scholarly journals A Convenient Way to do Valgus Osteotomy for Neglected Fracture Neck of Femur

2015 ◽  
Vol 11 (2) ◽  
pp. 147-151
Author(s):  
P Bansal ◽  
V Singhal ◽  
H Lal ◽  
D Mittal ◽  
RK Arya
Keyword(s):  
Young Adults ◽  
Successful Outcome ◽  
Harris Hip Score ◽  
Wedge Osteotomy ◽  
Valgus Osteotomy ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
Hip Screw ◽  
Prospective Longitudinal

Background Neglected fracture of neck of femur in young adults is a major problem in developing countries. Existing treatment options varies from osteotomy to various graft techniques (muscle pedicle, vascularized and nonvascularized fibula etc.). There is paucity of literature regarding the use of double angle barrel plate and hip screw in such cases. We conducted a prospective longitudinal observational study with displaced, neglected fracture neck of femur in young adults and compared the results with literature. Objectives The aim of this study was to determine feasibility and effectiveness of 120° double angle barrel plate and hip screw fixation in neglected fracture neck of femur. Effectiveness of fixed 30 degree closed wedge osteotomy in neglected fracture neck of femur. Methods Thirty cases of neglected (more than three weeks) femoral neck fracture (Pauwel II and III) of age 20-60 years were included in the study conducted at Postgraduate Institute Of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India in year 2004-06. Average age of the patient was 35.4 years (range, 22yrs-55yrs). In all cases internal fixation was done by 120° double angle barrel plate and hip Screw. At the end of follow-up, results were evaluated according to Askin Bryan Criteria and Harris-hip score. Results Union was achieved in 28 of 30 patients. Two patients that went into nonunion were later treated with hemireplacement arthroplasty. According to Askin Bryan Criteria at the end of study, 35% patients had excellent results, 50% patients had good results. Minimum follow-up in our study was 12 months and maximum was five years. Conclusion This study validates the use of double angled screw plate configuration for successful outcome in patients with neglected fracture neck of femur. Valgus osteotomy is also technically easy operation in hands of average trauma surgeon with the use of a fixed angle plate and hip screw.DOI: http://dx.doi.org/10.3126/kumj.v11i2.12491 Kathmandu University Medical Journal Vol.11(2) 2013: 147-151

scholarly journals Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

2020 ◽  
Vol 6 (5) ◽  
pp. 920
Author(s):  
Venugopal S. M. ◽  
Naveen Babu ◽  
Naresh Odnala ◽  
Gudaru Jagadesh
Keyword(s):  
Femoral Neck ◽  
Young Patients ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Osteotomy Site ◽  
Valgus Osteotomy ◽  
Neck Of Femur ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients &gt;60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.</p><p class="abstract"><strong>Conclusions:</strong> Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.</p>

scholarly journals Hemiarthroplasty for intra-capsular fracture neck of femur in elderly patients: a prospective observational study

2017 ◽  
Vol 3 (5) ◽  
pp. 991
Author(s):  
Abhishek Kalantri ◽  
Sunil Barod ◽  
Dilip Kothari ◽  
Archana Kothari ◽  
Ashok Nagla ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Road Traffic ◽  
Excellent Result ◽  
Operative Procedure ◽  
Functional Results ◽  
Harris Hip Score ◽  
Neck Of Femur ◽  
Mortality And Morbidity ◽  
Fracture Neck Of Femur

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. This study was aimed at evaluating the outcome of hemiarthroplasty, by assessing the quality of life and degree of function in the operated limb.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Out of 30 patients treated in this manner, all cases were available for follow-up period of 6 months. Patients of age 60 years and above, diagnosed with fracture neck of femur, were included in the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of patients belongs to age group 60-69 years was 56.7% Females were more common 56.7% than males in the present study. About 13.3% patients sustained the injury due to a fall from a height and 23.3% due to a road traffic accident. About 20 patients (60%) had a stay of less than 20 days in hospital. In our study Harris hip score, at end of six month ranged from 35 to 94.6. At final 6 months follow-up by Harris hip scoring system, 53.33% had excellent result, 33.3% had good results, 16.67% had fair results and 6.67% had poor results. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients. The mortality and morbidity are not high, operative procedure is simple, complications are less disabling. Early functional results are satisfactory.</span></p>

scholarly journals Surgical management of basicervical fracture neck of femur with dynamic hip screw and derotation screw: a prospective study

2019 ◽  
Vol 5 (4) ◽  
pp. 712
Author(s):  
Vijaykumar S. Kulambi ◽  
Ajay Shringeri Satish ◽  
Prathik Rangaraja
Keyword(s):  
Functional Outcome ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Care Hospital ◽  
Fracture Union ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
Hip Screw ◽  
One Year ◽  
Modified Harris Hip Score

<p class="abstract"><strong>Background:</strong> Basicervical region of femur is that part of femur which is intermediate between neck and intertrochanteric region. Fracture in this region carry substantially higher chances of failure due to greater fracture angle and are rotationally unstable. If treated inadequately they carry very high chances of fracture non-union and theoretically risk of osteonecrosis. The objective of the study was to analyse functional outcome of basicervical fracture neck of femur fixation with dynamic hip screw and de-rotation screw in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> 35 cases of basicervical fracture neck of femur admitted in Chigatteri General Hospital and Bapuji Hospital affiliated to JJM Medical College Davangere, in the period of October 2015 to October 2018. Functional outcome was assessed according to Modified Harris Hip Score after one year of follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> The fracture union was found in 100% cases, average time period for fracture union was 12.28±3.71 weeks (11-15 weeks range). The results according to Modified Harris hip score were excellent in 70%, good in 11.4%. good in 5.7% and poor in 2.8% at the end of one year. The correlation analysis with Pearson’s correlation coefficient (r) was 0.74 which show a highly positive correlation between the union of basicervical fracture neck of femur with dynamic hip screw and derotation screw.</p><p><strong>Conclusions:</strong> With the study of 35 cases of basicervical fracture neck femur we conclude that these are a unique type of fractures mid-way between neck and intertrochanteric fractures with rotational and axial instability, and also risk of osteonecrosis. DHS allows for controlled collapse of the fracture for uneventful healing, and de-rotation screw gives rotational stability. </p>

scholarly journals Cementless bipolar hemiarthroplasty for displaced fracture neck of femur with modular hydroxyapatite coated stem in elderly with cardiopulmonary co-morbidities

2017 ◽  
Vol 5 (5) ◽  
pp. 1862
Author(s):  
Towseef Ahmad Bhat ◽  
Zameer Ali ◽  
Amara Gulzar ◽  
Furqaan Mirza
Keyword(s):  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Anterolateral Approach ◽  
Bipolar Hemiarthroplasty ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
Cardiopulmonary Complications

Background: Bipolar hemiarthroplasty is one of the common procedures done for fracture neck of femur in elderly.  Debate about Cemented or cementless is still on. Cementing increases perioperative mortality by causing significant hemodynamic changes or embolization. Patients with cardiopulmonary complications are at higher risk of cementing complications. We report our series of 31 cases of fracture neck of femur with cardiopulmonary diseases operated over 2 years with modular cementless bipolar hemiarthroplasty.Methods: 31 elderly patients with cardiopulmonary co-morbidities (age=75 to 97 years) with displaced femoral neck fractures were operated between January 2011 to December 2013. Cementless bipolar hemiarthroplasty using hydroxyapatite coated stem was done by single surgeon using same implant in all the patients through anterolateral approach. Clinical and radiological follow-up was done with mean follow up of 54 months (36-72 months).Results: Total 31 cases with cardiopulmonary comorbidities were operated. The average follow up was 54 months. No intraoperative mortality was seen. 3 patients had splitting of femur during canal preparation. 1 patient died due to cardiac arrest in the post-operative period. 1 patient had surgical site infection. 3 patients had hemodynamic abnormalities and 1 patient had significant limb length discripency (1.5 cm). 2 patients died in the follow up because of comorbidities.  27 patients reached to pre-injury status with average harris hip score of 86 at final follow up.Conclusions: Cementless bipolar hemiarthroplasty with hydroxyapatite coated stem is a good option for femoral neck fractures in elderly patients with cardiopulmonary complications without risking the harmful effects of cementing.

scholarly journals The natural course of DSM-IV somatoform disorders and syndromes among adolescents and young adults: a prospective-longitudinal community study

2002 ◽  
Vol 17 (6) ◽  
pp. 321-331 ◽  
Author(s):  
Roselind Lieb ◽  
Petra Zimmermann ◽  
Robert H Friis ◽  
Michael Höfler ◽  
Sven Tholen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Young Adults ◽  
Somatoform Disorders ◽  
Epidemiologic Study ◽  
Natural Course ◽  
Adolescents And Young Adults ◽  
Prospective Longitudinal ◽  
Over Time

SummaryObjective.Although somatoform disorders are assumed to be chronic clinical conditions, epidemiological knowledge on their natural course based on representative samples is not available.Method.Data come from a prospective epidemiologic study of adolescents and young adults in Munich, Germany. Respondents’ diagnoses (N = 2548) at baseline and follow-up on average 42 months later are considered. The follow-up incidence, stability as well as selected baseline risk factors (sociodemographics, psychopathology, trauma exposure) for the incidence and stability of somatoform disorders and syndromes are prospectively examined. Diagnostic information was assessed by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI).Results.Over the follow-up period, incidence rate for any of the covered somatoform diagnoses was 25.7%. Stability for the overall group of any somatoform disorder/syndrome was 48%. Female gender, lower social class, the experience of any substance use, anxiety and affective disorder as well as the experience of traumatic sexual and physical threat events predicted new onsets of somatoform conditions, while stability was predicted by being female, prior existing substance use, affective and eating disorders as well as the experience of a serious accident.Conclusions.At least for a substantial proportion of individuals, the overall picture of somatization seems to be relatively stable, but with fluctuation in the symptom picture over time. Being female, the experience of substance use as well as anxiety disorder seem to constitute risk factors for the onset of new somatoform conditions as well as for a stable course over time.

scholarly journals AUSTIN MOORE PROSTHESIS IN THE MANAGEMENT OF FRACTURE NECK OF FEMUR IN AN ELDERLY POPULATION.

2020 ◽  
pp. 73-75
Author(s):  
Ravi Kumar ◽  
Chandan Kumar
Keyword(s):  
Functional Outcome ◽  
Treatment Option ◽  
Elderly Population ◽  
Tertiary Care ◽  
Walking Distance ◽  
Neck Of Femur ◽  
Protrusio Acetabuli ◽  
Fracture Neck Of Femur ◽  
Austin Moore

Introduction: Intracapsular fractures of the proximal femur form a major share of fractures in the 77 elderly. Hip replacement arthroplasty (partial or total) is emerging as a most viable treatment option, and in that, hemiarthroplasty with the Austin Moore Prosthesis is among the most commonly employed. In our study, we have made an attempt to assess the functional status at long term follow up after hemiarthroplasty with the AMP, used in the treatment of fracture neck of femur in the elderly population, and to substantiate the use of the prosthesis in modern day orthopaedic practice. Materials and : A retrospective study was carried out in patients above the age of 60 years, who had been diagnosed with non-pathological fracture neck of femur, treated operatively with hemiarthroplasty using the Austin Moore prosthesis in a tertiary care centre. A minimum follow up period of two years was considered. All the patients were evaluated clinically, and wherever possible, radiologically. Functional outcome was assessed based on the Harris Hip scoring system, and the results were analysed. Radiologically, an attempt was made to assess, among others, the amount of protrusio acetabuli at follow up, and femoral offset changes following hemiarthroplasty with the AMP. Results: In our study, we observed a positive functional outcome (excellent or good) in 9(45%) patients, with fair result in 6(30%) and poor in 5(25%). However, when pain alone was taken as criteria for assessment, upto 14(75%) patients had none to slight pain at follow up, and only 1(5%) patient had marked pain. Walking distance was significantly reduced in 6(30%) patients, who were either confined indoors or bedridden, but in only 1(5%) of them, the cause for the decreased ambulatory status was implant or procedure related (pain). Among the complications, 1 patient had a post-operative periprosthetic fracture that healed subsequently, 2 patients had marked osteolysis around the stem of the prosthesis, and only 1 patient had a radiological evidence of protrusio acetabuli. Discussion: Hemiarthroplasty with Austin Moore Prosthesis for fracture neck of femur remains a fairly good treatment option in elderly patients.

scholarly journals Functional Outcome of Intracapsular Femoral Neck Fractures Treated by Bipolar Hemiarthroplasty

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

scholarly journals Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review

2019 ◽  
Vol 6 (1) ◽  
pp. 25-30
Author(s):  
Rajendra Sanjel Chhetri ◽  
Kishor Prashad Khatri ◽  
Krishna Kharel
Keyword(s):  
Avascular Necrosis ◽  
Delayed Union ◽  
Harris Hip Score ◽  
Outcome Analysis ◽  
Fracture Union ◽  
Neck Of Femur ◽  
Strut Graft ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Fibular Strut

Introductions: Avascular necrosis and non-union are common but when the neck of femur fracture in adult is neglected, the chances of complications rises. Among various treatment options, we report the outcome of free fibular strut graft along with two cannulated hip screws in neglected fracture neck of femur. Methods: The outcome analysis of ‘fibular strut graft and two cannulated hip screws’ was conducted in patients with fracture neck of femur who presented at least three weeks after the time of injury, during August 2008 to December 2017, at Lumbini Zonal Hospital and Lumbini Hospital Technical College, Butwal, Nepal. All adult patients aged 18 to 60 years were included. Outcome variables were healing of fracture (union, delayed union, non-union), avascular necrosis and Harris Hip Score (HHS). Results: Out of 20 fractures, 17 (85%) united uneventfully, 2 (10%) had delayed union and 1 (5%) nonunion. We had 3 (15%) avascular necrosis of femoral head. The HHS was excellent in 8 (40%), good in 4 (20%), fair in 6 (30%) and poor in 2 (10%). Conclusions: Fibular Strut graft with two hip screws resulted in fracture union and improved hip functions in patients with neglected fracture of neck of femur.

scholarly journals Early Outcome of Endoscopic Third Ventriculostomy With or Without Choroid Plexus Cauterization and Ventriculoperitoneal Shunt as Primary Treatment of Hydrocephalus in Infants With Myelomeningocele

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Bamidele O Adebayo ◽  
Okezie Kanu ◽  
Olufemi B Bankole ◽  
Omotayo Ojo
Keyword(s):  
Success Rate ◽  
Choroid Plexus ◽  
Ventriculoperitoneal Shunt ◽  
Endoscopic Third Ventriculostomy ◽  
Successful Outcome ◽  
Csf Leak ◽  
Third Ventriculostomy ◽  
Prospective Longitudinal ◽  
Choroid Plexus Cauterization

Abstract INTRODUCTION Myelomeningocele is associated with hydrocephalus in 35% to 90% of cases. Hydrocephalus is usually treated with insertion of ventriculoperitoneal shunt. However, endoscopic third ventriculostomy with or without choroid plexus cauterization is a viable alternative. METHODS A prospective longitudinal study from January 2016 to December 2018 on patients with myelomeningocele who presented to Lagos University Teaching Hospital, Nigeria and who had hydrocephalus.Informed consent for research and surgery were obtained. ETV with or without CPC or VPS was done with general anesthesia using standard operative techniques. Patients were followed up monthly for at least 6 mo. The surgery was adjudged failed if there was progressive head enlargement as well as other signs of hydrocephalus necessitating another surgery for hydrocephalus. RESULTS A total of 48 patients completed the study. A total of Six patients were lost to follow-up. Age range of the patients was 1 to 44 wk. A total of Five patients had ETV, 21 had ETV/CPC, and 22 patients had VPS. The mean OFC at the time of surgery were 45.3 cm and 44.9 cm for the endoscopic and VPS arms respectively. There were 2 (7.6%) cases of CSF leak in the endoscopic arm and 3 (13.6%) cases of wound dehiscence, with 1 (4.5%) case of CSF leak in the VPS arm. Mean age at surgery for ETV/CPC arm was 12.3 wand 11.5 wk for the VPS arm. Mean time to failure was 9.9 and 6.3 wk for endoscopic and VPS arms respectively. Four (80%) of the patients who had ETV had a successful outcome, 11 (52.3%) of those who had ETV/CPC had a successful outcome and 13 (59%) of those who had VPS had a successful outcome. At 6 mo follow up, overall success rate for the endoscopic arm was 57.6% and 59% for the VPS. CONCLUSION Endoscopic third ventriculostomy with or without choroid plexus cauterization had similar success rate with VPS at 6 mos.

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