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Giotis D, Konstantinidis C, Plakoutsis S, Kotsias C, Konstantinou A, Tsiampas D, Vardakas D, Panagiotopoulos V. Internal Fixation With Cannulated Screws for Stable Femoral Neck Fractures in High-Risk Patients: Good Clinical Outcomes and Evaluation of Postoperative Complications. Cureus 2024; 16:e71767. [PMID: 39559651 PMCID: PMC11570436 DOI: 10.7759/cureus.71767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2024] [Indexed: 11/20/2024] Open
Abstract
This study aimed to investigate the clinical outcome and the postoperative complications after internal fixation with cannulated screws of stable femoral neck fractures (FNFs) in high-risk patients. A total of 76 patients (mean age 70.11 ± 9.83 years) with stable FNFs participated in the study. All patients underwent fixation with two or three cannulated screws (percutaneous). Postoperatively, they were evaluated with the Harris Hip Score (HHS), while parameters regarding other possible comorbidities or delayed complications were also assessed. Regarding the HHS, more than 75% of patients presented satisfactory results at the last follow-up. No wound infection or hip dislocation was reported. In seven cases (9.21%), complications were observed such as nonunion or osteonecrosis of the femoral head, which were treated successfully with a revision surgery. Conclusively, screw fixation in high-risk patients could be an effective, minimally invasive procedure for the treatment of stable FNFs with satisfactory clinical results, a low revision rate, and potential to return to pre-injury activities.
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Affiliation(s)
- Dimitrios Giotis
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | | | - Sotiris Plakoutsis
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | - Christos Kotsias
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | - Alkisti Konstantinou
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | - Dimitrios Tsiampas
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
| | - Dimitrios Vardakas
- Orthopaedic Department, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC
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Yeoh SC, Wu WT, Peng CH, Yao TK, Chang CM, Liu KL, Yu TC, Chen IH, Wang JH, Yeh KT. Femoral neck system versus multiple cannulated screws for the fixation of Pauwels classification type II femoral neck fractures in older female patients with low bone mass. BMC Musculoskelet Disord 2024; 25:62. [PMID: 38218794 PMCID: PMC10787435 DOI: 10.1186/s12891-024-07179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Femoral neck fractures in older adult patients are a major concern and often necessitate surgical intervention. This study compared the clinical outcomes of 2 surgical techniques: the femoral neck system (FNS) and cannulated compression screws (CCSs). METHODS A total of 40 female patients (mean age 73.50 ± 11.55 years) with femoral neck fractures of Pauwels classification type II and receiving surgical fixation between 2020 and 2022 were enrolled. The patients were categorized into an FNS group (n = 12) or a CCS group (n = 28), and surgical duration, intraoperative blood loss, length of hospital stay, and incidence of postoperative adverse events were analyzed. RESULTS No significant intergroup differences in demographic characteristics were discovered. The mean surgical duration for all patients was 52.88 ± 22.19 min, with no significant difference between the groups. However, the FNS group experienced significantly higher intraoperative blood loss (P = 0.002) and longer hospital stay (P = 0.023) than did the CCS group. The incidence of osteonecrosis was higher in the CCS group, whereas the incidence of nonunion or malunion was higher in the FNS group. The surgical method did not appear to be a significant risk factor. The main risk factor for revision surgery was longer duration until the first adverse event (P = 0.015). CONCLUSION The FNS does not appear to provide superior surgical outcomes compared with CCSs in older adult women with Pauwels classification type II femoral neck fractures. A longer duration between surgical fixation and the first adverse event before stabilization of the fracture site may be a risk factor for revision surgery.
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Affiliation(s)
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Cheng-Huan Peng
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Ting-Kuo Yao
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Chia-Ming Chang
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Kuan-Lin Liu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Tzai-Chiu Yu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Ing-Ho Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan.
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien, Taiwan.
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Cheng X, Yang Y, Zhu J, Li G, Chen W, Wang J, Zhang Q, Zhang Y. Finite element analysis of basicervical femoral neck fracture treated with proximal femoral bionic nail. J Orthop Surg Res 2023; 18:926. [PMID: 38053203 DOI: 10.1186/s13018-023-04415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Dynamic hip screws (DHS) and proximal femoral nail anti-rotation (PFNA) were recommended for basicervical femoral neck fracture (BFNF), however, with high rate of postoperative femoral neck shortening. The proximal femoral bionic nail (PFBN) was designed to decrease the postoperative complications associated with DHS and PFNA. The aim of this study is to compare the biomechanical characters of DHS, PFNA, and PFBN for fixation of BFNF. METHODS Using finite element analysis, we created a three-dimensional model of the BFNF for this investigation. The PFBN group, the PFNA group and the DHS + DS group were our three test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. RESULTS The PFBN group demonstrated the lowest stress on the implants, significantly lower than the PFNA and DHS + DS groups. In terms of stress on the implants, the PFBN group exhibited the best performance, with the lowest stress concentration at 112.0 MPa, followed by the PFNA group at 124.8 MPa and the DHS + DS group at 149.8 MPa. The PFBA group demonstrated the smallest displacement at the fracture interface, measuring 0.21 mm, coupled with a fracture interface pressure of 17.41 MPa, signifying excellent stability. CONCLUSIONS Compared with DHS and PFNA, PFBN has advantages in stress distribution and biological stability. We believe the concept of triangle fixation will be helpful to reduce femoral neck shortening associated with DHS and PFNA and thus improve the prognosis of BFNF.
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Affiliation(s)
- Xiaodong Cheng
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yanjiang Yang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Jian Zhu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, People's Republic of China
| | - Guimiao Li
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Juan Wang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Qi Zhang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, 050051, People's Republic of China.
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Wang W, Huang Z, Peng J, Fan J, Long X. Preoperative posterior tilt can be a risk factor of fixation failure in nondisplaced femoral neck fracture: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3197-3205. [PMID: 36947312 DOI: 10.1007/s00590-023-03518-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to identify whether posterior tilt increases the risk of treatment failure in nondisplaced femoral neck fractures. METHODS We searched the databases of the PubMed, Embase, and Cochrane Library from 1980 to 2022. The search strategy was based on the combination of keywords "nondisplaced," "hip fracture," "femoral neck fracture," and "internal fixation." Cohort studies enrolled patients with nondisplaced (Garden I and Garden II) femoral neck fractures were included. Two investigators independently extracted data and the other two assessed the methodological quality. Data were analyzed using Review Manager software. RESULTS We analyzed 13 cohort trials with a pooled sample of 4818 patients, with posterior tilt ≥ 20° in 698 patients and < 20° in 3578 patients in 11 trials, and posterior tilt ≥ 10° in 483 patients and < 10° in 496 patients in 4 trials. All studies were of high quality based on Newcastle-Ottawa Scale evaluation. Treatment failure was reported in 24.4% (170/698) of patients with posterior tilt ≥ 20° and 10.9% (392/3578) of patients with posterior tilt < 20°, indicating that posterior tilt ≥ 20° was significantly associated with a higher risk of treatment failure (Risk ratio, 2.73; 95% confidence interval [CI], 1.77-4.21). Posterior tilt ≥ 10° was not found to be a risk factor for fixation failure (risk ratio, 1.92; 95% CI 0.76-4.83). CONCLUSION Nondisplaced femoral neck fractures with posterior tilt ≥ 20° were associated with an increasing rate of failure when treated with internal fixation. LEVEL OF EVIDENCE : III, Systematic review and meta-analysis.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Chongqing General Hospital, No. 118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147, China
| | - Zhifeng Huang
- Department of Orthopedics, Chongqing General Hospital, No. 118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147, China
| | - Jing Peng
- Department of Orthopedics, Chongqing General Hospital, No. 118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147, China.
| | - Jun Fan
- Department of Orthopedics, Chongqing General Hospital, No. 118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147, China
| | - Xiaotao Long
- Department of Orthopedics, Chongqing General Hospital, No. 118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147, China
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Valcarenghi J, Martinov S, Chahidi E, Jennart H, Bui Quoc E, Dimanche MC, Hupez A, Bhogal H, Hafez K, Callewier A, Bath O, Hernigou J. Hip fractures re-operation compared with death at two year in elderly patients: lowest risk of revision with dual mobility total hip arthroplasty than with bipolar hemiarthroplasty or internal fixation of Garden I and II. INTERNATIONAL ORTHOPAEDICS 2022; 46:1945-1953. [PMID: 35699746 DOI: 10.1007/s00264-022-05479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study determined at two year follow-up the lifetime risk of re-operation for elderly patients with hip fractures undergoing internal fixation, dual mobility total hip arthroplasty, or bipolar hemiarthroplasty, using death of the patient as a competing risk. MATERIALS AND METHODS With the hypothesis that arthroplasties may have less complications without increasing mortality even for Garden I and Garden II fractures, we retrospectively reviewed 317 hips with femoral neck fractures operated between January 2015 and August 2019. The mean age at time of surgical intervention was 82.4 years (range 65 to 105). Sixty patients presented a nondisplaced hip fracture (Garden I or II) treated by internal fixtion (I-F), and 257 were treated by hip arthroplasty: 118 dual mobility total hip arthroplasty (DM-THA) and 139 with a bipolar hemiarthroplaty (B-H). Demographics, surgical and complications data, and mortality were collected and compared for each group. RESULTS The overall mortality rate was 22.4% at two years, and similar (p = 0.98) in all groups, respectively 22%, 22%, and 23% for DM-THA, B-H, and I-F groups. With dual mobility THA, the cumulative incidence of re-operations for any reason was (lower (9%) than with internal fixation (22%) or bipolar hemiarthroplasties (19%). CONCLUSION Using a double mobility total prosthesis does not increase the post-operative mortality of the patients, nor does it increase their survival. But, reducing the risk of complications certainly improves their quality of life during the little time they have left .
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Affiliation(s)
| | - Sagi Martinov
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | - Esfandiar Chahidi
- Orthopedic Department, Tivoli Hospital, La Louvière, Belgium.,Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | - Harold Jennart
- Orthopedic Department, Tivoli Hospital, La Louvière, Belgium
| | - Emily Bui Quoc
- Anesthetic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | | | - Alexandre Hupez
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | - Harkirat Bhogal
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | - Karim Hafez
- Orthopedic Department, Tivoli Hospital, La Louvière, Belgium
| | - Antoine Callewier
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | - Olivier Bath
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | - Jacques Hernigou
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium. .,Université Libre de Bruxelles, Bruxelles, Belgium.
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Erivan R, Hacquart T, Villatte G, Mulliez A, Descamps S, Boisgard S. Place of residence before and place of discharge after femoral neck fracture surgery are associated with mortality: A study of 1238 patients with at least three years' follow-up. Orthop Traumatol Surg Res 2021; 107:102876. [PMID: 33652150 DOI: 10.1016/j.otsr.2021.102876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/30/2020] [Accepted: 12/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Femoral neck fractures constitute a major public health challenge. The risk of death after surgery depends chiefly on the patient's general health and comorbidities. No studies assessing place of residence are available. The objectives of this study were to determine whether mortality differed according to the patient's previous place of residence and to the place of discharge, and to describe the complications occurring after femoral neck fracture surgery. HYPOTHESIS After femoral neck fracture surgery, the place of discharge is associated with the risk of death, and the complication rate is high. METHODS This single-centre retrospective study included 1241 adults who sustained a true femoral neck fracture between 2006 and 2016 and were followed up for at least 3 years. The following data were collected: age at the time of the fracture, sex, hospital stay length, place of residence before and after the fracture, characteristics of the fracture, type of treatment, time from the fracture to surgery, and whether anticoagulant therapy was given. We then recorded data on mortality and complications. RESULTS The 3-year mortality rate was 36.0±1.4% (95%CI, 33.3-38.7). Place of residence before the fracture was strongly associated with mortality: the risk of death was higher in patients who lived in care homes (hazard ratio [HR], 2.18) or were hospitalised (HR, 1.78) and lower in patients who lived at home (HR, 0.46). The risk of death was also higher in patients discharged to care homes (HR, 1.82) or to hospitals (HR, 1.90) and lower in patients discharged home (HR, 0.30). All these differences were statistically significant (p<0.0001). CONCLUSION Place of residence and likely place of discharge should be evaluated as soon as the patient is admitted to the emergency department, in order to provide the best information possible to the patient and family and to establish the most appropriate treatment strategy. Patient self-sufficiency is a major parameter that should be preserved to the extent possible. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Thomas Hacquart
- Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la recherche clinique et aux innovations (DRCI) - CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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Liu K, Nagamune K, Oe K, Kuroda R, Niikura T. Migration Measurement of Pins in Postoperative Recovery of the Proximal Femur Fractures Based on 3D Point Cloud Matching. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:406. [PMID: 33922398 PMCID: PMC8145055 DOI: 10.3390/medicina57050406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Internal fixation is one of the most effective methods for the treatment of proximal femur fractures. The migration of implants after the operation can seriously affect the reduction of treatment and even cause complications. Traditional diagnosis methods can not directly measure the extent of displacement. Methods: Based on the analysis of Hansson pins, this paper proposes a measurement method based on three-dimensional matching, which uses computerized tomography (CT) images of different periods of patients after the operation to analyze the implants' migration in three-dimensional space with the characteristics of fast speed and intuitive results. Results and conclusions: The measurement results show that the method proposed in this paper has more minor errors, more flexible coordinate system conversion, and more explicit displacement analysis than the traditional method of manually finding references in CT images and measuring displacement.
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Affiliation(s)
- Kaifeng Liu
- Department of Human and Artificial Intelligent Systems, Graduate School of Engineering, University of Fukui, Fukui 910-8507, Japan
| | - Kouki Nagamune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (K.N.); (K.O.); (R.K.); (T.N.)
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (K.N.); (K.O.); (R.K.); (T.N.)
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (K.N.); (K.O.); (R.K.); (T.N.)
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (K.N.); (K.O.); (R.K.); (T.N.)
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Erivan R, Soleihavoup M, Villatte G, Perez Prieto D, Descamps S, Boisgard S. Poor results of functional treatment of Garden-1 femoral neck fracture in dependent patients. Orthop Traumatol Surg Res 2020; 106:601-605. [PMID: 31862324 DOI: 10.1016/j.otsr.2019.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Variable results are reported after functional treatment for Garden-1 femoral neck fracture, with no definite factors for failure, particularly in the absence of selection for risk. It seems well indicated in frail and/or dependent patients with comorbidities, but this has not been specifically assessed, and failure is frequent in this target population. We therefore performed a retrospective study to: (1) assess results of functional treatment for Garden-1 impacted femoral neck fracture in dependent patients, and (2) analyze survival in terms of complications and death, and related factors. HYPOTHESIS Functional treatment for Garden-1 fracture in dependent patients gives poor results, with a high rate of surgical revision. MATERIAL AND METHODS A retrospective analysis was made of Garden-1 femoral neck fracture in dependent patients (Parker score≤5), with a minimum 2 years' follow-up. One hundred and forty-six patients were included: mean age, 81.3±8.7 years (range, 55.7-99.6 years). The endpoint was survival in terms of complications requiring surgery, secondary displacement requiring surgery, excessive pain requiring surgery, non-union or femoral head osteonecrosis. Secondary endpoints were overall mortality and mortality related to complications. RESULTS Mean follow-up was 4.2±2.6 years (range, 2.0-10.3 years). Ninety-one of the 146 patients (62.3%) required secondary surgery: 79 (54.1%) early (<3 months post-fracture), with 77 (52.7%) secondary displacements and 2 cases (1.4%) of excessive pain; and 12 (8.2%) late (162.2±132.3 days; range, 90-454 days), with 8 (5.4%) non-unions and 4 (2.7%) osteonecroses. Mean time to onset of secondary displacement was 13.6±11.8 days (range, 0-67.0 days). Two-year survival in terms of revision surgery was 34.1% [95% CI: 26.0-42.4]. At last follow-up, 91 patients (62.3%) had died; 2-year survival in terms of death was 69.9% [95% CI: 62.4-77.3]. Survival analysis in terms of complications revealed greater mortality in absence of complications: 42 of the 55 patients (76.3%) without complications requiring surgery died, versus 49 of the 91 (53.8%) with complications requiring surgery (p=0.012); relative risk of death in absence of complications requiring surgery was 1.42 [95% CI: 1.33-5.77]. DISCUSSION Functional treatment for Garden-1 fracture in dependent patients gave poor short- and medium-term results. Surgery is therefore recommended in this specific population; the present findings should improve survival. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Roger Erivan
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Marion Soleihavoup
- Université Clermont-Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | | | - Stéphane Descamps
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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Shin KH, Hong SH, Han SB. Posterior fully threaded positioning screw prevents femoral neck collapse in Garden I or II femoral neck fractures. Injury 2020; 51:1031-1037. [PMID: 32089281 DOI: 10.1016/j.injury.2020.01.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/23/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteosynthesis is recommended for Garden I and II femoral neck fracture treatment using parallel partially threaded cannulated screws. Postoperatively, excessive femoral neck shortening (FNS) and posterior tilt of the femoral neck (PTFN) are frequently encountered and are correlated with impaired quality of life and clinical outcomes. We hypothesized that stabilization by parallel partially threaded cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw would improve fracture healing without further FNS and PTFN in femoral neck fractures. METHODS We retrospectively reviewed Garden I and II femoral neck fractures treated by in situ fixation using parallel cannulated screws at our institution between January 2010 and November 2018. Patients with the applicable fractures were divided according to the utilization of posterior fully threaded screws: patients with partially threaded screws were included in Group C and those with posterior fully threaded screws were included in Group P. Intergroup comparisons were performed based on radiographic measurements that assessed the shortening in two vectors (the horizontal and vertical axes), FNS, and subsequent PTFN. RESULTS No significant intergroup difference was found in demographics and fracture characteristics, except in the follow-up duration. The mean FNS and shortening in both vectors were significantly smaller in Group P than in Group C (FNS, 5.02 ± 1.31 vs. 8.84 ± 3.48 mm, p < 0.001; horizontal axis, 4.07 ± 1.06 vs. 6.18 ± 2.77 mm, p < 0.001; and vertical axis, 2.55 ± 1.68 vs. 5.74 ± 3.41 mm, p < 0.001). The mean subsequent PTFN was significantly smaller in Group P (2.21 ± 2.99 vs. 7.56 ± 6.20 mm, p < 0.001). A significantly smaller number of patients in Group P had moderate (5-10 mm) or severe (>10 mm) FNS and moderate (5-10°) or severe (>10°) subsequent PTFN. CONCLUSION Parallel cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw as a length- and angle-stable construct for Garden I or II femoral neck fracture fixation can prevent femoral neck collapse in both the coronal and axial planes.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seok-Ha Hong
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
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Overmann AL, Richards JT, O'Hara NN, D'Alleyrand JC, Slobogean GP. Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis. Injury 2019; 50:2158-2166. [PMID: 31623902 DOI: 10.1016/j.injury.2019.09.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Internal fixation remains the treatment of choice for non-displaced femoral neck fractures in elderly patients. Improved outcomes with arthroplasty following displaced femoral neck fractures may indicate that outcomes of non-displaced patterns should be reexamined. The aim of our study was to conduct a systematic review of the orthopaedic literature to determine the outcomes of internal fixation for the treatment of non-displaced and minimally displaced femoral neck fractures in elderly patients. METHODS Relevant articles were identified using PubMed, Embase, and CENTRAL databases. Manuscripts were included if they contained (1) patients 60 years or older with (2) nondisplaced or minimally displaced (Garden I or II) femoral neck fractures (3) treated with internal fixation (4) separately reported outcomes in this patient population. The primary outcome was reoperation. Secondary outcomes included mortality, patient-reported outcomes, length of hospitalization, infection, and transfusions. Fixed and random effects modeling was used to determine pooled estimates of the outcomes. RESULTS Twenty-seven studies were identified with a total of 21,155 patients, all of which were treated with internal fixation. The pooled risk of reoperation was 14.1% (95% CI: 10.6-18.2). The risk of one-year mortality was 14.6% (95% CI: 11.5-18.2) based on the reporting in 15 studies. CONCLUSIONS The risk of reoperation and mortality following the treatment of nondisplaced femoral neck fractures in the elderly with internal fixation exceeds 14%. This complication profile may be unacceptably high. Arthroplasty may offer improved short-term functional outcomes and a reduced risk of reoperation. However, there is currently little evidence to consider this treatment to be an alternative to internal fixation.
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Affiliation(s)
- A L Overmann
- Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA
| | - J T Richards
- Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA
| | - N N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA
| | - J C D'Alleyrand
- Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA; Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA
| | - G P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA.
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Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM. Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis. J Orthop Surg Res 2019; 14:320. [PMID: 31604470 PMCID: PMC6787983 DOI: 10.1186/s13018-019-1377-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/13/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures. METHODS We performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration. RESULTS Our results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD - 0.800, 95% CI - 1.011 to - 0.589) and operation duration (SMD - 2.497, 95% CI - 2.801 to - 2.193) were shorter in the internal fixation group. CONCLUSIONS Compared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Nanty L, Canovas F, Rodriguez T, Faure P, Dagneaux L. Femoral neck shortening after internal fixation of Garden I fractures increases the risk of femoral head collapse. Orthop Traumatol Surg Res 2019; 105:999-1004. [PMID: 31320235 DOI: 10.1016/j.otsr.2019.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 04/12/2019] [Accepted: 05/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroplasty has not been proven superior over internal fixation for the treatment of non-displaced femoral neck fractures. However, internal fixation has been followed by high rates of revision for mechanical complications and of femoral neck impaction within the first postoperative year. The objective of this study was to determine whether femoral neck impaction was associated with avascular necrosis (AVN). HYPOTHESIS Fracture healing with femoral neck shortening by impaction after internal fixation of a femoral neck fracture is associated with AVN. MATERIAL AND METHODS A single-centre retrospective study in patients with Garden I fractures managed by screw fixation was performed to compare outcomes in the groups with and without femoral neck impaction. Follow-up radiographs were assessed for evidence of the femoral neck impaction during fracture healing. The occurrence of AVN was the primary evaluation criterion. The secondary evaluation criteria were risk factors for impaction and complications. RESULTS Of the 75 included patients, 9 (12%) experienced AVN. Impaction was significantly associated with AVN (p=0.02; relative risk, 4.38). Significant risk factors for impaction were a higher body mass index (p=0.0003) and valgus-impacted fracture reduction between the radiographs at baseline and immediately after surgery (p=0.0001). DISCUSSION Femoral neck impaction was a significant risk factor for AVN after screw fixation of Garden I fractures. Valgus-impacted fracture reduction must receive careful attention during fixation. We suggest static internal fixation if the impaction is reduced on a traction table and advise caution when using parallel screws. The diagnostic and therapeutic strategy proposed here deserves to be evaluated in a prospective study. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Léo Nanty
- Département de Chirurgie Orthopédique et Traumatologie, Unité de Chirurgie du membre inférieur et du rachis, Hôpital Lapeyronie, CHRU de Montpellier, 351, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - François Canovas
- Département de Chirurgie Orthopédique et Traumatologie, Unité de Chirurgie du membre inférieur et du rachis, Hôpital Lapeyronie, CHRU de Montpellier, 351, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Thibaut Rodriguez
- Département de Chirurgie Orthopédique et Traumatologie, Unité de Chirurgie du membre inférieur et du rachis, Hôpital Lapeyronie, CHRU de Montpellier, 351, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Patrick Faure
- Département de Chirurgie Orthopédique et Traumatologie, Unité de Chirurgie du membre inférieur et du rachis, Hôpital Lapeyronie, CHRU de Montpellier, 351, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Louis Dagneaux
- Département de Chirurgie Orthopédique et Traumatologie, Unité de Chirurgie du membre inférieur et du rachis, Hôpital Lapeyronie, CHRU de Montpellier, 351, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Amsellem D, Parratte S, Flecher X, Argenson JN, Ollivier M. Non-operative treatment is a reliable option in over two thirds of patients with Garden I hip fractures. Rates and risk factors for failure in 298 patients. Orthop Traumatol Surg Res 2019; 105:985-990. [PMID: 31303564 DOI: 10.1016/j.otsr.2019.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/22/2019] [Accepted: 04/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-operative treatment for impacted femoral neck fractures is a now rarely used strategy whose indications are controversial. No outcome predictors have been convincingly identified, in part due to the small sizes of available studies. We conducted a large retrospective study with the following objectives: (1) to evaluate the percentage of patients older than 65 years of age with non-operatively treated Garden I femoral neck fractures who experience secondary displacement, (2) to identify predictors of secondary displacement, and (3) to determine the frequency of non-operative treatment failure due to any cause and requiring joint replacement surgery. HYPOTHESIS Non-operative treatment is reliable in patients older than 65 years of age with Garden I femoral neck fractures. MATERIAL AND METHODS Approval was obtained from the French data protection authority to conduct a retrospective observational study of information in the Marseille university hospitals database. Consecutive patients who were older than 65 years of age at traumatology department admission for Garden I femoral neck fractures managed non-operatively between January 2007 and December 2017 were included. Non-operative treatment consisted in a walking test on day 1 followed by radiographs on days 2, 7, 14, 21, and 45 and after 3 and 12 months. Patients with secondary displacement underwent hip arthroplasty. Demographic data, cognitive performance, and radiological parameters were collected for each patient. We evaluated the rates of secondary displacement avascular necrosis, and non-union. RESULTS We included 298 patients with a mean age of 82 years (range, 65-101). Mean follow-up was 5±3 years. Secondary displacement occurred in 91 (30%) patients, at a mean of 16 days (range 2-45 days) after the fracture. Avascular necrosis of the femoral head developed in 13 (4.3%) patients and non-union in 11 (3.7%) patients. Secondary displacement was significantly associated with hypnotic treatment (OR, 4.1; 95%CI, 2.2-7.5; p=0.039), institutionalisation (OR, 6.7; 95%CI, 3.1-14.8; p=0.028), a history of repeated falls (OR, 13.5; 95%CI, 6.3-8.4; p<0.0001), having three or more comorbidities (OR, 3.2; 95%CI, 1.7-5.8; p=0.046), and having dementia (OR, 3.5; 95%CI, 1.7-6.9; p=0.0003). Secondary displacement occurred in 18 (12%) of the 151 community-dwelling patients with normal cognition and no history of repeated falls compared to 37 (75%) of the 50 institutionalised patients with dementia. DISCUSSION Non-operative treatment was effective in 196 (66%) of 298 patients with Garden I femoral neck fractures. Significant risk factors for secondary displacement were dementia, institutionalisation, hypnotic treatment, multiple comorbidities, and a history of repeated falls. Of 151 community-dwelling patients with normal cognition and no repeated falls, 133 (88%) achieved a full recovery with non-operative treatment alone. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Delphine Amsellem
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Department of orthopaedics and traumatology, institute of movement and locomotion, St. Marguerite hospital, 13009 Marseille, France
| | - Sébastien Parratte
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Department of orthopaedics and traumatology, institute of movement and locomotion, St. Marguerite hospital, 13009 Marseille, France
| | - Xavier Flecher
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Department of orthopaedics and traumatology, institute of movement and locomotion, St. Marguerite hospital, 13009 Marseille, France
| | - Jean-Noël Argenson
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Department of orthopaedics and traumatology, institute of movement and locomotion, St. Marguerite hospital, 13009 Marseille, France
| | - Matthieu Ollivier
- CNRS, ISM UMR 7287, Aix-Marseille université, 13288 Marseille cedex 09, France; Department of orthopaedics and traumatology, institute of movement and locomotion, St. Marguerite hospital, 13009 Marseille, France.
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Guyen O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res 2019; 105:S95-S101. [PMID: 30449680 DOI: 10.1016/j.otsr.2018.04.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 02/02/2023]
Abstract
The optimal treatment of recent femoral neck fractures remains debated. The available options are internal fixation, hemiarthroplasty (HA) and total hip arthroplasty (THA). There is a consensus in favour of internal fixation in younger patients. In elderly individuals who are institutionalised and have limited physical activity, HA is usually performed when the joint line is intact. Whether HA or THA deserves preference in patients aged 60 years or over is unclear. In addition, there are two types of HA, unipolar and bipolar, and two types of THA, conventional and dual-mobility. Both HA types provide similar outcomes with satisfactory stability but a risk of acetabular wear that may eventually require conversion to THA. THA is associated with better functional outcomes and a lower risk of revision surgery in self-sufficient, physically active patients. Instability is the leading complication of conventional THA and occurs with a higher incidence compared to HA. With all implant types, preoperative factors associated with mortality and complications include walking ability and level of self-sufficiency, nutritional status, and haematocrit. An evaluation of these factors before surgery is of paramount importance. Factors amenable to treatment should be corrected by working jointly with geriatricians to develop a preoperative management strategy. In patients who are self-sufficient, physically active, and free of risk factors, THA remains the option of choice, as it provides better functional outcomes. A dual-mobility implant deserves preference to prevent instability. HA is indicated in patients whose self-sufficiency and physical activity are limited. A unipolar implant should be used, as no evidence exists that bipolar implants provide additional benefits. When performing HA, the posterior approach should be avoided given the risk of instability. For THA, in contrast, the posterior approach is a reliable option in the hands of an experienced surgeon using a dual-mobility cup. Cement fixation of the stem is recommended to minimise the risk of peri-prosthetic fracture.
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Affiliation(s)
- Olivier Guyen
- Service d'orthopédie-traumatologie, hôpital Orthopédique - CHUV, avenue Pierre-Decker 4, 1011 Lausanne, Switzerland.
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Oba T, Makita H, Inaba Y, Yamana H, Saito T. New scoring system at admission to predict walking ability at discharge for patients with hip fracture. Orthop Traumatol Surg Res 2018; 104:1189-1192. [PMID: 30293749 DOI: 10.1016/j.otsr.2018.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/20/2018] [Accepted: 07/19/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A reliable scoring system that predicts the walking ability of hip fracture patients would be useful for clinicians. Here we developed a scoring system for hip fracture patients and evaluated its predictive ability. HYPOTHESIS We hypothesized that age, sex, presence of dementia, walking ability before the injury, fracture type, serum hemoglobin level, serum albumin level and interval in days between admission and surgery would be the predictive factors of the walking ability at discharge. MATERIAL AND METHODS Data from 409 patients who underwent hip fracture surgery were included. We analyzed factors that affected walking ability and developed a scoring system that predicts the probability of walking unaided or with a cane at discharge. RESULTS The mean age of the patients was 81.3 years. A total of 164 (40%) patients could walk unaided or with a cane at discharge. Multivariate logistic regression analysis showed that the obstructive factors for the ability to walk unaided or with a cane at discharge were older age (odds ratio [OR]=0.962, p=0.002), dementia (OR=0.126, p<0.001), use of a cane before injury (OR=0.396, p<0.001), trochanteric fracture (OR=0.571, p=0.027) and low serum albumin level (OR=4.15, p<0.001) at admission. The scoring system used the following formula: Score=5-0.04×age+albumin-2(with dementia)- 1(with use of a cane before injury)-1(with trochanteric fracture). The C-statistics for the scoring system was 0.81 (95% confidence interval, 0.77-0.85). DISCUSSION This newly developed scoring system of information at admission predicted the discharge mobility of hip fracture patients. In addition to the previously known risk factors, serum albumin level at admission was detected as a new predictor for mobility at discharge. LEVEL OF PROOF IV, retrospective study.
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Affiliation(s)
- Takayoshi Oba
- Department of Orthopaedic Surgery, Kanagawa Prefectural Ashigarakami Hospital, 866-1 Matusda-souryou, Matsuda-machi, Ashigarakami-gun, 2580003 Kanagawa, Japan.
| | - Hiroyuki Makita
- Department of Orthopaedic Surgery, Kanagawa Prefectural Ashigarakami Hospital, 866-1 Matusda-souryou, Matsuda-machi, Ashigarakami-gun, 2580003 Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 2360004 Kanagawa, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, 1113033 Tokyo, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 2360004 Kanagawa, Japan
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Merloz P. Optimization of perioperative management of proximal femoral fracture in the elderly. Orthop Traumatol Surg Res 2018; 104:S25-S30. [PMID: 29203430 DOI: 10.1016/j.otsr.2017.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/07/2017] [Accepted: 04/14/2017] [Indexed: 02/02/2023]
Abstract
Proximal femoral fracture in elderly subjects is a major event that is life-threatening in the medium-to-long term. Advanced age, male gender and number of comorbidities largely account for high mortality and require geriatric expertise. Protein-energy malnutrition and bone demineralization increase mortality. Mortality can, on the other hand, be reduced by acting on two variables accessible to medical intervention: daily activities and nutritional status. Functional and neurocognitive assessment allow the risk of dependency to be evaluated, and global geriatric work-up can prevent sudden breakdown of homeostasis. In the emergency setting, pain is to be alleviated, polymedication and anticoagulation therapy checked, and instability (notably cardiac and pulmonary) and confusion syndrome screened for on geriatric and anesthesiologic opinions. Surgery should be implemented without delay, within 48hours of admission, preferably using multimodal anesthesia. The technique should be geared to allow early weight-bearing and mobilization. The most comprehensive care plan involves team-work between emergency physicians, surgeons, orthopedic specialists, anesthesiologists, geriatricians, pharmacists, rehabilitation specialists and nursing staff, to reduce mortality and readmission and improve functional results. Post-fracture coordination seeks to prevent falls and further fractures and to treat bone demineralization.
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Affiliation(s)
- P Merloz
- Clinique universitaire d'orthopédie-traumatologie, CHU Albert-Michallon, BP 217, 38043 Grenoble cedex 9, France.
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