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Sample records for fracture femoral neck

  1. Ipsilateral femoral neck and trochanter fracture

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    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.

  2. Ipsilateral Acetabular and Femoral Neck and Shaft Fractures

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    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.

  3. 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.

  4. 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.

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

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    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).

  6. Femoral Neck Shaft Angle in Men with Fragility Fractures

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    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. 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.

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

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    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.

  9. A case report of missed femoral neck stress fracture

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    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.

  10. 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.

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

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    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.

  12. 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.

  13. 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

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

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    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.

  15. Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly

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    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.

  16. 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...

  17. Redox Status in Patients with Femoral Neck Fractures

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    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.

  18. 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.

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

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    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.

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

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    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.

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

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    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

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

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    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.

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

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    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

  4. 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...

  5. 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.

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

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    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

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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...

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

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    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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.)

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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.

  4. 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...

  5. 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.

  6. 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

  7. 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.).

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

    Science.gov (United States)

    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.

  9. 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...

  10. 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...

  11. 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. ...

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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...

  2. 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.

  3. 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.

  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. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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

  14. 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...

  15. 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...

  16. 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

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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....

  5. 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.

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

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    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.

  7. 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.

  8. 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

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

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    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

  10. 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.

  11. 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

  12. 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.

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

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    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.

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

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    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  16. 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.

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

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    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.

  18. 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.

  19. 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.

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

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    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.

  1. 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

  2. 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

  3. 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

  4. 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.

  5. [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.

  6. 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

  7. 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

  8. 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.

  9. 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。

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  15. 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.

  16. 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

  17. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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...

  2. 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

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

    Science.gov (United States)

    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

  4. 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

  5. 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.

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

    Science.gov (United States)

    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.

  7. Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures

    NARCIS (Netherlands)

    El Moumni, Mostafa; Schraven, Pim; ten Duis, Henk Jan; Wendt, Klaus

    2010-01-01

    Retrograde nailing is an attractive method for stabilisation of femoral shaft fractures in cases of polytrauma, ipsilateral pelvic, acetabular, tibial and femoral neck fractures, bilateral femoral fractures, obese and pregnant patients. However, retrograde nailing may result in complaints about the

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. Estimation of pretraumatic femoral antetorsion in bilateral femoral shaft fractures

    Energy Technology Data Exchange (ETDEWEB)

    Citak, Musa; Jagodzinski, Michael; Krettek, Christian; Huefner, Tobias [Hannover Medical School, Trauma Department, Hannover (Germany); Citak, Mustafa [BG-University Hospital Bergmannsheil, Department of Surgery, Bochum (Germany); Kendoff, Daniel; O' Loughlin, Padhraig F. [Hospital for Special Surgery, Orthopaedic Department, New York, NY (United States); Tavassol, Frank [Hannover Medical School, Department of Oral and Maxillofacial Surgery, Hannover (Germany)

    2009-12-15

    To describe a system for measurement of the pretraumatic femoral antetorsion angle post-bilateral femoral shaft fracture with the use of new imaging software which allows segmentation and three dimensional (3D) reconstruction of DICOM (digital imaging and communications in medicine) images. This case involved a 20-year-old patient with bilateral femoral shaft fractures. Following initial clinical examination, CT scans of both femurs were performed. Subsequently, the DICOM datasets were uploaded to the new software tool. Following segmentation and 3D reconstruction, pretraumatic femoral antetorsion angles were determined. Femoral antetorsion was described and assessed in two ways by referring to the intersection of the posterior condylar plane and (1) a line drawn between the center of the femoral head and femoral neck, (2) a line drawn between the centers of the femoral head and greater trochanter. Using these definitions, values for femoral antetorsion were found to be, respectively, 20 at the right fracture site and 19 on the left site, and 33 bilaterally. The investigators describe in this current technical report the use of new imaging software which enables the calculation of femoral AV following reduction of virtual fracture fragments which are created from standard DICOM images. We believe that this 3D reconstruction method of measuring the antetorsion angle can be integrated into a regular treatment algorithm and may potentially optimize clinical outcomes. (orig.)

  1. [Subtrochanteric femoral fractures].

    Science.gov (United States)

    Ulmar, B; Simon, S; Eschler, A; Mittlmeier, T

    2013-12-01

    Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. Clinical evaluation of the affected extremity shows disability of axial weight-bearing and pain during compression and rotation of the hip joint. Basic diagnostics include conventional x-rays of the injured femur in the anterior-posterior and lateral planes. These subtrochanteric femoral fractures are almost always treated surgically due to the inherent high degree of instability. The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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, ...

  7. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    BACKGROUND: In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  8. femoral neck fracture during physical therapy following surface replacement arthroplasty: a preventable complication? A case report

    Directory of Open Access Journals (Sweden)

    Dayton Michael R

    2010-02-01

    Full Text Available Abstract This case report describes two cases of peri-prosthetic fracture during physical therapy in patients who underwent a hip resurfacing, or surface replacement arthroplasty. The fractures occurred with forceful passive combined flexion and external rotation. Functional results were ultimately obtained in both cases, requiring conversion to total hip arthroplasty. Recognizing patient risk factors and cautioning therapists about the possibility of fracture may have prevented these complications.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. [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.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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

  19. [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.

  20. 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.

  1. 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

  2. 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.

  3. 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, ...

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. 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。

  10. 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.

  11. 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.

  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

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    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. 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.

  14. 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...

  15. Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

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    Renken Felix

    2012-08-01

    Full Text Available Abstract Background A minimal invasive approach for elective hip surgery has been implemented in our institution in the past. It is widely hypothesized that implanting artificial hips in a minimal invasive fashion decreases surgical trauma and is helpful in the rehabilitation process in elective hip surgery. Thereby geriatric patients requiring emergency hip surgery also could theoretically benefit from a procedure that involves less tissue trauma. Methods Sixty patients who sustained a fractured neck of femur were randomly assigned into two groups. In the minimal invasive arm, the so called “direct anterior approach” (DAA was chosen, in the conventional arm the Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty. Primary outcome parameter was the mobility as measured by the four-item-Barthel index. Secondary outcome parameters included pain, haemoglobin-levels, complications, duration of surgery, administration of blood transfusion and external length of incision. Radiographs were evaluated. Results A statistically significant difference (p = 0,009 regarding the mobility as measured with the four-item Barthel index was found at the 5th postoperative day, favouring the DAA. Evaluation of the intensity of pain with a visual analogue scale (VAS showed a statistically significant difference (p = 0,035 at day 16. No difference was evident in the comparison of radiographic results. Conclusions Comparing two different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur, it can be stated that mobilization status is improved for the DAA compared to the WJA when measured by the four-item Barthel index, there is less pain as measured using the VAS. There is no radiographic evidence that a minimal invasive technique leads to inferior implant position. Level of Evidence: Level II therapeutic study.

  16. 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

  17. 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.

  18. 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

  19. 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

  20. Classification of subtrochanteric femoral fractures.

    Science.gov (United States)

    Loizou, C L; McNamara, I; Ahmed, K; Pryor, G A; Parker, M J

    2010-07-01

    A review of the literature identified 15 different classification methods for subtrochanteric femoral fractures. Only eight of those classifications defined the area of bone, which constituted a subtrochanteric fracture. The actual length of femur defined as the subtrochanteric zone varied from 3 cm up to the level of the femoral isthmus. There was no agreement between the different classifications regarding the proximal and distal border or for those fractures, which traverse anatomical boundaries. In the various classifications, fractures were subdivided into 2-15 subgroups. The majority of the identified studies were unable to find the classifications useful in either determining treatment or predicting the outcome after treatment. We subdivided subtrochanteric fractures into three types based on the degree of fracture comminution. We examined the inter- and intra-observer agreement of our recommended classification. One orthopaedic consultant, one specialist hip fracture surgeon, two trainee registrar orthopaedic surgeons and one specialty trainee in orthopaedics, on two different occasions, 8 weeks apart, independently classified the radiographs of 20 patients with a subtrochanteric fracture. The mean kappa value for inter- and intra-observer variation was 0.71 and 0.79, respectively, with both showing substantial agreement and, therefore, this simpler classification is recommended. Based on the review of previous classification methods, we also recommend that the subtrochanteric zone be defined as the one in which the fracture line crossing the femur is predominantly within the area of bone extending 5 cm below the lower border of the lesser trochanter.

  1. 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

  2. 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

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

    Science.gov (United States)

    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.

  4. 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.

  5. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    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.

  6. 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

  7. 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

  8. 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

  9. 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 epidemiological data, comorbidities, mental state, complications and mortality. There was no lost to follow-up. The one-year mortality was 20.3%. In patients without preoperative antiplatelet agents it was 14.4% and in patients with preoperative antiplatelet agents was 30%. Age, ASA grade, number of comorbidities and antiplatelet agent therapy were predictors of one-year mortality. The one-year mortality of patients on clopidogrel was 46.1%, versus 24.3% in patients on acetylsalicylic acid. Patients with preoperative antiplatelet therapy were older and had greater number of comorbidities, ASA grade, delayed surgery, and a longer length of stay than patients without antiplatelet therapy. The one-year mortality was higher in patients with preoperative antiplatelet therapy. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  10. 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

  11. Artroplastia parcial no tratamento das fraturas do colo do fêmur Hemiarthroplasty in the treatment of fractures of the femoral neck

    Directory of Open Access Journals (Sweden)

    Nelson Keiske Ono

    2010-01-01

    Full Text Available OBJETIVO: Realizar avaliação epidemiológica e clínica dos pacientes com fratura desviada do colo femoral, que foram submetidos ao tratamento cirúrgico, com artroplastia parcial do quadril cimentada. MÉTODOS: Foram avaliados, de forma retrospectiva, todos os pacientes com fratura desviada do colo do fêmur (Garden III e IV submetidos à artroplastia parcial do quadril com prótese unipolar (Thompson, cimentada pela via de acesso posterolateral do quadril, no período de junho de 2005 a setembro de 2008. RESULTADOS: Foram avaliados, inicialmente, 70 pacientes. A média de idade foi de 83,1 anos. Houve predomínio de pacientes do sexo feminino (84,3%. Houve acompanhamento ambulatorial de 36 pacientes, cujo tempo de seguimento variou de 10 a 48 meses (média de 26,5 meses. Houve perda de seguimento de 15 pacientes. Dezenove pacientes foram a óbito, com uma taxa de mortalidade no primeiro ano de 25,4%. Os pacientes classificados como ASA III apresentaram taxa de 25,7%, enquanto os pacientes ASA II, uma taxa de 12,1%. Dois pacientes apresentaram trombose venosa profunda sintomática; um paciente, infecção do sítio operatório; e nenhum paciente apresentou luxação do quadril. A maioria dos pacientes evoluiu sem dor. Doze pacientes (33%, durante a evolução, apresentaram piora na capacidade de deambulação. CONCLUSÃO: Nenhum caso de luxação do quadril foi observado. Os pacientes classificados como ASA III apresentaram um índice de mortalidade mais elevado, em relação aos pacientes ASA I e II. Houve uma piora da capacidade de deambular em 33% dos pacientes. Não foi necessária revisão de nenhum paciente por soltura ou dor. Trinta pacientes não apresentavam dor (83,3%, quatro apresentavam dor moderada (11,1% e dois apresentavam dor intensa (5,5%.OBJETIVE: To epidemiologically and clinically evaluate patients with displaced femoral neck fractures that had surgical treatment with cemented hemiarthroplasty. METHODS: We evaluated

  12. 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.

  13. Fracture of the neck of the femur after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Gantscheff, M.; Wassilew, T.; Tantschew, P. (Meditsinska Akademiya, Sofia (Bulgaria))

    1983-02-01

    Several etiopathogenetic factors of the femoral neck fracture after radiotherapy are discussed taking extensive references into consideration. Results are described paying special attention to the discongruence of the hip joint existing in this fracture. The change of the volume of the femoral head, which can be considered as a consecutive symptom of some vascular lesions, leads to pathologic conditions in the biomechanics of the hip joint causing a special kind of stress fracture.

  14. Analysis of the gynecological risk factors of femoral neck fracture with osteoporosis in elderly women%老年女性股骨颈骨折妇科相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈古福; 查前龙; 朱德军

    2015-01-01

    目的:探讨老年女性骨质疏松性股骨颈骨折的危险因素,为早期准确预测其骨质疏松股骨颈骨折提供客观依据。方法采用病例对照研究方法,选择150例年龄>60岁的骨质疏松性股骨颈骨折女性患者作为骨折组,同时在周边地区随机选取150例年龄相当的无股骨颈骨折的老年女性作为对照组。通过问卷调查的方法,调查两组年龄、初潮年龄、绝经年龄、怀孕次数、生产次数、母乳喂养时间、体重指数等妇科相关情况。采用 Logistic 回归分析的方法对影响股骨颈骨折的因素进行分析。结果对照组与骨折组的初潮年龄、绝经年龄、怀孕次数、生产次数、母乳喂养时间、体重指数比较差异均有统计学意义(P <0.05或 P <0.01),其中老年女性骨质疏松性股骨颈骨折的发生与初潮年龄、怀孕次数、生产次数、母乳喂养时间呈正相关(P <0.05或 P<0.01),与绝经年龄、体重指数呈负相关(P <0.01)。结论初潮晚、绝经早、孕产次数多、母乳喂养时间长、体重指数低可能是老年女性骨质疏松性股骨颈骨折的重要危险因素。%Objective To investigate the risk factors for osteoporosis in elderly women with femoral neck fracture for accurately predicting early femoral neck fracture of osteoporotic and providing an objective basis. Methods 150 os-teoporotic femoral neck fracture women older than 60 years were selected as a research group with case-control study. Age-matched 150 cases were randomly selected in the surrounding area without femoral neck fractures as a control group. Through questionnaire survey, including age, menarche age, menopause age, number of pregnancies, number of births, breast feeding time, body mass index and other gynecological relevant circumstances. Logistic regression a-nalysis was used to evaluate the effect. Results The difference of menarche age, menopause age, number of preg

  15. Reconstruction plate fixation of subtrochanteric femoral fractures in children.

    Science.gov (United States)

    El-Sayed, Moustafa; Abulsaad, Mazen; El-Hadidi, Mahmoud; El-Adl, Wael; El-Batouty, Magdy

    2007-08-01

    Pediatric subtrochanteric femoral fractures are rare and have received limited attention in the literature Treatment is controversial. Different treatment options are used: skin traction, 90/90 skeletal traction, spica casting, cast bracing, internal fixation and external fixation. The aim of this study is to present our results with internal fixation of subtrochanteric femoral fractures in children using a reconstruction plate. Between 2000 and 2004, eighteen patients with closed subtrochanteric femoral fractures were treated in the Mansoura Emergency Hospital. The average age at the time of injury was 8.2 years (range 5.3 years to 11.5 years). Pathological fractures and fractures associated with neuromuscular diseases were excluded from this study. Eight patients had head injuries and/or multiple injuries. In all cases a single 4.5 mm contoured reconstruction plate was used and a 6.5 mm cancellous screw was inserted through the plate into the femoral neck. Average follow-up was 38 months (range, 12 to 47 months). All fractures united with anatomical alignment within an average of 8 weeks (range 6 to 12 weeks). There were no deep infections and no significant limb length discrepancies. At the latest follow-up, no patient had any restriction of activities. Internal fixation with a reconstruction plate appears as a good treatment option for children with subtrochanteric femoral fractures.

  16. 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.

  17. No dislocations after primary hip arthroplasty with the dual mobility cup in displaced femoral neck fracture in patients with dementia. A one-year follow-up in 20 patients

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    Graversen Anders Elneff

    2017-01-01

    Full Text Available Purpose: The aim of this study was to describe the dislocation rates, reoperation rates and mortality 30 day and one year following THA with AVANTAGE® dual mobility cup among dementia patients with an acute displaced intracapsular femoral neck fracture. Patients and methods: From 2010 to 2014 we identified 20 hip fracture patients with dementia, who have had total hip arthroplasty with the AVANTAGE® dual mobility cup. The primary outcome was dislocation. Secondary outcomes were revision surgery, 30 days and one year mortality, time to surgery and length of hospital stay. Results: Follow-up time was one year. None of the patients experienced dislocation or received revision surgery in the follow-up period. The 30-days mortality rate was 25% (confidence interval (CI 95%; 4–46% and the one year mortality was 45% (CI 95%; 21–69. Mean time to surgery was 27 h (CI 95%; 20–37 h and mean length of hospital stay was 5.5 days (CI 95%; 4, 0–7, 6 days. Conclusion: THA with the dual-mobility cup seems favourable in the treatment of patients with a displaced femoral neck fracture and patients with dementia. Correct placement of the cup is pivotal and technically demanding. Not all orthopedic surgeons perform total hip arthroplasty while challenges regarding the logistics can be encountered since time to surgery is known to affect the mortality negatively.

  18. Intramedullary fixation of a femoral shaft fracture with preservation of an existing hip resurfacing prosthesis.

    Science.gov (United States)

    Bilkhu, A; Sisodia, G; Chakrabarty, G; Muralikuttan, K P

    2015-04-01

    Femoral neck fractures have been reported as a cause for failure in patients with a hip resurfacing arthroplasty. However, the incidence and management of fractures of the femoral shaft with an ipsilateral hip resurfacing arthroplasty is relatively absent in current literature. Although, the gold standard for the fixation of a closed femoral shaft fracture is with the use of an intramedullary nail, this can be a challenge in the presence of a hip resurfacing arthroplasty. We describe the case of anterograde intramedullary nail fixation for a femoral shaft fracture in a patient with an ipsilateral hip resurfacing arthroplasty in situ.

  19. Does hip osteoarthritis have a protective effect against proximal femoral fractures? A retrospective study.

    Science.gov (United States)

    Calderazzi, Filippo; Groppi, Giulia; Ricotta, Agostino; Ceccarelli, Francesco

    2014-01-01

    The inverse relationship between proximal femoral fracture incidence and hip osteoarthritis remains controversial. However, femoral neck fractures rarely occur in patients with hip osteoarthritis, suggesting a protective effect of osteoarthritis. We sought to determine if the severity of osteoarthritis influenced fracture type. We examined the radiographs of 190 consecutive patients treated at our institution after hip trauma. They were divided into three groups according to the outcome of the trauma: femoral neck fracture; trochanteric fracture; and no fracture. We then analysed the severity of osteoarthritis within these groups. No relationship between the grade of hip osteoarthritis and the presence of a proximal femoral fracture was found. However, the grade of osteoarthritis was related both to the outcome of the trauma (posteoarthritis of the hip had a three-fold increased likelihood of trochanteric fracture compared to femoral neck fracture. Osteoarthritis does not protect against proximal femoral fractures, but strongly affects the location of the fracture in the proximal femur, increasing the possibility of a trochanteric location.

  20. Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail

    Institute of Scientific and Technical Information of China (English)

    吴立东; 吴琼华; 严世贵; 潘志军

    2004-01-01

    Objective: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures. Methods: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. Results: The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. Conclusions: The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.

  1. Pseudoarthrosis in atypical femoral fracture: case report.

    Science.gov (United States)

    Giannotti, S; Bottai, V; Dell'Osso, G; De Paola, G; Ghilardi, M; Guido, G

    2013-11-01

    Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.

  2. 股骨颈骨折内固定手术简史%A brief history of internal fixation of femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    梅炯

    2014-01-01

    1858年,德国外科医师VonLangenbeck采用镀银螺钉完成了世界第1例股骨颈骨折内固定手术.1875年,德国医生Franz K(o)nig在消毒后,成功利用金属螺钉实施股骨颈内固定术.1883年,美国外科医生Nicholass Senn提出了股骨颈骨折都应手术治疗的观点,但未能得到广泛认可.1931年,美国医生Smith-Petersen和他的同事发表了股骨颈骨折切开复位三翼钉内固定的治疗结果.随后,瑞典医生Sven Johansson、美国医生H.Heyward Wescott分别于1932年和1934年为闭合三翼钉内固定手术设计了相应的手术辅助器械.1941年,AAOS建议对股骨颈骨折使用三翼钉内固定.1976年,The British Medical Research Council指出,三翼钉不适用于有移位的股骨颈骨折.1980年,Asnis空心螺钉开始使用,并沿用至今.20世纪40年代,孟继懋和叶衍庆相继开展三翼钉内固定术治疗股骨颈骨折.1989年,危杰首先在中国就用AO空心钉治疗股骨颈骨折.此后,空心加压螺钉治疗股骨颈骨折在全国范围内得到了广泛的推广.%In 1858,a German surgeon named Von Langenbeck did the first internal fixation of femoral neck fracture (FNF) with metal silver screw.In 1875,a German doctor Franz K? nig did the same operation successfully with metal screws under antiseptic condition.In 1883,an American surgeon,Nicholass Senn suggested that all of the FNF should be treated by operation,but the proposition was not accepted extensively.In 1931,Smith-Petersen from the USA and his colleagues first published the report on the result of open reduction and internal fixation of FNF by the use of trifin nail.Due to the help of auxiliary appliance designed separately by the Swedish Sven Johansson (1932) and American H.Heyward Wescott (1934).In 1941,the American Academy of Orthopaedic Surgeons (AAOS) advocated the technique of trifin nail for its internal fixation.However,in 1976,the British Medical Research Council pointed out that the trifin nail was not

  3. Finite element analysis of femoral neck fracture with different fixation ways%三种内固定方式修复股骨颈骨折的有限元分析

    Institute of Scientific and Technical Information of China (English)

    夏志锋; 梁明; 李亚峰; 曾冠楠

    2016-01-01

    BACKGROUND:Finite element method is widely used in the femoral neck fracture, but the study concerning different fixation methods of femoral neck fracture is not much. OBJECTIVE:To analyze biomechanical properties of different fixation methods for femoral neck fracture using finite element analysis. METHODS:The femur of voluntters was scanned with CT, at thickness 0.6 mm, from the site above the greater trochanter of the femur. Scanning data were saved in .DICOM format. Data of right proximal femur were imported into Mimics software. Osteotomy was performed according to Pauwels I type fracture. Models of two tensile force screws, ful y threaded hol ow screw and proximal femoral locking plate were established. Three-dimensional finite element method was used to analyze stress distribution, stress concentration position, displacement distribution and maximum displacement in different models of femoral neck fracture with different internal fixation methods. RESULTS AND CONCLUSION:(1) The maximum stress value of two lag screws model was biggest. The maximum stress value of ful y threaded hol ow screw model was minimized. The maximum stresses of two lag screws model, ful y threaded hol ow screw model and proximal femoral locking plate model al were concentrated in the fixed end of fractures. (2) The femoral maximum stress of two lag screws model was biggest. The femoral maximum stress value of proximal femoral locking plate model was minimized. The femoral maximum stresses of two lag screws model, ful y threaded hol ow screw model and proximal femoral locking plate model al were concentrated in the medial femoral smal rotor near and medial femoral and fixation contact points. (3) The maximum displacement of two lag screws model was biggest. The maximum displacement of ful y threaded hol ow screw model was minimized. The maximum displacement of two lag screws model, ful y threaded hol ow screw model and proximal femoral locking plate model al was in the femoral head. (4

  4. 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.

  5. Clincal Observation on Pressurized Hollow Screw for Treating Femoral Neck Fracture of the Young and Middle-aged%加压空心螺纹钉治疗青壮年股骨颈骨折临床观察

    Institute of Scientific and Technical Information of China (English)

    朱庆东; 张家恒

    2012-01-01

    Objective:To investigate the clinical efficacy of pressurized hollow screw for the treatment of femoral neck fracture of the young and middle-aged patients. Methods; The pressurized hollow screw treatment was given under the C-arm X-ray fluoroscopy after traction. Results:The design of the compression screw was in line with the requirements of biomechanics,with great carrying capacity, which not only had the characteristics of compression, torsion and bending, but also could pressurize to make the fracture fragments in close contact in order to generate stress stimuli to promote fracture healing and femoral revascularization in the area of the fracture. Conclusion; The pressurized hollow screw for treatment of femoral neck fracture of the young and middle-aged patients is simple for operation and firm in fixation with high healing rate,less trauma and bleeding,which shows good clinical efficacy.%目的:探讨加压空心螺纹钉治疗青壮年股骨颈骨折的临床疗效.方法:56例患者行牵引后在C型臂X线机透视下进行加压空心螺纹钉治疗.结果:加压螺钉的设计符合生物力学的要求,其承载能力大,不但具有抗压、抗扭、抗弯的特性,又能加压使骨折断端紧密接触,在骨折处产生有利于骨折愈合的应力刺激,促进骨折愈合及股骨头再血管化.结论:加压空心螺纹钉治疗青壮年股骨颈骨折操作简单,创伤小,出血少,固定牢固,愈合率高,临床疗效较好.

  6. Prophylactic Nailing of Incomplete Atypical Femoral Fractures

    Directory of Open Access Journals (Sweden)

    Chang-Wug Oh

    2013-01-01

    Full Text Available Introduction. Recent reports have described the occurrence of low-energy subtrochanteric and femoral shaft fractures associated with long-term bisphosphonate use. Although information regarding the surgical treatment of these atypical femoral fractures is increasing, it is unclear if the preventive operation is useful in incomplete fractures. This study examined the results of preventive intramedullary nailing for incomplete atypical femoral fractures. Material and Methods. A retrospective search was conducted for patients older than 50 years receiving bisphosphonate therapy, with incomplete, nondisplaced fractures in either the subtrochanteric or diaphyseal area of the femur. Seventeen patients with a total of 20 incomplete, non-displaced lesions were included. The mean duration of bisphosphonate use was 50.5 months. Eleven of the 17 (64.7% patients had complete or incomplete fractures on the contralateral femur. All were treated with prophylactic fixation of an intramedullary (IM nail. The minimum followup was 12 months. Results. All cases healed with a mean period of 14.3 weeks. Nineteen of the 20 cases healed with the dissolution of incomplete fractures of the lateral aspect. A complete fracture developed at the time of nailing in one patient, but it healed with callus bridging. Conclusion. IM nailing appears to be a reliable way of preventing the progress of incomplete atypical femoral fractures.

  7. 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。

  8. Choice of Treatment and Clinical Analysis of Femoral Neck Fracture in Children%儿童股骨颈骨折的治疗选择及疗效分析

    Institute of Scientific and Technical Information of China (English)

    谢惠缄; 谢曦衷; 巫洪波; 郭汉明; 赖志军; 黄玉良; 张建民

    2001-01-01

    【目的】了解儿童股骨颈骨折不同治疗方法与治疗效果的关系,为治疗该病提供选择。【方法】分析我科1983年~1996年13年间收治的21例儿童股骨颈骨折的疗效。【结果】第1组14例采用电视X-ray下闭合复位+多根克氏针或小口径空心钉内固定术,11例愈合满意,合并股骨头缺血性坏死3例。第2组行皮肤牵引+髋人字石膏固定4例,3例治愈,合并股骨头缺血性坏死1例。第3组3例,行切开复位多根克氏针或小口径空心钉子内固定,治愈1例,合并股骨头缺血性坏死2例。【结论】儿童股骨颈骨折的治疗应以电视X-ray下闭合复位多克氏针内固定为首选,除非其它治疗方法失败,否则,不应轻易行切复位内固定术。%【Objective】To compare different approaches and their effectiveness on the treatment of the femoral neck fracture in children,in order to provide a reliable and effective way for the treatment of the disease.【Methods】Clinical data of 21 cases with femoral neck fracture from 1983 to 1993 were analyzed retrospectively.【Results】21 cases were divided into three groups:① group Ⅰ:14 cases underwent closed reduction and internal fixation with multiple Kirscher′s pins or cannulate compression screws under C-arm X-ray monitor.Of the 14 cases,11 cases were healed,3 cases developed ischemic necrosis of femoral head;② group Ⅱ:4 cases was treated with skin traction and hip spica cast plaster fixation,3 cases was healed,1 case developed ischemic necrosis of femoral head;③ group Ⅲ:3 cases underwent opened reduction and internal fixation with multiple pins or cannulate compression screws,1 case was healed,2 cases developed ischemic necrosis of femoral head.【Conclusion】Closed reduction and multiple pins internal fixation under C-arm X-ray monitor may be the best choice of treatment of femoral neck fracture in children.

  9. 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.)

  10. Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial.

    Science.gov (United States)

    Waaler Bjørnelv, G M; Frihagen, F; Madsen, J E; Nordsletten, L; Aas, E

    2012-06-01

    We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2 years, patients treated with hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective. Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly. A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82 years were randomized to either internal fixation (n = 86) or hemiarthroplasty (n = 80). Patients were followed up at 4, 12, and 24 months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients' quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios. Over the 2-year period, patients treated with hemiarthroplasty gained 0.15-0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (p = 0.81), €2,474 (p = 0.80), and €14,160 (p = 0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings. Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.

  11. 股骨颈自锁钉板系统的研制及其生物力学结构测试%Design and biomechanical structure evaluation of self-locking screw plate system for femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    昌耘冰; 尹东; 李凭跃

    2004-01-01

    BACKGROUND: A lot of internal fixators were used in femoral neck fracture, but they had quite a few defects in biomechanics.OBJECTIVE: To design the self-locking screw-plate(SLSP) system for the treatment of femoral neck fracture and to evaluate its biomechanical performance as well.DESIGN: A randomized controlled open trial.SETTING and PARTICIPANTS: The study was conducted in the Key Laboratory for Biomechanics, First Military Medical University. Twelve fresh cadaver specimens of human femur were used as testing materials.INTERVENTION: A new SLSP system was design based on the pathological and biomechanical characteristics of femoral neck fracture, which was composed of a main compressive screw, two affiliated screws and a self-locking plate. The specimens were divided into four groups for biomeMAIN OUTCOME MEASURES: Vertical displacement(rigidity), horizontal displacement (rigidity), counter-torsion strength and ultimate loads of femoral head after internal fixation in different groups RESULTS: The vertical displacements under 600 N vertical loads of the above four groups were(4. 25 ±0. 20), (5.58 ±0.41), (5.87 t0.35) and (6.40 ±0. 43) mm respectively, and the horizontal displacements were (1.78±0.25), (2.41±0.04), (2.42±0.25), and (2.79±0.31)mm respectively. There were statistical differences between SLSP group and the rest three groups( P < 0. 01). Compared with the torsional angle under equal 43% smaller than that of TCS group, HP group and DHS group respectively with significant differences( F = 96. 7, P < 0.01 ) . The ultimate loads and displacement of SLSP group were (3 830 ± 66) N and (7.49 ± 1.2) mm respectively significantly higher than that of the rest three groups.CONCLUSION: After the internal fixation with SLSP system in treating femoral neck fracture, the mechanical performance is superior to those of the others in vertical and horizontal displacement as well as counter-torsion strength and ultimate loads. SLSP system organically

  12. A locked hip screw-intramedullary nail (cephalomedullary nail) for the treatment of fractures of the proximal part of the femur combined with fractures of the femoral shaft.

    Science.gov (United States)

    Alho, A; Ekeland, A; Grøgaard, B; Dokke, J R

    1996-01-01

    Twenty-seven patients with complex femoral fractures (combined shaft and proximal femoral fractures) were treated with a modified Grosse-Kempf slotted locking nail (cephalomedullary nail), wherein two screws were inserted in the hip. Four types of complex, multifocal femoral fractures were represented in the series. Eleven of the femoral shaft fractures were secondary to a previous, internally fixed, not yet united hip fracture (type I). Ten comminuted peritrochanteric fractures occurred in normal bone (type II). Three similar fractures were pathologic because of metastasis. Two patients had an ipsilateral fracture of the femoral shaft and the trochanteric area (type III), and one of the shaft and the femoral neck (type IV). Locking was made static in 24 cases. Additional cerclage wiring was used in three type II fractures. Five complications were as follows: one cutting out of a screw in the femoral head, two fractures of the nail, one deep venous thrombosis, and one wound hematoma. Reoperations were two salvage operations using a new nail and one evacuation of hematoma. One patient with multiple injuries and four elderly patients died within 2 months. Eighteen patients with fractures in normal bone were followed for a median of 20 (6 to 37) months. All fractures united. Two nails were removed. The end result was excellent in ten patients, good in seven, and fair in one (2-cm shortening and 20-degree external rotation). We conclude that a locked intramedullary construct with locking screws in femoral neck and distal femur controls a complex fracture situation well.

  13. Accuracy of closed reduction for displaced subcapital femoral neck fractures assisted by C-arm X-ray machine%移位股骨颈头下骨折模拟C臂X射线机观察闭合复位的真实精确性

    Institute of Scientific and Technical Information of China (English)

    戚珊红

    2012-01-01

    BACKGROUND: Traction bed C-arm X-ray machine is used for closed reduction and internal fixation to treat femoral neckfracture has some errors.OBJECTIVE: To perspectively analyze the accuracy of closed reduction for femoral neck fractures by assisted C-arm X-raymachine.METHODS: Complete reduction of artificial femoral neck fractures was realized under direct vision and then fixed by kirschnerpins which were knocked in at both fractured ends respectively on lateral femoral neck to be used as metal marker. Femoral neckspecimens and C-arm X-ray machine were not removed and then the femoral neck specimens revolved 15° clockwise and 30°anticlockwise respectively. Anterior-posterior of the standard femoral neck was examined by C-arm X-ray machine, thencorresponding imaging was collected.RESULTS AND CONCLUSION: There was no significant difference of the displacement in the both ends of the subcapitalfemoral neck fractures (around 1 mm both) when the necks were located at the position of 15°, 30° clockwise and anticlockwiserespectively. There was significant difference of the displacement in the both ends of the subcapital femoral neck fractures(around 2 mm both) when the necks were located at the position of 30°, 30° clockwise and anticlockwise respectively. It is shownthat C-arm X-ray machine is used to observe the subcapital femoral neck fractures and can meet the reduction requirement ofGarden scores, but the femur head rotation cannot be identified. As a result, displaced femoral neck fractures necessitate openreduction.%背景:采用牵引床C臂X射线机下闭合复位、内固定治疗股骨颈头下骨折,可能有一定的误差.目的:模拟C臂X射线机下闭合复位透视分析骨折闭合复位的真实精确性.方法:直视下完全复位人工骨股骨颈头下骨折标本,使用克氏针固定.在股骨颈外侧,两个断端处分别使用克氏针打入,作为金属标志物.保持股骨颈标本、C臂X射线机位置不动,随后将股骨头

  14. 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.

  15. Biomechanical characteristics of bipolar femoral head prosthesis replacement and internal fixation for femoral neck fractures in the elderly%股骨头双极假体置换及内固定修复老年股骨颈骨折的生物力学特征

    Institute of Scientific and Technical Information of China (English)

    姜源涛; 焦建宝; 薛金伟; 王云飞

    2016-01-01

    背景:双极人工股骨头假体在股骨颈骨折患者中虽然能够取得理想的修复效果,但是临床上对于双极人工股骨头假体的生物力学性能尚存在较大的争议。目的:比较股骨头双极假体置换及内固定修复老年股骨颈骨折的生物力学性能。方法:选取23具(46侧)老年股骨颈骨折股骨标本进行分析,随机将标本分为内固定组和股骨头双极假体置换组,每组23侧。内固定组标本行常规金属植入物内固定,股骨头双极假体置换组行股骨头双极假体置换。在万能试验机上测定股骨假体柄的力学性能,比较股骨头双极假体置换及内固定的生物力学性能。结果与结论:①股骨头双极假体置换组的最大承载负荷显著高于内固定组(P<0.05);最大承载负荷趋势图显示,股骨头双极假体置换组最大承载负荷显著高于内固定组(P<0.05);②股骨头双极假体置换组轴向拔出试验位移显著短于内固定组(P<0.05);轴向拔出试验位移趋势图显示,股骨头双极假体置换组轴向拔出试验位移显著短于内固定组(P<0.05);③结果提示,与内固定植入物相比,股骨头双极假体置换修复老年股骨颈骨折更加稳定,修复效果更佳,能够提高患者髋关节功能,获得良好的初始稳定性。%BACKGROUND:Bipolar femoral head prosthesis has achieved the desired repair effect in patients with femoral neck fracture, but there is stil much controversy on the biomechanical properties of bipolar artificial femoral head prosthesis. OBJECTIVE:To compare biomechanical properties of the bipolar femoral head prosthesis replacement and internal fixation in the repair of femoral neck fracture in the elderly. METHODS:Twenty-three (46 sides) senile femoral neck fracture specimens were analyzed and randomized into internal fixation group(n=23)and bipolar femoral head prosthesis replacement group (n=23). Specimens in the internal

  16. Analysis of close reduction under the C-arm X-ray perspective for femoral neck fractures%股骨颈骨折闭合复位的实际效果分析

    Institute of Scientific and Technical Information of China (English)

    李欣; 陈仲; 杨洪昌

    2011-01-01

    Objective To evaluate the actual displacement of a femoral neck fracture following close reduction under the C-arm X-ray perspective.Methods From June, 2006 to June, 2009, we managed 12 patients with femoral neck fracture by open reduction and internal fixation.They were 8 males and 4 females, aged from 23 to 65 (average, 42.3) years old.We tried close reduction of their fractures under the C-arm X-ray perspective before a temporary fixation.Next we performed open reduction, readjusted the fracture ends, and placed internal fixation.The actual displacement of the fracture measured after open reduction was carefully compared with the close reduction under the X-ray perspective.Results A substantial displacement was found after open reduction in 7 patients who had achieved anatomic reduction under the X-ray perspective.In the other 5 patients who presented with a slight displacement after close reduction under X-ray perspective, the actual displacements were larger than the X-ray observations but completely reduced after open reduction.The actual measurements after open reduction were significantly larger (3.21 ± 0.96 mm on average) in the anteroposterior displacement ( t = 11.540, P = 0.000), but insignificantly larger (0.58 ±0.93 mm on average) in the superior-inferior displacement ( t = 2.184, P = 0.346) than those after close reduction.Conclusions In general, anatomic reduction can not be achieved for a femoral neck fracture under the C-arm X-ray perspective.Consequently, open reduction may be better than close reduction in the treatment of femoral neck fracture in that improper reduction can block blood supply to the femoral neck and dissection of the capsula articularis coxae can improve blood supply as well as help decompression.%目的 探讨股骨颈骨折闭合复位在C型臂X线机下达解剖复位时骨折端的实际移位情况.方法 自2006年6月至2009年6月对12例股骨颈骨折患者行切开复位内固定,其中男8例,女4例;年龄23

  17. Eccentricity adjustment in artificial hip replacement for treatment of femoral neck fracture%股骨颈骨折人工髋关节置换的偏心距调整

    Institute of Scientific and Technical Information of China (English)

    李瓦里; 孙波; 滕东辉; 刘世珑

    2009-01-01

    背景:研究表明,股骨偏心距短缩会导致外展肌肌力下降,偏心距过大,则增加置换后股骨颈假体折断的风险及增加骨水泥型股骨柄假体骨鞘的压应力,使其易松动和下沉.目的:探讨高龄股骨颈骨折人工髋关节置换过程中偏心距调整的重要性.设计、时间及地点:观察件实验,病例来自2004-01/2005-12天津中医药大学第一附属医院骨科.对象:选择天津中医药大学第一附属医院骨科收治的股骨颈骨折患者30例,男12例,女18例,年龄62~90岁,平均73.8岁.方法:全部患者均实施了人工髋关节置换术(由同一组手术医师操作),术前利用X-Caliper仪器,仔细测量骨盆正位片中健侧股骨头旋转中心、髋关节旋转中心、颈干角、股骨的横向偏心距、外展力臂、重力力臂等,利用三角函数进行准确计算.确定截骨平面的角度,选择合适假体以及术中对于偏心距的调整,比较置换后与健侧的差异.主要观察指标:偏心距的数值及置换后关节功能.结果:30例患者术前健侧偏心距平均38.7mm(22~57mm),术后患侧偏心距平均39.2 mm(21~59 mm):健侧平均38.7 mm.术后肢体不等长范围1.8~8.7 mm,平均3.4 mm,患侧肢体长者26例,占86.7%,短者4例,占13.3%.术后随访0.5~2.5年,根据Harris评分标准,优10例,良19例,可1例,优良率达97%.结论:股骨颈骨折人工关节置换中偏心距的合适与否与置换后关节功能密切相关.%BACKGROUND:It has been demonstrated that shortening of femoral eccentricity would lead to decreased abductor muscle strength,and overlengthening eccentricity would increase the risk of femoral neck prosthesis fracture and the compressive stress of cemented femoral stem prosthesis after artificial hip replacement,which easily causes prosthetic loosening and subsidence.OBJECTIVE:To investigate the importance of eccentricity adjustment in the artificial hip replacement for treatment of femoral neck fracture in

  18. 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.

  19. Bisphosphonate-induced atypical subtrochanteric femoral fracture

    OpenAIRE

    2013-01-01

    The use of bisphosphonates (BPs) is universally accepted in the management of osteoporosis. However, a small percentage of patients have been recognised to develop atypical subtrochanteric fractures of the femur with the prolonged use of BPs. We report a rare case of bilateral insufficiency lesions in the proximal femora, where a major subtrochanteric fracture developed with a minor fall. This was successfully treated with internal fixation using proximal femoral nail.

  20. Femoral head fractures: hemiarthroplasty or total hip arthroplasty?

    Science.gov (United States)

    Ullmark, Gösta

    2014-10-02

    Most femoral neck fractures are osteoporotic fractures in the elderly. The one-year mortality after neck fracture in this group is 24%.For hemiarthroplasty (HA) the bipolar heads have a risk reduction for reoperation due to acetabular erosion compared with monoblock heads. Surprisingly, the bipolar head had an increased reoperation risk for dislocation, infection and for periprosthetic fracture.Total hip arthroplasty (THA) after fracture has a four-fold raised risk for dislocation compared with THA after osteoarthritis. A larger head on the same neck (head to neck ratio) results in a theoretically larger range of movement and hence less risk for dislocation. The dual mobility bearing has, theoretically, the largest range of movement and good clinical results.Functional results are better for THA compared with HA. Arthroplasty for fracture has much better results compared with arthroplasty after a failed internal fixation; the risk for reoperation is more than doubled for the latter.A Swedish hip arthroplasty register study found a 20-fold higher risk for periprosthetic fracture when comparing uncemented HA with matt cemented HA. Also a polished cemented stem had 13½-fold higher risks compared with a matt.The mortality during the first day after surgery is higher for cemented compared with uncemented arthroplasties, but lower after one week, one month and one year. Analysing the time points together resulted in no difference.A matt cemented THA with a maximum head size, maybe dual mobility, has the best results, and is also for the low-demanding elderly.

  1. Managing periprosthetic femoral stem fractures.

    Science.gov (United States)

    Rosenberg, Aaron G

    2006-06-01

    Periprosthetic fractures can be difficult to manage. The classification system developed in Vancouver is simple and useful in determining appropriate treatment. It takes into account the site of the fracture, the stability of the implant, and the surrounding bone stock, which are the important elements of the fracture and hip that determines treatment. Understanding this classification system should allow the practitioner to choose the appropriate treatment. In addition to fracture management skills, understanding how to perform a host of hip revision technique may also be required.

  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. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo

    2014-01-01

    Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients...... with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features...... that distinguish AFFs from ordinary osteoporotic femoral diaphyseal fractures and to provide guidance on the importance of their transverse orientation. The requirement that fractures be noncomminuted was relaxed to include minimal comminution. The periosteal stress reaction at the fracture site was changed from...

  4. 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)

  5. Prosthetic replacement in elderly with femoral neck fracture of hemiplegic extremity%人工关节置换治疗老年人卒中后偏瘫侧股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    周伟; 倪江东; 贺学军; 易惠军

    2014-01-01

    Objective:To study the curative of prosthetic replacement in the elderly with femoral neck fracture of the hemiplegic ex -tremity.Methods:From June 2010 to June 2012,37 cases of the femoral neck fracture (Garden typeⅢand typeⅣ) of the hemiplegic ex-tremity were treated by prosthetic replacement .All the cases were followed up , the follow-up time was from 10 months to 34 months, av-eraging 20 months.The curative effects were evaluated by harris hip score .The harris hip scores before and after operation was observed , at the same time, according to its content was divided into pain , function, degree of motion, limb deformities four aspects to rate respec-tively.Resulst :The average harris hip score improved from 14.61 ±6.51 point preoperatively to 81.13 ±8.76 point at the last follow -up.Patients with postoperative scores were significantly higher than the former , and pain, function, degree of motion, limb deformities preoperative postoperative evaluation of the project were significant difference .Conclusion:Prosthetic replacement in the treatment of the elderly with femoral neck fracture of the hemiplegic extremity might be safe and effective method .%目的:观察和分析人工关节置换治疗脑卒中患者偏瘫侧股骨颈骨折的疗效和方法。方法:自2010年6月~2012年6月,我院采用人工关节置换术治疗老年人脑卒中患者偏瘫侧股骨颈骨折 GardenⅢ、Ⅳ型37例,随访10个月-34个月,平均20个月,观察手术前后harris评分,同时按其内容分为疼痛、功能、关节活动度、肢体畸形四方面分别进行评分。结果:患者harris评分由术前的(14.61±6.51)分恢复到术后末次随访时的(81.13±8.76)分。患者术后评分明显高于前者,而且疼痛、功能、关节活动度、肢体畸形各项目术前术后评定均差异显著。结论:人工关节置换治疗老年人卒中后偏瘫侧股骨颈骨折是安全有效的方法,在缓解疼痛

  6. 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.

  7. Biomechanical study of different internal-fixations in femoral neck fractures%不同内固定器固定股骨颈骨折的生物力学比较研究

    Institute of Scientific and Technical Information of China (English)

    马信龙; 马剑雄; 杨阳; 朱少文; 马宝意; 姬树青; 马韬; 陈阳; 王志彬

    2011-01-01

    Objective To compare the biomechanical effect of several commonly used internal fixators in treating the femoral neck fractures so as to provide clinical basis for the selection of ideal internal fixation.Methods Twelve artificial PMMA femoral models were selected,and the central neck of the specimens was sawn with an electric saw at Pauwels angle of 70° to form adduction type femoral neck fracture models.After anatomic reduction,the specimens were fixed with dynamic hip screw ( DHS),three hollow screws,proximal femoral nail (PFN) and dynamic sleeve three-wing screw according to the operative approach,respectively.Instron-8874 servo-hydraulic mechanical testing machine was used to fix the specimens which simulated uniped standing.Fifteen key points on proximal femur were selected as test points and were given gradation loading at speed of 10 mm/min with linear load 0-1 200 N.The strain of each point under 1200 N load,head sink displacement under different loads and the strain of eight points on principal pressure side were measured.Results There was a peak at the eight resistance strain gage at 1200 N load and the strain values of the DHS,three hollow screws,PFN and dynamic sleeve three-wing screw were (700 ±35) μεz,(756 ± 14) με,( 1362 ± 136) με and (3024 ± 127) με,with statistical significance (P < 0.01 ).Under the same load,the head sink displacement in the group of dynamic sleeve three-wing screw was greater than that of the hollow screws group and the PFN group ( P <0.01 ),but smaller thau that of the DHS group ( P < 0.01 ).The strain values at the eight resistance strain gage in the group of dynamic sleeve three-wing screw was larger than that of the other three groups under the same load (P < 0.01 ),and the strain values increased with the increase of load at the same fixation group.Conclusion Dynamic sleeve three-wing screw has good biomechanical stability for treatment of femoral neck fracture,which can be applied in the clinical

  8. 老年股骨颈骨折患者的围手术期特点及手术处理%Perioperative characteristics of femoral neck fractures in the elderly patients and surgical treatment

    Institute of Scientific and Technical Information of China (English)

    黄河; 宋涛; 吴永涛

    2011-01-01

    Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 75 years by analyzing the surgical treatment procedures. Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2005 and June 2008,There were 51 males and 35 females,at average age of 79.4 years.Of all, there were 79 patients with fresh fractures including 9 with type Garden Ⅰ or Ⅱ fractures and 70 with type Garden Ⅲ or Ⅳ fractures,7 with old fractures(all type Garden Ⅳ). 9 patients with type Garden Ⅰ or Ⅱ fractures were treated with caunulated screw fixation(CSF). Among 77 patients with type Garden Ⅲ or Ⅳ fractures including 70 fresh fractures and 7 old ones,72 patients were treated by hip hemiarthroplasty(HHA). but the other 5 by cemented total hip arthroplasty (THA) because of preexisting hip osteoarthritis. Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group, 81 minutes and 180 ml in HHA group,105 minutes and 350 ml in THA group.Postoperative hemoglobin was decreased by 12% ,17% and 18 % on average respectively in CSF group, HHA group and THA group, and postoperative albumin decreased by 11 % , 18 % and 20 % on average respectively in CSF group, HHA group and THA group.Conclusions The patients aged ≥ 75 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurolosical diseases and have high risk in operation. Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.%目的 分析75岁以上高龄股骨颈骨折患者的手术治疗过程,总结围手术其特点,对于今后高龄患者的治疗提供帮助.方法 回顾性研究自2005年6月至2008年6月手术治疗的86例75岁以上的股骨颈骨折患者的治疗过程,男51例、女35例,平均年龄79.4

  9. 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

    Objective To explore the related factors femoral head necrosis after the operation on adult femoral neck frac-tures by compressed hollow screws fixation. Methods The author reviewed the patients who were treated by compressed hol-low screws fixation from January 1st,2001 to December 31st,2010 and then made a statistical analysis on the following eight factors:age,gender,fracture type(Garden type),surgical reduction quality(Garden index),the time gap between injury and the operation,reset mode( open reduction or close reduction),the partial weight-bearing time after the operation,whether the fixation is removed. Among these eight factors,the statistically significant factors were selected and then analyzed by logistic re-gression analysis one by one. Results There are 185 cases with a complete set of follow-up data and the follow-up lasts from three to ten years(the average duration is 5. 5 years). Among the 185 cases,28 patients suffered from femoral head ischemic necrosis,which accounts for 15. 14% and the independent factors influencing femoral head necrosis included the following:fracture type,fracture reduction,the time gap between injury and the operation,the partial weight-bearing time after the opera-tion. Conclusion The major complication of femoral neck fractures operation by compressed hollow screws fixation is femoral head ischemic necrosis and the major risk factors are fracture type,fracture reduction,the time gap between injury and the op-eration and the partial weight-bearing time after the operation. Among those factors,reduction quality,the time gap between in-jury and the operation and the partial weight-bearing time after the operation are controlling factors and it is found that femoral head ischemic necrosis can be lowered down when the patient receives compressed hollow screws fixation at an earlier time,im-proves reduction quality and tries to bear partial weight after three months'fixation. The present data shows that compressed hol

  10. Femoral head fracture without hip dislocation

    Institute of Scientific and Technical Information of China (English)

    Aditya K Aggarwal; Ashwani Soni; Daljeet Singh

    2013-01-01

    Femoral head fractures without dislocation or subluxation are extremely rare injuries.We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high energy trauma due to road traffic accident.He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39.He received cementless total hip replacement.At latest follow-up of 2.3 years,functional outcome was excellent with Harris hip score of 95.Such isolated injuries have been described only once in the literature and have not been classified till now.The purpose of this report is to highlight the extreme rarity,possible mechanism involved and a novel classification system to classify such injuries.

  11. Optimum Configuration of Cannulated Lag Screws for the Fixation of Femoral Neck Fractures:A Biomechanical Study%空心钉在股骨颈中构型的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    王世坤; 王志义; 刘振宇

    2011-01-01

    Objective To determine which of configurations,a inverse triangular configuration and an upright triangular configuration,provide significantly improved fixation strength for fixation of femoral neck fractures with three cannulated lag screws. Methods Eight pairs of femurs were selected. A osteotomy was made. One femur of each pair was randomly selected for stabilization using cannulated lag screws in either an inverse triangular configuration or an upright triangular configuration. An Universal Material Testing Machine was used to apply vertical loads directly onto the femoral head. At each applied load, the inferior femoral head displacement reading and shearing displacement of the osteotomy were recorded. Results The inverse triangular configuration group sustained a higher (P<0. 05) average ultimate load to failure (3375 N) than did specimens in the upright triangular configuration (2725 N). At a load of 8 0 0 N , the average shearing displacement was less for specimens stabilized in the inverse triangular configuration (39. 1 μm) than for those stabilized in the upright triangular configuration (93. 1 μm;P<0. 05). Conclusion Three cannulated lag screws placed in the inverse triangular configuration provide significantly improved fixation strength compared with three screws placed in the upright triangular configuration for fixation of femoral neck fractures without posterior comminution.%目的 通过生物力学实验探讨空心钉固定股骨颈骨折时,3枚螺钉的构型对固定强度和稳定性的影响.方法 选取25~70岁尸体股骨8对,左右股骨随机分成两组.倾角50°截骨,3枚空心钉分别呈正三角和倒三角构型固定股骨颈骨折.生物力学实验机对股骨-螺钉复合体进行线性递增的加载,同时测量股骨头的位移和沿截骨面的剪切化移.结果 倒三角形构型的空心固定组较正三角形组具有更高的极限负荷和抗剪切能力,差异有统计学意义(P<0.05).结论 对于无

  12. 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.

  13. 经后外侧入路小切口全髋关节置换治疗股骨颈骨折%Total hip arthroplasty with posterior minimal incision for the treatment of femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    刘程俊; 谢直跃; 顾祖超; 杨立明; 张宇

    2011-01-01

    背景:全髋关节置换已成为老年人创伤性股骨颈骨折常见的治疗方式之一,小切口微创方式可减少手术创伤及患者痛苦,便于老年患者假体置换后早期康复.目的:探讨经后外侧入路小切口行全髋关节置换后治疗股骨颈骨折的临床效果.方法:回顾性分析25例创伤后股骨颈骨折(Garden Ⅲ、Ⅳ型)患者资料,均行经后外侧入路小切口全髋关节置换.结果与结论:25例患者随访≥6个月.置换后复查X射线示假体位置良好;1例出现脱位,处理后未再发生脱位;1例下肢不等长,不影响行走.置换后9个月Harris评分平均85.7.置换后未发生感染、神经损伤、假体松动、假体周围骨质情况及深静脉血栓形成.说明经后外侧入路小切口全髋关节置换具有创伤小、人工关节稳定性强、患者恢复时间短等优点,适合老年股骨颈骨折(Garden Ⅲ、Ⅳ型)患者.%BACKGROUND: Total hip arthroplasty has become one of the common treatment modalities of the traumatic femoral neckfractures in the aged. Total hip arthroplasty with minimal incision not only reduces the surgical trauma and the patients suffering,but also benefits the recovery from operation in the aged.OBJECTIVE: To explore the clinical results of total hip arthroplasty with posterior minimal incision for the treatment of femoralneck fractures.METHODS: A total of 25 cases of traumatic femoral neck fractures (Garden Ⅲ and Ⅳ) underwent total hip arthroplasty withposterior minimal incision were retrospectively analyzed.RESULTS AND CONCLUSION: All 25 cases were followed up for more than 6 months. According to the X-ray examination afteroperation, the prosthesis was in good position. One case had prosthesis dislocation, and the dislocation didn't happen aftertreatment. One case had lower limb discrepancy which did not influence walks. The average Harris score was 85.7 in the 9thmonth after operation. There was no infection, nerve injury, prosthetic

  14. 老年人股骨颈骨折股骨头置换术中短柄假体的有限元分析%Finite element analysis of the short-stem prothesis in femoral head replacement among the elderly femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    吕大伟; 苏琴; 姚咏明; 赵晓东

    2015-01-01

    目的:针对老年人股骨颈骨折后假体置换术,使用有限元分析的方法对股骨短柄假体与常规股骨假体的生物力学特性进行对比。方法利用薄层CT资料建立股骨三维有限元模型,利用我院股骨中空多孔股骨假体相关参数建立两种髋关节股骨假体三维有限元模型;应用Ansys 5.7有限元分析软件考察两种假体植入后的应力分布,并进行比较。结果短柄假体所受最大mises应力较常规股骨假体明显减小;力学传导模式仍为远端应力集中,最大mises应力仍出现在张力侧。结论老年人股骨颈骨折关节置换术中短柄假体力学特性优越。%Objective To compare biomechanical properties of the short-stem prosthesis with conventional prosthesis with the finite element analysis method for the elderly femoral neck fracture after femoral head replace -ment.Methods Three-dimensional finite element models of the upper femur and prosthesis were established .The stress distribution difference between the short-stem prosthesis and conventional prosthesis was compared by using fi-nite element analysis software Ansys 5.7.Results The maximum mises stress of the short-stem prosthesis de-creased significantly,while stress distribution model remained the same .Conclusion The short-stem prosthesis presents superior mechanical properties in femoral head replacement among the elderly femoral neck fractures .

  15. 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

  16. Laceration of femoral vessels by an avulsion fracture fragment of the lesser trochanter after bipolar hemiarthroplasty.

    Science.gov (United States)

    Ha, Yong-Chan; Luminita, Simion; Cho, Se-Hyun; Choi, Jun-Young; Koo, Kyung-Hoi

    2005-08-01

    Femoral vessel injuries after bipolar hemiarthroplasty have not been reported. The current report describes a case of a dual major vessel (superficial femoral artery and vein) injury associated with an avulsion fracture fragment of the lesser trochanter in a 76-year-old woman who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. The superficial femoral artery was repaired and the defect of the superficial femoral vein was reconstructed with a Gore-Tex graft (WL Gore and Associates Inc, Flagstaff, Ariz). The clinical result was satisfactory and there was no vascular problem at 1-year follow-up. Early diagnosis of this vascular injury prevents serious complications including gangrene of the injured limb.

  17. 不同早期锻炼方案在股骨颈骨折患者中应用效果的对比研究%Application effect of different early exercise programs on patients with femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    王荣兰

    2014-01-01

    Objective To compare the application effect of different early exercise programs on patients with femoral neck fractures . Methods A hundred patients with femoral neck fracture undergoing surgery in Haikou People ’ s Hospital from January 2011 to May 2013,as the research subjects,were assigned into observation group and control group randomly ,and each group had 50 cases.The pa-tients in control group underwent routine functional exercises in bed after surgery , while the patients in observation group took sitting from the bed and cycling exercise in addition .Prevalence of postoperative complications and the patient ’ s anxiety level were evaluated within two weeks after surgery in patients of two groups , and the patient ’ s activities of daily living were evaluated two weeks , four weeks,eight weeks after surgery respectively .Results Prevalence of postoperative complications and the patient ’s anxiety level of the patients in observation group were significantly lower than the control group 2 weeks after surgery ,and the differences between the two groups were statistically significant (P<0.05).The patient’s activities of daily living were significantly higher than the control group two weeks ,four weeks ,eight weeks after surgery respectively ,and the differences between the two groups were statistically significant ( P<0.05).Conclusions Exercises of sitting from the bed combined with cycling are conducive to the rehabilitation of patients with fem -oral neck fracture ,which is worth promotion in clinical practice .%目的:探讨不同的早期锻炼方案在股骨颈骨折患者中的应用效果。方法选取2011年1月-2013年5月在该院骨科住院的100例股骨颈骨折并做手术治疗的患者作为研究对象,随机分为观察组和对照组,每组50例。对照组患者术后行常规的床上功能锻炼;观察组在对照组功能锻炼基础上,给予早期离床坐及踩单车运动。观察患者术后2周内并发症

  18. 老年股骨颈骨折患者术后痴呆发病的影响因素分析%The study of postoperative delirium in predicting dementia in elderly patients with femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    胡国伦; 陈代全; 龚定华; 李学斌; 齐晓岚

    2015-01-01

    Objective To study the postoperative delirium in predicting dementia in elderly patients with femoral neck frac‐ture and provide prevention advises for postoperative delirium .Methods 120 elderly patients with femoral neck fracture were in‐cluded .All patients were tested normal by Clinical Dementia Rating (CDR) preoperative .Basic imformation and postoperative deliri‐um in predicting dementia were recored in detail .After one year of follow up ,all patients were tested by CDR again and divided into dementia group and without dementia group .Results There were 40 patients (33 .3% ) with delirium postoperative with dementia 1 week after operation;there were 16 patients got 0 .5 -3 .0 CDR score after one year follow up (40 .0% ) .There were 80 patients (66 .7% ) did not experience delirium postoperative 1 week after operation ,and 4 patients (5 .0% ) with dementia got CDR score higher than zero after one year folloew up;the difference was statistically significant (P<0 .05) .Single factor analyse showed that there were close correlation between age ,introverted ,level of education < 6 years ,diabetes mellitus ,delirium ,LDL‐C level and de‐mentia (P<0 .05) .Multiple factors showed that age ,diabetes history and delirium were the independent risk factors of dementia in elderly patients with femoral neck fracture (P<0 .05) .ROC curve showed that the AUC area of postoperative delirium in predic‐ting dementia in elderly patients with femoral neck fracture was 0 .878 .Conclusion In elderly patients without the history of de‐mentia ,age ,diabetes history and delirium after hip fracture surgery are the major predictor of dementia within half years .%目的:探讨老年股骨颈骨折患者术后痴呆发病的影响因素分析,为该类患者术后痴呆发生的预防提供可参考依据。方法共纳入120例贵州盘江投资控股(集团)有限公司总医院骨科因股骨颈骨折行手术治疗的老年患者作为研究对象,所有患者

  19. 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

  20. Platelet-rich plasma combined with closed reduction and hollow screw internal fixation for femoral neck fracture%PRP联合闭合复位空心螺钉内固定治疗股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    陈志军; 杨彪; 张大华

    2016-01-01

    目的:分析自体富血小板血浆( PRP)联合闭合复位空心螺钉内固定治疗股骨颈骨折的临床效果。方法回顾性分析2010年5月至2014年8月在我院治疗的200例股骨颈骨折患者的临床资料,分为PRP组和对照组,各100例。 PRP组采用PRP联合闭合复位空心螺钉内固定治疗,对照组单纯采用闭合复位空心螺钉内固定治疗,记录2组患者住院时间、骨折愈合时间、切口愈合情况、术后并发症、Harris评分及髋关节功能恢复情况。结果 PRP组住院时间、骨折愈合时间明显短于对照组,切口甲级愈合率高于对照组,术后合并股骨头坏死及骨折不愈合率明显低于对照组,差异均具有统计学意义(P<0.05)。 PRP组患者术后6个月、12个月Harris评分分别为87.35、90.82分,均高于对照组的81.37、84.32分,术后6个月、12个月髋关节功能优良率分别为86%、90%,高于对照组的67%和76%,差异均具有统计学意义(P<0.05)。结论 PRP联合闭合复位空心螺钉内固定治疗股骨颈骨折能明显缩短骨折愈合时间,减少术后并发症,提高患者髋关节功能及术后生活质量,安全性和有效性较高。%Objective To explore the clinical effect of autologous platelet-rich plasma ( PRP) combined with closed reduction and hol-low screw internal fixation for femoral neck fracture .Methods Totally 200 cases of femoral neck fracture were collected from May 2010 to August 2014 in our hospital .Randomly divided them into two groups , namely the PRP group and the control group , with 100 patients in each group.The PRP group were given autologous platelet-rich plasma ( PRP) combined with closed reduction and hollow screw internal fixation , while the control group were given closed reduction and hollow screw internal fixation merely .The length of stay , time of fracture healing , wound healing state , postoperative complications rate

  1. Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model trial

    Institute of Scientific and Technical Information of China (English)

    WANG Jun-qiang; ZHAO Chun-peng; SU Yong-gang; ZHOU Li; HU Lei; WANG Tian-miao; WANG Man-yi

    2011-01-01

    screws in femoral neck fractures.Guidewire passes in the robot group were significantly less than in the optoelectronic group.However,both navigated procedures were associated with time-consuming registration and high rates of failed matching procedures.

  2. 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

  3. The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

    Directory of Open Access Journals (Sweden)

    J. Harding

    2013-01-01

    Full Text Available Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection. Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

  4. Treatment of displaced femoral neck fractures with percutaneous compression plate in young and middle-aged patients%经皮加压钢板固定治疗中青年移位型股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    王松华; 刘璠; 查涛; 杨志刚

    2016-01-01

    Objective To explore the operative treatment of displaced femoral neck fractures with percutaneous compression plate (PCCP) in young and middle-aged patients.Methods Forty-three young and middle-aged patients with displaced femoral neck fracture were treated with PCCP from May 2011 to May 2015.They were 24 males and 19 females,aged from 21 to 55 years (mean,38.2 years).According to the Garden classification,29 cases were type Ⅲ and 14 type Ⅳ.According to the Pauwels classification,18 cases were type Ⅱ and 25 type Ⅲ.After reduction was conducted manually or using percutaneous joystick technique,nailing was carried out under the guidance of the three-dimensional position sticker which had been invented by ourselves for minimally invasive treatment of hip fractures.Clinical and radiographic outcomes were recorded after operation and postoperative hip function was evaluated using Harris score.Results Manual reduction succeeded in 38 cases and the other 5 cases experienced reduction by percutaneous joystick technique after failure of manual reduction.For this series,the operation time ranged from 35 to 60 minutes (mean,53.2 minutes),explicit blood loss from 20 to 80 mL (mean,65.3 mL),frequency of X-ray exposure from 6 to 20 times (mean,11.8 times) during operation,the partial weight-bearing time from 14 to 30 days (mean,22.5 days),and the full weight-bearing time from 2.5 to 4.0 months (mean,3.2 months).The 43 cases were followed up for 12 to 46 months (mean,28.5 months).Bone union was achieved in all after 3 to 7 months (mean,4.3 months).The Harris hip scores at the final follow-ups ranged from 71 to 98 points (mean,92.7 points).The excellent to good rate was 95.3%,with 26 excellent cases,15 good ones and 2 fair ones.Two cases developed femoral avascular necrosis.No nonunion,implant failure or hip varus was observed during follow-ups.Conclusion Although it is difficult to treat displaced femoral neck fractures in young and middle-aged patients using PCCP

  5. [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.

  6. 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.

  7. 应用皮质支撑原理固定股骨颈骨折的生物力学研究%Biomechanical study on femoral neck fracture fixation based on cortical screw support theory

    Institute of Scientific and Technical Information of China (English)

    王立江; 魏海强; 郭连江; 黎宁; 彭阿钦

    2009-01-01

    Objective To evaluate the biomechanical effect of cortical screw support technique in fixation of the femoral neck fractures. Methods The models of subcapital femoral neck fracture were made in eight matched pairs of embamled cadaver femurs and decided into experiment group and control group (four pairs per group). The side of experiment group was fixed using three cannulated compression screws with cortical screw support and that of control group with conventional screw placement. The speci-mens in two groups were tested in aspects of torsion and axial loading. Results In axial load test at load of 600 N and 800 N, the displacements in cortical screw support group were (0.677±0.135) mm and (0.907±0.132) mm respectively, while those of femoral head in conventional screw placement group were (0.899±0.160) mm and (1.202±0.152) nun respectively (P <0.05). There was signifi-cant difference between the two groups (P < 0.05). The maximal vertical loading for failure of the fixa-tion was (2 782±228) N in cortical screw support group and (1 950±281) N in conventional screw placement group (P < 0.01). In torsibility test at 4° and 6° torsibility, the torque-moments of cortical screw support group were (10.406±1.515) Nm and (15.328 ±1.471) Nm respectively and those of conventional screw placement group (6.628±1.163) Nm and (9.072±1.570) Nm respectively, with statistical difference between two groups (P <0.01). The maximal torque-moment for failure of the fixa-tion was (25.437±5.213) Nm in cortical screw support group and (13.235±3.012) Nm in conven-tional screw placement group (P < 0.01). Conclusion Fixation of femoral neck fractures by using cortical screw support can significantly enhance anti-torsion and anti-compression of internal fixation.%目的 根据皮质支撑的方法 ,探讨应用空心螺钉固定股骨颈骨折的生物力学效果.方法 选择8具成人防腐股骨标本,用随机数字表法分成两组,每组4具,制成股

  8. 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。

  9. 两种手术方式治疗老年患者股骨颈骨折疗效的比较%Comparison of the Efficacy of Two Operative Methods on Elder Patients with Femoral Neck Fractures

    Institute of Scientific and Technical Information of China (English)

    伍燕臻; 黄承夸

    2012-01-01

    Objective To compare the efficacy of two operative methods on elder patients with femoral neck fractures. Methods 96 elder patients defined as femoral neck fracture were enrolled and randomly assigned into artificial entire hip replace and artificial thighbone head replacement. The operative time, blood loss during operation, early post-operative complications, and Harris hip score were compared between these two methods. Results ①Compared to the artificial entire hip replacement, the operative time in artificial thighbone head replacement was significantly shorter (P0.05 ); ② the incidence of early post-operative complications was low in both groups and there was no significant difference ; ③the Harris hip score was significantly higher in artificial entire hip replacement than that in artificial thighbone head replacement (89. 6% vs. 75% ,P =0.04). Conclusion Although the operative time is longer, the Harris hip score in artificial entire hip replacement is significantly higher than that in artificial thighbone head replacement, which deserved to be clinically applied.%目的 比较两种手术方式治疗老年患者股骨颈骨折的疗效. 方法 收集96例确诊为股骨颈骨折老年患者,随机分为人工全髓置换术及人工股骨头置换术,每组各48例,比较两种手术方式的手术时间、术中出血量、术后早期并发症以及随访2年后Harris评分. 结果 ①与人工全髋置换术组患者相比,采用人工股骨头置换术可以缩短手术治疗时间(P<0.05),人工股骨头置换术术中失血量少于人工全髋置换术,但差别无统计学意义(P>0.05);②两种手术方式术后早期并发症发生率均较低,组间差别无统计学意义(P>0.05);③人工全髋置换术优良率高于人工股骨头置换术,差异具有统计学意义(89.6% vs.75%,P=0.04). 结论 对于老年股骨颈骨折患者,采用人工全髋关节置换术治疗虽然手术时间较长,但Harris评分高于人工股骨头置换术,值得临床推广.

  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. 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).

  12. 老年股骨颈骨折患者护理中的伦理学问题%Ethical Considerations in the Nursing of Elderly Femoral Neck Fracture Patients

    Institute of Scientific and Technical Information of China (English)

    翁蔚

    2012-01-01

    目的 了解在护理过程中,老年股骨颈骨折患者在心理、生理及康复训练中的需求.方法 针对老年骨折患者生理、心理的特点及护理中的伦理学问题进行有针对性的护理指导.结果 老年患者心理压力减轻、疑虑消除、自理能力增加、康复训练效果明显.结论 必须正确认识老年人的生理和心理特点,针对其身体状况制订合理的护理计划,老年人护理工作不仅要提供疾病护理还应重视心理护理.%Objective:To investigate the demands of psychology, physiology and rehabilitation training in the nursing of elderly femoral neck fracture patients. Method: Guidance was performed in the nursing according to the physiological and psychological characteristics and ethical considerations of elderly patients. Result: Elderly patients psychological pressure was reduced and eliminated, self - care ability increased, rehabilitation training effects obviously improved. Conclusion: The physiological and the psychological characteristics of elderly patients should be correctly understood, reasonable nursing plan should be established according to their physical condition. In the nursing of elderly patients, not only disease nursing but also psychological care should be paid attention to.

  13. 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.

  14. Fracture Union in Closed Interlocking Nail in Femoral Fracture

    Directory of Open Access Journals (Sweden)

    R L Sahu

    2010-09-01

    Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. The Reliability of Classifications of Proximal Femoral Fractures with 3-Dimensional Computed Tomography: The New Concept of Comprehensive Classification

    Directory of Open Access Journals (Sweden)

    Hiroaki Kijima

    2014-01-01

    Full Text Available The reliability of proximal femoral fracture classifications using 3DCT was evaluated, and a comprehensive “area classification” was developed. Eleven orthopedists (5–26 years from graduation classified 27 proximal femoral fractures at one hospital from June 2013 to July 2014 based on preoperative images. Various classifications were compared to “area classification.” In “area classification,” the proximal femur is divided into 4 areas with 3 boundary lines: Line-1 is the center of the neck, Line-2 is the border between the neck and the trochanteric zone, and Line-3 links the inferior borders of the greater and lesser trochanters. A fracture only in the first area was classified as a pure first area fracture; one in the first and second area was classified as a 1-2 type fracture. In the same way, fractures were classified as pure 2, 3-4, 1-2-3, and so on. “Area classification” reliability was highest when orthopedists with varying experience classified proximal femoral fractures using 3DCT. Other classifications cannot classify proximal femoral fractures if they exceed each classification’s particular zones. However, fractures that exceed the target zones are “dangerous” fractures. “Area classification” can classify such fractures, and it is therefore useful for selecting osteosynthesis methods.

  19. Periprosthetic subtrochanteric femoral fracture in a megaprosthesis of the knee

    Directory of Open Access Journals (Sweden)

    Vaishya Raju

    2013-10-01

    Full Text Available 【Abstract】We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur after a megaprosthesis of the knee, done for resistant nonunion of distal femur with secondary osteoarthrosis in a 51 years old man. Treatment with a locking femoral plate was able to achieve primary union with a good result. Key words: Periprosthetic fractures; Femur; Femoral fractures; Knee

  20. Nonunion of paediatric talar neck fracture

    Directory of Open Access Journals (Sweden)

    Jindal Nipun

    2014-02-01

    Full Text Available 【Abstract】Fractures of the paediatric talus are infrequent injuries, most complicated by posttraumatic arthrosis and avascular necrosis in the course of treatment. Non- union in children has not been reported before in literature. We report a case of a 12-year-old boy who had a nonunion of Hawkins type II fracture of talar neck. The nonunion was treated surgically with a good clinical outcome. The goals of management in nonunion of paediatric talar neck fracture are different from those in fresh fractures. A suboptimal reduction should be acceptable without trying a radical surgery which may cause further impairment.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. 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

  3. Arthroscopic Treatment of Medial Femoral Condylar Coronal Fractures and Nonunions

    Science.gov (United States)

    Ercin, Ersin; Bilgili, M. Gokhan; Basaran, S. Hakan; Baca, Emre; Kural, Cemal; Avkan, M. Cevdet

    2013-01-01

    Nonunion of medial femoral condylar coronal fractures are uncommon. In neglected Hoffa fractures despite nonunion, there is a risk of missing accompanying ligamentous and intra-articular injuries. Neither preoperative clinical examination nor magnetic resonance imaging showed these injuries before arthroscopy. Arthroscopy before internal fixation gives additional information and changes the surgical protocol for these fractures and nonunions. PMID:24400191

  4. Femoral fractures : indications an[d] biomechanics of external fixation

    NARCIS (Netherlands)

    A.H. Broekhuizen (Tom); B. van Linge

    1988-01-01

    textabstractInternal fixation can be carried out in various ways. For femoral shaft fractures, an (interlocking) nail is becoming increasingly popular, instead of open realignment of the fracture. External fixation, which has become a generally accepted method of treating fractures of the lower

  5. 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.

  6. Total hip arthroplasty for the treatment of old femoral neck fractures with lower limb length discrepancy%全髋关节置换治疗伴有下肢短缩的陈旧性股骨颈骨折☆

    Institute of Scientific and Technical Information of China (English)

    魏人前; 曹兴海; 涂大华

    2012-01-01

    BACKGROUND: Most femoral neck fracture patients with lower limb length discrepancy have experienced long-term traction orfailure internal fixation, the hip has severe osteoporosis, soft tissues around the hip joint and joint capsules contracture oravascular necrosis as well as the lower limb length discrepancy, so the clinical treatment is difficult.OBJECTIVE: To explore the clinical effect of total hip arthroplasty for treatment of old femoral neck fracture complicated with limplength discrepancy.METHODS: Thirty-five cases of old femoral neck fractures with lower limb length discrepancy were treated with total hiparthroplasty. Skeletal traction on the femoral condyle and the X-ray measurement of both lower extremities and pelvis wereprepared preoperatively, it was done to anticipate for the level of femoral neck osteotomy and the level of loosing up tissuearound hip joint, as well as to adjust the length of the prosthesis head and neck in order to maintain the length of the limbs duringsurgery.RESULTS AND CONCLUSION: Results of the 6 patients with shortened limb ranging 3.0-4.0 cm preoperartively, only 1 casehad limb length discrepancy in 1 cm after surgery, as for the rest 5 cases and 29 patients with shortened limb ranging 1 to 2 cmpreoperatively, none limb had been shortened postoperatively compared with its contralateral limb. According to Harris scoresystem, the mean preoperative Harris score was significantly improved after 1 year postoperatively (P < 0.05). Total hipreplacement can recover hip function rapidly and steady with a high good rate and satisfactory short term effect. Therefore,total hip arthroplasty is a very important and an effective treatment method for old femoral neck fracture with limp lengthdiscrepancy.%背景:由于多数伴有下肢短缩的陈旧性股骨颈骨折患者经历过长期牵引或失败的内固定手术,髋部已严重骨质疏松,髋关节周围软组织及关节囊挛缩或股骨头缺血坏死,下肢短缩,临床治疗

  7. Two I.CO.S.s and general cannulated compression screw in femoral neck fracture fixation: a biomechanical comparison of 2 different configurations%2种构型2枚I.CO.S.固定股骨颈骨折的生物力学比较

    Institute of Scientific and Technical Information of China (English)

    陆慧; 吴元勇; 朱明; 倪卫东

    2011-01-01

    目的:探讨双重空心加压螺钉(Ideal compression screw,I.CO.S.)在治疗股骨颈骨折中的生物力学作用,并为临床上选择合适空间构型的2枚此类螺钉治疗股骨颈骨折提供一定的理论依据.方法:采集20具尸体股骨标本,模拟股骨颈头下型骨折,随机分为I.CO.S.组(实验组)和普通空心加压螺钉组(对照组),每组各10个标本,分别随机采用2枚水平位(2枚螺钉前后平行位于股骨颈轴心上方)和垂直位(2枚螺钉上下平行位于股骨颈轴心上下方)固定各5个.测定各组载荷下的应变值、股骨头的水平和垂直位移、并进行屈服力学性能测试.结果:在生物力学稳定性方面,I.CO.S.在水平位移和屈服载荷方面较普通空心加压螺钉好,螺钉水平位固定在应变、水平位移和屈服载荷方面较垂直位好.结论:I.C0.S.固定股骨颈骨折的稳定性较好,且2枚I.CO.S.水平位固定有较高的稳定性可应用于临床.%Objective : To explore the hiomechanical stability for treatment of femoral neck fracture with ideal compression screw ( I.CO. s. ) and to provide theoretical basis for choosing appropriate geometric configurations of two I.CO.S.s in clinical application. Methods : 20 cadaveric human femurs were selected and divided randomly into two groups : experiment group and control group, 10 in each one which was then divided equally into two sub-groups. The model of subcapital femoral neck fracture was made , then given anatomical reduction and fixed with I.CO.S. ( experiment group ) and general cannulated compression screw ( control group)separately with two different configurations : horizontal one ( parallel screws in superior aspect of femoral neck ) and vertical one( parallel screws in sagittal plane of femoral neck ) . The different biomechanical performances were evaluated through experimental stress analysis. Results : In hiomechanical stahility aspect,I.CO.S.was better than general screw in the horizontal

  8. 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。

  9. 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.

  10. 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.

  11. Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment.

    Science.gov (United States)

    Gong, Yu-Bao; Li, Qing-Song; Yang, Chen; Li, Shu-Qiang; Liu, Jian-Guo; Qi, Xin

    2011-01-01

    Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare. Three cases of this rare type of injury were retrospectively reviewed. The sites of femoral shaft fractures and Hoffa fractures were documented. All femoral shaft fractures were managed with internal fixation. The rate of misdiagnosis for the Hoffa fractures was documented. Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up. Femoral fractures were either transverse or composite in all three cases. Ipsilateral Hoffa fractures occurred at medial condyle in two cases, and lateral condyle in one case. Only one Hoffa fracture was identified preoperatively. All the femoral shaft fractures healed uneventfully. In the patient whose Hoffa fracture was correctly diagnosed, the modified HSS score was 94. In another patient, whose Hoffa fracture was treated by a second operation, the modified HSS score was 93. And in the third case, who refused additional operation for the Hoffa fracture, the modified HSS score was only 70. Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture, especially in motorcycle accident. This type of injury is very rare and misdiagnosis is common.

  12. Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment

    Institute of Scientific and Technical Information of China (English)

    GONG Yu-bao; LI Qing-song; YANG Chen; LI Shu-qiang; LIU Jian-guo; QI Xin

    2011-01-01

    Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare.Three cases of this rare type of injury were retrospectively reviewed.The sites of femoral shaft fractures and Hoffa fractures were documented.All femoral shaft fractures were managed with internal fixation.The rate of misdiagnosis for the Hoffa fractures was documented.Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up.Femoral fractures were either transverse or composite in all three cases.Ipsilateral Hoffa fractures occurred at medial condyle in two cases,and lateral condyle in one case.Only one Hoffa fracture was identified preoperatively.All the femoral shaft fractures healed uneventfully.In the patient whose Hoffa fracture was correctly diagnosed,the modified HSS score was 94.In another patient,whose Hoffa fracture was treated by a second operation,the modified HSS score was 93.And in the third case,who refused additional operation for the Hoffa fracture,the modified HSS score was only 70.Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture,especially in motorcycle accident.This type of injury is very rare and misdiagnosis is common.

  13. Management of Bilateral Femoral Fractures in Pregnancy: A Case ...

    African Journals Online (AJOL)

    Management of Bilateral Femoral Fractures in Pregnancy: A Case Report. ... There was no history of loss of consciousness, abdominal pains or vaginal bleeding. ... and manage the pregnancy to the point where the baby is safe for delivery.

  14. Cost of treatment of paediatric femoral shaft fractures: compression ...

    African Journals Online (AJOL)

    Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment. ... Log in or Register to get access to full text downloads. ... Results: Thirty-one patients who had ORIF and 31 matched controls were ...

  15. The quadratus femoris graft in old transcervical femoral fractures.

    Directory of Open Access Journals (Sweden)

    Delima D

    1989-07-01

    Full Text Available Sixteen patients with an old transcervical femoral fracture were treated with the quadratus femoris muscle pedicle bone graft with supplementary autografting. The result was a good functional hip in 14 cases.

  16. Neck of femur fracture fixation in a bilateral amputee: an uncommon condition requiring an improvised fracture table positioning technique.

    Science.gov (United States)

    Berg, Andrew James; Bhatia, Chandra

    2014-02-21

    While neck of femur fractures are common it is rare to see this injury in a bilateral leg amputee. Special consideration needs to be given to the management of these patients. We report the case of a 58-year-old man with bilateral leg amputation who presented to the emergency department with left hip pain following a fall. A fracture of the left neck of femur with extension into the femoral shaft was diagnosed. Internal fixation was planned with a dynamic hip screw. Standard fracture table setup, which allows for traction of the fractured limb and positioning of the contralateral limb such that anteroposterior and lateral X-rays can be obtained, was not possible in this case due to the amputations. We highlight considerations that need to be made in positioning a bilateral amputee for neck of femur fracture fixation and also highlight an improvised technique that can be utilised by other surgeons.

  17. 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.

  18. Discussion on spinal anesthesia dosage of elderly patients in the open operation of femoral neck and intertrochanter fracture%老年股骨颈、粗隆间骨折手术脊麻用药剂量探讨

    Institute of Scientific and Technical Information of China (English)

    费建平; 雷月; 张代玲

    2015-01-01

    Objective To explore reasonable medication doses of the elderly during femoral neck and intertrochanteric fractures open surgery,allofthepatientsadoptcombinedspinal-epiduralanesthesia(CSEA).Methods 52ASAⅠ~Ⅲpa-tients undergoing femoral neck and intertrochanteric fractures open surgery were randomly divided into two groups according to the different medication doses A group (10mg) 29 cases.B group(≤8mg) 23 cases.They were treated with L-bupivacaine 10mg(group A) and L-bupivacaine do not exceed 8 mg(group B),To observe adverse events of circulation and respiration caused by spinal anesthesia with different doses in elderly patients .At last,elderly patients are given reasonable dose in spinal anesthesia.Results In different age groups,the heart rate,diastolic blood pressure after spinal anesthesia was no statistically significant(P>0.05).After completion of spinal anesthesia ,systolic blood pressure decreased significantly within 30min,the difference was statistically significant (P0.05).The pain relief rate was 100%,all patients can successfully complete the surgery .The pain relief rate of A group and B group has no statistically significant (P>0.05).The blood circulation fluctuation rate of B group (21.7%,5/23) was lower than that of A group(65.5%,19/29),the difference was statistically significant (P0.05).The arrhythmia,respiratory depression and additional epidural medication rate of 2 group was no statistically significant(P>0.05).Conclusion Patients aged 75 years and older,≤6mg L-bupivacaine spinal anesthesia is more safe .In patients younger than 75 years old,the right spinal anesthesia dosage is not more than 8mg of L-bupivacaine.At the same time, Its were also important to preoperative treatment of basic diseases ,prolong anesthesia induction period ,try to shorten the opera-tion time.At last,we should renamed the meaning of “the anesthesia induction period” of elderly patients with spinal ,in order to actively processing cycle fluctuations after

  19. Application of comfort painless nursing in femoral neck fracture nursing%舒适无痛护理在股骨颈骨折护理中的应用

    Institute of Scientific and Technical Information of China (English)

    郑丽芳

    2015-01-01

    目的:研究分析舒适无痛护理在股骨颈骨折护理中的应用疗效。方法选择2010年2月~2014年2月我院接诊的80例手术患者进行研究。按照护理方式不同将其分为治疗组(40例)和对照组(40例)。对照组单纯给予患者常规的临床护理。治疗组在给予常规的临床护理的同时,对患者选派责任护士,进行专职舒适无痛护理。对比两组中的临床效果,采用VAS法对患者的疼痛情况作出评价,记录患者治疗过程中的并发症的发生情况,并比较患者对此次治疗的满意度。结果治疗组在接受舒适无痛护理后的疼痛级别均有所改善,而且患者整体的疼痛发生率(50.00%)要明显低于对照组(87.50%)。治疗组中的术后并发症(2.50%)明显低于对照组(27.50%)。在治疗结束后,采用调查问卷法对护理效果进行评估,得出舒适无痛护理使患者非常满意,其整体满意率高达97.50%,明显高于普通常规的护理(77.50%)。结论舒适无痛护理在股骨颈骨折护理中有着良好的医疗效果,可以有效的减轻患者的疼痛,大大提高患者的满意度,值得在临床医学中推广使用。%Objective To study the clinical effect of comfort painless nursing in the treatment of femoral neck fracture.Methods 80 cases of patients were selected in our hospital for study from February,2013 to August,2014. The patients were randomly divided into the treatment group (40 cases) and control group (40 cases). The control group were received conventional clinical nursing alone. The treatment group were received routine clinical nursing, while the patients had been given comfort painless nursing for the environment, patients’ psychological and physiological and complication prevention. Clinical effects were compared between the two groups by VAS method to the patient’s pain evaluated, records of patients during the treatment of

  20. Surgical Technique of Cannulated Screw Placement Guided by 3D Printing Template in Pediatric Femoral Neck Fracture%3D打印个体化手术导航模板引导儿童股骨颈骨折空心螺钉置入的应用

    Institute of Scientific and Technical Information of China (English)

    郑朋飞; 楼跃; 徐鹏; 唐凯

    2016-01-01

    目的:探讨利用计算机辅助设计和3D打印技术制作的个体化手术导航模板实现儿童股骨颈骨折空心螺钉精确置入的可行性。方法:选取1例儿童股骨颈骨折患者,依据CT数据使用计算机辅助模拟骨折复位和股骨颈空心螺钉置入过程,通过软件设计并打印出与复位后股骨近端匹配的经颈螺钉置入导航模板,术前3D模型模拟手术验证可行后,术中在导航模板辅助下置入导针及螺钉。结果:3D打印的导航模板术中与股骨近端骨性标志匹配良好,能够辅助螺钉精确置入股骨颈并稳定骨折端,螺钉置入后经术中X检查与术前设计基本一致。螺钉置入的手术时间约为12min,术中使用X线透视仅4次。术后X线片示股骨颈骨折复位良好,两枚空心螺钉的进钉点、进钉方向、螺钉长度均与术前设计方案一致,螺钉未损伤骺板。术后3个月随访,股骨颈骨折临床愈合,按Ratliff评价标准评价髋关节术后功能情况为优,螺钉无松动、断裂。结论:3D打印个体化手术导航模板可以辅助股骨颈空心螺钉的精确置入,减少医源性股骨颈骨骺及血供损伤,节省手术时间,减少术中出血,减少患者及手术操作人员的射线暴露,值得推广应用。%Objective: To investigate the feasibility and accuracy of a drill template for the placement of screws in femoral neck based on digital design and 3D printing technology. Methods: The preoperative CT images of 1child with femoral neck fracture were collected. With the data, the individual proximal femur model was made by the 3D printer. The reduction of fracture and the cannulated screw of femoral neck were simulated by the computer. The screw which was through the femoral neck designed by the software and printed to match the proximal femur after reduction was placed into the navigate template. After the feasibility of the 3D model operation was

  1. The surgical treatment of femoral neck fracture of shift type in young adults(Garden Ⅲ, Ⅳ)%青壮年移位型股骨颈骨折(Garden Ⅲ、Ⅳ)的手术治疗

    Institute of Scientific and Technical Information of China (English)

    周俊; 周传友; 陈武

    2014-01-01

    ObjectiveTo evaluate the effects of the hollow compression screws joint hip musculoskeletal flap transplantation in treating femoral neck fracture of shift type in young adults.MethodsBetween June 2008 and June 2012, 27 young adults with femoral neck fracture(GardenⅢ,Ⅳ) were treated with hollow compression screws joint hip musculoskeletal flap transplantation in treating femoral neck fracture of shift type using modified Smith-Peterson(S-P).Results27 patients were followed up 18 to 60 months, on average 36 months. The time of fracture healing was 4 to 8 months, on average 6.5 months. 35 cases of healing, healing rate was 93.3%. 3 cases of femoral head necrosis, necrosis rate was 10.0%.ConclusionHollow compression screws joint hip musculoskeletal flap transplantation is a reliable method for treating femoral neck fracture of shift type in young adults, with a high rate of fracture healing and a low rate of head necrosis, and is worthy of clinical promotion.%目的:评价空心加压螺钉联合臀中肌骨瓣移植治疗青壮年移位型股骨颈骨折的疗效。方法2008年6月~2012年6月我院对27例移位型青壮年股骨颈骨折(Garden Ⅲ、Ⅳ)患者采用改良Smith-Peterson入路(S-P)空心加压螺钉联合臀中肌骨瓣移植治疗。结果27例患者均获随访,随访时间18~60个月,平均36个月。骨性愈合时间4~8个月、平均6.5个月,骨折愈合25例,愈合率93.3%,股骨头坏死3例、其中2例骨折不愈合后期发展为股骨头缺血坏死、另1例为内固定取出术后出现股骨头坏死。股骨头坏死率为10.0%。结论采用改良S-P入路对股骨头周围血供破坏小,臀中肌骨瓣移植联合空心加压螺钉治疗青壮年移位型股骨颈骨折,对提高青壮年移位型股骨颈骨折愈合率和降低股骨头缺血坏死率疗效肯定,值得临床使用。

  2. Valgus osteotomy for nonunion and neglected neck of femur fractures.

    Science.gov (United States)

    Varghese, Viju Daniel; Livingston, Abel; Boopalan, P R; Jepegnanam, Thilak S

    2016-05-18

    Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics. The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomy-optimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.

  3. Nonunion of coronal shear fracture of femoral condyle

    Directory of Open Access Journals (Sweden)

    Singh Ajay Pal

    2011-06-01

    Full Text Available 【Abstract】Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union was achieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed. Key words: Femoral fracture; Fracture fixation, internal; Retrospective studies

  4. Comparison of the postoperative quality of life between internal fixation and hemiarthroplasty for the elderly with femoral neck basement fracture%高龄股骨颈基底型骨折人工关节置换与内固定术后生活质量评价

    Institute of Scientific and Technical Information of China (English)

    申剑; 薛庆云; 文良元; 黄公怡

    2012-01-01

    背景:股骨颈基底型骨折属于股骨颈骨折,同时又是囊外骨折,治疗方法有多种选择,由于发生率低故相关研究甚少.目的:比较分析高龄(70岁以上)股骨颈基底型骨折行人工股骨头置换与闭合复位内固定患者术后生活质量差异.方法:1995年9月至2009年6月共收治38例股骨颈基底型骨折患者,男12例,女26例;年龄70~91岁,平均79.4岁;全部患者均为外伤性新鲜骨折,其中16例选择人工股骨头置换为一组,另22例选择内固定术为一组.对比两组患者手术时间、术中出血量、术后下地时间及术后1年运用Harris评分中部分项目评定患者生活质量并结合术后1年髋部正侧位X线片.结果:两组在手术时间、术中出血量、术后下地时间等比较,差异有统计学意义(P <0.001).人工股骨头置换组在1年后生活自理、髋部疼痛及行走距离等方面较内固定组优异.人工股骨头置换组1年后均未出现假体松动,而内固定组骨折均愈合.结论:人工股骨头置换术治疗高龄股骨颈基底型骨折近期效果较理想,具有以下优点:(1)术后可早期负重活动,较快恢复伤前活动能力;(2)降低术后并发症和内科合并症的发生几率;(3)近期感觉及功能优于内固定.但同时股骨颈基底型骨折作为囊外骨折血供较好,骨折愈合率高,对于预期生存时间超过5年、骨质量较好的老年患者考虑行内固定治疗,可避免人工关节置换后期的磨损、松动及下沉.%Background:The femoral neck basement fracture is classified as both femoral neck fracture and extracapsular fracture. Sowe have many choices of treatment for it. However, there are few studies on it for low incidence rate.Objective: The aim of the present study is to compare the postoperative quality of life in aged patients (70 years old and a-bove) who had undergone the hemiarthroplasty versus internal fixation, with femoral neck basement fracture

  5. 股骨颈断端愈合去除空心钉后的有限元分析%The finite element analysis of the femoral head after repair of the femoral neck fracture and removal of the inserted cannulated screws

    Institute of Scientific and Technical Information of China (English)

    吴伟; 喻爱喜; 漆白文; 肖卫东

    2015-01-01

    Objective To discuss the biomechanics factors which caused osteonecrosis of the femoral head (ONFH) after removal of the cannulated screws inserted in the healing operation of femoral neck fracture.Methods Using the finite element analysis,finite element models with three or two cannulated screws inserted in the healing operation were established respectively.In the models,the directions of inserted cannulated screws and the femoral neck were parallel.The distribution of inserted cannulated screws was the most centralized,the most dispersive and between them.The far-end depth of inserted cannulated screws was 10,5,and 2 mm.Under the same load and constraint,the stresses of the femeral head in different models were compared by the finite element analysis.Results The stress of the femeral head reached to a maximum value of 46.1 mPa when the distribution of three inserted cannulated screws was the most dispersive and their far-end depth was 2 mm.And it reached to a mimimum value of 10.3 mPa when the distribution of two inserted cannulated screws was the most centralized and their far-end depth was 10 mm.Conclusion The distribution,the far-end depth and number of inserted cannulated screws were the biomechanics factors which caused ONFH.This experiment indirectly proved the cannulated screws insert method recommended by international institute for internal fixation (AO) foundation made the least effect to the stress of femeral head after the inserted cannulated screws were removed.%目的 探讨股骨颈骨折断端骨性愈合去除空心钉后股骨头坏死的生物力学因素.方法 利用有限元分析技术分别建立3枚或2枚空心钉固定股骨颈骨折的有限元模型,空心钉平行于股骨颈方向,排列分布处于最集中、最分散及介于两者之间,空心钉远端分别位于股骨头下10、5、2 mm.在相同的加载和约束情况下,通过有限元分析计算比较各模型中内固定去除以后股骨头的受力情况.结果 当3

  6. 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.

  7. 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.

  8. Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?

    Science.gov (United States)

    Khan, Sameer Khalid; Savaridas, Terence; Hemers, Jennifer S.; Maarouf, Zouheir; Orgee, Jane M.; Orr, Michael M.

    2016-01-01

    Summary We present 2 cases of elderly females presenting with atraumatic, near-vertical (Pauwells grade 3), intracapsular neck of femur fractures. Following diagnosis of osteoporosis on DEXA scans, they had received alendronic acid for 7 and 10 years respectively. Routine blood tests and serum estimations of calcium, vitamin-D and thyroid-stimulating hormone, done at admission, were within the normal ranges. These patients were managed with a hemiarthroplasty and a dynamic hip screw (DHS) respectively, following discontinuation of bisphosphonates. We present these 2 cases in light of emerging evidence that associates long-term bisphosphonate use with atypical low energy femoral fractures. Only subtrochanteric/diaphyseal fractures have been reported to date. We present a new variant of atypical femoral neck fractures in metaphyseal bone related to prolonged bisphosphonate therapy. PMID:27252743

  9. Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation

    Institute of Scientific and Technical Information of China (English)

    WANG Wen-yue; YANG Tian-fu; FANG Yue; LEI Ming-ming; WANG Guang-lin; LIU Lei

    2010-01-01

    Objective:Subtrochanteric femoral fractures are severe injuries.Although many treatment methods have been developed,controversy exists regarding the optimal management of these fractures.This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation(PFNA-long).Methods:Between October 2006 and February 2008,25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long.Closed reduction and fixation were performed in 20 cases.In the remaining 5 cases,closed reduction was difficult,so limited open reduction was performed,with bone grafting in 4 cases and circumferential wiring in 4 cases.Results:The average follow-up time was 16.1 months.All subtrochanteric femoral fractures healed uneventfully except one case of delayed union.The mean union time was 26.2 weeks.Technical difficulties with nail insertion were encountered in 3 cases.No implant failure was observed.Conclusion:PFNA-long is effective in treatment of subtrochanteric femoral fractures,with a high rate of bone union,minor soft tissue damage,early return to functional exercise and few implant-related complications.

  10. Low-energy trauma-induced intercondylar femoral fracture

    Science.gov (United States)

    Aeby, Mathias; Wyss, Tobias; Mentrup, Birgit; Kunstmann, Erdmute; Jakob, Franz; Aeberli, Daniel

    2016-01-01

    Summary We present a 44-year-old female patient with recurrent fragility fractures including an intercondylar femoral fracture and with normal planar bone densitometry. Diagnosis of hypophosphatasia was suggested by low volumetric cortical bone mineral density and laboratory findings. DNA sequencing revealed heterozygous mutations in the exons 5, 6 and 9 of the ALPL gene, thus confirming the suspected diagnosis. PMID:27920814

  11. Femoral Geometry in Male Patients with Atraumatic Hip Fracture - Original Investigation

    Directory of Open Access Journals (Sweden)

    Gülten Tan

    2007-03-01

    Full Text Available Aims: Hip fracture is the most serious complication of osteoporosis and the most disabling type of fracture. In this study, we aimed to compare femoral geometry in hip fractured male patients aged more than 65 years old with age matched controls. Patients and Methods: 20 male patients with a history of nontraumatic hip fracture and 19 age-matched healthy controls were included in this study. Bone mineral density of neck and trochanter of hip were measured by DEXA. In addition to BMD, an experienced radiologist measured proximal femur geometric parameters potentially involved in bone strength. Results: Mean BMDs of trochanteric region were not significantly different between groups, but mean BMDs of neck region were statistically significantly lower in the hip fractured group. Neck shaft angle and femur shaft width were the geometric parameters found to be significantly higher in the hip fractured group. The correlation between femur geometric and the anthropometric measurements was present only in the kontrol group. Conclusion: We concluded that besides femur geometric measurements, correlation between these measurements might be an important factors for the fracture risk. (From the World of Osteoporosis 2007;13:15-8

  12. Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Selahattin Ozyurek

    2015-07-01

    Full Text Available Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2 with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2 intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa fracture during primary ACL reconstruction (2. Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.

  13. 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.

  14. Subchondral insufficiency fracture of the femoral head in younger adults

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Takuaki; Nakashima, Yasuharu; Shuto, Toshihide; Jingushi, Seiya; Iwamoto, Yukihide [Graduate School of Medical Sciences, Kyushu University, Department of Orthopaedic Surgery, Fukuoka (Japan)

    2007-06-15

    We report two cases of subchondral insufficiency fracture of the femoral head observed in younger adults without any history of overexertion. In both cases, MRI revealed an irregular, discontinuous low-intensity band on the T1-weighted images. Both patients were treated operatively, and histological examination confirmed the diagnosis of subchondral fracture. A diagnosis of subchondral insufficiency fracture needs to be put in as one of the diagnoses in younger patients with a hip pain. (orig.)

  15. 三枚与四枚螺钉置入治疗Pauwels Ⅲ型股骨颈骨折的有限元分析%Finite element analysis of the three and four cannulated screws for Pauwels III femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    张浩; 史雪峰; 杨春宝; 吕继宏; 项毅; 孙振军; 官敬涛; 唐勇; 续力民

    2016-01-01

    背景:股骨颈骨折的内固定方式主要采用3枚空心螺钉倒三角固定,有学者提出Pauwels Ⅲ型的股骨颈骨折在应用3枚空心拉力螺钉固定的基础上增加1枚抗螺钉,以增强固定效果,但稳定性未得到验证。目的:研究3枚与4枚螺钉置入治疗Pauwels Ⅲ型股骨颈骨折中的生物力学稳定性及螺钉应力分布。方法:将第4代人工骨sawbones的CT数据导入Mimics软件中,进行三维重建,将模型导入3-matic软件中,创建股骨颈中段PauwelsⅢ型骨折模型,应用UG 8.0软件制作空心螺钉模型,导入到骨折模型中,创建3枚螺钉与4枚螺钉置入治疗Pauwels Ⅲ型股骨颈骨折的有限元模型。在相同条件下,应用abaqus软件中对两模型股骨头顶端施加轴向载荷411 N,比较两模型骨折断端两标志点的位移变化及内固定系统Von Mises应力分布情况。结果与结论:①3枚钉模型两点间位移为0.42 mm,4枚钉模型两点间位移为0.17 mm,4枚螺钉模型骨折断端移位小于3枚螺钉模型;②两模型Von Mises应力峰值分别为547 MPa、27.8 MPa,4枚螺钉模型的Von Mises峰值小于3枚螺钉模型,两模型的应力集中部位为均为骨折断端处,但4枚螺钉模型的应力范围更广、应力更加分散;③从有限元分析的结果来看,4枚螺钉置入治疗Pauwels Ⅲ型股骨颈骨折具有更强的抗剪切力效果,具有更强的生物力学稳定性,其临床优势尚需进一步的临床对比研究证实。%BACKGROUND:Femoral neck fracture is mainly fixed by three inverted triangle cannulated screws. Scholars have proposed to add a cannulated screw to enhance the fixation strength of femoral neck fracture of Pauwels III type based on three cannulated screw fixation, but the stability is not verified. OBJECTIVE:To analyze the biomechanical stability and stress of the three and four cannulated screws for the treatment of the Pauwels III femoral neck

  16. 全髋关节置换术治疗老年股骨颈骨折48例临床分析%Clinical analysis of total hip arthroplasty in the treatment of 48 cases of older femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    陈刚; 曹怀焱; 贺检

    2012-01-01

    Objective To investigate the best surgical method and \\.h.e, clinical effects of older femoral neck fracture. Methods 96 cases of older femoral neck fracture were randomly divided into the observation group and the control group, each group had 48 cases respectively.The observation group was implemented total hip arthroplasty (THA), but the control group was implemented femoral head replacement. Then the clinical effects and adverse reaction (ADR) of the two groups were compared. Results The operation time of the observation group was shorter than that of the control group, the difference was statistically significant (P < 0.05). The amount of bleeding of the observation group was more than that of the control group, but the postoperatton activities time of observation group was earlier than that of the control group, there were significant. Differences between the two groups (P < 0.01). The excellent rate of the observation group was 87.50%, while the control group was 66.67%, after comparison, there was a significant difference between the two groups (P < 0.01). The observation group and the control group had 4 cases (8.33%) and 13 cases (27.08%) of postoperative complications respectively, the two groups had significant differences (P < 0.05). Conclusion T11A in the treatment of older femoral neck fractures can recover the normal position of hip joint quickly, rebuild hip joint function, improve limb pain and dysfunction, avoid complications caused by long-term stay in bed and reduce the mortality of older patients with femoral neck fracture, which is one of the excellent and ideal treatment in nowadays.%目的 探讨老年股骨颈骨折的最佳手术方式及临床疗效.方法 将96例老年股骨颈骨折患者随机分为观察组和对照组,每组各48例,观察组采用全髋关节置换术,对照组采用人工股骨头置换术,比较两组临床疗效及不良反应.结果 观察组手术时间短于对照组,两组比

  17. Proximal femoral replacement for the treatment of periprosthetic fractures.

    Science.gov (United States)

    Klein, Gregg R; Parvizi, Javad; Rapuri, Venkat; Wolf, Christopher F; Hozack, William J; Sharkey, Peter F; Purtill, James J

    2005-08-01

    A periprosthetic fracture around the femoral component is a rare but potentially problematic complication after total hip arthroplasty. Reconstruction can be challenging, especially when severe bone stock deficiency is encountered. Proximal femoral replacement is one method of treating the severely deficient proximal part of the femur. The present report describes the outcomes of revision total hip arthroplasty with use of a proximal femoral replacement in a cohort of patients who had a Vancouver type-B3 periprosthetic fracture. With use of a computerized institutional database, all patients in whom a Vancouver type-B3 fracture (characterized by severe proximal bone deficiency and a loose femoral stem) had been treated with a proximal femoral replacement were identified. A modular femoral replacement with proximal porous coating had been used in all cases. The twenty-one patients who were identified had had a mean age of 78.3 years (range, fifty-two to ninety years) at the time of the index operation. The clinical and radiographic records of these patients were reviewed. At the time of the latest follow-up (mean, 3.2 years), all but one of the patients were able to walk and had minimal to no pain. Complications included persistent wound drainage that was treated with incision and drainage (two hips), dislocation (two hips), refracture of the femur distal to the stem (one hip), and acetabular cage failure (one hip). Despite a relatively high complication rate, we believe that proximal femoral replacement is a viable option for the treatment of periprosthetic fractures in older patients with severe bone deficiency. If a proximal femoral replacement is used, the stability of the hip must be tested diligently intraoperatively and a constrained acetabular liner should be utilized if instability is encountered. In order to enhance the bone stock, the proximal part of the femur, however poor in quality, should be retained for reapproximation onto the implant.

  18. 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。

  19. Effects of nutrition management based on health quotient in elderly postoperative patients with femoral neck fracture%以健商为基础的营养管理在老年股骨颈骨折术后患者中应用的效果

    Institute of Scientific and Technical Information of China (English)

    朱宏伟; 霍晓鹏; 孙红; 赖小星

    2016-01-01

    目的 运用健商理念对老年股骨颈骨折患者实施综合性的营养管理,探讨术后患者营养状况改善的效果.方法 将健商理念引入患者术后综合营养管理,建立一套系统的三级营养评估筛查系统,并实施持续改进的以健商分数为标准的分级细化营养干预和健康教育制度,比较71例患者入院及术后14d健商指数和营养相关指标.结果 71例老年股骨颈骨折患者入院和手术后14d健商评分差异有统计学意义(P<0.01),患者McDonald营养学指数的差异有统计学意义(P<0.05).结论 以健商为基础的营养管理,能够更好地解决老年股骨颈骨折术后患者营养健康相关的问题,提高营养支持,改善营养相关的指标,利于疾病的恢复.%Objective To implement comprehensive nutrition management based on the advanced concept of health quotient in elderly patients with femoral neck fracture,and explore the effect in improving nutriture of patients after operation.Methods The concept of health quotient was introduced to comprehensive nutrition management,and a systematic assessment and screening system of three-level nutrition was built.Besides,we carried out hierarchical and thinning nutritional intervention based on health quotient score and health education system with continual improvement.The index of health quotient and relevant index of nutrition were evaluated among 71 patients after being hospitalized and 14 days after operation.Results There were statistically significant differences in the score of health quotient and McDonald nutrition index among 71 elderly patients with femoral neck fracture after being hospitalized and 14 days after operation (P < 0.05).Conclusions Nutrition management based on health quotient can solve the problem related to nutrition and health after operation among elderly patients with femoral neck fracture,improve the nutritional support and nutrition-related indicators,it is conducive to the recovery.

  20. Treatment of 66 cases of femoral neck fracture in aged patients with artificial joint replacement with small incision%后外侧小切口人工关节置换术治疗高龄股骨颈骨折66例

    Institute of Scientific and Technical Information of China (English)

    黄伟

    2016-01-01

    目的:分析后外侧小切口人工关节置换术在治疗高龄股骨颈骨折中的临床效果。方法:选取我院2010年1月~2013年8月66例进行后外侧小切口人工关节置换术治疗高龄股骨颈骨折患者的临床资料加以分析,随之定期进行术后走访。结果:手术过程中无一例死亡,经过为期10个月走访可知,66例患者中有疗效显著的患者59例,有所改善的患者为5例,2例患者出现下肢深静脉血栓等并发症(并发症发生率为3.03%),随之采取热敷、溶栓治疗,并发症消失。结论:后外侧小切口人工关节置换术治疗高龄股骨颈骨折患者,其效果显著,术中创伤小,术后恢复快,并发症少,值得临床推广使用。%Objective To analyze small lateral incision arthroplasty clinical effect in the treatment of femoral neck fracture.Methods I Hospital in January 2010~ August 2013 after 66 cases were small lateral incision arthroplasty in treatment of elderly patients with femoral neck fracture clinical data to be analyzed, along with regular postoperative visits.Result No deaths during surgery, after a period of 10 months visited found that 66 patients had a significant effect in 59 patients, improved patient for five cases, two cases of patients with complications such as deep vein thrombosis (complication rate was 3.03%), followed by taking heat, thrombolytic therapy, complications disappear. The results were statistically significant (P <0.05).Conclusions Posterolateral small incision arthroplasty in treatment of elderly patients with femoral neck fracture, the effect is significant, small surgical trauma, rapid recovery, fewer complications, worthy of clinical use.

  1. 关节置换治疗56例老年股骨颈骨折患者围术期安全性分析%Analysis on safety of joint arthroplasty during perioperative period in 56 aged cases of femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    邓玉海; 王序全; 黄平; 陈浩; 陈益果; 赵智君; 王征; 宋翼; 华晨曦

    2013-01-01

    目的探讨高龄股骨颈骨折髋关节置换术的围术期安全性。方法回顾性分析56例行髋关节置换术的65岁以上老年髋部骨折病例资料。结果56例中54例平均住院21 d(18~31 d)顺利出院,Harris 评分从术前30分(0~38分)增加至出院时83分(72~91分),髋关节功能明显改善;围术期死亡2例,均为术前手术耐受力评分较差;术后形成血肿3例(5.4%),血肿穿刺后继发感染1例(1.79%),术后早期后脱位3例(5.4%),无1例有临床症状的深静脉血栓发生。结论髋关节置换术是治疗高龄股骨颈骨折的有效手段,但是,手术耐受能力较差者应慎重选择手术。%Objective To investigate the safety of hip arthroplasty during the perioperative period in aged patients with femoral neck fracture .Methods The clinical data in 56 elderly cases of femoral neck fracture treated by hip arthroplasty ,aged more than 65 years old ,were performed the retrospective analysis .Results Among 56 cases ,54 cases hospitalized for 21d[(18-31)d] and suc-cessfully were discharged ,the Harris scores were increased from preoperative 30 (0 -38) to postoperative 83 (72 -91) ,the func-tion of hip joint was obviously improved ;2 cases with the preoperative poor tolerance score died during perioperative period ,there were 3 cases(5 .4% ) of postoperative hip hematoma ,1 cases(1 .79% ) of postoperative hematoma developed secondary bacterial in-fection after puncture and 3 cases (5 .4% ) of postoperative posterior dislocation in the early stage and no case of deep venous thrombosis (DVT) accompanying clinical symptoms .Conclusion Hip arthroplasty is a effective measure for treating aged patients with femoral neck fracture .But those patients with poor operative tolerance should select this operation cautiously

  2. 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

  3. Sequential subtrochanteric femoral fracture after atypical diaphyseal fracture in a long-term bisphosphonate user: a case report.

    Science.gov (United States)

    Park, K-T; Lee, K-B

    2015-01-01

    Recent reports have found a relationship between long-term bisphosphonate therapy and the occurrence of low-energy subtrochanteric or diaphyseal atypical femoral fractures. These fractures usually occur at only one site in the same bone. We report a rare case of a patient with sequential atypical femoral fractures (first, a diaphyseal fracture, and second, an ipsilateral subtrochanteric fracture) after low-energy trauma. We present the clinical and operative findings and discuss how to prevent subsequent atypical femoral fractures. This case indicates that an atypical subtrochanteric femoral fracture can occur after an atypical diaphyseal fracture in a long-term bisphosphonate user. Doctors should be aware of the possibility of a second fracture and explain the risk to the patient. Key words: bisphosphonate, atypical femoral fracture, low-energy trauma, subtrochanteric and diaphyseal femoral fractures.

  4. Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate.

    Science.gov (United States)

    Johnson, Benjamin; Stevenson, Jonathan; Chamma, Ramsey; Patel, Amit; Rhee, Shin-Jae; Lever, Caroline; Starks, Ian; Roberts, Phillip J

    2014-05-01

    The proximal femoral locking compression plate is a fixed angled anatomically contoured stainless steel plate used to treat pertrochanteric fractures of the proximal femur. Recent reports quote a high failure rate associated with this implant. We aimed to identify the common methods of failure and determine the elements of surgical techniques that could be altered to potentially improve outcomes should this implant be used for the treatment of unstable pertrochanteric fractures. Retrospective chart analysis. Three separate centers. Twenty-nine patients with 29 fractures. All patients were treated for pertrochanteric fractures using the proximal femoral locking compression plate. The patient demographics, fracture classification, implant details, and complications. Twelve of 29 fractures (41.4%) suffered a complication associated with the implant, and 83% of these occurred in elderly women. Complications included bending, backing-out, fracture, or cut-out of the proximal screws and plate fracture. Common technical errors included the following: (1) leaving the plate proud proximally, (2) malposition of the proximal screws within the femoral neck/head, (3) inappropriate use of the hook plate, (4) creating too ridged a construct when used as a bridging plate. Our experience with the use of this implant suggests an unacceptably high failure rate (41.4%). A knowledge of the common pitfalls encountered when using this device is critical in an effort to reduce failure rates. Based on our data, we would urge caution when considering this device for unstable pertrochanteric fractures, especially in the elderly female. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  5. Treatment of AO/OTA 31-A3 intertrochanteric femoral fractures with a percutaneous compression plate

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    Fei Luo

    2014-01-01

    Full Text Available OBJECTIVE: AO/OTA 31-A3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared with other types of intertrochanteric fractures. The choice of the fixation method has been a focus of dispute among orthopedic trauma surgeons. The purpose of this study was to review the outcomes of these fractures treated with a percutaneous compression plate at our institute. METHOD: Seventeen patients with AO/OTA 31-A3 intertrochanteric femoral fractures were treated with a percutaneous compression plate at our institute from January 2010 to December 2011. The clinical data and imaging results were retrospectively analyzed. RESULTS: The medical complication of popliteal vein thrombosis occurred in one patient. Sixteen patients were followed up for 12 to 21 months. Two patients had malunion and mild pain. Fracture collapse occurred in two patients, with one having head penetration. These two patients had moderate pain. There were no occurrences of nonunion or reoperation. The mean Harris hip score obtained during the last follow-up was 84.1 (61-97. Patients with a poor quality of reduction were more likely to have pain results (p = 0.001. A trend existed toward the presence of a poor quality of reduction (p = 0.05 in patients with a collapse of fracture. Patients with poor preoperative mobility were more likely to have a lower Harris hip score (p = 0.000. CONCLUSION: The percutaneous compression plate is an alternative device for the treatment of AO/OTA 31-A3 intertrochanteric femoral fractures. Good fracture reduction and an ideal placement position of the neck screw are important in the success of the device.

  6. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

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    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  7. Distal Femoral Locking Compression Plate Fixation in Distal Femoral Fractures: Early Results

    Directory of Open Access Journals (Sweden)

    EJ Yeap

    2007-05-01

    Full Text Available We conducted a retrospective review on eleven patients who were treated for Type A and C distal femoral fractures (based on AO classification between January 2004 and December 2004. All fractures were fixed with titanium distal femoral locking compression plate. The patient’s ages ranged from 15 to 85 with a mean of 44. Clinical assessment was conducted at least 6 months post-operatively using the Schatzker scoring system. Results showed that four patients had excellent results, four good, two fair and one failure.

  8. Comparison the efficacy of minimally invasive and conventional incision in artificial hip replacement for treatment of femoral neck fracture in elderly%快捷小切口与常规切口人工髋关节置换术治疗老年股骨颈骨折的疗效对比

    Institute of Scientific and Technical Information of China (English)

    李军民; 肖信约; 张伟; 任云峰; 贾福; 张仲子; 吴中雄; 宣靖; 杨正宗

    2012-01-01

    Objective To compare the efficacy of the minimally invasive incision and conventional incision in artificial hip replacement for treatment of femoral neck fracture in elderly. Methods All of 240 old patients with displaced femoral neck fracture were randomly divided into four groups, the minimally invasive incision total hip replacement group, the conventional incision total hip replacement group, the minimally invasive incision femoral head arthroplasty group, and the conventional incision femoral head arthroplasty group, 60 cases each. Then each group underwent statistical analysis, for incision length, operation time, the amount of blooding, postoperative drainage volume,activity time and Harris score after operation. Results There was statistically significant difference in incision length, operation time, the amount of blooding, postoperative drainage volume and activity time between the minimally invasive incision total hip replacement group and conventional incision group (P 0.05). There was statistically significant difference in incision length, operation time, the amount of blooding, postoperative drainage volume and activity time between the minimally invasive incision femoral head arthroplasty group and conventional incision group (P 0.05). The efficacy of minimally invasive incision group was better than conventional incision group. Conclusion The minimally invasive incision hip arthroplasty has the advantages of minimal incision, short operation time, less trauma, little scar, quicker recovery. It is an ideal method for treatment of displaced femoral neck fracture in elderly.%目的 对比快捷小切口与常规切口行人工髋关节置换治疗老年股骨颈骨折的临床疗效.方法 将240例老年移位股骨颈骨折随机分为全髋置换小切口组、全髋置换常规切口组、半髋置换小切口组、半髋置换常规切口组(各60例).对每组切口长度、手术时间、出血量、术后引流量、下地活动时间、术

  9. Radiographic features of teriparatide-induced healing of femoral fractures

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    Youngwoo Kim

    2015-12-01

    Full Text Available Teriparatide is a drug that is used to increase bone remodeling, formation, and density for the treatment of osteoporosis. We present three cases of patients with a femoral insufficiency fracture. The patients were administered teripatatide in an attempt to treat severe osteoporosis and to enhance fracture healing. We found several radiographic features around the femoral fractures during the healing period. 1 Callus formation was found at a very early stage in the treatment. Teriparatide substantially increased the unusually abundant callus formation around the fracture site at 2 weeks. Moreover, this callus formation continued for 8 weeks and led to healing of the fracture. 2 Abundant callus formation was found circumferentially around the cortex with a ‘cloud-like’ appearance. 3 Remodeling of the teriparatide-induced callus formation was found to be part of the normal fracture healing process. After 1 year, normal remodeling was observed on plain radiographs. These findings indicate that teriparatide can be used as an adjuvant therapy in the management of femoral insufficiency fractures.

  10. Calculation of pediatric femoral fracture rotation from direct roentgenograms.

    Science.gov (United States)

    Ozel, M S; Ketenci, I E; Kaya, E; Tuna, S; Saygi, B

    2013-12-01

    Radiologic determination of pediatric femoral fracture rotation has been debated. Measuring the antetorsion angle of the fractured femur by computed tomography and comparing it with the opposite side has been the method of choice for this purpose. However, no simple method for direct measurement of femoral fracture rotation exists in the literature. In this study, our aim was to test a mathematical method of measuring the axial plane malrotation from direct roentgenograms. A pediatric femoral shaft fracture model was produced. The bone was secured to a wooden frame that allowed the distal part of the fracture to rotate around an axis. Radiographs were taken at known intervals of rotation ranging from the neutral position to 60° external rotation and to 60° internal rotation in 5° increments of rotation. Five independent, blinded observers measured the radiographs and calculated the fracture rotation according to a standard formula. Calculated rotation values were compared with known rotation values. Calculated rotation values were close to actual rotation values throughout the arc of rotation. The mean absolute error of five observers for all measurements of external and internal rotation was 3.97° (±0.83). The correlation coefficient between calculated and actual rotation values was 0.9927. The interobserver intraclass correlation coefficient for calculated rotation was 0.997. Absolute error and correlation coefficient values indicate that this method is accurate and reliable in determining the fracture rotation.

  11. The Curative Effect Analyze of Treatment Old Displacement Type Femoral Neck Fracture by Hollow Compression Screw Internal Fixation%空心加压螺钉内固定治疗老年移位型股骨颈骨折疗效分析

    Institute of Scientific and Technical Information of China (English)

    马永成

    2016-01-01

    目的:探讨空心加压螺钉内固定治疗老年移位型股骨颈骨折疗效情况.方法分析我院骨外科2014年8月—2015年11月收治的老年移位型股骨颈骨折患者80例临床资料,依据固定方式不同进行临床分组,钢板固定组40例和空心加压螺钉内固定组40例.观察两组老年移位型股骨颈骨折患者术后功能恢复优良率和术后并发症发生率情况.结果空心加压螺钉内固定组老年移位型股骨颈骨折患者术后功能恢复优良率95%高于钢板固定组75%,空心加压螺钉内固定组老年移位型股骨颈骨折患者术后并发症发生率0低于钢板固定组10%,P<0.05,差异均有统计学意义.结论空心加压螺钉内固定治疗老年移位型股骨颈骨折患者临床疗效明显,并发症少,值得临床推广应用.%Objective To approach curative effect of treatment old displacement type femoral neck fracture by hollow com-pression screw internal fixation. Methods The 80 cases clinical data of old displacement type femoral neck fracture patients in our hospital bone surgery from 2014.8 to 2015.11 were analyzed,which was to be divided into two groups by different fixed mode,steel plate fixed group 40 cases and hollow compression screw internal fixation group 40 cases. The functional recovery excellent rate and complication rate of two groups old displacement type femoral neck fracture patients after oper-ation were detected. Result The functional recovery excellent rate 95% of hollow compression screw internal fixation group hollow compression screw internal fixation group was higher than steel plate fixed group 75%,the complication rate 0 of hollow compression screw internal fixation group hollow compression screw internal fixation group was lower than steel plate fixed group 10%,P<0.05,the difference were statistical significance. Conclusion The clinical curative effect of treatment ? old displacement type femoral neck fracture by hollow compression screw

  12. Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

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    Tanaka Motoyuki

    2012-08-01

    Full Text Available Abstract We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249

  13. Quality of life in old patients with proximal femoral fractures

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    T A Raskina

    2012-01-01

    Full Text Available Objective: to study quality of life in Kemerovo old patients with proximal femoral fractures. Patients and methods. Quality of life in osteoporotic fractures was analyzed in 219 patients (173 women and 46 men who had sustained the injury in January 2004 to December 2008. Results. In the patients with hip fractures, the lowest (41.94+31.16 scores values were recorded by the physical functioning scale reflecting the degree to which their health limited the performance of physical exercises (self-service, walking, going upstairs, weight carriage, etc.. The role functioning and life activity scales showed the highest values (50.96+19.04 and 51.44+26.51 scores, respectively. The mean value of the physical component scale was 46.42+28.26 scores. That of the psychological component scale was 49.56+19.55 scores. Conclusion. The patients with proximal femoral fractures were found to have lower scores on all SF-36 dimensions.

  14. Transparotid approach for mandibular condylar neck and subcondylar fractures

    OpenAIRE

    Croce, A; Moretti, A.; Vitullo, F.; CASTRIOTTA, A.; M. Rosa; Citraro, L

    2010-01-01

    SUMMARY Mandibular condylar neck fractures and subcondylar fractures represent, respectively, 19-29% and 62-70% of all mandibular fractures; treatment involves some problems, common to both, concerning the choice of an adequate approach. Herewith, personal experience is reported related to the surgical treatment of some cases of mandibular condylar neck and subcondylar fractures by transparotid approaches with partial parotidectomy, removing the salivary tissue overlying the condylar neck and...

  15. Subtrochanteric Femoral Insufficiency Fracture Following Bisphosphonate Therapy for Osseous Metastases

    OpenAIRE

    Bush, Lisabeth A.; Chew, Felix S.

    2015-01-01

    We present the case of an insufficiency fracture of the femoral shaft in a 61-year-old man who had received bisphosphonate therapy to reduce the fracture risk from lytic renal cell carcinoma metastases to the spine. Approximately 1.5 years after beginning monthly intravenous infusions of zoledronic acid (Zometa), the patient complained of persistent thigh pain. Radionuclide bone scan showed mildly increased activity in the lateral subtrochanteric cortex of the right femur, where there was foc...

  16. Pediatric femoral shaft fractures treated by flexible intramedullary nailing

    Institute of Scientific and Technical Information of China (English)

    K.C.Kapil Mani; R.C.Dirgha Raj; Acharya Parimal

    2015-01-01

    Background:Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization.Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail,or external fixators in the case of open fractures.The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age.Methods:There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy.Long leg cast was applied at the time of fixation.Partial weight bearing was started 2 weeks after surgery.Patients were evaluated in follow-up study to observe the alignment of fracture,infection,delayed union,nonunion,limb length discrepancy,motion of knee joint,and time to unite the fracture.Results:We were able to follow up 28 out of 32 patients.The patients were 8.14 years of age on average.The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks.There were 3 cases of varus angulation,2 cases of anterior angulation,and 4 cases of limb lengthening.Conclusion:Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery,short rehabilitation period,less immobilization and psychological impact,and cost-effective.

  17. Unusual presentation of a radial neck fracture in a child

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    Murali Poduval

    2013-01-01

    Full Text Available Fracture of the radial neck are uncommon injuries. In children, they may present as radial neck fractures, a components of forearm fracture dislocations, or as isolated fracture dislocations. Here, we present an unusual and previously undescribed variant of radial neck fracture with dislocation of the radial head to the medial side and ulnar nerve injury. The fracture dislocation was openly reduced and fixed with a small fragment plate. The fracture healed with some loss of rotational movements. At short followup of 6 months patient had useful elbow function but ulnar nerve did not recover.

  18. Early result of hemiarthroplasty in elderly patients with fracture neck of femur

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    Mue Daniel

    2015-01-01

    Full Text Available Background: Fractured neck of femur is a frequent and severe injury in elderly patients with consequent high morbidity and mortality. Hemiarthroplasty is an established treatment modality for displaced intracapsular femoral neck fractures in elderly patients above 60 years. This study analysed the early functional outcome and complications of Austin Moore endoprosthesis in elderly patients above 60 years with fractured neck of femur. Materials and Methods: Retrospective data were obtained over a 5 year period from January 2007 to December 2012. Thirty-five elderly patients of 60 years and above with displaced intracapsular fracture neck of femur treated with hemiarthroplasty using Austin Moore endoprosthesis were included. Data were analysed using SPSS version 21. Results: A total of 35 patients were involved. The age-range was 60-90 years with mean age of 69.7 ΁ 7 years. The predominant mechanism of injury was trivial falls in 18 (66.7% patients. The commonest complication was pressure sore in 2 (5.7% patients, followed by surgical site infection in 1 (2.9% patient and periprosthetic fracture in 1 (2.9% patients. Early post-operative mortality was 2.9%. Post-operative hip functional status according to Postel and Merle d Aubigne revealed that majority (66.6% of patients had satisfactory hip function. Conclusion: Functional outcome of Austin Moore in elderly patients above 60 years with fracture neck of femur was satisfactory in most of the cases with minimal morbidity. Careful patient selection for hemiarthroplasty is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.

  19. Subtrochanteric Femoral Insufficiency Fracture Following Bisphosphonate Therapy for Osseous Metastases.

    Science.gov (United States)

    Bush, Lisabeth A; Chew, Felix S

    2008-01-01

    We present the case of an insufficiency fracture of the femoral shaft in a 61-year-old man who had received bisphosphonate therapy to reduce the fracture risk from lytic renal cell carcinoma metastases to the spine. Approximately 1.5 years after beginning monthly intravenous infusions of zoledronic acid (Zometa), the patient complained of persistent thigh pain. Radionuclide bone scan showed mildly increased activity in the lateral subtrochanteric cortex of the right femur, where there was focally increased T2 signal on MRI and a small, triangular ridge or cortical beak on radiographs. The lesion was initially thought to represent a metastasis, but after the patient returned with a transverse femoral shaft fracture through the ridge following minimal trauma, MRI and biopsy of the lesion failed to show any evidence of tumor. We suggest that this fracture is similar to the low-energy proximal femoral shaft fractures recently reported in postmenopausal women who have received oral bisphosphonates for osteoporosis. Suppression of bone turnover may play a role in the development of these fractures.

  20. Pattern of femoral fractures and associated injuries in a Nigerian ...

    African Journals Online (AJOL)

    2014-10-09

    Oct 9, 2014 ... Key words: Associated injuries, femoral fractures, Nigeria, pattern ... Nnewi Campus, Anambra State, 2Plastic Surgery Unit, St. Francis Hospital, Asata, Enugu, Nigeria. Address for .... Follow‑up for patients include physical therapy, early mobilization, counseling and medical therapy, out‑patient visits until ...

  1. Periprosthetic subtrochanteric femoral fracture in a megaprosthesis of the knee

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya; Ajay Pal Singh; Abhishek Vaish

    2013-01-01

    We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur after a megaprosthesis of the knee,done for resistant nonunion of distal femur with secondary osteoarthrosis in a 51 years old man.Treatment with a locking femoral plate was able to achieve primary union with a good result.

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

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    Raaymakers Ernst

    2008-01-01

    replacement if necessary because of avascular necrosis or osteoarthritis is considerably postponed; and better milieu for hip replacement can be achieved by the development of sclerotic bone in the subchondral areas of the acetabulum and femoral head. Between 65 and 80 years of age, a total hip replacement is probably the best option for fit patients. We treat fresh femoral neck fractures with a hemiarthroplasty in patients over the biological age of 80 years. Logically the same choice will be made for patients with a nonunion. During the period 1973-1995 we performed hemiarthroplasty ( n = 34 in patient with low general condition. Their mean age was 79 years. The average survival in these patients was less than three years and that explains probably the low late complication rate: in this group. Total hip replacement was performed in 37 younger patients with a mean age of 69 years. They were not considered for a valgization osteotomy because of age being over 70 years, severe osteoporosis or a total collapse of the femoral head. In this group, we observed one aseptic cup revision and two extractions of the prosthesis because of a deep infection.

  3. The pathological characteristics and total hip replacement treatment of nonunion old-femoral-neck fracture%陈旧性股骨颈骨折不愈合的临床病理特点和全髋关节置换术的治疗对策

    Institute of Scientific and Technical Information of China (English)

    叶志强; 宋炎成; 蔡道章

    2011-01-01

    目的从临床病理角度探讨全髋关节置换术(THA)治疗陈旧性股骨颈骨折不愈合的经验教训.方法 分析39例陈旧性股骨颈骨折不愈合在该院行THA患者的病例资料,通过术前和术中观察的临床病理特点,总结术前、术中和术后处理的注意事项.结果 陈旧性股骨颈骨折不愈合多具有患肢明显的短缩畸形,关节囊挛缩、肥厚,股骨上端和髋臼的骨质疏松,同侧膝关节和踝关节不同程度的功能障碍.由于患髋周围软组织挛缩,术中需进行广泛松解,手术创面大,术后渗血较多,术中应注意彻底止血.2例于术后1周内发生关节脱位,1例发生深静脉血栓,这3例并发症保守治疗均治愈.经平均3年4个月的随访,所有髋关节功能恢复良好,Harris评分优良率84.6%.结论 THA是治疗陈旧性股骨颈骨折不愈合的较为理想的方法,根据患髋周围软组织挛缩、患肢明显的短缩畸形等病理特点,术前充分准备,术中应注意彻底止血,术后早期功能锻炼是手术成功和术后取得较好疗效的关键.%Objective To summarize the experience in trealing the unhealed anliqualed femoral neck fracture with total hip replacement as the clinical palhology was concerned. Methods A relrospeclive study was carried out based on the data of 39 palienls wilh unhealed anliqualed femoral neck fraclure who underwent lolal hip arlhroplasly ( THA). According to the clinical pathological characteristics which were observed preoperalively and inlraopertively, the experiences of the preoperative preparalion and the inlraoperative as well as posloperative managemenl were summed up. Results The unhealed antiqualed femoral neck fracture presented obvious short deformity of involved limb, the conlraclion and hypertrophy of the articular capsule, osteoporosis of the acelabulum and upper segment of the femur, and various dysfunction of collateral knee and ankle. During the operation, the capsule needed to be

  4. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

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    Korkmaz MF

    2014-04-01

    Full Text Available Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF classification and the American Society of Anesthesiologists' (ASA physical status classification (ASA grade. Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years, and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range

  5. 股骨颈骨折直接行髋关节置换术与内固定失败后再行髋关节置换术的比较%Comparison of primary hip replacement with secondary replacement after failed internal fixation in the treatment of femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    王剑火; 张玉九; 李玉茂; 李平生

    2011-01-01

    Objective To explore the difference of the outcomes of primary hip replacement and secondary replacement after failed internal fixation in the treatment of femoral neck fractures for optimal choice of operation method for femoral neck fractures. Methods 43 patients with a secondary hip replacement after failed internal fixation (Group A) and 52 patients with a primary hip replacement (Group B) in the treatment of femoral neck fractures were retrospectively analyzed.All patients were followed up at least 2 years. Details of operation, complications, hip function and quality of life at 2 years after operation were compared between two groups. The hip function, including the pain movement and walking, was evaluated by the Charnley scoring system. The health-related quality of patients' life was evaluated by using the EQ-5D index. Results Operation time, amount of hemorrhage during operation, the Chamley score of hip function and EQ-5D index score of quality of life were 1.9±0.2 and 1.4±0.2h 、 525.6±50.8 and 462.3±47.8ml 、 13.4±2.3 and15.2±2.4 、 0.67±0.26 and 0.72±0.25 for Group A and Group B,respectively. The difference was significant for the above 4 respects (P<0.05).Conclusion The outcomes of secondary hip replacement after failed internal fixation is worse than those of primary hip replacement in the treatment of femoral neck fractures, which indicates that primary hip replacement is worth being recommended for patients with femoral neck fractures who are easier to develop to be a fracture nonunion or avascular necrosis of femoral head if they are treated with internal fixation.%目的 通过对股骨颈骨折直接行髋关节置换术与内固定失败后再行髋关节置换术临床结果的比较,为股骨颈骨折手术方式的选择提供依据.方法 回顾性分析随访2年的43例股骨颈骨折内固定失败后冉次行髋关节置换术(A组)和52例股骨颈骨折直接行髋关节置换术(B组)的临床资料,比较两组患者

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

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    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.

  7. Treatment of periprosthetic femoral fractures with modular stems.

    Science.gov (United States)

    Hernandez-Vaquero, Daniel; Fernandez-Lombardia, Jesus; de los Rios, Jimena Llorens; Perez-Coto, Ivan; Iglesias-Fernandez, Susana

    2015-10-01

    The purpose of this study was to analyse the efficacy of modular femoral stems for the treatment of certain post-operative periprosthetic fractures in patients with hip arthroplasty. Of a total series of 61 modular revision stems, 17 were used to address periprosthetic femoral fractures and 12 of these are the object of this study. The average follow-up was 3.7 years (range 1-14 years). The evaluations were performed at three and six months, and then annually using the HHS score and radiographic studies for the assessment of loosening, subsidence and bone integration of the stem. Seven cases had type B2 fractures and five type B3 ones. All patients walked freely, eight of them using canes. HHS improved to a post-operative mean of 78 (range 72-83). Radiographically, fracture healing was observed at three months in nine cases. In six cases stem subsidence of a mean of 3.9 mm (range 2-12 mm) was observed, which stabilized a year following implantation and did not need revision surgery. In two cases a subsequent dislocation (at three and seven months after surgery) occurred, which were treated with constrained acetabular systems. In nine cases hypotrophy of the cortex in the diaphyseal area was noted, which did not alter the patients' clinical course. Modular femoral stems are an acceptable treatment in type B2 and B3 periprosthetic fractures.

  8. Subchondral stress fracture of femoral head in a healthy adult

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    Anand Ashish

    2010-01-01

    Full Text Available Subchondral fracture of the femoral head is an uncommon entity and usually occurs as an insufficiency fracture associated with poor bone quality or as a fatigue fracture in young military recruits. This condition should be considered in the differential diagnosis of acute hip pain in young patients along with transient osteoporosis and avascular necrosis of the hip. We report a case of acute onset hip pain in an asymptomatic healthy adult in which the diagnosis was made by magnetic resonance imaging and the patient responded well to conservative treatment.

  9. A Case of Femoral Fracture in Klippel Trenaunay Syndrome

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    Sam Nahas

    2014-01-01

    Full Text Available We present a case of Klippel Trenaunay syndrome (KTS who presented with severe bilateral knee osteoarthritis (OA. Preoperative planning was commenced for a total knee replacement (TKR. Whilst on the waiting list the patient suffered a fall and sustained a complete femoral diaphysis fracture. Conservative management in the form of skin traction was initially chosen as significant extra- and intramedullary vascular malformations posed an increased risk of perioperative bleeding. This failed to progress to union, and so open reduction and internal fixation was performed. This subsequently resulted in on-going delayed union, which was subsequently managed with low intensity pulsed ultrasound (LIPUS, otherwise known as Exogen (Bioventus. exogen. Secondary exogen, 2012. There are only two previous documented cases of femoral fracture in KTS. This is the first report of a patient with this rare syndrome receiving this treatment. We discuss the management of fracture in this challenging group of patients.

  10. Contralateral reversed distal femoral locking plate for fixation of subtrochanteric femoral fractures

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    Paritosh Gogna; Reetadyuti Mukhopadhyay; Amanpreet Singh; Ashish Devgan; Sahil Arora; Amit Batra; Sushil Kumar Yadav

    2015-01-01

    Purpose:Subtrochanteric fractures of the femur are being managed successfully with various intramedullary and extramedulary implants with reasonable success.However,these implants require precise placement under image intensifier guidance,which exposes the surgeon to substantial amount of radiation.It also restricts the management of these fractures at peripheral centers where facility of image intensifiers is not available.Keeping this in mind we designed this study to identify if contralateral reversed distal femoral locking plate can be used successfully without the use of image intensifier.Methods:Twenty-four consecutive patients (18 men and 6 women) with a mean age of 28 years (range 19-47 years) suffering subtrochanteric fractures of the femur underwent open reduction and internal fixation with reversed contralateral distal femoral locking plate.The outcome was assessed at the mean follow-up period of 3.2 years (range 2-4.6 years) using the Harris hip score.Results:Twenty-one fractures united with the primary procedure,with a mean time of consolidation being 11 weeks (range,9-16 weeks).One patient developed superficial suture line infection,which resolved with oral antibiotics.Another patient had a fall 3 weeks after surgery and broke the plate.Repeat surgery with reversed distal femoral locking compression plate was performed along with bone grafting and the fracture united.Two cases had nonunion,which went in for union after bone grafting.The mean Harris hip score at the time of final follow-up was 90.63 (range 82-97).Conclusion:The reversed contralateral distal femoral plate is a biomechanically sound implant,which when used for fixation of the subtrochanteric fractures with minimal soft tissue stripping shows results comparable to those achieved by using other extramedullary implants as well as intramedullary devices.The added advantage of this implant is its usability in the absence of an image intensifier.

  11. Surgical outcome of proximal femoral fractures using proximal femoral - locking compression plate

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    Prakash A. Sasnur

    2015-07-01

    Full Text Available Introduction: Proximal femoral fractures are complex fractures following devastating injuries in young and elderly population. Despite marked improvement in implant design, surgical technique and patient care these fractures are associated with high incidence of implant failure, refracture and varus collapse. Intramedullary nails are technically demanding and associated with high re-operation rates. The study was done to evaluate the outcome of proximal femoral fractures treated with proximal femur locking compression plate (PF-LCP. Methods: This study is conducted at Al Ameen Medical College and Hospital, Bijapur during the period Jan 2012 to March 2014.Pertrochanteric fractures especially unstable intertrochanteric & subtrochanteric fractures were included. Technical difficulties with the implant and operating time were quantified. Union of fracture site and implant related complications were followed up clinically and radiological. The Harris Hip Score was used to evaluate the functional outcome. Results: Thirty-two patients were available for final evaluation with average age of 55.4 years. The average operation time was 1 hour and 35 minutes with mean blood loss of 180ml. Union was achieved in all the cases with an average time of 17 weeks. Complications included one case of delayed union and three cases of varus collapse. Conclusion: PF-LCP achieves anatomical reduction and stable fixation with higher union rate and fewer complications.

  12. Titanium elastic nailing in pediatric femoral diaphyseal fractures

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    Singh Roop

    2006-01-01

    Full Text Available Background: The need for operative fixation of pediatric femoral fractures is increasingly being recognised in the present decade. The conventional traction and casting method for management of pediatric femoral fractures is giving way for the operative stabilisation of the fracture. Methods : Thirty five pediatric patients in age group 6-14 years with diaphyseal femoral fractures were stabilised with two titanium nails. Patients were followed up clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al. Technical problems and complications associated with the procedure were also analysed. Results : Overall results observed were excellent in 25, satisfactory in 8 and poor in 2 patients. Hospital time averaged 12.30 days in the series. All the fractures healed with an average time to union of 9.6 (6-14.4 weeks. Return to school was early with an average of 7.8 weeks. The soft tissue discomfort near the knee produced by the nails ends was the most common problem encountered. Shortening was observed in three cases and restriction of knee flexion in 5 patients. There was no delayed union, infection or refractures. Per operative technical problems included failure of closed reduction in 2 cases and cork screwing of nails in one case. Conclusion : We believe that with proper operative technique and aftercare TENs may prove to be an ideal implant for pediatric femoral fracture fixation. The most of the complication associated with the procedure are infact features of inexact technique and can be eliminated by strictly adhering to the basic principles and technical aspects.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  14. Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

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    David Walmsley

    2014-01-01

    Full Text Available Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.

  15. InterTan钉板系统与空心钉固定Pauwels Ⅲ型股骨颈骨折的有限元分析%InterTan compression hip screw versus three parallel cannulated screws for Pauwels Ⅲ femoral neck fractures: a finite element analysis

    Institute of Scientific and Technical Information of China (English)

    张晟; 王一民; 王博炜; 佟矿; 余斌

    2013-01-01

    目的 用有限元分析的方法研究InterTan钉板系统与3枚互相平行的空心钉固定PauwelsⅢ型股骨颈骨折的生物力学特点. 方法选取1名男性健康志愿者,28岁,体质量为75 kg,通过16排螺旋CT扫描,取右侧近端股骨数据作为样本.通过逆向工程软件分别重建PauwelsⅢ型股骨颈骨折三维可视化模型、InterTan钉板系统固定模型及3枚互相平行空心钉固定模型,并于Ansys软件中建立2种内固定模型的三维有限元模型,予以轴向700 N应力,研究不同内固定的von Mises应力分布和位移分布、股骨的yon Mises应力分布和位移分布,并比较内固定和股骨模型的应力峰值和位移峰值. 结果 内固定物的应力主要集中于骨折线附近,其中InterTan钉板系统钉板系统固定模型的应力峰值(65.7 MPa)低于空心钉固定模型(116.4 MPa);骨端的应力分布集中于股骨近端内侧,InterTan钉板系统固定模型的应力峰值(13.2 MPa)小于空心钉固定模型(27.6 MPa).lnterTan钉板系统固定模型中,内固定物位移方向为垂直向下,内固定物和骨端的位移峰值分别为0.84和0.76 mm;空心钉固定模型中,位移方向沿着股骨颈方向,内固定物和骨端的位移峰值分别为1.49和1.61 mm. 结论 使用InterTan钉板系统固定PauwelsⅢ型股骨颈骨折时,应力分布均匀,固定稳定性优于3枚互相平行空心钉固定.InterTan钉板系统固定时,位移方向垂直向下,髋内翻是需要预防的并发症;后者位移方向沿着股骨颈向外侧,股骨颈短缩为需要预防的并发症.%Objective To explore the biomechanical properties of InterTan compression hip screw versus versus three parallel cannulated screws in the fixation of Pauwels Ⅲ femoral neck fracture and their clinical implications.Methods A healthy male volunteer,28 years of age and 75 kg in weight,was enrolled in the present study.The spiral CT scans of his right proximal femur were used for reconstruction

  16. Analysis of function and related impact factors after operation of femoral neck fracture for patients aged less than sixty years%60岁以下股骨颈骨折手术治疗术后功能及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    周靖; 党育; 张培训; 王静; 付中国; 张殿英; 王天兵; 徐海林; 薛峰

    2011-01-01

    Objective: To investigate function and related impact factors after operation of femoral neck fracture for patients aged less than sixty years. Methods: In our study,93 patients aged less than sixty years with femoral neck fractures receiving operation from April 2001 to August 2009 and having complete follow-up data were evaluated in terms of age, sex, co-diseases, side of bone fracture, type of bone fracture (Garden classification) , time between injury and operation, operation procedures, operation time, time in bed, removal internal fixation and function score during follow-up period. Nonparametric test, rank correlation analysis and Logistic regression analysis were used by SPSS 13.0. Results: Function scores showed non-normal distribution. By nonparametric test, the following variable in function scores was of statistic significance; the Garden classification (H = 7.900, P = 0.048). By analysis of correlation , the following variable in function scores was of statistic significance: Garden classification ( rs = 0.206, P= 0.048). By Logistic regression analysis, the following variable in function scores was of statistic significance; Garden classification (P =0.030). Conclusion: Hip function score is of non-normal distribution, and Garden classification is the most important factor influencing the function after operation for femoral neck fracture for patients aged less than sixty years.%目的:探讨60岁以下患者股骨颈骨折术后随访资料中关节功能及相关影响因素.方法:回顾性分析2001年4月至2009年8月采用手术治疗的93例60岁以下股骨颈骨折患者的临床资料,就年龄、性别、合并疾病、骨折侧别、骨折类型(Garden分型)、自受伤至手术的时间、手术方式、手术时间、卧床时间、内固定是否取出以及随访时髋关节功能评分等因素进行术后随访调查.应用SPSS 13.0统计软件包进行非参数检验、等级相关分析、Logistic回归分析等统计学分析.

  17. Nonunion of coronal shear fracture of femoral condyle

    Institute of Scientific and Technical Information of China (English)

    Ajay Pal Singh; Ish Kumar Dhammi; Raju Vaishya; Anil Kumar Jain; Arun Pal Singh; Prashant Modi

    2011-01-01

    Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union was achieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.

  18. Atypical femoral fractures bilaterally in a patient receiving bisphosphonate: a case report

    Science.gov (United States)

    Moghnie, Alessandro; Scamacca, Veronica; De Fabrizio, Giovanni; Valentini, Roberto

    2016-01-01

    Summary Atypical femoral fractures are often associated with prolonged bisphosphonate use. The American Society for Bone and Mineral Research (ASBMR) has set the diagnosis criteria for atypical subtrochanteric and diaphyseal femoral fractures by classifying them according to their major and minor criteria. Prolonged bisphosphonate use is correlated with AFF, but the pathogenetic mechanism that causes this kind of fracture has not been defined yet. We describe simultaneous bilaterally femoral fractures in a 76-year-old woman. PMID:27252749

  19. 中央柄设计对髋关节表面置换术后股骨颈骨折风险影响的有限元分析%The influence of prosthesis stem design on femoral neck fracture by using finite element analysis

    Institute of Scientific and Technical Information of China (English)

    高宗炎; 高雁卿; 郑稼; 金毅; 唐超; 杨卫兵

    2015-01-01

    Objective To investigate the influence of prosthesis metaphyseal stem design on femoral neck fracture with a range of implant orientations.Methods A finite element model of the hip resurfacing arthroplasty was reconstructed on the basis of data of a normal femur (from a 63-year-old male) and a 50 mm birmingham hip resurfacing (BHR) prosthesis.And this modeling was used to indicate the effects of prosthesis metaphyseal stem design on femoral neck fracture with a given load of 0-6 kN,with a range of varus-valgus implant orientations.Results The analysis suggested that the intact femoral neck strength could be maintained across a wider range of varus-valgus orientations for short-stemmed and stemless prostheses.The model predicted that the damage initiation load would be decreased by approximately 20% with varus implant orientation and 10% in neutral orientation.Compared with the stemmed,traditional-design prosthesis,the short-stemmed and stemless designs had less weakening effect upon the femoral neck.For the stemless design in all orientations,the femoral neck strength was predicted to be within 5% of that for the intact bone,and the strength with the short-stemmed design was within 3% of the intact case.Conclusion The study suggests that a short-stemmed resurfacing head offers improved tolerance to misalignment over traditional designs.While femoral neck fractures are multifactorial,biomechanical factors are of clear importance to the clinical outcome,so this may reduce the risk for patients at the edge of the indications for hip resurfacing.%目的 观察表面置换股骨假体中央柄不同设计对置换术后股骨颈骨折风险的影响.方法 CT扫描1名63岁健康男性股骨近端,构建股骨近端有限元模型,以直径50 mm的Birmingham hip resurfacing(简称BHR)假体为模板,建立传统假体、短中央柄假体、无中央柄假体的模型,分别于中立位、外翻10°、内翻10°放置假体并骨水泥固定,模拟下肢单腿

  20. 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.

  1. Dose-Effect Relationships for Femoral Fractures After Multimodality Limb-Sparing Therapy of Soft-Tissue Sarcomas of the Proximal Lower Extremity

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    Pak, Daniel; Vineberg, Karen A. [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Griffith, Kent A. [Biostatistics Unit, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI (United States); Sabolch, Aaron [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Chugh, Rashmi [Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI (United States); Ben-Josef, Edgar [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Biermann, Janet Sybil [Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI (United States); Feng, Mary, E-mail: maryfeng@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

    2012-07-15

    Purpose: We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). Methods and Materials: We examined 131 patients with proximal lower extremity STS who received limb-sparing surgery and external-beam radiation therapy between 1985 and 2006. Five (4%) patients sustained pathologic femoral fractures. Dosimetric analysis was limited to 4 fracture patients with full three-dimensional dose information, who were compared with 59 nonfracture patients. The mean doses and volumes of bone (V{sub d}) receiving specified doses ({>=}30 Gy, 45 Gy, 60 Gy) at the femoral body, femoral neck, intertrochanteric region, and subtrochanteric region were compared. Clinical predictive factors were also evaluated. Results: Of 4 fracture patients in our dosimetric series, there were three femoral neck fractures with a mean dose of 57.6 {+-} 8.9 Gy, V30 of 14.5 {+-} 2.3 cc, V45 of 11.8 {+-} 1.1 cc, and V60 of 7.2 {+-} 2.2 cc at the femoral neck compared with 22.9 {+-} 20.8 Gy, 4.8 {+-} 5.6 cc, 2.5 {+-} 3.9 cc, and 0.8 {+-} 2.7 cc, respectively, for nonfracture patients (p < 0.03 for all). The femoral neck fracture rate was higher than at the subtrochanteric region despite lower mean doses at these subregions. All fracture sites received mean doses greater than 40 Gy. Also, with our policy of prophylactic femoral intramedullary nailing for high-risk patients, there was no significant difference in fracture rates between patients with and without periosteal excision. There were no significant differences in age, sex, tumor size, timing of radiation therapy, and use of chemotherapy between fracture and nonfracture patients. Conclusions: These dose-volume toxicity relationships provide RT optimization goals to guide future efforts for reducing pathologic fracture rates. Prophylactic femoral intramedullary nailing may also reduce fracture risk for susceptible patients.

  2. Effect observation of prosthesis for total hip replacement in treatment of femoral neck fractures in the elderly%假体全髋关节置换治疗老年移位性股骨颈骨折的效果观察

    Institute of Scientific and Technical Information of China (English)

    潘波

    2015-01-01

    目的:探讨在老年移位性股骨颈骨折患者中实施假体全髋关节置换治疗的临床价值.方法:将2012-06/2014-06到我院骨科治疗的64例老年移位性股骨颈骨折患者纳入研究,给予患者假体全髋关节置换术治疗,术后给予10个月~2年时间随访,同时结合美国骨科学会5级评分标准与 Harris髋关节评分标准,评估患者的远期情况.结果:本组64例病例均顺利完成手术,术中未见患者血管神经受累,且无其他合并症.经随访统计,共有54例患者骨折愈合良好,临床优良率是84.38%.且与术前相比,患者末次随访的 Harris 分值明显提高,有统计学意义(P <0.05).结论:在老年移位性股骨颈骨折患者中实施假体全髋关节置换术治疗,疗效显著、安全,有利于患者髋关节功能早日恢复,值得加强普及.%AIM:To investigate the clinical value of prosthesis for total hip replacement in treatment of elderly patients with dis-placed femoral neck fracture.METHODS:64 cases of elderly patients with displaced femoral neck fractures from June 2012 to June 2014 in our hospital department of orthopedics were included in the study,patients were given a prosthesis in total hip replace-ment treatment,and 10 months ~2 years follow-up were given af-ter operation.Meanwhile long-term assessment of the situation in patients were made combined with USA Department of Orthope-dics Level 5 standard score and Harris hip score standard.RE-SULTS:The operation of 64 cases were successfully completed, without vascular nerve involvement during operation,or other complications.After the follow-up statistics,a total of 54 patients with fracture were healing well,the rate was 84.38% in clinical. Compared with the preoperative,the Harris score of the last fol-low-up of patients increased significantly,with statistical signifi-cance (P <0.05).CONCLUSION:When the elderly patients with displaced femoral

  3. 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

  4. Subchondral insufficiency fracture of the femoral head after liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, Kenyu; Yamamoto, Takuaki; Nakashima, Yasuharu; Mawatari, Taro; Motomura, Goro; Ikemura, Satoshi; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Fukuoka (Japan)

    2009-09-15

    A 53-year-old woman developed a subchondral insufficiency fracture of the right femoral head after undergoing a liver transplantation. Radiographs obtained at her first visit demonstrated a slight subchondral collapse in the superolateral portion of the femoral head. Magnetic resonance imaging (MRI) disclosed an irregular, discontinuous, low-intensity band on the T1-weighted image. After 7 months of conservative treatment, the hip pain and the radiograph abnormalities had both disappeared. On the follow-up T1-weighted MR image obtained 17 months after the onset, the band of low signal intensity was not obvious. A subchondral insufficiency fracture is one of the diagnoses to be considered in patients presenting with hip pain after a liver transplantation. (orig.)

  5. Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

    Directory of Open Access Journals (Sweden)

    Mohammad Haghighi

    2017-03-01

    Full Text Available Background:Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead topostoperative acute anemia and some other complications.Tranexamic acid (TA is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusionrequirements during some elective surgeries (1-3.The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA on intraoperative blood loss and asubsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.Methods:Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullarynailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. GroupI, the intervention group with eighteen patients received 15 mg/kg (TA via intravenous infusion before surgical incision.Patients in the placebo group received an identical volume of normal saline.Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobinchange as well as transfusion rates and volumes were compared between the two groups.Results:Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups,respectively (P=0.570. Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group(5.6% compared to the placebo group (30% (P=0.06. No significant difference in The Allowable Blood Loss during thesurgery was found between the two groups (P=0.894.Conclusion:Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion duringtraumatic femoral fracture operation.

  6. Biomechanical characteristics of two geometric configurations of cannulated compression screws in the fixation of femoral neck fracture%两种构型空心加压螺钉固定头颈型股骨颈骨折的生物力学特征

    Institute of Scientific and Technical Information of China (English)

    史威; 范婕; 张英泽; 杨搏贵; 贾卫斗; 李素红

    2007-01-01

    BACKGROUND : After femoral neck fracture, incidences of ischemic necrosis and bone non-healing are closely related to biomechanical characteristics of internal fixation devices. Compression stress can improve fracture healing, tension force can delay fracture healing, and shear stress can inhibit fracture healing. How to relieve shear stress and expand compression stress is of significance for theories and clinical applications.OBJECTIVE: To compare the biomechanical characteristics of the two geometric configurations of three cannulated compression screws in the fixation for femoral neck fracture and to provide a theoretical foundation in the treatment of femoral neck fracture.DESIGN : Observational contrast study.SETTING: Department of Orthopaedics, the 251 Hospital of Chinese PLA; Department of Orthopaedics, the Third Hospital, Hebei Medical University.PARTICIPANTS: The experiment was carried out in the Hebei Orthopaedic Institute from November 2002 to March 2003. Five cadavers including 4 males and 1 female with similar bone mineral density (BMD) were provided by Department of Anatomy, Hebei Medical University. X-ray photographs proved that all the cadavers did not have rheumatism, tuberculosis, tumor, fracture or deformity.METHODS: Ten femurs were randomly divided into inverted and upright isosceles triangle with 5 in each group. Femur samples with femoral neck fracture were fixed with three cannulated screws and measured with the biomechanical machine (CSS-44020, made in Changchun Experimental Researching Institute, provided by Hebei Orthopaedics Institute). The compression strength, torsibility and the maximal vertical loading were compared between the two configurations of screws.MAIN OUTCOME MEASURES:①Displacement of femoral head at 600 N and 750 N during torsibility test; ②torque-moment at 2°and 4°during torsibility test;③load during maximal vertical loading test.CONCLUSION: The effect of three cannulated compression screws configured as an

  7. OUTCOME ANALYSIS OF PROXIMAL FEMORAL NAIL IN STABLE INTERTROCHANTERIC FEMUR FRACTURES

    Directory of Open Access Journals (Sweden)

    Suneet

    2015-02-01

    Full Text Available BACKGROUND: Proximal femoral nail is commonly recommended as treatment of choice for unstable and reverse oblique intertrochanteric fracture in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip scre w. Although in stable fracture types DHS is still being preferred as the treatment modality of choice. Proximal femoral nail owing to better biomechanics , less complications can still be used as the method of choice in stable fracture pattern as well. The aim of this study is to evaluate the results of PFN nail in stable intertrochanteric fracture and include evaluation of the mean operative time , amount of blood loss , complications and functional status of the patient . MATERIALS AND METHODS : In this study 30 patients presented to Orthopedics Department Hamidia Hospital Bhopal with stable intertrochanteric fracture were treated with p roximal femoral nail. All patients were followed up for a period of 1 year and functional outcome assessment including amount of shortening , neck - shaft angle , Harris hip score was noted. RESULTS : At the time of final follow - up , all 30 patients showed union with average Harris hip score of 86.6 (range 62 - 94 . 14 patients had excellent score , 9 patients had good score , 5 patients ha d fair score and 2 patients had poor outcome . Mean neck shaft angle achieved post - reduction was 131.4 degrees and at final follow - up was 128.4 degrees. Limb length discrepancy was assessed in the final follow - up with average shortening of 5 mm and 4 patien ts had shortening above 1.5 cm. Average blood loss was 80 ml , the mean operative time was 65 minutes. Complications w ere seen in 3 cases with one case of local wound infection, one of screw cut - out and one of screw penetration. CONCLUSION : With proper tech nique PFN gives excellent results with less blood loss and shorter incision with less soft tissue trauma are added advantages which ultimately lead to less morbidity and

  8. 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...

  9. 老年患者股骨颈骨折术后肺部感染的临床分析及干预对策%Clinical analysis and intervention strategies of pulmonary infection after surgery in elderly patients with femoral neck fracture

    Institute of Scientific and Technical Information of China (English)

    邓月华

    2015-01-01

    目的:分析老年患者股骨颈骨折术后并发肺部感染的危险因素,提出针对性的预防护理干预对策,以降低感染率。方法收集本科室2008年1月至2013年12月病历齐全的老年股骨颈骨折176例患者资料,根据是否发生肺部感染分为两组(即感染组和非感染组),比较两组患者感染的高危因素。结果高龄、早期缺乏活动、合并糖尿病、慢性支气管炎、长期反复使用抗菌药物、营养状况差、长期吸烟等因素可增加肺部感染的发生率,以上指标均具有统计学意义(P均<0.05)。感染组42例患者经积极治疗后感染于7~14 d得到控制。结论针对上述因素,积极干预,鼓励患者早期活动,彻底吸痰、加强肺功能锻炼、体位干预、饮食干预及加强基础护理,积极治疗原发病等措施,可以降低老年患者股骨颈骨折术后肺部感染的发生率。%Objectives To analyze the risk factors of pulmonary infection after surgery in elderly patients with femoral neck fracture, to propose targeted prevention and nursing intervention strategies, and to reduce the infection rates. Methods The clinical date of 176 elderly patients with femoral neck fracture were collected from January 2008 to December 2013 in our department, and those cases were divided into two groups (the infected group and the non-infected group) depending on whether they had pulmonary infection, then compared and summarized risk factors of infection. Results Advanced age, early lack of activity, diabetes, chronic bronchitis, long-term repeated use of antibiotics, poor nutritional status and long-term smoking could increase the incidence of pulmonary infection, all the indicators mentioned-above had significant differences (P all < 0.05). There were 42 cases with severe infetion in the infected group were treated within 7-14 d. Conclusions In response to these factors, doctors and nurses should take active intervention

  10. 医护合作的功能锻炼指导在股骨颈骨折术后老年患者功能锻炼中的应用%Application of physician-nurse collaborative functional exercise instruction to improve the compliance of elderly femoral neck fracture patients after surgery

    Institute of Scientific and Technical Information of China (English)

    高丽; 贾燕瑞

    2012-01-01

    Objective To investigate the influence of physician-nurse collaborative functional exercise instruction mode on the compliance of elderly femoral neck fracture patients.Methods 60 elderly patients with femoral neck fracture were randomly divided into the experimental group and the control group,each with 30 cases.The control group was treated with conventional functional exercise instruction while the experimental group was treated with physician-nurse collaborative functional exercise instruction.Results The patients who took functional exercise according to the exact action,time and part as doctors and nurses requested were more in the experimental group than in the control group,and the differences were statistically significant (x2 =10.184,10.311,15.148,respectively;P < 0.05).When discharged from the hospital,the patients in the experimental group could grasp (5.65 ± 0.63) exercise action,better than (3.62 ± 0.64) in the control group,and the difference was statistically significant (t =11.963,P < 0.01).Conclusions Physician-nurse collaborative functional exercise instruction mode is helpful to improve the compliance of elderly femoral neck fracture patients in the hospital.%目的 探讨医护合作的功能锻炼指导模式对股骨颈骨折术后患者住院期间功能锻炼依从性的影响.方法 选取60例股骨颈骨折老年患者,随机分为观察组与对照组各30例.对照组给予常规的功能锻炼指导模式,观察组给予医护合作的功能锻炼指导模式.结果 观察组患者完全按照医护人员要求的动作、时间和部位进行功能锻炼的人数多于对照组,差异均有统计学意义(x2分别为10.184,10.311,15.148;P <0.05);出院时观察组患者功能锻炼动作掌握的平均个数为(5.65±0.63)个,多于对照组的(3.62±0.64)个,差异有统计学意义(t=11.963,P<0.01).结论 医护合作的功能锻炼指导模式有利于提高股骨颈骨折术后老年患者住院期间功能锻炼的依从性.

  11. 全髋关节置换与空心螺钉置入内固定修复中老年股骨颈骨折:髋关节功能比较%Total hip arthroplasty versus hollow screw fixation for the repair of femoral neck fractures in the middle-aged and elder patients:hip function

    Institute of Scientific and Technical Information of China (English)

    林庆波

    2015-01-01

    BACKGROUND:The repair method of femoral neck fractures included internal fixation and hip arthroplasty. The selection of repair methods is affected by many factors, such as age, condition of patients, and own physical condition. The selection of repair methods for femoral neck fractures is always controversial. OBJECTIVE:To compare the hip function and prognosis of elderly patients with femoral neck fractures after total hip arthroplasty and hol ow screw fixation. METHODS:140 patients aged less than 60 years, who accepted treatment in Rizhao Hospital of Traditional Chinese Medicine from April 2012 to February 2014, were selected. They were randomly divided into replacement group and fixation group (n=70). Patients in the replacement group received total hip arthroplasty, and patients in the fixation group received hol ow compression screw fixation. Harris score of the hip, complications and satisfactions of the hip were observed, compared and analyzed between the two groups at 1 month post surgery. RESULTS AND CONCLUSION:The excel ent and good rate of Harris score at 1 month post surgery was significantly higher in the replacement group (90%) than in the fixation group (63%) (P  目的:对比中老年股骨颈骨折患者行全髋关节置换与空心螺钉置入内固定治疗后的髋关节功能及预后。  方法:选取2012年4月至2014年2月日照市中医医院收治的140例股骨颈骨折患者,年龄小于60岁,随机分为置换组和内固定组,每组70例。置换组采用全髋关节置换治疗,内固定组患者采取空心加压螺钉置入内固定治疗。观察两组患者治疗后1个月的髋关节功能Harris评分、并发症发生情况及关节功能满意度,并进行对比分析。  结果与结论:治疗后1个月,置换组Harris评分的优良率为90%,明显高于内固定组63%,差异有显著性意义(P<0.05);置换组并发症发生率为6%,明显低于内固定组29%

  12. 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。

  13. 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

  14. 55岁以下成年移位股骨颈骨折内固定术后失败的研究分析%Failure of internal fixation on displaced femoral neck fractures in adults under fifty-five years old

    Institute of Scientific and Technical Information of China (English)

    俞银贤; 马金忠; 朱力波; 陆海明; 桑伟林

    2012-01-01

    目的:回顾性研究年龄55岁以下成年患者移位股骨颈骨折内固定治疗失败病例以提高对其治疗的重视.方法:2007年1月至2010年6月治疗55岁以下移位股骨颈骨折内固定术后失败患者18例,男13例,女5例;年龄27~55岁,平均(48.0±6.0)岁;空心钉治疗17例,髓内钉治疗1例.入院时诊断为股骨头坏死16例,骨不连合并股骨头坏死2例.结果:18例患者内固定术后至手术失败时间8~32个月,平均23个月.复位内固定术后Garden指数不佳;入院时髋关节Harris评分33~80分,平均(56.0±12.5)分.8例股骨头坏死病例和2例骨不连合并股骨头坏死病例接受了全髋关节置换术,5例股骨头坏死病例接受了表面髋关节置换术,3例虽然影像学有股骨头坏死征象但临床症状不明显,接受了保守治疗.所有行髋关节表面置换和全髋关节置换的病例术后随访12~53个月,平均34个月,术后Harris评分(94.0±3.0)分(89~96分).结论:股骨头坏死是55岁以下成年移位股骨颈骨折闭合复位内固定术后常见并发症,必须提高对青壮年股骨颈骨折闭合复位内固定治疗的重视.%Objective:To investigate the failure of internal fixation on displaced femoral neck fractures in adults under fifty-five years old retrospectively inorder to pay more attention to the treatment of these fractures. Methods: From Junary 2007 to June 2010,18 failed cases of internal fixation on displaced femoral neck fractures in adults under fifty-five years old were treated,there were 13 males and 5 females with an average age of (48.0±6.0) years old ranging from 27 to 55. Among them, 17 patients were treated with cannulated screws and ) patient was treated with intramedullaiy nail; 16 patients were diagnosed as osteonecrosis and 2 patients as osteonecrosis associated with nonunion. Results:The average time from internal fixation to failure was 23 months (ranged, 8 to 32 months). The quality of fracture reduction in

  15. 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.

  16. The clinical efficacy of small incision for total hip arthroplasty on osteoporosis treatment of elder patients with fracture of the femoral neck%老年股骨颈骨折患者小切口全髋关节置换术联合抗骨质疏松治疗的效果观察

    Institute of Scientific and Technical Information of China (English)

    赵春斌; 宋建军; 张占山; 平少华

    2014-01-01

    Objective To investigate the clinical effect of small incision for total hip arthroplasty on osteoporosis treatment of elder patients with fracture of the femoral neck.Methods Fifty-six elder patients with femoral neck methods were selected as our subjects,who were hospitalize from Jan.2011 to Dec.2013 in Xiahuayuan Meikuang Hospital,Zhangjiakou Company Limited.They were randomly divided into the observation group (26 cases) and control group (30 cases).All patients were treated with small incision total hip arthroplasty.The patients in the observation group were given the alendronate sodium.The curative effect,hospitalization time,bone mineral density were recorded.Results The long-term efficacy of the excellent and good rate of the observation group was 96.2% (25/26),higher than that in control group(86.6% (26/30)),and the difference was statistically significant(x2 =4.125,P < 0.05).The length of hospitalized time in observation group was (26 ± 4) d,shorter than that in the control group (35 ± 3) d,and the difference was statistically significant(t =9.102,P < 0.05).The bone density of patients in the observation group was (0.64 ± 0.03) g/cm2,higher than that in control((0.61 ± 0.05) g/cm2),and there was significant difference between two groups (t =8.461,P < 0.05).Conclusion The effect of small incision total hip arthroplasty combined with anti osteoporosis drugs for the treatment of femoral neck fractures in the elderly is good and worthy of clinical usage.%目的 探讨小切口全髋关节置换术联合抗骨质疏松药物治疗老年股骨颈骨折的临床效果.方法 2011年1月至2013年12月收入我院的56例老年股骨颈骨折患者,按随机数字表分为观察组26例和对照组30例,两组患者均给予小切口全髋关节置换术治疗.观察组术后加服抗骨质疏松药物阿仑膦酸钠.观察两组的疗效、住院时间和骨密度的差异.结果 观察组远期疗效优良率为96.2%(25/26),对照组为86.6

  17. Open Reduction and Internal Fixation with DHS Combined with Anti-rotation Screw to Treat Pauwels Type Ⅲ Femoral Neck Fracture in Young Adults%切开复位DHS联合抗旋螺钉固定治疗青壮年股骨颈PauwelsⅢ型骨折

    Institute of Scientific and Technical Information of China (English)

    曲国胜; 刘建华; 马英; 杨国良; 冯世斌

    2011-01-01

    目的:评价切开复位DHS 联合抗旋螺钉固定治疗青壮年股骨颈Pauwels Ⅲ型骨折的临床效果.方法:采用回顾性分析的方法,总结2005 年2月~2009 年4月,我院手术治疗的Pauwels Ⅲ型骨折患者26 例.其中,男22 例,女4例,年龄19~47 岁,平均38.4 岁.骨折按Pauwels 型均为Ⅲ型,采用切开复位DHS 联合空心钉固定.结果:本组患者随访时间20~70 个月,平均31.2 个月.除3例发生股骨头缺血性坏死外,其余23名患者骨折均得到愈合.根据Harris 髋关节功能评分系统评估疗效,优18 例,良5例,差3例.结论:切开复位DHS 联合抗旋螺钉固定治疗青壮年股骨颈Pauwels Ⅲ型骨折的疗效肯定,解剖复位、坚强固定是获得满意疗效的关键.%Objective:To evaluate the result of Pauwels type Ⅲ femoral neck fracture in young adults treated with open reduction and internal fixation with DHS combined with anti-rotation screw.Methods:A retrospective analysis was done on the clinical date of 16 cases of young Pauwels type Ⅲ fracture,which were surgically treated in our hospital from February 2005 to April 2009.There were 15 males and 1 females,with an average of 38.4 years old (ranged from l9 to 47 years old).All were Pauwels type Ⅲ fracture and treated with the method of open reduction and fixed with DHS combined with anti-ration screw.Results: The average period of follow-up of these 16 cases was 20~70 months.l4 patients got fracture union,and 2 cases suffered from osteonecrosis of femoral neck.According to Harris criterion,the results of the treatment was evaluated as excellent in 11 cases,good in 3 cases,bad in 2 cases.Conclusion:Effect of the open reduction and internal fixation with DHS combine with anti-rotation screw to treat young Pauwels type Ⅲ fracture is definite,anatomic reduction and rigid fixation of operation can lower the rate of complications effectively.

  18. 空心加压螺钉与动力髋螺钉螺旋刀片治疗股骨颈骨折的临床疗效及生物力学分析%Cannulated compression screw versus dynamic hip screw-blade in the treatment of femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    骆东; 孙大辉; 姚霁航; 杨凯; 张晓猛; 鞠维娜; 祁宝昌

    2016-01-01

    Objective To compare the curative effect and biomechanical performance of cannulated compression screw (CCS) and dynamic hip screw-blade (DHS-B) in the treatment of patients with femoral neck fracture.Methods Between February 2010 and February 2014,102 patients with femoral neck fracture were treated with CCS or DHS-B at our department.They were 54 males and 48 females,aged from 15 to 86 years.There were 30 subcapital fractures,51 transcervical ones and 21 base ones.CCS was used in 60 patients and DHS-B in 42.In-hospital data were collected retrospectively to compare the curative effects in 2 groups.Furthermore,femoral neck fracture models were established using 12 adult cadaveric femoral specimens.The 12 models were randomized into 2 equal groups (n =6).Group A was subjected to fixation by 3 CCSs and group B to fixation by DHS-B.The 2 groups were compared in terms of axial loading test,rotation test and destructive axial loading test.Results The operation time (59.4 ± 20.2 min),incision size (4.1 ±0.6 cm) and intraoperative blood loss (25.9 ±9.9 mL) in the CCS group were significantly less than those in the DHS-B group (88.6±22.9 min,12.1 ±1.2cmand 156.7±107.1 mL) (P <0.05).The Harris hip score for the DHS-B group (91.9±9.8) was significantly higher than that for the CCS group (87.2 ± 9.2) (P < 0.05).There were no significant differences between the 2 groups in hospital stay,partial weight-bearing time,or postoperative complications (P > 0.05).At 500 N vertical loading,the stress values at both medial and lateral sides of the femur in group A were significantly smaller than those in group B (P < 0.05).There were no significant differences between groups A and B in the average sinking displacement of femoral head or the torque at a torsion angle of 6° (P > 0.05).The maximum load in group A (2,135 ±120 N) was significantly smaller than that in group B (2,986 ± 98 N) (P < 0.05).Conclusion In treatment of femoral neck fracture,DHS-B fixation is

  19. Modified Watson-Jones approach with locking compression paediatric hip plate for femoral neck fractures in children%改良Watson-Jones入路联合小儿髋部锁定加压接骨板治疗股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    王波; 楼跃; 唐凯; 张志群; 林刚; 孙祥水; 刘飞; 倪磊; 鞠黎

    2016-01-01

    Objective To evaluate the methods and curative effect of modified Watson-Jones approach with locking compression paediatric hip plate(LCP-PHP) for femoral neck fractures in children.Methods From January 2012 to August 2014,11 children including 6 male and 5 female with femoral neck fractures(5 lefts,6 rights) underwent operation of modified Watson-Jones approach with LCP-PHP in Nanjing Children's Hospital Affiliated to Nanjing Medical University.The average age at injury was 7.8 years old.All the children received preoperative X-ray and postoperative X-ray regularly.Neck stem angles of preoperative health side,neck stem angles of the sick side 3 days after surgery and the last follow-up were measured,and the loss of neck stem angles,delayed union,nonunion,osteonecrosis,premature physeal closure were evaluated by using X-ray.Meanwhile,hip function of the last follow-up was evaluated by Harris score.Results All the patients were postoperatively followed up for 13-44 months with an average of 26 months.The neck stem angles of preoperative health side 134.70° ± 3.58°,postoperative sick side in 3 days 134.60°±3.46° and the last follow-up 133.50°±3.25°,and there was no statistical difference (F=3.63,P>0.05).The loss of neck stem angles,delayed union,nonunion,and premature physeal closure did not occur.Osteonecrosis(Ratliff type Ⅰ) occurred in 1 child.Harris score was very good in 9 cases(82.0%) and good in 2 cases (18.0%).Conclusions The modified Watson-Jones approach with LCP-PHP for unsuccessful closed reduction femur neck fractures in children can clearly show the fracture,with internal fixation stability and less complications.%目的 探讨改良Watson-Jones入路联合小儿髋部锁定加压接骨板(LCP-PHP)治疗股骨颈骨折的方法及疗效.方法 2012年1月至2014年8月南京医科大学附属南京儿童医院采用改良Watson-Jones入路联合LCP-PHP治疗11例闭合复位失败的股骨颈骨折患儿,其中男6例,女5

  20. Treatment options for unstable trochanteric fractures: Screw or helical proximal femoral nail

    Institute of Scientific and Technical Information of China (English)

    Jeetendra Bajpai; Rajesh Maheshwari; Akansha Bajpai; Sumit Saini

    2015-01-01

    Purpose: To compare treatment outcome of screw proximal femoral nail (PFN) system with that of a helical PFN.Methods: The study included 77 patients with closed unstable intertrochanteric fracture classified as AO 31A2 & 31A3, between June 2008 to August 2011.Inclusion criteria were: all mature skeletons above 50 years of age;closed unstable trochanteric fracture classified as AO 31A2 & A3.Exclusion criteria were: immature skeleton, pathological fracture of any cause other than osteoporosis, inability to walk independently prior to injury.Patients were randomized to 2 treatment groups based on admission sequence.Forty patients were treated with screw PFN and thirty seven were treated with helical PFN.Results: Both groups were similar in respect of time of surgery, blood loss and functional assessment and duration of hospitalization.In screw PFN group 2 patients had superficial wound infection, 1 patient had persistent hip pain and 1 patient had shortening >1 cm but <2 cm, while in helical PFN group 1 patient had superficial wound infection.Conclusion: Both screw and helical PFN are very effective implants in osteoporotic and unstable trochanteric fractures even in Indian patients where the bones are narrow and neck diameter is small.It is an implant of choice for osteoporotic and unstable trochanteric fractures.

  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. MANAGEMENT OF DISTAL FEMORAL FRACTURES USING DYNAMIC CONDYLAR SCREWS

    Directory of Open Access Journals (Sweden)

    Ambrish

    2015-11-01

    Full Text Available BACKGROUND Fractures of distal end of femur are complex injuries which are difficult to manage & are unstable and comminuted. Despite advances in implants treatment of distal femoral fractures remains a challenge. AIMS This study was done to analyze the functional outcome & complications associated with surgical management of fractures of distal end of femur in adults using Dynamic Condylar Screw (DCS. SETTINGS & DESIGN It was a prospective clinical study done at BMCH, Chitradurga. METHODS The present study included 25 patients with 13 Supracondylar and 12 Intercondylar fractures of femur. They were operated after stabilization using Dynamic Condylar Screw. RESULTS The study showed maximum presentation between 4th and 5th decade with mean age of 39.2 years with sex incidence of 11.5:1 (M:F. Mode of injury was RTA in 17, simple fall in 5, fall from height in 2 and assault in 1 patient. Patients presented to hospital within 0 to 4 days of injury. Left side was involved in 12 and right side in 13 cases. There were 9-A1, 3-A2, 1-A3, 2-C1, 8-C2 and 2-C3 fractures. Six patients had compound fracture. Patients were operated from 3 days to 40 days after admission at an average of 12.36 days. Results were found to be excellent in 8, good in 9, moderate in 3 and poor in 5 patients. Complication in form of valgus angulation, shortening, splintering of proximal femoral fragment, deep infection, Implant failure and lateral angulation at fracture site, Non-union with deep infection were noticed. Average range of knee flexion was 1040 and average time to radiological union was 13.42 weeks. CONCLUSION This study showed that DCS is a good method of treating closed type A1, A2, A3, C1 and C2 fractures. Type C3 and compound fractures treated by this method had more poor results. DCS provides rigid fixation and good purchase in osteoporotic bone. Early mobilization prevents knee stiffness.

  3. Ultrasound-guided femoral nerve block for pain control in an infant with a femur fracture due to nonaccidental trauma.

    Science.gov (United States)

    Frenkel, Oron; Mansour, Karim; Fischer, Jason W J

    2012-02-01

    A 3-month-old infant girl was transferred to our emergency department (ED) with a subtrochanteric femoral neck fracture due to nonaccidental trauma. She received multiple doses of parenteral analgesics both before arrival and in our ED. We performed an ultrasound-guided femoral nerve block using 2.0 mL of 0.25% bupivicaine (approximately 1.25 mg/kg) before placing the patient in a Pavlik harness. Successful pain control was achieved within 15 minutes of the procedure allowing pain-free manipulation of the affected extremity. The patient required only a single dose of parenteral narcotics during the ensuing 18 hours. To our knowledge, this is the first report of an ultrasound-guided femoral nerve block used in the ED for pain control in a pediatric patient.

  4. 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

  5. 半髋置换术与内固定术治疗老年移位型股骨颈骨折的系统评价%Hemiarthroplasty compared with internal fixation for displaced femoral neck fractures in the elderly: a systematic review

    Institute of Scientific and Technical Information of China (English)

    王丛; 陈根元; 萧文耀; 杨成业; 侯卫华; 李俊锋

    2011-01-01

    [目的]系统评价一期人工股骨头置换术与闭合复位内固定术治疗老年移位型股骨颈骨折的疗效.[方法]计算机检索MEDLINE(1966 ~2011年3月)、EMBASE(1966 ~ 2011年3月)、Cochrane图书馆(2011第3期)及CBM、CNKI、万方、维普中文数据库(均截止2011年3月),手工检索中、英文已发表或未发表的资料和会议论文并查阅相关文章的参考文献.纳入人工股骨头置换术与闭合复位内固定术治疗老年移位型股骨颈骨折的所有随机对照试验(RCT).由2名评价员独立提取资料,并对其方法学质量进行评价.对符合纳入标准的研究用RevMan 5.0进行统计分析.[结果]纳入7个随机对照试验,共计1 537例病人.Meta分析显示:与闭合复位内固定术相比,人工股骨头置换术治疗老年移位型股骨颈骨折能降低术后24 ~ 36个月的再手术率[RR=0.15,95% CI (0.10 ~0.24)P <0.000 01]和主要并发症发生率[RR =0.17,95% CI (0.12 ~0.23) P<0.00001].[结论]治疗老年移位型股骨颈骨折,人工股骨头置换术较闭合复位内固定术能降低术后24 ~36个月的再手术率和主要并发症发生率;两种治疗方法术后12~36个月的病死率差异无统计学意义.但年龄及精神状况是否对手术方式选择产生影响,尚需包含以上两种因素的大样本、多中心随机对照试验的开展.%[Objective]To evaluate the effects of hemiarthroplasty and internal fixation for treatment of displaced femoral neck fracture in elderly persons. [Method] We searched and internalized for all randomized controlled trials and quasi-randomized controlled trials of hemiarthroplasty and internal fixation for displaced femoral neck fractures in the elderly by electronically searching MEDLINE( 1966 to march,2011) ,EMBASE (1966 to march,2011) .Cochrane Library( Issue 3,2011) ,CBM,CNKI, WANFANG,and VIP (up to march 2011 ). Published or unpublished materials and conference papers in Chinese and English

  6. Risk of femoral shaft and subtrochanteric fractures among users of bisphosphonates and raloxifene

    DEFF Research Database (Denmark)

    Vestergaard, P; Schwartz, F; Rejnmark, L;

    2010-01-01

    Prior studies have suggested an association between bisphosphonate use and subtrochanteric fractures. This cohort study showed an increased risk of subtrochanteric and femoral shaft fractures both before and after the start of drugs against osteoporosis including bisphosphonates. This may suggest...

  7. Expert tibia nail for subtrochanteric femoral fracture to prevent thermal injury

    Directory of Open Access Journals (Sweden)

    Kyung-Jae Lee

    2015-01-01

    Conclusion: Expert tibia nail may be considered one of the treatment options for subtrochanteric femoral fracture with narrow medullary canal. We also emphasize the importance of preoperative evaluation of the medullary canal size for these risky fractures.

  8. Fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures%机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    刘建全; 刘黎军; 黄俊锋; 尤微; 王大平

    2015-01-01

    目的 探讨机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折的疗效.方法 回顾性分析2012年10月至2014年6月采用机器人导航定位系统辅助下经皮空心螺钉内固定治疗的21例股骨颈骨折患者资料(导航组),男8例,女13例;年龄为20 ~ 85岁,平均(65.2±4.2)岁;骨折按Garden分型:Ⅰ型2例,Ⅱ型5例,Ⅲ型9例,Ⅳ型5例.选择同期采用传统徒手定位方法手术治疗的25例股骨颈骨折患者作为对照组.比较两组患者的手术时间、术中透视次数、术中出血量、总钻孔次数、骨折愈合时间及末次随访时髋关节Harris评分等. 结果 导航组患者的手术时间[(75.2±10.6) min]和骨折愈合时间[(5.3±2.5)个月]短于对照组[(85.1±11.3) min、(6.1±3.0)个月],但差异均无统计学意义(P>0.05).导航组患者的术中透视次数[(28.5±9.8)次]、术中出血量[(9.4±7.6)mL]及总钻孔次数[(9.2±4.5)次]显著少于对照组[(48.6±8.1)次、(40.2±10.3)mL、(17.5±8.5)次],差异均有统计学意义(P<0.05).导航组患者末次随访时髋关节Harris评分平均为(87.6±3.1)分,对照组患者平均为(86.9±4.7)分,差异无统计学意义(P>0.05).随访期间导航组无一例患者发生伤口感染、内固定物松动、骨折再移位及股骨头缺血性坏死等并发症. 结论 与传统徒手定位方法相比,机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折具有设备操作相对简单、术中螺钉置入更加精准和规范等优点,实现了手术的微创化,减少了放射线的接触时间.%Objective To discuss clinical efficacy of fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures.Methods From October 2012 to June 2014,21 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation.They were 8 men and 13 women,20 to 85 years of age

  9. The control analysis of different internal fixation surgical methods in the treatment of unstable femoral neck fracture%不同内固定手术方法治疗不稳定型股骨颈骨折的对照分析

    Institute of Scientific and Technical Information of China (English)

    周军杰; 曹成福; 庞金辉; 陈贤奇; 高文武

    2013-01-01

    [目的]评价不稳定型股骨颈骨折分别采用滑动式鹅头钉(DHS)和InterTAN髓内钉内固定的临床疗效.[方法]回顾性分析2007年2月~2011年2月,307例接受内固定手术治疗的股骨颈骨折患者,男189例,女118例;年龄38 ~69岁,平均(50.64±5.25)岁.股骨颈骨折分型按Pauwels分型:Ⅱ型86例,Ⅲ型221例.本研究病例损伤至手术时间2~5d,平均(3.15±2.03)d.本组病例随机采用滑动式鹅头钉(DHS)或InterTAN髓内钉内固定,采用滑动式鹅头钉(DHS) 136例,采用InterTAN髓内钉内固定171例.患者手术后经规范术后随访,临床髋关节功能按Harris评价标准.[结果]283例患者获得随访,随访时间11 ~32个月,平均(15.4±3.25)个月.Harris评分:DHS组从术前平均(13.52±3.06)分提高到末次随访时的平均(83.54 ±2.15)分;其中优65例,良48例,可17例,差6例,优良率为83.1% (113/136),差评中1例(0.74%)发生骨不连,3例(2.21%)发生髋内翻畸形,2例(1.47%)发生股骨头坏死.InterTAN组从术前平均(11.86±4.75)分提高到末次随访时的平均(91.75±3.62)分;其中优92例,良66例,可13例,优良率为92.4% (158/171),无骨折不愈合及髋内翻畸形、无髓内钉断裂.本研究中所有病例均无感染.[结论]应用InterTAN髓内钉内固定技术治疗不稳定型股骨颈骨折,手术创伤小,固定坚强,可早期活动,与DHS比较,具有较少的骨不连和髋内翻发生率,结果令人满意.%[ Objective] To evaluate the clinical outcome of unstable femoral neck fracture treated by internal fixation of dynamic hip screw system ( DHS) and the InterTAN(R) intramedullary nail. [ Method ] Retrospective analysis of 307 cases of femoral neck fractures treated by internal fixation (from February 2007 to February 2011) was made,including 189 males and 118 females with an average age of 50. 64 ±5. 25 years (range,38 -69 years). According to the Pauwels classification,there were 86 cases of type Ⅱ,and 221 cases of

  10. Osteoporosis among hospitalized patients with proximal femoral fractures in Assiut University Trauma Unit, Egypt.

    Science.gov (United States)

    Farouk, Osama; Mahran, Dalia G; Said, Hatem G; Alaa, Mohamed M; Eisa, Amr; Imam, Hisham; Said, G Z

    2017-12-01

    The study was done to investigate osteoporosis prevalence in 275 hip fracture admissions at the Trauma Unit of Assiut University Hospitals and associated factors, which are understudied in our locality. Prevalence was 74.9%. Female sex, older age, low body mass index, and fall on the ground were associated with osteoporosis. This study aims to identify osteoporosis prevalence in hip fracture admissions at the Trauma Unit of Assiut University Hospitals and to study the independent correlates of osteoporosis-related fracture. A prospective cross-sectional study was carried out in 275 hip fracture patients admitted to the Trauma Unit of Assiut University Hospitals from January through December 2014 of both sexes aged 50 years and older. Exclusion criteria were polytrauma, major accidents, and history of chronic conditions and long-term medication associated with osteoporosis risk increase and bilateral hip fractures. For every patient, weight, height, and bone mineral density by dual-energy x-ray absorptiometry (DEXA) were recorded. Tests of significance for non-parametric data were used. The questionnaire included sociodemographic characteristics, dietary habits, lifestyle factors such as smoking and physical activity, and female obstetric and gynecological factors. Mean age was 70.82 ± 11.02 SD; 51.6% were males and 8.4% were obese. Fall on ground was in 81.1% of fractures. Osteoporosis (femoral neck T score ≤ -2.5 SD) prevalence was 74.9%. By univariable analysis, significant correlates were female gender, older age, normal BMI, and fall on the ground. Milk and cheese daily intake was significantly associated with lower prevalence of osteoporosis. In a multivariable logistic regression model, female sex, older age, low BMI, and fall on the ground were associated with osteoporosis. Osteoporosis prevalence is high among hip fracture patients and associated with female sex, increase in age, low BMI, and fall on ground. Strategies to prevent osteoporosis are

  11. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    -six fractures of the lateral femoral wall occurred during the operative procedure itself. A fracture of the lateral femoral wall occurred in only 3% (three) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (thirty-one) of the ninety......-nine with an AO/OTA type 31-A2.2 or A2.3 fracture (p fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture......BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...

  12. The biomechanical comparison of original and new dynamic sleeve three-wing screws for femoral neck fracture%改良前后动态套筒式三翼钉固定股骨颈骨折的生物力学比较

    Institute of Scientific and Technical Information of China (English)

    马信龙; 王杰; 王志彬; 马剑雄; 马韬; 杨阳; 徐卫国; 朱少文; 马宝意; 陈阳; 邢丹

    2012-01-01

    Objective To compare the biomechanical property of original and new dynamic sleeve three-wing screws.Methods Twelve artificial polymethylmethacrylate (PMMA) femoral models and twelve adult cadaver femurs were selected,and then adduction-type femoral neck fracture models were prepared.The specimens were divided randomly into 2 groups,and each group had 6 specimens.According to the operative approach,the fractures were fixed with original dynamic sleeve three-wing screw (DSTS) or new DSTS after anatomic reduction.Then the specimens were fixed in simulated uniped standing position with an instron-8874 servo-hydraulic mechanical testing machine.Ten key points at the proximal femurs and two key points at the femoral shaft were selected to be the positions at which the strain was recorded.The continuous load (PMMA group:0-1200 N; cadaver femur group:0-800 N) was put to the specimens at the rate of 10 mm/min.The strain values under the maximum load,the femoral head sinking displacement and the strain values of No.8 gauge under different loads were recorded.Results There was a peak at the No.8 resistance strain gauge under 1200 N in PMMA group,and the strain values of original and new DSTS were (-2744±35) and (-718±14) με,respectively.There was a peak at the No.8 resistance gauge under 800N in cadaver femur group,and the strain values of original and new DSTS were (-2813±38) and (-2032±22) με,respectively.The differences of strain values above were significant.The femoral head sinking displacement of the new DSTS was much less than that of original DSTS under the same load.Conclusion The new DSTS has better biomechanical properties,using which the femoral neck fracture can be fixed more stably.%目的 比较动态套筒式三翼钉改良前后的生物力学性能.方法 采用聚甲基丙烯酸甲酯(polymethyl methacrylate,PMMA)制作人工股骨模型12根,收集成人尸体股骨12根,制备内收型股骨颈骨折模型.均随机分为两组,每组6根标本.

  13. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report

    Directory of Open Access Journals (Sweden)

    Luo

    2016-03-01

    Full Text Available Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  14. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report

    Science.gov (United States)

    Luo, Peng; HE, Xing-Wen; Chen, Qing-Yun; Hong, Hao; Yang, Lei

    2016-01-01

    Introduction The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. Case Presentation A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT) examination confirmed that the mass was a spontaneous lumbar hernia. Conclusions A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.

  15. Amputated limb by cerclage wire of femoral diaphyseal fracture: a case report.

    Science.gov (United States)

    Won, Yougun; Yang, Kyu-Hyun; Kim, Kwang-Kyoun; Weaver, M J; Allen, Elizabeth M

    2016-12-01

    An entrapment of the femoral artery by cerclage wiring is a rare complication after spiral diaphyseal femoral fractures. We report the case of an 82-year-old female treated by an antegrade intramedullary nailing and multiple cable augmentation, which was then complicated by injury to the femoral artery that resulted in ipsilateral leg necrosis and amputation. The entrapment was caused by direct belting by the cable and resulted in a total obstruction of the femoral artery.

  16. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail

    Directory of Open Access Journals (Sweden)

    Pedro Luciano Teixeira Gomes

    2016-08-01

    Full Text Available ABSTRACT Proximal femoral nails with a helical blade are a new generation of implants used for treating transtrochanteric fractures. The blade design provides rotational and angular stability for the fracture. Despite greater biomechanical resistance, they sometimes present complications. In the literature, there are some reports of cases of perforation of the femoral head caused by helical blades. Here, a clinical case of medial migration of the helical blade through the femoral head and acetabulum into the pelvic cavity is presented.

  17. Pelvic migration of the helical blade after treatment of transtrochanteric fracture using a proximal femoral nail.

    Science.gov (United States)

    Gomes, Pedro Luciano Teixeira; Castelo, Luís Sá; Lopes, António Lemos; Maio, Marta; Miranda, Adélia; Dias, António Marques

    2016-01-01

    Proximal femoral nails with a helical blade are a new generation of implants used for treating transtrochanteric fractures. The blade design provides rotational and angular stability for the fracture. Despite greater biomechanical resistance, they sometimes present complications. In the literature, there are some reports of cases of perforation of the femoral head caused by helical blades. Here, a clinical case of medial migration of the helical blade through the femoral head and acetabulum into the pelvic cavity is presented.

  18. 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.

  19. 关节置换与植入物内固定治疗老年移位型股骨颈骨折的系统评价%Systematic review of arthroplasty combined with internal fixation for displaced femoral neck fractures in elderly patients

    Institute of Scientific and Technical Information of China (English)

    陈跃平; 高辉; 陈亮; 罗东方; 尹庆水

    2012-01-01

    背景:老年移位型股骨颈骨折治疗常需要内固定或人工髋关节置换,两种术式如何选择一直是骨科医生争论的焦点.目的:对髋关节置换与内固定治疗老年移位型股骨颈骨折的疗效和安全性进行系统评价.方法:计算机检索Cochrane图书馆(2011年第5期)、MEDLINE(1966-01/2011-05)、EMbase(1984-01/2011-05)、CNKI (1979-01/2011-05).收集所有髋关节置换与内固定比较治疗老年人(>60岁)移位型股骨颈骨折的随机对照试验(RCT),筛选出符合纳入标准的文献,对其进行严格的质量评价,利用Cochrane 协作网提供的RevMan5.1.2软件对纳入研究结果进行Meta 分析,使用GRADEpro version3.2.2软件对纳入研究进行证据评级.结果与结论:共检索到相关文献87篇,最终纳入13个RCT,共2 436例患者.Meta 分析结果显示,随访2年、10年或10年以上病死率,关节置换和内固定组比较差异均无显著意义.随访2 年、10年或10年以上再手术率及并发症,关节置换组均显著低于内固定组.提示无论短期还是长期选择关节置换治疗老年人移位型股骨颈骨折可明显降低术后再次手术率及主要并发症.%BACKGROUND: Treatment of femoral neck fracture in elderly patients is always through internal fixation or arthroplasty, but howto choose the two procedures for the treatment is the debate focus of orthopedic surgeons.OBJECTIVE: To review the clinical outcomes and safety between arthroplasty and internal fixation in treatment of elderly patientswith femoral neck fracture.METHODS: Cochrane central register of controlled trials (fifth book in 2011), MEDLINE (1966-01/2011-05), EMbase(1984-01/2011-05) and CNKI (1979-01/2011-05) were (> 60 years) searched. Only randomized clinical trials that comparedarthroplasty with internal fixation for the treatment of femoral neck fracture in the elderly (>60 years) were included. The analysiswas performed with software RevMan5.1.2 from the Cochrane collaboration

  20. Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins.

    Science.gov (United States)

    Christie, J; Howie, C R; Armour, P C

    1988-03-01

    One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.

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

    DEFF Research Database (Denmark)

    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....

  2. 动态套筒式三翼钉固定不同角度PMMA股骨颈骨折的生物力学研究%Biomechanical research of dynamic sleeve three-wing screw in fixing femoral neck fracture of different angles

    Institute of Scientific and Technical Information of China (English)

    杨阳; 马信龙; 马剑雄; 王志彬; 马宝意; 王沛

    2010-01-01

    Objective To explore the biomechanical stability of dynamic sleeve three-wing screw for treatment of femoral neck fracture and to provide theoretical basis for choosing the screw in clinical application.Methods Nine artificial PMMA femoral model were prepared and divided randomly into three groups (n=3),and the specimens were saw up with a hand saw at Pauwels angle of 30° ,50° and 70° in the central neck ,respectively and then fixed with dynamic sleeve three-wing screw.Specimens were fixed at simulated uniped standing position at Instron-8874 servo-hydraulic mechanical testing machine.Linear load of 0~1 200 N was loaded at the rate of 10 mm/min and strains at 11 key points under 1 200 N load were measured,as well as head sink displacement and the strain at principal pressure side and principal tension side under different loads.Results Strengthening peaks were observed at the number six resistance strain gage under the 1 200 N load in all tree groups,and the numerical difference of the three groups was statistically significant(P<0.01).Under the load of 600~1 200 N,head sink displacement compare were performed in each two of the three groups under the same load,respectively,and showed statistically significant difference(P<0.01) ;the strain of principal pressure side and principal tension side of the femoral neck was higher with the increasing Pauwels angle under the same load,the difference was significant(P<0.01).Conclusion With the increasing Pauwel's angle,the shearing force was greater,the contact area of fracture line was smaller,and the fracture was more unstable;in contrast,the shearing force was smaller with the Pauwel's angle smaller,the contact area of fracture line was larger,and the fracture was more stable.%目的 探讨动态套筒式三翼钉治疗股骨颈骨折中的生物力学作用,为临床选择此内固定器治疗股骨颈骨折提供理论依据.方法 利用聚甲基丙烯酸甲酯(PMMA)制作人工股骨模型9

  3. 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.

  4. Comparison of different procedures in the treatment of displaced femoral neck fractures in middle-aged and elderly patients.%不同手术方法治疗中老年移位型股骨颈骨折的疗效分析

    Institute of Scientific and Technical Information of China (English)

    桂先革; 曾晖; 熊奡; 康斌; 张勇; 陶可; 辛风

    2011-01-01

    Objective To evaluate the clinical outcome of the internal fixation and arthroplasty for the displaced femoral neck fractures in the middle-aged and elderly patients. Methods All the 80 middle-aged and elderly patients with displaced femoral neck fractures who had been treated from January 2006 to June 2009 were reviewed. Of them, 23 cases received internal fixation (Croup A), 27 femoral head arthroplasty ( FHA, Croup B) and the other 28 total hip arthroplasty (THA, Croup C). Comparisons were made among the 3 groups in hospitalization, operating time, intraoperative bleeding, postoperative complications, and functional recovery. Results The operating time and blood loss in Group C is the most than that in Group A and Group B. Group A have the most postoperative complication, Group B have the leastKarris score. Croup C have the more pain score than Croup B, Croup C have the most turn-lion score and Croup Fi have (he least- Statistical analysis showed that there is a significant difference in operating time, intraoperative bleeding, poslopera-live complications and postoperative Harris score, and no significant difference in the hospitalizalion , walking score and motion range. Conclusion Internal fixation can he applied lo patients who are relatively young and active, have good quality of bone and can tolerate ambulalion lately; THA is suitable for patients with the displaced femoral neck fractures of the elderly those who are active , have good genera! Condition or have relatively longer life expectancy or preexislent hip diseases. FHA is suitable for patients who have a poor general condition or have serious medical diseases but can lolerale general surgery in preoperative assessment.%目的 评价不同手术方法治疗中老年移位型股骨颈骨折的疗效.方法 回顾性分析2006年1月至2009年6月收治的80例分别采用内固定(A组,25例)、人工股骨头置换(B组,27例)及全髋关节置换(C组,28例)手术治疗的中老年移位型股骨

  5. Predictors of atypical femoral fractures during long term bisphosphonate therapy: A case series & review of literature

    Directory of Open Access Journals (Sweden)

    Sanjay Kumar Bhadada

    2014-01-01

    Full Text Available Background & objectives: Bisphosphonates (BPs are the most widely prescribed medicines for the treatment of osteoporosis because of their efficacy and favourable safety profile. There have been, several reports on an increased incidence of atypical femoral fractures after long term treatment with BPs. The objective of this study was to evaluate the clinical presentation including prodromal symptoms, skeletal radiograph findings, type and duration of BPs received and treatment outcome of patients who developed atypical femoral fractures during bisphosphonate therapy. Methods: In this retrospective study, eight patients with atypical femoral fractures were analysed based on clinical features, biochemical and radiological investigations. Results: Of the eight patients, who sustained atypical femoral fractures, six were on alendronate and two were on zoledronate therapy before the fractures. In addition to BPs, two patients were on long term corticosteroid therapy for rheumatoid arthritis and Addison′s disease. Three patients had bilateral atypical femoral fractures. Except one, all of them had prodromal symptoms prior to fracture. Skeletal radiograph showed cortical thickening, pointed (beaking of cortical margin and transverse fracture in meta-diaphyseal location. Serum calcium, phosphate, alkaline phosphatase (ALP and intact parathyroid hormone (iPTH concentrations were within the reference range in all patients. Interpretation & conclusions: Long term bisphosphonate therapy may increase the risk of atypical femoral fractures. Presence of prodromal pain, thickened cortex with cortical beaking may be an early clue for predicting the atypical fractures. High risk patients need periodical skeletal survey and a close follow up for early detection of cases.

  6. A STUDY OF MANAGEMENT OF SUBTROCHANTERIC FRACTURE FEMUR BY PROXIMAL FEMORAL NAILING

    Directory of Open Access Journals (Sweden)

    Venkateswara Rao

    2015-08-01

    Full Text Available Numerous variations of intramedullary nails have been devised to achieve a stable fixation and early mobilisation of pertrochanteric fracture, among which is the proximal femoral nail (PFN. We report here the results of a prospective study carried out at our institute on 60 consecutive patients who had suffered high subtrochanteric fracture between May 2011 and October 2014 and were subsequently treated with a PFN. Close t o anatomical reduction of the fracture fragments was achieved in 54 patients, while limited open reduction was required in 3 patients. In the present series, 3.33(2 of cases had superficial infection and no deep infections were recorded. Cut of the anti - r otational screw was noted in 1 patient. Fracture of the shaft with breakage of the nail was noted 1.66% (1 of patients. In the current series, the mean Harris Hip score was 80.76 and it was ranging from 100 - 29. In this series all the patients between 20 – 3 0 years had excellent result irrespective of the type of fracture. Older age group patients had relatively poor results and 50% (5 of them had poor results and another 50% (5 had good to fair results. In this study excellent outcome was not seen in the o lder age group patients.Our results indicate the necessity of a careful surgical technique and modifications that are specific to the individual fracture pattern in order to reduce complications. Osteosynthesis with the PFN offers the advantages of high ro tational stability of the head - neck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking.

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

    Science.gov (United States)

    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. Curative effect of cemented prosthesis and cement-less prosthesis in the treatment of old aged femoral neck fracture%骨水泥型与生物型假体髋关节置换术治疗老年股骨颈骨折疗效研究

    Institute of Scientific and Technical Information of China (English)

    马川; 江锋; 黄陈翼; 刘宗超

    2016-01-01

    目的:探讨骨水泥型与生物型假体髋关节置换术治疗不稳定型老年股骨颈骨折的疗效。方法于2013年1月至2015年1月在选择初次接受全髋关节置换手术的不稳定型老年股骨颈骨折患者60例,随机分为骨水泥型组和生物型假体组,各30例,分别行相应假体髋关节置换术,术后随访6个月。比较两组患者手术时间、术中出血量、住院天数、术后并发症发生情况、术后髋关节脱位发生情况和髋关节 Harris评分。结果骨水泥型组和生物型组手术时间、术中出血量比较差异无统计学意义(P>0.05),骨水泥型组住院时间短于生物型组(P<0.05)。骨水泥型组术后并发症总发生率高于生物型组(P<0.05)。术后1个月和6个月时,两组患者均出现髋关节脱位的情况。术后1个月和6个月时,骨水泥型组 Harris评分高于生物型组( P<0.05)。结论与生物型假体髋关节置换术相比,骨水泥型假体髋关节置换术不增加手术时间和术中出血量,患者住院时间更短,在改善患者术后早期髋关节功能方面有重要作用,但更易发生并发症。%Objective To observe the clinical effect of cemented prosthesis and cement‐less prosthesis in the treatment of old aged femoral neck fracture .Methods From Jan .2013 to Jan .2015 ,60 old patients with femoral neck fracture were randomly divided into cemented prosthesis group and cement‐less prosthesis group .Relevant index were compared between the two groups .Results The operative time and blood loss were without significant differences between the two groups (P>0 .05) ,but the time for hospital stay of cemented prosthesis group was less than cement‐less prosthesis group(P< 0 .05) .The Harris scores ,detected one month and six months after operation ,of cemented prosthesis group were significantly higher than cement‐less prosthesis group ( P<0 .05) .Conclusion Compared with

  9. 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.

  10. 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

  11. Hip fracture in a patient affected by transient osteoporosis of the femoral head during the last trimester of pregnancy.

    Science.gov (United States)

    Spinarelli, Antonio; Patella, Vittorio; Speciale, Domenico; Petrera, Massimo; Vittore, Donato; Pesce, Vito; Patella, Silvio

    2009-05-01

    Few cases of hip fracture in pregnant women affected by transient osteoporosis of the femoral head have been reported in the literature, but its real incidence seems to be underestimated. During pregnancy, osteoporosis manifests itself with an insidious onset of hip pain and limp without any trauma or infective episode in clinical history. Its clinical course is characterized by spontaneous recovery a few weeks to several months after delivery. This article describes the case of a 35-year-old woman with a sudden onset of bilateral hip pain during the last trimester of her first pregnancy; she had neither history of steroid therapy nor alcohol abuse; her body temperature and serological parameters were normal. Bilateral transient osteoporosis of the femoral heads was suspected and confirmed by magnetic resonance imaging. Fifteen days postpartum, she was admitted to our clinic with a displaced femoral neck fracture. A cementless total hip arthroplasty was performed to quickly begin a rehabilitative program. She underwent antiresorptive therapy with alendronic acid 70 mg/week and vitamin D for 3 months. Three months after the fracture, a dual-energy x-ray absorptiometry scan showed osteopenia (T-score, -1.5). Risedronic acid 35 mg/week and vitamin D were then prescribed. The last physical examination at 3 months postoperatively revealed a gradual recovery of the autonomy in activities of daily life.

  12. Early curative effects and influencing factors of primary total hip replacement for senile femoral neck fractures%初次全髋关节置换术治疗老年股骨颈骨折的近期疗效及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    邓波; 王静成; 熊传芝; 颜连启; 孙钰

    2016-01-01

    Objective To investigate the early curative effects and influencing factors of primary total hip replacement for senile femoral neck fractures.Methods Between January 2013 and May 2015,116 elderly patients with femoral neck fracture underwent primary total hip replacement.They were 34 males and 82 females,with an average age of 70.2 years.By the Garden classification,we had 23 cases of type Ⅰ,34 cases of type Ⅱ,38 cases of type Ⅲ,and 21 cases of type Ⅳ.Their clinical data were statistically analyzed,including gender,age,body mass index (BMI),preoperative concomitant diseases,Garden classification,injury causes,operative indexes,postoperative rehabilitation time,and postoperative complications.Single factor analyses were conducted to find out the relative factors using x2 test before multiple factors analyses using logistic regression to screen the significant factors influencing hip functional recovery.Results The 116 patients obtained follow-ups for 12 to 23 months (mean,18.3 months).According to the Harris hip scores for hip function at the last follow-up evaluation,36 cases were excellent,52 good,20 fair,and 8 poor,giving a good to excellent rate of 75.9%.Single factor analyses found that age,BMI,operation time,surgical approach,discrepancy in bilateral lower limb lengths,postoperative analgesia,total blood loss,postoperative rehabilitation time,and postoperative complications were significantly related to hip functional recovery (P < 0.05).Logistic regression analyses found that BMI,surgical approach,discrepancy in bilateral lower limb lengths,postoperative analgesia,total blood loss,and postoperative rehabilitation time were the main factors influencing hip function recovery (P < 0.05).Conclusions Primary total hip replacement may lead to fine early curative effects for elderly patients with femoral neck fracture.Smaller BMI,minimally invasive approach,less discrepancy in bilateral lower limb lengths,post-operative analgesia,less total blood loss

  13. 不同手术时机行关节置换术对老年股骨颈骨折患者术后髋关节功能的影响%Different timing of surgery for joint replacement surgery on femoral neck fracture patients about harris indexes

    Institute of Scientific and Technical Information of China (English)

    尹虎

    2012-01-01

    Objective According to the assessment of the curative effect on different operation time of total hiparthroplasty for femoral neck fractures,to explore the effect of the different timing of surgery,itraoperative and postoperative blood loss,early postoperative complications and hip function recovery,and provide theoretical basis for selection of operation time of total hip arthroplasty for femoral neck fractures,to better guide clinical practice.Methods Retrospective analysis 90 femoral neck fracture patients with complete follow-up data for total hip arthroplasty,90 patients were divided into two groups,observation group was given the emergency surgery,the control group was given the delayed operation group.The differences of two groups about operation time,intraoperative blood loss,postoperative drainage,early postoperative complications and postoperative functional restoration of hip joint were compared.Results After 3 months follow-up,the comparison of operation time,intraoperative blood loss and postoperative drainage for the emergency operation group and the delayed operation group,the difference was statistically significant(t=2.37,15.38,22.73,all P<0.05).The emergency operation group and the delayed operation group in the postoperative complications,P>0.05,the difference was not statistically significant.After 1 month,the difference of the two groups of hip joint function by Harris score was statistically significant(t=2.76,P<0.05);and after 3 months,the difference was not statistically significant(P>0.05).Conclusion Emergency surgery can effectively shorten the operation time,reduce blood loss and postoperative drainage and conducive to the recovery of hip function in patients,reduce the pain caused by the disease,but the ultimate the hip function is not affected.%目的 探讨不同手术时机行全髋关节置换术治疗老年股骨颈骨折患者对术后髋关节功能的影响.方法 回顾性分析随访资料完整的全髋关节置换

  14. 重建后关节囊及外旋肌群人工全髋关节置换术在股骨颈骨折的临床疗效%Therapeutic effect of total hip replacement with Posterior arthrosis cpsule reconstruction and Short external rotator muscle repair on Femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    陈春雷; 李拱榆

    2014-01-01

    Objective To explore the therapeutic effect of total hip replacement with Posterior arthrosis cpsule reconstruction and Short external rotator muscle repair on Femoral neck fractures. Methods Fourty patients with Femoral neck fractures. were select-ed and divided into two groups with 20 cases in each groups. A group was given the treatment of total hip replacement with Poste-rior arthrosis cpsule reconstruction and external rotator muscle repair whiIe B group was given the treatment of traditional total hip replacement only with external rotator muscle repair. The operation incision length, operation time, intraoperative bleeding volume, postoperative drainage volume and hospital stay were all recorded. And postoperative complication in 6 months of two groups in-cluding infection, hematoma, nerve injury, joint dislocation, deep vein thrombosis and Harris hip score were observed and com-pared. Results ①The intraoperative bleeding volume and postoperative drainage volume in A group were less than those in A group (P0.05). ②There was no significant difference of Harris hip score at 6 months after surgery between the two groups (95%VS 85%, P>0.05). ③There were lower incidence of postoperative infection, hematoma and joint dislocation in group A than those in group B (P0.05). Conclusion The therapeutic effect of total hip replacement with Posterior arthrosis cpsule reconstruction and Short external rotator muscle repair on Femoral neck fractures is obvious were less postoperative infection, hematoma and joint disloca-tion, which is worthy of clinical application.%目的:探讨重建后关节囊及外旋肌群人工全髋关节置换术在股骨颈骨折中的临床疗效。方法选择我院2012年3月-2013年3月收治的股骨颈骨折的患者40例,根据手术方式不同随机分为两组,每组20例:A 组采取重建后关节囊及外旋肌群人工全髋关节置换术;B组采取传统经后侧入路行髋关节置换术(仅修补外旋肌群

  15. Treatment of senile femoral neck fractures using bipolar hemiarthroplasty with enhanced repair of a U-shaped capsular flap via a modified posterior mini-incision%改良后路微创切口并强化修复“U”形关节囊瓣的双极头置换治疗高龄股骨颈骨折

    Institute of Scientific and Technical Information of China (English)

    周雪明; 刘彬; 吴润柏; 王智; 莫新发; 刘先银

    2015-01-01

    Objective To evaluate the efficacy of bipolar hemiarthroplasty with cnhanced repair of a U-shaped capsular flap via a modified posterior mini-incision for senile femoral neck fractures.Methods Between June 2008 and June 2013,86 senile patients with femoral neck fracture were treated operatively.They were 20 males and 66 females,80 to 95 years of age (mean,84.6 years).There were 70 cases of Garden type Ⅲ and 16 cases of Garden type Ⅳ.They all underwent bipolar hemiarthroplasty via a modified posterior mini-incision.A U-shaped posterior capsular flap with its base close to the acetabulum was made before exposure of the hip joint.Next this flap and short external rotators were repaired particularly after the bipolar prostheses were implanted.Incision length,surgical time,iotra-operative loss of blood,and length of lower limb were measured.Malposition of prosthesis,hip dislocation and other complications were monitored.The outcomes were assessed according to Harris hip score at the last follow-up.Results The mean incision length was 9.2 cm (range,8 to 12 cm).The mean surgical time was 75.2 min (range,55 to 130 min).The mean intra-operative loss of blood was 250.1 mL (range,120 to 620 mL).The proximal skin margin of the incision was bruised in 3 cases,deep venous thrombosis occurred at the lower limb 3 weeks postoperatively in one case,and length discrepancy between bilateral lower limbs was observed in 6 cases.No dislocation,incision infection,sciatic nerve injury,or component malpositioning happened in this group.All patients were evaluated after a mean follow-up period of 14 months(from 12 to 35 months).One patient died from lung cancer one year postoperatively.According to the Harris hip scores at the last follow-up,68 cases were excellent,15 good and 3 fair,giving an excellent to good rate of 96.5%.Conclusions The modified posterior mini-incision for localization of body surface is accurate,reliable and simple for senile femoral neck fractures.The bipolar

  16. Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases

    DEFF Research Database (Denmark)

    Houshian, Shirzad; Gøthgen, Charlotte Buch; Pedersen, Niels Wisbech;

    2004-01-01

    We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4-11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children c...... in 6 children and 10 degrees of internal rotational deformity in 1 child. No angular deformity had occurred. Elastic stable intramedullary nailing seems to be a safe method for the treatment of femoral shaft fractures in children between 4 and 11 years of age....

  17. Injuries Associated with Femoral Shaft Fractures with Special Emphasis on Occult Injuries

    Directory of Open Access Journals (Sweden)

    E Carlos Rodriguez-Merchan

    2013-12-01

    Full Text Available Background: Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and how many of them were undetected. Methods: We studied 148 patients (150 femoral shaft fractures with an average age of 52 (range: 18-97. Femoral shaft fractures were treated with antegrade intramedullary nailing in 118 cases (78.7%, and with open reduction and internal fixation in 32 cases (21.3%. Unlocked reamed intramedullary nailing was performed in Winquist type I and type II fractures, while statically locked unreamed intramedullary nailing was carried out in Winquist type III and type IV fractures. Results: There were 70 patients with associated injuries (46.4%. The associated injuries went undetected in 18 out of 70 patients (25.5%. Six femoral nonunions (4% occurred in patients under 70 years of age (high-energy accidents treated by open reduction and internal fixation. Conclusion: Injuries associated with femoral shaft fractures were very frequent (46.4% in our series, with 25.5% undetected. Open reduction and internal fixation was a poor prognostic factor of nonunion in these fractures.

  18. Injuries Associated with Femoral Shaft Fractures with Special Emphasis on Occult Injuries

    Directory of Open Access Journals (Sweden)

    E Carlos Rodriguez-Merchan

    2013-12-01

    Full Text Available   Background: Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and how many of them were undetected. Methods: We studied 148 patients (150 femoral shaft fractures with an average age of 52 (range: 18-97. Femoral shaft fractures were treated with antegrade intramedullary nailing in 118 cases (78.7%, and with open reduction and internal fixation in 32 cases (21.3%. Unlocked reamed intramedullary nailing was performed in Winquist type I and type II fractures, while statically locked unreamed intramedullary nailing was carried out in Winquist type III and type IV fractures. Results: There were 70 patients with associated injuries (46.4%. The associated injuries went undetected in 18 out of 70 patients (25.5%. Six femoral nonunions (4% occurred in patients under 70 years of age (high-energy accidents treated by open reduction and internal fixation. Conclusion: Injuries associated with femoral shaft fractures were very frequent (46.4% in our series, with 25.5% undetected. Open reduction and internal fixation was a poor prognostic factor of nonunion in these fractures.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Plating and Grafting for Nonunion of a Subtrochanteric Femoral Fracture in a Dog

    OpenAIRE

    1984-01-01

    Healing problems following pin and wire reduction of an unstable subtrochanteric femoral fracture are described. A nonunion was treated in a two year old spayed Springer Spaniel by plating and autogenous bone grafting.

  2. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report

    Directory of Open Access Journals (Sweden)

    Bogdan Deleanu

    2016-02-01

    Conclusion: The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

  3. 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.

  4. COMPARATIVE STUDY OF FRACTURE NECK OF FEM UR TREATED WITH UNIPOLAR AND BIPOLAR HEMIARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Nava Krishna Prasad

    2015-03-01

    Full Text Available OBJECTIVES: This study has been carried out to compare the functional outcome of intracapsular fracture neck of femur treated with unipolar (Austin Moore prosthesis and bipolar prosthesis. METHODS: Fifteen out of thirty patients with displaced fracture of femoral nec k treated with unipolar prosthesis and other fifteen of patients treated with bipolar prosthesis from August 2012 to January 2015 in the Department of Orthopedics, Governmen t medical college, Ananthapuram . Functional outcome was assessed and compared using Modified Harris hip score and radiological assessment with a follow up of one year. RESULTS: Two group s of patients with mean age 72. 2years in AMP and 65.3 years in bipolar were evaluated and the mean hi p score of unipolar was 82.6±8.72and bipolar was 86.17±8.12 respectively. CONCLUSION: Functional outcome with mean Modified Harris hip score is better in Bipolar group than unipolar (Austin Moore prosthesis. Complications like painful hip, acetabular eros ion, periprosthetic fractures are more in unipolar group. Hence bipolar prosthesis is better in elderly patients with fracture neck of femur.

  5. A missense single nucleotide polymorphism, V114I of the Werner syndrome gene, is associated with risk of osteoporosis and femoral fracture in the Japanese population.

    Science.gov (United States)

    Zhou, Heying; Mori, Seijiro; Tanaka, Masashi; Sawabe, Motoji; Arai, Tomio; Muramatsu, Masaaki; Mieno, Makiko Naka; Shinkai, Shoji; Yamada, Yoshiji; Miyachi, Motohiko; Murakami, Haruka; Sanada, Kiyoshi; Ito, Hideki

    2015-11-01

    Werner syndrome is a rare autosomal recessive disorder caused by mutations in the human WRN gene and characterized by the early onset of normal aging symptoms. Given that patients with this disease exhibit osteoporosis, the present study aimed to determine whether the WRN gene contributes to the etiology of osteoporosis. A genetic association study of eight non-synonymous polymorphisms in the WRN gene and the incidence of femoral fracture was undertaken in 1,632 consecutive Japanese autopsies in which 140 patients had experienced the fracture during their lifetime. The results were validated in 251 unrelated postmenopausal Japanese women with osteoporosis and 269 non-institutionalized, community-dwelling Japanese adults. A statistically significant association was observed between rs2230009 (c.340G > A)--which results in a Val to Ile substitution--and fracture risk; the incidence of femoral fracture increased dose-dependently with the number of A alleles (p = 0.0120). Femoral neck bone and whole bone densities were lower among postmenopausal women with osteoporosis and community-dwelling adults, respectively, if they were of the AG instead of the GG genotype. The results suggest that Japanese subjects bearing at least one A allele of rs2230009 of the WRN gene are at a significantly higher risk of femoral fracture, possibly due to decreased bone density.

  6. Treatment of displaced neck fractures of the femur with total hip arthroplasty.

    Science.gov (United States)

    Rudelli, Sergio; Viriato, Sergio P; Meireles, Tadeu L O; Frederico, Tiago N

    2012-02-01

    We report our experience in unstable fractures of the femoral neck in a consecutive series of patients who underwent total hip arthroplasty. Over a period of 12 years, 88 patients were treated with a cemented total hip arthroplasty; 3 patients were lost to follow-up, leaving 86 fractures (85 patients) for retrospective analysis. Seven patients had dislocations, all but 1 of which were treated successfully without reoperation. Four patients required reoperation in the same hip undergoing arthroplasty. There was a graded increase in mortality rates across the continuum of risk groups at the time of surgery. The low incidence (4.6%) of a second procedure on the hip repaired initially, as well as low mortality rates, makes this treatment strategy quite satisfactory.

  7. A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures.

    Science.gov (United States)

    Ellis, Henry Bone; Ho, Christine A; Podeszwa, David A; Wilson, Philip L

    2011-12-01

    Stainless steel flexible Enders rods have been used for intramedullary fixation of pediatric femur fractures with good success. Despite intraoperative anatomic alignment, length unstable femur fractures can present postoperatively with fracture shortening. The purpose of this study was to review all length unstable pediatric femoral shaft fractures in which Enders rods were used and compare those that were locked to those that were not locked. A retrospective clinical and radiographic review of all patients at a single institution undergoing flexible intramedullary fixation for length unstable femoral shaft fractures from 2001 to 2008. A length unstable fracture was defined as either a comminuted fracture or a spiral fracture longer than twice the diameter of the femoral shaft. A total of 107 length unstable femoral shaft fractures fixed with Enders rods were identified, of which 37 cases (35%) had both Enders rods "locked" through the eyelet in the distal femur with a 2.7 mm fully threaded cortical screw. Patient demographics, clinical course, complications, fracture characteristics, and radiographic outcomes were compared for the locked and nonlocked groups. There were no statistical differences between the groups in demographic data, operative variables, fracture pattern, fracture location, time to union, femoral alignment, or major complications. Shortening of the femur and nail migration measured at 1 to 6 weeks postoperatively was significantly greater for the nonlocked cases. The medial and lateral locked Enders rods moved 1.3 and 1.9 mm, respectively, and the unlocked Enders each moved 12.1 mm (P Enders rods for length unstable pediatric fractures is an excellent option to prevent shortening and resulted in no additional complications, added surgical time, or increased blood loss. Level III.

  8. Transparotid approach for mandibular condylar neck and subcondylar fractures.

    Science.gov (United States)

    Croce, A; Moretti, A; Vitullo, F; Castriotta, A; Rosa, De M; Citraro, L

    2010-12-01

    Mandibular condylar neck fractures and subcondylar fractures represent, respectively, 19-29% and 62-70% of all mandibular fractures; treatment involves some problems, common to both, concerning the choice of an adequate approach. Herewith, personal experience is reported related to the surgical treatment of some cases of mandibular condylar neck and subcondylar fractures by transparotid approaches with partial parotidectomy, removing the salivary tissue overlying the condylar neck and/or the subcondylar region. Over the last 5 years, we observed 22 fractures of the condylar neck and 10 fractures of the subcondylar region. In 13 patients (11 male, 2 female, age range 10-68 years, mean 33 years), 10 of whom had other mandibular and/or other maxillo-facial and skeleton fractures - 50% of these with dislocated condylar heads - and the other 3 for their free choice, regarding the different treatments, 18 transparotid approaches with partial parotidectomy (bilateral in 5 cases), were performed reducing and fixing 12 condylar neck fractures and 5 subcondylar region fractures with appropriate plates (2.0 mm) and screws. After surgery, no intermaxillary fixation was performed. Complications included 4 salivary fistulae (bilateral in 1 patient), which closed spontaneously after 4 or 5 weeks with a dressing, 1 case of Frey's syndrome, which healed after 2 treatments with botulin and 6 cases of transient facial palsy lasting 4-8 weeks (1 case bilateral) affecting zygomatic, buccal and marginal mandibular nerves. During follow-up, functional parameters considered were: restoration of original pre-injury occlusion; vertical, lateral and protrusion mandibular movements. All patients re-acquired the original pre-injury occlusion; the maximal post-operative intrinsical distance was at least 40 mm after a variable period of rehabilitation and lateral and protrusion movements also led to satisfactory final results. All patients were free of pain and had no deflection or clicking upon

  9. Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review

    Directory of Open Access Journals (Sweden)

    Flávia Vieira Guimarães Hartmann

    Full Text Available Abstract Background: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5 cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. Objective: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. Methods: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Results: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture

  10. Stress fractures of the femoral shaft in women's college lacrosse: a report of seven cases and a review of the literature.

    Science.gov (United States)

    Kang, L; Belcher, D; Hulstyn, M J

    2005-12-01

    Stress fractures do not often occur in the shaft of the femur. They are more common in the femoral neck, the tibial shaft, the metatarsals, and other bones of the foot. In female athletes, stress fractures classically afflict the distance runner, the ballerina, the gymnast, and the figure skater. To describe the clinical presentation, diagnosis, treatment, and outcome of seven college female lacrosse players with femoral shaft stress fractures, and review the literature. The unusual results of this study support the principle that clinical suspicion should be high when treating any female athlete regardless of the sport. In this case series, an abrupt change in the quality of the running surface during the competitive training season was the only underlying common thread among the athletes. The findings suggest that risk factors for the female athlete are variable and are no longer limited to the undernourished or overtrained.

  11. A STUDY ON SURGICAL MANAGEMENT OF INTERTROCHANTERIC AND SUBTROCHANTERIC FRACTURES OF FEMUR BY PROXIMAL FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Kuppa Srinivas

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES: To study the various fracture patte rns, mechanism of injury, operative difficulties encountered, result in terms of radiological union and ultimate functional outcome of intertrochanteric and subtrochanteric fractures of femur treated by proximal femoral nail. RESULTS: In the present study , 22 cases of subtrochanteric and intertrochanteric fractures of proximal femur treated by proximal femoral nail at Govt. General Hospital, Kurnool from August 2010 to July 2012 were included. Out of 22 cases, 18 were subtrochanteric and 4 were intertrochanteric fractures. In subtrochanteric fractures, seinsheimer type III were 44.4%,in intertrochanteric fractures evan’s unstable fractures were 75%. The mean age group was 45years with males 82%, right side femur were involved in 55%, road traffic accidents accounted for 55%, associated injuries found in 36%. Mean duration of hospital stay was 16.83 days, union was achieved in 86.6% with mean time for union was 12.75 weeks. Hip joint stiffness was found 23% and non - union in 4%. CONCLUSI ON: By the analysis of data collected in the present study, proximal femoral nail is an effective device in the management of complex proximal femoral fractures. It offers superior stabilization and good fracture union

  12. Changes in the Serum Level of Vitamin D During Healing of Tibial and Femoral Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Ettehad

    2014-01-01

    Full Text Available Background: Several systemic factors and hormones are thought to regulate the fracture healing process. Vitamin D has emerged as a compound or hormone that actively participates in the regulation of calcium homeostasis and bone metabolism. Objectives: The aim of this study is to determine the serum changes in the level of vitamin D during the acute healing period of tibial and femoral shaft fractures. Patients and Methods: This cross-sectional study included of 73 patients with tibial and femoral shaft fractures referred to the Poursina Hospital between February 2011 and February 2012. Changes in the serum levels of vitamin D were assessed three times in a period of three weeks (at the first visit, end of first week, and end of the third week. Variables such as age, gender, fractured bone, concomitant fracture of tibia and fibula, type of fracture, time of measurement and serum levels of 25-hydroxyvitamin D were assessed. All statistical analyses were performed using the SPSS software. Results: Forty tibial fractures and 33 femoral fractures were recorded. Mean vitamin D levels at the time of admission, after one week and at the end of the third week for the 73 participants included in the study were 39.23, 31.49, and 28.57 ng/mL, respectively. The overall reduction of vitamin D level was significantly more evident in the first week versus the following (P < 0.0001. Conclusions: Serum levels of vitamin D in patients with tibial or femoral fractures were reduced during the curative period of the fracture. This can be related the role of vitamin D in the formation and mineralization of the callus. Patients with tibial or femoral shaft fractures may benefit from the administration of vitamin D supplements during the fracture healing process.

  13. 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.

  14. The scapular neck fracture : biomechanical, clinical and surgical aspects

    NARCIS (Netherlands)

    Noort, Arthur van

    2005-01-01

    After a short introduction to the topics of this thesis, in chapter 2 we described the functional and radiological results of a retrospective study in patients with an ipsilateral scapular neck and clavicular shaft fracture (floating shoulder). Forty-six patients were treated between 1991 and 1996.

  15. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture

    Science.gov (United States)

    Ozaki, Yu; Ochi, Hironori; Watari, Taiji; Matsumoto, Mikio; Kaneko, Kazuo

    2016-01-01

    Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture. PMID:27818818

  16. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture

    Directory of Open Access Journals (Sweden)

    Yu Ozaki

    2016-01-01

    Full Text Available Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture.

  17. Development of a fixation device for robot assisted fracture reduction of femoral shaft fractures: a biomechanical study.

    Science.gov (United States)

    Weber-Spickschen, T S; Oszwald, M; Westphal, R; Krettek, C; Wahl, F; Gosling, T

    2010-01-01

    Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40 degrees and a 90 degrees version). We measured relative movements between the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90 degrees showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90 degrees complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.

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

    DEFF Research Database (Denmark)

    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...

  19. Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates.

    Science.gov (United States)

    Nieves, Jeri W; Cosman, Felicia

    2010-03-01

    Several case series and multiple individual case reports suggest that some subtrochanteric and femoral shaft fractures might occur in patients who have been treated with long-term bisphosphonates. Several unique clinical and radiographic features are emerging: prodromal thigh pain prior to the fracture, complete absence of trauma precipitating the fracture, and bilateral fractures in some patients. Radiographic features include presence of stress reaction, transverse or short oblique fractures, and thick femoral cortices. The overall incidence of subtrochanteric and shaft fractures combined is below 30 per 100,000 person-years, so this type of fracture is much less common than proximal femur (hip) fracture. Furthermore, the unique "atypical" fracture type is a subset of all subtrochanteric and femoral shaft fractures. The putative mechanism is unknown, and more research is needed to identify distinctive characteristics and the pathophysiology of these atypical fractures. There is no rationale to withhold bisphosphonate therapy from patients with osteoporosis, although continued use of bisphosphonate therapy beyond a treatment period of 3 to 5 years should be re-evaluated annually.

  20. Location of fractures and the characteristics of patients with atypical femoral fractures: analyses of 38 Japanese cases.

    Science.gov (United States)

    Hyodo, Kojiro; Nishino, Tomofumi; Kamada, Hiroshi; Nozawa, Daisuke; Mishima, Hajime; Yamazaki, Masashi

    2017-03-01

    The purpose of this study was to determine fracture location and the characteristics of patients with atypical femoral fractures (AFFs). We studied 38 AFFs in 34 patients admitted to our institution between November 2007 and July 2013. The diagnostic criteria for the AFFs were based on 2014 American Society of Bone and Mineral Research guidelines. We classified the fracture location as proximal, middle, or distal to trisect the femoral diaphysis from just distal to the lesser trochanter to just proximal to the supracondylar flare. Bowing was defined as a line through the inside of the tip of the great trochanter and a condylar center that was outside the medullary cavity. We investigated the fracture's location, existence of coronal bowing, and bisphosphonates (BPs), glucocorticoids (GCs), and proton pump inhibitors therapy. We analyzed associations between fracture location and demographic and clinical factors. Twelve fractures were proximal, 25 were middle, and one was distal. Nineteen limbs showed femoral bowing. Thirty-one patients received BP treatment-20 patients received alendronic acid, eight risedronic acid, and three minodronic acid. Fourteen patients received a GC, and 16 received a proton pump inhibitor. There was a significant association between coronal bowing and middle fracture locations, GC therapy and proximal fracture locations, and older age and middle fracture locations. Tall height and heavy weight had an association with proximal fracture location, and short height and light weight had an association with middle fracture location. In conclusion, we provide evidence supporting a causal relationship between BP-related severely suppressed bone turnover and AFFs. We also provide evidence supporting additional influences from altered distribution of mechanical stress with femoral bowing and various factors, such as GC therapy, age, body weight, and height, which might negatively affect bone intensity and quality and result in fracture.