scholarly journals Pediatric Femoral Neck Fractures

2014 ◽  
Vol 13 (2) ◽  
pp. 198-204
Author(s):  
Ramji Lal Sahu
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Weight Bearing ◽  
Medical Science ◽  
Delayed Union ◽  
Femoral Neck Fractures ◽  
Full Weight Bearing ◽  
Coxa Vara ◽  
Anatomical Reduction ◽  
Mean Time

Introduction: Femoral neck fractures are rare injuries in children, but the high incidence of long term complications make it an important clinical entity. The aim of this prospective study was to analyze the clinical outcomes of pediatric femur neck fractures. Methods: The study included 16 children (10 boys and 6 girls) who sustained femoral neck fractures and completed an average follow-up of 28 months. The children were treated with anatomical reduction and internal fixation with partially threaded cancellous screws. The outcomes were clinically and radio logically assessed for fracture healing, joint movements and implant failure. Results: The mean age of included patients was 10 years (range, 6 to 16 years) and the average followup was 28 months (range, 17 -48 months). Coxa- vara was the most common complication Other complications included nonunion associated with Partial a vascular necrosis and delayed union was seen in one case but later on it had been corrected. Two cases of slight coxa vara were seen radiologically but clinically patients had no problem in walking and daily activities. All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) except two cases. Full weight bearing was possible in a mean time of 8.8 weeks. The results were excellent in 68.75% and good in 18.75% patients. Conclusions: We conclude that the early operation using anatomical reduction and internal fixation of pediatric femoral neck fracture offers the best results and provide early healing less complication with good results and is economical. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18303 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.198-204

scholarly journals Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures

2018 ◽  
Vol 9 ◽  
pp. 215145931876538 ◽  
Author(s):  
Method Kabelitz ◽  
Yannick Fritz ◽  
Patrick Grueninger ◽  
Christoph Meier ◽  
Patrick Fries ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Weight Bearing ◽  
Femoral Neck Fractures ◽  
Periprosthetic Fractures ◽  
Full Weight Bearing ◽  
Morbidity Rate ◽  
Old Patients ◽  
Invasive Approach ◽  
Very Old ◽  
Very Old Patients

Background: Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. Methods: We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. Results: We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B2) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B1 and 2 Vancouver AG) were treated conservatively. One periprosthetic femoral fracture (Vancouver B1) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Conclusion: Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level of Evidence: Level III, Therapeutic study.

scholarly journals Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

2022 ◽  
Author(s):  
Xuefeng Zhou ◽  
Sichao Gu ◽  
Li Li ◽  
Lei Xu ◽  
Xujin Wang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Clinical Efficacy ◽  
Weight Bearing ◽  
Operation Time ◽  
Femoral Neck Fractures ◽  
Teaching Hospitals ◽  
Harris Hip Score ◽  
Clinical Report ◽  
Short Term

Abstract Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

scholarly journals A Comparative Study Of Surgical Management Of Subtrochanteric Fractures In Children

2012 ◽  
Vol 11 (3) ◽  
pp. 178-184
Author(s):  
RL Sahu ◽  
P Gupta
Keyword(s):  
Femoral Fracture ◽  
Weight Bearing ◽  
Excellent Result ◽  
Medical Science ◽  
Long Bone ◽  
Full Weight Bearing ◽  
Entry Site ◽  
Early Weight Bearing ◽  
Fractures In Children ◽  
Mean Time

Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were    followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between  the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result. DOI: http://dx.doi.org/10.3329/bjms.v11i3.11718 Bangladesh Journal of Medical Science Vol. 11 No. 03 July’12  

scholarly journals A comparative study of surgical management of subtrochanteric fractures in children

2012 ◽  
Vol 11 (2) ◽  
pp. 91-97
Author(s):  
Ramji Lal Sahu ◽  
Pratiksha Gupta
Keyword(s):  
Femoral Fracture ◽  
Weight Bearing ◽  
Medical Science ◽  
Femoral Fractures ◽  
Long Bone ◽  
Full Weight Bearing ◽  
Entry Site ◽  
Early Weight Bearing ◽  
Fractures In Children ◽  
Mean Time

Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result.DOI: http://dx.doi.org/10.3329/bjms.v11i2.9664 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 91-97

scholarly journals Slipped capital femoral epiphysis after treatment of femoral neck fracture

2019 ◽  
Vol 36 (ICON-Suppl) ◽  
Author(s):  
Muhammad Amin Chinoy ◽  
Sateesh Pal ◽  
Mansoor Ali Khan
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Weight Bearing ◽  
Slipped Capital Femoral Epiphysis ◽  
Coxa Vara ◽  
Femur Neck Fracture ◽  
Anatomic Reduction ◽  
Neck Fracture ◽  
Stable Internal Fixation

Slipped capital femoral epiphysis (SCFE) in children after treatment of femoral neck fracture is a very rare condition. This complication should be recognized promptly and treated urgently. The risk of development of this complication can be minimized by anatomical reduction of the fracture and stable internal fixation of the fracture. Five years old male child sustained right sided femur neck fracture and was treated with closed reduction and Hip spica cast application. The fracture healed with a varus deformity. After 7 months, he developed slip of femoral epiphysis with a coxa vara deformity of proximal femur, which was treated with in situ fixation with Cannulated screws. His subsequent course remained uneventful up to five months.Slipped capital femoral epiphysis (SCFE) after treatment of femoral neck fracture in children is a rare complication that should be recognized and treated promptly. The onset of SCFE may show inadequate reduction or fixation of the fracture. Anatomic reduction and stable internal fixation for femoral neck fracture in children provides best outcomes. Postoperative care and delayed weight bearing are also equally important to avoid complications. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1725 How to cite this:Chinoy MA, Pal S, Khan MA. Slipped capital femoral epiphysis after treatment of femoral neck fracture. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S94-S97. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1725 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jian Zhu ◽  
Hongzhi Hu ◽  
Xiangtian Deng ◽  
Yiran Zhang ◽  
Xiaodong Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Internal Fixation ◽  
Calibration Curve ◽  
Weight Bearing ◽  
Femoral Neck Fractures ◽  
Multivariate Logistic Regression ◽  
Independent Risk Factors

Abstract Objective We aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients. Methods We conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs between January 2016 and January 2019. We collected data on demographics, preoperative radiological parameters, surgery, serum biochemical markers, and postoperative rehabilitation. In addition, we performed univariate and multivariate logistic regression analyses to determine independent risk factors for reoperation, and then developed a nomogram to assess the risks of reoperation. Besides, discriminative ability, calibration, and clinical usefulness of the nomogram were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), respectively. We employed bootstrap method to validate the performance of the developed nomogram. Results Our analysis showed that among the 255 patients, 28 (11.0%) underwent reoperation due to osteonecrosis of the femoral head (14 cases), mechanical failure (8 cases) or nonunion (6 cases). All of the 28 patients underwent conversion surgery to arthroplasty. The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle ≥ 20°, Pauwel’s III type, younger patients, preoperative elevated levels of alkaline phosphatase (ALP), preoperative hypoalbuminemia, and early postoperative weight-bearing were independent risk factors for reoperation. In addition, the C-index and the bootstrap value of the developed nomogram was 0.850 (95% CI = 0.803–0.913) and 0.811, respectively. Besides, the calibration curve showed good consistency between the actual diagnosed reoperation and the predicted probability, while the DCA indicated that the nomogram was clinically valuable. Conclusions Our analysis showed we successfully developed and validated a nomogram for personalized prediction of reoperation after internal fixation of nondisplaced FNFs in elderly patients. This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation.

scholarly journals Valgus Impacted Femoral Neck Fractures: Surgery or Non-Operative Approach?

2021 ◽  
Author(s):  
Arvin Najafi ◽  
Mohsen Tavakoli ◽  
Danoosh Zargar ◽  
Dorsa Hadavi ◽  
Ehsan Seif ◽  
...  
Keyword(s):  
Treatment Group ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Operative Treatment ◽  
Weight Bearing ◽  
Operative Management ◽  
Femoral Neck Fractures ◽  
Significant Difference ◽  
Non Operative Management ◽  
Partial Weight

Background: Non-operative management of valgus impacted femoral neck fracture leads to prolonged bed rest which may lead to deep vein thrombosis. The preferred method is the internal fixation because of pain control, enhanced mobilization, and better fracture healing but fails in older patients and individuals with medical comorbidities. The present study aims to assess the functional outcomes after the internal fixation or the non-operative management. Methods: A retrospective cohort study was conducted at a Level I trauma center from January 2013 to December 2019 on all patients with valgus-impacted femoral neck fractures [Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association Classification (AO/OTA 31-B1)]. Overall, 81 patients were managed operatively with three partially threaded, cannulated screws in a parallel configuration and 21 patients were managed non operatively with instant mobilization, physical therapy, and partial weight-bearing protocol. Results: 6 (28.0%) patients in the non-operative group and 3 (4.0%) cases in the operative group experienced fracture displacement (P < 0.001). 48 (59.2%) patients of the operative treatment group returned to baseline ambulatory function at 3 months, while this figure was 43.0% in the non-operative treatment group, not significantly different (P = 0.100). There was no significant difference in the mortality rates at one month and three months between the two groups (2 patients in each group, P = 0.140).  Conclusion: The ideal treatment of valgus-impacted femoral neck fractures is still controversial. The main purpose in the treatment of hip fractures is to return the patient to functional level equal to the level he or she was before the fracture. Surgically treated patients had lower failure rates in comparison with the other group.  

scholarly journals Hemiarthroplasty of the hip using the direct anterior approach

2021 ◽  
Author(s):  
Michael Nogler ◽  
Filippo Randelli ◽  
George A. Macheras ◽  
Martin Thaler
Keyword(s):  
Femoral Neck ◽  
Minimally Invasive ◽  
Anterior Approach ◽  
Weight Bearing ◽  
Hip Osteoarthritis ◽  
Direct Anterior Approach ◽  
Femoral Neck Fractures ◽  
Postoperative Treatment ◽  
Full Weight Bearing ◽  
Invasive Approach

Abstract Objective Minimally invasive approach in total hip arthroplasty for the treatment of femoral neck fractures with a hemiarthroplasty. Indications Femoral neck fractures of patients without hip osteoarthritis where the acetabulum is still intact. Contraindications Lesions and infections of the skin in the approach area; hip osteoarthritis; surgeon’s lack of experience with the technique. Surgical technique The direct anterior approach (DAA) uses the Smith–Peterson interval between the tensor fasciae latae (TFL) and the rectus and sartorius muscle. After coagulation of the ascending branches of the femoral circumflex vessels, the capsule is opened. The remaining parts of the femoral neck are removed and osteotomized if necessary. The femoral head is removed with a cork screw. Then the shaft is supported by 2 sharp retractors at the greater trochanter from cranial, and the leg is externally rotated, hyperextended, and adducted. A TFL release can be performed which we also recommend. The femoral canal is opened step by step and extended with rasps which are introduced with the double curved broach handle. Cement and the final implant are introduced and after the trial reduction also the final head. The hip is reduced, the capsule adapted and the wound closed. Postoperative management For this approach, there are no approach specific recommendations. Postoperative treatment depends on whether the approach was extended with muscle releases and on the type of reconstruction performed. If the approach was limited to the minimally invasive direct anterior portal, quicker rehabilitation can be expected due to the reduced muscle damage. We prefer mobilization with full weight bearing as tolerated on the next day.

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