FEMORAL NECK FRACTURES GARDEN I AND II: EVALUATION OF THE DEVIATION IN LATERAL VIEW

ABSTRACT Objective: To evaluate the rate of deviation in the lateral radiographic incidence in patients with femoral neck fracture classified as non-diverted in the anteroposterior view (Garden I and II). Methods: Nineteen selected patients with femoral neck fractures classified as Garden I and II were retrospectively evaluated, estimating the degree of deviation in the lateral view. Results: Fifteen cases (79%) presented deviations in lateral view, with a mean of 18.6 degrees (±15.5). Conclusion: Most fractures of the femoral neck classified as Garden I and II present some degree of posterior deviation in the X-ray lateral view. Level of Evidence III, Retrospective Comparative Study.

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Treatment of the femoral neck peudoarthrosis in childhood: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1304237v ◽

2013 ◽

Vol 141 (3-4) ◽

pp. 237-241

Author(s):

Zoran Vukasinovic ◽

Igor Seslija ◽

Mladen Pavlovic ◽

Zorica Zivkovic

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Bed Rest ◽

Primary Treatment ◽

Femoral Neck Fractures ◽

Coxa Vara ◽

X Ray ◽

Fractures In Children ◽

Neck Fracture

Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5?year?old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X?ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit?). Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow?up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X?ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults) can prevent the occurrence of femoral neck pseudoarthrosis.

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BIOMECHANICAL ANALYSIS OF FEMORAL NECK FRACTURE FIXATION IN SYNTHETIC BONE

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182603182288 ◽

2018 ◽

Vol 26 (3) ◽

pp. 162-165

Author(s):

HENRIQUE MANSUR ◽

RAFAEL ALVAREZ ◽

ANDERSON FREITAS ◽

CESAR BARBOSA GONÇALVES ◽

MAX ROGERIO FREITAS RAMOS

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Femoral Neck Fractures ◽

Biomechanical Analysis ◽

Type Ii ◽

Cannulated Screws ◽

Level Of Evidence ◽

Synthetic Bone ◽

Significant Difference ◽

Neck Fracture

ABSTRACT Objectives To analyze the results of biomechanical assays of the fixation of Pauwels type II femoral neck fractures in synthetic bones, using two parallel cannulated screws or three cannulated screws in an inverted pyramid formation. Methods Ten Brazilian-made synthetic bones were divided into 2 groups. Groups A and B utilized three and two cannulated screws, respectively, after osteotomy in the middle third of the femur, perpendicular to the axis of the femoral neck, simulating a Pauwels type II femoral neck fracture. The resistance of these fixations was analyzed by compression on the axis of the force resulting from hip compression, simulated with a manual hydraulic press. The T-test and post hoc analysis were used to compare the groups, and the significance criterion adopted was p < 0.05. Results In group A, which used fixation with three screws, synthesis failure was seen at a mean force of 526 N. In group B, which used two screws, the mean force was 466 N. The results presented a statistically significant difference (p = 0.02). Conclusion The osteosynthesis of femoral neck fractures in synthetic bone fixated with two screws presented inferior results to fixation with three screws. Level of Evidence III; Case-control study.

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Impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture

Hip International ◽

10.1177/11207000211028502 ◽

2021 ◽

pp. 112070002110285

Author(s):

Pradip Ramamurti ◽

Safa C Fassihi ◽

David Sacolick ◽

Alex Gu ◽

Chapman Wei ◽

...

Keyword(s):

Renal Function ◽

Risk Factor ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Impaired Renal Function ◽

Independent Risk Factor ◽

Femoral Neck Fractures ◽

Stage 4 ◽

Ckd Stage ◽

Neck Fracture

Background: The metabolic abnormalities that occur secondary to chronic kidney disease (CKD) increase the risk of femoral neck fractures compared to the general population. The purpose of this study is to determine whether impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. Methods: The ACS-NSQIP database was reviewed for patients who underwent total hip arthroplasty, hemiarthroplasty and open reduction internal fixation (ORIF) for femoral neck fractures between 2007 and 2018. Patients were split into cohorts based on calculated estimated glomerular filtration rate. Demographic information, comorbidities, and 30-day complications were analysed with univariate and multivariate analyses using chi-square, Fischer’s exact and analysis of variance testing. Results: The total number of patients for the study was 163,717. Patients with CKD stage 4 and 5 had an increased rate of any complication (39.1 and 36.7% respectively) compared with higher eGFRs ( p < 0.001). Similarly, 30-day mortality was increased at 6.0% and 6.7% for both stage 4 and 5 ( p < 0.001). By multivariate regression, those with CKD Stage 4 and 5 were at increased risk for any complication compared to patients with a normal preoperative eGFR of 90–120 ( p < 0.001). Conclusions: This study demonstrated that patients with CKD Stage 4 and 5 are at increased risks of all complications, including death, renal, pulmonary and thromboembolic disease. Therefore, these patients should be cared for from a multidisciplinary approach with close attention to postoperative medications and fall prevention to help mitigate the risk of complications in the immediate postoperative period.

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

10.21203/rs.3.rs-150244/v1 ◽

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.

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Calcar buttressed screw fixation for femoral neck fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185337 ◽

2018 ◽

Vol 5 (1) ◽

pp. 145

Author(s):

K. K. Arvind Manoj ◽

R. Karthik ◽

A. Vishnu Sankar

Keyword(s):

Femoral Neck ◽

Functional Outcome ◽

Femoral Neck Fracture ◽

Screw Fixation ◽

Femoral Neck Fractures ◽

Fixation Strength ◽

Harris Hip Score ◽

Average Period ◽

Excellent Outcome ◽

Neck Fracture

Background: The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture as far as treatment and results are concerned. There are different views regarding the optimal method of internal ﬁxation in femoral neck fractures. Biomechanical data from literature suggest that calcar ﬁxation is superior to central screws placement. This study aims to analyse the functional and radiological outcome of femoral neck fractures treated by calcar buttressed screw fixation described by Filipov as biplane double supported screw fixation.Methods: This is a prospective study conducted in our institution from May 2015 to May 2018.The study included 43 patients (31 male, 12 female) with femoral neck fracture. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Patients were followed up for average period of 2 years. Functional outcome was evaluated using Harris Hip score.Results: Bone union occurred in 40 patients (93%) with average period of 3-4 months. 51.2% of cases had excellent outcome. 23.2% of cases had good and 16.3% of cases had fair outcome. 9.3% of cases ended with poor outcome. Non union was reported in 3 patients (7%) and AVN in one patient. Various factors like age, Garden and Pauwel fracture types, time of presentation and time of surgery were statistically significant to the final functional outcome in our study.Conclusions: By providing additional calcar buttress compared to conventional method, this technique of screw fixation enhances femoral neck fracture fixation strength and reduces the fixation failure.

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

Kansas Journal of Medicine ◽

10.17161/kjm.v13i.14563 ◽

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.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0124 ◽

2016 ◽

Vol 98 (6) ◽

pp. 376-379 ◽

Cited By ~ 4

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.

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Modified F Configuration in the Treatment of Pauwels Type III Femoral Neck Fracture: a Finite Element Analysis

10.21203/rs.3.rs-135954/v1 ◽

2021 ◽

Author(s):

Shiyuan Lin ◽

Huizi Li ◽

Kai Tong ◽

Zihang Feng ◽

Gang Wang ◽

...

Keyword(s):

Finite Element ◽

Stress Distribution ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Femoral Neck Fractures ◽

Cannulated Screw ◽

Type Iii ◽

Neck Fracture ◽

Maximum Crack ◽

Hip Screw

Abstract Background: The optimal treatment of Pauwels type III femoral neck fracture in young patients remains a worldwide challenge in orthopedic surgery. Methods: Finite element models of four internal fixations were developed to treat Pauwels type III Femoral neck fracture: a: the traditional inverted triangular cannulated screw model, b: the F-technique cannulated screw model, c: the modified F-technique cannulated screw model using a fully threaded screw instead of a partially threaded distally, d: the dynamic hip screw coupled with anti-rotational screw model. Under the same conditions, finite element analyses were carried out to compare the displacement and von Mises stress distribution of four internal fixations and femurs, the maximum crack distances of the fracture surfaces, Z axis displacements of four models as well as the stress distribution in the subtrochanteric region. Results: The modified F-technique configuration resulted in a more stable fixation as compared to the other three approaches, with respect to the maximum displacement and stress peaks of femur and internal fixations, the maximum crack distances of the fracture surfaces, Z axis displacements of four configurations as well as the stress distribution in the subtrochanteric region.Conclusions: Our results suggested that modified F-technique configuration show a better performance in resisting shearing and rotational forces in treating Pauwels type III femoral neck fractures compared to those using traditional inverted triangular, the F-technique configuration or dynamic hip screw coupled with anti-rotational screw, providing a new choice for the treatment of femoral neck fractures.

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Comparative Analysis of Preoperative and Postoperative Muscle Around Hip Joint by Computed Tomography Between Intertrochanteric Fracture and Femur Neck Fracture

10.21203/rs.3.rs-65484/v1 ◽

2020 ◽

Author(s):

Sung Yoon Jung ◽

Hyeon Jun Kim ◽

Kyu Taek Oh

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Intertrochanteric Fracture ◽

Femoral Neck Fractures ◽

Final Visit ◽

Cross Sectional ◽

Fracture Group ◽

Significant Difference ◽

Neck Fracture

Abstract Background:This study assessed the changes in hip muscles by comparing the preoperative and postoperative CT scan results between patients with intertrochanteric versus femoral neck fractures. Methods:48 patients who received surgical treatment for intertrochanteric or femoral neck fractures from February 2013 to February 2019 and underwent pelvic computed tomography(CT) preoperative and postoperatively aged 65 and older with a minimum follow-up of 1 year were included. The subjects were divided into two groups: 26 patients with intertrochanteric fracture and 22 patients with femoral neck fracture. We measured the cross-sectional area(CSA) and attenuation of the gluteus medius(G.med), gluteus minimus(G.min), iliopsoas(IP), and rectus femoris(RF) on the contralateral side. Patient basic data were collected from medial records including sex, age, height, weight, BMI, BMD, Harris hip score (HHS), and length of follow-up until the final visit. Results: There was no significant difference in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up until the final visit between two groups. The femoral neck fracture group had significantly larger CSA and cross-sectional area per weight(CSA/Wt) of the G.med and G.min(G.med CSA, CSA/wt preoperative 1995.29 vs 1713.64, 38.87 vs 32.74; postoperative 2144.98 vs 1815.56, 37.48 vs 32.78/G.min preoperative 745.22 vs 566.59, 14.32 vs 10.96; postoperative 764.39 vs 619.17, 14.78 vs 11.25). On the contrary, the intertrochanteric fracture group had significantly greater CSA and CSA/Wt of the IP and RF(IP preoperative 810.86 vs 661.88, 17.73 vs 9.42; postoperative 681.98 vs 571.32, 12.68 vs 9.88/RF preoperative 503.66 vs 386.72, 9.42 vs 7.23; postoperative 426.24 vs 349.31, 7.17 vs 5.23). HHS related with function had no significant correlation with postoperative CSA and CSA/Wt. There was no significant difference in attenuation between two groups. All subjects had a significant decrease of muscle attenuation postoperatively.Conclusions: The CSA of the hip abductor(G.med and G.min) was significantly larger in the femoral neck fracture group, while the CSA of the hip flexor(IP and RF) was significantly higher in the intertrochanteric fracture group. Based on these findings, choosing the rehabilitation program suitable for the fracture site is expected to be beneficial in hip fracture rehabilitation.

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