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1
Khan, Hanif Ullah, Abdul Waheed Jan, and Abdus Samad Khan. "FRACTURE NECK OF FEMUR." Professional Medical Journal 22, no. 07 (July 10, 2015): 949–53. http://dx.doi.org/10.29309/tpmj/2015.22.07.1192.
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Fracture neck of femur is a devastating injury. One of its main complicationsis avascular necrosis (AVN) of the femoral head. For the fixation of femoral neck fractures,cannulated screws are now universally used. The aim of the study was to determine thefrequency of avascular necrosis in fracture neck of femur fixed with cannulated screws.Study Design: Descriptive cross sectional study. Setting: Orthopedic unit of Ayub TeachingHospital Abbottabad. Period: 7th March, 2011 to 6th September, 2011. Material and Methods:Recruiting 113 patients of either gender between 15 to 60 years of age with fracture neck offemur who were fixed with cannulated screws. The data was entered and analyzed with thehelp of SPSS 10.Results: There were 113 patients with an overall mean age of 43.51 years+ 11.94SD. Maximum number of patients was 56 (49.50%) from the age group of 46 to 60years. Avascular necrosis was noted in 23 (20.35%) cases. The maximum number of patientswith avascular necrosis was 13 (56.52%) belonging to the age group of 15 to 25. Conclusion:Avascular necrosis was high in younger ages in displaced fractures of neck of femur treatedwith cannulated screws.
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Vitale, Elsa, Angela Notarnicola, Lorenzo Moretti, Antonio Esposito, Vito Pesce, and Biagio Moretti. "Multidimensional prognostic index in the elderly with hip or neck femur fracture." Orthopedic Reviews 4, no. 2 (April 12, 2012): 15. http://dx.doi.org/10.4081/or.2012.e15.
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Hip and neck femur fracture surgery was associated with high post-operative mortality and poor functional results. The decision-making process with regards to the elderly with hip or neck femur fractures was of great importance, requiring consideration of ethical, medico legal and economic factors in addition to the purely medical ones. An important component in the decision-making process was the precise knowledge of the expected mortality. We considered here several articles from 1 January 2002 to 31 August 2010 that identified the possible scoring system to predict mortality in the elderly undergoing hip or neck femur fracture surgery. We found seven studies which included a total of 12,177 patients that were assigned to hip/neck femur fracture surgery. Each study identified the possible scoring system to predict mortality in the elderly undergoing hip/neck femur fracture surgery. By reviewing the literature available, it was shown that there were more multidimensional prognostic indexes in the elderly after hospitalization than multidimensional prognostic indexes with hip or neck femur fracture which could be used as a simple point scoring system at the bedside to predict mortality in the elderly undergoing hip or neck femur fracture surgery. Although, all the prognostic indexes searched worked well for a general population, but they were of limited validity in the specific, relatively homogeneous population of hip/neck femur fracture patients.
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Murali, Sujayendra Davanagere, Nikhil Hegde, and Hitesh Shah. "Valgus-impacted fracture of neck of femur in a 12-year-old child." BMJ Case Reports 14, no. 3 (March 2021): e240707. http://dx.doi.org/10.1136/bcr-2020-240707.
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Though uncommon, fracture of neck of femur in children is a devastating injury due to the complications it may cause. Treatment depends on the age of the child, the displacement of the fracture and the type of fracture based on Delbet classification. Surgical treatment is indicated in displaced fractures. We report a case of an impacted fracture of neck of femur in a 12-year-old girl. The girl was managed non-operatively. The fracture united uneventfully. An impacted fracture of neck of femur is common in the adult population. To the best of our knowledge, this fracture pattern has not been reported in the paediatric age group.
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Choi, C. U., S. K. Rah, B. J. Shin, Y. S. Seo, and W. H. Joo. "Comparison Between Ipsilateral Femur Neck and Shaft Fracture and Femur Neck Fracture." Journal of the Korean Orthopaedic Association 27, no. 3 (1992): 686. http://dx.doi.org/10.4055/jkoa.1992.27.3.686.
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Dharmarajan, R., R. Vadivelu, and T. Lawrence. "An Unusual Neurological Complication following Internal Fixation of Pertrochanteric Fracture Neck of the Femur." HIP International 12, no. 4 (October 2002): 400–402. http://dx.doi.org/10.1177/112070000201200410.
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Fracture of the femoral neck is a common injury in the elderly population and may be associated with significant morbidity. More than 25,000 patients per year in the UK receive treatment for femoral neck fractures. Neurological injury associated with pertrochanteric fracture of the neck of the femur is rare. Sciatic nerve injury following isolated pertrochanteric femoral neck fractures is very rare and has not previously been reported in the literature. We describe a case of foot drop secondary to sciatic nerve injury following fracture of neck of the femur, with recovery after surgical exploration and nerve release.
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Tokyay, Abbas, Melih Güven, Mehmet E. Encan, Erhan Okay, and Ozgur Akbaba. "The Influence of Acetabular Morphology on Prediction of Proximal Femur Fractures Types in an Elderly Population." HIP International 27, no. 5 (May 23, 2017): 489–93. http://dx.doi.org/10.5301/hipint.5000476.
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Introduction The role of proximal femur morphology to the development of certain proximal femur fracture types both femoral neck and trochanteric fractures has been observed. However, the relavance of acetabular morphology to the development of proximal femur fractures is not extensively questioned. Therefore the aim of the study was to determine whether there is a correlation between acetabular morphology and pathogenesis of 2 different hip fracture types after low energy trauma. Methods This retrospective study includes 60 cases (41 women, 19 men) with a proximal femoral fracture after a low energy trauma between July 2012 and December 2014. Acetabular depth and acetabular index were measured on pelvic radiographs. Neck shaft angle, hip axis length and cortical index were measured on pelvic computed tomography scans. All measurements were performed on the contralateral hip. Results Mean age was 77.56 ± 8.99 years (range 61-92 years). No statistically significant difference was found with regard to neck shaft angle, acetabular depth or cortical index measurements between patients with femoral neck fracture and patients with trochanteric femoral fractures (p>0.05). Acetabular index measurement was higher (p = 0.001) and hip axis length measurement was lower (p = 0.001) in trochanteric fracture group as compared to femoral neck fracture. Conclusions The rate of trochanteric femur fractures is higher in patients with high acetabular index, whereas the rate of femoral neck fractures is higher in patients with increased hip axis length.
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Dharmshaktu, Ganesh Singh. "An unreported variant of fracture neck femur: a case report." International Journal of Scientific Reports 1, no. 1 (May 2, 2015): 102. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20150215.
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<p class="abstract">Fracture neck femur is common but ‘unsolved’ injury. Despite many classifications certain fractures do not fit into well recognized patterns or classifications. We report an unreported variation of the intraoperatively detected fracture. The fracture consisted of a subcapital fracture with a long intramedullary spike along the neck of femur attached to proximal segment. The patient was managed accordingly with good functional outcome. </p><p class="keywords"><strong><span lang="EN-US">Keywords: </span></strong>Fracture neck femur, Classification, Management, Hip trauma<strong></strong></p>
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D., Sidharth, Thyagarajan U., Raghavendran B., and Raghul Siddharth. "Management of acetabulum fracture with contralateral neck of femur in an obese patient: a rare case report." International Journal of Research in Orthopaedics 8, no. 2 (February 25, 2022): 278. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20220618.
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<p class="abstract">Acetabular fractures are complex fractures that pose a challenge for orthopaedic trauma surgeons due to their extension into the hip joint. The simultaneous occurrence of contralateral neck of femur fracture in an obese patient makes postoperative wound healing and rehabilitation even challenging. Here, we report a case of management of acetabulum fracture with contralateral neck of femur fracture in an obese patient. We are reporting a case of a 50-year-old obese female from Chennai who presented to the Department of Orthopaedics, SRIHER, Chennai, with complaints of bilateral hip pain and inability to weight bear on bilateral lower limb, following a high-velocity road traffic accident. She was diagnosed to have left acetabulum fracture with right hip displaced neck of femur fracture. We managed her with right hip bipolar hemiarthroplasty and left acetabulum open reduction and internal fixation. 6 month follow up showed excellent radiological and functional outcome. This case report highlights how obesity alters the surgical and medical management in obese patients with contralateral acetabulum and neck of femur fracture and the importance of a multidisciplinary approach in such polytrauma patients.</p>
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Talebi, Shahin, and Shayan Amjadi. "An Occult Ipsilateral Femoral Neck Fracture Associated With Mid-Shaft Femur Fracture." Journal of Research in Orthopedic Science 7, no. 4 (November 1, 2020): 185–88. http://dx.doi.org/10.32598/jrosj.7.4.703.1.
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Occult ipsilateral femoral neck fractures associated with femoral shaft fractures are frequently missed. They may lead to adverse outcomes, such as fracture displacement and delayed treatment followed by poor outcomes, including delayed union, malunion, nonunion, and osteonecrosis, which may lead to early arthroplasty. These adverse effects can be prevented by the awareness of this combined injury pattern, the adequate preoperative and intraoperative imaging of the femoral neck, and proper treatment. A 27-year-old man was admitted with a displaced fracture of the right femur. Fluoroscopic evaluation was performed after the intramedullary nailing of the shaft fracture. The evaluation revealed an ipsilateral displaced femoral neck fracture, which was fixed with two cannulated screw inserted anterior to the nail. Between 2% and 9% of all femoral shaft fractures are associated with ipsilateral femoral shaft fractures. This case report necessitates the increase of awareness for the presence of associated femoral shaft and neck fractures in patients undergoing antegrade femoral nailing. Also, we recommend appropriate preoperative, intraoperative, and postoperative imaging.
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Kulambi, Vijaykumar S., Ajay Shringeri Satish, and Prathik Rangaraja. "Surgical management of basicervical fracture neck of femur with dynamic hip screw and derotation screw: a prospective study." International Journal of Research in Orthopaedics 5, no. 4 (June 27, 2019): 712. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20192690.
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<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>
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Roytman, Gregory R., Alim F. Ramji, Brian Beitler, Brad Yoo, Michael P. Leslie, Michael Baumgaertner, Steven M. Tommasini, and Daniel H. Wiznia. "Simulating Prophylactic Fixation Methods for Osteoporotic Femoral Neck Fracture Prevention." Geriatric Orthopaedic Surgery & Rehabilitation 13 (January 2022): 215145932211413. http://dx.doi.org/10.1177/21514593221141376.
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Introduction Geriatric patients who suffer femoral neck fractures have high morbidity and mortality. Prophylactic fixation of the femoral neck is a potential avenue to reduce the incidence of femoral neck fractures. We studied 3 different implants traditionally used to stabilize the femoral neck: 6.5 mm cannulated screws (CANN), the femoral neck system (FNS) (Depuy Synthes), and the dynamic hip screw (DHS) (Depuy Synthes). Materials and Methods Five osteoporotic Sawbone femurs were used for each model and a control group. Two scenarios were investigated: single leg stance to measure construct stiffness and lateral impact to measure construct stiffness, energy to fracture, and qualitative examination of fracture patterns. Stiffness for each femur and energy to fracture for the lateral impact scenario were calculated and compared between groups using one-way ANOVA. Results DHS showed significantly higher stiffness than the other 2 implants and the control in single leg stance. In the lateral impact scenario, the DHS and CANN were significantly stiffer FNS and the control. Femurs implanted with CANN tended to fracture at the greater trochanter while FNS fractured in a transverse subtrochanteric pattern, and DHS fractured obliquely in the subtrochanteric region. Discussion FNS and DHS experienced fracture patterns less amenable to surgical correction. CANN and DHS proved better able to resist external forces in the lateral fall scenario. CANN also proved better able to resist external forces in the single leg stance scenario and experienced a more amenable fracture pattern in the lateral fall scenario. Conclusions FNS was less able to resist external forces compared with the other implants. This work informs the potential implications between the choice of implants that, although historically have not been used prophylactically, may be considered in the future for prophylactic stabilization of the femoral neck. Cadaveric study and clinical trials are recommended for further study.
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Kim, Keun-Woe, Ui-Seong Yoon, Yong-Hoon Kim, Hak-Jin Min, Jin-Sup Yeom, and Young-Ho Lee. "Femur Neck Fracture during Closed Nailing of Femur Shaft Fracture." Journal of the Korean Society of Fractures 9, no. 4 (1996): 936. http://dx.doi.org/10.12671/jksf.1996.9.4.936.
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Kumar, Vishnu Senthil. "Fracture neck of femur in severe coxa-vara – Challenging management in an Achondroplasia patient." IP International Journal of Orthopaedic Rheumatology 8, no. 1 (July 15, 2022): 29–32. http://dx.doi.org/10.18231/j.ijor.2022.007.
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Achondroplasia is a skeletal dysplasia of autosomal dominant inheritance. Fibroblast growth factor receptor 3 mutation at p16.3 locus of chromosome 4 leads to inhibition of sub-chondral growth. Middle aged achondroplastic patient with left fracture neck of femur following a fall of heavy object. It was a challenging case because of coxa-vara and meticulous templating is needed. 38 year old male sustained fracture neck of left femur in severe coxa-vara. Closed reduction with 16 mm partially threaded cannulated cancellous screw perpendicular to native neck- shaft angle. At regular follow up, mild lysis was seen around the screw and implant removal was done. Now with neck of femur non-union, walking full weight bearing with walker. The future course included excision arthroplasty or custom made prosthesis. Achrondroplasia characterised by defects in en-chondral bone formation leading to retarded cartilage growth. Literature search on peri-articular fracture management showed peadiatric disatal femur fracture fixed with percutaneous screws. In adult, neck of femur fracture is managed by percutaneous screw, DHS or prosthesis. Due to altered geometry of proximal femur DHS and Prosthesis was deferred.Early failure of CC screws in our case is due to perpendicular placement of screws which increased strain due to altered bio-mechanics. Achondroplastic dwarfs live a normal life. They are prone to peri-articular fractures because of anatomical variations. We wanted to highlight the difficulties and importance of pre-op planning and implant choice of fracture fixation in an adult achondroplasia patient.
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Sakale, HarshalS, SandeepK Yadav, AlokC Agrawal, BikramKeshri Kar, Bikas Sahoo, and RahulK Chandan. "Pediatric fracture neck of femur." Journal of Orthopaedic Diseases and Traumatology 1, no. 1 (2018): 11. http://dx.doi.org/10.4103/jodp.jodp_7_18.
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Douglas, A. S. "Seasonality of Hip Fracture and Haemorrhagic Disease of the Newborn." Scottish Medical Journal 38, no. 2 (April 1993): 37–40. http://dx.doi.org/10.1177/003693309303800202.
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The objective is to examine and compare the seasonalities offractured neck of femur and haemorrhagic disease of the newborn. The data are from two sources. Admissions for fractured neck of femur in Scotland over five years (1983–87) are examined by age, sex, mortality, operative intervention and source of admission. Data from the United States (1927–36) are examined for infant death rates from suspected haemorrhagic disease of the newborn 3–14 days after birth. The sine curves are examined. The rhythms, while not identical, have similarities. The peaks are in January-February and the troughs in July-August. Amongst hip fractures the peak is one month earlier and the seasonal excess around 20–25 per cent in both conditions. Rickets, haemorrhagic disease of the newborn and fractured neck of femur have comparable seasonal rhythms. Vitamin D regulates the systhesis of the vitamin K dependent bone protein osteocalcin, which is functionally abnormal in postmenopausal women. This may be a significant factor in the seasonal variation of hip fracture.
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Bruyere, Olivier, Christian Roux, Johann Detilleux, Daniel O. Slosman, Tim D. Spector, Patrice Fardellone, Kim Brixen, et al. "Relationship between Bone Mineral Density Changes and Fracture Risk Reduction in Patients Treated with Strontium Ranelate." Journal of Clinical Endocrinology & Metabolism 92, no. 8 (August 1, 2007): 3076–81. http://dx.doi.org/10.1210/jc.2006-2758.
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Abstract Objective: Our objective was to analyze the relationship between bone mineral density (BMD) changes and fracture incidence during 3-yr treatment with strontium ranelate. Patients: Women from the strontium ranelate arm of the Spinal Osteoporosis Therapeutic Intervention study and the TReatment Of Peripheral OSteoporosis study were evaluated. Outcome Measures: The outcome measures included BMD at the lumbar spine, femoral neck, and total proximal femur assessed at baseline and after a follow-up of 1 and 3 yr; semiquantitative visual assessment of vertebral fractures; and nonvertebral fractures based on written documentation. Results: After 3 yr of strontium ranelate treatment, each percentage point increase in femoral neck and total proximal femur BMD was associated with a 3% (95% adjusted confidence interval, 1–5%) and 2% (1–4%) reduction in risk of a new vertebral fracture, respectively. The 3-yr changes in femoral neck and total proximal femur BMD explained 76% and 74%, respectively, of the reduction in vertebral fractures observed during the treatment. Three-year changes in spine BMD were not statistically associated with the incidence of new vertebral fracture (P = 0.10). No significant associations were found between 3-yr changes in BMD and incidence of new nonvertebral fractures, but a trend was found for femoral neck BMD (P = 0.09) and for total proximal femur BMD (P = 0.07). An increase in femoral neck BMD after 1 yr was significantly associated with the reduction in incidence of new vertebral fractures observed after 3 yr (P = 0.04). Conclusion: During 3-yr strontium ranelate treatment, an increase in femoral neck BMD was associated with a proportional reduction in vertebral fracture incidence.
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Parker, Martyn. "Fractured neck of femur - solving the unsolved fracture." Trauma 2, no. 1 (January 2000): 33–41. http://dx.doi.org/10.1177/146040860000200104.
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Parker, M. "Fractured neck of femur -- solving the unsolved fracture." Trauma 2, no. 1 (January 1, 2000): 33–41. http://dx.doi.org/10.1191/146040800671916278.
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Hashem, Majdi, and Mohammad S. Al-Tuwaijri. "Fixator-Assisted Nailing for Femur Neck Fracture Nonunion: A Case Series Study." Advances in Orthopedics 2022 (April 14, 2022): 1–8. http://dx.doi.org/10.1155/2022/5676144.
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Background. Femoral neck fractures in young adults tend to be a result of high-energy trauma with a common pattern of Pauwels type III fracture, and they require timely and meticulous diagnosis and management. The objective of this study was to assess the clinical and radiological outcomes of the fixator-assisted nailing technique for managing femur neck fracture nonunion. Methods. This was a case series study of 16 patients with nonunion femoral neck fractures treated via a fixator-assisted nailing technique. Our inclusion criteria comprised the inclusion of any patient between the ages of 14 and 60 years old with a neglected neck of femur fracture or nonunion of the femur neck. In addition, we only included patients without further posttreatment trauma and without known metabolic diseases. The conditions that were excluded from this study included hip joints with preexisting osteoarthritis, radiographic evidence of avascular necrosis of the femoral head, and associated ipsilateral acetabulum fracture or fracture-dislocation. The fracture characteristics that were selected for the fixator-assisted nailing (FAN) technique were clear signs of pseudoarthrosis (such as sclerosis, clear fracture line defects, and failure of implants), in addition to evidence of varus malalignment. All fractures were Pauwels type III. Radiographs of the pelvis with both hips and a posteroanterior (PA) view of the injured hip were taken. Full weight bearing was allowed in all the patients from the first day postoperatively. Physical therapy was started for pain reduction modalities, stretching, and abductor strengthening. Results. Union of the femur neck fracture and osteotomy site was achieved in all patients. An excellent functional status after four months of follow-up was found based on a modified Harris hip score questionnaire. At follow-up, no patient was suffering from pain or flexion contracture. Preoperative limb length discrepancy (LLD) (cm) was 1.8 ± 0.8 cm and postoperative was 0 ± 0.1 cm, p < 0.001 . Preoperative neck-shaft angle (NSA) (o) was 85.6 ± 4.4 and postoperative was 126.9 ± 2.5, p < 0.001 . Preoperative Pauwels angle (o) was an average of 50.4 ± 5.9 and postoperative was 31.3 ± 2.5, p < 0.001 . Conclusion. Our study indicates that FAN has a high success rate in young patients with nonunited femoral neck fractures.
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Chhetri, Rajendra Sanjel, Kishor Prashad Khatri, and Krishna Kharel. "Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review." Journal of Patan Academy of Health Sciences 6, no. 1 (June 30, 2019): 25–30. http://dx.doi.org/10.3126/jpahs.v6i1.27073.
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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.
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Naser, Mohd Abdul. "Evaluation of treatment of fracture neck femur with uncemented HA coated modular bipolar prosthesis." MedPulse International Journal of Orthopedics 20, no. 3 (2021): 61–65. http://dx.doi.org/10.26611/10202034.
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Background: Background: Fracture of the femoral neck has been reported with increasing incidence in recent times due to prevalence of osteoporosis. Uncemented HA coated modular bipolar hemiarthroplasty systems provide a customised press fit solution which improve the patient outcome with respect to limb length discreptancy. We report our series of 15 cases of fracture neck of femur operated over years with modular cementless HA bipolar hemiarthroplasty. Methods: 15 patients (age=50 to 70 years) with displaced femoral neck fractures were operated between January 2019 to December 2019. Cementless HA coated modular bipolar hemiarthroplasty using hydroxyapatite coated stem was done by single surgeon using same implant in all the patients through Moores approach. Clinical and radiological follow-up was done. Results: Total 15 cases with fracture neck femur were operated. The average follow up was 48 months. No intraoperative mortality was seen. 1 patient had calcar fracture of femur during canal preparation. 1 patient had delayed transient sciatic nerve palsy, and 1 patient had insignificant limb length discripency (0.5 cm). 12 patients reached to pre-injury status with average harris hip score of 88 at final follow up. Conclusions: Cementless bipolar hemiarthroplasty with hydroxyapatite coated stem is a good option for femoral neck fractures in elderly patients.
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Rai, S. K., Rohit Vikas, Vyom Sharma, S. S. Wani, and Rohit Varma. "Fracture neck of femur treated with hemiarthroplasty and cannulated cancellous screw fixation: a comparative study." International Journal of Research in Orthopaedics 3, no. 4 (June 23, 2017): 849. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20172885.
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<p class="abstract"><strong>Background:</strong> Intracapsular fracture neck of femur has always presented great challenges to every Orthopaedic surgeons and it is remain a mystery whether to fix or to replace the fracture in the elderly. The aim of the study was to analyze the functional outcome of two widely used and accepted modalities of treatment in the age group 57-75 years, in Garden’s type I and II fractures, namely (a) cannulated cancellous screw fixation(internal fixation) and (b) modular bipolar prosthetic replacement of the femoral head (hemiarthroplasty).</p><p class="abstract"><strong>Methods:</strong> The total 110 patients were including in the study from age groups 57-75 (mean age 66). The Garden classification of fracture neck of femur was used to evaluate the displacement of femoral neck fractures. Only grade 1 and 2 was included in the study. 55 patients were included in each group A and B. Osteosynthesis (fracture fixation) was carried out by closed reduction and insertion of cannulated cancellous screw and in other group hemiarthroplasty was done.<strong></strong></p><p class="abstract"><strong>Results:</strong> In group A 55 patient with fracture neck of femur was treated by osteosynthesis i.e. fixation using 02 or 03 cannulated cancellous screw and in group B, 55 patients with fracture neck of femur was treated by modular bipolar replacement hemiarthroplasty. In Group A out of 55, 41 patients union was achieved between 08 to 14 months (mean 11.5 month), 09 patients developed non-union even after 16 months and 05 patients develop collapse of head with AVN with shortening at end of 02 year, however in Group B out of 55 patients 51 patients started walking after 2<sup>nd</sup> postoperative days, 02 patients developed infection, and 02 patients developed posterior dislocation.</p><p><strong>Conclusions:</strong> The fracture fixation may be tempting for fracture neck femur in age group 57-75 especially of Garden Type I but internal fixation put risk of non-union and AVN and second surgery may be required after few months or years if patients survive. Based on results in our study we therefore can conclude that in Garden Type I and II femur neck fractures in the patients between 57-75 years of age, hemiarthroplasty is the better modality of treatment.</p>
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ASGHAR, MUHAMMAD, MUKHTAR AHMED TARIQ, and MUHAMMAD SHAFEE. "PAUWEL'S OSTEOTOMY AND OSEOSYNTHESIS." Professional Medical Journal 14, no. 01 (March 10, 2007): 89–96. http://dx.doi.org/10.29309/tpmj/2007.14.01.3631.
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Introduction:- Fracture neck of femur is one of serious injuries encountered in orthopaedic trauma management. It can result from trivial trauma in elderly but are usually the result of high-energy trauma in the younger age group. Objective- To evaluate the results of Pauwel's osteotomy and oseosynthesis in patients with non union of femoral neck fractures. Setting Orthopaedic Unit, Nishtar Hospital, Multan. Duration 1989-1998. Material and methods Sample size 30 patients. Results: 30 cases of neglected fracture neck of femur treated. 5 patients were treated first with traction where greater trochanter migrated a way up to bring it down to the proper level. Then osteotomy was done. In 25 cases Pauwels' osteotomy was primarily done and fixed with 120 degree osteotomy plate. Follow up period ranged from 7 months to 2 and half years. Patients were assessed for reduction of the fracture site in according to alignment index by Garden for union of the fracture and range of mobility and pain relief in follow up period. Conclusion:- This is a reliable method of dealing with nonunion of the fracture neck of the femur in young adults.
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Napoli, Nicola, Jenny Jin, Katherine Peters, Rosanna Wustrack, Shane Burch, Aldric Chau, Jane Cauley, Kristine Ensrud, Michael Kelly, and Dennis M. Black. "Are Women with Thicker Cortices in the Femoral Shaft at Higher Risk of Subtrochanteric/Diaphyseal Fractures? The Study of Osteoporotic Fractures." Journal of Clinical Endocrinology & Metabolism 97, no. 7 (July 1, 2012): 2414–22. http://dx.doi.org/10.1210/jc.2011-3256.
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Abstract Context: Femoral shaft cortical thickening has been mentioned in reports of atypical subtrochanteric and diaphyseal (S/D) femur fractures, but it is unclear whether thickening precedes fracture or results from a preceding stress fracture and what role bisphosphonates might play in cortical thickening. Objective: Our objective was to examine the relationship of cortical thickness to S/D fracture risk as well as establish normal reference values for femoral cortical thickness in a large population-based cohort of older women. Design: Using pelvic radiographs obtained in 1986–1988, we measured femoral shaft cortical thickness 3 cm below the lesser trochanter in women in the Study of Osteoporotic Fractures. We measured this in a random sample and in those with S/D fractures and femoral neck and intertrochanteric fractures. Low-energy S/D fractures were identified from review of radiographic reports obtained between 1986 and 2010. Radiographs to evaluate atypia were not available. Analysis used case-cohort, proportional hazards models. Outcomes: Cortical thickness as a risk factor for low-energy S/D femur fractures as well as femoral neck and intertrochanteric fractures in the Study of Osteoporotic Fractures, adjusting for age and bone mineral density in proportional hazards models. Results: After age adjustment, women with thinner medial cortices were at a higher risk of S/D femur fracture, with a relative hazard of 3.94 (95% confidence interval = 1.23–12.6) in the lowest vs. highest quartile. Similar hazard ratios were seen for femoral neck and intertrochanteric fractures. Medial or total cortical thickness was more strongly related to fracture risk than lateral cortical thickness. Conclusions: In primarily bisphosphonate-naive women, we found no evidence that thick femoral cortices placed women at higher risk for low-energy S/D femur fractures; in fact, the opposite was true. Women with thin cortices were also at a higher risk for femoral neck and intertrochanteric fractures. Whether cortical thickness among bisphosphonate users plays a role in atypical S/D fractures remains to be determined.
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Jee, Govind Mohan, and Nitin Kumar. "Muscle pedicle bone graft in ununited fracture neck of femur in children." Indian Journal of Orthopaedics Surgery 8, no. 1 (March 15, 2022): 17–22. http://dx.doi.org/10.18231/j.ijos.2022.004.
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Delayed presentation of fracture neck of femur is not uncommon in our scenario and is difficult to treat because of precarious vascularity and bony defect at fracture site. The purpose of the present study is the analysis of functional outcome of the muscle pedicle bone graft porcedure in ununited fracture neck of femur in children and adolescents.: Sixteen patients with ununited fracture neck of femur (presenting late) in children and adolescents were treated with quadratus femoris based muscle pedicle bone graft along with open reduction and internal fixation. Mean age of the patient was 14.25 year (range 12-16 years). Boys dominated our series (n= 10 i.e.62.50%). Road traffic accident was the leading cause. Average injury –surgery interval was 5.88 week (range 3-9 week). A minimum follow up was two years. There were 2 Transepiphyseal, 11 Transcervical and 3 Cervicotrochanteric fractures. Most of the cases showed union in 16 to 24 weeks. In one case there was implant failure. : The result was analysed using Harris Hip Score. We had 11 (68.75%) excellent, 2 (12.50%) Good, 2(12.50%) Fair and one (06.25%) Poor results in our series.Quadratus femoris based Muscle pedicle bone with internal fixation is a very effective method to address the difficult problem of non-union fracture neck of femur. There was statistically significant association (p value <.005) between accuracy of reduction and functional outcome.
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Ahmed, Masroor, Muhammad Bux, Ghulam Hussain, Mukesh Kumar, and Naveed Ahmed. "FUNCTIONAL OUTCOME OF DELAYED PRESENTING FRACTURE NECK OF FEMUR MANAGED BY CANNULATED SCREW AND FIBULAR GRAFT." Journal of Ayub Medical College Abbottabad 34, no. 1 (December 31, 2021): 41–44. http://dx.doi.org/10.55519/jamc-01-8122.
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Background: Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. Methods: A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. Results: Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were included in study. out of which 14 (40%) of the patients had sub-capital fracture and 21 (60%) patients had trans-cervical fracture neck of femur. Mean age of patients was 32.14±10.20 years. Twenty-eight (80%) patients out of 35 had excellent and good outcome, 4 (11.4%) cases had fair and 3 (8.5%) had poor outcome Conclusion: Cannulated screw fixation along with non-vascularized fibular graft is effective technique to management of delayed presenting fracture neck of femur as it is easy, inexpensive and does not require any special instrumentation or expertise
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Agrawal, AlokC, Bikas Sahoo, BikramK Kar, Harshal Sakale, SandeepK Yadav, and Sameer Mittal. "Classification of fracture neck of femur." Journal of Orthopaedic Diseases and Traumatology 1, no. 1 (2018): 5. http://dx.doi.org/10.4103/jodp.jodp_15_18.
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Sandhu, HardasSingh. "Management of fracture neck of femur." Indian Journal of Orthopaedics 39, no. 2 (2005): 130. http://dx.doi.org/10.4103/0019-5413.36794.
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LaMonica, Julia N., Brian Rhee, Kenneth Milligan, Michael Leslie, Steven M. Tommasini, and Daniel H. Wiznia. "Finite Element Evaluation of the Femoral Neck System as Prophylactic Fixation to Prevent Contralateral Hip Fractures." Geriatric Orthopaedic Surgery & Rehabilitation 13 (January 2022): 215145932211351. http://dx.doi.org/10.1177/21514593221135117.
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Introduction Hip fractures cause significant morbidity and mortality for geriatric patients, and incidence is increasing as the population ages. Following a primary hip fracture, up to 20% may suffer a contralateral hip fracture within 5 years despite fracture risk reduction measures, including fall prevention and osteoporosis pharmacologic treatment. The aim of this study is to assess whether insertion of the Femoral Neck System (Depuy Synthes, West Chester, PA) into the contralateral proximal femur may strengthen the bone and decrease the incidence of contralateral hip fractures. Materials and Methods ScanIP, an image processing software was used to produce 3-dimensional models of a cadaver femur with the implanted device. Models were meshed and exported to Abaqus for finite element analysis to evaluate the device’s ability to reduce stress in the proximal femur. Results were analyzed for element-wise volume and von-Mises stresses. Results The implant reduced peak stress and bone failure at all levels of bone quality. Specifically in osteoporotic bone, the implant decreased peak stress by 27%, proximal femur trabecular bone failure by 5% and cortical bone failure by 100% in the femoral neck. Conclusions Our results from computer generated finite element analyses indicate that the Femoral Neck System may strengthen an osteoporotic proximal femur in the event of a lateral fall. Further investigation with expanded finite element analysis and cadaveric biomechanical studies are needed to validate these results.
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Vijay, Varun, and Naveen Srivastava. "Cannulated cancellous screws fixation in intracapsular fracture neck femur: a study with an emphasis on result of osteosynthesis." International Journal of Research in Orthopaedics 2, no. 3 (September 3, 2016): 180. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20163128.
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<p class="abstract"><strong>Background:</strong> Fracture neck of femur has always presented a great challenge to the orthopaedic surgeons. It is rightly called as “unsolved fracture” as far as treatment and results are concerned. Results generally depend upon time period elapsed from fracture to surgery, adequacy of reduction and fixation. Fixation with cannulated cancellous screw is usually adequate for femoral neck fractures. The aim of the study was to analyse the results of treatment of fracture neck of femur with cannulated cancellous screw fixation and to compare the results with others in the literature using the same modality. </p><p class="abstract"><strong>Methods:</strong> 25 patients with intra capsular neck of femur fracture were followed for a period of two years post-surgery and their functional outcome was assessed based upon harris hip scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> According to harris hip scoring system, we had excellent results in 72% cases, good in 16% cases, fair in 8% and poor in 4%. One patient went into non-union and two developed avascular necrosis of femoral head.</p><p><strong>Conclusions:</strong> Management of intracapsular fracture neck of femur with cannulated cancellous screw fixation is a very good method of treatment being a surgically easy procedure. Use of multiple cannulated cancellous screw have a compression effect at the fracture site. It also avoids re displacement and rotation.</p>
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Anup, Khare, and M. M. Mehra. "Retrograde Femoral Interlocking Nail in Complex Fractures." Journal of Orthopaedic Surgery 10, no. 1 (June 2002): 17–21. http://dx.doi.org/10.1177/230949900201000104.
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Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur. This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture. The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90° of movement, these were old fractures and noncooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil. Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is economical also.
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Arfee, Sakib, Asma Jabeen, Akib Arfee, and Adnan Aadil Arfee. "Outcome of management of intracapsular fracture neck of femur in young adult patients." International Journal of Research in Medical Sciences 8, no. 12 (November 27, 2020): 4456. http://dx.doi.org/10.18203/2320-6012.ijrms20205324.
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Background: Almost four centuries back fracture neck of femur was described, but till today this fracture is unsolved, though situation has largely improved from the days of Sir Astley Cooper, who had said “I have never met one in whom union had taken place”. High incidence of complications with this fracture even in modern day show that we still have not found way to treat this fracture appropriately and its treatment remains a challenging problem. The objective of the study was to assess the final outcome of management of intracapsular fracture neck of femur in young adult patients after internal fixation.Methods: This study has been conducted at Orthopedic Department of Government Medical College and hospital, Jammu from 2018 to 2020. 30 young adult patients with fractures neck of femur treated with CCS (27 patients) and DHS (3 patients) after taking informed consent were selected for the study.Results: 30 young adult patients in age group of 18-60 years, constituted this study. 27 patients were treated with closed reduction and internal fixation with CCS (group A) and 3 patients were treated with DHS (group B). 3 patients were lost to the follow up, all of them from group A.Conclusions: DHS appears to be more forgiving implant than CCS in fracture neck of femur in young adult patients. However number in this group is very small and hence larger studies are needed. In fixation with CCS anatomical reduction of fracture, proper screw placement is the most important criterion for achieving better results.
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Khandelwal, Dr RCS, Dr Rajkumar Rathod, Dr Umang Sanghvi, Dr Aditya K. Agrawal, and Dr Chetan Shende. "Iatrogenic fracture neck femur while internal fixation of fracture shaft femur by femur interlocking nail." International Journal of Orthopaedics Sciences 4, no. 2g (April 1, 2018): 432–33. http://dx.doi.org/10.22271/ortho.2018.v4.i2g.67.
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Manzoor, Basharat, Shehzad Mehmood, and M. Javed Iqbal. "FEMORAL NECK FRACTURE." Professional Medical Journal 25, no. 12 (December 8, 2018): 1805–8. http://dx.doi.org/10.29309/tpmj/18.4530.
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Femoral neck fracture is common in the elderly, with only 2-3% found in patient younger than 50 years. Osteoprosis & co-mordities increase the incidence of their fractures. Non-Operative treatment is indicated only is unfit or non-ambulatory patients age, general health status and Socio economic condition of patients along with availability of facilities are important to select the treatment modality. There are many operative treatment options, prosthetic replacement with Austin Moore prosthesis (AMP) is one of the treatment option in this age group. Post Operative complications are thigh pain, hip dislocation & infection. Objectives: To determine the results of Austin moore prosthesis in fracture neck of femur in elderly patients in terms of mid-thigh pain. Study Design: Descriptive Case series & setting in Orthopedic Department Allied Hospital Faisalabad. Period: Study Period is from April 2008 to August 2010. Setting: All the cases done in Orthopedic department Allied & DHQ Hospital Faisalabad. Methods: All the patients were evaluated in emergency department of Orthopedics as per ATLS protocol and diagnose by obtaining X-Rays pelvis with both Hip Joints and were operated by consultant through moore’s approach Head of Femur was removed and replaced by Austinmoor’s prosthesis of appropriate size. In all cases one dose of prophylactic broad spectrum antibiotic were giving. Results: 56 Patients (31 males 55.4% + 25 female 44.6) with mean age 73.08 +8.13 are Included in the criteria and were operated with same implant. After 2 monthspost operatively 40 Patients had no pain 07 (12.5%) had mild (71.4%). Pain & 08 Patients 14.3 % had moderate pain. After 03 month post operatively 43 Patients (78.2%) had no pain, 02 (3.6%) had mil, 08 Patients (14.5%) moderate and 01(1.8%) had scene. Conclusion: Prosthetic replacement with AMP is one of the treatment options in femoral neck fracture.
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Khadabadi, Nikhil A., and Kiran S. Patil. "Simultaneous Bilateral Femoral Neck Stress Fracture in a Young Stone Mason." Case Reports in Orthopedics 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/306246.
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Unilateral stress fractures of the femoral neck are very uncommon and bilateral involvement is even rarer. They commonly occur in athletes, military recruits, older persons, or individuals with underlying metabolic disorders and very seldom in normal individuals. We present a rare case of simultaneous bilateral fracture neck of femur in a 25-year-old man who came with complaints of pain in bilateral groin for 1 month. There was no history of trauma or history suggestive of excessive activity prior to the onset of pain, but there was history of lifting heavy weights daily. On evaluation with MRI scan bilateral fracture of the femur neck was diagnosed and patient was operated on bilaterally with internal fixation done using dynamic hip screw. Patient then regained his routine activity over a period of 6 months and on follow-up at 1 year no avascular necrosis changes were seen in the femur head. We presented this case because of its unusual presentation and the diagnostic challenge it poses.
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Pelet, Leyvraz, Garofalo, Borens, and Mouhsine. "Sub- or Intertrochanteric Fracture Following Screw Fixation of an Intracapsular Proximal Femoral Fracture: True Complication or Technical Error?" Swiss Surgery 9, no. 2 (April 1, 2003): 82–86. http://dx.doi.org/10.1024/1023-9332.9.2.82.
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Purpose: To review, retrospectively, the possible causes of sub- or intertrochanteric fractures after screw fixation of intracapsular fractures of the proximal femur. Methods: Eighty-four patients with an intracapsular fracture of proximal femur were operated between 1995 and 1998 by using three cannulated 6.25mm screws. The screws were inserted in a triangular configuration, one screw in the upper part of the femoral neck and two screws in the inferior part. Between 1999 and 2001, we use two screws proximally and one screw distally. Results: In the first series, two patients died within one week after operation. Sixty-four fractures healed without problems. Four patients developed an atrophic non-union; avascular necrosis of the femoral head was found in 11 patients. Three patients (3.6%) suffered a sub- and/or intertrochanteric fracture after a mean postoperative time of 30 days, in one case without obvious trauma. In all three cases surgical revision was necessary. Between 1999 and 2001 we did not observe any fracture after screwing. Conclusion: Two screws in the inferior part of the femoral neck create a stress riser in the subtrochanteric region, potentially inducing a fracture in the weakened bone. For internal fixation for proximal intracapsular femoral fracture only one screw must be inserted in the inferior part of neck.
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Sjarwani, Achmad, and OK Ilham Abdullah Irsyam. "LONG TERM FUNCTIONAL EVALUATION AUTOFIBULAR STRUT GRAFT IN CASE OF FRACTURES NECK FEMUR IN RSUD DR SOETOMO SURABAYA." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 7, no. 1 (December 6, 2019): 55. http://dx.doi.org/10.20473/joints.v7i1.2018.55-64.
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Background: Neck femur fracture has a poor prognosis due to its anatomical structure. Fractures that occur in the elderly often have a heavy comorbid so that the mortality rate in 1 year in this case reaches 30-50%. The techniques that have been developed at this time are not satisfactory results with non-union rate of about 30%.Purpose: Assessing the long-term effectiveness of fibular auto strut graft techniques for neck femoral fracture therapy.Methods: The study was conducted retrospectively using primary data in the form of clinical evaluation and secondary data in the form of medical record data and questionnaires of neck femur fracture patients who performed non-vascularized autofibular strutgraft therapy in the period January 2005 to August 2015 in operating room IRD RSUD Dr. Soetomo Surabaya. Patients were evaluated with Harris Hip Score.Result: Medical record data shows that surgery was performed in January 2005 until August 2015 in the IRD hospital operating room. Soetomo Surabaya with 15 patients that fit criteris inclusion. The final result of Harris Hip Score is excellent in 66.66% of patients, good in 20% of patients, and poor on 13.33% of patients. It can be seen that in large part, the technique of autofibular strutgraft (Surabaya Technique) gives good results to the sufferer.Conclusion: Autofibular strutgraft and reinforcement with cancellous lag screw on neck femur fracture can generally provide good functional results in long term evaluation. From the assessment of functional aspects, abnormal anatomical conditions, and Range of Motion (ROM), obtained satisfactory results. This supports autofibular strutgraft as a neck femur fracture therapy as a major therapeutic option at a young age.
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Ahmed, Awes, Khalil Ahmed, and Kashif Ali Shaikh. "Frequency of Surgical Outcome of Patients Who Underwent Basicervical Femur Fractures Treatment with Dynamic Hip Screw Combiner with Derotation Hip Screw at Teritay Care Hospital, Karachi." Pakistan Journal of Medical and Health Sciences 16, no. 11 (November 30, 2022): 588–91. http://dx.doi.org/10.53350/pjmhs20221611588.
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Background: A basicervical fracture occurs when the femoral neck breaks below its intertrochanteric connection1. It's between a femoral neck fracture, treated with cancellous screws, and an intertrochanteric fracture, treated with sliding screws2. Previous studies revealed basicervical fractures might be treated with the DHS like intertrochanteric fractures. Basicervical fractures are less stable than intertrochanteric fractures 3,4, hence the DHS alone may not lead to a good functional outcome 5. A basal femoral neck fracture is one type of femoral fracture. Objective: To determine the frequency of surgical outcome of patients who underwent basicervical femur fractures treatment with dynamic hip screw combined with derotation hip screw at Tertiary Care Hospital, Karachi. Study Design: Descriptive Case study. Setting: This study was conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Duration: Six months after the approval of synopsis from August 23, 2019 to February 22, 2020. Methodology: JPMC in Karachi treated all included patients. Participants consented after learning about the study's methods, risks, and benefits. The wound was shaved and dressed the night before surgery. The patient's arms and legs were tied to the traction foot component using a fracture table. Image intensifiers were employed to verify the closed reduction. Straight cut from the greater trochanter down the thigh. Using an angle guide, a threaded guide pin was placed into the femoral head. Non-absorbable sutures closed the wound. Incision closed with suction drainage. All obtained data was kept in a performa and evaluated electronically for research. Results: Mean ± SD of age was 51.3±7.16 years. In distribution of gender, 67 (64.4%) were male while 37 (35.6%) were female. Surgical outcome was divided into two parts i.e. functional and radiological outcome. In Functional outcome 17 (16.35%) were having excellent hip score, 38 (36.55%) having good score, 22 (21.15%) having fair score while 27 (25.95%) having poor score. In radiological outcomes 33 (31.75%) had fracture reduction, 51 (49.02%) had fracture fixation, 20 (19.23%) had fracture union. Practical Implication: This study will help to determine the patient’s surgical outcomes on implying the dynamic hip screw combined with derotation hip screw, in treating basicervical femur fractures. Conclusion: It is to be concluded that DHS may allow better restoration of functional and radiological outcomes for the treatment of basicervical femur fractures in well selected patients that meet the indications for surgery whenever the technical competence and facilities exist. Keywords: Basicervical Femur Fractures, Dynamic Hip Screw, Derotation Hip Screw, Fracture, Hip Fracture
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Dahuja, Anshul, Shiraz Bhatty, Kapil Bansal, Rashmeet Kaur, and Radhe Shayam. "Role of PFN in ipsilateral fracture neck and shaft femur: a single solution to double fracture." International Journal of Research in Orthopaedics 4, no. 3 (April 25, 2018): 384. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20181472.
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<p class="abstract"><strong>Background:</strong> Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern that presents a diagnostic and treatment challenge. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced proximal femoral nails (PFN).</p><p class="abstract"><strong>Methods:</strong> We analysed the retrospective data of 25 consecutive patients who had sustained a high energy trauma who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with PFN between January 2010 and January 2017.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average follow up period was 1.2 years. All ipsilateral neck and shaft fractures were united with proximal femur nail (PFN). Neck fracture union averaged 4.3 months (range, 3–6 months). Shaft fracture union averaged 5.4 months (range, 4–7 months). Eighteen patients (70%) had a good functional result, five patients (21%) had fair result and in two patients the result (9%) was poor.</p><p class="abstract"><strong>Conclusions:</strong> We observed although technically demanding, the reconstruction nail is an acceptable, cost effective and minimal invasive alternative for the management of concomitant ipsilateral fractures of the femoral neck and shaft, with a good functional outcome and fewer complications.</p>
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Popsuishapka, Olexii, Serhii Dovhan, and Oleksandr Khomyak. "Остеосинтез у разі переломів шийки та вертлюгової зони стегнової кістки в дітей." ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, no. 2 (October 12, 2021): 10–16. http://dx.doi.org/10.15674/0030-59872021210-16.
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Proximal femur fractures are uncommon injuries in children, accounting for less than 1 % of all fractures per year, but usually result in hospitalization and are at risk of complications. We have designed a device for bone fragments fixation in the case of proximal femur fractures and the method of its application in adults. The device consists of rods that are screwed into the cap of the head, the diaphyseal part and the module, which is located in the subtrochanter area. The rods can be connected to the module at any angle in the frontal plane. The device provides a certain stage of installation of the elements, which allows you to effectively place it with minimal bone destruction. Objective. Share your own experience in the treatment of femoral neck and proximal femur fractures in children. Material. The experience of treatment of 28 children with femoral neck fracture or proximal femur fractures for the period 2005–2020 is presented, 11 of them were treated conservatively with the skeletal traction. Osteosynthesis by the author’s device was performed in 17 patients: 15 closed reduction, 2 in case of intertrochanteric fracture, — open reduction. The method of osteosynthesis and postoperative management of patients is described in detail. Results. In children who were treated conservatively, the fracture consolidation was achieved within 5–7 months, in one of them — in the position of varus deformity. In contrast to conservative treatment, children began to walk with crutches after a few days after surgery, with partial weight-bearing on injured limb. The device was removed in 16 patients after 5–8 months, and complete fracture consolidation of the fragments in their anatomical position was noted. There were no pathological tissue reactions to the metal device. Conclusions. The proposed device and method of closed osteosynthesis with its usage in the case of proximal femur and femoral neck fractures in children can be recommended in the practice of pediatric traumatology.
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McLoughlin, Liam. "Churchill’s fractured neck of femur." Journal of Medical Biography 27, no. 3 (March 14, 2019): 129–36. http://dx.doi.org/10.1177/0967772018785858.
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In June 1962 at the age of 87 years, Sir Winston Churchill (1874–1965) fell over in his hotel room at the Hotel de Paris in Monte Carlo and sustained a fracture to the neck of his left femur. He was flown back to London and the fracture operated on at The Middlesex Hospital by two eminent orthopaedic surgeons, Mr Phillip Newman (1911–1994), Consultant to the The Middlesex Hospital and The Royal National Orthopaedic Hospital, Stanmore, and The Institute of Orthopaedics, London, and Professor Herbert Seddon (1903–1977), Consultant to the The Royal National Orthopaedic Hospital, Stanmore, and Director of The Institute of Orthopaedics under whom Churchill was admitted as a private patient. Churchill’s recovery was complicated by the development of deep vein thrombosis. During his convalescence, Churchill befriended Seddon who recorded his time with him in his private papers. On 21 August, Churchill was discharged to his home at 28 Hyde Park Gate which had been modified during his admission and made a return to public life in November 1962 at a dinner at the dining club he had originally founded, The Other Club.
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Choudhury, Suvam, T. S. K. Gupta, Subhransu S. Nayak, and Tanmoy Mohanty. "Long Term Results of Valgus Intertrochanteric Osteotomy in Old Fracture Neck of Femur – A Prospective Analysis." Odisha Journal of Orthopaedics and Trauma 3, no. 1 (2022): 34–38. http://dx.doi.org/10.13107/ojot.2022.v03i01.031.
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A prospective study (data collected retrospectively from January 2011 to December 2018) was conducted in the department of orthopaedics in SCB Medical College and Hospital from December 2018 to December 2020 on patients with old fracture neck of femur. A total of 42 cases were included for the study who had undergone this surgery before December 2019. Valgus Intertrochanteric Osteotomies included McMurray’s Osteotomy, Modified Pauwel’s Osteotomy and Transfracture Abduction Osteotomy. Thirty six patients were followed up only as Six patients could not be contacted. Valgus Intertrochanteric Osteotomy of proximal femur was found to be the mainstay of the treatment in young patients. Initially Mc Murrays Osteotomy was preferred but in recent times modified Pauwel’s Intertrochanteric Valgus Osteotomy and Trans Fracture Abduction Osteotomy was considered as an augmentation to the healing of a fracture neck of femur which presented late. Keywords: Valgus intertrochanteric osteotomy, Old neck of femur fracture, Fixation
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Choi, Siu-Wai, Frankie K. L. Leung, Tak-Wing Lau, and Gordon T. C. Wong. "Impact of postoperative haemoglobin on length of stay post fractured hip repair in patients with standardised perioperative management." HIP International 29, no. 2 (May 7, 2018): 172–76. http://dx.doi.org/10.1177/1120700018773428.
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Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.
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Multani, Pankhuri, Diksha Nagrale, and Bhawna Ujjainkar. "Physiotherapy Rehabilitation in Elderly Patients with Postoperative Femoral Neck Fracture - A Case Report." International Journal of Health Sciences and Research 12, no. 3 (March 10, 2022): 174–78. http://dx.doi.org/10.52403/ijhsr.20220324.
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The femoral neck fracture in the elderly is a major public health concern. Femoral neck fractures are a prevalent type of hip fracture that has a significant morbidity and mortality rate. As a result, the focus of this study is on physical therapy procedures for older individuals who have had their proximal femoral fractures surgically repaired. Physical therapy aids in the postoperative treatment of patients with proximal femoral fractures by increasing muscular strength, improving walking safety and performance, and understanding the patient's condition, allowing the elderly to become more independent. To avoid respiratory issues and other complications that result from immobility, it is critical for such patients to continue to stay orthostatic and walk as soon as possible, regardless of the nature of the fracture or the material used for fixation, though this is frequently not possible due to the patient's general health status. Introduction: This case study is focused on the treatment of a person with a femoral neck fracture. Femoral neck fractures are prevalent in the older population, reflecting a major cost of health insurance. Case Description: This is the case of 60 years old female who sustained a fracture of the neck of the femur after she meet with an accident. She underwent total hip arthroplasty. The patient was mesomorphic. Physical therapy rehabilitation provided care in ways including postoperative weight-bearing, gait training, improving the strength of quadriceps and hamstring muscles. Conclusion: According to the findings, the decisive surgical procedure and early physiotherapy rehabilitation contributed to the patient's functional goals progressing, which is an important understanding of a successful recovery. Key words: Fracture, Femur fracture, Trauma, Osteogenesis imperfecta, Range of motion, Osteomyelitis, Osteoporosis, Osteopenia, Aged, Physiotherapy, Rehabilitation.
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Sanchez, Maria Dolores Porcel, and Karen L. Perry. "CPD article: Fractures of the femur." Companion Animal 26, no. 5 (May 2, 2021): 1–15. http://dx.doi.org/10.12968/coan.2020.0096.
Full textAbstract:
Femoral fractures occur commonly in dogs and cats, accounting for 45% of all long bone fractures. Femoral fractures are classified based on anatomic locational and include fractures of the proximal epiphysis, proximal physeal fractures, subcapital fractures, fractures of the femoral neck, trochanteric fractures, subtrochanteric fractures, fractures of the femoral shaft, supracondylar fractures, distal physeal fractures, unicondylar fractures, bicondylar fractures and fractures affecting the femoral trochlea. In general, femoral fractures are not amenable to treatment with external coaptation, so surgical stabilisation or a salvage procedure is required. Selection of an implant system will depend on fracture configuration and location, and requires a thorough understanding of the forces to which the implant system will be subjected. Complications associated with stabilisation may include premature physeal closure, resorption of the femoral head or neck, malunion, non-union, altered coxofemoral development, implant failure, sciatic neurapraxia, quadriceps contracture, patellar luxation and infection. The complication rate can be substantially reduced by the use of meticulous surgical technique and appropriate implant selection with the prognosis for complete functional recovery remaining good to excellent, providing that an optimal healing environment is preserved.
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Dadrewalla, Arshan J., Joseph Battle, and Raymond Anakwe. "Case Report – Short-term Bisphosphonate Use Associated Stress Fractures." Journal of Orthopaedic Case Reports 12, no. 10 (2022): 78–82. http://dx.doi.org/10.13107/jocr.2022.v12.i10.3376.
Full textAbstract:
Introduction: Long-term bisphosphonate use has been linked to an increased risk of pathological neck of femur fractures. Case Presentation: We write concerning a patient who presented with left hip pain following a low impact fall, which was diagnosed as a pathological left neck of femur fracture. This was a subtrochanteric stress fracture most frequently seen in patients who take bisphosphonate medications. A key point of difference in our patient is the length of time of bisphosphonate use. A further interesting point was the method of imaging used to diagnose this fracture whereby plain radiographs and computerized tomography imaging both did not show any acute fracture whereas only a magnetic resonance imaging (MRI) hip demonstrated this fracture. Surgical insertion of a prophylactic intramedullary nail was done to stabilize the fracture and reduce the risk of progression to a complete fracture. Conclusion: This case brings up multiple key points not reviewed previously such as the fact a fracture developed only 1 month after bisphosphonate use rather than months or years. These points suggest that there should be a low threshold for investigation (including MRI scanning) into potential pathological fractures and that bisphosphonate use should be a red flag to initiate these investigations regardless of length of use. Keywords: Atypical stress fractures, bisphosphonate use, magnetic resonance imaging.
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Agrawal, AlokC, Abhishek Jain, BikasK Sahoo, SandeepK Yadav, BikramKeshri Kar, and HarshalS Sakale. "Early management of fracture neck of femur." Journal of Orthopaedic Diseases and Traumatology 1, no. 1 (2018): 8. http://dx.doi.org/10.4103/jodp.jodp_8_18.
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Agrawal, AlokC. "Neglected fracture neck of femur: Our experience." Journal of Orthopaedic Diseases and Traumatology 1, no. 1 (2018): 21. http://dx.doi.org/10.4103/jodp.jodp_9_18.
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Kakwani, R., and G. Tawari. "Computerised templating for fracture neck of femur." Injury Extra 42, no. 9 (September 2011): 166. http://dx.doi.org/10.1016/j.injury.2011.06.404.
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Green, Carl M., Moez Zeiton, Katherine Foulkes, and Jim Barrie. "Acute Fracture Neck of Femur Among Inpatients." Journal of Patient Safety 14, no. 4 (December 2018): 202–5. http://dx.doi.org/10.1097/pts.0000000000000193.
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