Multiple screw fixation versus cementless bipolar hemiarthroplasty for femur neck fracture using a nationwide hip fracture registry

Cementless bipolar hemiarthroplasty (BHA) recently gained popularity as a treatment for femur neck fracture (FNF), but there have been few studies comparing this with multiple screw fixation (MSF) in the elderly population. The purpose of this study is to compare (1) surgery-related parameters, (2) reoperation rate as a local complication, (3) in-hospital systemic complication rate, and (4) mortality rate at 1 year after MSF and cementless BHA in patients with FNF using nationwide data. Six-hundred sixty-six hips (aged ≥ 50 years) extracted from nationwide Hip Fracture Registry were included in this study (133 MSF and 533 cementless BHA). One hundred fifty-six hips were divided into nondisplaced FNF (Group A) and 510 into displaced FNF (Group B). We evaluated (1) surgery-related parameters (anesthesia type, time to surgery, operation time, estimated blood loss and volume of postoperative transfusion), (2) the rate of and reasons for reoperation, (3) the rate and type of in-hospital systemic complications and (4) one-year mortality rate after surgery. In Group A, MSF showed shorter operation time (p = 0.004) and lower incidence of in-hospital systemic complications (p = 0.003). In Group B, cementless BHA demonstrated lower reoperation rate than MSF (p < 0.001). In both Group A and B, cementless BHA was associated with higher estimated blood loss than MSF (p < 0.001). Based on findings in our study, MSF might be a more favorable option for nondisplaced FNF, whereas cementless BHA might be a better one for displaced FNF in patients older than fifty. Nevertheless, our nationwide study also showed that numbers of cementless BHAs were being performed for nondisplaced FNF even in teaching hospitals.

A Larger Sized Cup Accelerates Cartilage Erosion of Acetabulum after Bipolar Hemiarthroplasty in Elderly with Femur Neck Fracture

Purpose: Bipolar Hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up.Patients and Methods: We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65-96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A- bipolar cup size > actual head size, Group B- cup size < head size, Group C- cup size = head size. The degree of both superior and medial acetabular cartilage erosion was identified and calculated on postoperative radiographs using line of acetabular margin and Kohler’s line.Results: The mean superior and medial acetabular erosion were 1.62 ± 1.6 mm (range, 0 – 4.4) and 4.15 ± 2.7 mm (range, 0 – 8.2) in Group A, 1.30 ± 1.3 mm (range, 0 – 3.8) and 4.11 ± 2.7 mm (range, 0 – 7.8) in Group B, and 0.90 ± 1.1 mm (range, 0 – 2.6) and 3.16 ± 2.9 mm (range, 0 – 7.9) in Group C (p=0.039 and p=0.187, respectively). The superior acetabular erosion showed significant difference between the three groups. During mean follow-up period of 12.3 years, five patients (5/117, 4.3%) underwent conversion to THA due to superior acetabular erosion. All of three patient underwent BHA with a larger bipolar cup than the actual femoral head.Conclusion: A lager sized cup accelerated superior cartilage erosion of acetabulum after bipolar hemiarthroplasty. An optimal cup size should be considered when undergoing BHA in elderly patients.

Shepherd’s Crook Deformity with Pathological Femur Neck Fracture in a Patient with Fibrous Dysplasia Managed with Proximal Femoral Nailing and Valgus Osteotomy

Fibrous dysplasia is a rare condition in which bone is replaced by fibroosseous tissue. It is a benign condition, divided into monostotic and polyostotic fibrous dysplasia, which accounts for about 5-7% of all benign bone tumours. Here, authors reported a case of a 38-year-old male that presented with left hip pain since 15 days and had a history of trauma. X-ray pelvis and Magnetic Resonance Imaging (MRI) showed shepherd’s crook deformity in the left proximal femur with pathological femur neck fracture. It was managed with valgus osteotomy for deformity correction and fracture fixation using long proximal femur nail and cannulated cancellous screws. At one and half year follow-up, the patient showed good hip and knee range of motion with no complications.

SIMULTANEOUS INSUFFICIENCY FRACTURE OF BILATERAL NECK OF FEMUR WITH COXA VARA

Simultaneous insufficiency fracture of bilateral neck of femur with displacement and coxa vara is very uncommon , and very challenging. Osteomalacia is a known cause of insufficiency fracture. We present a case of a young female with non traumatic simultaneous bilateral femur neck fracture. On radiological and laboratory investigation fracture was diagnosed as insufficiency fracture due to osteomalacia with coxa vara. Treatment was done by intertrochanteric valgus osteotomy and fixation by dynamic condylar screw with a prebend plate along with oral and parentral vitamin D therapy. On six month follow up both side fractures were well united and patient was able to walk without pain with full weight bearing and with normal gait .Her lab investigations also returned to normal during follow up.

Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Introduction: Valgus intertrochanteric osteotomy alters the biomechanical environment of thefracture site and restores limb length. Very few reports have dealt with the results of this procedureinternally fixed with a dynamic hip screw and double angle barrel plate. Hence, the prospectivestudy was performed at the institution level for the evaluation of results of valgus osteotomy andfixation of the femur neck fracture in young patients. Material and Methods: A total of 32 patientswere included in the study. There were 24 males and 8 females in the study. Before osteotomy, theaverage neck-shaft angle was 101° (80–120°), with an average limb shortening of 2.3cm (1.0–3.2cm). The greater trochanter was up riding in fourteen cases and needed skeletal traction beforesurgery. None of these had evidence of vascular necrosis on plain radiograph or MRI. The fractureswere treated with a dynamic hip screw and double angle barrel plate. The patients had a minimumfollow-up of 14months and a maximum of 42months. Results: In a total of 28 patients the excellentresults were obtained, however in 4 patients the poor result was due to cut – out of implants. Noneof the patients were lost on follow up, the fracture went on to achieve the satisfactory union afterthe minimum of 14 weeks follows up. The average preoperative neck-shaft angle of 101° (range 80–120°) increased to 134° (range 120–145°) after surgery. The average limb length discrepancypostoperatively was 2.3cm. Conclusion: From the study, it was concluded that valgus osteotomyand fixation with dynamic hip screw and 120° double angle barrel plate has a high success rate inyoung patients with neglected and ununited intracapsular fracture neck of the femur as far as theunion of fracture is concerned.