INTRACAPSULAR FEMORAL NECK FRACTURES

Objectives: To compare of functional outcomes in terms of post-operativemobility for unipolar versus bipolar un-cemented hemiarthroplasty in elderly patients withdisplaced intracapsular femoral neck fractures. Study Design: Randomized Control Trial.Setting: Department of Orthopedics Bahawal Victoria Hospital, Bahawalpur. Period: April 2015to October 2016. Methodology: Sample size is (calculated by taking n6 =138, confidenceinterval 95, power of study 80, P1= 33%, P2=13%) 69 in each group. Sampling technique usedwas non probability consecutive sampling. All patients who meet the inclusion criteria presentingto orthopedic unit of Nishtar Hospital Multan with fracture neck of femur were selected for study.Patients were divided into two groups randomly by lottery method and enrolled for unipolaror bipolar hemiarthroplasty. Chi-square test was used to compare outcome variable in bothgroups. A p-value < 0.05 was considered statistically significant. Effect modifiers like age andsex was controlled by stratification. Chi square test was applied to see significant difference.Results: Overall, there were 100% (n=138) patients in this study, both genders. The mean ageof the patients was 66.35±4.29 years. (Range: 60 to 80years)Mean age and SD of group A (nowalking aid) was 54.52 ± 3.10 and in group B (walking aid) 54.99 ± 3.19. Time up go score wasnoted as successful 33.3% (n=46) and 66.7% (n=92) as unsuccessful. Walking aid was notedin 65.2% (n=90) patients. Functional outcome was noted as good in 26.8% (n=37) patientsand noted as bad in 73.2% (n=101) patients. Out of 100% (n=38) patients, good outcomewas 26.3% (n=10) unipolar and 73.7% (n=28) bipolar. Out of 100% (n=100) Bad outcomewas 59% unipolar and bipolar 41%. Conclusion: Functional outcome in term of mobility isbetter in case of bipolar prosthesis as compared to unipolar. Thus in our conclusion bipolarprosthesis is preferred procedure as compared to unipolar hemiarthroplasty in treating patientswith displaced intracapsular femoral neck fracture.

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Functional Outcome of Intracapsular Femoral Neck Fractures Treated by Bipolar Hemiarthroplasty

10.53350/pjmhs21155988 ◽

2021 ◽

Vol 15 (5) ◽

pp. 988-991

Author(s):

Zamir Hussain Tunioi ◽

Rizwan Ali Jhatiyal ◽

M Azeem Akhund ◽

M Kashif Abbasi ◽

L Das Maheshwari ◽

...

Keyword(s):

Femoral Neck ◽

Functional Outcome ◽

Femoral Neck Fractures ◽

University Hospital ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Cross Sectional ◽

Average Hospital

Aim: To evaluate the functional outcome of bipolar hemiarthroplasty in intracapsular fracture neck of femur. Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopaedic Surgery & Traumatology, Peoples Medical University Hospital, Shaheed Benazir Abad from 1st December 2017 to 31st December 2020. Methodology: Sixty six cases of intracapsular femoral neck fractures with age ranging from 50 year to 75 year of either gender who were ambulatory before injury were included; while basicervical, younger than 50 years, with neuromuscular disorder, unfit for surgery, open fracture, bilateral injuries, osteoarthritis of hip, Rheumatoid, Gouty, pathological fractures, bedridden & who did not give consent for study, were excluded from the study. Functional outcome assessed by Harris hip score & data analyzed by SPSS version 23. Results: Twenty six (59.09%) were male and 40 (40.91%) were female with mean age of 64.3±7.77 year. Average time from injury to hospital arrival was 14.7±6.8 hours. Average time from hospitalization to surgery was 4.67±2.23 days. Average time of surgery was 55.67±9.9 minutes. Average hospital stay was 9.7±4.3 days. The average time of follow-up was 18.45±7.63 months. Conclusion: Bipolar implant is safe, effective, reliable, stable and cost effective implant for intracpsular fracture of femoral neck in elderly populace. The 66.66% of patients have satisfactory Harris hip score in follow up duration of 18.45±7.63 months. Keywords: Functional, Outcome, Femoral neck fractures, FNF, Bipolar, Hemiarthroplasty, HHS

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Faculty Opinions recommendation of Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726574877.793521362 ◽

2016 ◽

Author(s):

Mark D Neuman

Keyword(s):

Femoral Neck ◽

Elderly Patients ◽

Functional Outcome ◽

Femoral Component ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Medium Term ◽

Displaced Femoral Neck Fractures

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A study of prospective analysis of unipolar versus bipolar hemiarthroplasty of hip joint in patients with fracture neck of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211621 ◽

2021 ◽

Vol 7 (3) ◽

pp. 629

Author(s):

Raja X. ◽

Arjun Sarvesh ◽

Karthikeyen M. ◽

A. E. Manoharan

Keyword(s):

Femoral Neck ◽

Weight Bearing ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Early Weight Bearing ◽

Group I ◽

Significant Difference ◽

Group Ii

Background: Femoral neck fractures occur most commonly in elderly females and are a major cause of morbidity and mortality in this age group and require immediate and appropriate management. Aim of the study was to compare the functional outcome of unipolar Austin Moore's prosthesis (AMP) hemiarthroplasty (HA) and bipolar (BHA) HA with femoral neck fractures using Harris hip score system.Methods: The study was conducted on 60 patients aged above 50 years with fractured neck of femur admitted in Vinayaka missions Kirupananda Variyar medical college and hospital from August 2017 to August 2019. Patients with femoral neck fracture were allocated randomly to have 30 cases of AMP.Results: Out of the 60 cases, the patients in the bipolar (nonmodular) HA group II showed better functional outcomes compared to unipolar (AMP) HA group I after six months follow-ups. At 12 months of follow-up, there was no significant difference between group I (AMP) and group II (BHA).Conclusions: Our study demonstrates, hemiarthroplasty of the hip for femoral neck fractures is a good option in elderly patients. The mortality and morbidity are not high, the operative procedure is simple, complications are less disabling, early weight-bearing and functional results are satisfactory and second surgery are less frequently required.

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Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-014-2053-1 ◽

2014 ◽

Vol 134 (9) ◽

pp. 1251-1259 ◽

Cited By ~ 18

Author(s):

Kari Kanto ◽

Raine Sihvonen ◽

Antti Eskelinen ◽

Minna Laitinen

Keyword(s):

Femoral Neck ◽

Elderly Patients ◽

Functional Outcome ◽

Femoral Component ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Medium Term ◽

Displaced Femoral Neck Fractures

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Surgical management of intracapsular fracture neck femur by hemiarthroplasty between uncemented bipolar prosthesis and Austin Moore’s prosthesis: a comparative study in elderly population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192565 ◽

2019 ◽

Vol 5 (4) ◽

pp. 612

Author(s):

H. D. Veeranna ◽

K. B. Ravi ◽

K. Anudeep Kumar

Keyword(s):

Femoral Neck ◽

Elderly Population ◽

Early Mobilization ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Bipolar Prosthesis ◽

Fracture Neck Femur ◽

Displaced Femoral Neck Fractures

Background: Intracapsular femoral neck fractures are common in elderly population after a simple fall. To avoid the drawbacks of internal fixation and for the early mobilization, hemiarthroplasty is performed in elderly. The aim of this study is to compare the outcome AMP with uncemented bipolar prosthesis in geriatric patients.Methods: 51 patients above 60 years and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either AMP (Austin Moore prosthesis) or bipolar hemiarthroplasty, in the Department of Orthopaedics, Sri Siddhartha medical college, Tumkur between April 2014 and May 2017. The patients were summoned at 6 weeks, 12 weeks, 6 months and 1 year. Functional outcome was assessed and compared with modified Harris hip score and radiological parameters.Results: The mean Harris hip score in bipolar and AMP group was 86.31±12.1 and 79.86±15.42, respectively (p=0.182). The range of motion was 204.52±28.2 and 183.62±36 (p=0.014) respectively. Functional activities like use of public transport and ability to wear shoe or socks was better with bipolar group. Incidence of complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion was encountered in AMP group.Conclusions: The use of uncemented bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.

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A PROSPECTIVE STUDY OF COMPLICATIONS IN BIPOLAR HEMIARTHROPLASTY USING MODIFIED HARDINGE APPROACH IN THE MANAGEMENT OF FEMORAL NECK FRACTURES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1287 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Mukka Naveen ◽

N. Srinivas Reddy

Keyword(s):

Femoral Neck ◽

Functional Outcomes ◽

Hip Dislocation ◽

Femoral Neck Fractures ◽

Surgical Approaches ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Geriatric Population ◽

Neck Fracture ◽

Hardinge Approach

Introduction: Fracture of femoral neck is on the rise in the recent years owing to the increase in the geriatric population, severe osteoporosis and increased brittleness of the bone with advancing age. Total hip replacement was mostly used in the initial days but owing to higher chances of dislocations, it is less preferred. Bipolar hemiarthroplasty has become one of the main methods of treatment. A variety of surgical approaches have been used. Posterior approach is the most preferred approach currently, followed by Hardinge approach. Complications like dislocation, infection and abductor lurch are still common with current approaches. This study was undertaken to show the functional outcomes of a Modified Hardinge approach which seems to have optimal results out of all the approaches. Aim: To evaluate the functional outcomes and complications of modified hardinge approach. Materials and Methods: A total of 20 patients with fracture neck of femur were taken into the study and treated with Bipolar Hemiarthroplasty using modified Hardinge approach between June 2018 and October 2019. Each patient was put through the same preoperative and postoperative protocols. They was screened for comorbidities and were taken up for surgery. Complications after this approach were evaluated post operatively for a period of 6 months. Results: The mean hip score was 80. Complications like posterior hip dislocation and infection were nil. Abductor lurch was not noted in any of the patients. One patient had infection out of 20 which was managed accordingly. Conclusion: Bipolar hemiarthroplasty through modified Hardinge approach can be used in the management of femoral neck fractures with lowest complication rate. Complications like posterior dislocation and abductor lurch were nil in the study. The only downside of the procedure being a longer learning curve makes it a less used approach compared to others. Keywords: Hemiarthroplasty, modified Hardinge approach, femoral neck fracture

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A Retrospective Cohort Study of the Variable Pitch Fully Threaded Headless Screws and Partially Threaded Screws in the Treatment of Femoral Neck Fractures

10.21203/rs.3.rs-107862/v1 ◽

2020 ◽

Author(s):

Yilin Wang ◽

Na Han ◽

Dianying Zhang ◽

Peixun Zhang ◽

Baoguo Jiang

Keyword(s):

Femoral Neck ◽

Statistical Significance ◽

Femoral Neck Fractures ◽

P Value ◽

Chi Square ◽

Variable Pitch ◽

Decrease Rate ◽

Significant Difference ◽

Femoral Shortening ◽

Shortening Rate

Abstract (1) Introduction: The choices of the treatments for femoral neck fractures remain controversial. The purpose of this study is to evaluate the prognoses of the variable pitch fully threaded headless screws in the fixation of femoral neck fractures and to compare them with those of partially threaded cannulated screws. (2) Materials and Methods: Between 1st January 2012 and 31st December 2016, there were 89 patients with the main diagnose of femoral neck fracture who accepted the treatment of closed reduction cannulated screw fixation in Peking University People’s Hospital. 34 cases of partially threaded screws and 23 cases of fully threaded screws met the criterion. The characteristics, prognoses and the imaging changes of all cases were described and the differences between the two groups were compared. Statistical analyses were performed using SPSS version 23.0 (SPSS Inc., USA). Mann-Whitney U test, Analysis of Variance and Chi-square test were used. Statistical significance was defined as P value (two sided) less than 0.05. (3) Results: There was no significant difference in the general characteristics, fracture classifications and reduction quality between the two groups. The fully threaded group had a significant lower angle decrease rate (30.4% vs. 58.8%, P = 0.035), femoral neck shortening rate (26.1% vs. 52.9%, P = 0.044) and screw back-sliding rate (21.7% vs. 50.0%, P = 0.032), but a higher screw cut-out rate (21.7% vs. 0.0%, P = 0.008). No significant difference was found in the nonunion rate (8.7% vs. 0.0%, P = 0.159), avascular necrosis rate (17.4% vs. 23.5%, P = 0.744) and the good and excellent rate of Harris score (73.9% vs. 82.4%, P = 0.443). (4) Conclusion: Compared with the partially threaded screws, the variable pitch fully threaded headless screws had a lower screw back-sliding rate, femoral shortening rate, angle decrease rate and similar function score, but would result in more screw cut-outs and nonunions in Garden III-IV and Pauwels III fractures. As a conclusion, the variable pitch full threaded screws are recommended in stable undisplaced fractures rather than displaced unstable fractures. Further qualified investigations with a larger scale of patients and longer follow-up are needed in the future.

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Study of femoral neck fractures in elderly patients of Malayalam population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194831 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1207

Author(s):

Jayakrishnan Rajasekharan

Keyword(s):

Elderly Patients ◽

Mean Value ◽

Harris Hip Score ◽

P Value ◽

Chi Square ◽

Neck Of Femur ◽

Old Patients ◽

Neck Fracture ◽

Chi Square Test ◽

History Of

Background: 53 elderly patients aged between 51 to 80 were operated for fracture of neck of Femur to compare the two methods for early healing.Methods: All patients selected for bipolar hemiarthopalsty. Out of them 25 were cemented, and 28 were un-cemented. Every patients was operated through posterior (Southern- Moore) approach. Harris Hip score was studied to assess the duration of improvement.Results: History of the patients was 12 (22.6%) were diabetic mellitus, 14 (26.4%) were Hypertensive 9 (16.9%) were alcoholic, 18 (33.9%) were normal (NAD) in the comparison of Harris Hip score at different age-in 51-60 years mean value was 92.8, (SD±0.3), in 61-70 years mean value was 85.1 (SD±0.26), in 71-80 years mean value was 81.9 (SD±0.26), On total sum of score was 729.6, DF was 51, MSS was 363, 0.07, F=ratio was 5019, p value was highly significant (p<0.01). In the comparative study of Harris Hip score degrees in both methods were quite functional, chi-square test was 3.90 DF=3, and p>0.05.Conclusions: This study of bipolar hemiartho pasty with cement or without cement will be quite effective to treat the neck fracture in old patients due to its dual fixation because calcar femorale present in the neck of the femur become function less with advancement of age moreover neck of the femur is devoid of periosteum Hence healing of neck fracture of the femur is medical challenge.

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