Intracapsular Femoral Neck Fractures—A Surgical Management Algorithm

Background and Objectives: Femoral neck fractures are common and constitute one of the largest healthcare burdens of the modern age. Fractures within the joint capsule (intracapsular) provide a specific surgical challenge due to the difficulty in predicting rates of bony union and whether the blood supply to the femoral head has been disrupted in a way that would lead to avascular necrosis. Most femoral neck fractures are treated surgically, aiming to maintain mobility, whilst reducing pain and complications associated with prolonged bedrest. Materials and Methods: We performed a narrative review of intracapsular hip fracture management, highlighting the latest advancements in fixation techniques, generating an evidence-based algorithm for their management. Results: Multiple different fracture configurations are encountered within the category of intracapsular hip fractures, with each pattern having different optimal surgical strategies. Additionally, these injuries typically occur in patients where further procedures due to operative complications are associated with a considerable increase in mortality, highlighting the need for choosing the correct index operation. Conclusions: Factors such as pathological causes for the fracture, pre-existing symptomatic osteoarthritis, patient’s physiological age and fracture displacement all need to be considered when choosing optimal management.

Bilateral Intracapsular Hip Fracture in a Patient With Low Functional Demand Treated With a One-stage Bilateral Hemiarthroplasties. A Case Report and Literature Review.

Bilateral femoral neck fracture is a rare injury. While they may be of traumatic origin, they are generally associated with some underlying condition that predisposes to this pathology, such as neurological disorders or bone metabolism diseases. We present an 83-year-old woman with severe osteoporosis who had a simultaneous bilateral intracapsular hip fracture.

CORRELATION BETWEEN HARRIS HIP SCORE (HHS) AND BODY MASS INDEX (BMI) IN PATIENTS WITH FEMORAL NECK FRACTURE AFTER HEMIARTHROPLASTY

Femoral neck fracture is an intracapsular hip fracture. Hemiarthroplasty is one of the treatment options that replaces femoral aspect of hip joint with a prosthesis, while leaving the acetabulum intact. The treatment’s goal is to return the patient to premorbid capacity. Harris Hip Score (HHS) is an assessment for the outcome of hip surgery which contains: pain, functional capacity, deformity and range of motion (ROM). The purpose of study is to determine relation of BMI and Harris Hip Score (HHS) in patients with femoral neck fracture after hemiarthroplasty. This study is analytic-observational study with cross-sectional design conducted in June-September 2014 in Orthopedic’s Polyclinic of General Hospital dr. Zainoel Abidin Banda Aceh. Respondents in this study is 26. Comparative assessment of outcome was analysed by Kruskal-Wallis test with Mann-Whitney test as Post-hoc analysis and correlative assessment was analysed by Spearman test. Comparative assessment present significant relation of BMI (p = 0,006; r=0.458) with Harris Hip Score (HHS) in patients with femoral neck fracture after hemiarthroplasty.

Total Hip Arthroplasty for Hip Fractures: Time to Surgery With Respect to Surgical Revision, Failure, and Mortality

Introduction: There are increasing demands to perform surgery of hip fractures without delay. However, few studies have assessed the time to surgery in relation to outcome measurements. Methods: A total of 643 consecutive patients with a minimum age of 60 years underwent total hip arthroplasty (THA) for an intracapsular hip fracture. For this retrospective case series, demographic data and the outcome measurements—(1) any surgical revision, (2) implant failure, and (3) mortality—were documented from a prospective clinical database. The time from admission to surgery was also documented prospectively and then data were divided into 4 groups according to the time of surgery: (1) within 12 hours, (2) >12 to 24 hours, (3) >24 to 48 hours, and (4) later than >48 hours. The study end point was 2 years after surgery. Final evaluation was conducted for any missing data through a telephone interview. Results: The patients comprised 456 women (70.9%) and 187 men (29.1%) with a mean age of 80.2 years (range 60-104 years; standard deviation ±7.4). Descriptive data were without effect in all 4 groups. Time to surgery did not significantly influence revision for any reason ( P = .323), implant failure ( P = .521), and mortality ( P = .643). Cox regression analysis identified male sex ( P < .001; 95% confidence interval (CI), 1.27-2.44), American Society of Anesthesiologists score ≥3 ( P < .001; 95% CI, 2.12-21.59), C-reactive protein level >21 mg/L ( P < .018; 95% CI, 1.09-2.60), hemoglobin level <12.0 g/dL ( P = .033; 95% CI, 1.04-2.68), and dementia ( P < .000; 95% CI, 1.50-2.86) as independent significant risk factors for mortality. Conclusion: Time to surgery had no effect on revision for any reason, implant failure, and mortality in patients undergoing THA for an intracapsular hip fracture.