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Ridha M, Al-Jabri T, Stelzhammer T, Shah Z, Oragui E, Giannoudis PV. Osteosynthesis, hemiarthroplasty, total hip arthroplasty in hip fractures: All I need to know. Injury 2024; 55:111377. [PMID: 38324951 DOI: 10.1016/j.injury.2024.111377] [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] [Indexed: 02/09/2024]
Abstract
Recent data from the UK's National Hip Fracture Database (NHFD) demonstrate an upward trajectory in the incidence of hip fractures, a trend which is expected to persist. In 2023 alone, the NHFD reported 72,160 cases, underscoring the prevalence of these injuries. These fractures are associated with significant morbidity, mortality, and economic costs. National guidelines for the surgical management of these fractures are established, although the implementation of total hip arthroplasty (THA) as a primary treatment modality varies. This review offers a narrative synthesis of contemporary literature on hip fractures, focusing on epidemiology, classification systems, and treatment options, with a particular emphasis on the outcomes of THA.
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Affiliation(s)
- Mohamed Ridha
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, London, Stanmore, HA7 4LP, UK
| | - Talal Al-Jabri
- Trauma and Orthopaedic Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Thomas Stelzhammer
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Zameer Shah
- Department of Orthopaedics, Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Emeka Oragui
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd., London SW10 9NH, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
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Fard SB, Jamshidi SMMM, Hoveidaei AH, Razzaghof M, Mortazavi SJ. Nonunion following valgus subtrochanteric osteotomy for neglected femoral neck fracture: A case report. Int J Surg Case Rep 2023; 103:107905. [PMID: 36652819 PMCID: PMC9860415 DOI: 10.1016/j.ijscr.2023.107905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Femoral neck fractures account for roughly half of the two million hip fractures that occur each year worldwide. There is a high rate of neglected cases and potential complications such as nonunion or avascular necrosis (AVN) in developing countries. More than 30 % of patients may experience non-union following a femoral fracture. There is no consensus on the best neglected femoral neck fracture treatment. CASE PRESENTATION A 30-year-old female known case of rheumatoid arthritis came with a neglected femoral neck fracture to our center. We salvaged the viable hip by subtrochanteric valgus osteotomy and fixation by angled blade plate (ABP). After eight months, she returned with left hip pain and nonunion of the fracture and osteotomy sites. We refixed the fracture with a longer ABP together with autografting of both sites. After two years, she had complete union, full hip range of motion, and painless ambulation. CLINICAL DISCUSSION Subtrochanteric valgus osteotomy is susceptible to nonunion especially in patients with medical comorbidities. CONCLUSION Careful selection of osteotomy site and appropriate fixation device might prevent of non-union.
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Affiliation(s)
| | | | - Amir Human Hoveidaei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S.M. Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author at: Department of Orthopedic Surgery, Imam University Hospital, End of Keshavarz Blvd, Tehran 1419733141, Iran.
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Treatment of Chronic Femoral Neck Fracture With Cemented Bipolar Hemiarthroplasty and Management of Intraoperative Fracture With Cerclage Cabling. J Orthop Trauma 2022; 36:S17-S18. [PMID: 35838569 DOI: 10.1097/bot.0000000000002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 02/02/2023]
Abstract
We cover the operative treatment of a neglected chronic femoral neck fracture nonunion treated at 6 months. We begin with a description of the case and concomitant injuries. The operative portion includes the direct lateral approach with the patient in lateral decubitus position, exposure of the fracture site, osteotomy of the neck, debridement of the nonunion site, broaching, trialing, recognition and treatment of an intraoperative proximal femur fracture using cerclage cabling above and below the lesser trochanter, cementation of final components, and reduction. We conclude with the patient's radiographs at 2 weeks and clinical outcome at 6-week follow-up.
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Garg B, Vatsya P. "Cage in Box" - A modification of AIIMS BOX technique for large gap nonunion in young patients with neglected femur neck fractures. Injury 2022; 53:1196-1201. [PMID: 34657751 DOI: 10.1016/j.injury.2021.09.046] [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: 06/03/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023]
Abstract
Neck of femur fractures have often been termed as "The Unsolved Fractures", since they have a guarded outcome even after improved understanding of biomechanics and biology of this area. Gap-nonunion is one such dreaded complication of this fracture, especially in younger (<60 years) population, where arthroplasty may not be the best go-to option. We have earlier described "The AIIMS BOX" technique to manage such cases of gap non-union in neglected neck femur fractures [1]. Here we intend to describe a more successful modification of this technique. We operated 7 cases of gap non-union with our new "Cage in Box" strategy and followed these cases for 5 years. 6 patients from this group achieved excellent to good outcomes and only 1 reported a poor outcome. All the patients, except the one with poor outcome, could walk without aid and do activities of daily living independently. 3 patients developed AVN but had no evidence of collapse. 3 patients also developed Coxa vara, but it was significant only in one case. 6/7 patients were able to squat. We describe this method in detail and feel this can be a viable option in the armamentarium of orthopedic surgeons, along with valgus osteotomy, vascularized and non-vascularized fibular strut graft as well as Meyer's Graft, to help them solve this unsolved fracture.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pulak Vatsya
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Magu N, Lahoti O. Management of femoral neck fracture non union with modified Pauwels' osteotomy. J Clin Orthop Trauma 2021; 25:101721. [PMID: 34926156 PMCID: PMC8665358 DOI: 10.1016/j.jcot.2021.101721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
Modified Pauwels' intertrochanteric osteotomy is a promising procedure to heal a non union of the femoral neck fracture, with a success rate of 80-90%. Caxa vara correction and limb length equalization can be achieved simultaneously with this procedure. Two stage surgical procedure has the advantage of keeping blood loss and bone exposure to minimise the risk of infection. We herewith present some tips and tricks and the details of doing this osteotomy.
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Affiliation(s)
- N.K. Magu
- Max Smart Super-Speciality Hospital, Saket, New Delhi, India
| | - Om Lahoti
- King's College Hospital, Denmark Hill, London, United Kingdom
- Corresponding author.
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Saini N, Ranjan R, Jain VK, Shukla A. Pooling of neglected and delayed trauma patients - Consequences of 'lockdown' and 'Unlock' phases of COVID-19 pandemic- A retrospective cohort analysis from a tertiary centre. J Clin Orthop Trauma 2021; 21:101533. [PMID: 34334981 PMCID: PMC8312047 DOI: 10.1016/j.jcot.2021.101533] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in nationwide lockdown and quarantine strategies to break the chain of transmission of the SARS-CoV-2 virus in India. Management of patients with trauma has been particularly challenging across the country. AIMS To evaluate the effect of delay in surgery in patients with traumatic injuries along with the peri-operative outcomes during the 'Lockdown' and 'Unlock' phases of the COVID-19 pandemic at a Level I Trauma centre in the National Capital Region (NCR) of India. METHODS This retrospective, observational cohort study included 488 patients. Comparative analysis to assess patient characteristics, mechanism of trauma, clinical outcomes in patients managed operatively during 'Lockdown period' (24 March 2020 to 31 May 2020) Group A with Group B, who presented during 'Unlock phases' (01 June 2020 to 31 December 2020). RESULTS The average delay in surgery, surgical time and hospital stay was significantly increased in group B patients (p-value <0.05). The average blood loss, stay in the Intensive Care Unit (ICU) and blood transfusion requirement were clinically higher in group B but these differences were not statistically significant (p-value >0.05). Only in group B; 9.01% patients (42 out of 466) required bone grafting. CONCLUSION 'Neglect' and delay in receiving operative management of orthopaedic trauma has led to unprecedented rise in number of complications of fractures, such as mal-union, delayed union or non-union during COVID-19 Pandemic. Patients have had to undergo longer surgical procedures with increased risk of intra-operative blood loss, need of peri-operative blood transfusion and bone grafting supplementation to facilitate union. Diligent attention to achieve the most optimal configuration of fractures should be planned in conservatively managed injuries during the pandemic to minimize future intra-operative difficulties.
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Affiliation(s)
- Naresh Saini
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Ravi Ranjan
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Ajay Shukla
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
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Georgiadis GM, Andrews KA, Redfern RE. Gunshot Fracture of the Femoral Neck: Internal Fixation and Immediate Proximal Femoral Valgus Osteotomy: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00119. [PMID: 34534132 DOI: 10.2106/jbjs.cc.20.01009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report on a 22-year-old patient with a comminuted femoral neck fracture because of a low-velocity gunshot wound. Treatment consisted of reduction and internal fixation with a fixed angled blade plate and immediate valgus osteotomy. He went on to uneventful healing and an excellent clinical result. CONCLUSIONS A comminuted gunshot femoral neck fracture in a young patient is a rare and potentially devastating injury. If stable, and there are no other associated emergent injuries, reduction, internal fixation, and immediate valgus osteotomy should be considered.
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Affiliation(s)
| | - Kyle A Andrews
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
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Santoshi JA, Reddy L, Agrawal U. Femoral Neck Nonunion Associated With Delayed Union of Ipsilateral Femoral Shaft Fracture. Cureus 2021; 13:e15612. [PMID: 34277230 PMCID: PMC8274465 DOI: 10.7759/cureus.15612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 36-year-old man, who presented to us five months after the initial trauma. He had been treated elsewhere with a cephalomedullary femoral nail. He described severe pain in his right thigh and groin that confined him to a wheelchair. He had shortening of the right lower limb and painful restriction of movements of the right hip. Radiographs demonstrated hypertrophic callus with a gap at the femoral shaft while the neck fracture was in varus malalignment with bone resorption; the neck fracture been fixed using two hip screws that were missing the nail. The patient was managed with removal of the previous hardware, reamed retrograde nailing and Pauwels’ intertrochanteric valgus osteotomy fixed using a 120o double-angled condylar blade plate. Both the fracture sites were not opened. Postoperatively, the femoral shaft showed radiographic evidence of union at three months, while the femoral neck and the intertrochanteric osteotomy site had united at five months. As per the Friedman and Wyman criteria, our patient has a “good” outcome at the four-year follow-up.
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Affiliation(s)
- John A Santoshi
- Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Lingaraj Reddy
- Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, IND
| | - Udit Agrawal
- Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
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Singh D, Dhammi IK, Jain A, Shahi P, Kumar S, Bansal K. Osteosynthesis in femoral neck fracture in two patients with ipsilateral lower limb amputation. BMJ Case Rep 2021; 14:14/3/e239060. [PMID: 33766963 PMCID: PMC8006772 DOI: 10.1136/bcr-2020-239060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Femoral neck fracture in lower limb amputees poses treatment problems. The altered biomechanics of the hip in amputees, stump length, associated osteoporosis and difficulty in positioning these patients on the operation table are few of the technical challenges faced by an operating surgeon especially while salvaging the native hip joint. We report a case series of two lower limb amputee patients with fracture neck of femur in whom we salvaged the native hip joint by performing osteosynthesis. We observed satisfactory results of osteosynthesis in both of our patients on follow-up, with both achieving pretrauma ambulatory status in 6-8 weeks postoperatively. We concluded that each lower limb amputee patient with fracture neck of femur should be carefully evaluated on presentation and managed individually. These patients can be positioned and managed by osteosynthesis on a standard operating table or fracture table without requiring any special operating theatre set-up (traction devices).
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Affiliation(s)
- Deepak Singh
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Ish Kumar Dhammi
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Archit Jain
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Pratyush Shahi
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Saurabh Kumar
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
| | - Kuldeep Bansal
- Orthopaedics, University College of Medical Sciences, Delhi, Delhi, India
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10
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Fassihi SC, Mortman R, Shalkevich J, Lee D, Stoll WT, Thakkar S. Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient. Arthroplast Today 2020; 6:296-304. [PMID: 32509942 PMCID: PMC7264979 DOI: 10.1016/j.artd.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022] Open
Abstract
Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally. Bilateral THA was ultimately performed, and the patient had favorable outcomes at 1 year postoperatively. In determining the optimal management strategy for such patients, a multidisciplinary approach should be used, with input from the patient’s family, pediatrician, pediatric endocrinologist, pediatric orthopaedic surgeon, and adult reconstruction surgeon. From a surgical standpoint, this report highlights the importance of selecting the appropriate bearing surfaces, broaching technique, mode of implant fixation, and implant features when performing THA in the active pediatric patient.
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Affiliation(s)
- Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Ryan Mortman
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Jacob Shalkevich
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Danny Lee
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - William T Stoll
- Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, Georgetown University MedStar Health, Washington, DC, USA
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Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery -challenges and considerations. J Clin Orthop Trauma 2020; 11:S291-S295. [PMID: 32367999 PMCID: PMC7196552 DOI: 10.1016/j.jcot.2020.04.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open
Abstract
The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on the health care systems around the world. As the disease has spread, many developed and developing countries have been stretched on their resources such as personnel as well as adequate equipment. As a result of resource disparity, in a populous country like India, the elective orthopaedic surgeries stand cancelled whilst trauma and emergency services have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines. Though these guidelines provide strategies to deal with trauma and orthopaedic surgery management in the present scenario, once the COVID-19 pandemic stabilizes, restarting elective orthopaedic surgery and managing delayed trauma conditions in evolving health care systems is going to be a profound task. We look at the future challenges and considerations of re-establishing trauma and orthopaedic flow during the post-COVID-19 phase and suggest an algorithm to follow (Fig. 1).
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Affiliation(s)
- Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK,Corresponding author.
| | - Vijay K. Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Abhishek Vaish
- Trauma and Orthopaedic Surgeon, Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Hitesh Lal
- Department of Orthopaedics, Sports Injury Centre, Safdarjung Hospital, New Delhi, India
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Abstract
The emergence of COVID-19 has impacted orthopaedic surgery worldwide. India, with
its large population and limited health resources, will be overwrought over the
coming days due to the number of cases of critically ill patients with COVID-19.
It is important to understand the challenges for orthopaedic (and other)
surgeons in India when dealing with patients during the COVID-19 pandemic. This
article highlights the challenges in the triaging of patients, care in dealing
with a patient with COVID-19 in orthopaedic surgery, and the effects on
academics and research activities; it also suggests immediate measures and
recommendations that also apply to other specialties.
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Affiliation(s)
- Vijay K Jain
- Associate Professor, Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Raju Vaishya
- Senior Consultant, Department of Orthopaedic, Joint Replacement and Arthroscopic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
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Alemnew EF, Lemma DT, Abate SM, Regassa BA. Effectiveness of intravenous dexamethasone on fascia iliaca compartment block with bupivacaine as part of postoperative multimodal analgesia for an open reduction and internal fixation surgery of femoral fracture in Hawassa Comprehensive Referral Hospital, Ethiopia, 2019: A randomized controlled trial. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Toro G, Moretti A, Paoletta M, De Cicco A, Braile A, Panni AS. Neglected femoral neck fractures in cerebral palsy: a narrative review. EFORT Open Rev 2020; 5:58-64. [PMID: 32071774 PMCID: PMC7017596 DOI: 10.1302/2058-5241.5.190019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a 'neglected femoral neck fracture' (NFNF).Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and motor impairments. However, considering the high prevalence of fractures in these patients, the incidence of NFNF in this population is probably underestimated, and this condition might result in persistent hip or abdominal pain.Several techniques are available for the treatment of NFNF (i.e. muscle pedicle bone graft, fixation with fibular graft, valgisation osteotomy), but most of them could affect motor function.Motor function must be preserved for as long as possible, in order to enhance the quality of life of CP patients.After discussing published NFNF cases in CP patients and available treatment options, a practical approach is proposed to facilitate the orthopaedic surgeon to both early identify and appropriately manage these challenging fractures. Cite this article: EFORT Open Rev 2020;5:58-64. DOI: 10.1302/2058-5241.5.190019.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Giuseppe Toro, University of Campania ‘Luigi Vanvitelli’, Department of Medical and Surgical Specialties and Dentistry, Via L. De Crecchio 4, 80138 Naples, Italy.
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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16
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Impaction Bone Grafting and Valgus Osteotomy: A Technical Trick for the Treatment of Femoral Neck Nonunions. J Orthop Trauma 2019; 33:e403-e408. [PMID: 31259803 DOI: 10.1097/bot.0000000000001564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoral neck nonunions in young adults is among the most challenging problems to treat. This is due to their inherent problems, such as neck resorption, increase in fracture gap, sclerosis of fracture margins, and avascular necrosis. Hip salvage in these cases, although challenging, is recommended in the Asian subcontinent where social and religious activities require squatting and sitting cross-legged. Muscle pedicle grafts and other vascularized bone grafting techniques are preferred treatment options, but they are technically demanding and require advanced microsurgical skills. Valgus osteotomy, although successful in certain cases, has a high failure rate in patients with poor bone stock. We present a simple technique of valgus subtrochanteric osteotomy, impaction bone grafting, and stabilization with a sliding hip screw. Here, we describe in detail about the surgical technique and present the clinical outcomes in 44 patients, with a mean follow-up of 3.4 years and a union rate of 95.5%.
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Behera P, Sn L, Khurana A, Meena UK, Gopinathan NR. Can Three Screws and a Fibula be a Viable Treatment for Managing Neglected Femoral Neck Fracture in Trans-Femoral Amputees? - A Report of Two Cases. Cureus 2019; 11:e5682. [PMID: 31720151 PMCID: PMC6823007 DOI: 10.7759/cureus.5682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Management of neglected femoral neck fracture in a trans-femoral amputee is difficult and challenging. There are limited options available for management of such a fracture. While arthroplasty (hemi or total) can be offered in older individuals, young patients should be offered an attempt of salvage of their native hips. Neglected femoral neck fracture in two young male patients who were trans-femoral amputees was managed by fixation through a Watson-Jones approach. Strategically placed Schanz screws and K-wires were used as joysticks for obtaining reduction and three 6.5mm cannulated screws were placed in a triangular fashion. An augmentation of the fixation was done with free fibula autograft placed in the center of the triangle. Union was achieved in both the cases. Patients were pain-free at the latest follow-up visit. Meticulous clinical and radiological evaluation is mandatory in multiply injured patients to avoid missing fractures. Fixation of neglected femoral neck fractures in young transfemoral amputees with three screws and a fibula can be considered a viable alternative to valgus osteotomy in cases where the stump is small for successful placement of the implant and where implant availability is an issue or the surgeon is comfortable in using screws and fibula for non-unions of femoral neck.
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Affiliation(s)
- Prateek Behera
- Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Lokesh Sn
- Orthopaedics, Employess State Insurance Corporation Hospital, Chennai, IND
| | - Ankit Khurana
- Orthopaedics, All India Institute of Medical Sciences, Delhi, IND
| | | | - Nirmal Raj Gopinathan
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
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Nayak C, Acharyya B, Jain M, Kamboj K. Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate. Chin J Traumatol 2019; 22:29-33. [PMID: 30824174 PMCID: PMC6529366 DOI: 10.1016/j.cjtee.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/15/2018] [Accepted: 01/05/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup. METHODS We report a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein for valgus osteotomy was added to reduction fixation secured with a commonly available 135° dynamic hip screw and plate. RESULTS Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3. CONCLUSION 135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results.
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Affiliation(s)
- Chandrakant Nayak
- Department of Orthopedics, Nil Ratan Sircar Medical College & Hospital, Kolkata 700014, India
| | - Biplab Acharyya
- Department of Orthopedics, Nil Ratan Sircar Medical College & Hospital, Kolkata 700014, India
| | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India,Corresponding author.
| | - Kulbhushan Kamboj
- Department of Orthopedics, Lady Hardinge Medical College, New Delhi 110001, India
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Abstract
OBJECTIVES To evaluate the outcomes of neglected pilon fractures treated by the Ilizarov fixator and to determine whether this technique was successful in avoiding an ankle arthrodesis. DESIGN Retrospective case series. SETTING Level I university trauma center. PATIENTS Between January 2003 and March 2015, 18 patients (mean age of 42.17 years) with an untreated pilon fracture with late presentation (>1 month) were evaluated. Six patients were women and 12 were men. The mean duration from trauma to management was 11.17 weeks (range: 7-15). All fractures were OTA/AO 43 type C. Four cases were open fractures. INTERVENTION Closed fracture reduction, correction of deformity, and restoration of alignment by the Ilizarov fixator. MAIN OUTCOME MEASUREMENTS The radiographs were evaluated for tibial alignment, quality of reduction, and development of arthrosis. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for functional assessment. RESULTS The follow-up period ranged from 18 to 168 months (mean; 38.00). The quality of reduction was excellent in 2 cases, satisfactory in 13 cases, and poor in 3 cases. The external fixator period averaged 29.06 weeks (range: 6.1-7.5 months). All fractures healed without deep infection. Ankle dorsiflexion and plantar flexion averaged 8.67 and 25.67 degrees, respectively, in 15 cases. Arthrodesis was performed for the remaining 3 cases. The mean AOFAS Ankle-Hindfoot score was 82.67. One case had mild anterior translation, and another 1 had a procurvatum of 5 degrees. Arthrosis developed in 6 ankles. CONCLUSIONS A satisfactory outcome was achieved after management by the Ilizarov fixator while avoiding arthrodesis in most cases of this series of neglected pilon fractures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Toro G, Moretti A, Toro G, Tirelli A, Calabrò G, Toro A, Iolascon G. Surgical treatment of neglected hip fracture in children with cerebral palsy: case report and review of the literature. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:317-323. [PMID: 29354160 PMCID: PMC5762222 DOI: 10.11138/ccmbm/2017.14.3.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CASE A clinical case of a 15-year-old cerebral palsy child with a Sandhu type 2 neglected femoral neck fracture is presented. The patient was treated using cannulated screws and cancellous bone graft augmented with mesenchymal stem cells. At 6 months after the surgery complete fracture healing was observed. CONCLUSION To early diagnose this fractures, it is mandatory to perform a comprehensive clinical and radiological evaluation including also a second level imaging. The use of cannulated screws with cancellous bone graft and MSCs is a viable treatment option in these patients.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella Toro
- Unit of Radiology and Nuclear Medicine, “Santa Maria della Speranza” Hospital, Battipaglia (SA), Italy
| | | | - Giampiero Calabrò
- Unit of Orthopaedics and Traumatology, “Martiri del Villa Malta” Hospital, Sarno (SA), Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, “Martiri del Villa Malta” Hospital, Sarno (SA), Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Address for correspondence: Giovanni Iolascon, MD, Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy, E-mail:
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DHS osteosynthesis with internal bone grafting in unstable delayed presented intracapsular neck femur fractures. Injury 2017; 48 Suppl 2:S44-S49. [PMID: 28802420 DOI: 10.1016/s0020-1383(17)30493-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to assess fracture union and complications following use of dynamic hip screw (DHS) with internal bone grafting in treatment of unstable delayed presented intracapsular neck femur fractures in patients younger than 65 years of age. MATERIAL AND METHODS Thirty two patients with displaced intracapsular neck femur fractures(Garden III and IV, Pauwels III, with comminution) with delayed presentation (15-60 days) in the 45-65 year age group (mean 54.4±10.2 years) were included in this study. All patients were treated with dynamic sliding hip screw with closed cancellous bone grafting through a tunnel of a triple reamer. The average time to union was 3.8 months (3-5 months). Satisfactory union was achieved in all patients except two. One case developed avascular necrosis of the femoral head. Other complications were coxa vara in two, shortening of less than 10mm in three cases but there were no cases of infection or implant failure. Excellent results were achieved in 27, good/fair in 4 and poor in 1 patient. CONCLUSION Osteosynthesis with DHS and primary cancellous bone grafting in indicated cases is a simple, providing biological stimulation for early union. Failure in a particular case can be treated with any appropriate second procedure.
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Zhang YL, Zhang W, Zhang CQ. A new angle and its relationship with early fixation failure of femoral neck fractures treated with three cannulated compression screws. Orthop Traumatol Surg Res 2017; 103:229-234. [PMID: 28093376 DOI: 10.1016/j.otsr.2016.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Pauwels angle has been used widely, however an accurate evaluation of this angle is difficult because of deformity of the affected lower extremity. Therefore we designed a new measurement of the orientation of femoral neck fracture and applied this in a retrospective study to assess: (1) its reproducibility, (2) its advantages compared with the Pauwels angle, (3) its relationship with the short-term prognosis treated with three cannulated compression screws. HYPOTHESIS This new measurement is reproducible and has some reference meaning for the treatment of femoral neck fractures. METHODS Two hundred and twenty-eight patients with femoral neck fractures treated with three cannulated compression screws were retrospectively analyzed. The VN angle, which was the angle between the fracture line and the vertical of the neck axis, and the Pauwels angle were measured respectively. The method of ICC was performed to assess the reproducibility of the two angles, and the absolute value of difference in pre-operative and post-operative radiographs was used to evaluate the uniformity of the two angles. These fractures were divided into four groups according to VN angle (VN<0° (n=92), 0°≤VN<10° (n=82), 10°≤VN<15° (n=26), VN≥15° (n=28)), and the short-term (within 6 months) fixation results of radiographs in these fractures were evaluated. RESULTS The ICC of the VN angle and the Pauwels angle in pre-operative radiographs were 0.937 (95% confidence interval (CI): 0.922-0.950) and 0.942 respectively (95% CI: 0.914-0.970), indicating both angles had a good inter-rater reproducibility. However, there was a great difference between the Pauwels angle in pre-operative and post-operative radiographs (P=0.037), the absolute difference was 10.66±6.47 (range: 1.72-38.48), while no statistical difference for the VN angle (P=0.084) and the absolute difference was 2.20±1.63 (range: 0.05-7.56). The overall fixation failure rate which was defined as screw loosening, varus collapse, obvious fracture displacement or femoral neck shortening was 11.84%, and the mean failure rates according to VN angles were respectively 0%, 3.24% (95% CI: 1.64-4.84), 22.69% (95% CI: 16.43-28.96), 65.45% (95% CI: 59.36-71.53). The mean failure rates of fractures according to post-operative Pauwels angle (<30°, 30-50°, >50°) were respectively 0%, 1.46% (95% CI: 1.42-1.50) and 36.24% (95% CI: 34.93-37.54). DISCUSSION The VN angle has a good inter-rater reproducibility, a higher reliability than the Pauwels angle and is closely related to the short-term prognosis of femoral neck fractures treated with cannulated compression screws. LEVEL OF EVIDENCE Level IV, retrospective diagnostic study.
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Affiliation(s)
- Y L Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Western Xueyuan Road, 325000 Wenzhou, China
| | - W Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, 200233 Shanghai, China.
| | - C Q Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, 200233 Shanghai, China
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Khani GMK, Hafeez K, Bux M, Rasheed N, Ahmed N, Anjum MP. Use of fibular bone graft and cancellous screw fixation in the management of neglected femur neck fractures in young patients. Int J Health Sci (Qassim) 2017; 11:7-10. [PMID: 29114187 PMCID: PMC5669514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To present the clinical outcome of patients with neglected femur neck fracture treated with fibular bone graft. METHODS During May 2010-February 2013, 15 patients younger than 35 years of age with neglected fracture neck of femur were managed with non-vascularized fibular graft and cannulated screws. Fractures were classified according to Sandhu Classification. Hip function was assessed using Harris hip score. RESULTS Fifteen patients with mean age of 28.67 years were managed. Mean period of delay from injury to presentation was 3.07 months. Mean follow-up was 18.5 months. Union was achieved in 13 cases. 2 patients developed nonunion with progression of avascular necrosis (AVN). Patients with healed fracture did not show radiological signs of AVN till the past follow-up. Functional status was evaluated at 6 months according to Harris hip score and was poor in 2 patients, fair in 2 patients, good in 6 patients, and excellent in 5 patients. CONCLUSION Fibular graft along with two cancellous screws proved to be an effective technique in our cases with neglected femur neck fractures.
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Affiliation(s)
- Ghulam Mustafa Kaim Khani
- Department of Orthopaedics, Dow International Medical College, Dow University of Health Sciences (Ojha Campus), Karachi, Pakistan
| | - Kamran Hafeez
- Consultant Orthopaedic Surgeon, Buraidah Central Hospital, Buraidah, Al-Qaseem Region, Saudi Arabia,Address for correspondence: Dr. Kamran Hafeez, Consultant Orthopaedic Surgeon, Buraidah Central Hospital, Buraidah, Al-Qaseem Region, Saudi Arabia. Phone: +966535853411. E-mail:
| | - Muhammad Bux
- Department of Orthopaedics, Lyari General Hospital, Karachi, Pakistan
| | - Nusrat Rasheed
- Department of Orthopaedics, Dow International Medical College, Dow University of Health Sciences (Ojha Campus), Karachi, Pakistan
| | - Naveed Ahmed
- Department of Orthopaedics, Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - M. Perwez Anjum
- Department of Orthopaedics, Dow International Medical College, Dow University of Health Sciences (Ojha Campus), Karachi, Pakistan
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Tripathy SK, Sen RK, Goyal T. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review. Indian J Orthop 2016; 50:345-51. [PMID: 27512214 PMCID: PMC4964765 DOI: 10.4103/0019-5413.185587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
- Address for correspondence: Dr. Sujit Kumar Tripathy, Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha, India. E-mail:
| | - Ramesh Kumar Sen
- Department of Orthopaedics, Fortis Hospital, Mohali, Punjab, India
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Varghese VD, Livingston A, Boopalan PR, Jepegnanam TS. Valgus osteotomy for nonunion and neglected neck of femur fractures. World J Orthop 2016; 7:301-307. [PMID: 27190758 PMCID: PMC4865720 DOI: 10.5312/wjo.v7.i5.301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/27/2016] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics. The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomy-optimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
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Salgotra K, Kohli S, Vishwakarma N. Short-term Results of Muscle-Pedicle Bone Grafting with Tensor Fascia Lata for Delayed Femoral Neck Fractures; Case Series and Literature Review. Bull Emerg Trauma 2016; 4:101-104. [PMID: 27331067 PMCID: PMC4897991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/06/2016] [Accepted: 02/25/2016] [Indexed: 06/06/2023] Open
Abstract
Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft) and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG) using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7%) men and 1 (14.3%) women among the patients. Overall 5 (71.5%) patients had transcervical and 2 (28.5%) had subcapital fractures. At the end of 6 months, 6 (85.7%) patients were pain free and on plain radiographs fracture union was noted. One (14.3%) patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures.
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Affiliation(s)
- Kuldip Salgotra
- Department of Orthopedics, Mahatma Gandhi Mission (MGM), University of Heath Sciences, Mumbai, India
| | - Sarabjeet Kohli
- Department of Orthopedics, Mahatma Gandhi Mission (MGM), University of Heath Sciences, Mumbai, India
| | - Nilesh Vishwakarma
- Department of Orthopedics, Mahatma Gandhi Mission (MGM), University of Heath Sciences, Mumbai, India
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