients. Prospective matched study with a minimum follow-up of 5 years].

    Science.gov (United States)

    Lizaur-Utrilla, A; Sanz-Reig, J; Miralles-Muñoz, F A

    2014-01-01

    To evaluate outcomes of cementless total hip replacement after acute femoral neck fracture in active patients. A prospective matched study was conducted to compare the results between 76 patients with fractures and 76 patients with osteoarthritis. The Harris score, short-WOMAC and SF-12 were used for the clinical assessment. The mean follow-up was 7.3 years (range 5-11). There were no significant differences in medical or surgical complications between the 2 groups. Functional outcomes were similar, but more walking aids were used in fracture group. There were 6 revisions among the fractures group (one dislocation, 2 deep infections, 3 aseptic loosening), and 2 aseptic loosening among controls. There was no significant difference in arthroplasty survival at 10 years (88.7 vs. 96.1%, P=.15). The mortality rates at 2 and 10 years were similar. Cementless total hip replacement for treatment of acute femoral neck fracture showed similar results to those of elective surgery for osteoarthritis in these selected patients. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  12. Influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations in total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    LI Yong-jiang; YANG Guo-jing; ZHANG Li-cheng; CAI Chun-yuan; WU Li-jun

    2010-01-01

    Objective: To study the influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations, which meets the criteria for desired range of motion (ROM) for activities of daily living in total hip arthroplasty (THA).Methods: Athree-dimensional generic, parametric and kinematic simulation module of THA was developed to analyze the cup safe-zone and the optimum combination of cup and neck antetorsion. A ROM of flexion≥ 120°, internal rotation ≥45° at 90° flexion, extension ≥30° and external rotation ≥ 40° was defined as the criteria for desired ROM for activities of daily living. The cup safe-zone was defined as the area that fulfills all the criteria of desired ROM before the neck impinged on the liner of the cup. For a fixed stemneck (CCD)-angle of 130°, theoretical safe-zones fulfilling the desired ROM were investigated at different general headneck ratios (GR=2, 2.17, 2.37, 2.61 and 2.92) and femoral anteversions (FA=0°, 10°, 20° and 30°).Results: Large GRs greatly increased the size of safezones and when the CCD-angle was 130°, a GR>2.37 could further increase the size of safe-zones. There was a complex interplay between the orientation angles of the femoral and acetabular components. When the CCD-angle was 130°, the optimum relationship between operative acetabular anteversion (OA) and femoral antetorsion (FA) could be estimated by the formula: OA=-0.80×FA+47.06, andthe minimum allowable operative acetabular inclination (OImin) would be more than 210.5×GR-2.255.Conclusions: Large GRs greatly increase the size of safe-zones and it is recommended that the GR be more than 2.37 so as to extend the acceptable range of error that surgeons cannot avoid completely during operation. As to the optimum operative acetabular inclination (OI), surgeons need to make a decision combining with other factors, including stress distribution, soft tissue and cup wear conditions, as well as patients' individual situations

  13. 磷酸钙骨水泥对股骨颈骨折内固定辅强作用的组织学评价%Histological evaluation of calcium phosphate cement in augmentation of femoral neck fracture fixation

    Institute of Scientific and Technical Information of China (English)

    张伟; 赵军; 胡春明; 李玉林; 森川圭造; 杉本友宏; 佐藤啓二; 丹羽滋郎; 徐莘香

    2006-01-01

    宿主骨的改变.主要观察指标:术后不同时间各组骨水泥周围新骨形成情况及宿主骨的变化.结果:实验选用45只成熟中国绵羊,全部进入结果分析.术后不同时间各组骨水泥周围新骨形成情况及宿主骨的变化:①非辅强组:术后3周在螺钉周围产生少量纤维组织,且宿主骨骨床有显微破坏,但显微破坏在术后6及12周时可见修复.②磷酸钙骨水泥辅强组:术后3,6,12周磷酸钙骨水泥充满于螺钉和宿主骨之间,而且磷酸钙骨水泥表面有新骨形成,在新骨和磷酸钙骨水泥之间没有纤维组织介入.在术后12周可见大量新骨形成,且见许多骨小管.③聚甲基丙烯酸甲酯辅强组:术后3周在骨床与聚甲基丙烯酸甲酯之间产生大量纤维组织,可见明显骨吸收,术后6及12周尤为明显.结论:由于磷酸钙骨水泥具有良好的组织相容性、骨传导性及自身改建能力,因此对股骨颈骨折提供了长期有益的辅强作用.%BACKGROUND: Structural characteristics of calcium phosphate cement (CPC) offer substantial mechanical integrity for fracture stabilization and fixation during the healing process, with particular applications in mechanically compromised osteoporotic bone.OBJECTIVE: To investigate the mechanism of the augmentation to fixation with CPC, comparing with screw fixation augmented by polymenthymethacrylate (PMMA) bone cement or with unaugmented screw fixation for femoral neck fractures in sheep by histological evaluation.DESIGN: Randomized controlled, duplicated observation and opening study.SETTING: Departments of Orthopeadics and General Surgery, the First Hospital of Jilin University; Department of Pathology, Basic Medical College of Jilin University; Department of Plastic Surgery, Aichi Medical University of Japan.MATERIALS: The experiment was completed in the Taonan Municipal Hospital of Jilin, Jilin University and Aichi Medical University of Japan from January 1999 to January 2004. A

  14. Expanding the utility of modified vascularized femoral periosteal bone-flaps: An analysis of its form and a comparison with a conventional-bone-graft

    Science.gov (United States)

    Hamada, Yoshitaka; Hibino, Naohito; Kobayashi, Anna

    2014-01-01

    Background Vascularized medial femoral condyle (MFC) corticoperiosteal bone-flap is a well-accepted technique when dealing with tissue defects or infection. Its role in refractory conditions and in the possible use for options concerning modifications of this bone-flap compared to a conventional iliac bone graft (conventional-graft) are rarely discussed. Methods We reviewed 21 consecutive cases concerning alternatives with some modifications of original MFC bone-flap surgery used to treat refractory conditions with bone defects, necrosis, or infection in the extremities. We present our devised approaches for this boneflap, and especially modifications of the grafted bone (including strut bone, perforator to the vastus medialis muscle, and the use of one vascular pedicle for some bone flaps) as well as the combined use of artificial bone as hybrid bone transplantation. We also compared the clinical results of 21 cases that received a conventional-graft. Results and Conclusions Following flap placement, 100% of the nonunion sites healed in an average of 2 months, which was significantly shorter than 5.5 months for the conventional-graft. The results showed the expanding possibility for options with regard to the form and options of this bone-flap as well as the shortening the duration of treatment, especially at the site of an infected distal tibia, insertion of the Achilles tendon on the posterior aspect of calcaneal osteomyelitis, distal end of the clavicle, clavicle or forearm with a bone defect, small bones with refractory conditions, and a femur without implant failure. However, it was not efficient for treating a forearm without bone defect. PMID:25983463

  15. The association between metabolic syndrome, bone mineral density, hip bone geometry and fracture risk: The Rotterdam study

    NARCIS (Netherlands)

    T. Muka (Taulant); K. Trajanoska (Katerina); J.C. Kiefte-de Jong (Jessica); L. Oei (Ling); A.G. Uitterlinden (André); A. Hofman (Albert); A. Dehghan (Abbas); M.C. Zillikens (Carola); O.H. Franco (Oscar); F. Rivadeneira Ramirez (Fernando)

    2015-01-01

    textabstractThe association between metabolic syndrome (MS) and bone health remains unclear. We aimed to study the association between MS and hip bone geometry (HBG), femoral neck bone mineral density (FN-BMD), and the risk of osteoporosis and incident fractures. Data of 2040 women and 1510 men part

  16. The association between metabolic syndrome, bone mineral density, hip bone geometry and fracture risk: The Rotterdam study

    NARCIS (Netherlands)

    T. Muka (Taulant); K. Trajanoska (Katerina); J.C. Kiefte-de Jong (Jessica); L. Oei (Ling); A.G. Uitterlinden (André); A. Hofman (Albert); A. Dehghan (Abbas); M.C. Zillikens (Carola); O.H. Franco (Oscar); F. Rivadeneira Ramirez (Fernando)

    2015-01-01

    textabstractThe association between metabolic syndrome (MS) and bone health remains unclear. We aimed to study the association between MS and hip bone geometry (HBG), femoral neck bone mineral density (FN-BMD), and the risk of osteoporosis and incident fractures. Data of 2040 women and 1510 men part

  17. 股骨颈骨折空心加压螺钉内固定后股骨头坏死分析%Cannulated Compression Screws for the Treatment of Adult Femoral Neck Fractures Clinical Analy-sis of Risk Factors for Avascular Necrosis of the Femoral Head

    Institute of Scientific and Technical Information of China (English)

    顾小明; 黄立新

    2014-01-01

    -low screws fixation is a satisfying treatment of femoral neck fractures as it brings a low rate of femoral head necrosis and the op-eration is easy to carry out since it has a low requirement on technology and produces less trauma. For those senior femoral neck fracture patients who have good body condition,longer life expectancy and no bone displacement or only slight bone dis-placement,or for those young femoral neck fractures patients,compressed hollow screws fixation is their top priority.%目的:探讨成人股骨颈骨折空心加压螺钉内固定术后股骨头坏死的相关因素,为临床治疗决策提供参考。方法回顾分析2001年1月1日至2010年12月31日期间采用空心加压螺钉内固定手术患者,对年龄、性别、骨折类型( Garden分型)、手术复位质量( Garden指数)、受伤至手术时间间隔,复位方式(切开或闭合复位)、术后开始部分负重时间,内固定是否取出8个因素进行统计分析,筛选出差异有统计学意义的因素,然后对各单因素运用logistic多因素回归分析。结果其中有完整随访资料的185例,随访3~10年,平均5.5年,其中28例发生股骨头缺血坏死,坏死率15.14%,影响股骨头坏死的独立因素分别为:骨折类型,骨折复位质量,受伤至手术时间,术后开始部分负重的时间。结论空心加压螺钉治疗股骨颈骨折主要并发症是股骨头缺血性坏死,骨折类型、骨折复位质量、受伤至手术时间、术后开始部分负重的时间是发生股骨头坏死的主要危险因素。其中复位质量、受伤至手术时间、术后开始部分负重的时间是可控的因素,尽早手术复位骨折内固定,提高骨折复位质量,内固定3个月后开始部分负重均能降低股骨头缺血性坏死的发生。现有资料显示,空心加压螺钉内固定治疗股骨颈骨折的总体疗效满意,股骨头坏死率低,手术简单易行,技术要求

  18. Glucocorticoids Significantly Influence the Transcriptome of Bone Microvascular Endothelial Cells of Human Femoral Head

    Institute of Scientific and Technical Information of China (English)

    Qing-Sheng Yu; Wan-Shou Guo; Li-Ming Cheng; Yu-Feng Lu; Jian-Ying Shen; Ping Li

    2015-01-01

    Background:Appropriate expression and regulation of the transcriptome,which mainly comprise ofmRNAs and lncRNAs,are important for all biological and cellular processes including the physiological activities of bone microvascular endothelial cells (BMECs).Through an intricate intracellular signaling systems,the transcriptome regulates the pharmacological response of the cells.Although studies have elucidated the impact of glucocorticoids (GCs) cell-specific gene expression signatures,it remains necessary to comprehensively characterize the impact of lncRNAs to transcriptional changes.Methods:BMECs were divided into two groups.One was treated with GCs and the other left untreated as a paired control.Differential expression was analyzed with GeneSpring software V12.0 (Agilent,Santa Clara,CA,USA) and hierarchical clustering was conducted using Cluster 3.0 software.The Gene Ontology (GO) analysis was performed with Molecular Annotation System provided by CapitalBio Corporation.Results:Our results highlight the involvement of genes implicated in development,differentiation and apoptosis following GC stimulation.Elucidation of differential gene expression emphasizes the importance of regulatory gene networks induced by GCs.We identified 73 up-regulated and 166 down-regulated long noncoding RNAs,the expression of 107 of which significantly correlated with 172 mRNAs induced by hydrocortisone.Conclusions:Transcriptome analysis of BMECs from human samples was performed to identify specific gene networks induced by GCs.Our results identified complex RNA crosstalk underlying the pathogenesis of steroid-induced necrosis of femoral head.

  19. High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup.

    Science.gov (United States)

    Van Houwelingen, Andrew P; Duncan, Clive P; Masri, Bassam A; Greidanus, Nelson V; Garbuz, Donald S

    2013-02-01

    Currently, the two most commonly used options for the revision of femoral components in North America are: cylindrical, nonmodular, cobalt-chromium stems and tapered, fluted, modular, titanium (TFMT) stems. Previous reports have cited high failure rates with cylindrical cobalt chrome stems in large femoral defects but the longer term survival of the fluted stems is unknown. We examined the 5- to 10-year survival of TFMT stems implanted for severe femoral defects. We reviewed all 65 patients with severe proximal bone defects revised with the TMFT stem between January 2000 and 2006. Ten were lost to followup and seven were dead, leaving 48 patients for followup at 5 to 10 years (mean, 84 months; range, 60-120 months). All patients completed five quality-of-life (QOL) questionnaires. Radiographs were evaluated for loosening, subsidence, and preservation of proximal host bone stock. Implant survivorship was 90%. No patient underwent revision for either subsidence or loosening. Subsidence occurred in seven patients (average, 12.3 mm) but all achieved secondary stability. Five patients underwent revision as a result of fracture of the stem and all had the original standard stem design, which has since been modified. All five implant fractures occurred at the modular stem junction. Mean QOL outcomes were: WOMAC = 81 (pain), Oxford = 75, SF-12 = 54 (mental) and 38 (physical), UCLA Activity = 4, and satisfaction overall = 73. Midterm survivorship of modular titanium stems in large femoral defects is high; however, ongoing surveillance of stem junctional fatigue life is required. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  20. Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion

    Institute of Scientific and Technical Information of China (English)

    YAN Zuo-qin; CHEN Yun-su; LI Wen-jun; YANG Yi; HUO Jian-zhong; CHEN Zheng-rong; SHI Jian-hui; GE Jun-bo

    2006-01-01

    Objective:To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell (BMCs) infusion.Methods: 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages.Results: No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱ in 15 hips, stage Ⅲ in 14hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6hips, stage Ⅱ in 13 hips, stage Ⅲ in 13 hips, stage Ⅳ in 7hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 (46-89), and improved to 86 (70-94)postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %.Conclusions: Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.

  1. Static bone cavity in the condylar neck and mandibular notch of the mandible.

    Science.gov (United States)

    Minowa, K; Kobayashi, I; Matsuda, A; Ohmori, K; Kurokawa, Y; Inoue, N; Totsuka, Y; Nakamura, M

    2009-03-01

    This study presents the radiographic findings of two cases of static bone cavity in the inferior aspect of the condylar neck and mandibular notch of the mandible. On plain CT, a soft tissue mass was observed in each cavity. The submandibular gland and the other glands were not found in each cavity. On contrast-enhanced CT, the soft tissue in the cavity in the inferior aspect of the condylar neck had marked linear enhancement and dilated vasculature structure was observed in the cavity. On the contrast-enhanced MRI, the soft tissue in the cavity of the mandibular notch had marked enhancement and flow void was detected in the cavity. In the inferior aspect of the condylar neck, the cavity size had enlarged radiographically over a period of three years. Vascular lesions were found in the cavity located in the inferior aspect of the condylar neck and mandibular notch of the mandible by both CT and MRI. The vascular lesion might explain the enlargement of the static bone cavity.

  2. Early postoperative bone scintigraphy in the evaluation of microvascular bone grafts in head and neck reconstruction

    Directory of Open Access Journals (Sweden)

    Poissonnet Gilles

    2007-04-01

    Full Text Available Abstract Background Bone scintigraphy was performed to monitor anastomotic patency and bone viability. Methods In this retrospective study, bone scans were carried out during the first three postoperative days in a series of 60 patients who underwent microvascular bone grafting for reconstruction of the mandible or maxilla. Results In our series, early bone scans detected a compromised vascular supply to the bone with high accuracy (p Conclusion When performing bone scintigraphy during the first three postoperative days, it not only helps to detect complications with high accuracy, as described in earlier studies, but it is also an additional reliable monitoring tool to decide whether or not microvascular revision surgery should be performed. Bone scans were especially useful in buried free flaps where early postoperative monitoring depended exclusively on scans. According to our experience, we recommend bone scans as soon as possible after surgery and immediately in cases suspicious of vascularized bone graft failure.

  3. Correção da falha óssea femoral e tibial pelo método do transporte ósseo de Ilizarov Femoral and tibial bone loss correction using Ilizarov's bone transport

    Directory of Open Access Journals (Sweden)

    Celso Herminio Ferraz Picado

    2000-12-01

    pacientes ficaram satisfeitos com o resultado do tratamento. Concluímos que a resposta biológica ao transporte ósseo é formidável, com a formação do regenerado reparando grandes falhas ósseas. Entretanto, consideramos que o aparelho circular externo preconizado por Ilizarov traz consigo diversas complicações principalmente relacionadas a presença dos fios transfixantes, causando sofrimento para os pacientes, principalmente quando instalados no fêmur.Eleven patients carrying diaphyseal bone fissure secondary to ressection of infected bone segments, 5 in the femur and 6 in the tibia, submitted to the Ilizarov bone transport technique were retrospectively analyzed. In the group of patients with femoral lesion the bone fissure varied from 7 cm to 12 cm, and in two there was a 2 cm shortening of the limb. In the group with tibial lesion the bone fissure varied from 2.5 cm to 10 cm, with limb shortening in two patients, respectively 1.5 cm and 2 cm. The mean follow-up period since the end of the treatment until evaluation was 49 months for the femoral lesion patients and 28.3 months for the tibial lesion patients. The femoral transports were bifocal and the tibial transports were bifocal in 4 patients and trifocal in 2. In all, patients formation of regenerate occurred. Consolidation of the target focus was naturally obtained in 7 patients; one patient needed bone grafting to obtain the focus consolidation. In three patients the nonunion of the target focus demanded modification of the treatment method with the external circular fixator withdrawal. In all the patients infection adjacent to the wires was observed. There was rupture of the wires in all assemblies made in the thigh. All the wires lost the tension initially imposed to them. Two patients submitted to femoral transport evolved with septic arthritis of the knee. Mobility of the knee was severely impaired in the patients submitted to femoral transport, and the same was observed in relation to the ankle of

  4. Treatment of osteonecrosis of femoral head with BMSCs-seeded bio-derived bone materials combined with rhBMP-2 in rabbits

    Institute of Scientific and Technical Information of China (English)

    XIAO Zeng-ming; JIANG Hua; ZHAN Xin-li; WU Zhen-guo; ZHANG Xing-lin

    2008-01-01

    Objective: To evaluate the effect of autologous bone marrow mesenchymal stem cells (BMSCs) seeded bio-derived bone materials (BBM) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) in repairing defect of osteonecrosis of femoral head (ONFH). Methods: Early-stage osteonecrosis in the left hip was induced in 36 adult New Zealand white rabbits (provided by the Animal Center of Guangxi Medical University, Nanning, China) after core decompression and delivery of liquid nitrogen into the femoral head. Then the animals were divided into three groups according to the type of implants for bone repair: 12 rabbits with nothing (GroupⅠ, the blank control group), 12 with BBM combined with rhBMP-2 (Group Ⅱ), and 12 with BMSCs-seeded BBM combined with rhBMP-2 (Group Ⅲ). At 4, 8, and 12 weeks after surgery, X-ray of the femoral head of every 4 rabbits in each group was taken, and then they were killed and the femoral heads were collected at each time point, respectively. Gross observation was made on the femoral heads. After hematoxylin and eosin staining, Lane-sandhu scores of X-ray and bone densitometry were calculated and the histomorphometric measurements were made for the new bone trabeculae. Results: At 12 weeks after surgery, two femoral heads collapsed in GroupⅠ, but none in Group Ⅱor Group Ⅲ. X-ray examination showed that the femoral heads in Group Ⅰ had defect shadow or collapsed while those in Group Ⅱ had a low density and those in Group Ⅲ presented with a normal density. Histologically, the defects of femoral heads were primarily filled with no new bone but fibrous tissues in Group Ⅰ. In contrast, new bone regeneration and fibrous tissues occurred in Group Ⅱ and only new bone regeneration occurrd in Group Ⅲ. Lane-sandhu scores of X-ray, bone mineral density and rate of new bone in trabecular area in Group Ⅲ were higher signifIcantly than those of the other two groups. Conclusions: Our findings indicate a superior choice of

  5. Influence of bone density and surgical treatment choice on failure of femoral neck fracture

    DEFF Research Database (Denmark)

    Viberg, Bjarke

    gender, and with some uncemented stem designs. One of the papers in thesis finds a higher failure rate for older uncemented HA compared to cemented HA, especially after 5-10 years. The uncemented HA do not seem to benefit from hydroxy-apatite coating when failure rates for the uncemented HA were compared...

  6. A Modified Technique of Fixation for Proximal Femoral Valgus Osteotomy in Abnormal Bone: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Logheswaren S

    2017-07-01

    Full Text Available The ideal size of intramedullary device to fix corrective osteotomy of proximal femur in abnormal bone in children and small patients may not be easily available. We report the successful use of Rush rod in combination with multiple Kirschner wires to fix the corrective osteotomy of coxa vara and shepherd crook deformity in two patients with osteogenesis imperfecta and fibrous dysplasia. The union was achieved on time, neck shaft angle and rotation were maintained.

  7. Short-Stem Hip Arthroplasty as a Solution for limited Proximal Femoral Bone Stock

    Directory of Open Access Journals (Sweden)

    Ai E Gamboa

    2015-08-01

    Full Text Available We describe an uncommon scenario where the femoral diaphysis was subjugated by previous long stemmed revision knee replacements limiting options for primary hip arthroplasty. A  short stemmed pressfit femoral componet was implanted bilaterally. At 11 years the implants remain stable with improved clinical function. This case emphasizes the importance of preoperative templating and  the utility of considering the use of unconventional stems in the management of unusual situations.

  8. Analysis of Comfort Nursing on Patients With Femoral Neck Fracture%舒适护理对股骨颈骨折患者的影响分析

    Institute of Scientific and Technical Information of China (English)

    尚美佳

    2016-01-01

    ObjectiveComfort nursing methods and its effect on patients with femoral neck fracture are to be studied.MethodsChose 78 patients with femoral neck fracture who were treated in hospital from September 2014 to November 2015 and separated them into two groups randomly,44 patients in study group were given comfort nursing,while another 34 patients in control group were given conventional nursingand then compared nursing effects and patients’ recovery conditions between two groups.ResultsPatients’ nursing efficacy in study group was 95.45%,which was much higher than 82.35% in control group. There was a differential between two groups and such a differential had statistic value(P<0.05).Conclusion Comfort nursing is quite effective on patients with femoral neck fracture; it is conducive to increasing patients’satisfaction,reducing physical uncomfortable feeling and keeping them in good mood.%目的:探究股骨颈骨折患者采取舒适护理的措施和效果。方法选取我院在2014年9月~2015年11月收治的78例股骨颈骨折患者,随机分组,实验组44例患者采取舒适护理,对照组34例患者选择常规护理,比较两组患者的护理效果和身体恢复情况。结果实验组患者护理有效率为95.45%,对照组患者护理有效率为82.35%,实验组患者的护理效果更优,差异有统计学意义(P<0.05)。结论股骨颈骨折患者采取舒适护理可促使治疗效果以及护理满意度提高,效果好,减轻身体不适,保持良好的心理状态。

  9. 老年股骨颈骨折的护理体会%Nursing care experiences on femoral neck fractures in older people

    Institute of Scientific and Technical Information of China (English)

    彭海容

    2011-01-01

    目的 探讨老年股骨颈骨折的护理效果及护理措施.方法 对2005年6月-2010年1月间在我院接受诊治的老年股骨颈骨折患者42例实施全面的护理措施.结果 经系统的手术治疗及护理,本组42例均获得临床痊愈,平均住院(26.20±2.52)d.本组共发生围手术期并发症4例,发生率为9.52%,其中肺部感染2例,泌尿道感染1例,切口感染1例.随访6个月~5年,所有患者康复良好.结论 全面的护理在老年股骨颈骨折患者围手术期中具有重要的作用.%Objective To investigate the effect and measure of nursing care to femoral neck fractures in older people. Methods 42 older patients with femoral neck fractures in our hospital from June 2005 to January 2010 received the comprehensive care. Results 42 cases got the clinical healing and the average length of stay was ( 26.20±2.52)days by the comprehensive care and treatment. There were 4 cases with perioperative complications and the rate was 9.52%,and there were 2 cases with pulmonary infection,1 case with urinary tract infection, 1 case with postoperative infection. All of them were recovered well by following-up for 6 months to 5 years. Conclusion The comprehensive care plays an important role on femoral neck fractures in older people during perioperative nursing.

  10. 老年股骨颈骨折患者的循证治疗分析%Evidence - based treatment for elderly patient with femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    彭昊; 帕力哈提·白克吐尔逊

    2011-01-01

    Objective To develop an evidence - based treatment for an elderly patient with femoral neck fracture.Method Based on the clinical question raised by a elderly patient with femoral neck fracture, we searched PubMed ( 2000 ~ 2010), Cochrane (2008.4), Medline ( 2000 ~ 2010), Embase ( 2000 ~ 2010) ,Trip database, Ovid database and ACP online journal for related systematic review, RCT and metaanalysis.Then the evidence was assessed to obtain high - quality evidence for clinical treatment.Results A total of 1 evidence -based guideline ,2 RCT,8 systematic reviews and 9 meta -analyses were included.Based on these data and conditions of the individual patient, an evidence - based treatment plan was developed.Conclusion Using an evidence -based method,a rational and safe treatment strategy can be drawn for elderly patient with femoral neck fracture.%目的 为老年股骨颈骨折患者制定偱证治疗方案.方法 在充分评估患者病情后,进行临床提问,计算机检索Cochrane图书馆(2008年4月),PubMed(2002年至2010年),Medline(2000年至2010年)和Embase(2000年至2010年),Trip database,Ovid database 和 ACP(American College of physicians) online journal 关于股骨颈骨折治疗的偱证临床指南,RCT(Randomized controlled trial),系统评价和Meta分析,并评价其质量,获取最佳证据用于临床治疗.结果 共检出关于股骨颈骨折的8篇系统评价,9篇Meta分析,1篇偱证治疗指南,2篇 RCT.结合患者实际情况,制定出偱证治疗方案.结论 采用偱证治疗方法,可为患者确定合理而安全的治疗方案.

  11. Hydrogel containing hepatocyte growth factor promotes the repair of femoral neck defects in rabbits%含肝细胞生长因子水凝胶修复家兔股骨颈部缺损

    Institute of Scientific and Technical Information of China (English)

    郭林; 甄瑞鑫; 赵德伟; 田丰德; 于晶; 朱瑞萍

    2014-01-01

    背景:肝细胞生长因子可促进骨组织再生,在骨组织修复方面有着巨大的潜力,但是在体内较短的半衰期限制了其在临床的应用。  目的:观察含有肝细胞生长因子的半合成细胞外基质样水凝胶体内促进股骨颈骨缺损修复的作用。  方法:取12只兔制作双侧股骨颈骨缺损模型,采用自体配对对比,左侧为对照侧不对骨缺损做任何处置,右侧为实验侧植入含有肝细胞生长因子的半合成细胞外基质样水凝胶。  结果与结论:苏木精-伊红染色见2周时实验侧缺损修复区血管分布较对照侧均匀;4周时实验侧缺损区均匀填充新生骨小梁,而对照侧由外向内骨小梁形成减少;8周时实验侧缺损区皮质骨形成,并且骨髓腔再通,有骨髓细胞填充,对照侧仍有粗大骨痂填充缺损区,堵塞髓腔。钼靶X射线观测到8周时,实验侧难以区分正常骨质与新生骨质交界线,而对照侧缺损区与周围骨质分界明显。证实含有肝细胞生长因子的半合成细胞外基质样水凝胶可以促进家兔股骨颈部骨缺损的骨组织修复。%BACKGROUND:Hepatocyte growth factor can promote bone regeneration and has a great potential in bone repair, but its shorter half-life in vivolimits its clinical application. OBJECTIVE:To observe the promoting effect of semisynthetic extracelular matrix-like hydrogel containing hepatocyte growth factor on the repair of femoral neck defectsin vivo. METHODS:Twelve rabbits were taken to make bilateral femoral neck defect models. Based on autologous paired comparison, the left side was control side without treatment, and the right side served as experimental side undergoing implantation of semisynthetic extracelular matrix-like hydrogel containing hepatocyte growth factor. RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed more uniform distribution of vessels in the defect area of the experimental

  12. Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011

    Directory of Open Access Journals (Sweden)

    Mohammad Javdan

    2013-01-01

    Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.

  13. Randomised trial comparing the transversus abdominis plane block posterior approach or quadratus lumborum block type I with femoral block for postoperative analgesia in femoral neck fracture, both ultrasound-guided.

    Science.gov (United States)

    Parras, T; Blanco, R

    2016-03-01

    A double-blind randomised controlled trial was conducted to compare the analgesic effect of the transversus abdominis plane block posterior approach or the quadratus lumborum block I versus femoral block, both ultrasound-guided. Prospective study with parallel groups with 104 patients with neck of femur fracture undergoing hemiarthroplasty (although 7 participants did not finish the study). The inclusion criteria were patients older than 65 years old, ASA I-III status, who required and gave their consent for hemiarthroplasty. The exclusion criteria were patients with known allergy to local anaesthetics, mental disability, peripheral neuropathy, a coagulopathy disorder, and those patients who received morphine, or a block was performed previous to the surgery. Each patient received one block followed by a spinal anaesthetic technique, performed by the anaesthetist. Pain was measured using a visual analogue score, sensory blockade using cold spray, and motor blockade, evaluating the leg movement. These were compared on arrival in recovery and at 6, 12, 18, and 24h later. Total opioid amount administered in 24 hours, duration of stay in post-anaesthesia care unit, patient satisfaction, and adverse effects were also recorded. A lower visual analogue score was observed in the quadratus lumborum block group at 6, 12, 18 and 24h (3.7, 1.4, 0.8, 0.7 versus 5.2, 4.6, 3.4, 2.6 in the femoral group, P<.01). Opioid use in 24h was lower in this group (9.7 versus 16.9mg in the femoral group, P<.01). The sensory and motor blockade, satisfaction, and adverse effects, were similar in both groups. Quadratus lumborum block is an effective analgesic option to be used in patients with neck of femur fracture. More clinical trials are required to validate this. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Potent effect of zinc acexamate on bone components in the femoral-metaphyseal tissues of elderly female rats.

    Science.gov (United States)

    Yamaguchi, M; Gao, Y H

    1998-03-01

    1. The effect of zinc compounds on bone components in the femoral-metaphyseal tissues from elderly female rats (50 weeks old) was investigated in vitro. Bone tissues were cultured for 24 hr in Dulbecco's modified Eagle medium containing either vehicle or zinc compounds (10[-7] to 10[-5] M). 2. Zinc content, alkaline phosphatase activity, deoxyribonucleic acid (DNA) and calcium contents in the metaphyseal tissues were significantly increased by the presence of zinc sulfate (10[-6] and 10[-5] M), beta-alanyl-L-histidinato zinc (AHZ; 10[-6] and 10[-5] M) and zinc acexamate (10[-7] to 10[-5] M). At 10[-5] M, the effect of zinc acexamate on the increase of bone components was more potent than that of zinc sulfate or AHZ. 3. The effect of zinc acexamate (10[-5] M) on the increase of alkaline phosphatase activity in the metaphyseal tissues was remarkable as compared with that of insulin (10[-8] M), estrogen (10[-9] M), insulin-like growth factor-I (10[-8] M), transforming growth factor-beta (10[-10] M), sodium fluoride (10[-3] M), dexamethasone (10[-7] M) and vitamin K2 (menaquinone-4; 10[-5] M) with an effective concentration. 4. The stimulatory effect of zinc acexamate (10[-5] M) on alkaline phosphatase activity and calcium content in the metaphyseal tissues was completely blocked by the presence of dipicolinate (10[-3] M), a chelator of zinc ion, and of cycloheximide (10[-6] M), an inhibitor of protein synthesis. 5. The present study demonstrates that zinc acexamate has a potent anabolic effect on bone components in the femoral-metaphyseal tissues from female elderly rats in vitro. The effect of zinc acexamate may be based in part on protein synthesis related to zinc ion in bone cells.

  15. The effect of deferoxamine on angiogenesis and bone repair in steroid-induced osteonecrosis of rabbit femoral heads.

    Science.gov (United States)

    Li, Jia; Fan, Lihong; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-02-01

    In this study, we examined whether local deferoxamine (DFO) administration can promote angiogenesis and bone repair in steroid-induced osteonecrosis of the femoral head (ONFH). Steroid-induced ONFH was induced in 65 mature male New Zealand white rabbits by methylprednisolone in combination with lipopolysaccharide. Six weeks later, the rabbits received no treatment (model group, N = 15), bilateral core decompression (CD group, N = 20) or CD in combination with local DFO administration (DFO group, N = 20). Six weeks after the surgery, vascularization in the femoral head was evaluated by ink artery infusion angiography and immunohistochemical staining for von Willebrand Factor (vWF). Bone repair was assessed by histologic analysis and micro-computed tomography (micro-CT). Immunohistochemical staining was performed to analyze the expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1α (HIF-1α), bone morphogenetic protein-2 (BMP-2), and osteocalcin (OCN). Ink artery infusion angiography and microvessel analysis by immuohistochemical staining for vWF showed more blood vessels in the DFO group than other groups. The expression of HIF-1α, VEGF, BMP-2, and OCN, indicated by immunohistochemical staining, was higher in the DFO group compared with other groups. Micro-CT scanning results indicated that the DFO group had larger volume of newly formed bone than the CD group. This work indicated that local DFO administration improved angiogenesis and bone repair of early stage ONFH in rabbit model, and it may offer an efficient, economic, and simple therapy for early stage ONFH.

  16. Pullulan/dextran/nHA macroporous composite beads for bone repair in a femoral condyle defect in rats.

    Directory of Open Access Journals (Sweden)

    Silke Schlaubitz

    Full Text Available The repair of bone defects is of particular interest for orthopedic, oral, maxillofacial, and dental surgery. Bone loss requiring reconstruction is conventionally addressed through bone grafting. Depending on the size and the location of the defect, this method has limits and risks. Biomaterials can offer an alternative and have features supporting bone repair. Here, we propose to evaluate the cellular penetration and bone formation of new macroporous beads based on pullulan/dextran that has been supplemented with nanocrystalline hydroxyapatite in a rat model. Cross-linked beads of 300-500 µm diameters were used in a lateral femoral condyle defect and analyzed by magnetic resonance imaging, micro-computed tomography, and histology in comparison to the empty defects 15, 30, and 70 days after implantation. Inflammation was absent for both conditions. For empty defects, cellularisation and mineralization started from the periphery of the defect. For the defects containing beads, cellular structures filling out the spaces between the scaffolds with increasing interconnectivity and trabecular-like organization were observed over time. The analysis of calcified sections showed increased mineralization over time for both conditions, but was more pronounced for the samples containing beads. Bone Mineral Density and Bone Mineral Content were both significantly higher at day 70 for the beads in comparison to empty defects as well as compared with earlier time points. Analysis of newly formed tissue around the beads showed an increase of osteoid tissue, measured as percentage of the defect surface. This study suggests that the use of beads for the repair of small size defects in bone may be expanded on to meet the clinical need for a ready-to-use fill-up material that can favor bone formation and mineralization, as well as promote vessel ingrowth into the defect site.

  17. Effects of different tunnel sizes of femoral head core decompression on femoral neck biomechanics%股骨头钻孔减压孔径对股骨颈生物力学影响的实验研究

    Institute of Scientific and Technical Information of China (English)

    何国忠; 庞清江; 陈先军; 余霄; 赵卫东

    2013-01-01

    Objective To observe the effects of different tunnel sizes of the femoral head core decompression on femoral neck biomechanics. Methods 24 fresh cadaver femur specimens were randomly divided into four groups: a normal group, a single-tunnel core decompression group (D=10 mm), a 2-tunnel core decompression group (D=7mm) and a 3- tunnel core decompression group (D=7mm). 3 points in main tension side, main pressure side and the lesser trochanter were chosen as the test points of strain from ON to 1200N load. Results The strain of the 2-tunnel group was the lowest among the normal group, the single-tunnel group, 2-tunnel group and 3-tunnel group; furthermore, the strain values of all of the 3 core decompression groups were larger than that in the normal group in tension side and the pressure side. Conclusions There is a significant effect on the femoral neck biomechanics by femoral head core decompression. The 2-tunnel (D= 7mm) with the lowest strain value may be the best choice to femoral head core decompression.%目的 观察经转子间股骨头减压钻孔的孔径对股骨颈生物力学的影响.方法 取新鲜尸体股骨标本24具,随机分成4组:正常组、单孔减压组(D=10 mm)、双孔减压组(D=7 mm)和3孔减压组(D=7 mm).在股骨颈主张力侧、主压力侧和小转子处各选择1点作为应变测试点,检测4组标本在,0~1200N分级载荷下各测点的应变.结果 在股骨颈主张力侧和主压力侧的测试点中,单孔减压组、双孔减压组和3孔减压组的应变值均大于正常组,其中双孔减压组的应变值在三组钻孔组间最小,并且与其它组间相比差异具有显著性(P<0.05).结论 经转子间股骨头钻孔减压明显影响股骨颈生物力学性能,与单纯大孔钻孔面积相同的2小孔钻孔减压对股骨颈生物力学性能影响较小.

  18. Hansson Pin 治疗股骨颈骨折的生物力学测试与临床应用分析%Biomechanical Experiment and Clinical Application of Hansson Pin for the Treatment of Femoral Neck Fracture

    Institute of Scientific and Technical Information of China (English)

    林博文; 肖德明; 黎伟凡; 麦汉溪; 朱杰诚; 曾纪葵

    2001-01-01

    目的 探讨HanssonPin治疗股骨颈骨折的疗效。方法 临床治疗39例,并作生物力学测试。结果 全部病例得到随访,时间4~36个月,平均23个月。骨性愈合31例,其中12例有滑针、股骨颈缩短表现,半年内出现滑针、塌陷移位3例;股骨头缺血性坏死5例。生物力学性能显示HanssonPin的承力效果优于骨圆针。结论 HanssonPin作为股骨颈内固定操作简单,但术后早期负重行走滑针率较高。%Objective To investigate the clinical therapeatic effectivenessof the femoral neck fracture treated by Hansson pin and biomechanical test was carried out in cadaveri femoral specimens.Methods Thirty-nine cases of femoral neck fracture were treated by Hansson Pin and biomechanical test was carried out in cadaveri femoral specimens.Results All patients were foll owed up for an average duration of 23 months.The results show that 31 cases healed up, as a result of pins sliding, so that femoral neck was shortening in 12 cases; femoral head collapsed was found in 3 cases and ischemic necrosis of femoral head appeared in 5 cases . The biomechanical character of Hansson pin is only better than round pin.Conclusion Hansson pinis easy to be used , but the rate of sliding pin is 38.46%,which is resulted from allowing the patient to wear early

  19. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research.

    Science.gov (United States)

    Shane, Elizabeth; Burr, David; Ebeling, Peter R; Abrahamsen, Bo; Adler, Robert A; Brown, Thomas D; Cheung, Angela M; Cosman, Felicia; Curtis, Jeffrey R; Dell, Richard; Dempster, David; Einhorn, Thomas A; Genant, Harry K; Geusens, Piet; Klaushofer, Klaus; Koval, Kenneth; Lane, Joseph M; McKiernan, Fergus; McKinney, Ross; Ng, Alvin; Nieves, Jeri; O'Keefe, Regis; Papapoulos, Socrates; Sen, Howe Tet; van der Meulen, Marjolein C H; Weinstein, Robert S; Whyte, Michael

    2010-11-01

    Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of

  20. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    DEFF Research Database (Denmark)

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael

    2009-01-01

    BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral......, and rate of reoperation within the first year. In a subgroup of 50 randomly selected patients, reliability tests for measurement of posterior tilt were performed. RESULTS: Intra- and interclass coefficients for the new measurement were > or = 0.94. 23% (26/113) of patients were reoperated and increased...... score, time from admission to operation, surgeon's expertise, postoperative reduction, and implant positioning, a preoperative posterior tilt of > or = 20 degrees was the only significant predictor of reoperation (p measurement for posterior tilt appears to be reliable...

  1. Indications for the microvascular medial femoral condylar flap in craniomaxillofacial surgery.

    Science.gov (United States)

    Thiele, Oliver Christian; Kremer, Thomas; Kneser, Ulrich; Mischkowski, Robert Andreas

    2014-07-01

    The medial femoral condylar flap makes it possible to reconstruct bone, cartilage, and skin, but elongation of the pedicle is usually required to bridge the distances to the vascular connections in the neck. The indications in the maxillofacial area include reconstruction of the temporomandibular joint (TMJ), pseudarthrosis of the jaws, osteonecrosis of the jaws and skull, and augmentation of bone in irradiated or otherwise compromised tissue. If small bony defects require safe and reliable osseous, osteochondral, or osteocutaneous reconstruction, the medial femoral condylar flap can be used to fill the gap between small avascular, and larger microvascular, bone transplants.

  2. Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study

    Science.gov (United States)

    Dong, Chenhui; Wang, Yunjiao; Wang, Ziming; Wang, Yu; Wu, Siyu; Du, Quanyin; Wang, Aimin

    2016-01-01

    Background Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients. Methods In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained. Results Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3–10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups. Conclusion In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events. PMID:27149117

  3. Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Chenhui Dong

    Full Text Available Chronic renal failure (CRF predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO aids to adjust and optimize the overall condition of patients.In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained.Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18 or delayed (3-10 days; n = 10 surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10. During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group, mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups.In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events.

  4. Osteoporosis and low bone mass at the femur neck or lumbar spine in older adults: United States, 2005-2008

    Science.gov (United States)

    Many current clinical guidelines recommend that assessment of osteoporosis or low bone mass, as defined by the World Health Organization (WHO) (1), be based on bone mineral density at either the femur neck region of the proximal femur (hip) or the lumbar spine (2,3). This data brief presents the mos...

  5. SHORT TERM RESULTS OF MUSCLE PEDICLE BONE GRAFT (MPBG IN FRACTURE NECK FEMUR: A CASE SERIES OF 7 CASES

    Directory of Open Access Journals (Sweden)

    Sarabjeet

    2016-03-01

    Full Text Available INTRODUCTION Neglected, untreated and delayed neck femur fractures are commonly encountered fractures and the treatment dilemma arises specially when the patient is physiologically young and osteosynthesis is the preferred option. Past literature creates confusion as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularised fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata (TFL and Quadratus femoris graft and vascularised bone grafting do not have clear lines of indications. We present a series of fracture neck femur cases, each with delayed presentation beyond the vascular emergency period, which were treated with osteosynthesis with MPBG using tensor fascia lata muscle pedicle graft.

  6. 吻合血管腓骨移植治疗陈旧性股骨颈骨折%Treatment of Non-union Femoral Neck Fractures with Vascularized Fibula Grafting

    Institute of Scientific and Technical Information of China (English)

    王春生; 王坤正; 党晓谦; 陈君长; 张开放; 金辽沙

    2003-01-01

    Objective: To investigate the value of transplantation of vascularized fibula intreating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Meth-ods:Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck.The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results:Onehundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibulagraft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3and 81.6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impacton the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral headand preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the af-fected femoral head and neck, could promote the femoral head restoration and reconstruction. In addi-tion, the periosteum of fibula plays a role in fracture healing.%目的:了解吻合血管腓骨移植治疗陈旧性股骨颈骨折和预防股骨头坏死的效果.方法:带血管腓骨移植到股骨颈的前外侧,腓动静脉与旋股外动静脉吻合.结果:1982~2002年间共吻合血管腓骨移植治疗陈旧性股骨颈骨折129例.获得随访89例,随访时间3~19年,随访患者进行X线和功能检查.按骨折愈合和功能情况分析,有效率和良好率分别是95.4%和85.1%.结论:对股骨颈骨折,腓骨有协同固定作用,对股骨头坏死腓骨作为皮质骨有支撑和防止塌陷的作用,吻合的腓骨血管为股骨头颈部提供血供,促进了股骨颈骨折的愈合和股骨头的恢复与重建.腓骨骨膜在骨折的愈合中可能起一定的作用.

  7. Microindentation for in vivo measurement of bone tissue material properties in atypical femoral fracture patients and controls.

    Science.gov (United States)

    Güerri-Fernández, Roberto C; Nogués, Xavier; Quesada Gómez, José M; Torres Del Pliego, Elisa; Puig, Lluís; García-Giralt, Natalia; Yoskovitz, Guy; Mellibovsky, Leonardo; Hansma, Paul K; Díez-Pérez, Adolfo

    2013-01-01

    Atypical femoral fractures (AFF) associated with long-term bisphosphonates (LTB) are a growing concern. Their etiology is unknown, but bone material properties might be deteriorated. In an AFF series, we analyzed the bone material properties by microindentation. Four groups of patients were included: 6 AFF, 38 typical osteoporotic fractures, 6 LTB, and 20 controls without fracture. Neither typical osteoporotic fractures nor controls have received any antiosteoporotic medication. A general laboratory workup, bone densitometry by dual-energy X-ray absorptiometry (DXA), and microindentation testing at the tibia were done in all patients. Total indentation distance (Total ID), indentation distance increase (IDI), and creep indentation distance (Creep ID) were measured (microns). Age-adjusted analysis of covariance (ANCOVA) was used for comparisons. Controls were significantly younger than fracture groups. Bisphosphonate exposure was on average 5.5 years (range 5 to 12 years) for the AFF and 5.4 years (range 5 to 8 years) for the LTB groups. Total ID (microns) showed better material properties (lower Total ID) for controls 36 (± 6; mean ± SD) than for AFF 46 (± 4) and for typical femoral fractures 47 (± 13), respectively. Patients on LTB showed values between controls and fractures, 38 (± 4), although not significantly different from any of the other three groups. IDI values showed a similar pattern 13 (± 2), 16 (± 6), 19 (± 3), and 18 (± 5). After adjusting by age, significant differences were seen between controls and typical (p Creep ID between groups. Our data suggest that patients with AFF have a deep deterioration in bone material properties at a tissue level similar to that for the osteoporotic fracture group. The LTB group shows levels that are in between controls and both type of fractures, although not statistically different. These results suggest that bisphosphonate therapy probably does not put the majority of patients at risk

  8. 股骨颈关节囊内骨样骨瘤的临床及影像特点%Clinical and imaging features of intra-articular osteoid osteoma in the femoral neck

    Institute of Scientific and Technical Information of China (English)

    曾泳瀚; 程晓光; 栾贻新; 顾翔; 李江涛

    2012-01-01

    Objective To evaluate the clinical and imaging characteristics of osteoid osteoma in femoral neck and to improve diagnostic accuracy of this disease.Methods Twenty-one patients (18 males and 3 females,age,7-26 years,median age,13 years) with pathologically proven osteoid osteoma of the femoral neck were retrospectively analyzed for their clinical profile and radiologic features.CT and X-ray examinations were performed in all patients,10 of them pefformed post-contrast CT scan and 4 of them performed MRI examinations.Results Nineteen patients had hip pain (pain worse at night in 11,and 8 received salicylates treatment with good response),and 2 patients only with intermittent claudication.The duration ranged from 2 months to 54 months (median duration 12 months).X-ray: Nidus was seen on plain film in 10 cases,18 cases showed different degrees of bone sclerosis of the nidus.CT: Nidus was demonstrated in all cases.Among them,8 were intracortical,6 were subperiosteal,7 were endosteal.Twenty cases showed different degrees of bone sclerosis of the nidus-extra-articular anteromedial cortical surface of the femur neck.Nineteen cases showed "vascular groove sign".MRI: Nidus was seen in 4 cases.Bone sclerosis was low signal on all sequences.Three cases had joint effusion,4 cases had bone marrow edema,and 2 cases had synovial thickening.Conclusions Although osteoid osteoma of femoral neck has non-specific clinical features,the radiographic findings are usually typical.The nidus of osteoid osteoma is often located within the joint.Bony sclerosis occurs at the area of extra-articular anteromedial cortical surface of the femur neck.CT examination remains an optimal method to identify the nidus.%目的 分析股骨颈骨样骨瘤的临床及影像特点,提高对本病的诊断水平.方法 回顾性分析21例经手术病理证实的股骨颈骨样骨瘤的临床及影像学资料.其中男18例、女3例;年龄7~26岁,中位年龄13岁.所有病例均行常规X线及CT检

  9. Osteotomia femoral em cúpula para correção do ângulo de inclinação do colo do fémur Femoral cupola osteotomy for correction of femoral neck inclination angle

    Directory of Open Access Journals (Sweden)

    Paulo lamaguti

    1996-04-01

    Full Text Available Utilizou-se a osteotomia femoral em cúpula em um cão que apresentava aumento do ângulo de inclinação do colo do fêmur e subluxação da articulação coxofemoral. A linha de osteotomia situou-se cerca de 1 cm distal ao trocanter menor, no sentido látero-medial. Para a imobilização utilizou-se um fio de Steinmann passando pelo trocanter maior e por toda a extensão do fêmur. Um fio de aço foi colocado em orifícios ósseos produzidos nos segmentos proximal e distal do fêmur para a realização de sutura óssea. A técnica empregada culminou em: diminuição de 35° no ângulo de inclinação, rebaixamento da cabeça do fêmur, elevação do trocanter maior, congruência da articulação e encurtamento de 3cm do membro. A consolidação ocorreu cerca de 90 dias após a cirurgia.Femoral cupola osteotomy was performed in a dog with a large femoral inclination angie and hip subluxation. Osteotomy owas performed 1 cm distal to the lesser trochanter from lateral to medial cortex. Immobilization was performed owith a Steinamnnpin drivenfrom the greater trochanter and through two boles drilled proximal and distal to the osteotomy line. The technique produced: 35° decrease on inclination angle, lowering of the femoral head, elevation of the greater trochanter, congruity of the hip and 3cm limb shortening. Consolidation occured 90 days after the surgery.

  10. The Fate and Distribution of Autologous Bone Marrow Mesenchymal Stem Cells with Intra-Arterial Infusion in Osteonecrosis of the Femoral Head in Dogs

    Directory of Open Access Journals (Sweden)

    Hongting Jin

    2016-01-01

    Full Text Available This study aimed to investigate if autologous bone marrow mesenchymal stem cells (MSCs could treat osteonecrosis of the femoral head (ONFH and what the fate and distribution of the cells are in dogs. Twelve Beagle dogs were randomly divided into two groups: MSCs group and SHAM operated group. After three weeks, dogs in MSCs group and SHAM operated group were intra-arterially injected with autologous MSCs and 0.9% normal saline, respectively. Eight weeks after treatment, the necrotic volume of the femoral heads was significantly reduced in MSCs group. Moreover, the trabecular bone volume was increased and the empty lacunae rate was decreased in MSCs group. In addition, the BrdU-positive MSCs were unevenly distributed in femoral heads and various vital organs. But no obvious abnormalities were observed. Furthermore, most of BrdU-positive MSCs in necrotic region expressed osteocalcin in MSCs group and a few expressed peroxisome proliferator-activated receptor-γ (PPAR-γ. Taken together, these data indicated that intra-arterially infused MSCs could migrate into the necrotic field of femoral heads and differentiate into osteoblasts, thus improving the necrosis of femoral heads. It suggests that intra-arterial infusion of autologous MSCs might be a feasible and relatively safe method for the treatment of femoral head necrosis.

  11. Evaluation of rhBMP-2/collagen/TCP-HA bone graft with and without bone marrow cells in the canine femoral multi defect model.

    Science.gov (United States)

    Luangphakdy, V; Shinohara, K; Pan, H; Boehm, C; Samaranska, A; Muschler, G F

    2015-01-12

    Recombinant human bone morphogenetic protein-2, when applied to an absorbable type 1 bovine collagen sponge (rhBMP-2/ACS) is an effective therapy in many bone grafting settings. Bone marrow aspirate (BMA) has also been used as a source of transplantable osteogenic connective tissue progenitors. This study was designed to characterize the performance of a scaffold comprising rhBMP-2/ACS in which the sponge wraps around tri-calcium phosphate hydroxyapatite granules (rhBMP-2/ACS/TCP-HA) and to test the hypothesis that addition of BMA will improve the performance of this construct in the Canine Femoral Multi Defect Model. In each subject, two sites were grafted with rhBMP-2/ACS/TCP-HA scaffold loaded with BMA clot and two other sites with rhBMP-2/ACS/TCP-HA scaffold loaded with wound blood (WB). After correction for unresorbed TCP-HA granules, sites grafted with rhBMP-2/ACS/TCP-HA+BMA and rhBMP-2/ACS/TCP-HA+WB were similar, with mean percent bone volumes of 10.9 %±1.2 and 11.2 %±1.2, respectively. No differences were seen in quantitative histomorphometry. While bone formation using both constructs was robust, this study did not support the hypothesis that the addition of unprocessed bone marrow aspirate clot improved bone regeneration in a site engrafted with rhBMP-2/ACS/TCP-HA+BMA. In contrast to prior studies using this model, new bone formation was greater at the center of the defect where TCP-HA was distributed. This finding suggests a potential synergy between rhBMP-2 and the centrally placed ceramic and cellular components of the graft construct. Further optimization may also require more uniform distribution of TCP-HA, alternative cell delivery strategies, and a more rigorous large animal segmental defect model.

  12. Bone marrow aspirate concentrate in combination with intravenous iloprost increases bone healing in patients with avascular necrosis of the femoral head: a matched pair analysis

    Directory of Open Access Journals (Sweden)

    Hakan Pilge

    2017-01-01

    Full Text Available With disease progression, avascular necrosis (AVN of the femoral head may lead to a collapse of the articular surface. The exact pathophysiology of AVN remains unclear, although several conditions are known that can result in spontaneous cell death, leading to a reduction of trabecular bone and the development of AVN. Hip AVN treatment is stage-dependent in which two main stages of the disease can be distinguished: pre-collapse (ARCO 0-II and post-collapse stage (ARCO III-IV, crescent sign. In the pre-collapse phase, core decompression (CD, with or without the addition of bone marrow (e.g. bone marrow aspirate concentrate, BMAC or bone graft, is a common treatment alternative. In the postcollapse phase, THA (total hip arthroplasty must be performed in most of the patients. In addition to surgical treatment, the intravenous application of Iloprost has been shown to have a curative potential and analgesic effect. From October 2009 to October 2014, 49 patients with AVN (stages I-III were treated with core decompression at our institution. All patients were divided into group A (CD + BMAC and group B (CD alone. Of these patients, 20 were included in a matched pair analysis. The patients were matched to age, gender, ARCO-stage, Kerboul combined necrotic angle, the cause of AVN, and whether Iloprost-therapy was performed. The Merle d’Aubigné Score and the Kerboul combined necrotic angle in a-p and lateral radiographs were evaluated pre- and postoperatively. The primary endpoint was a total hip arthroplasty. In group A, two patients needed THA while in group B four patients were treated with THA. In group A, the Merle d’Aubigné Score improved from 13.5 (pre-operatively to 15.3 (postoperatively. In group B there was no difference between the pre- (14.3 and postoperative (14.1 assessment. The mean of the Kerboul angle showed no difference in both groups compared pre- to postoperatively (group A: pre-op 212°, postop 220°, group B: pre-op 213

  13. Osteotomia valgizante para pseudartrose do colo do fêmur: relato de 32 casos Valgusing intertrochanteric osteotomy for the treatment of femoral neck non-unions: report of 32 cases

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2009-04-01

    Full Text Available OBJETIVO: Avaliar a consolidação pós-osteotomia osteotomia valgizante do fêmur no tratamento do pseudartrose do colo femoral. MÉTODO: Durante 15 anos (1988-2003, 32 casos de pseudartrose do colo do fêmur foram tratados com osteotomia valgizante e fixação. O seguimento médio dos casos foi de 9,8 anos e a média de idade dos pacientes foi de 41,7 anos. RESULTADOS: Dos 32 casos quatro evoluíram para prótese total do quadril e 28 evoluíram para consolidação (87,4%. Oito casos evoluíram necrose parcial. CONCLUSÃO: A osteotomia valgizante é altamente eficaz para obtenção da consolidação na pseudartrose do colo do fêmur 87,4% (28/32 A recuperação integral da função do quadril só foi obtida em 56,2% (18/32PURPOSE: The purpose of the present study was to review the results of femoral neck non-unions treatment with valgusing intertrochanteric osteotomy. METHODS: Between 1988 and 2003 we treaded thirty two femoral neck non-unions with valgusing osteotomy and fixation. The mean follow-up time was 9.8 years and the mean age was 41.7 years. RESULTS: Twenty eight (87.4% of the thirty two valgusing osteotomies evolved to femoral neck union, while four cases (12.6% evolved to total hip arthroplasty. Eight cases evolved to partial osteonecrosis. CONCLUSIONS: The valgusing intertrochanteric osteotomy for treating femoral neck non-unions achieved consolidation in 87.4% (28/32. However, only 56.2% (18/32 achieved full recovery of hip function.

  14. Preliminary study report: topological texture features extracted from standard radiographs of the heel bone are correlated with femoral bone mineral density

    Science.gov (United States)

    Boehm, H. F.; Lutz, J.; Koerner, M.; Notohamiprodjo, M.; Reiser, M.

    2009-02-01

    With the growing number of eldery patients in industrialized nations the incidence of geriatric, i.e. osteoporotic fractures is steadily on the rise. It is of great importance to understand the characteristics of hip fractures and to provide diagnostic tests for the assessment of an individual's fracture-risk that allow to take preventive action and give therapeutic advice. At present, bone-mineral-density (BMD) obtained from DXA (dual-energy x-ray-absorptiometry) is the clinical standard of reference for diagnosis and follow-up of osteoporosis. Since availability of DXA - other than that of clinical X-ray imaging - is usually restricted to specialized medical centers it is worth trying to implement alternative methods to estimate an individual's BMD. Radiographs of the peripheral skeleton, e.g. the ankle, range among the most ordered diagnostic procedures in surgery for exclusion or confirmation of fracture. It would be highly beneficial if - as a by-product of conventional imaging - one could obtain a quantitative parameter that is closely correlated with femoral BMD in addition to the original diagnostic information, e.g. fracture status at the peripheral site. Previous studies could demonstrate a correlation between calcaneal BMD and osteoporosis. The objective of our study was to test the hypothesis that topological analysis of calcaneal bone texture depicted by a lateral x-ray projection of the ankle allows to estimate femoral BMD. Our analysis on 34 post-menopausal patients indicate that texture properties based on graylevel topology in calcaneal x-ray-films are closely correlated with BMD at the hip and may qualify as a substitute indicator of femoral fracture risk.

  15. Bone platform switching: a retrospective study on the slope of reverse conical neck.

    Science.gov (United States)

    Danza, Matteo; Riccardo, Guidi; Carinci, Francesco

    2010-01-01

    Bone platform switching results in an inward bone ring in the coronal part of an implant that is in continuity with the alveolar bone crest. Bone platform switching is achieved by using a dental implant with a reverse conical neck (RCN). A retrospective study was performed to determine the impact of RCN on crestal bone remodeling (CBR). A series of 191 implants with the same morphology, but three slopes of RCN, were evaluated. Lost implants and CBR around implants still in place at the end of the follow-up were considered to investigate those variables potentially associated with the clinical outcome. Radiographic examinations were performed for each implant before surgery and at the end of the follow-up to detect the degree of CBR. Time-dependent cutoff values were used to select implants with higher CBR. These implants were considered unsuccessful. The Kaplan-Meier algorithm was applied to detect those variables potentially associated with the clinical outcome (ie, lost implants or implants with higher CBR). Only 5 of 191 implants were lost (survival rate 97.4%). No statistical differences were detected among the studied variables by using lost implants. Although no statistical differences were detected among the three types of implants, the data seem to indicate a correlation between CBR and the slope of the RCN, with a better outcome for implants with a more angulated RCN.

  16. 髋关节表面置换术中股骨头缺损区骨水泥填充和空置两种处理方法的生物力学比较%Biomechanical comparison of bone-cement filling and cement vacancy treatments for femoral head defect in hip resurfacing arthroplasty

    Institute of Scientific and Technical Information of China (English)

    何志勇; 李明; 陶崑; 方超华; 章军辉; 狄正林

    2014-01-01

    Objective To investigate the reliable treatment methods for the femoral head defect during the hip resurfacing arthroplasty,by comparing the biomechanical effects between bone cement filling and cement vacancy using three-dimensional (3-D) finite element analysis.Methods The 3-D finite element model of the normal femur was constructed based on the CT scanning.Four defect models were established by the computer assissted design technology.The defect diameter was 50%of the femoral head diameter in two models, and it was 80%of the femoral head diameter in the other two models.The femoral head defects were dealt with cement filling or vacancy.The models were loaded with the simulated standing stress, and the biomechanical indices of the femoral head and neck were compared and analyzed, including the stress peak and the equivalent strain.Results The stress concentration in the femoral head: in the model of 50%diameter defect, the stress concentration was not significant in the cement filling group, but it was significant in areaⅠof the femoral head in the vacancy group;in the model of 80%diameter defect filled with cement, the stress concentration exceeded 100% in area Ⅰ of the femoral head, while in the vacancy group, it exceeded 1000%in areaⅠ;the maximum stress concentration in areaⅡwas as high as 766.89%.The stress concentration in the femoral neck:in the model of 50% diameter defect, the stress concentration in the femoral neck was between -50% and 50% in both groups;in the model of 80%diameter defect, it was between -50% and 50% in the cement filling group, while it was extremely increased in the vacancy group.The equivalent strain in the femoral head:in the model of 50% diameter defect, the equivalent strain did not chang significantly in the cement filling group, while it increased significantly in the proximal part of the head in the vacancy group;in the model of 80%diameter defect, it increased significantly in the vacancy group.The equivalent strain in

  17. Survival of dental implants in native and grafted bone in irradiated head and neck cancer patients: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Aravind Buddula

    2011-01-01

    Full Text Available Aim: To study the long-term survival of dental implants placed in native or grafted bone in irradiated bone in subjects who had received radiation for head and neck cancer. Materials and Methods: A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 and July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. Results: A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987-July 2008. There was no statistically significant difference between implant failure in native and grafted bone (P=0.76. Survival of implants in grafted bone was 82.3% and 98.1% in maxilla and mandible, respectively, after 3 years. Survival of implants in native bone in maxilla and mandible was 79.8% and 100%, respectively, after 3 years. For implants placed in the native bone, there was a higher likelihood of failure in the maxilla compared to the mandible and there was also a tendency for implants placed in the posterior region to fail compared to those placed in the anterior region. Conclusion: There was no significant difference in survival when implants were placed in native or grafted bone in irradiated head and neck cancer patients. For implants placed in native bone, survival was significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior.

  18. Bone response and mechanical strength of rabbit femoral defects filled with injectable CaP cements containing TGF-beta 1 loaded gelatin microparticles.

    NARCIS (Netherlands)

    Link, D.P.; Dolder, J. van den; Beucken, J.J.J.P van den; Wolke, J.G.C.; Mikos, A.G.; Jansen, J.A.

    2008-01-01

    This study focused at the potential of transforming growth factor beta 1 (TGF-beta 1) loaded gelatin microparticles to enhance the bone response and mechanical strength of rabbit femoral defects filled with injectable calcium phosphate (CaP)/gelatin microparticle composites. Therefore, TGF-beta1

  19. Bone Marrow Stromal Cells Contribute to Bone Formation Following Infusion into Femoral Cavities of a Mouse Model of Osteogenesis Imperfecta

    Science.gov (United States)

    Li, Feng; Wang, Xujun; Niyibizi, Christopher

    2010-01-01

    Currently, there are conflicting data in literature regarding contribution of bone marrow stromal cells (BMSCs) to bone formation when the cells are systemically delivered in recipient animals. To understand if BMSCs contribute to bone cell phenotype and bone formation in osteogenesis imperfecta bones (OI), MSCs marked with GFP were directly infused into the femurs of a mouse model of OI (oim). The contribution of the cells to the cell phenotype and bone formation was assessed by histology, immunohistochemistry and biomechanical loading of recipient bones. Two weeks following infusion of BMSCs, histological examination of the recipient femurs demonstrated presence of new bone when compared to femurs injected with saline which showed little or no bone formation. The new bone contained few donor cells as demonstrated by GFP fluorescence. At six weeks following cell injection, new bone was still detectable in the recipient femurs but was enhanced by injection of the cells suspended in pepsin solublized type I collagen. Immunofluorescence and immunohistochemical staining showed that donor GFP positive cells in the new bone were localized with osteocalcin expressing cells suggesting that the cells differentiated into osteoblasts in vivo. Biomechanical loading to failure in thee point bending, revealed that, femurs infused with BMSCs in PBS or in soluble type I collagen were biomechanically stronger than those injected with PBS or type I collagen alone. Taken together, the results indicate that transplanted cells differentiated into osteoblasts in vivo and contributed to bone formation in vivo; we also speculate that donor cells induced differentiation or recruitment of endogenous cells to initiate reparative process at early stages following transplantation. PMID:20570757

  20. Refractory metabolic acidosis in patients with sepsis following hemiarthroplasty for femoral neck fracture: a causative role for paracetamol and flucloxacillin?

    OpenAIRE

    2011-01-01

    The authors report two cases of pyroglutamic acidosis as a result of paracetamol and flucloxacillin therapy in patients with prosthesis infection following hemiarthroplasty for neck of femur fractures. Pyroglutamic acidosis is an important and often unrecognised cause of refractory metabolic acidosis that disproportionately affects older women, and can be caused by drugs such as paracetamol and flucloxacillin in the setting of sepsis, renal failure and malnutrition. Although relatively rare, ...

  1. Three-Dimensional Analysis of the Contact Pattern between the Cortical Bone and Femoral Prosthesis after Cementless Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Hiroshi Wada

    2016-01-01

    Full Text Available The cementless stem Excia (B. Braun, Melsungen, Germany implant has a rectangular cross-sectional shape with back-and-forth flanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial fixation and early bone formation. Here, the conformity of the Excia stem to the femoral canal morphology was three-dimensionally assessed using computed tomography. Forty-three patients (45 hips were examined after primary total hip arthroplasty with a mean follow-up of 27 ± 3 months (range: 24–36 months. Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83% (20/24 hips of those occurring within 3 months after surgery. First- (n=12 hips, second- (n=32, and third- (n=1 degree stress shielding were observed. The stem was typically in contact with the cortical bone in the anterolateral mid-portion (100% and posteromedial distal portions (85%. Stress shielding did not progress, even in cases where the stems were in contact with the distal portions. The anterior flange was in contact with the bone in all cases. The stability of the mid-lateral portion with the dicalcium phosphate dihydrate coating and the anterior flange may have inhibited the progression of stress shielding beyond the second degree.

  2. Femoral head vascularisation in Legg-Calve-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Lamer, Sylvie; Dorgeret, Sophie; Brillet, Pierre-Yves; Hassan, Max; Sebag, Guy H. [Department of Paediatric Radiology, Hopital Robert Debre, 48 boulevard Serurier, 75935 Paris Cedex (France); Lariboisiere-Saint-Louis University, Paris (France); Khairouni, Abdeslam; Mazda, Keyvan; Bacheville, Eric; Pennecot, Georges F. [Department of Paediatric Orthopaedics, Hopital Robert Debre, Paris (France); Bloch, Juliette [Department of Biostatistics, Hopital Robert Debre, Paris (France)

    2002-08-01

    Heading AbstractBackground. It has been reported that MRI using a dynamic gadolinium-enhanced subtraction technique can allow the early identification of ischaemia and the pattern of revascularisation in Legg-Calve-Perthes (LCP) disease with increased spatial and contrast resolution. Therefore, dynamic gadolinium-enhanced subtraction (DGS) MRI may be a possible non-ionising substitute for bone scintigraphy.Objective. The purpose of this prospective study was to compare DGS MRI and bone scintigraphy in the assessment of femoral head perfusion in LCP disease.Materials and methods. Twenty-six DGS MR images and bone scintigraphies of 25 hips in 23 children were obtained at different stages of LCP disease; three stage I, 12 stage II, six stage III and five stage IV (Waldenstroem classification). The extent of necrosis, epiphyseal revascularisation pathways (lateral pillar, medial pillar, and/or transphyseal perfusion) and metaphyseal changes were analysed.Results. Total agreement between both techniques was noted in the depiction of epiphyseal necrosis (kappa=1), and metaphyseal abnormalities (kappa=0.9). DGS MRI demonstrated better revascularisation in the lateral (kappa=0.62) and medial pillars (kappa=0.52). The presence of basal transphyseal reperfusion was more conspicuous with MRI.Conclusions. DGS MRI allows early detection of epiphyseal ischaemia and accurate analysis of the different revascularisation patterns. These changes are directly related to the prognosis of LCP disease and can aid therapeutic decision making. (orig.)

  3. Experimental and computational analysis of micromotions of an uncemented femoral knee implant using elastic and plastic bone material models.

    Science.gov (United States)

    Berahmani, Sanaz; Janssen, Dennis; Verdonschot, Nico

    2017-08-16

    It is essential to calculate micromotions at the bone-implant interface of an uncemented femoral total knee replacement (TKR) using a reliable computational model. In the current study, experimental measurements of micromotions were compared with predicted micromotions by Finite Element Analysis (FEA) using two bone material models: linear elastic and post-yield material behavior, while an actual range of interference fit was simulated. The primary aim was to investigate whether a plasticity model is essential in order to calculate realistic micromotions. Additionally, experimental bone damage at the interface was compared with the FEA simulated range. TKR surgical cuts were applied to five cadaveric femora and micro- and clinical CT- scans of these un-implanted specimens were made to extract geometrical and material properties, respectively. Micromotions at the interface were measured using digital image correlation. Cadaver-specific FEA models were created based on the experimental set-up. The average experimental micromotion of all specimens was 53.1±42.3µm (mean±standard deviation (SD)), which was significantly higher than the micromotions predicted by both models, using either the plastic or elastic material model (26.5±23.9µm and 10.1±10.1µm, respectively; p-valuematerial models). The difference between the two material models was also significant (p-value<0.001). The predicted damage had a magnitude and distribution which was comparable to the experimental bone damage. We conclude that, although the plastic model could not fully predict the micro motions, it is more suitable for pre-clinical assessment of a press-fit TKR implant than using an elastic bone model. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Salter-Harris type II fracture of the femoral bone in a 14-year-old boy - case report.

    Science.gov (United States)

    Kuleta-Bosak, Elżbieta; Bożek, Paweł; Kluczewska, Ewa; Tomaszewski, Ryszard; Machnik-Broncel, Joanna

    2010-01-01

    Distal femoral physis fractures with displacement are rare injuries seen in adolescents related with high incidence of complication. They may lead to premature physeal closure consequently, to growth arrest and bone deformity. The case of a 14-year-old boy with Salter-Harris type II displaced fracture underwent surgery with open reduction has been described. CT examination with multiplanar reconstruction was used in pre-operative assessment of distal femur growth plate fracture. Knowledge of classification, prognosis and methods of treatment is necessary in accurate pre- and postoperative assessment of physial fractures in adolescents. CT and multiplanar reconstruction improve the understanding of patterns of injury, relative prevalence and accuracy of pre-operative planning.

  5. Salter-Harris type II fracture of the femoral bone in a 14-year-old boy – case report

    Science.gov (United States)

    Kuleta-Bosak, Elżbieta; Bożek, Paweł; Kluczewska, Ewa; Tomaszewski, Ryszard; Machnik-Broncel, Joanna

    2010-01-01

    Summary Background: Distal femoral physis fractures with displacement are rare injuries seen in adolescents related with high incidence of complication. They may lead to premature physeal closure consequently, to growth arrest and bone deformity. Case Report: The case of a 14-year-old boy with Salter-Harris type II displaced fracture underwent surgery with open reduction has been described. CT examination with multiplanar reconstruction was used in pre-operative assessment of distal femur growth plate fracture. Conclusions: Knowledge of classification, prognosis and methods of treatment is necessary in accurate pre- and postoperative assessment of physial fractures in adolescents. CT and multiplanar reconstruction improve the understanding of patterns of injury, relative prevalence and accuracy of pre-operative planning. PMID:22802768

  6. Internal fixation of femoral neck fractures in the elderly%老年股骨颈骨折的内固定治疗

    Institute of Scientific and Technical Information of China (English)

    危杰; 吴晓亮; 王满宜

    2009-01-01

    目的 探讨内固定治疗老年股骨颈骨折的疗效. 方法回顾研究2000年1月至2007年12月采用内固定治疗且获得随访的139例老年股骨颈骨折患者资料,其中男52例,女87例;年龄65~93岁,平均71.6岁;受伤至入院时间为1 h~30 d,平均56.7 h.骨折按Garden分型:Ⅰ型17例,Ⅱ型43例,Ⅲ型62例,Ⅳ型17例.移位骨折79例,非移位骨折60例.内固定材料:空心钉131例,动力髋螺钉5例,动力髋螺钉加空心钉3例.对患者住院时间、骨折愈合率、术后并发症、股骨头缺血坏死率、内固定失效率及患者功能恢复情况进行总结分析. 结果 139例患者住院时间为5~59 d,平均15.4 d.术后获7~77个月(平均35个月)随访.骨折愈合126例,占90.6%(126/139);愈合时间2~12个月,平均6.2个月.其中22例患者术后出现并发症.骨折不愈合内固定失效13例,占9.4%(13/139);股骨头缺血性坏死9例,占6.5%(9/139).正常行走者81例,占58.3%(81/139),需要助行器械者50例,占36.0%(50/139),不能行走者8例,占5.7%(8/139).结论 老年股骨颈骨折内固定治疗骨折愈合率高,股骨头缺血坏死率较低,内固定治疗老年股骨颈骨折具有积极意义.术前病情评估和合并症的积极治疗非常重要,条件允许时应尽早手术.%Objective To evaluate the outcome of the old patients who were treated for femoral neck fractures in our hospital during 2000-2007. Methods A retrospective study was conducted to evaluate outcomes of the 139 old patients who had received internal fixation for femoral neck fractures in our department during 2000-2007. The mechanism of injury, duration between injury and hospitalization, severity of fracture, anamnesis, time of hospital stay, anaesthesia, operation, postoperative complications, fracture healing, in-cidence of avascular necrosis of femoral head, failure of fixation, and functional restoration of the patients were documented. Results Fracture healing was found in 126 cases (90

  7. Exercise to Counteract Loss of Bone and Muscle During Androgen Deprivation Therapy in Men with Prostate Cancer

    Science.gov (United States)

    2009-08-01

    to get a bone scintigraphy, 1) and 13 did not qualify (started medications that influence bone metabolism, 4; unrepaired hernias , 2; positive bone...before vs 0.785±0.098 g/cm2 after) subregions of the hip. However, BMD at the femoral neck, a common site of osteoporotic fracture, decreased over the

  8. Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Jin JW

    2015-08-01

    Full Text Available Jianwen Jin,1 Gang Wang,2 Maowei Gong,3 Hong Zhang,3 Junle Liu21Department of Clinical Medicine, Fujian Health College, Fuzhou, 2Department of Anesthesiology, Chinese People’s Liberation Army 105 Hospital, Hefei, 3Anesthesia and Operation Center, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of ChinaBackground: Geriatric patients with femoral neck fracture (FNF have unacceptably high rates of postoperative complications and mortality. The purpose of this study was to compare the effects of epidural anesthesia versus peripheral nerve block (PNB on postoperative outcomes in elderly Chinese patients with FNF.Methods: This retrospective study explored mortality and postoperative complications in geriatric patients with FNF who underwent epidural anesthesia or PNB at the Chinese People’s Liberation Army General Hospital from January 2008 to December 2012. The electronic database at the Chinese People’s Liberation Army General Hospital includes discharge records for all patients treated in the hospital. Information on patient demographics, preoperative comorbidity, postoperative complications, type of anesthesia used, and in-hospital, 30-day, and 1-year mortality after surgery was obtained from this database.Results: Two hundred and fifty-eight patients were identified for analysis. The mean patient age was 79.7 years, and 71.7% of the patients were women. In-hospital, 30-day, and 1-year postoperative mortality was 4.3%, 12.4%, and 22.9%, respectively, and no differences in mortality or cardiovascular complications were found between patients who received epidural anesthesia and those who received PNB. More patients with dementia or delirium were given PNB. No statistically significant differences were found between groups for other comorbidities or intraoperative parameters. The most common complications were acute cardiovascular events (23.6%, electrolyte disturbances (20.9%, and hypoxemia (18.2%. Patients

  9. Measuring the osteochondral connection of the femoral head and neck in patients with impingement femoroacetabulare by determining the angle of two alpha in lateral and anteroposterior hip radiographic images

    Directory of Open Access Journals (Sweden)

    Anđelković Zoran

    2013-01-01

    Full Text Available Background/Aim. Femoroacetabular impingement, a pathophysiological mechanism of small morphological changes of the hip leads to early arthritic changes. The aim of this study was to present a simple method for the quantification of femoral head and neck junction in patients with cam form of femoroacetabular impingement, in standardized anteroposterior and profile DUNN 90 radiograms of the hips. Methods. In standardized anteroposterior and profile DUNN 90 images of the hips we determined the angle of 2 alpha, defined by our own original method. We tested 141 hips in 81 patients without clinical signs of femoroacetabular impingement, and 153 hips in 76 patients with clinically clear signs of femoroacetabular impingement. Results. The value of the angle 2 alpha in anteroposterior hip radiograms was on average 113.7° for the patients with clinical symptoms of impingement, and 84.2° for the control group of patients (p ≤ 0.0001, and in DUNN 90 profile radiography of the hip, the value of 2 alpha angle in the patients group was 97.2°, and 74.6° in the control group (p ≤ 0.0001. The proposed method of determining the angle 2 alpha showed a high level sensitivity (97.8% and specificity (98.7 and positive predictive value (98.6%. It was false positive in only 1.3%, and false negative in 2.12% of patients. Conclusion. Using standardized anteroposterior and profile radiographs of the hips, and without determination of femoral neck axis in patients with femoroacetabular impingement with the cam effect at the junction of the femoral head and neck, we proposed the method of measuring joint abnormalities of femoral head and neck junction, very capable to predict the disease development in an asymptomatic risk group of patients and high sensitive in the diagnosis of the disease in the group of patients.

  10. Biomechanical and system analysis of the human femoral bone: correlation and anatomical approach

    Directory of Open Access Journals (Sweden)

    Haddad John J

    2007-05-01

    Full Text Available Abstract Background The human femur is the subsystem of the locomotor apparatus and has got four levels of its organization. This phenomenon is the result of the evolution of the locomotor apparatus, encompassing both constitutional and individual variability. The main aim of this investigation was to study the organization of the human femur as a system of collaborating anatomical structures and, on the basis of system analysis, to define the less stable parameters, whose reorganization can cause the exchange of the system's status. Methods Twenty-five (25 linear and non-linear (angle parameters were, therefore, investigated by specially designed tool and caliper on a material of 166 macerated human femurs of adult individuals of both sexes. The absolute values were transformed into the relative one (1.0 by the meaning of the transverse diameter of the femoral diaphysis, and handled with current methods of descriptive statistical analysis. By the value of variance (q2, the results were distributed into four major classes. Results The belonging of each group to the class was subsequently estimated in grades. According to this method, the excerpt was distributed into four classes as well depending on the total grades. The Pearson's coefficient in each class was calculated between the relative values of the investigated parameters. Two generations of system parameters were subsequently defined and analyzed. Conclusion This study has derived that the system meaning of each level of the femoral organization is related to the 'shaping effect' of femoral units' functions. Inasmuch as the angular parameters were most instable at this system, they were defined as morphological substrates of the individual variety.

  11. Histopathological and Histomorphometrical Effects of Atorvastatin on Experimental Femoral Cortical Bone Defect Healing in Rats

    Directory of Open Access Journals (Sweden)

    M Valilu

    2012-05-01

    Full Text Available Background: Bone remodeling has always been the goal of surgeons for a long time. Recently, it was shown that statins that are commonly prescribed for lowering cholesterol also have beneficial effects on bone healing. Therefore, the present study was undertaken to evaluate the probable effects of atorvastatin on osteogenesis in the rat femur. Methods: This experimental study was conducted on 30 male Sprague-Dawley (SD rats. The animals were divided randomly into one control and two experiment groups. After induction of anesthesia, a hole of 2 mm in diameter was made in femur width. The control group received physiological serum but the experiment groups one and two, respectively, received 10 and 20 mg/kg/PO of atorvastatin on daily basis. After euthanizing the rats, histopathological and histomorphometrical evaluations of the bones were performed 45 days after the intervention. Results: In the control group, the defects seemed to be filled with woven bone and bone marrow, depictive of a poor osteogenic activity. In the experiment groups, many osteoblast groupings and young bone trabeculae had been formed and bone trabeculae were more organized. Histomorphometric results, showed that atorvastatin had significantly promoted bone healing in the experiment groups compared with the controls (P<0.001. Moreover, the analysis showed that atorvastatin had more significant effects in group three receiving high doses of the medication in comparison with group two (P<0.001. Conclusion: The findings of this study showed that atorvastatin is capable of stimulating osteogenesis in rats.

  12. The effect of enterocystoplasty on bone strength assessed at four different skeletal sites in a rat model

    DEFF Research Database (Denmark)

    Gerharz, E.W.; Mosekilde, Li.; Thomsen, J.S.

    2003-01-01

    ; colocystoplasty; or sham operation (controls). After 8 months the lumbar vertebrae, femora, and tibiae were harvested at necropsy. Bone strength was assessed biomechanically at four different skeletal sites: vertebra L3, femoral middiaphysis, femoral neck, and distal femoral metaphysis. Bone mass and architecture...... were assessed using standard static histomorphometry of the proximal tibial metaphysis (trabecular bone volume [BV/TV]; trabecular number [Tb.N]) and ash weight. Statistically significant differences of biomechanical parameters between groups were observed at three skeletal sites with corresponding......, this is the first experimental study to demonstrate the relevance of histomorphometrically proven bone loss after enterocystoplasty in terms of biomechanical variables....

  13. Hip arthroplasty in the treatment of old femoral neck fractures in the elderly%人工髋关节置换术治疗老年陈旧性股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    杨勇; 郭庆华; 贺占坤

    2013-01-01

      目的评估人工髋关节置换术治疗老年陈旧性股骨颈骨折的短期临床疗效.方法2006年1月至2011年12月,采用人工髋关节置换术治疗老年陈旧性股骨颈骨折25例26髋,男12例,女13例,其中1例女性为双侧,平均年龄72岁(55~84岁),骨折至手术时间平均5.6个月(3~25个月).术前分析延迟治疗的原因,术前拍摄X线片,仔细进行模板测量,确定髋关节旋转中心、偏距、髋臼和股骨假体大小、颈长和截骨位置;术后3、6个月、1年及以后每年均复查并拍X线片了解假体的状况,采用 Harris 评分评估术后患髋功能恢复情况.结果术后随访36个月(12~60个月),术后1年内死亡2例,发生深静脉栓塞1例,出现坐骨神经麻痹1例.无术后关节感染及脱位,无术后人工假体下沉、断裂、松动等并发症发生.术后1年随访 Harris 评分83.68分(59~90分),与术前相比(Harris 评分28.70分)差异有统计学意义(P<0.05);18例患髋无疼痛,5例偶尔存在疼痛,2例存在中度不适,疗效满意.结论人工髋关节置换术能有效改善老年陈旧性股骨颈骨折患者髋关节功能,减轻疼痛,提高患者的生活质量.%Objective To evaluate the short-term clinical outcomes of hip arthroplasty in the treatment of old femoral neck fractures in elderly patients. Methods From January 2006 to December 2011, 25 elderly patients (26 hip joints) with old femoral neck fractures were treated with hip arthroplasty. There were 12 males and 13 females, among whom 1 female patient had bilateral fractures. The mean age of the patients was 72 years old (range; 55-84 years). The mean time interval from injury to operation was 5.6 months (range; 3-25 months). Preoperatively the reason of the delayed treatment was analyzed, and the X-ray films were shot. The templates were measured carefully, and the hip rotation center, offset distance, the acetabulum and the size of the femoral prosthesis, the neck length and cut bone

  14. A-mode ultrasound-based intra-femoral bone cement detection and 3D reconstruction in RTHR.

    Science.gov (United States)

    Heger, Stefan; Mumme, Thorsten; Sellei, Richard; De La Fuente, Matias; Wirtz, Dieter-C; Radermacher, Klaus

    2007-05-01

    Due to the difficulty of determining the 3D boundary of the cement-bone interface in Revision Total Hip Replacement (RTHR), the removal of the distal intra-femoral bone cement can be a time-consuming and risky operation. Within the framework of computer- and robot-assisted cement removal, the principles and first results of an automatic detection and 3D surface reconstruction of the cement-bone boundary using A-mode ultrasound are described. Sound propagation time and attenuation of cement were determined considering different techniques for the preparation of bone cement, such as the use of a vacuum system (Optivac, Biomet). A laboratory setup using a rotating, standard 5-MHz transducer was developed. The prototype enables scanning of bisected cement-prepared femur samples in a 90 degrees rotation range along their rotation axis. For system evaluation ex vivo, the distal femur of a human cadaver was prepared with bone cement and drilled (Ø 10 mm) to simulate the prosthesis cavity in a first approximation. The sample was cut in half and CT scanned (0.24 mm resolution; 0.5 mm distance; 0.5 mm thickness), and 3D voxel models of the manually segmented bone cement were reconstructed, providing the ground truth. Afterwards, 90 degrees segments of each ex-vivo sample were scanned by the A-mode ultrasound system. To obtain better ultrasound penetration, we used coded signal excitation and pulse compression filtering. A-mode ultrasound signal detection, filtering and segmentation were accomplished fully automatically. Subsequently, 3D voxel models of each sample were calculated. Accuracy evaluation of the measured ultrasound data was performed by ICP matching of each ultrasound dataset ( approximately 8000 points) to the corresponding CT dataset and calculation of the residual median distance error between the corresponding datasets. Prior to each ICP matching, an initial pre-registration was calculated using prominent landmarks in the corresponding datasets. This method

  15. The efficacy comparison between hollow screw fixation and head and tail nail fixation treatment for the elderly femoral neck fractures%空心拉力螺钉内固定与首尾钉内固定治疗老年人不同类型股骨颈骨折疗效比较

    Institute of Scientific and Technical Information of China (English)

    郝应文; 唐军伟

    2014-01-01

    Objective To analyze and compare the efficacies of internal fixation by the cancellous bone screw and by the head and tail nail in the treatment of femoral neck fracture of the elderly. Methods 103 cases of elderly femoral neck fractures who were followed up for more than one year accepted the retrospective analysis. They were divided into group A(n=55)and group B(n=48)according to the treatment they received. Group A was treated by cancellous bone screw,and group B was treated by head and tail nail. The efficacy was evaluated by Harris score. Results There was no statistical difference in the efficacy of the treatment between two groups( P >0. 05)and Harris score was improved in each type of femoral neck fracture. However,the excellent rate was higher in group A than in group B(91. 2% vs. 62. 5%)for subcapital type ( P 0. 05),and lower in group A than in group B(66. 7% vs. 95. 0%) ( P 0.05)。两组患者不同类型术后髋关节Harris评分均有不同程度的改善。头下型骨折:A组优良率为91.2%,B组优良率为62.5%,A组优良率高于B组( P 0.05);基底型骨折:A组优良率为66.7%,B组优良率为95.0%,B组优良率高于A组( P <0.05)。结论空心拉力螺钉内固定与首尾钉内固定治疗老年人股骨颈骨折,都可以达到良好的骨折复位效果,头下型骨折空心拉力螺钉内固定效果更优,基底型骨折首尾钉内固定效果更优。

  16. Influence of ingrowth regions on bone remodelling around a cementless hip resurfacing femoral implant.

    Science.gov (United States)

    Haider, Ifaz T; Speirs, Andrew D; Beaulé, Paul E; Frei, Hanspeter

    2015-01-01

    Hip resurfacing arthroplasty is an alternative to traditional hip replacement that can conserve proximal bone stock and has gained popularity but bone resorption may limit implant survival and remains a clinical concern. The goal of this study was to analyze bone remodelling patterns around an uncemented resurfacing implant and the influence of ingrowth regions on resorption. A computed tomography-derived finite element model of a proximal femur with a virtually implanted resurfacing component was simulated under peak walking loads. Bone ingrowth was simulated by six interface conditions: fully bonded; fully friction; bonded cap with friction stem; a small bonded region at the stem-cup intersection with the remaining surface friction; fully frictional, except for a bonded band along the distal end of the cap and superior half of the cap bonded with the rest frictional. Interface condition had a large influence on remodelling patterns. Bone resorption was minimized when no ingrowth occurred at the bone-implant interface. Bonding only the superior half of the cap increased bone resorption slightly but allowed for a large ingrowth region to improve secondary stability.

  17. Weight-bearing physical activity, calcium intake, systemic glucocorticoids, chronic inflammation, and body constitution as determinants of lumbar and femoral bone mineral in juvenile chronic arthritis.

    Science.gov (United States)

    Kotaniemi, A; Savolainen, A; Kröger, H; Kautiainen, H; Isomäki, H

    1999-01-01

    The associations between the lumbar and femoral bone mineral and several body constitutional, lifestyle, and disease related variables were studied in 111 children with juvenile chronic arthritis (JCA) by factor and multiple linear regression analyses. In addition to the measurement of bone mineral density (BMD), bone width and bone mineral volumetric density (BMDvol) were determined by dual-x-ray absorptiometry (DXA). Factor analysis of 13 explanatory variables yielded six non-correlating factors, named as body size, physical activity, calcium intake, glucocorticoids, disease duration, and disease activity. These six factors were used as new variables to explain BMD, BMDvol, and bone width by multiple linear regression analyses. These showed body size, physical activity, and calcium intake as significant positive and disease activity and glucocorticoids as significant negative determinants of BMD in JCA. The analyses revealed also considerable differences in the relationships between factors and BM Dvol or bone width.

  18. Atraumatic diplaced bilateral femoral neck fracture in a patient with hypophosphatemic rickets in postpartum period: A missed diagnosis

    Directory of Open Access Journals (Sweden)

    Erdal Uzun

    2016-01-01

    Conclusion: For patients with bone metabolic diseases and/or the patients in pregnancy and postpartum period, preventive measures should be increased to reduce the risk of pathologic fracture. Admitting to the hospital physicians must be more careful about detecting fractures in these patients.

  19. Perioperative nursing for elder patients with femoral neck fracture%高龄股骨颈骨折患者围术期护理

    Institute of Scientific and Technical Information of China (English)

    常艳; 常伟丽

    2011-01-01

    Objective: To analyze the features of perioperative nursing for elder patients with femoral neck fracture who over the age of 80, and provide insight into the treatment care for elder patients. Methods: Retrospective study was performed of 61 cases of femoral neck fracture patients over the age of 80 receiving surgery during the period from June 2000 to June 2008. Care providing included preoperative health education, nichetargeting psychological care. Heart condition of the patients during and after operation was monitored, and blood pressure and blood sugar level were controlled. The vital signs after operation and sensorimotor distal limb blood circulation were closely observed, and the nursing of complications such as bedsores, lung infections, urinary tract infection and deep venous thrombosis were strengthened. Results: 61 patients were successfully operated, discharged with crutches or a walker and without incision infection and symptomatic deep venous thrombosis. Patients were able to sit up 3 to 5 day after operation and ambulate with crutches 5 to 10 days after operation. There occurred 6 cases of electrolyte disturbance, 4 cases of postoperative pulmonary infection, 3 cases of hy -potension, 2 cases of cardiac insufficiency, 2 cases of atrial fibrillation, 2 cases of stress ulcer, 1 case of postoperative uri -nary tract infection, and 1 case of bedsore. After active treatment and care, the symptoms of all patients improved. Conclusion: Patients with femoral neck fracture over the age of 80 should be given surgical treatment as early as possible to shorten the time in bed. Thus reasonable and effective perioperative nursing for patients with femoral neck fracture over the age of 80 is an important guarantee of successful operation.%目的:分析80岁以上高龄股骨颈骨折患者的围术期护理,总结围术期的特点,对今后高龄患者的治疗护理提供帮助.方法:回顾性研究2000年6月~2008年6月我院手术治疗的61例80

  20. Anti-platelet drugs in patients with femoral neck fractures undergoing cemented hip hemiarthroplasty surgery. A study of complications and mortality.

    Science.gov (United States)

    Agudo Quiles, M; Sanz-Reig, J; Alcalá-Santaella Oria de Rueca, R

    2015-01-01

    To assess complications and factors predicting one-year mortality in patients on antiplatelet agents presenting with femoral neck fractures undergoing hip hemiarthroplasty surgery. A review was made on 50 patients on preoperative antiplatelet agents and 83 patients without preoperative antiplatelet agents. Patients in both groups were treated with cemented hip hemiarthroplasty. A statistical comparison was performed using epidemiologi