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

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.

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Survey of the Outcome of Femoral Head Prosthesis Replacement of Unipolar Type for Intracapsular Femoral Neck Fracture in Elderly Patients.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.44.235 ◽

1995 ◽

Vol 44 (1) ◽

pp. 235-241

Author(s):

Yukihiko Tsutsumi ◽

Tatsuo Kutsuna ◽

Kazuo Konishi ◽

Toshimitsu Koga ◽

Ai Umemura ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Elderly Patients ◽

Femoral Neck Fracture ◽

Prosthesis Replacement ◽

Neck Fracture ◽

Intracapsular Femoral Neck Fracture

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Outcome Analysis of Osteosynthesis Versus Hemiarthroplasty for the Treatment of Displaced Femoral Neck Fracture in Young Elderly Patient

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i33a31771 ◽

2021 ◽

pp. 53-59

Author(s):

Muhammad Rafique Joyo ◽

Nizam Ahmed ◽

Ghazanfar Ali Shah ◽

Aftab Alam Khanzada ◽

Tanveer Afzal ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Functional Performance ◽

Clinical Status ◽

The Elderly ◽

Recurrent Dislocation ◽

Outcome Analysis ◽

Sudden Increase ◽

Neck Fracture ◽

The Mean

This study was designed to compare the osteosynthesis and hemiarthroplasty treatment among the elderly population and evaluate the postoperative functional performance of these two recommended treatments of a displaced femoral neck fracture. Methodology: This retrospective study was conducted in Bone Care trauma center Heerabad Hospital Hyderabad Pakistan from March 2019 to March 2020. A total of 74 patients of age between 60 to 70 years were selected. All the selected patients were diagnosed with femoral neck fractures (Garden’s III and IV). Harris's hip score was used to evaluate the clinical status of patients with pain, whereas we used Palmer and Parker's mobility to access mobility. Implant breakage, screw cut, and nonunion were considered as parameters of osteosynthesis failure. At the same time, hemiarthroplasty failure was defined as two or more recurrent dislocation, aseptic loosening, periprosthetic fracture, and infection. Results: In the first three postoperative months, the mean score of the hemiarthroplasty group was reported as 74.44±8.480, which was comparatively high than the osteosynthesis group (66.44±8.520). After six months, this score reached 80.12±7.005 in the hemiarthroplasty group and reached its maximum of 92.14±7.125. After the first three months, the increment ratio was relatively slow with six ratios, but in the last visit, we observed a sudden increase in score in both groups. Regarding Palmer and Parker's mobility score, the hemiarthroplasty group reflected better outcomes than the osteosynthesis group. Conclusion: Our study concluded that management of displaced femoral neck fracture with osteosynthesis revealed a high probability of nonunion, screw cutout complications and enhanced the risk of reoperation. Patients treated with osteosynthesis showed delay rehabilitation.

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Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0124 ◽

2016 ◽

Vol 98 (6) ◽

pp. 376-379 ◽

Cited By ~ 4

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.

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