scholarly journals Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures

2018 ◽  
Vol 9 ◽  
pp. 215145931876538 ◽  
Author(s):  
Method Kabelitz ◽  
Yannick Fritz ◽  
Patrick Grueninger ◽  
Christoph Meier ◽  
Patrick Fries ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Weight Bearing ◽  
Femoral Neck Fractures ◽  
Periprosthetic Fractures ◽  
Full Weight Bearing ◽  
Morbidity Rate ◽  
Old Patients ◽  
Invasive Approach ◽  
Very Old ◽  
Very Old Patients

Background: Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. Methods: We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. Results: We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B2) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B1 and 2 Vancouver AG) were treated conservatively. One periprosthetic femoral fracture (Vancouver B1) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Conclusion: Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level of Evidence: Level III, Therapeutic study.

scholarly journals Hemiarthroplasty of the hip using the direct anterior approach

2021 ◽  
Author(s):  
Michael Nogler ◽  
Filippo Randelli ◽  
George A. Macheras ◽  
Martin Thaler
Keyword(s):  
Femoral Neck ◽  
Minimally Invasive ◽  
Anterior Approach ◽  
Weight Bearing ◽  
Hip Osteoarthritis ◽  
Direct Anterior Approach ◽  
Femoral Neck Fractures ◽  
Postoperative Treatment ◽  
Full Weight Bearing ◽  
Invasive Approach

Abstract Objective Minimally invasive approach in total hip arthroplasty for the treatment of femoral neck fractures with a hemiarthroplasty. Indications Femoral neck fractures of patients without hip osteoarthritis where the acetabulum is still intact. Contraindications Lesions and infections of the skin in the approach area; hip osteoarthritis; surgeon’s lack of experience with the technique. Surgical technique The direct anterior approach (DAA) uses the Smith–Peterson interval between the tensor fasciae latae (TFL) and the rectus and sartorius muscle. After coagulation of the ascending branches of the femoral circumflex vessels, the capsule is opened. The remaining parts of the femoral neck are removed and osteotomized if necessary. The femoral head is removed with a cork screw. Then the shaft is supported by 2 sharp retractors at the greater trochanter from cranial, and the leg is externally rotated, hyperextended, and adducted. A TFL release can be performed which we also recommend. The femoral canal is opened step by step and extended with rasps which are introduced with the double curved broach handle. Cement and the final implant are introduced and after the trial reduction also the final head. The hip is reduced, the capsule adapted and the wound closed. Postoperative management For this approach, there are no approach specific recommendations. Postoperative treatment depends on whether the approach was extended with muscle releases and on the type of reconstruction performed. If the approach was limited to the minimally invasive direct anterior portal, quicker rehabilitation can be expected due to the reduced muscle damage. We prefer mobilization with full weight bearing as tolerated on the next day.

scholarly journals Pediatric Femoral Neck Fractures

2014 ◽  
Vol 13 (2) ◽  
pp. 198-204
Author(s):  
Ramji Lal Sahu
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Weight Bearing ◽  
Medical Science ◽  
Delayed Union ◽  
Femoral Neck Fractures ◽  
Full Weight Bearing ◽  
Coxa Vara ◽  
Anatomical Reduction ◽  
Mean Time

Introduction: Femoral neck fractures are rare injuries in children, but the high incidence of long term complications make it an important clinical entity. The aim of this prospective study was to analyze the clinical outcomes of pediatric femur neck fractures. Methods: The study included 16 children (10 boys and 6 girls) who sustained femoral neck fractures and completed an average follow-up of 28 months. The children were treated with anatomical reduction and internal fixation with partially threaded cancellous screws. The outcomes were clinically and radio logically assessed for fracture healing, joint movements and implant failure. Results: The mean age of included patients was 10 years (range, 6 to 16 years) and the average followup was 28 months (range, 17 -48 months). Coxa- vara was the most common complication Other complications included nonunion associated with Partial a vascular necrosis and delayed union was seen in one case but later on it had been corrected. Two cases of slight coxa vara were seen radiologically but clinically patients had no problem in walking and daily activities. All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) except two cases. Full weight bearing was possible in a mean time of 8.8 weeks. The results were excellent in 68.75% and good in 18.75% patients. Conclusions: We conclude that the early operation using anatomical reduction and internal fixation of pediatric femoral neck fracture offers the best results and provide early healing less complication with good results and is economical. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18303 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.198-204

scholarly journals Real-world long-term outcomes based on three therapeutic strategies in very old patients with three-vessel disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Deshan Yuan ◽  
Sida Jia ◽  
Ce Zhang ◽  
Lin Jiang ◽  
Lianjun Xu ◽  
...  
Keyword(s):  
Real World ◽  
Cardiac Death ◽  
Artery Bypass ◽  
Therapeutic Strategies ◽  
Old Patients ◽  
Very Old ◽  
Vessel Disease ◽  
Significant Difference ◽  
Very Old Patients

Abstract Background There are relatively limited data regarding real-world outcomes in very old patients with three-vessel disease (3VD) receiving different therapeutic strategies. This study aimed to perform analysis of long-term clinical outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) in this population. Methods We included 711 patients aged ≥ 75 years from a prospective cohort of patients with 3VD. Consecutive enrollment of these patients began from April 2004 to February 2011 at Fu Wai Hospital. Patients were categorized into three groups (MT, n = 296; CABG, n = 129; PCI, n = 286) on the basis of different treatment strategies. Results During a median follow-up of 7.25 years, 262 deaths and 354 major adverse cardiac and cerebrovascular events (MACCE) occurred. Multivariate Cox analysis showed that the risk of cardiac death was significantly lower for CABG compared with PCI (adjusted hazard ratio [HR] = 0.475, 95% confidence interval [CI] 0.232–0.974, P = 0.042). Additionally, MACCE appeared to show a trend towards a better outcome for CABG (adjusted HR = 0.759, 95% CI 0.536–1.074, P = 0.119). Furthermore, CABG was significantly superior in terms of unplanned revascularization (adjusted HR = 0.279, 95% CI 0.079–0.982, P = 0.047) and myocardial infarction (adjusted HR = 0.196, 95% CI 0.043–0.892, P = 0.035). No significant difference in all-cause death between CABG and PCI was observed. MT had a higher risk of cardiac death than PCI (adjusted HR = 1.636, 95% CI 1.092–2.449, P = 0.017). Subgroup analysis showed that there was a significant interaction between treatment strategy (PCI vs. CABG) and sex for MACCE (P = 0.026), with a lower risk in men for CABG compared with that of PCI, but not in women. Conclusions CABG can be performed with reasonable results in very old patients with 3VD. Sex should be taken into consideration in therapeutic decision-making in this population.

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