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

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.

Download Full-text

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

10.21203/rs.3.rs-551508/v1 ◽

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.

Download Full-text

The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01958-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shuai Cui ◽

Dehui Wang ◽

Xuejie Wang ◽

Zehui Li ◽

Wenlai Guo

Keyword(s):

Femoral Neck ◽

Internal Fixation ◽

Hip Replacement ◽

Operation Time ◽

The Elderly ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Controlled Trials ◽

Short Term ◽

Randomized Controlled

Abstract Background Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors. Materials and methods Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared. Results There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up. Conclusions In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.

Download Full-text

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175066 ◽

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

Background: 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.Methods: 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.Results: 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. Conclusions: 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.

Download Full-text

Similar Short Term Outcomes with Press-fit Bipolar Hemiarthroplasty and Cemented Total Hip Replacements in Femoral Neck Fractures

Materiale Plastice ◽

10.37358/mp.17.2.4829 ◽

2017 ◽

Vol 54 (2) ◽

pp. 262-264 ◽

Cited By ~ 1

Author(s):

Dinu Vermesan ◽

Radu Prejbeanu ◽

Horia Haragus ◽

Marius Niculescu

Keyword(s):

Femoral Neck ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Short Term ◽

Total Hip ◽

Press Fit ◽

Total Hip Replacements ◽

Displaced Femoral Neck Fractures ◽

Duration Of Surgery ◽

Hip Replacements

There is limited data of short-term outcomes comparing press-fit bipolar and cemented total hip replacements in patients with femoral neck fractures. We therefore aimed to compare the perioperative incidents and immediate outcomes between press-fit stem bipolar head hemiarthroplasty and cemented total hip replacement in elderly patients with displaced femoral neck fractures. We reviewed prospectively collected data from 115 consecutive patients over 12 months. There were 21 cemented total hip replacements and 33 bipolar head press-fit stem hemiarthroplasties, with a male to female ratio of 1:1.84 and an average follow-up of 9.9 months (range 3-15). There were no differences between the two groups with respect to age (mean 77.4 years old), cortical index (0.77/ 0.82, p=0.087), hospitalization (17.7/ 16.7 days, p=0.59), bleeding, blood transfusions (14.3/ 18.2%, p=1.00) and Barthel index preoperatively, at discharge and 3 months (5.67/ 5.48, p=0.62; 10.57/ 10.47, p=0.89; 13.81/ 13.28, p=0.47). For all 54 patients the hemoglobin dropped from 13 to 11.2 g/dL after surgery without difference between implants. The mean duration of surgery was 21minutes (p[0.01) shorter for the press-fit hemiarthroplasty group compared to cemented total hip replacements. Our findings show comparable blood loss and functional outcomes with press-fit bipolar hemiarthroplasty and cemented total hip replacements for treating displaced femoral neck fractures in the elderly. Both were safe and allowed early recovery, with the only significant difference being the longer duration of surgery for the total arthroplasty.

Download Full-text

Bilateral Complications of Hemiarthroplasty after Displaced Femoral Neck Fracture Treatment

Acta Chirurgica Latviensis ◽

10.1515/chilat-2017-0005 ◽

2016 ◽

Vol 16 (2) ◽

pp. 24-25

Author(s):

Andris Dzerins ◽

Peteris Studers ◽

Matiss Zolmanis

Keyword(s):

Femoral Neck ◽

Elderly Population ◽

The Elderly ◽

Treatment Method ◽

Femoral Neck Fractures ◽

Angular Deformity ◽

Fracture Treatment ◽

Displaced Femoral Neck Fractures ◽

Neck Fracture ◽

The Right

SummaryHemiarthroplasty (HA) of the hip joint is a commonly used treatment method for displaced femoral neck fractures (FNF) in the elderly population. The revision rates following hemiarthroplasty for trauma are 4-24% (2), but there are few studies in the literature presenting bilateral complications of HA following FNF treatment. We present a 67-year-old female with migration and angular deformity of the left unipolar prosthesis followed by malposition and subluxation of the right unipolar prosthesis after sixteen months, which are not common complications and they are even less frequent to occur in one patient.

Download Full-text

Long-stem Prosthesis for Intertrochanteric and Femoral Neck Fractures in the Elderly: Retrospective Comparison of Short-term Clinical Outcomes

Turkish Journal of Osteoporosis ◽

10.4274/tod.galenos.2020.29291 ◽

2021 ◽

Vol 27 (1) ◽

pp. 30-36

Author(s):

Çağdaş Biçen ◽

Mehmet Akdemir ◽

Mehmet Aykut Türken ◽

Kübra Çekok

Keyword(s):

Femoral Neck ◽

Clinical Outcomes ◽

The Elderly ◽

Femoral Neck Fractures ◽

Short Term ◽

Retrospective Comparison ◽

Long Stem ◽

Long Stem Prosthesis

Download Full-text

Hip fractures among the elderly in Kyoto, Japan: a 10-year study

Archives of Osteoporosis ◽

10.1007/s11657-021-00888-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maki Asada ◽

Motoyuki Horii ◽

Kazuya Ikoma ◽

Tsuyoshi Goto ◽

Naoki Okubo ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Incidence Rate ◽

Acute Care ◽

Hip Fractures ◽

Age Groups ◽

The Elderly ◽

Femoral Neck Fractures ◽

Age Group ◽

Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

Download Full-text