scholarly journals Single Stage Hemiarthroplasty Bipolar Surgical Procedure in 1 year Neglected Femoral Neck Fracture with 4cm Limb Shortening: A Case Report

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0005
Author(s):  
I Wayan Suryanto Dusak ◽  
I Dewa Gede Bracika Damma Prasada
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Difficult Problem ◽  
Long Term Results ◽  
Soft Tissue Release ◽  
Leg Length ◽  
Non Union ◽  
Satisfactory Outcome ◽  
Neck Fracture

The neglected femoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. In developing countries many of these fractures present late, often as a result of delayed referral or because of initial management by traditional bone-setters. Case Presentation: A 25- year-old female came to the outpatient clinic with chief complain pain on her right groin after a motorcycle accident 1 year ago. On physical examination a 4 cm leg length discrepancy was measured, and the patient walked with limping gait. Conventional x-ray confirmed displaced fracture of neck femur. Patient is treated with hemiarthroplasty bipolar without soft tissue release. Discussion: Neglected femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Fracture displacement disrupts the terminal branches to the femoral head and leads to development of osteonecrosis. The goal of treatment in neglected femoral neck fracture is to achieve a painless, mobile and stable hip. In neglected femoral neck fracture more than 6 months, hence prosthetic replacement (hemi or total) is generally preferred. Hemiarthroplasty can be performed when the acetabulum is normal. Conclusion: Hemiarthroplasty bipolar give satisfactory outcome for neglected femoral neck fracture and provides a predictable, reproducible functional recovery although long-term results are yet to be seen

scholarly journals Re-Recognition of Garden Index as a Criterion for Evaluating the Quality of Femoral Neck Fracture Reduction: An Imaging Study Based on Cadaver Specimens

2021 ◽  
Author(s):  
Leyi Cai ◽  
Wenjie Li ◽  
Wenhao Zheng ◽  
Jianshun Wang ◽  
Xiaoshan Guo ◽  
...  
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Kirschner Wire ◽  
Imaging Study ◽  
Lateral View ◽  
Healthy Human ◽  
Rotational Displacement ◽  
Significant Difference ◽  
Neck Fracture

Abstract ObjectiveTo investigate whether the Garden index can determine the rotational displacement of femoral neck fracture. MethodsTen healthy human femoral specimens were obtained. A 2.0 mm diameter Kirschner-wire was placed in the center of the femoral head. The osteotomy was perpendicular in the middle of the femoral neck. The distal osteotomy surface was indicated the angle of rotation (pronation and supination to 90°, every 10° was an interval). The X-ray of anterior-posterior and lateral view was taken at different angles according to the mark. The Garden index and other relevant data were analyzed with the PCAS system. Meanwhile, the change of the area of the femoral head fovea at different rotation angles was observed. ResultsThere was no significant difference in the Garden index in 0~30° at pronation and supination position (P>0.05). In range of 40°~90°, there was a statistical difference in the Garden index (P<0.05). With the increase of the pronation angle, the area of the femoral head fovea is gradually reduced; as the angle of the supination increases, the area of the femoral head fovea is gradually increased. ConclusionThe Garden Index cannot accurately determine the rotational displacement of the femoral neck fracture during the pronation or supination range of 0~30°. Changes in the area of the femoral head fovea can help determine the rotational displacement of the femoral neck fracture.Level of EvidenceLevel V.

scholarly journals Impact of Cigarette Smoking on Re-operation and Revision Surgery after Femoral Neck Fracture Treatment

2020 ◽  
Vol 13 ◽  
pp. 195-201
Author(s):  
Mitchell Messner ◽  
Alexander Chong ◽  
Bruce Piatt
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Non Union ◽  
Initial Fixation ◽  
Neck Fracture ◽  
Group 3 ◽  
Former Smokers ◽  
Group 2 ◽  
Group 1

Introduction. Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Methods. Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. Results. A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Conclusion. Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.

scholarly journals Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

2016 ◽  
Vol 98 (6) ◽  
pp. 376-379 ◽  
Author(s):  
O Riaz ◽  
R Arshad ◽  
S Nisar ◽  
R Vanker
Keyword(s):  
Femoral Neck ◽  
Serum Albumin ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Fixation Failure ◽  
Non Union ◽  
Preoperative Serum ◽  
Neck Fracture ◽  
Posterior Tilt ◽  
Intracapsular Femoral Neck Fracture

Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%–19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60–101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease

2022 ◽  
Vol 104-B (1) ◽  
pp. 134-141
Author(s):  
Peter H. J. Cnudde ◽  
Jonatan Nåtman ◽  
Nils P. Hailer ◽  
Cecilia Rogmark
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Hip Arthroplasty ◽  
Neurological Disease ◽  
Dislocation Rate ◽  
Dual Mobility ◽  
Increased Risk ◽  
National Patient ◽  
Neck Fracture

Aims The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). Results A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. Conclusion Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA. Cite this article: Bone Joint J 2022;104-B(1):134–141.

scholarly journals Prediction Value of SPECT/CT in Avascular Necrosis of Femoral Head After Femur Neck Fracture

2019 ◽  
Vol 10 ◽  
pp. 215145931987294
Author(s):  
Sung Jun Park ◽  
Bong Seong Ko ◽  
Kyoung Ho Moon ◽  
Minkyung Lee
Keyword(s):  
Computed Tomography ◽  
Femoral Head ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Single Photon ◽  
Photon Emission ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Neck Fracture ◽  
Photon Emission Computed Tomography

Introduction: The aim of this study was to determine the diagnostic value of single-photon emission computed tomography/computed tomography (SPECT/CT) in prediction of avascular necrosis (AVN) after femoral neck fracture and to evaluate whether photon defect in femoral head as seen in SPECT/CT can be an index for choice of surgical method. Methods: This study was based on 97 patients who took SPECT/CT after femoral neck fracture from November 2012 to November 2017, with 64 patients with femoral intertrochanteric fracture in which chances of AVN is rare as a comparison group. Among 97 patients with femoral neck fracture, osteosynthesis was conducted in 7 patients with less than 15% of photon defect in damaged femoral head and 7 patients who wanted osteosynthesis, despite photon defect more than 15%, and 83 patients with photon defect more than 25% had arthroplasty. Patient with osteosynthesis was followed up with AVN by conducting magnetic resonance imaging (MRI) in 1 year after the surgery. Results: Quantitative analysis of SPECT/CT in 14 patients who had femoral neck osteosynthesis showed that 7 patients with femoral neck fracture showed photon defect of 15% or more, but less than 25% and 3 patients in these were diagnosed with AVN after 1-year follow-up by MRI. Sensitivity and specificity of SPECT/CT in predicting AVN was 100% and 63.6%, respectively, with prediction accuracy of 71.4%. Among 14 patients with femoral neck fracture who had osteosynthesis, photon defect in 3 patients diagnosed with AVN was 19.6% ± 5.2%, but photon defect in 11 patients who was not diagnosed with AVN was 10.7% ± 5.2%, showing statistically significant difference between 2 groups ( P = .001). Conclusion: Single-photon emission computed tomography/CT in patients with femoral neck fracture is considered to have diagnostic value in predicting occurrence of AVN, and percentage of photon defect is considered to be an useful index in determining the operative method.

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