Intertrochanteric hip stress fracture in a male ultramarathon runner

2022 ◽  
Vol 15 (1) ◽  
pp. e239594
Author(s):  
Jeffrey P Nadwodny ◽  
George Pujalte ◽  
Tais Garcia de Oliveira Bertasi ◽  
Tamara Huff
Keyword(s):  
Femoral Neck ◽  
Stress Fracture ◽  
High Performance ◽  
Elderly Population ◽  
Young Male ◽  
The Elderly ◽  
High Energy ◽  
Stress Fractures ◽  
Intertrochanteric Fractures ◽  
Operative Fixation

Stress fractures are injuries frequently seen in high-performance athletes, especially runners. In the femur, the most commonly affected locations are the femoral neck, condylar area and proximal shaft. Intertrochanteric fractures are much more common in the elderly population, especially among those with osteoporosis, but they can also be a result of high-energy repetitive mechanisms. We present a case of an intertrochanteric stress fracture in a young male runner. The diagnosis was suspected after persistent pain following his first marathon, and it was confirmed with an MRI. Operative fixation of the fracture was performed 22 days after the pain started, which allowed the patient to return to his activities, including 50 km marathon 4 months following the surgery.

scholarly journals Bilateral stress fracture of the femoral neck in association with simultaneously developing osteonecrosis of the femoral head: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tomofumi Nishino ◽  
Hisashi Sugaya ◽  
Naoya Kikuchi ◽  
Yu Watanabe ◽  
Hajime Mishima ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Femoral Head ◽  
Femoral Neck ◽  
Stress Fracture ◽  
Overuse Injury ◽  
Early Stage ◽  
Stress Fractures ◽  
Resonance Imaging ◽  
Femoral Neck Stress Fracture

Abstract Background Femoral neck stress fractures are rare and often recognized as overuse injuries that occur in young athletes or military personnel. A case following osteonecrosis of the femoral head is quite rare; even more uncommon is its occurrence in the bilateral hips. Magnetic resonance imaging has been established as the preferred tool for diagnosing nondisplaced femoral neck stress fracture due to overuse injury. Magnetic resonance imaging was also useful to detect the initial lesion even in this case, although the etiology was different between overuse injury and insufficiency fracture. Case presentation A 41-year-old Japanese woman diagnosed with bilateral early stage idiopathic osteonecrosis of the femoral head was observed non-weight-bearing as much as possible using a stick. However, her pain and difficulty in walking progressed. Bilateral femoral neck stress fractures were subsequently detected by magnetic resonance imaging. The fracture initially appeared as a spot of bone marrow edema at the medial site of the femoral neck, and then developed into a fracture line. The patient underwent internal fixation of both hips with sliding hip screws to stabilize the stress fractures. In addition, the preparatory reaming served as core decompression of the femoral heads, as well as being treatment for osteonecrosis. Her bone mineral density and 25-hydroxy vitamin D values were low for her age. We administered eldecalcitol and teriparatide acetate. Her symptoms mostly improved, and the fracture lines and necrotic lesions on magnetic resonance imaging reduced at 5 months after the surgery. Conclusions Bilateral femoral neck stress fractures are a very rare condition and are often missed. It is important to listen to the patient’s complaints and perform an appropriate examination. We encountered a case of bilateral femoral neck stress fracture that occurred in a patient with early stage osteonecrosis of the femoral head, and were able to observe progression of stress fracture since before fracture occurred. This is considered to be the first report to capture imaging changes before and after the onset.

scholarly journals Assessment of the outcome of fracture intertrochanteric femur treated by trochanteric fixation nail in the elderly population

2020 ◽  
Vol 7 (1) ◽  
pp. 125
Author(s):  
Vipin Tyagi ◽  
Rahul Kakran ◽  
Amit Dwivedi ◽  
Fenil Shah
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Early Rehabilitation ◽  
Harris Hip Score ◽  
High Morbidity ◽  
Intertrochanteric Fractures ◽  
Early Weight Bearing ◽  
Duration Of Surgery ◽  
The Mean ◽  
Trochanteric Fixation Nail

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures femur in elderly population are more commonly forbidden high morbidity. The surgical stabilization together with early rehabilitation is the main challenge. The elderly population have poor bone mass quality and also the chances of complications like nonunion or implant failure are more with conventional procedures. Stable fixation and early rehabilitation is the main aim in intertrochanteric fractures. The aim is to assess the functional outcome of intertrochanteric fractures femur managed by trochanteric fixation nail (TFN) in the elderly population.</p><p class="abstract"><strong>Methods:</strong> The study includes 40 patients, 30 male and 10 female, with fracture intertrochanteric femur treated with TFN from September 2018 to May 2019 at Yashoda Superspeciality Hospital, Nehrunagar, Ghaziabad. The patients were evaluated at 4, 8, 12 weeks postoperatively and assessed by the Modified Harris hip score. Classification used is AO classification.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of patients was 64 years. The mean duration of surgery was 48±10 min. The Harris hip score was 96.90±4.60, which is better than scores from other implants used for intertrochanteric fractures femur.</p><p class="abstract"><strong>Conclusions:</strong> In this study, we conclude that TFN is a good choice in managing the intertrochanteric fractures, having higher bone union rate and less union time. The period of immobilization is decreased, early weight bearing and less complications.</p>

scholarly journals Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Oscar Vazquez ◽  
Axel Gamulin ◽  
Didier Hannouche ◽  
Wilson Belaieff
Keyword(s):  
Blood Transfusion ◽  
Femoral Neck ◽  
Elderly Population ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Medical Complications ◽  
Short Term ◽  
Duration Of Surgery ◽  
Discharge Location ◽  
Surgical Site Complications

Abstract Background Femoral neck fractures (FNF) are frequent in the elderly population, and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the dynamic hip screw system (DHS) are considered gold standards for osteosynthesis. The newly available femoral neck system (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate the short-term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS, and FNS. Methods All the patients of the author’s institution aged ≥ 75 years with a non-displaced (Garden I and II) FNF eligible for osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS, or FNS depending on the surgeon’s preference. Clinical data (age, gender, ASA score, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from the patients’ charts. The radiological analysis assessed the fracture classification, fracture impaction, and proximal femur shortening at 3 and 6 months using the institutional imaging software. Results Baseline characteristics in the TS (n = 32), DHS (n = 16), and FNS (n = 15) groups were similar with respect to age (mean 85 years), gender (female to male ratio 4:1), and ASA score. There were no significant differences across the groups for the need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location, and mortality within 3 months. The duration of surgery was significantly lower in the FNS group (43.3 vs 68.8 min; p < 0.001). The radiological assessment found similar impaction (5.2 mm ± 4.8) and shortening (8.6 mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with a shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multicenter randomized studies are however necessary to confirm these first results.

scholarly journals Lateral lumbar interbody fusion in the elderly: a 10-year experience

2018 ◽  
Vol 29 (5) ◽  
pp. 525-529 ◽  
Author(s):  
Nitin Agarwal ◽  
Andrew Faramand ◽  
Nima Alan ◽  
Zachary J. Tempel ◽  
D. Kojo Hamilton ◽  
...  
Keyword(s):  
Bone Density ◽  
Femoral Neck ◽  
Blood Loss ◽  
Elderly Population ◽  
Interbody Fusion ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Lumbar Interbody Fusion ◽  
The Mean ◽  
Graft Subsidence

OBJECTIVEElderly patients, often presenting with multiple medical comorbidities, are touted to be at an increased risk of peri- and postoperative complications following spine surgery. Various minimally invasive surgical techniques have been developed and employed to treat an array of spinal conditions while minimizing complications. Lateral lumbar interbody fusion (LLIF) is one such approach. The authors describe clinical outcomes in patients over the age of 70 years following stand-alone LLIF.METHODSA retrospective query of a prospectively maintained database was performed for patients over the age of 70 years who underwent stand-alone LLIF. Patients with posterior segmental fixation and/or fusion were excluded. The preoperative and postoperative values for the Oswestry Disability Index (ODI) were analyzed to compare outcomes after intervention. Femoral neck t-scores were acquired from bone density scans and correlated with the incidence of graft subsidence.RESULTSAmong the study cohort of 55 patients, the median age at the time of surgery was 74 years (range 70–87 years). Seventeen patients had at least 3 medical comorbidities at surgery. Twenty-three patients underwent a 1-level, 14 a 2-level, and 18 patients a 3-level or greater stand-alone lateral fusion. The median estimated blood loss was 25 ml (range 5–280 ml). No statistically significant relationship was detected between volume of blood loss and the number of operative levels. The median length of hospital stay was 2 days (range 1–4 days). No statistically significant relationship was observed between the length of hospital stay and age at the time of surgery. There was one intraoperative death secondary to cardiac arrest, with a mortality rate of 1.8%. One patient developed a transient femoral nerve injury. Five patients with symptomatic graft subsidence subsequently underwent posterior instrumentation. A lower femoral neck t-score < −1.0 correlated with a higher incidence of graft subsidence (p = 0.006). The mean ODI score 1 year postoperatively of 31.1 was significantly (p = 0.003) less than the mean preoperative ODI score of 46.2.CONCLUSIONSStand-alone LLIF can be safely and effectively performed in the elderly population. Careful evaluation of preoperative bone density parameters should be employed to minimize risk of subsidence and need for additional surgery. Despite an association with increased comorbidities, age alone should not be a deterrent when considering stand-alone LLIF in the elderly population.

scholarly journals Osteosynthesis of Non-displaced Femoral Neck Fractures in the Elderly Population Using the Femoral Neck System (FNS): Short-term Clinical and Radiological Outcomes

2021 ◽  
Author(s):  
Oscar Vazquez ◽  
Axel Gamulin ◽  
Didier Hannouche ◽  
Wilson Belaieff
Keyword(s):  
Blood Transfusion ◽  
Femoral Neck ◽  
Elderly Population ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Medical Complications ◽  
Short Term ◽  
Duration Of Surgery ◽  
Discharge Location ◽  
Surgical Site Complications

Abstract Background: femoral neck fractures (FNF) are frequent in the elderly population and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the Dynamic Hip Screw system (DHS) are considered gold standards for osteosynthesis. The newly available Femoral Neck System (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate short term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS and FNS. Methods: all the patients of the author’s institution aged ≥ 75y with a non-displaced (Garden I and II) FNF eligible to osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS or FNS depending on surgeon’s preference. Clinical data (age, gender, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from patients’ charts. Radiological analysis assessed fracture classification, fracture impaction and proximal femur shortening at 3 and 6 months using the institutional imaging software.Results: the TS (n=32), DHS (n=16) and FNS (n=15) groups were similar with respect to age (mean 85y) and gender (female: male ratio 4:1). There were no significant differences across groups for need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location and mortality within 3 months. Duration of surgery was significantly lower in the FNS group (43.3 vs 68.8min; p<0.001). Radiological assessment found similar impaction (5,2mm ± 4.8) and shortening (8.6mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion: The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multi-center randomized studies are however necessary to confirm these first results.

scholarly journals The role of primary cemented total hip arthroplasty in the management of fractures of the neck of femur in the elderly population

2017 ◽  
Vol 4 (1) ◽  
pp. 8
Author(s):  
Yeshwanth Subash ◽  
Jagadeesh B. ◽  
Ravikrishna R. ◽  
Prabhu Manickam
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Elderly Population ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Cemented Total Hip Arthroplasty

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Femoral neck fractures are common injuries in the elderly population and are associated with high rates of morbidity and mortality. The aim of surgical intervention in these elderly patients is to restore them to the pre-fracture status as rapidly as possible. The aim of this study was to evaluate the role of total hip arthroplasty as a primary option in the management of these fractures and to compare the results with studies of other authors as available in literature</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">45 patients with femoral neck fractures treated with cemented total hip arthroplasty were studied from January 2011 to January 2013 and were followed up for a minimum period of two years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">There were 18 males and 27 females ranging from 60 to 75 years of age. Mean age was 64.6 years. Majority (80%) of the fractures were completely displaced, Garden type 4 fractures followed by type 3 in 20% of cases. The most common mode of injury was a simple slip and fall. Excellent results were seen in 17 patients, good results in 24 patients and fair results in 4 patients. No poor results were seen</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">Cemented total hip arthroplasty is a very useful procedure for the primary treatment of femoral neck fractures in elderly patients. This procedure markedly improves the functional status of the patients and gives good functional results</span><span lang="EN-IN">.</span></p>

scholarly journals Femoral Neck Stress Fractures in Military Personnel

2009 ◽  
Vol 48 (174) ◽  
pp. 99-102 ◽  
Author(s):  
Amit Joshi ◽  
B R KC ◽  
B C Shah ◽  
P Chand ◽  
B B Thapa ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Stress Fracture ◽  
Clinical Symptoms ◽  
Initial Period ◽  
Military Training ◽  
Stress Fractures ◽  
Non Union ◽  
Army Hospital ◽  
Clinical Onset ◽  
Femoral Neck Stress Fracture

Introduction: Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union. Methods: The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profi le, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed. Results: The mean age of the patient was 19.94 years. Total 74% of them developed fi rst symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion).Conclusions: Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity.Key Words: displaced stress fractures, non-union, osteonecrosis, recruits

scholarly journals Complex Ankle Fractures, Presentation of 3 Cases and Review of the Literature

2020 ◽  
pp. 1-6
Author(s):  
Montoya Saenz Rocio ◽  
Montoya Saenz Rocio ◽  
Carlos Cano ◽  
Marques Parrilla Carlos
Keyword(s):  
Soft Tissue ◽  
Elderly Population ◽  
Young Patients ◽  
Soft Tissue Injuries ◽  
The Elderly ◽  
High Energy ◽  
Ankle Fractures ◽  
Inherent Risk ◽  
Fixation Devices ◽  
Main Complication

Ankle fractures represent a significant percentage of all fractures, and there is currently an increased incidence, both among the elderly population with associated comorbidities and among young patients with high-energy traumas. These fractures have an inherent risk of complications. In this connection, it is crucial that we turn our attention to soft tissue injuries, with wound infection as the main complication in this category. The last objective of this study is to highlight the possible derived complications in complex ankle fractures, and to explain the advantages of the use of different fixation devices, through the presentation of three clinical cases treated in our center. We conclude in order to prevent or reduce the complications resulting from the direct surgical treatment of high-energy trauma in the distal end of the tibia, it is essential to properly manage the soft tissue based on the type of lesion and the characteristics of the patient.

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