scholarly journals Primary Total Hip Arthroplasty versus Open Reduction and Internal Fixation in Displaced Fracture of Femoral Neck in Adults

2021 ◽  
Author(s):  
Kamran Asadi ◽  
Yasaman Soleimanmanesh ◽  
Arman Keymoradzadeh ◽  
Nazanin Soleimanmanesh
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Fixation Device ◽  
Non Union ◽  
Internal Fixation Device ◽  
Fixation Group ◽  
Neck Fracture ◽  
Hip Function ◽  
Displaced Fracture

Background: Femoral neck fracture as a prevalent skeletal injury accounts for 7% of orthopedic hospital admission. The aim of the present study is to evaluate the functional outcome of patients with femoral neck fracture treated with total hip arthroplasty (THA) and compare them with those undergoing fixation treatment. Methods: In this study, we reviewed patients in the age range of 45-60 years old with femoral neck fracture during 2007-2017. The subjects were assigned to either THA or fixation group. The primary outcome was hip function, evaluated with the Harris Hip Scale (HHS). Secondary outcomes included pain, local infection, avascular necrosis (AVN), thromboembolic event, loosening of the prosthetic and internal fixation device, prosthetic dislocation, non-union, and delayed-union. Results: In this study, 34 patients with displaced fracture of femoral neck were treated with acute THA and 38 patients were treated with fixation. The HHS was higher in the THA group compared to the fixation group (P < 0.050). The results of the present study indicated no significant difference in early postoperative complications over the first month between the two groups, but frequency of complications such as non-union, AVN, pain and loosening of the internal fixation device in the fixation group were significantly higher than the THA group after six months (P < 0.050). Conclusion: Over a period of six months, THA provided better hip function and significantly fewer postoperative complications compared to fixation.

scholarly journals Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hsuan-Hsiao Ma ◽  
Te-Feng Arthur Chou ◽  
Shang-Wen Tsai ◽  
Cheng-Fong Chen ◽  
Po-Kuei Wu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Reoperation Rate ◽  
Fixation Group ◽  
Neck Fracture

Abstract Background Although internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures. Methods We performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration. Results Our results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD − 0.800, 95% CI − 1.011 to − 0.589) and operation duration (SMD − 2.497, 95% CI − 2.801 to − 2.193) were shorter in the internal fixation group. Conclusions Compared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.

scholarly journals Treatment of nonunion after femoral neck fracture with valgus intertrochanteric osteotomy: a case report with 18-year follow-up

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110126
Author(s):  
Qi-Jia Zhou ◽  
Xiao-Qiang Peng ◽  
Zheng-Guo Fei ◽  
Xiao-Hu Zhu ◽  
Chun-Guang Sun
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Term Effect ◽  
Intertrochanteric Osteotomy ◽  
Fixation Device ◽  
Internal Fixation Device ◽  
Long Term Effect ◽  
Neck Fracture

We herein report the long-term effect of valgus intertrochanteric osteotomy for nonunion after femoral neck fracture. In this report, we describe our experience using valgus intertrochanteric osteotomy to treat nonunion after femoral neck fracture in a 20-year-old woman. The patient was discharged from the hospital 10 days after the operation, the internal fixation device was removed 1 year after the operation, and the patient was then followed up for 18 years. Valgus intertrochanteric osteotomy can effectively treat nonunion after adductive femoral neck fracture.

Combination of CRP with NLR is a sensitive tool for screening fixation-related infection in patients undergoing conversion total hip arthroplasty after failed internal fixation for femoral neck fracture

2021 ◽  
pp. 1-7
Author(s):  
Hong Xu ◽  
Jin-Wei Xie ◽  
Li Liu ◽  
Duan Wang ◽  
Ze-Yu Huang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Sensitivity And Specificity ◽  
Hip Arthroplasty ◽  
Lymphocyte Ratio ◽  
Total Hip ◽  
Sensitive Tool ◽  
Neck Fracture

Aims Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture. Methods We retrospectively included 340 patients who underwent conversion THA after internal fixation for femoral neck fracture from January 2008 to September 2020. Those patients constituted two groups: noninfected patients and patients diagnosed with FRI according to the 2013 International Consensus Meeting Criteria. Receiver operating characteristic (ROC) curves were used to determine maximum sensitivity and specificity of these two preoperative ratios. The diagnostic performance of the two ratios combined with preoperative CRP or ESR was also evaluated. Results The numbers of patients with and without FRI were 19 (5.6%) and 321 (94.4%), respectively. Areas under the ROC curve for diagnosing FRI were 0.763 for MLR, 0.686 for NLR, 0.905 for CRP, and 0.769 for ESR. Based on the Youden index, the optimal predictive cutoffs were 0.25 for MLR and 2.38 for NLR. Sensitivity and specificity were 78.9% and 71.0% for MLR, and 78.9% and 56.4% for NLR, respectively. The combination of CRP with MLR showed a sensitivity of 84.2% and specificity of 94.6%, while the corresponding values for the combination of CRP with NLR were 89.5% and 91.5%, respectively. Conclusion The presence of preoperative FRI among patients undergoing conversion THA after internal fixation for femoral neck fracture should be determined. The combination of preoperative CRP with NLR is sensitive tool for screening FRI in those patients.

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.

scholarly journals Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly

2016 ◽  
Vol 129 (21) ◽  
pp. 2630-2638 ◽  
Author(s):  
Chen-Yi Ye ◽  
An Liu ◽  
Ming-Yuan Xu ◽  
Nwofor Samuel Nonso ◽  
Rong-Xin He
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
The Elderly ◽  
Neck Fracture ◽  
Intracapsular Femoral Neck Fracture
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