Co-occurrence of subchondral insufficiency fracture of the femoral head and contralateral femoral neck fracture in a rheumatic patient receiving steroid treatment

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.

Download Full-text

DSA Observation of Hemodynamic Response of Femoral Head With Femoral Neck Fracture During Traction

Journal of Orthopaedic Trauma ◽

10.1097/bot.0b013e318265ea97 ◽

2012 ◽

Vol 26 (9) ◽

pp. e168 ◽

Cited By ~ 1

Author(s):

Jun Lin ◽

Huilin Yang

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hemodynamic Response ◽

Neck Fracture

Download Full-text

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

The Bone & Joint Journal ◽

10.1302/0301-620x.104b1.bjj-2021-0855.r1 ◽

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.

Download Full-text