scholarly journals More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

2021 ◽  
Author(s):  
Jorn Kalsbeek ◽  
Ariaan van Walsum ◽  
Herbert Roerdink ◽  
Inger Schipper
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Treatment Failure ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Non Union ◽  
Initial Radiograph ◽  
Neck Fracture ◽  
Posterior Tilt ◽  
Risk Of Treatment

Abstract Purpose In this study, we aimed to determine the correlation between the preoperative posterior tilt of the femoral head and treatment failure in patients with a Garden type I and II femoral neck fracture (FNF) treated with the dynamic locking blade plate (DLBP). Methods Preoperative posterior tilt was measured in a prospective documented cohort of 193 patients with a Garden type I and II FNF treated with the DLBP. The correlation between preoperative posterior tilt and failure, defined as revision surgery because of avascular necrosis, non-union, or cut-out, was analyzed. Results Patients with failed fracture treatment (5.5%) had a higher degree of posterior tilt on the initial radiograph than the patients with uneventful healed fractures: 21.4° and 13.8°, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20° and 12.5% if the preoperative posterior tilt was ≥ 20°. A posterior tilt of ≥ 20° was associated with an odds ratio of 4.24 (95% CI 1.09–16.83; p = 0.04). Conclusion Garden type I and II FNFs with a significant preoperative posterior tilt (≥ 20°) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt ≥ 20° of the femoral head should be considered as a significant predictor for failure of treatment in Garden type I and II FNFs treated with the DLBP.

scholarly journals Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

2016 ◽  
Vol 98 (6) ◽  
pp. 376-379 ◽  
Author(s):  
O Riaz ◽  
R Arshad ◽  
S Nisar ◽  
R Vanker
Keyword(s):  
Femoral Neck ◽  
Serum Albumin ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Fixation Failure ◽  
Non Union ◽  
Preoperative Serum ◽  
Neck Fracture ◽  
Posterior Tilt ◽  
Intracapsular Femoral Neck Fracture

Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%–19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60–101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

scholarly journals Impact of Cigarette Smoking on Re-operation and Revision Surgery after Femoral Neck Fracture Treatment

2020 ◽  
Vol 13 ◽  
pp. 195-201
Author(s):  
Mitchell Messner ◽  
Alexander Chong ◽  
Bruce Piatt
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Non Union ◽  
Initial Fixation ◽  
Neck Fracture ◽  
Group 3 ◽  
Former Smokers ◽  
Group 2 ◽  
Group 1

Introduction. Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Methods. Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. Results. A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Conclusion. Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.

Early Roentgenological Grading of Femoral Shortening is Correlated to the Late Outcome after Femoral Neck Fractures

1995 ◽  
Vol 36 (3) ◽  
pp. 233-236 ◽  
Author(s):  
L. Hernefalk ◽  
P. Granström ◽  
K. Messner
Keyword(s):  
Femoral Neck ◽  
Fold Increase ◽  
Late Complications ◽  
Femoral Neck Fractures ◽  
Intercondylar Notch ◽  
Late Outcome ◽  
Non Union ◽  
Prognostic Accuracy ◽  
Femoral Shortening ◽  
Neck Fracture

Using orthoradiography, the distance between the centre of the femoral head and the intercondylar notch was assessed at regular intervals in 144 patients who were followed for a 2-year period after osteosynthesis of a femoral neck fracture. Late complications, such as segmental collapse and non-union, occurred in 27% of the patients. The degree of femoral shortening was significantly correlated to the incidence of late complications. At 1 month, femoral shortening of more than 5 mm was observed in 85% of patients who developed late complications, and in only 5% of patients without such complications. Thus, the observation of a shortening of more than 5 mm predicted a greater than 6-fold increase of the incidence of late complications. The prognostic accuracy of this observation 1 month after treatment was 92%.

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

2004 ◽  
Vol 35 (3) ◽  
pp. 335-343 ◽  
Author(s):  
Alexandros E Beris ◽  
Alexander H Payatakes ◽  
Vassilios K Kostopoulos ◽  
Anastasios V Korompilias ◽  
Alexandros N Mavrodontidis ◽  
...  
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Valgus Osteotomy ◽  
Non Union ◽  
Fibular Grafting ◽  
Free Vascularized Fibular Grafting

scholarly journals Four-Year Prospective Evaluation of Femoral Neck Fractures: Types and Complications

2020 ◽  
Vol 7 (3) ◽  
pp. 129-134
Author(s):  
Ali Yeganeh ◽  
◽  
Mehdi Moghtadaei ◽  
Amir Sobhani ◽  
Mehdi Abbasi ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Avascular Necrosis ◽  
Cross Sectional Study ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Cross Sectional ◽  
Non Union ◽  
Type Iv ◽  
The Mean ◽  
Type Of Fracture

Background: Despite the advances in the methods of treating femoral neck fractures, treating some types of these fractures is still challenging. Therefore, understanding these fractures, their treatments, and the ways to control their complications are necessary for the orthopedists.  Objectives: In this study, we evaluate patients with acute femoral neck fractures with respect to the type of fractures and complications. Methods: In a 4-year cross-sectional study, the patients with acute femoral neck fractures who were admitted to Rasoul Akram Hospital were selected. Anatomical features and the type of fracture were determined by using plain radiography and CT scan. Fractures were classified according to the Garden classification. The patients were also evaluated for any postoperative complications for at least 6 months. Results: A total of 124 patients were enrolled. The Mean±SD age of the patients was 64.9±12.7 years and 87 (74.4%) were male. Based on the Garden classification, 7 fractures (5.9%) belonged to type I, 10 fractures (8.5%) to type II, 48 fractures (41%) to type III, and 52 fractures (44.4%) to type IV. Avascular necrosis in 28 cases (23.9%), non-union in 14 cases (12%), and claudication and pain in 35 cases (29.9%) were noted. The mean age of patients was different between fracture groups (P=0.01).  Conclusion: Our results showed that most of the patients with femoral neck fractures admitted to Rasoul Akram Hospital were associated with displacement. In this study, the most common complications were pain and claudication, avascular necrosis of the femoral head, and nonunion. In sum, further displacement of the fracture will result in more complications.

scholarly journals Comparison of Early Clinical Results of Femoral Neck System and Cannulated Screws in the Treatment of Unstable Femoral Neck Fractures

2020 ◽  
Author(s):  
Xiaoqiang Zhou ◽  
Zhiqiang Li ◽  
Renjie Xu ◽  
Yuanshi She ◽  
Xiangxin Zhang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Blood Loss ◽  
Femoral Neck Fracture ◽  
Complication Rate ◽  
Operation Time ◽  
Femoral Neck Fractures ◽  
Cannulated Screws ◽  
Intraoperative Blood Loss ◽  
Neck Fracture

Abstract Objective: To compare the early clinical effects of femoral neck system and three cannulated screws in the treatment of patients with unstable femoral neck fractures.Methods: A retrospective analysis was conducted on 81 patients who received FNS or cannulated screws internal fixation for Pauwels Type-3 femoral neck fracture in our hospital from January 2019 to December 2019. A pair-matched clinical research was performed. People who received FNS were test group and people received cannulated screws were control group. Matching requirements were as follows： the same gender, the similar age and the similar BMI. A total of 30 pairs were successfully matched, with an average age of 53.84 years old. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative VAS score, time walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the two groups.Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all the patients were followed up for 10-22 months. Patients in the FNS group had lower postoperative VAS scores, earlier time to walk without crutches, higher Harris scores at the last follow-up and lower complication rate (P<0.05). However, intraoperative blood loss and hospitalization costs in the FNS group were more（P<0.05）. There was no statistically significant difference in operation time, hospital stay and femoral head necrosis rate between two group (P>0.05).Conclusion: For patients who were unstable femoral neck fracture, FNS has better clinical efficacy than cannulated screws, though FNS is more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fracture.Fund program: Key medical research project of Jiangsu Health Committee（K2019010）

scholarly journals Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jichao Liu ◽  
Zhengwei Li ◽  
Jie Ding ◽  
Bingzhe Huang ◽  
Chengdong Piao
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Classification System ◽  
Femoral Neck Fractures ◽  
Injury Mechanism ◽  
Anterior Dislocation ◽  
Rare Type ◽  
Neck Fracture ◽  
Comprehensive Search

Abstract Background Femoral neck fracture combined with anterior dislocation of the femoral head is very rare. To our knowledge, there is no classification system yet for this rare form of injury, and the injury mechanism of femoral neck fracture combined with obturator head dislocation has not been described in the literature. In this study, we systematically reviewed the literature and the cases treated in our hospital, and identified and classified all injury types according to the injury mechanism of femoral neck fracture combined with anterior dislocation of the femoral head. Further, based on the experience of treating a patient with femoral neck fracture and obturator dislocation of the femoral head, a theoretical hypothesis was proposed for the injury mechanism of this rare type of injury. Methods A comprehensive search was conducted on PubMed, WOS, CNKI database. These fractures were classified according to the dislocation site and injury mechanism (one injury or two injuries). Results 1891 articles were initially identified through PubMed and other databases, and after bibliographic research, study screening, and removing duplicates, 1455 articles were selected. After applying the exclusion criteria, a total of 18 full-text articles describing femoral neck fractures combined with anterior dislocation of the femoral head. Different dislocation sites have different injury mechanisms. Our classification system, to the best of the authors’ knowledge, allowed us to include all types of femoral neck fractures combined with anterior dislocation of the femoral head from the literature. According to the proposed classification system, the morphological features of femoral neck fracture combined with anterior dislocation of the femoral head can be accurately conveyed between doctors. Conclusions All injury patterns can likely be identified using the proposed classification system. This can help avoid confusion in the nomenclature of femoral neck fractures combined with anterior dislocation of the femoral head and help surgeons to more accurately detect lesions, thereby guiding surgical treatment.

scholarly journals Single Stage Hemiarthroplasty Bipolar Surgical Procedure in 1 year Neglected Femoral Neck Fracture with 4cm Limb Shortening: A Case Report

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0005
Author(s):  
I Wayan Suryanto Dusak ◽  
I Dewa Gede Bracika Damma Prasada
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Difficult Problem ◽  
Long Term Results ◽  
Soft Tissue Release ◽  
Leg Length ◽  
Non Union ◽  
Satisfactory Outcome ◽  
Neck Fracture

The neglected femoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. In developing countries many of these fractures present late, often as a result of delayed referral or because of initial management by traditional bone-setters. Case Presentation: A 25- year-old female came to the outpatient clinic with chief complain pain on her right groin after a motorcycle accident 1 year ago. On physical examination a 4 cm leg length discrepancy was measured, and the patient walked with limping gait. Conventional x-ray confirmed displaced fracture of neck femur. Patient is treated with hemiarthroplasty bipolar without soft tissue release. Discussion: Neglected femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Fracture displacement disrupts the terminal branches to the femoral head and leads to development of osteonecrosis. The goal of treatment in neglected femoral neck fracture is to achieve a painless, mobile and stable hip. In neglected femoral neck fracture more than 6 months, hence prosthetic replacement (hemi or total) is generally preferred. Hemiarthroplasty can be performed when the acetabulum is normal. Conclusion: Hemiarthroplasty bipolar give satisfactory outcome for neglected femoral neck fracture and provides a predictable, reproducible functional recovery although long-term results are yet to be seen

Low Field Magnetic Resonance Imaging of Femoral Neck Fractures

1989 ◽  
Vol 30 (3) ◽  
pp. 247-252 ◽  
Author(s):  
J. I. Ragnarsson ◽  
L. Ekelund ◽  
J. Kärrholm ◽  
S.-O. Hietala
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Femoral Head ◽  
Femoral Neck ◽  
Resonance Imaging ◽  
Non Union ◽  
Low Field ◽  
Time Period ◽  
Titanium Screws ◽  
Neck Fracture

Fourteen patients with cervical hip fractures were treated with internal fixation using titanium screws. The femoral head vitality was evaluated with 99Tcm-MDP scintigraphy and scintimetry within 2 weeks postoperatively and by serial low field magnetic resonance imaging (MR). Two patients with reduced radionuclide uptake (femoral head ratio <1.0) developed radiographic signs of femoral head necrosis. MR disclosed the definite area of the necrosis at 2 and 12 months after fracture, respectively. In three of the patients with a high scintimetric uptake (femoral head ratio ≥1.0), MR revealed a focal decrease of the signal intensity in the femoral head or neck at 2, 3 and 7 months after fracture, respectively. The radiographs in one of these patients were normal at 7 months after fracture. The second one showed signs of necrosis at 16 months and the last one developed delayed/non-union. With a non-ferromagnetic osteosynthesis the healing course after femoral neck fracture can be studied with low field MR equipment without disturbing artifacts. The time period between ischaemia and definite abnormalities on MR may embrace several months.

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