Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors

A csípőtáji törésekhez idős korban magas halálozás társul. A szakirodalomban kevés a nagy beteganyagot feldolgozó, országos kiterjedésű ellátórendszer adatain alapuló feldolgozás. Célkitűzés: A tanulmány célja a 60 év feletti akut, monotraumás combnyaktöröttek primer ellátását követő halálozások vizsgálata havonta és évente ötéves utánkövetéssel, valamint a különböző rizikófaktoraik halálozásra gyakorolt hatásainak értékelése az egyes időperiódusokban. Módszer: Az adatok az Országos Egészségbiztosítási Pénztár adatbázisából származnak. Az értékelés bázisát a fekvőbeteg-ellátást végző intézményekből combnyaktörés primer műtéti ellátását követően 2000. évben emittált betegek képezik. Bemutatjuk az átlagos évenkénti, havonkénti és heti halálozási arányokat, valamint rizikótényezők szerinti alakulásukat havonként és évenként. A rizikótényezők és a halálozás kapcsolatának értékelése logisztikus és Cox-regressziós analízissel történik. Eredmények: A tanulmányban 3783 fő került elemzésre. Átlagéletkoruk 77,97 (SD 8,52) év. A halálozás az első héten 1,71%, 30 napon belül 8,99%, az első évben 30,74%, öt év alatt 61,88% volt. A halálozás havi szinten az első 5 hónapig mutat csökkenést, éves szinten az első év után stagnál. A rizikófaktorok közül a férfinem és a magasabb életkor öt évig, a kísérőbetegségek hatásai a negyedik évig, a laterális combnyaktöréstípus és a 12 órán túli ellátás két évig, a korai lokális szövődmények egy évig, a hétvégi ellátások az első hónapban eredményeznek magasabb halálozási kockázatot. Az országos és egyetemi ellátásokat követően az első évben alacsonyabb a halálozási kockázat. Következtetések: A csípőtáji törések managementjében a halálozások csökkentése érdekében hangsúlyozzuk a 12 órán belüli ellátás, a törési típusnak megfelelő módszerválasztás, a hét minden napján történő azonos ellátási feltételek biztosítása, az ellátások centrumokba történő szervezése, a beteg általános állapotának és kísérőbetegségeinek megfelelő akut ellátás és az utókezelések fontosságát.

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A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-017-0528-9 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 27

Author(s):

Dan-Feng Xu ◽

Fang-Gang Bi ◽

Chi-Yuan Ma ◽

Zheng-Fa Wen ◽

Xun-Zi Cai

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Neck Fracture

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Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04647-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiaolei Ren ◽

Lin Ling ◽

Lin Qi ◽

Zhongyue Liu ◽

Wenchao Zhang ◽

...

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Joint Infection ◽

Female Gender ◽

Opioid Use ◽

Related Risk ◽

Modifiable Factors ◽

Neck Fracture

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. Methods Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. Results Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01–2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25–2.21)], AVN [1.65 (1.07–2.56)], femoral neck fracture [1.75 (1.39–2.20)], RA [1.37 (1.23–1.54)], CVD [1.34 (1.03–1.74)], chronic pulmonary disease (CPD) [1.22 (1.08–1.37)], neurological disease [1.19 (1.05–1.35)], opioid use [1.53 (1.35–1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13–1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45–0.93)], and OA [0.70 (0.62–0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. Conclusion Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.

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Life style risk factors for femoral neck fracture in Dr. Sardjito General Hospital, Yogyakarta

Journal of thee Medical Sciences (Berkala Ilmu Kedokteran) ◽

10.19106/jmedsci005001201812 ◽

2018 ◽

Vol 50 (2) ◽

Author(s):

Helmiza Fahry ◽

Sugeng Yuwana

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

General Hospital ◽

Life Style ◽

Neck Fracture

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Az ellenoldali csípőtáji törésig eltelt időt befolyásoló prognosztikai tényezők vizsgálata

Orvosi Hetilap ◽

10.1556/650.2018.31179 ◽

2018 ◽

Vol 159 (38) ◽

pp. 1543-1547

Author(s):

Krisztina Juhász ◽

Imre Boncz ◽

Péter Kanizsai ◽

Andor Sebestyén

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Fractures ◽

Age Groups ◽

Significant Difference ◽

Neck Fracture ◽

The Impact

Abstract: Introduction: Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. Aim: The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. Method: Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. Results: 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. Conclusions: The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543–1547.

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The clinical and radiographic characteristics of avascular necrosis after pediatric femoral neck fracture: a systematic review and retrospective study of 115 patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02037-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Pengfei Xin ◽

Yonggang Tu ◽

Zhinan Hong ◽

Fan Yang ◽

Fengxiang Pang ◽

...

Keyword(s):

Systematic Review ◽

Retrospective Study ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Rapid Progression ◽

Femoral Head Collapse ◽

Neck Fracture ◽

Strong Relation ◽

The Mean

Abstract Background Avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) showed poor prognosis, but its clinical and radiographic characteristics remained unclear. Methods A systematic review and a retrospective study were performed to evaluate the clinical and radiographic characteristics of patients with AVN after PFNF. Results A total of 686 patients with PFNF and 203 patients with AVN from 21 articles were analyzed. Ratliff’s classification was used in 178 patients, with types I, II, and III AVN accounting for 58.4%, 25.3%, and 16.3%, respectively. Ratliff’s assessment was used in 147 patients, of whom 88.4% had an unsatisfactory prognosis. In retrospective study, 115 patients with a mean age of 13.6 ± 2.0 years were included. The mean interval between AVN and PFNF was 13.7 ± 9.5 months. At the time of diagnosis, 59.1% cases were symptomatic and 65.2% progressed to collapsed stage. Fifty (43.5%), 61 (53.0%), and 4 patients (3.5%) were defined as types I, II, and III , respectively, via Ratliff’s classification. Thirteen (11.3%), 40 (34.8%), and 62 patients (53.9%) showed types A/B, C1, and C2 disease, respectively, via the JIC classification. Multivariate analysis demonstrated a strong relation between collapsed stage and symptomatic cases (OR = 6.25, 95% CI = 2.39–16.36) and JIC classification (OR = 3.41, 95% CI = 1.62–7.17). Conclusion AVN after PFNF showed a tendency toward extensive necrotic lesions, presumably resulting in a rapid progression of femoral head collapse. And the symptoms and the JIC classification are other two risk factors of collapse progression.

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