Femoral Neck Shaft Angle and Management of Proximal Femur Fractures

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Miranda J. Rogers ◽  
Taylor L. King ◽  
Jaewhan Kim ◽  
Temitope F. Adeyemi ◽  
Thomas F. Higgins ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Neck Shaft Angle ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Shaft Angle

scholarly journals TO EVALUATE THE EFFICACY OF KICK STAND SCREW IN FIXATION OF SUBTROCHANTERIC FEMORAL FRACTURES USING CONTRALATERAL REVERSED DISTAL FEMORAL LOCKING PLATEPROSPECTIVE SINGLE CENTRIC STUDY

2020 ◽  
pp. 1-4
Author(s):  
Prashant Pandey ◽  
K K Pandey ◽  
Ajay Dhanopeeya ◽  
Surya Prakash Garg
Keyword(s):  
Proximal Femur ◽  
Locking Plate ◽  
Harris Hip Score ◽  
Plate Bending ◽  
Neck Shaft Angle ◽  
Subtrochanteric Fractures ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Shaft Angle

PURPOSE- All type of plates when used for proximal femur fractures always has chances of mechanical failure due to lack of strength of the construct, but addition of ‘kick stand screw’ has some effects on stability of the construct. Aim of our study is to evaluate the efficacy of kick stand screw in fixation of subtrochanteric fractures using contralateral reversed distal femoral locking plate. METHOD- 30 patients of subtrochanteric fractures fixed using contralateral reversed distal femoral locking plate. N(1st)=15 fixed without kick stand screw and other N(2nd)=15 fixed using kick stand screw. Calcar screw( Kick Stand Screw) is placed to support calcar region (inferior to the center in AP view and central in Lateral view). In other group screws are placed as oriented in screw holes. Outcome was assessed using Harris Hip Score and VAS score and change in the neck shaft angle is also followed. RESULT- Union rate was 80% in 1st group as compare to 94% in second group. Mean Harris hip score at the one year follow up was 71.2 in 1st group as compare to 89.2 in 2nd group. Mean Visual analogue scale was 3.2 in first group as compare to 1.6 in second group at final follow up. Mean neck shaft angle at final follow-up was 120 degree in first group as compared to135 degree in second group. Complication- 1st Group of patients had three failures 2 in the form of screw break down and one in the form of plate bending, all three lend up in to varus deformity but the 2nd group had only one failure in the form of plate bending. CONCLUSION-In our study cases in which kick stand screw was used they showed better mechanical strength and gave better clinical results. So in proximal femur fractures including subtrochanteric fracture fixation ‘kick stand screw’ must be used.

The Influence of Acetabular Morphology on Prediction of Proximal Femur Fractures Types in an Elderly Population

2017 ◽  
Vol 27 (5) ◽  
pp. 489-493 ◽  
Author(s):  
Abbas Tokyay ◽  
Melih Güven ◽  
Mehmet E. Encan ◽  
Erhan Okay ◽  
Ozgur Akbaba
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Acetabular Index ◽  
Hip Axis Length ◽  
Neck Shaft Angle ◽  
Femur Fractures ◽  
Acetabular Morphology ◽  
Neck Fracture ◽  
Axis Length ◽  
Fracture Types

Introduction The role of proximal femur morphology to the development of certain proximal femur fracture types both femoral neck and trochanteric fractures has been observed. However, the relavance of acetabular morphology to the development of proximal femur fractures is not extensively questioned. Therefore the aim of the study was to determine whether there is a correlation between acetabular morphology and pathogenesis of 2 different hip fracture types after low energy trauma. Methods This retrospective study includes 60 cases (41 women, 19 men) with a proximal femoral fracture after a low energy trauma between July 2012 and December 2014. Acetabular depth and acetabular index were measured on pelvic radiographs. Neck shaft angle, hip axis length and cortical index were measured on pelvic computed tomography scans. All measurements were performed on the contralateral hip. Results Mean age was 77.56 ± 8.99 years (range 61-92 years). No statistically significant difference was found with regard to neck shaft angle, acetabular depth or cortical index measurements between patients with femoral neck fracture and patients with trochanteric femoral fractures (p>0.05). Acetabular index measurement was higher (p = 0.001) and hip axis length measurement was lower (p = 0.001) in trochanteric fracture group as compared to femoral neck fracture. Conclusions The rate of trochanteric femur fractures is higher in patients with high acetabular index, whereas the rate of femoral neck fractures is higher in patients with increased hip axis length.

scholarly journals Treatment of Proximal Femur Fractures on the Background of Osteoporosis

2004 ◽  
Vol 11 (1) ◽  
pp. 27-31 ◽  
Author(s):  
A F Lazarev ◽  
E I Solod ◽  
A O Ragozin ◽  
M G Kakabadze ◽  
A F Lazarev ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Femoral Neck Fractures ◽  
Mineral Density ◽  
Stable Fixation ◽  
Fracture Characteristics ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Choice Of Treatment ◽  
Density Evaluation

Analysis of treatment of 526 patients with proximal femur fractures (362 patients with femoral neck fractures and 164 patients with trochanteric zone fractures) was performed. Patients' age ranged from 34 to 92 (mean 67). Algorithm of differentiated choice of operative tactics depending on fracture characteristics and injury term was presented. Low invasive osteosynthesis of femoral neck with bundle of stressed V-shaped pins was suggested. Theoretical and practical ground of that technique was given. Stress within fixative-bone system created after osteosynthesis by V-shaped pins, provided stable fixation even in marked osteoporosis. The importance of bone mineral density evaluation for the choice of treatment tactics as well as the necessity of medicamental correction of the disturbed bone remodeling after surgical treatment was noted.

scholarly journals Three-dimensional morphological study of the proximal femur in Crowe type IV developmental dysplasia of the hip

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yuhui Yang ◽  
Weihong Liao ◽  
Weiqun Yi ◽  
Hai Jiang ◽  
Guangtao Fu ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Three Dimensional ◽  
Developmental Dysplasia ◽  
Medullary Canal ◽  
Femoral Offset ◽  
Neck Shaft Angle ◽  
Type Iv ◽  
Shaft Angle ◽  
Dysplasia Of The Hip

Abstract Background When performing femoral reconstruction in patients with Crowe type IV developmental dysplasia of the hip (DDH), anatomical deformity presents many technical challenges to orthopedic surgeons. The false acetabulum is suggested to influence load transmission and femoral development. The aim of this study was to describe the morphological features of dysplastic femurs in Crowe type IV DDH and further evaluate the potential effect of the false acetabulum on morphological features and medullary canal of Crowe type IV femurs. Methods We analyzed preoperative computed tomography scans from 45 patients with 51 hips (25 hips without false acetabulum in the IVa group and 26 hips with false acetabulum in the IVb group) who were diagnosed with Crowe type IV DDH and 30 normal hips in our hospital between January 2009 and January 2019. Three-dimensional reconstruction was performed using Mimics software, and the coronal femoral plane was determined to evaluate the following parameters: dislocation height, dislocation ratio, height of the femoral head (FH), height of the greater trochanter (GT), GT–FH height discrepancy, height of the isthmus, neck-shaft angle, femoral offset and anteversion of the femoral neck. The mediolateral (ML) width, anterolateral (AP) width and diameter of medullary canal of the proximal femur were measured on the axial sections. Further, canal flare index (CFI), metaphyseal-CFI and diaphyseal-CFI were also calculated. Results Compared with the normal femurs, the Crowe type IV DDH femurs had a higher femoral head, larger GT–FH height discrepancy, larger femoral neck anteversion, higher isthmus position and smaller femoral offset. Dislocation height and dislocation rate were significantly larger in the IVa DDH group (65.34 ± 9.83 mm vs. 52.24 ± 11.42 mm). Further, the IVb femurs had a significantly lower isthmus position, larger neck-shaft angle and smaller femoral neck anteversion than IVa femurs. The ML, AP canal widths and the diameter of medullary canal in both DDH groups were significantly smaller than the normal group. Dimensional parameters of IVa femurs were also narrower than IVb femurs in most sections, but with no difference at the level of isthmus. According to the CFIs, the variation of proximal medullary canal in IVb femurs was mainly located in the diaphyseal region, while that in IVa femurs was located in the whole proximal femur. Conclusions High dislocated femurs are associated with more anteverted femoral neck, smaller femoral offset and narrower medullary canal. Without stimulation of the false acetabulum, IVa DDH femurs were associated with higher dislocation and notably narrower medullary canal, whose variation of medullary canal was located in the whole proximal femur.

scholarly journals Outcomes of the proximal femur fractures repaired with half-pin devices as compared with various types of osteosynthesis

2021 ◽  
Vol 27 (2) ◽  
pp. 175-181
Author(s):  
F.B. Salokhiddinov ◽  
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Fixation Device ◽  
Group Iii ◽  
Proximal Femur Fractures ◽  
Bone Fixation ◽  
Femur Fractures ◽  
Group I ◽  
Pin Fixation ◽  
Poor Outcomes

Objective To review outcomes of the proximal femur fractures repaired with half-pin apparatus in comparison with various types of osteosynthesis. Material and methods The study enrolled 86 patients with proximal femur fractures treated at the general hospital of the Tashkent Medical Academy. Of these, 52 were females and 34 were males. The mean age of the participants was 54.1 ± 1.1 years (range, 22 to 92 years). The effectiveness of the treatment was evaluated depending on the treatment method used. The patients were divided into 3 groups: group I included 39 patients who underwent closed percutaneous osteosynthesis with Ilizarov wires; group II consisted of 29 patients who underwent osteosynthesis with bone plates; group III included 18 patients who underwent surgical treatment using the external half-pin fixator we developed. Results Outcomes were evaluated in 58 patients at one to two years. In group I, good results were rated as good obtained in 45.8% (n = 11), as fair in 33.3% (n = 8) and poor in 20.9 % (n = 5) of patients due to nonunited fracture, avascular necrosis of the femoral head and hip joint ankylosis. Group II showed 68.4 % (n = 12) good, 4 (21 % (n = 4) fair and 10.5 % (n = 2) poor results. The latter occurred due to patient noncompliance and unauthorized early removal of the plaster cast. Group III demonstrated 73.4 % (n = 11) good, 13.3% (n = 2) fair and 13.3 % (n = 2) poor outcomes. Patients with poor outcomes developed lesion of the femoral neck following a subcapital femoral neck fracture at 2 months of frame removal that healed with a 2.0 cm limb length discrepancy. Conclusion The external half-pin fixator offered could facilitate stable bone fixation after reduction and gradual dynamic compression for successful bone healing. The bone fixation period with external half-pin fixation device was dependent on the fracture type and averaged to 4 ± 1 months in type A fracture and 5 ± 1 months in type B fractures. Fixation of the proximal femur fractures with half-pin fixation device allows stabilization of the general state of patients, easier postoperative care, prevention of secondary complications and early exercises for the adjacent joints. The technique offered can be a method of choice among the current technologies.

A-mode Ultrasound Analysis of Postoperative Thigh Edema in Patients with Hip Fracture

2017 ◽  
Vol 54 (3) ◽  
pp. 553-556 ◽  
Author(s):  
Horia Haragus ◽  
Radu Prejbeanu ◽  
Bogdan Timar ◽  
Dinu Vermesan
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Body Mass ◽  
Proximal Femur ◽  
Muscle Layer ◽  
Superficial Layer ◽  
Thigh Circumference ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Significant Difference

Postoperative edema and lean body mass may contribute to functional outcome in frailty hip fracture patients. Advances in body mass determination have produced consistent results with A-mode ultrasound. We therefore aimed to determine the utility of A-mode ultrasound in analyzing postoperative limb edema in patients receiving treatment for proximal femur fractures. 4 males and 6 females, with an average age of 74.3 years were included. 4 had fractures of the femoral neck treated by hemiarthroplasty and the rest had extracapsular fractures which were stabilized with short intramedullary nails. Measurements were done using a commercially available A-mode 2.5MHz transducer on the thighs approximately 15 cm proximal to the patella. Comparison showed significant difference between the operated and contralateral thigh circumference (P=0.001) as well as muscle layer thickness differences between femoral neck patients and those with fractures of the trochanteric region (P=0.016). There was no correlation between the A-mode ultrasound determined superficial layer difference and entire layer difference (R2=0.037; P=0.59). However, there was linear correlation between the A-mode ultrasound determined entire layer difference and limb circumference difference, (R2=0.414; P=0.044). Postoperative thigh edema is present in all surgically treated patients for proximal femur fractures. A-mode ultrasound might be a reliable tool to examine adipose and muscle layers separately in the immediate postoperative period. There may be a difference in edema distribution between femoral neck and peritrochanteric fractures but larger samples are required.

scholarly journals The PFNA® Augmented in Revision Surgery of Proximal Femur Fractures

2014 ◽  
Vol 8 (1) ◽  
pp. 232-236 ◽  
Author(s):  
Alexander Scola ◽  
Florian Gebhard ◽  
Christoph Dehner ◽  
Götz Röderer
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Revision Surgery ◽  
Cement Leakage ◽  
Clinical Results ◽  
Proximal Femur Fracture ◽  
Bone Stock ◽  
Proximal Femur Fractures ◽  
Femur Fractures

Objectives: Modern implants for proximal femur fracture treatment have clearly improved clinical results. However, complications, including cut-out and loss of reduction, requiring revision surgery still occur. A major challenge in these cases is a loss of bone stock due to the existing implant, which is usually exacerbated by osteoporosis. A potential solution is the augmentation of implants, for example, of the femoral neck blade using bone cement. Materials and Methods: Ten patients (five loosening of femoral neck implant, two pseudarthrosis, two implant failures and one acute fracture) were included. The initial hardware was removed and a PFNA augmented was implanted. The perforated femoral neck blade was augmented using polymethyl methacrylate cement. Clinical and radiological follow-up was performed at a mean of 5.4 months (SD ±4.34). The main outcome parameters were fracture healing and implant-related complications. Results: Technical handling was uneventful in all cases. No cement leakage into the joint occurred in any of the cases. The mean amount of cement injected was 5.3 ml. The fracture healed during follow-up in all cases except two patients who died from causes unrelated to the procedure and prior to complete consolidation. Problem-free elective hardware removal of the PFNA augmented was performed in two cases. Discussion: The PFNA augmented is a potential implant for joint-preserving revision surgery in proximal femur fractures. The augmentation improves implant anchorage in the impaired bone stock. In this preliminary series, no negative biological side effects of the cement (i.e. osteonecrosis) were observed.

scholarly journals Morphometric Study of Proximal end of Femur of Nepalese People

2019 ◽  
Vol 4 (1) ◽  
pp. 9-14
Author(s):  
Rajeev Mukhia ◽  
Phanindra Prasad Poudel ◽  
Chacchu Bhattarai ◽  
Sidharth Timsina
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
The Body ◽  
Morphometric Study ◽  
Neck Length ◽  
Left Femur ◽  
Head Diameter ◽  
Neck Shaft Angle ◽  
Femur Neck ◽  
Shaft Angle

Introduction: The femur is the largest and strongest bone of the body that forms the skeleton of the thigh. The morphometry of proximal end of femur are variable between different individuals with different Nationality. The aims and objective of the study is to find out the morphometric measurements- Femur Length, Femur head diameter, Femur neck shaft angle, and Femur neck length, breadth and thickness. Methods: A total of 75 femurs of both sex were collected from the Department of Anatomy, MCOMS, Pokhara. The parameters on proximal femur were measured manually with the help of measuring scale, thread, protector and vernier calliper. The collected data were analyzed with Microsoft Excel 2007 software and represented graphically. Results: In the present study, the average femoral length for entire femur was 42±2.81 cm, femoral head diameter was13.05±0.9 cm, femoral neck length was 4.12±0.32 cm, femoral neck breadth was 2.94±0.30 cm, and femoral neck thickness was 2.36±0.42 cm. The femur neck shaft angle of left femur was significantly higher than that of right femur (P-value 0.03). There was no difference between other dimensions of proximal end of right and left femur. Conclusion: The results of the present study show that the dimensions of proximal femur in Nepalese Population are different as compared to other countries population. The knowledge of different dimensions of proximal femur will be important in anthropological and medico-legal practice for sex determination and as well as to radiologists and orthopaedic surgeons for diagnosis and planning of treatment.

scholarly journals Остеосинтез у разі переломів шийки та вертлюгової зони стегнової кістки в дітей

2021 ◽  
pp. 10-16
Author(s):  
Olexii Popsuishapka ◽  
Serhii Dovhan ◽  
Oleksandr Khomyak
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Weight Bearing ◽  
Bone Destruction ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Fractures In Children ◽  
Fracture Consolidation ◽  
Tissue Reactions ◽  
Partial Weight

Proximal femur fractures are uncommon injuries in children, accounting for less than 1 % of all fractures per year, but usually result in hospitalization and are at risk of complications. We have designed a device for bone fragments fixation in the case of proximal femur fractures and the method of its application in adults. The device consists of rods that are screwed into the cap of the head, the diaphyseal part and the module, which is located in the subtrochanter area. The rods can be connected to the module at any angle in the frontal plane.  The device provides a certain stage of installation of the elements, which allows you to effectively place it with minimal bone destruction. Objective. Share your own experience in the treatment of femoral neck and proximal femur fractures in children. Material. The experience of treatment of 28 children with femoral neck fracture or proximal femur fractures for the period 2005–2020 is presented, 11 of them were treated conservatively with the skeletal traction. Osteosynthesis by the author’s device was performed in 17 patients: 15 closed reduction, 2 in case of intertrochanteric fracture, — open reduction. The method of osteosynthesis and postoperative management of patients is described in detail. Results. In children who were treated conservatively, the fracture consolidation was achieved within 5–7 months, in one of them — in the position of varus deformity. In contrast to conservative treatment, children began to walk with crutches after a few days after surgery, with partial weight-bearing on injured limb. The device was removed in 16 patients after 5–8 months, and complete fracture consolidation of the fragments in their anatomical position was noted. There were no pathological tissue reactions to the metal device. Conclusions. The proposed device and method of closed osteosynthesis with its usage in the case of proximal femur and femoral neck fractures in children can be recommended in the practice of pediatric traumatology.

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