scholarly journals Threading the Needle: Intrapelvic Displacement of a Femoral Neck Fracture through the Obturator Foramen

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Gautham Prabhakar ◽  
Nicholas Kusnezov ◽  
Nicholas Rensing ◽  
Amr Abdelgawad
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Young Patient ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Obturator Foramen ◽  
Displaced Femoral Neck Fractures ◽  
Anatomic Reduction ◽  
Neck Fracture

Despite timely and appropriate management, displaced femoral neck fractures are often devastating injuries for the young patient. The risk of negative sequelae is further amplified with increasing displacement and vertical fracture patterns. Open anatomic reduction with rigid internal fixation is essential to maximize the healing potential in displaced fractures of the femoral neck. Successful primary osteosynthesis of significantly displaced femoral neck fractures in the young patient has been reported in the literature. We present a unique case of open reduction and internal fixation of a high-energy femoral neck fracture with extrusion of the head through the obturator foramen into the pelvis without associated acetabular or pelvic injury.

scholarly journals Essential Role of Reliable Reduction Quality in Internal Fixation of Femoral Neck Fractures in the Non-elderly Patients—A Propensity Score Matching Analysis

2021 ◽  
Author(s):  
Longhai Qiu ◽  
Yuliang Huang ◽  
Guowen Li ◽  
Hongbo Wu ◽  
Zhiwen Zhang ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Propensity Score ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Kaplan Meier ◽  
Reduction Group ◽  
Neck Fracture

Abstract Background: The rate of failure of internal fixation for femoral neck fractures has remained largely unchanged over the past 30 years. The current study attempted to identify the controllable variables influencing the failure of internal fixation of femoral neck fractures. Methods:The study included 190 patients aged from 20 to 65 with femoral neck fracture caused by low energy violent injuries, who were treated with multiple cannulated screws over the period 2005-2019 at a single centre. Kaplan-Meier (KM) survival analysis was firstly utilized to evaluate the potential interaction between each variable and cumulative rates of reoperation. If P < 0.1 in KM survival analysis, the variables would be included in subsequent Cox survival analysis to explore the influencing need for reoperation of a femoral neck fracture. Next, all of the 190 patients were divided into perfect reduction group (Garden Alignment Index Ⅰ) and imperfect reduction group (Garden Alignment Index Ⅱ, Ⅲ, Ⅳ). Propensity score matching (PSM) analysis resulted in 39 pairs. After the baseline variables were balanced between the two groups, Cox survival analysis was utilized again to explore the variables influencing the need of reoperation of a femoral neck fracture. Finally, KM survival analysis was utilized to compare the cumulative rate of reoperation between perfect reduction (Group PR) and imperfect reduction（Group IR）as a subgroup analysis. Results: Before PSM analysis, the mean age was 49.96±12.02 years and the total reoperation rate was 17.40%. Cox survival analysis showed that only reduction quality was interrelated with the need for reoperation before PSM analysis and after PSM analysis. Kaplan–Meier cumulative reoperation rate was higher in Group IR than in Group PR after PSM analysis. Conclusion: To prolong the service life of the original femoral head, it is essential to achieve a completely anatomical reduction and maintain the reduction quality until the patient fully recovers.

scholarly journals Internal Fixation Versus Hemiarthroplasty for Displaced Intra-Capsular Femoral Neck Fractures in ASA 3-5 Geriatric Patients

2016 ◽  
Vol 10 (1) ◽  
pp. 765-771 ◽  
Author(s):  
W. Rezaie ◽  
W. Wei ◽  
B.I. Cleffken ◽  
C.H. van der Vlies ◽  
B.I. Cleffken ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Geriatric Patients ◽  
Mortality Rates ◽  
Femoral Neck Fractures ◽  
Inclusion Criteria ◽  
Operation Rate ◽  
Neck Fracture ◽  
The Mean

Background: The treatment of choice for elderly with a displaced intra-capsular femoral neck fractures is prosthetic replacement. This is however a major surgical procedure for geriatric patients with multiple co-morbidities which can threaten hemodynamic stability and lead to death. In this study we compared the outcome of internal fixation (IF) versus hemiarthroplasty (HA) for the management of intra-capsular femoral neck fractures in the elderly with severe co-morbidities. Methods: We conducted a retrospective cohort study of all the patients who were admitted to our Level-II trauma centre with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria were: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either internal fixation or a cemented hemiprosthesis. The primary outcome was 6-month mortality rate. Secondary outcomes were 30-day mortality, post-operative complications, re-operation rate and length of hospital stay. Results: 80 patients met our inclusion criteria. The mean age of the IF group was 81.6 years and in the HA group it was 84.5 years (P=0.07). The medical records were retrieved 34-64 months after surgery. Two intra-operative deaths due to cement implantation syndrome were found in the HA group and none in the IF group. Twelve patients (21.8%) in the HA group died within 30 days after surgery and 2 (8.0%) in the IF group (P=0.21). The mean operating time was 83 min. for the HA group and 51 min. for the IF group (P=0.000). There were more implant-related complications in the IF than in the HA group (36% vs 9.1% respectively, P=0.008). The 6-month mortality rates didn’t differ between the IF and the HA groups (respectively 28.0% vs 34.5%, P=0.62). Conclusion: The post-operative mortality rates did not differ between the IF and the HA groups in elderly patients with a displaced femoral neck fracture and ASA 3 to 5. However, the HA associated with less implant-related complications than the IF in this group and it is therefore the treatment of choice.

scholarly journals The Role of The Medial Buttress Plate In The Treatment of Pauwels Type Ⅱ And Ⅲ Femoral Neck Fracture: A Retrospective Study And Preliminary Results

2021 ◽  
Author(s):  
Chao Ma ◽  
Yanshi Liu ◽  
Jialin Liu ◽  
Li Chen ◽  
Jinyong Huang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Statistical Significance ◽  
Implant Failure ◽  
Harris Hip Score ◽  
Cannulated Screws ◽  
Displaced Femoral Neck Fractures ◽  
Anatomic Reduction ◽  
Neck Fracture ◽  
Buttress Plate

Abstract Background: The purpose of this study was to compare the effectiveness of multiple cannulated screws combined with medial buttress plate or not for the treatment of unstable femoral neck fracture.Methods: 69 nonelderly patients with Garden type III-IV femoral neck fracture were retrospectively analyzed. The patients were divided into MCS (multiple cannulated screws) group and CMBP (combined with medial buttress plate) group according to the surgical method. Patient’s demographic data, Harris Hip Score, EQ-5D index and complications at minimum of 2 years follow-up were analyzed.Results: There were 47 patients in the MCS group (35 male and 12 females) with a mean age of 40.28±12.64 years, whereas 22 patients in the CMBP group (17 male and 5 females) with a mean age of 43.86±12.55 years. In the MCS group, there were one avascular necrosis, five postoperative nonunion, five implant failure, and two femoral neck shortening. While one implant failure, two postoperative nonunion and two impingement in the CMBP group. The difference of HHS scores was statistically significant at 3 months after surgery between the two groups (P<0.05), whereas there was no statistical significance at 6 months, 1 year and 2 years (P>0.05). The same results were found in EQ-5D index.Conclusions: Anatomic reduction and stable fixation contribute to satisfactory outcomes in the treatment of nonelderly displaced femoral neck fractures. A buttress plate in the medial region of the femur neck with cannulated screws offers patients the best biomechanical microenvironment needed for fracture healing without obviously blood-supply disruption, especially in Pauwels type Ⅱ and III.

scholarly journals Results of the application of a new method of internal fixation of femoral neck fractures - self-tapping antirotation cannulated screws (SAF)

2013 ◽  
Vol 60 (2) ◽  
pp. 71-79
Author(s):  
Igor Kostic ◽  
Milan Mitkovic ◽  
Milorad Mitkovic
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Fracture Healing ◽  
Femoral Neck Fracture ◽  
Functional Recovery ◽  
Femoral Neck Fractures ◽  
New Method ◽  
Cannulated Screws ◽  
Neck Fracture

Introduction: Femoral neck fractures are one of the most common fractures primarily the elderly, coupled with a high degree of morbidity and mortality. The treatment is applied a number of methods of internal fixation (multiple cannulated screws available, DHS system, cefalomedullary). At the Department of Orthopedics and Traumatology of Nis developed a new method of fixation of femoral neck fracture, which allows stable fixation of dislocated and nondislocated femoral neck fracture. Self-tapping antirotation fixation (SAF) using two cannulated screws to initial compression fractures intraoperative and postoperative dynamic linear compression of the fracture with early full support to the patient. Matherial and methods: In the period between 2008 to 2012, 53 patients treated for femoral neck fracture in the Clinic for orthopedic and traumatology, Clinical center in Nis, Serbia, by SAF (the self-tapping cannulated screws antirotation; ORTOKON doo Nis). All patients were followed up after surgery in a minimum period of 13 weeks (13-106 weeks). The outcome was evaluated on the basis of clinical and radiological signs of fracture healing and the Harris hip score of functional recovery of the patient. Results: Of the total number of patients (53) treated with this method of fixation, 31 of them were females and 22 males, mean age 52.7 years (28-75 years). The average time of surgery was 36.4 minutes (19-70 minutes). During the postoperative follow-up of all patients (53) operated by this method, six patients were lost in the further postoperative monitoring, so that 47 patients remained for final evaluation. The total incidence of nonunion of femoral neck fracture after surgery this method was 6.4% (three patients). Shortening of the femoral neck after fixation by this method was recorded in 27 cases, and what amounted to an average of 2.8 mm (1, 2 mm in nondislocated to 4.55 with dislocated fracture) and did not affect the functional outcome. During radiographic follow-up was not detected fracture implants. Conclusion: Self-tapping screws cannulated antirotacioni (SAF method) represent a reliable method of fixation of dislocated and nondislocated femoral neck fracture. The main prerequisite for the proper healing of femoral neck fractures with this method is that anatomical fracture reduction is achieved by a closed or open method. This way of fixation allows the early full weight bearing patient operated limb and faster postoperative functional recovery of the fracture healing in optimal time.

scholarly journals Slipped capital femoral epiphysis after treatment of femoral neck fracture

2019 ◽  
Vol 36 (ICON-Suppl) ◽  
Author(s):  
Muhammad Amin Chinoy ◽  
Sateesh Pal ◽  
Mansoor Ali Khan
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Weight Bearing ◽  
Slipped Capital Femoral Epiphysis ◽  
Coxa Vara ◽  
Femur Neck Fracture ◽  
Anatomic Reduction ◽  
Neck Fracture ◽  
Stable Internal Fixation

Slipped capital femoral epiphysis (SCFE) in children after treatment of femoral neck fracture is a very rare condition. This complication should be recognized promptly and treated urgently. The risk of development of this complication can be minimized by anatomical reduction of the fracture and stable internal fixation of the fracture. Five years old male child sustained right sided femur neck fracture and was treated with closed reduction and Hip spica cast application. The fracture healed with a varus deformity. After 7 months, he developed slip of femoral epiphysis with a coxa vara deformity of proximal femur, which was treated with in situ fixation with Cannulated screws. His subsequent course remained uneventful up to five months.Slipped capital femoral epiphysis (SCFE) after treatment of femoral neck fracture in children is a rare complication that should be recognized and treated promptly. The onset of SCFE may show inadequate reduction or fixation of the fracture. Anatomic reduction and stable internal fixation for femoral neck fracture in children provides best outcomes. Postoperative care and delayed weight bearing are also equally important to avoid complications. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1725 How to cite this:Chinoy MA, Pal S, Khan MA. Slipped capital femoral epiphysis after treatment of femoral neck fracture. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S94-S97. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1725 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Recovery after Hip Fractures: Influence of Bipolar Hemiarthroplasty on Physical Disability and Social Dependency in the Elderly

2011 ◽  
Vol 21 (6) ◽  
pp. 751-756 ◽  
Author(s):  
Johannes Schneppendahl ◽  
Marcel Betsch ◽  
Vanco Petrov ◽  
Friedrich Böttner ◽  
Simon Thelen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Geriatric Patients ◽  
Femoral Neck Fractures ◽  
Bipolar Hemiarthroplasty ◽  
Displaced Femoral Neck Fractures ◽  
Neck Fracture ◽  
Original Type

Surgical treatment of femoral neck fractures is associated with a significant impact on quality of life. The aim of this study was to determine the long-term influence of displaced femoral neck fractures treated by bipolar hemiarthroplasty on the activities of daily living, quality of life and social dependency. We studied 487 geriatric patients treated in the years 1989 to 2003. At the beginning of follow-up in 2004, 166 patients were alive and evaluation was carried out on 145 patients (87.3%) at 91.3 (14 - 244) months postoperatively by a standardized questionnaire. All enrolled patients had been treated with cemented bipolar hemiarthroplasty for a displaced femoral neck fracture. Patients were evaluated concerning their average pre- and postoperative ability to walk, the need for assisting devices, type of residency and the SF-12® Score. Femoral neck fracture and hemiarthroplasty had a significant influence on all recorded aspects of quality of life. Even though almost two thirds of the patients needed assisting devices to walk after surgery, about two thirds returned to their original type of accommodation and the majority reached their original degree of mobility. Compared to a normal population no significant impact was observed on the quality of life measured by the SF-12® score. We consider bipolar hemiarthroplasty an effective treatment option for displaced femoral neck fractures in geriatric patients. Most patients returned to their original type of accommodation and level of mobility, even though the majority required a number of assisting devices to do so.

THE BIOMECHANICAL EFFECTS OF DIFFERENT INTERNAL FIXATIONS IN THE TREATMENT OF FEMORAL NECK FRACTURES

2013 ◽  
Vol 13 (01) ◽  
pp. 1350004
Author(s):  
XIN-LONG MA ◽  
JIAN-XIONG MA ◽  
TAO MA ◽  
DAN XING ◽  
JIE WANG ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Statistical Significance ◽  
Testing Machine ◽  
Femoral Neck Fractures ◽  
Resistance Strain ◽  
Strain Gages ◽  
Linear Load ◽  
Anatomic Reduction ◽  
Neck Fracture

The objective of this study was to contrast the biomechanical effects of standard internal fixations for femoral neck fracture treatment and provide a theoretical basis for the selection of the ideal internal fixation in the clinic. Twelve artificial PMMA femoral models were selected, and the central necks of the specimens were sawn with a electric saw at Pauwels angle of 70° to form an adduction-type femoral neck fracture model. After anatomic reduction, we fixed the specimens respectively with the DHS, three hollow screws, PFN, and dynamic sleeve three-wing screw according to the operative approach. Instron-8874 servo-hydraulic mechanical testing machine was used to fix the specimens which simulated uniped standing. We selected 15 key points on the proximal femur as test points and gave the model gradation loading at the rate of 10 mm/min with linear load 0 ~ 1200 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. A peak was observed at the eight resistance strain gages at 1200 N load, with the strain values of the DHS, three hollow screws, PFN, and dynamic sleeve three-wing screw were (-700 ± 35), (-756 ± 14), (-1362 ± 136), and (3024 ± 127) με, showing statistical significance (P < 0.01). Under the same load, the head sink displacement in the group with the dynamic sleeve three-wing screw was greater than the hollow screws and PFN groups (P < 0.01), but smaller than the DHS group (P < 0.01). The strain values at the eight resistance strain gages in the group with the dynamic sleeve three-wing screw was larger than the other three groups under the same load, showing statistical significance (P < 0.01), and the strain values demonstrated an increasing trend with the increase of load at the same fixation group. The dynamic sleeve three-wing screw has good biomechanical stability for the treatment of femoral neck fractures, which can be applied in clinical practice.

Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis

2020 ◽  
pp. 1-9
Author(s):  
Zhengbing Su ◽  
Linlin Liang ◽  
Yong Hao
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Meta Analysis ◽  
Healing Time ◽  
Femoral Neck Fractures ◽  
Type Iii ◽  
Support Plate ◽  
Neck Fracture ◽  
Harris Score

BACKGROUND: Femoral neck fractures often occur in the elderly, which usually results in hip pain. OBJECTIVE: The purpose of this study was to evaluate the difference in the treatment of Pauwels type III femoral neck fractures with medial femoral support plate combined with cannulated screws and cannulated screws alone. METHODS: PubMed, ScienceDirect, China Academic Journals Full-text Database (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), Embase and Cochrane Library were used to collect clinical controlled trials of the medial femoral support plate combined with hollow screw internal fixation and simple hollow screw internal fixation for Pauwels type III femoral neck fracture. RESULTS: Seven articles (n= 409 cases) were evaluated for quality and included in this meta-analysis. Four hundred and nine patients with Pauwels type III femoral neck fractures were included: 202 in the experimental group and 207 in the control group. The results showed that, compared with simple hollow screw internal fixation, the medial femoral support plate combined with hollow screw internal fixation has a longer operation time (MD= 23.05, 95% CI= 13.86–32.24), and more intraoperative blood loss (MD= 91.55, 95% CI= 50.72–132.39), shorter healing time (MD=-1.48, 95% CI (-1.71, -1.26)), lower incidence of complications (RR= 0.34, 95% CI= 0.19–0.61), lower VAS score (MD=-1.28, 95% CI (-1.83, -0.72)), and higher Harris score (MD= 8.49, 95% CI (4.15, 12.83)). CONCLUSION: Medial femoral plate combined with cannulated screw for Pauwels type III femoral neck fracture can shorten healing time, reduce postoperative complications, and improve the postoperative Harris score.

scholarly journals Femoral neck fracture treatment methods and results evaluation in children in a 5 year period Mashhd, Iran

2015 ◽  
Vol 14 (2) ◽  
pp. 183-185
Author(s):  
Mohammad Hallaj Moghadam ◽  
Hasan Rahmi Shervin ◽  
Masoomeh Alami
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
External Rotation ◽  
Medical Science ◽  
Reduction Rate ◽  
High Energy ◽  
Late Complications ◽  
Femoral Neck Fractures ◽  
Treatment Methods ◽  
Neck Fracture

Background: Femoral neck fractures are rare in children. This type of fracture usually originates from high energy traumas. This fracture has serious complications and one of the most disabling one is avascular necrosis. The goal of this research is active follow up of patients in order to decide about the rate of late complications, patient’s function after surgery and residual pain.Methods: In this five year study, 35 patients were evaluated and different parameters studied. These parameters included: age, sex, side of fracture, mechanics of injury, type of reduction, rate and type of complication followed surgery.Results: In general, femoral neck fractures are more common between 16 and 20. It is two fold common in females than males and it was more common in left side. The most common mechanisms was falling. Treatment methods were open reduction in 88 % and close reduction in 12%. The most common type of fractures was type 3. Following treatment, 60% of patients remained uncomplicated and 40% had complication. In fact, limitation in internal and external rotation in 20 to 30 degree was the most common complication. 30% of patients complained of mild pain during walking.Conclusion: After appropriate treatment most patients with femoral neck fracture have no complications, however in some cases a vascular necrosis occurs as a serious complication. This study will provide clues and information to design studies with more patients to assess how different treatment methods have impact on outcomes of patients.Bangladesh Journal of Medical Science Vol.14(2) 2015 p.183-185

Sign in / Sign up

Export Citation Format

Share Document