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Sadeghpour A, Mahdipour S, Ghanjpour Sales J, Aslani H, Moharrami MR, Alizadeh H. Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial. J Orthop 2024; 51:32-38. [PMID: 38299065 PMCID: PMC10825919 DOI: 10.1016/j.jor.2023.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024] Open
Abstract
Background The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent. Methods This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS). Results Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001). Conclusion Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.
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Affiliation(s)
- Alireza Sadeghpour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahab Mahdipour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Ghanjpour Sales
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Aslani
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Moharrami
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Alizadeh
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Han S, Zhang ZY, Zhou K, Yin GK, Liu YC, Wang BJ, Wen Z. Positive buttress reduction in femoral neck fractures: a literature review. J Orthop Surg Res 2024; 19:262. [PMID: 38658987 PMCID: PMC11044489 DOI: 10.1186/s13018-024-04649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Femoral neck fractures (FNFs) in young adults are usually caused by high-energy trauma, and their treatment remains a challenging issue for orthopedic surgeons. The quality of reduction is considered an important factor in improving the poor prognosis of patients with FNFs. In recent years, positive buttress closed reduction technique has received widespread attention in the treatment of FNFs. This comprehensive literature review is designed to encapsulate the impacts of both non-anatomic and anatomic reduction on the biomechanical stability, clinical outcomes, and postoperative complications in the management of FNFs, conjecture the efficacy of positively braced reduction techniques and provide a thorough summarization of the clinical outcomes. METHODS In this literature review, we have examined all clinical and biomechanical studies related to the treatment of FNFs using non-anatomical reduction or positive and negative buttress reduction. PubMed, Web of Science, Google Scholar and Embase Library databases were searched systematically for studies published before September 1, 2023. Published literature on fracture reduction techniques for treating FNFs was reviewed. In addition, we evaluated the included literature using the MINORs tool. RESULTS Although the "arch bridge" structure formed by the positive buttress reduction technique improved the support to the cortical bone and provided a more stable biomechanical structure, no significant differences were noted in the clinical efficacy and incidence of postoperative complications between the positive buttress reduction and anatomical reduction. CONCLUSION Positive buttress reduction is an effective treatment method for young patients with FNFs. When facing difficult-to-reduce FNF, positive buttress reduction should be considered first, followed by anatomical reduction. However, negative buttress reduction should be avoided.
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Affiliation(s)
- Shun Han
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Ze-Yang Zhang
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Ke Zhou
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Gui-Kun Yin
- Department of Orthopaedic, Central Hospital of Zhuanghe City, Zhuanghe, 116400, P. R. China
| | - Yu-Chen Liu
- Department of Orthopaedic, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China
| | - Ben-Jie Wang
- Department of Orthopaedic, Affiliated Xinhua Hospital of Dalian University, Liaoning Province, Dalian, 116001, P. R. China.
| | - Zhun Wen
- Department of Orthopaedic, Central Hospital of Zhuanghe City, Zhuanghe, 116400, P. R. China.
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Zheng S, Lin D, Chen P, Lin C, Chen B, Zheng K, Lin F. Comparison of femoral neck shortening after femoral neck system and cannulated cancellous screw fixation for displaced femoral neck fractures in young adults. Injury 2024; 55:111564. [PMID: 38640596 DOI: 10.1016/j.injury.2024.111564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/04/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The purpose of this study was to compare the outcomes of femoral neck shortening between the femoral neck system (FNS) and the cannulated cancellous screws (CCS) for displaced femoral neck fractures in young adults PATIENTS AND METHODS: In this retrospective analysis, 225 patients aged 18-65 years with displaced femoral neck fracture were divided into two groups according to internal fixation: 135 patients in the FNS group and 90 patients in the CCS group. The length of hospital stay, duration of surgery, intraoperative blood loss, quality of reduction, extent of femoral neck shortening, incidence of femoral neck shortening, femoral neck shortening at each follow-up visit, Harris hip score (HHS), reoperation, and complications were compared between the two groups. RESULTS The median follow-up time was 28.2 (26.0, 31.2) months in the FNS group and 30.2 (26.3, 34.7) months in the CCS group. The follow-up time, age, sex distribution, body mass index (BMI), mechanism of injury, injured side, length of hospital stay, time from injury to surgery, and fracture classification were similar between the groups. Duration of surgery was longer in the FNS group (65.0 (55.0, 87.0) min versus 55.0 (50.0, 65.0) min, P<0.001); intraoperative blood loss was greater in the FNS group (50.0 (20.0, 60.0) ml versus 20.0 (10.0, 35.0) ml, P<0.001). Femoral neck shortening was 2.4 (1.0, 4.5) mm in the FNS group versus 0.6 (0.0, 2.6) mm in the CCS group at 1 month postoperatively (P<0.001); 3.7 (1.8, 6.4) mm in the FNS group versus 1.2 (0.6, 3.8) mm in the CCS group at 3 months (P<0.001); 4.1(2.4, 7.7) mm in the FNS group versus 2.3 (1.1, 4.4) mm in the CCS group at 6 months (P<0.001); 4.2 (2.6, 7.7) mm in the FNS group versus 2.6 (1.3, 4.6) mm in the CCS group at 12 months (P<0.001); and 4.5 (2.8, 8.0) mm in the FNS group versus 2.8 (1.5, 4.8) mm in the CCS group at 18 months (P<0.001). The two groups showed no significant differences in HHS, reoperation, and reduction quality. CONCLUSION Compared to CCS, FNS is deficient in preventing femoral neck shortening. Future research should focus on improving FNS in terms of preventing femoral neck shortening.
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Affiliation(s)
- Shunze Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China
| | - Dongze Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Peisheng Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Chaohui Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Bin Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Ke Zheng
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China.
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Kutzner KP, Walz A, Afghanyar Y, Drees P, Schneider M. Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips. Arch Orthop Trauma Surg 2024; 144:1793-1802. [PMID: 38172436 DOI: 10.1007/s00402-023-05170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The indications for cementless short-stem total hip arthroplasty (THA) have been expanded due to encouraging results. However, no evidence in cases of femoral neck fractures (FNFs) is available. We aimed to prospectively obtain data on the safety and the clinical outcomes of a cementless calcar-guided short stem in patients with FNFs. MATERIALS AND METHODS We conducted a prospective observational study of 68 patients diagnosed with FNFs who underwent short-stem THA between 2016 and 2019 with a calcar-guided stem. Complications during follow-up leading to revision were documented, and patient reported outcome measurements recorded. Stem migration was analyzed using the Einzel-Bild-Röntgen-Analysis Femoral Component Analysis software. RESULTS The mean follow-up was 33.8 ± 14.8 months. The patient mortality at last follow-up was 10.6%. Two patients required stem revision, due to periprosthetic fracture and late aseptic loosening, respectively, corresponding to 96.2% stem survival. Survivorship for the endpoint of revision for any reason was 91.1% at 6 years. All revisions occurred in females. The mean Harris Hip Score at the last follow-up was 93.0 ± 8.9. The mean axial migration at last follow-up was 1.90 ± 1.81 mm. No significant influence on migration was found regarding gender, age, weight, and body mass index. CONCLUSIONS The clinical and radiological findings were satisfying and most patients benefited from the minimally invasive procedure. However, as for conventional THA as well, implant survivorship and mortality were markedly worse compared to results regarding osteoarthritis. Especially in elderly female patients with FNF, cementless short-stem THA is a concern and a cemented THA should be the first choice.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Alexander Walz
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Michael Schneider
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
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Li Y, Wang Y, Dong B, Yang P, Sun Y, Zhou L, Shen J, Ma X, Ma J. Comparison of rehabilitation outcomes between robot-assisted and freehand screw placement in treatment of femoral neck fractures: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:208. [PMID: 38459524 PMCID: PMC10921808 DOI: 10.1186/s12891-024-07325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/29/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE To compare the postoperative rehabilitation of femoral neck fractures treated with robot-assisted nailing and freehand nailing. METHODS We systematically searched the PubMed, EMBASE, Cochrane, China National Knowledge Infrastructure(CNKI), WanFang database, China Science and Technology Journal Database (VIP) and Web of Science databases to identify potentially eligible articles. Indispensable data such as the year of publication, country, study type, robot type, age, number of patients, sex distribution, study design, and outcome indicators were extracted. The outcome indicators of interest included healing rate, length of healing time, Harris score, operation time, frequency of X-ray fluoroscopy, frequency of guide pin insertion, and intraoperative blood loss. RevMan 5.4.1 was used for the meta-analysis. RESULTS Fourteen studies with 908 participants were included in this meta-analysis. The results showed that in terms of healing rate (SMD = 2.75, 95% CI, 1.03 to 7.32, P = 0.04) and Harris score (SMD = 2.27, 95% CI, 0.79 to 3.75, P = 0.003), robot-assisted screw placement technique scores were higher than the traditional freehand technique. Additionally, operative time (SMD = -12.72, 95% CI, -19.74 to -5.70, P = 0.0004), healing time (SMD = -13.63, 95% CI, -20.18 to -7.08, P < 0.0001), frequency of X-ray fluoroscopy (SMD = - 13.64, 95% CI, - 18.32 to - 8.95, P < 0.00001), frequency of guide pin insertion (SMD = - 7.95, 95% CI, - 10.13 to - 5.76, P < 0.00001), and intraoperative blood loss (SMD = - 17.33, 95% CI, - 23.66 to - 11.00, P < 0.00001) were lower for patients who underwent robotic-assisted screw placement than those for patients who underwent the conventional freehand technique. CONCLUSION Compared to the freehand nailing technique, robot-assisted nailing helps improve postoperative healing rates in patients with femoral neck fractures; shortens healing times; better restores hip function; reduces the number of intraoperative fluoroscopies, guides pin placements; reduces intraoperative bleeding; and increases perioperative safety.
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Affiliation(s)
- Yiyang Li
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Yan Wang
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Benchao Dong
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Peichuan Yang
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Yadi Sun
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Liyun Zhou
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Jiahui Shen
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Xinlong Ma
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China.
| | - Jianxiong Ma
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China.
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Yan TX, Dong SJ, Ning B, Zhao YC. Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures. World J Clin Cases 2024; 12:1076-1083. [PMID: 38464920 PMCID: PMC10921305 DOI: 10.12998/wjcc.v12.i6.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/30/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Hip fractures account for 23.8% of all fractures in patients over the age of 75 years. More than half of these patients are older than 80 years. Bipolar hemiarthroplasty (BHA) was established as an effective management option for these patients. Various approaches can be used for the BHA procedure. However, there is a high risk of postoperative dislocation. The conjoined tendon-preserving posterior (CPP) lateral approach was introduced to reduce postoperative dislocation rates. AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients. METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA. The patients were followed up for at least 1 year. Among the 80 patients, 57 (71.3%) were female. The time to operation averaged 2.3 d (range: 1-5 d). The mean age was 80.5 years (range: 67-90 years), and the mean body mass index was 24.9 kg/m2 (range: 17-36 kg/m2). According to the Garden classification, 42.5% of patients were type Ⅲ and 57.5% of patients were type Ⅳ. Uncemented bipolar hip prostheses were used for all patients. Torn conjoined tendons, dislocations, and adverse complications during and after surgery were recorded. RESULTS The mean postoperative follow-up time was 15.3 months (range: 12-18 months). The average surgery time was 52 min (range: 40-70 min) with an average blood loss of 120 mL (range: 80-320 mL). The transfusion rate was 10% (8 of 80 patients). The gemellus inferior was torn in 4 patients (5%), while it was difficult to identify in 2 patients (2.5%) during surgery. The posterior capsule was punctured by the fractured femoral neck in 3 patients, but the conjoined tendon and the piriformis tendon remained intact. No patients had stem varus greater than 3 degrees or femoral fracture. There were no patients with stem subsidence more than 5 mm at the last follow-up. No postoperative dislocations were observed throughout the follow-up period. No significance was found between preoperative and postoperative mean Health Service System scores (87.30 ± 2.98 vs 86.10 ± 6.10, t = 1.89, P = 0.063). CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications. For surgeons familiar with the posterior lateral approach, there is no need for additional surgical instruments, and it does not increase surgical difficulty.
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Affiliation(s)
- Ting-Xin Yan
- Department of Joint Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Sheng-Jie Dong
- Department of Joint Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
| | - Bo Ning
- Department of Joint Surgery, Dongying People's Hospital, Dongying 257091, Shandong Province, China
| | - Yu-Chi Zhao
- Department of Joint Surgery, Yantaishan Hospital, Yantai 264003, Shandong Province, China
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Deng W, Wan J, Wang D, Geng K, Zhang G, Hou R. Experimental analysis of femoral head intraosseous vascular anastomosis in the treatment of porcine subcapital femoral neck fractures. Heliyon 2024; 10:e25211. [PMID: 38327464 PMCID: PMC10847604 DOI: 10.1016/j.heliyon.2024.e25211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Femoral neck fractures are challenging injuries associated with a compromised blood supply to the femoral head, leading to a high risk of avascular necrosis and poor clinical outcomes. This study aimed to investigate the efficacy of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. Methods Ten Landrace pigs were used as experimental animal models. The femoral head was completely removed after femoral neck sub-cephalic fracture. It was fixed on the medial side of the knee joint, and the blood supply to the femoral head was reconstructed by anastomosing the femoral head vessels. One week later, blood flow in the femoral head was observed by borehole, digital subtraction angiography examination, and hematoxylin and eosin staining. Further, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling tests were performed to detect pathological changes in the femoral head. Results After one-week, digital subtraction angiography of the femoral head revealed a blood circulation rate of 70 %, and the blood seepage rate of the borehole was 80 %. Hematoxylin and eosin staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling test results showed that necrosis of bone marrow cells in the experimental group was significantly improved compared to that in the control group. Discussion This study highlights the potential benefits of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. Further research and clinical trials are warranted to validate these findings and to explore the translational potential of this technique in human patients.
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Affiliation(s)
- Wei Deng
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Jiaming Wan
- Yangzhou University Medical College, Yangzhou, China
| | - Dingsong Wang
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Kailong Geng
- Suzhou Medical College of Soochow University, Suzhou, China
| | | | - Ruixing Hou
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Ruihua Orthopedic Hospital, Suzhou, China
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Suto A, Fujii K, Nakatani T, Ogawa K, Ichihara T, Li S, Sato K, Miura K, Funayama T, Yamazaki M. Correlation between preoperative CT scan of the paraspinal, psoas, and gluteus muscles and postoperative ambulatory status in patients with femoral neck fractures. BMC Musculoskelet Disord 2024; 25:132. [PMID: 38347481 PMCID: PMC10860248 DOI: 10.1186/s12891-024-07251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between femoral neck fractures and sarcopenia. METHODS This was a retrospective analysis of 92 patients with femoral neck fractures, from September 2017 to March 2020, who were classified into high ambulatory status (HG) and low ambulatory status (LG) groups. Ambulatory status was assessed before surgery, one week after surgery, at discharge, and during the final follow-up. To evaluate sarcopenia, muscle mass and fatty degeneration of the muscles were measured using preoperative CT. An axial slice of the superior end of the L5 vertebra was used to evaluate the paraspinal and psoas muscles, a slice of the superior end of the femoral head for the gluteus maximus muscle, and a slice of the inferior end of the sacroiliac joint for the gluteus medius muscle. The degeneration of the muscles was evaluated according to the Goutallier classification. RESULTS The cross-sectional area of the gluteus medius and paraspinal muscles was significantly correlated with ambulatory status before the injury, at discharge, and during the final follow-up. CONCLUSIONS Measurement of the gluteus medius and paraspinal muscles has the potential to evaluate sarcopenia and predict ambulatory status after femoral neck fractures.
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Affiliation(s)
- Akihito Suto
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Takushi Nakatani
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kaishi Ogawa
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Takumi Ichihara
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Sayori Li
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kosuke Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan.
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
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Fan X, Zhou Y, Dai S, Lao K, Zhang Q, Yu T. Bio-mechanical effects of femoral neck system versus cannulated screws on treating young patients with Pauwels type III femoral neck fractures: a finite element analysis. BMC Musculoskelet Disord 2024; 25:83. [PMID: 38245678 PMCID: PMC10799488 DOI: 10.1186/s12891-023-07110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION As a novel internal fixation for femoral neck fractures, the femoral neck system has some advantages for young Pauwels type III femoral neck fractures without clear biomechanical effects and mechanisms. Thus, the objection of the study is to realize the biomechanical effects and mechanism of FNS cannulated screws on treating young patients with Pauwels type III femoral neck fractures compared to cannulated screws which are commonly used for femoral neck fractures by finite element analysis. METHODS Firstly, the model of young Pauwels type III femoral neck fractures, femoral neck system (FNS), and three cannulated screws (CS) arranged in an inverted triangle were established, and the internal fixations were set up to fix young Pauwels type III femoral neck fractures. Under 2100 N load, the finite element was performed, and the deformation, peak von Mises stress (VMS), and contact at fracture segments were recorded to analyze the biomechanical effects and mechanism of FNS and three-CS fixing young Pauwels type III femoral neck fractures. RESULTS Compared to three-CS, the deformation of the whole model, internal fixation, and fracture segments after FNS fixation were lower, and the peak VMS of the whole model and the internal fixation after FNS were higher with lower peak VMS of the distal femur and the fracture segments. With a sticking contact status, the contact pressure at fracture segments after FNS fixation was lower than that of three-CS. CONCLUSIONS FNS can provide better mechanical effects for young patients with Pauwels type III femoral neck fractures, which may be the mechanical mechanism of the clinical effects of FNS on femoral neck fracture. Although there is high stress on FNS, it is still an effective and safe internal fixation for young patients with Pauwels type III femoral neck fractures.
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Affiliation(s)
- Xiao Fan
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Yimin Zhou
- Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, 100007, China
| | - Shiyou Dai
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Kecheng Lao
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Qiliang Zhang
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China.
| | - Tengbo Yu
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China.
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Liu G, Yang C, Wang R, Tang J, Wu H, Wei L, Hu J. Application of robot navigation system for insertion of femoral neck system in the treatment of femoral neck fracture. BMC Musculoskelet Disord 2024; 25:47. [PMID: 38200451 PMCID: PMC10777528 DOI: 10.1186/s12891-024-07172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To evaluate the short-term clinical efficacy and advantages of surgery robot positioning system for insertion of Femoral Neck System (FNS) in the treatment of femoral neck fractures. METHODS The clinical data of 52 patients with Femoral neck fracture (FNF) who had been treated with FNS between June 2020 and September 2021 were retrospectively analyzed. Among them, 26 patients were treated with traditional FNS (control group), while 26 additional patients were treated with FNS assisted by an orthopaedic robot positioning system (study group). The operation duration, frequency of key-guide needle placement, intraoperative blood loss, incision length, fracture healing rate, fracture healing time, and the Harris scores at the last follow-up were calculated and compared between the 2 groups. RESULTS The study group had shorter operation duration, fewer numbers of placing the key-guide needle, less intraoperative blood loss, and smaller surgical incisions than the control group (all, P < 0.05). There was no significant difference in the rate of fracture healing rate between the 2 groups (P = 0.47), while the fracture healing duration of the study group was shorter than that of the control group (P = 0.03). At the last follow-up, compared with the control group, the Harris score and the number of excellent and good ratings were significantly higher in the study group (all, P < 0.05). CONCLUSIONS Using orthopaedic surgery robot positioning system-assisted FNS in the treatment of FNFs can effectively improve the efficiency of surgery, shorten operation time, and reduce the number of placing the key-guide needle, intraoperative blood loss, and operative trauma. Simultaneously, it shortens the duration of fracture healing and improves the recovery of hip function.
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Affiliation(s)
- Gang Liu
- Department of Trauma Center, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi, 545005, China
| | - Chengzhi Yang
- Department of Trauma Center, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi, 545005, China
| | - Renchong Wang
- Department of Trauma Center, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi, 545005, China
| | - Jingli Tang
- Department of Trauma Center, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi, 545005, China
| | - Hao Wu
- Department of Trauma Center, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi, 545005, China
| | - Lu Wei
- Department of Trauma Center, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi, 545005, China
| | - Juzheng Hu
- Department of Trauma Center, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi, 545005, China.
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Wang C, Tan B, Qian Q. The impact of perioperative enhanced recovery nursing model on postoperative delirium and rehabilitation quality in elderly patients with femoral neck fractures. BMC Musculoskelet Disord 2023; 24:947. [PMID: 38057753 DOI: 10.1186/s12891-023-07068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of introducing the Enhanced Recovery After Surgery (ERAS) nursing model on postoperative delirium occurrence and rehabilitation quality in elderly patients with femoral neck fractures. METHODS A total of 160 elderly patients with femoral neck fractures, who met the inclusion criteria and were admitted between March 2021 to March 2023, were divided into two groups: the traditional care group and the ERAS nursing model group. In addition to traditional care measures, the ERAS nursing model group received interventions based on the principles of the ERAS nursing model. The occurrence of delirium and sleep quality were observed at 24, 48, and 72 h postoperatively, as well as during the overall hospital stay. The duration of hospitalization, time to first mobilization, and post-discharge follow-up on quality of life were compared between the two groups. RESULTS The ERAS nursing model group exhibited a significant difference in the occurrence of delirium at 48 and 72 h postoperatively, as well as during the overall hospital stay (P < 0.05). However, there was no significant difference in the occurrence of delirium at 24 h postoperatively (P > 0.05). The sleep quality of the two groups showed a statistically significant difference (P < 0.05). The ERAS nursing model group had shorter time to first mobilization, reduced hospitalization duration, and higher Harris and SF-36 scores during post-discharge follow-up, compared to the traditional care group (P < 0.05). CONCLUSIONS The implementation of the ERAS nursing model in elderly patients with femoral neck fractures improved postoperative sleep quality, reduced delirium occurrence, shortened average hospitalization duration, and enhanced patients' quality of life.
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Affiliation(s)
- Cheng Wang
- Department of Orthopedics, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Bingyin Tan
- Department of Pharmacy, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Qing Qian
- Department of Orthopedics, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430033, China.
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Chung YY, Baek SN, Park TG, Kim MY. The Effects of COVID-19 Pandemic on the Recovery of Hip Fracture Patients. Hip Pelvis 2023; 35:253-258. [PMID: 38125271 PMCID: PMC10728043 DOI: 10.5371/hp.2023.35.4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose To figure out how complete control of family visits to prevent infection of coronavirus disease 2019 (COVID-19) affected the activity recovery of hip fracture patients admitted to nursing hospitals. Materials and Methods Eighty-one patients with hip surgery in the two years prior to COVID-19 pandemic were classified as Group A, and 103 patients in the next two years were designated as Group B. The subjects' walking ability was evaluated by using the modified Koval index (MKI). In order to analyze the impact of the family visit control to the subjects, each group was classified into two different groups: (1) inpatients group who admitted to nursing hospitals and (2) home-treated patients. Additionally, statistical elements were processed in consideration of other factors that may affect the results of the experiment. Results The MKI evaluated at 6 months postoperative was 3.31±1.79 in Group A and 2.77±1.91 in Group B, and it was meaningfully low after the pandemic (P=0.04). There was significantly low among both of Group A 2.74±1.76 and Group B 1.93±1.81 after the pandemic (P=0.03) among those treated at the nursing hospital. The rate of deterioration of the MKI was 35 (43.2%) in Group A and 57 (55.3%) in Group B, which increased by 12.1% after the pandemic. Conclusion The pandemic had a negative effect on the recovery of postoperative activities of elderly hip fracture patients who admitted to nursing hospitals when family access was completely restricted to prevent infection.
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Affiliation(s)
- Young Yool Chung
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung Nyun Baek
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Tae Gyu Park
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Min Young Kim
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Kim H, Kim JS, Sung YB. Postoperative Valgus Deformity and Progression of Ostheoarthritis in Non-Displaced Femoral Neck Fractures. Hip Pelvis 2023; 35:259-267. [PMID: 38125270 PMCID: PMC10728049 DOI: 10.5371/hp.2023.35.4.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Nondisplaced femoral neck fractures have traditionally been treated with in situ fixation. However, poor surgical and clinical outcomes have been reported for fractures with valgus deformity >15°, and the reduction of valgus impaction has recently been emphasized. In addition, early degenerative osteoarthritis can be caused by cam-type femoroacetabular impingement after healing of femoral neck fractures. This study was designed with the objective of confirming the difference in progression of radiographic osteoarthritis according to the severity of the valgus deformity. Materials and Methods Patients who underwent internal fixation using multiple cannulateld screws for management of nondisplaced femoral neck fractures were divided into two groups: high valgus group (postoperative valgus angle ≥15°) and low valgus group (postoperative valgus angle <15°). Evaluation of demographic data and changes in the joint space width from the immediate postoperative period to the latest follow-up was performed. Results A significant decrease in joint space width in both hip joints was observed in the high valgus group when compared with the low valgus group, including cases with an initial valgus angle less than 15° and those corrected to less than 15° of valgus by reduction. No complications requiring surgical treatment were observed in either group; however, two cases of avascular necrosis, one in each group, which developed in the low valgus group after reduction of the fracture, were followed for observation. Conclusion Performing in situ fixation in cases involving a valgus deformity ≥15° in non-displaced femoral neck fractures may cause accelerated narrowing of the hip joint space.
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Affiliation(s)
- Hyungtae Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ji Su Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yerl Bo Sung
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Chen L, Jiang JB, Ma H, Duan X, Chen JL. Factors associated with early failure of the femoral neck system (FNS) in patients with femoral neck fractures. BMC Musculoskelet Disord 2023; 24:912. [PMID: 38012667 PMCID: PMC10680198 DOI: 10.1186/s12891-023-06994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Femoral neck system (FNS) is a new type of internal fixation system which has been widely used for treating femoral neck fractures (FNFs).Compared with other internal fixation methods, FNS is minimally invasive and stable, and often achieves satisfactory short-term efficacy.Early failure of FNS (EFFNS) is not uncommon, however, there are few literatures and reports on factors associated with EFFNS.This study aimed to survey the prevalence and risk factors of EFFNS. METHODS We retrospectively analysed 62 patients with FNFs and underwent FNS fixation between 2019 and 2021. Demographic data, clinical characteristics, radiographic features and treatment process were described. Multifactor logistic regression analysis was used to analyse the different influencing factors. RESULTS Out of the 62 FNFs patients, 10 patients (16.1%) developed EFFNS, including 6 cases of severe femoral neck shortening, 2 cases of screw-out, 1 case of avascular necrosis of the femoral head and 1 case of nonunion. In the failure group, all patients were younger than 65 years old, which was significantly higher than 59.6% in the healing group (P = 0.012). There were no significant differences in sex(P = 0.490), BMI (P = 0.709), injured side (P = 0.312), injury mechanism (P = 0.617), reduction method(P = 0.570),femoral neck-shaft angle(P = 0.545), Pauwels classification (P = 0.564) and Garden classification (P = 0.195). Moreover, we not found that Garden classification (P = 0.464) and age (P = 0.128) were statistically significant risk factors for EFFNS at multivariate analysis. CONCLUSION In this study, sex, BMI, injury side, injury mechanism, reduction method, Pauwels angle, femoral neck-shift angle, Pauwels classification and Garden classification were excluded as EFFNS risk factors. Moreover, our study demonstrated that age and Garden classification were not significant risk factors at multivariate analysis. TRIAL REGISTRATION ChiCTR, ChiCTR2100051360. Registered on 21 September, 2021. https://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- L Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - J B Jiang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - H Ma
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - X Duan
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - J L Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- Trauma Center, West China Hospital, Sichuan University, Chengdu, China.
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Lind D, Nåtman J, Mohaddes M, Rogmark C. Long-term risk of reoperation after modular hemiarthroplasty : Any differences between uni- or bipolar design? BMC Musculoskelet Disord 2023; 24:911. [PMID: 38001417 PMCID: PMC10668427 DOI: 10.1186/s12891-023-07035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND It is unclear whether unipolar (UHA) or bipolar (BHA) hemiarthroplasty should be the preferred treatment of femoral neck fracture (FNF). AIM We investigated the reoperation rate at 13 years post-fracture after BHA and UHA as treatment of FNF, including a subgroup analysis of individuals who survived 5 years or more, and described the reasons for reoperation after BHA and UHA respectively. METHODS In an observational cohort study on prospectively collected national register data, 16,216 BHA and 22,186 UHA were available for matching. A propensity score for treatment with bipolar HA was estimated using logistic regression. Matching was done using the 1:1 nearest neighbor matching without replacement. Of the 16,216 BHA patients, 12,280 were matched to a UHA control. A subgroup analysis based on the matched sample excluded individuals who died within 5 years and comprised 3,637 individuals with BHA and 3,537 with UHA. Kaplan-Meier survival analysis was used. RESULTS In the Kaplan-Meier analysis, 92% of the BHA group was free from reoperation at 13 years (95% CI 0.91-0.93), compared to 92% in the UHA group (CI 0.89-0.94). BHA was associated with more reoperations until 3 years. Reoperation due to infection was most common after BHA, n = 212 (1.7%) compared to n = 141 (1.1%) after UHA. Dislocation led to reoperation in 192 of the BHA cases (1.6%) and in 157 of the UHA cases (1.3%). Acetabular erosion/pain occurred in 0.1% and 0.4%. Amongst those surviving ≥ 5 years, 93% of the BHA group was free from reoperation (CI 0.92-0.94) at 13 years, 92% after UHA (CI 0.90-0.94). BHA had more reoperations during the 1st year only. The causes for reoperations showed similar rates except for acetabular erosion/pain. Here the BHA group had 2 cases (0.1%), the UHA had 39 (1.1%). CONCLUSION With a modular hemiarthroplasty relatively few patients need a reoperation. During the first years, there is a higher reoperation rate after BHA compared to UHA. Thereafter, no differences are seen. In patients who survive ≥ 5 years after the fracture there are more reoperations due to acetabular erosion after UHA, but crude numbers are extremely low, and the total reoperation rate is not affected.
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Affiliation(s)
- Dennis Lind
- Department of Orthopedics, Skane University Hospital, Lund University, Lund, Sweden.
| | - Jonatan Nåtman
- Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Maziar Mohaddes
- Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, Lund, Sweden
- Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
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Taşkent HC, Alemdaroğlu KB, Uslan Y, Ercan N, Demir T. Biomechanical performance of talon cannulated compression device in pauwels type III fractures: a comparative study. Injury 2023; 54:111018. [PMID: 37730490 DOI: 10.1016/j.injury.2023.111018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Pauwels Type III fractures are unstable and frequently treated with cannulated screws (CS) or dynamic hip screws (DHS). The newly developed talon-cannulated compression devices (TCCD) have the potential to provide rotational stability, mainly through their talon. The study investigates whether TCCD has mechanical advantages over conventional screws or can be as stable as DHS in a reverse triangle configuration for an unstable femoral neck fracture. MATERIAL AND METHODS After creating a standard Pauwels Type III unstable femoral neck fracture in 36 synthetic femur bones in cortical/hard cancellous bone density, 18 were reserved for dynamic-static tests, and 18 were used for torsional tests. Each group containing 18 synthetic bones was divided into three groups to apply three different fixation materials (CS, DHS, and TCCD), with six models in each group. The displacement amounts after dynamic-static tests were measured using the AutoCAD program according to the reference measurement criteria. During the dynamic tests, a series of photographs were taken. During the static tests, the beginning and post-test photographs were taken. Finally, torsional tests were performed until implant failure occurred in the synthetic femur. RESULTS In static axial loading tests, TCDD was found to be statistically superior to conventional CS in AL-BL distance (p = 0,014) and CL distance (p = 0,013) measurements, and there was no significant difference between the other groups. There was no significant difference between all groups in dynamic axial compression tests in any points of interest. In torsional tests, TCCD outperformed cannulated screws in stiffness (p = 0,001) and maximum torque (p = 0,001) categories, and they provided statistically significant superiority to DHS in yield torque (p<0,001) category. CONCLUSIONS Biomechanically, TCCD predominates conventional cannulated screws in femoral neck fractures. TCCD also has superior torsional properties than DHS in the yield torque category. Therefore, TCCD could be the implant of choice for unstable femoral neck fractures.
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Affiliation(s)
- Hayri Can Taşkent
- SBÜ Ankara Training & Research Hospital Department of Orthopaedics and Traumatology, Turkey
| | | | - Yunus Uslan
- TOBB University of Economics and Technology, Mechanical Engineering, Turkey
| | - Niyazi Ercan
- SBÜ Ankara Training & Research Hospital Department of Orthopaedics and Traumatology, Turkey
| | - Teyfik Demir
- TOBB University of Economics and Technology, Mechanical Engineering, Turkey
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Senra AR, Carvalho DR, da Silva MR, Sousa AN, Torres J. Proximal femur geometry: a major predictor of proximal femur fracture subtypes. Hip Int 2023; 33:1100-1106. [PMID: 36253960 DOI: 10.1177/11207000221129785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Proximal femur geometry (PFG) represents an important risk factor for the occurrence of hip fractures. There are currently few studies regarding the correlation between PFG and the occurrence of a specific fracture subtype, and those that exist have small cohorts and present with different methodologies and contradictory results. Therefore, there is no consensus in the literature regarding this topic. The present study aimed to establish the contribution of the PFG in the occurrence of different subtypes of proximal femur fractures (PFF): intertrochanteric, neck and subtrochanteric. METHODS Analysis of 1022 plain anteroposterior pelvic radiographs of patients consecutively admitted to the emergency room of a Level 1 Trauma Centre between 2013 and 2019 after low energy trauma who presented with PFF and underwent surgical treatment. Patients were analysed considering age, gender and subtype of PFF (intertrochanteric, neck or subtrochanteric). Radiological parameters including cervicodiaphyseal angle (CDA), horizontal offset (HO), femoral neck width (FNW), femoral neck length (FNL), great trochanter-pubic symphysis distance (GTPSD), acetabular teardrop distance (ATD) and width of the intertrochanteric region (WIR) were measured and compared between the different subtypes of fractures (7154 measurements). Statistical analysis was conducted recurring to absolute measurements and measurements ratios. The correlation was assessed using t-test. RESULTS There were statistically significant differences in proximal femur geometry between the different subtypes of fractures. Patients presenting with femoral neck fractures had greater CDA (132.5 ± 6.9 vs. 130.0 ± 7.3; p < 0.001) and lower HO (45.8 ± 7.4 vs. 49.0 ± 8.0; p < 0.001), HO/ATD (0.34 ± 0.068 vs. 0.37 ± 0.072; p < 0.001) and HO/GTPSD (0.26 ± 0.049 vs. 0.28 ± 0.039; p < 0.001) than patients with intertrochanteric/subtrochanteric fractures. CONCLUSIONS PFG represents an important contributor to the occurrence of different fracture subtypes. Femoral neck fractures are associated with greater CDA and lower HO, HO/ATD and HO/GTPSD when compared to intertrochanteric or subtrochanteric fractures.
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Affiliation(s)
| | - Diogo R Carvalho
- Department of Orthopaedics and Traumatology, Baixo Vouga Hospital Centre, Aveiro, Portugal
| | - Miguel R da Silva
- Department of Orthopaedics and Traumatology, Saint John's University Hospital, Porto, Portugal
| | - António N Sousa
- Department of Orthopaedics and Traumatology, Saint John's University Hospital, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine University of Porto, Portugal
| | - João Torres
- Department of Orthopaedics and Traumatology, Saint John's University Hospital, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine University of Porto, Portugal
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Cong B, Han Z, Zhang H. Exploring the displacement characteristics of Garden III femoral neck fractures and the reliability, validity, and value of the anteroposterior Garden Index in assessing displacement severity. J Orthop Surg Res 2023; 18:797. [PMID: 37875945 PMCID: PMC10594693 DOI: 10.1186/s13018-023-04269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Femoral neck fractures represent a significant public health concern, particularly in the elderly population. A thorough understanding and assessment of these fractures are deemed essential for optimal treatment and management. Displacement characteristics of Garden III femoral neck fractures were explored in this study, and the reliability, validity, and clinical utility of the anteroposterior Garden Index in evaluating displacement severity were investigated. METHODS Patients diagnosed with Garden III femoral neck fractures were included in this study. The anteroposterior Garden Index was computed from X-ray images by three experienced orthopedic doctors. Additionally, the contact area of the fracture endpoint and displacement of the femoral neck were evaluated using 128-slice 3D CT scans. Inter-observer and retest reliability of the Garden Index measurements were assessed, along with its correlation with CT measurements. RESULTS In this study, a total of 110 patients with Garden III femoral neck fractures were analyzed, showcasing an almost equal gender distribution and an age range spanning from 20 to 88 years. An average Garden Index of 135° (± 16°) was observed. The intra-observer repeatability of the Garden Index was found to exceed 90%. A significant positive correlation was identified between the Garden Index and the contact surface area of the fracture endpoint (r = 0.82, P < 0.001), while a significant negative correlation was noted with the upward displacement of the femoral neck (r = - 0.79, P < 0.001). CONCLUSIONS The anteroposterior Garden Index has been demonstrated to have promising potential as a reliable and valid tool for assessing the displacement severity of Garden III femoral neck fractures. Nonetheless, further research is needed to elucidate its relationship with other fracture characteristics and to enhance its criterion and construct validity.
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Affiliation(s)
- Bo Cong
- Yantai Key Laboratory for Repair and Reconstruction of Bone and Joint, Yantaishan Hospital Affiliated to Binzhou Medical University, 10087 Keji Avenue, Laishan District, Yantai, 264003 China
| | - Ziyin Han
- Yantai Key Laboratory for Repair and Reconstruction of Bone and Joint, Yantaishan Hospital Affiliated to Binzhou Medical University, 10087 Keji Avenue, Laishan District, Yantai, 264003 China
| | - Haiguang Zhang
- Yantai Key Laboratory for Repair and Reconstruction of Bone and Joint, Yantaishan Hospital Affiliated to Binzhou Medical University, 10087 Keji Avenue, Laishan District, Yantai, 264003 China
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Zhao Y, Li J, Liu Y, Cui G, Li Z. Comparison of reconstruction nails versus dual implants in the treatment of ipsilateral femoral neck and shaft fractures in adults: a meta-analysis and systematic review. BMC Musculoskelet Disord 2023; 24:800. [PMID: 37814281 PMCID: PMC10561477 DOI: 10.1186/s12891-023-06933-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/01/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE There is no consensus on the optimal treatment for ipsilateral femoral neck and shaft fractures. This meta-analysis aims to assess the effectiveness of reconstruction nails and dual implants in treating ipsilateral femoral neck and shaft fractures to provide a basis for decision-making when selecting the optimal approach. METHODS Relevant articles were retrieved from Pubmed, Embase, and Cochrane databases using the keywords "neck of femur", "shaft" and "fracture fixation" from inception until November 17, 2022. The screening process of the studies was conducted independently by two assessors, who assessed each study's eligibility and two assessors assessed the quality. Then compared differences in outcome measures using RevMan 5.3 software. RESULTS A total of ten retrospective cohort studies were included. There were no significant differences in union time, union rate, union-related complications (malunion, nonunion, delayed union) of femoral neck and shaft fractures, osteonecrosis of the femoral head, and functional outcomes (Friedman-Wyman scoring system) (P > 0.05). CONCLUSION Our pooled estimates indicated that reconstruction nails and dual implants for ipsilateral femoral neck and shaft fractures could yield satisfactory surgical results, and that there is no difference between the two treatment methods. TRIAL REGISTRATION This meta-analysis was registered on the PROSPERO website (registration number: CRD42022379606).
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Affiliation(s)
- Yongchao Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jian Li
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China
| | - Yadong Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Guanlu Cui
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhengwei Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Thomasius F. [Development of the new guidelines on osteoporosis : Methodological and content development]. Orthopadie (Heidelb) 2023; 52:818-823. [PMID: 37695556 DOI: 10.1007/s00132-023-04429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
Since 2018, the present S3 guideline Prophylaxis, Diagnosis and Therapy of Osteoporosis (AWMF 183-001) has been updated following a previous update of the underlying PICO questions (Population-Intervention-Comparison-Outcome questions) for a systematic literature search. The focus of the guideline update, in addition to updating the evidence supporting literature along with recommendations, was the development of a risk calculator for vertebral fractures and femoral neck fractures. This is essential for managing risk assessment because of the multitude of risk factors that contribute to fracture risk. This article considers the development of the guideline update methodologically and substantively, the latter by reflecting on the core themes of the guideline update.
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Affiliation(s)
- Friederike Thomasius
- Frankfurter Hormon & Osteoporosezentrum, Goethestr. 23, 60313, Frankfurt, Deutschland.
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Huh JW, Seo HE, Lee DH, Yoo JH. Risk Factors of the 2-Year Mortality after Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture. Hip Pelvis 2023; 35:164-174. [PMID: 37727299 PMCID: PMC10505842 DOI: 10.5371/hp.2023.35.3.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose This study investigates the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR), albumin, and 2-year mortality in elderly patients having hemiarthroplasty for displaced femoral neck fracture (FNF). Materials and Methods We retrospectively reviewed 284 elderly patients who underwent hemiarthroplasty for Garden type IV FNF from September 2014 to September 2020. Using the receiver operating characteristic curve, optimal cutoff values for LCR, NLR, and albumin were established, and patients were categorized as low or high. Associations with 2-year mortality were evaluated through univariate and multivariate Cox regression analyses. Results Of the 284 patients, 124 patients (45.9%) died within 2 years post-surgery. The optimal cutoff values were: LCR at 7.758 (specificity 58.5%, sensitivity 25.0%), NLR at 3.854 (specificity 39.2%, sensitivity 40.0%), and albumin at 3.750 (specificity 65.9%, sensitivity 21.9%). Patients with low LCR (<7.758), high NLR (≥3.854), and low albumin (<3.750) had a statistically significant reduced survival time compared to their counterparts. Conclusion Lower preoperative LCR and albumin levels, along with higher NLR, effectively predict 2-year mortality and 30-day post-surgery complications in elderly patients with Garden type IV FNF undergoing hemiarthroplasty.
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Affiliation(s)
- Jung Wook Huh
- Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea
| | - Han Eol Seo
- Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea
| | - Dong Ha Lee
- Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea
| | - Jae Heung Yoo
- Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea
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Kim HS, Yoo JH, Lee YK, Park JS, Won YY. Treatment of Femoral Neck Fractures in the Elderly: A Survey of the Korean Hip Society Surgeons. Hip Pelvis 2023; 35:157-163. [PMID: 37727295 PMCID: PMC10505840 DOI: 10.5371/hp.2023.35.3.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose This study examined the methods for treatment of femoral neck fracture (FNF) preferred by members of the Korean Hip Society (KHS) and identified factors that influence decisions regarding the surgical intervention of choice. Materials and Methods A total of 97 members of the KHS responded to the 16-question survey which included questions about the mean number of surgeries performed each month for treatment of femoral neck fractures, the cut-off age for deciding between internal fixation and arthroplasty, the implant used most often, usage of cement, and factors influencing each decision. Results The mean cut-off age used when deciding between internal fixation and arthroplasty was 64 years old. Hemiarthroplasty (HA) (70%) was the most preferred option for treatment of displaced FNFs in cases where arthroplasty was indicated (total hip arthroplasty [THA] 19% and dual mobility THA 11%). The main reasons for selection of arthroplasty over reduction with internal fixation were age and pre-fracture ambulatory status. Pre-trauma ambulatory status and/or sports activity were the main factors in selection of HA over THA. Cement was used by 33% of responders. Poor bone quality and a broad femoral canal were factors that influenced the usage of cement. Conclusion Management of FNFs in the elderly is a major health problem worldwide; thus, remaining alert to current trends in treatment is essential for surgeons. The mean cut-off age used in deciding between internal fixation and arthroplasty was 64 years old. HA is the preferred method for treatment of displaced FNFs for members of the KHS.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Je-Hyun Yoo
- Department of Orthropaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Seok Park
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - Ye-Yeon Won
- Department of Orthopaedic Surgery, Ajou University Medical Center, Ajou University College of Medicine, Suwon, Korea
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Zhang Y, Zhang X, Li C, Lin Y, Lv Y, Huang S, Wang B, Wang Y, Zhu Z. Prediction of hip joint function and analysis of risk factors for internal fixation failure after Femoral Neck System (FNS). BMC Musculoskelet Disord 2023; 24:674. [PMID: 37620843 PMCID: PMC10463719 DOI: 10.1186/s12891-023-06805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE Analysis of the risk factors affecting hip function and complications after femoral neck system (FNS) surgery for femoral neck fractures is of great significance for improving the procedure's efficacy. METHODS The data of patients with femoral neck fractures who underwent FNS surgery in our hospital between October 2019 and October 2020 were retrospectively analyzed. Age, gender, time from injury to operation, fracture classification, operation time, fracture reduction, and postoperative weight-bearing time information were set as potential factors that may affect the results. Hip Harris scores were performed at 12 months postoperatively, and postoperative complication data (e.g., femoral head necrosis, nonunion, and femoral neck shortness) were collected. The risk factors affecting hip function and complications after FNS surgery were predicted using linear and logistic regression analyses. RESULTS A total of 69 cases of femoral neck fracture were included, with an average age of 56.09 ± 11.50 years. The linear analysis demonstrated that the age and fracture type of the patients were the risk factors affecting the Harris score of the hip joint after FNS surgery. Older patients with displaced femoral neck fractures had an inferior postoperative hip function. In addition, fracture type, reduction of the femoral neck, and postoperative weight-bearing significantly impacted postoperative complications. Displaced fractures, negative fixation, and premature weight-bearing (< 6 weeks) were risk factors for postoperative complications. The Harris score of patients with a shortened femoral neck in the included cases was not significantly different from that of patients without shortening (P = 0.25). CONCLUSIONS Advanced age and fracture type are important evaluation indicators of the Harris score after FNS internal fixation of femoral neck fractures in young patients. Fracture type, fracture reduction, and postoperative weight-bearing time are risk factors for complications after FNS.
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Affiliation(s)
- Yazhong Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China.
| | - Xu Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China
| | - Chao Li
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China
| | - Yan Lin
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China
| | - Yongxiang Lv
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China
| | - Shaolong Huang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China
| | - Bin Wang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China
| | - Yunqing Wang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China
| | - Ziqiang Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, No 32 Meijian Road, Xuzhou, 221000, Jiangsu, China.
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Wei Y, Lin T, Liu Y, Chen Z, Zhou C. Fibula allograft with cannulated screw fixation versus ordinary cannulated screw fixation for femoral neck fractures: a 10-year retrospective comparative study. J Orthop Surg Res 2023; 18:570. [PMID: 37543623 PMCID: PMC10403915 DOI: 10.1186/s13018-023-04002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND For femoral neck fractures in young and middle-aged patients, both fibula allograft with cannulated screw fixation and ordinary cannulated screw fixation are clinically effective treatments. However, for unstable femoral neck fractures, ordinary cannulated screw fixation is characterized by a high risk of postoperative complications and a high rate of mechanical failure after internal fixation. For this study, we systematically compared the long-term efficacy and postoperative complications of these two procedures. METHODS A total of 156 subjects diagnosed as femoral neck fractures participated in our study. Subjects in the combination group underwent fibula allograft with cannulated screw fixation (n = 76), and those in the control group were treated with ordinary cannulated screw fixation (n = 80). Baseline characteristics, perioperative outcomes, Harris hip score (HHS) and EuroQoL five-dimension questionnaire (EQ-5D); and the incidence of postoperative and bone healing complications in the two groups were recorded and compared. RESULTS The average follow-up time was more than 10 years. Intra-operative blood loss significantly increased in the combination group compared with the control group (P < 0.05). There were significantly improved performances in healing time, the time course of recovery of full-weight-bearing stepping, HHS and EQ-5D scores in the combination group compared with the control group (P < 0.05). Besides, the incidence rates of femoral head necrosis, nonunion, femoral neck shortening and total hip replacement were significantly lower in the combination group than those in the control group (P < 0.05). CONCLUSION Fibula allograft with cannulated screw fixation shows a better long-term therapeutic effect than ordinary cannulated screw fixation for femoral neck fractures in young and middle-aged patients. Patients receiving the combination strategy have faster and high-quality functional recovery after femoral neck fractures and a lower incidence rate of postoperative complications.
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Affiliation(s)
- Yangwenxiang Wei
- The First Clinical of Medical School, Guangzhou University of Chinese Medicine, No. 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
- The Lab of Orthopaedics of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Tianye Lin
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510240, Guangdong, China
| | - Yuhao Liu
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Zhenqiu Chen
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China.
| | - Chi Zhou
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China.
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Zhong Z, Lan X, Xiang Z, Duan X. Femoral neck system and cannulated compression screws in the treatment of non-anatomical reduction Pauwels type-III femoral neck fractures: A finite element analysis. Clin Biomech (Bristol, Avon) 2023; 108:106060. [PMID: 37536196 DOI: 10.1016/j.clinbiomech.2023.106060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND High shear force is a major factor detrimental to the healing of vertical femoral neck fractures. In addition to firm fixation, reduction quality is crucial for postoperative stability. The present study aimed to compare the biomechanical stability of the newly invented femoral neck system and three inverted-triangle cannulated compression screws treatments for non-anatomical reduction of Pauwels type-III femoral neck fractures. METHODS A total of 18 non-anatomical reduction Pauwels type-III femoral neck fracture finite element models were fabricated and fixed using three inverted-triangle cannulated compression screws or the femoral neck system. A 1950-N force was applied to the femoral head to simulate the physiological load during a single-leg stance. Parameters of the maximum total deformation, the interfragmentary gap, and the maximum von Mises stress of the implants and the proximal femur were analyzed. FINDINGS The results of the maximum total deformation, interfragmentary gap, and maximum von Mises stress of the implants in the negative-negative buttress model fixed by the femoral neck system were the largest among all groups (3.58 mm, 0.252 mm, and 729.68 MPa, respectively). In contrast, the anatomical-anatomical reduction model fixed by three inverted-triangle cannulated compression screws demonstrated the minimum total deformation, interfragmentary gap, and minimum von Mises stress of implants (1.107 mm, 0.09 mm, and 189.83 MPa, respectively). INTERPRETATION Anatomical reduction or positive buttress in femoral neck fractures should be recommended during fracture reduction. The femoral neck system showed weaker biomechanical stability than three inverted-triangle cannulated compression screws in treating Pauwels type-III femoral neck fractures.
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Affiliation(s)
- Zhou Zhong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China
| | - Xuejun Lan
- Department of Health Management Center, General Practice Center, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China
| | - Zhou Xiang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China.
| | - Xin Duan
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China; Department of Orthopedic Surgery, Sichuan Fifth People's Hospital, Chengdu 610000, China.
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Stoffel K, Michelitsch C, Arora R, Babst R, Candrian C, Eickhoff A, Gebhard F, Platz A, Schmid FA, Weschenfelder W, Sommer C. Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational case series. Arch Orthop Trauma Surg 2023; 143:4155-4164. [PMID: 36460761 PMCID: PMC10293436 DOI: 10.1007/s00402-022-04686-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/27/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Osteosynthesis of femoral neck fractures (FNFs) is an important treatment option, especially for younger patients. We aimed to assess the rate of early implant-related complications in FNF osteosynthesis using the Femoral Neck System (FNS). PATIENTS AND METHODS Consecutive patients diagnosed with displaced or nondisplaced FNFs were treated with FNS in this prospective, observational, multicenter investigation. Patients were followed up for minimally 3 months and up to 12 months if radiologic bone union and no pain was not achieved beforehand. Predefined treatment-related adverse events (AEs, defined as implant failure, loss of reduction, iatrogenic fractures, deep infection, and surgical revision), radiologic bone union, and patient-reported Harris hip score (HHS) and EQ-5D-5L index score were assessed. RESULTS One hundred and twenty-five patients were included in the study. Thirty-eight (30.4%) fractures were displaced (Garden III and IV), and 37 (29.6%) were vertical fractures (Pauwels type III). Predefined treatment-related AE rate at 3 months was 8 patients, 6.4% (95% CI, 2.8-12.2), and at 12 months, 11 patients, 8.8% (95% CI, 4.5-15.2). Cumulative incidences of bone union were 68% at 3 months, 90% at 6 months, and 98% at 12 months. The mean changes of HHS and EQ-5D-5L index score between preinjury and at 12 months were -7.5 (95% CI, [ - 21.1] to [6.2]) and - 0.03 (95% CI, [ - 0.21] to [0.15]), respectively; neither were statistically significant. CONCLUSION The current study on osteosynthesis of FNFs with the FNS resulted in treatment-related complication rates of 6.4% (95% CI, 2.8-12.2) at 3 months and 8.8% (95% CI, 4.5-15.2) at 12 months. On average, patients returned to preinjury function and quality of life. The current study may also indicate that the conventional wisdom of treating stable FNF in patients aged between 60 and 80 years with osteosynthesis may need to be reconsidered. REGISTRATION The study is registered with ClinicalTrials.gov (registration number: NCT02422355).
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Affiliation(s)
- Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | - Rohit Arora
- Department for Orthopaedics Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Reto Babst
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Orthopedics and Trauma, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Alexander Eickhoff
- Department of Trauma Surgery, Hand, Plastic and Reconstructive Surgery, University of Ulm, Ulm, Germany
| | - Florian Gebhard
- Department of Trauma Surgery, Hand, Plastic and Reconstructive Surgery, University of Ulm, Ulm, Germany
| | - Andreas Platz
- Department of General, Hand, and Trauma Surgery, City Hospital Triemli, Zurich, Switzerland
| | - Florian Andreas Schmid
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Wolfram Weschenfelder
- Department of Trauma, Hand and Reconstructive Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christoph Sommer
- Department of Surgery, Kantonsspital Graubuenden, Chur, Switzerland
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Garcia-Lopez E, Anigwe C, Wong SE, Zhang AL, Lansdown DA. Age is predictive of higher rate of conversion to total hip arthroplasty after core decompression for osteonecrosis of the hip. J Orthop 2023; 41:79-83. [PMID: 37362960 PMCID: PMC10285448 DOI: 10.1016/j.jor.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Background Core decompression may be performed for early osteonecrosis with a goal of improving symptoms and potentially delaying the need for total hip arthroplasty. The effectiveness and complication rate of this procedure is not well understood given the relatively rare nature of hip osteonecrosis. Purpose The purpose of this study is to determine time to total hip arthroplasty (THA) after core compression, assess predictors of early conversion to THA, and to examine complications after hip core decompressions. Methods Using Current Procedural Terminology (CPT) codes, we queried the Mariner PearlDiver dataset for patients who underwent hip core decompression. Patient demographics were recorded and subsequent THA conversion within 2 years after surgery were tracked. Patient demographic factors, including age, sex, obesity, diabetes, prior fractures, steroid use, tobacco use, or alcohol use, were evaluated as possible predictors of early conversion to THA. International Classification of Diseases (ICD) codes were used to identify complications at 90 days after core decompression. Multiple linear regression was used to test if the patient demographics significantly predicted conversion to THA and complications after core decompression. Results Between 2010 and 2020, 555 patients underwent hip core decompression. Within 2 years of core decompression, 226 patients converted to THA (40.7%). Age was the only significant risk factor for conversion to THA. The highest proportion of patients (61.1%, 138/226) who converted to THA were between age 40-59. The 90-day complication rate was 2.9% (16/555). The most common complication was femoral neck fracture (11/16 of all complications). Discussion There is a high failure rate following core decompression for hip osteonecrosis with over one third of patients converting to THA within 2 years. Age was the only variable predictive of conversion to THA. The overall complication rate after core decompression is low at 90 days. Conclusion Patients should be counseled regarding the risk of early conversion to THA if over 40 and the potential risk of femoral neck fracture.
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Affiliation(s)
- Edgar Garcia-Lopez
- Corresponding author. 500 Parnassus Ave, MU-320W, San Francisco, CA, USA.
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Huguet J, Mariscal G, Balfagón A, Mayorga D, Ulldemolins P, Guillot A, Barrés M. Management and Outcomes of Hip Fractures in Lower Limb Amputees: A Case Series. Indian J Orthop 2023; 57:1063-1067. [PMID: 37384017 PMCID: PMC10293151 DOI: 10.1007/s43465-023-00890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/04/2023] [Indexed: 06/30/2023]
Abstract
Background Hip fractures in amputees pose a significant challenge for the orthopedic surgeon due to technical difficulties and there is no standardisation in their management. Their treatment is consequently left to the surgeon's ingenuity. The aim of this study is to describe the clinical characteristics and outcome of a series of hip fractures in lower limb amputees. Methods A total of 12 patients and 15 hip fractures in lower limb amputees were included. Amputations below the malleoli and prosthetic surgery due to osteoarthritis constitute the exclusion criteria. Demographic, amputation-related and fracture data as well as radiological, functional, and clinical outcomes were collected through the patients' medical records. Results Age at fracture and at amputation were different depending on the cause of amputation. Most patients (10/12) were male. Seven patients had an infracondylar amputation and five patients had a supracondylar amputation. Ten hip fractures were on the same side of the amputation, three were contralateral and one was bilateral. Pertrochanteric (6/15) and subcapital (5/15) were the main types observed. Different traction methods and surgical procedures were used. We observed no significant differences in terms of outcome regardless of the fracture, traction method, and surgical management. No complications related to surgery or during follow-up were found. Mortality at one year postoperatively was absent. Conclusion Provided an experienced orthopaedic surgeon, a pre-operative assessment, a comprehensive surgical planning, and a multidisciplinary rehabilitation strategy are present; a satisfactory outcome is to be expected.
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Affiliation(s)
- Juan Huguet
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
| | - Gonzalo Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
| | - Antonio Balfagón
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
| | - David Mayorga
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
| | - Pablo Ulldemolins
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
| | - Anna Guillot
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
| | - Mariano Barrés
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Valencia Spain
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29
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Hou ZJ. [A case of hip joint disconnection caused by iatrogenic external iliac artery injury]. Zhongguo Gu Shang 2023; 36:589-90. [PMID: 37366105 DOI: 10.12200/j.issn.1003-0034.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Zhao-Jun Hou
- The Second People's Hospital of Pingliang, Pingliang 744000, Gansu, China
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Wang S, Yu X, Li B, Ding Q, Wang T, Li Q, Liu L, Wu H. Pipkin type III femoral head fracture: which treatment strategy can be recommended? J Orthop Traumatol 2023; 24:28. [PMID: 37328665 DOI: 10.1186/s10195-023-00701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 05/01/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Pipkin type III femoral head fractures are relatively rare injuries. Few studies have explored and described the treatment and outcomes of Pipkin type III femoral head fractures. The purpose of this study was to evaluate the efficacy of open reduction and internal fixation (ORIF) in treating Pipkin type III femoral head fractures. METHODS We retrospectively reviewed 12 patients with Pipkin type III femoral head fractures who underwent ORIF from July 2010 and January 2018. The complications and reoperations were recorded. The visual analog scale (VAS) pain score, Harris hip score (HHS), Thompson-Epstein criteria, and SF-12 score [including the physical component summary (PCS) and the mental component summary (MCS)] were used for functional assessment. RESULTS Among the 12 patients, ten were males and two were females, with a mean age of 34.2 ± 11.9 years. The median follow-up time was 6 years (range 4-8 years). Five patients (42%) developed osteonecrosis of the femoral head, and one patient (8%) developed nonunion. These six patients (50%) underwent total hip arthroplasty (THA). One patient (8%) developed heterotopic ossification and underwent ectopic bone excision; this patient also presented with post-traumatic arthritis. The mean final VAS pain score and HHS were 4.1 ± 3.1 points and 62.8 ± 24.4 points, respectively. According to the Thompson-Epstein criteria, there was one patient (8%) with excellent, four patients (33%) with good, one patient (8%) with fair, and six patients (50%) with poor outcomes. The PCS score and MCS score were 41.7 ± 34.7 points and 63.2 ± 14.5 points, respectively. CONCLUSION Limited by the high incidence of osteonecrosis of the femoral head, it is difficult to achieve satisfactory functional outcomes when treating Pipkin type III femoral head fractures using ORIF, and a primary THA may be considered. However, for younger patients, considering the survivorship of prosthesis, ORIF may be recommended with the proviso that the patient is fully informed of the high complication rate associated with this procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Xiaojun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Bohua Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qing Ding
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Tianqi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Qin Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lei Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, People's Republic of China.
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.
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Jung CH, Cha Y, Chung JY, Park CH, Kim TY, Yoo JI, Kim JT, Jeon Y. Trajectory of bolt and length of plate in femoral neck system determine the stability of femur neck fracture and risk of subsequent subtrochanteric fracture : a finite element analysis. BMC Musculoskelet Disord 2023; 24:465. [PMID: 37280558 DOI: 10.1186/s12891-023-06579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND This study aimed to analyze the differences in the stability of fractures, stress distribution around the distal-most screw according to the length of the plate and the trajectory of the bolt in Pauwels type III femoral neck fracture using the femoral neck system (FNS). METHODS Finite element models of Pauwels type III femoral neck fractures were established with surgical variations in the trajectory of the bolt (central, inferior, valgus, and varus) and length of the lateral plate (1- and 2-hole plate). The models were subsequently subjected to normal walking and stair-climbing loads. RESULTS The screw-holding cortical bone in subtrochanter in the model with a 2-hole plate and the bolt in the inferior trajectory and the models with 1-hole or 2-hole plate and the bolt in valgus trajectory had shown greater maximum principal strain than the models with central or varus trajectories. The gap and sliding distance on the fracture surface were larger with inferior or varus trajectories of the bolt and smaller with the valgus trajectory of the bolt under both loads, compared to those of the central trajectory. CONCLUSION For the fixation of Pauwels type III femoral neck fracture, the trajectory of the FNS bolt and the length of the plate affect the mechanical stability of the fracture and the strain of cortical bone around the distal-most screw. The surgical target should stay on the central trajectory of the bolt and the 2-hole plate's mechanical benefits did not exceed the risk.
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Affiliation(s)
- Chang-Ho Jung
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji university hospital, Daejeon, Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, New Daesung Hospital, Bucheon, Korea
| | - Tae Young Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
| | - Yongho Jeon
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
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Chochola A, Bartoníček J, Douša P, Tuček M. Long-term results of valgus intertrochanteric osteotomy for partial avascular necrosis of the femoral head after femoral neck fracture in adolescents. BMC Musculoskelet Disord 2023; 24:460. [PMID: 37277815 DOI: 10.1186/s12891-023-06598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
PURPOSE The study evaluates long-term results in patients treated by valgus intertrochanteric osteotomy (VITO) for partial avascular necrosis of the femoral head (ANFH) after fracture of the femoral neck in adolescent age. Although this method is mentioned in literature frequently, there are only few studies in the literature dealing with it in detail. METHODS Authors evaluated five patients at the interval of 15 to 20 years following VITO. The mean age of the patients at the time of injury was 13.6 years and at the time of VITO 16.7 years. The studied parameters included resorption of necrotic segment of femoral head, development of posttraumatic osteoarthritis and leg shortening. RESULTS Comparison of radiographs and MRI scans before and after VITO showed resorption of the necrotic segment of the femoral head and its remodeling in all five patients. However, two patients gradually developed slight osteoarthritic changes. In one patient, remodeling of the femoral head occurred during the first 6 years postoperatively. Subsequently, the patient developed severe osteoarthritis with marked clinical symptoms. CONCLUSION VITO can improve the long-term function of the hip joint in adolescents with ANFH after a femoral neck fracture, but cannot restore completely the original shape and structure of the femoral head.
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Affiliation(s)
- Antonín Chochola
- Department of Orthopaedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Jan Bartoníček
- Department of Orthopaedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Pavel Douša
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Šrobárova 1150/50, 100 34, Prague 10, Czech Republic
| | - Michal Tuček
- Department of Orthopaedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 169 02, Prague 6, Czech Republic.
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Tang W, Wei C, Dai L, Lu D, Meng W, Zhou Z, Gu S, Li H, Ding Y. Radiological evaluation of effectiveness of PCCP fixation for femoral neck fracture: med-term effectiveness in a retrospective multicenter. Curr Med Imaging 2023:CMIR-EPUB-132254. [PMID: 37272459 DOI: 10.2174/1573405620666230602123016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/11/2023] [Accepted: 04/12/2023] [Indexed: 06/06/2023]
Abstract
Background It has been reported in the literature that the complication rate of percutaneous compression plate (PCCP) is the lowest among the new internal fixators for the treatment of femoral neck fracture (FNS). However, no multicenter studies of PCCP for FNS have been reported. This study aimed to evaluate the med-term effectiveness of PCCP in a multicenter mainly through radiology. Methods 265 patients with FNF treated with PCCP fixation in our five hospitals between January 2011 and December 2020 were retrospectively analyzed. 140 men and 125 women; aged 19-79 (mean 51.6)years. The follow-up time was 2-5 years (mean 3.1). Radiological evaluation of the therapeutic effect was the main outcome, and the function was the secondary outcome. Results One case of screw cutting out, 3 cases of screw back out, 25 cases of neck shortening, 2 cases of nonunion, 8 cases of delayed healing, and 29 cases of avascular necrosis (AVN). Bivariate correlation showed that shortening healing was correlated with age, Singh index, and Garden alignment index, poor healing was correlated with garden alignment index, and AVN was correlated with Pauwels and Garden classifications and operation timing. Further pairwise comparison analysis showed that age of > 65 and Singh index IV were dangerous factors for neck shortening, and the operation timing > 3 days, Pauwels II and III, and Garden III and IV were dangerous factors for AVN. The excellent and good rate of function in 198 patients who were readmitted for internal fixator removal or other surgery was 90.9%. Conclusion PCCP for FNS has satisfactory med-term efficacy with a low complication rate. The main complication is AVN, which is prone to occur in patients with displaced Pauwels II or III FNF and operation timing > 3 days. Another main complication is shortening healing, which is prone to occur in patients with an age of > 65 and Singh index IV.
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Affiliation(s)
- Wen Tang
- Radiological Department; Orthopaedic Department, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi 214062, Jiangsu, P.R. China
| | - Changbao Wei
- Orthopaedic Department, Orthopaedic Department, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi 214062, Jiangsu, P.R. China
| | - Liansheng Dai
- Orthopaedic Department, Jiangnan University Affiliated Hospital, Wuxi 214000, Jiangsu, P.R. China
| | - Dong Lu
- Orthopaedic Department, Jiangyin People's Hospital, Jiangyin 214400, Jiangsu, P.R. China
| | - Weichun Meng
- Orthopaedic Department, Yixing People's Hospital, Yixing 214200, Jiangsu, P.R. China
| | - Zihong Zhou
- Orthopaedic Department, Wuxi People's Hospital, 214000, Jiangsu, P.R. China
| | - Sanjun Gu
- Orthopaedic Department, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi 214062, Jiangsu, P.R. China
| | - Haifeng Li
- Orthopaedic Department, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi 214062, Jiangsu, P.R. China
| | - Yanping Ding
- Radiological Department; Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi 214062, Jiangsu, P.R. China
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Jiang Q, Liu Y, Bai X, Deng Y, Cao Y, Yu C, Song Q, Li Y. Nonanatomical reduction of femoral neck fractures in young patients treated with femoral neck system: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:412. [PMID: 37226140 PMCID: PMC10207767 DOI: 10.1186/s12891-023-06551-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023] Open
Abstract
PURPOSE Negative buttress reduction should be avoided in the treatment of femoral neck fractures (FNFs) using conventional fixation. As the femoral neck system (FNS) has been recently developed and utilized widely to treat FNFs, the association of reduction quality with postoperative complications and clinical function has not been clarified. The purpose of this study was to evaluate the clinical effect of nonanatomical reduction in young patients with FNFs treated with FNS. METHODS This multicenter, retrospective cohort study included 58 patients with FNFs treated with FNS between September 2019 and December 2021. According to the reduction quality immediately following surgery, patients were classified into positive, anatomical, and negative buttress reduction groups. Postoperative complications were assessed with 12 months of follow-up. The logistic regression model was used to identify risk factors for postoperative complications. The postoperative hip function was assessed using the Harris hip scores (HHS) system. RESULTS At a follow-up of 12 months, a total of eight patients (8/58, 13.8%) had postoperative complications in three groups. Compared with the anatomical reduction group, negative buttress reduction was significantly associated with a higher complication rate (OR = 2.99, 95%CI 1.10-8.10, P = 0.03). No significant associations were found between positive buttress reduction and the incidence of postoperative complications (OR = 1.21, 95%CI 0.35-4.14, P = 0.76). The difference was not statistically significant in Harris hip scores. CONCLUSION Negative buttress reduction should be avoided in young patients with FNFs treated with FNS.
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Affiliation(s)
- Qilong Jiang
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Yang Liu
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xinwen Bai
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Yu Deng
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Yong Cao
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Chengxiang Yu
- Department of Orthopaedic Surgery, Chongqing Sanbo Changan Hospital, Chongqing, China
| | - Qizhi Song
- Central Sterile Supply Department, Chonggang General Hospital, No. 1, Dayan Sancun, Dadukou District, Chongqing, 400010, China
| | - Yan Li
- Central Sterile Supply Department, Chonggang General Hospital, No. 1, Dayan Sancun, Dadukou District, Chongqing, 400010, China.
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He Y, Tang X, Liao Y, Liu S, Li L, Li P. The Comparison between Cemented and Uncemented Hemiarthroplasty in Patients with Femoral Neck Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop Surg 2023. [PMID: 37154088 DOI: 10.1111/os.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. OBJECTIVE We performed an updated systematic review and meta-analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures. METHODS A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta-analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI). RESULTS Twenty-four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0-17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6-5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4-11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3-5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39-0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16-0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11-0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40-0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23-0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71-10.02; P < 0.001). CONCLUSION This meta-analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.
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Affiliation(s)
- Yue He
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiumei Tang
- Institute of Hospital Management West China Hospital, Sichuan University, Chengdu, China
| | - Yan Liao
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shihua Liu
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingli Li
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Pengcheng Li
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Mei J. [Bone defects in femoral neck fractures:better evaluation, better decision-making]. Zhongguo Gu Shang 2023; 36:199-203. [PMID: 36946008 DOI: 10.12200/j.issn.1003-0034.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
- Jiong Mei
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200233, China
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Dai YH, Qin T. [Biomechanical characteristics of retinaculum in the treatment of femoral neck fractures]. Zhongguo Gu Shang 2023; 36:251-5. [PMID: 36946018 DOI: 10.12200/j.issn.1003-0034.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To investigate the biomechanical characteristics of retinaculum in the treatment of femoral neck fractures. METHODS The CT data of a 75-year-old female volunteer was processed by software to construct an intact femur model and femoral neck fracture model fixed with three cannulated screws, which were divided into models with retinaculum or not. The Von-Mises stress distribution and displacement were compared to analyze the stability differences between the different models to study the mechanical characteristics of the retinaculum in the treatment of femoral neck fractures. RESULTS In the intact femur, the most obvious displacement appeared in the weight-bearing area of the femoral head, with retinaculum 0.381 37 mm, and without retinaculum 0.381 68 mm. The most concentrated part of the Von-Mises stress distribution was located in the medial and inferior part of the femoral neck, with retinaculum 11.80 MPa, without retinaculum 11.91 MPa. In the femoral neck fracture fixed with three cannulated screws model, the most obvious position of displacement also appeared in the weight-bearing area of the femoral head, with retinaculum 0.457 27 mm, without retinaculum 0.458 63 mm. The most concentrated part of the Von-Mises located at the medical and inferior part of the femoral neck, with retinaculum 59.22 MPa, without retinaculum 59.14 MPa. For the cannulated screws, the Von-Mises force peaks all appeared in the posterior and superior screw, with retinaculum 107.48 MPa, without retinaculum 110.84 MPa. Among the three screws, the Von-Mises stress of the anterior-superior screw was the smallest, which was 67.88 MPa vs 68.76 MPa in the retinaculum and non-retinaculum groups, respectively. CONCLUSION The complete retinaculum has little effect on the stability of intact femur and femoral neck fractures with anatomical reduction after internal fixation, and cannot effectively improve the stability of the fracture end after the fracture.
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Affiliation(s)
- Ya-Hui Dai
- Department of Orthopaedics Surgery, Songjiang District Central Hospital, Shanghai 201600, China
| | - Tao Qin
- Department of Orthopaedics Surgery, Songjiang District Central Hospital, Shanghai 201600, China
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Gómez-Palomo JM, Martínez-Crespo A, Pérez-López C, Víquez-da Silva R, Zamora-Navas P. Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:102-109. [PMID: 36272501 DOI: 10.1016/j.recot.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/21/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture. METHODS A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out. OUTCOMES A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95%CI: 1.07-111.50; P=.007), thrombocytopenia (OR: 27.72; 95%CI: 3.48-221.01; P=.002), history of thromboembolism event (OR: 8.80; 95%CI: 1.31-59.38; P=.026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95%CI: 3.65-125.12; P=.001) and liver disease (OR: 32.04; 95%CI: 2.59-396.29; P=.007). CONCLUSIONS Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.
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Affiliation(s)
- J M Gómez-Palomo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Campus Teatinos, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | - A Martínez-Crespo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital de Montilla, Montilla, Córdoba, España
| | - C Pérez-López
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Víquez-da Silva
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Campus Teatinos, Málaga, España
| | - P Zamora-Navas
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Campus Teatinos, Málaga, España; Universidad de Málaga (UMA), Málaga, España
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Gómez-Palomo JM, Martínez-Crespo A, Pérez-López C, Víquez-da Silva R, Zamora-Navas P. [Translated article] Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T102-T109. [PMID: 36535344 DOI: 10.1016/j.recot.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture. METHODS A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out. OUTCOMES A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95% CI: 1.07-111.50; P = .007), thrombocytopenia (OR: 27.72;95% CI: 3.48-221.01; P = .002), history of thromboembolism event (OR: 8.80; 95% CI: 1.31-59.38; P = .026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95% CI: 3.65-125.12; P = .001) and liver disease (OR: 32.04; 95% CI: 2.59-396.29; P = .007). CONCLUSIONS Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.
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Affiliation(s)
- J M Gómez-Palomo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Campus Teatinos, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - A Martínez-Crespo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital de Montilla, Montilla, Córdoba, Spain
| | - C Pérez-López
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - R Víquez-da Silva
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Campus Teatinos, Málaga, Spain
| | - P Zamora-Navas
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Campus Teatinos, Málaga, Spain; Universidad de Málaga (UMA), Málaga, Spain
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Oh S, Park Y, Kwoun H, Eom E, Kim DA. Three-dimensional pelvis computed tomography-assisted Taylor approach for spinal anesthesia in hip arthroplasty: a retrospective study. Korean J Anesthesiol 2023; 76:12-16. [PMID: 36116483 PMCID: PMC9902187 DOI: 10.4097/kja.22099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/14/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Needle insertion for spinal anesthesia using the Taylor approach is challenging as the L5-S1 space is difficult to locate from the surface anatomy. In this study, we suggest the use of three-dimensional (3D) pelvis computed tomography (CT) to assist anesthesiologists in locating the needle insertion point. By comparing the success rate of 3D pelvis CT-assisted Taylor approach to that of other approaches in the existing literatures, we suggest this technique as an alternative method for subarachnoid block in the L5-S1 space. METHODS In this retrospective observational study, we reviewed the records of hip arthroplasty using the 3D pelvis CT-assisted Taylor approach. An imaginary guidance line was created from the intersection point of the midline and intercristal line on the posterior view of the 3D pelvis CT to the ideal skin insertion point for Taylor approach. The primary outcome was the success rate. The secondary outcomes included the angle between the intercristal line and the guidance line, and the length of the guidance line and the distance between the ideal needle insertion point and the L5-S1 space. RESULTS We reviewed the records of the 276 patients who underwent hip arthroplasty using 3D CT-assisted Taylor approach. In this cohort, the 3D CT-assisted Taylor approach in L5-S1 subarachnoid block failed in only 25/276 patients. The success rate of 3D CT-assisted Taylor approach was 90.9%. CONCLUSIONS A 3D pelvis CT-assisted Taylor approach of spinal anesthesia can be an alternative method for subarachnoid block in the L5-S1 space with an acceptable success rate.
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Affiliation(s)
- Saecheol Oh
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, Daejeon, Korea
| | - Yoojung Park
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, Suwon, Korea
| | - Hana Kwoun
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eunjin Eom
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Dal-ah Kim
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea,Corresponding author: Dal-ah Kim, M.D. Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, KoreaTel: +82-32-280-7420Fax: +82-32-280-5416
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Franco H, Wainwright C, Chernilo J, Tan ES, O'Callaghan W. Brain Natriuretic Peptide levels on hospital admission are a useful predictor of cardiac complications and mortality in geriatric patients with proximal femur fractures. J Orthop 2023; 36:82-87. [PMID: 36620093 PMCID: PMC9817089 DOI: 10.1016/j.jor.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose Proximal femur fractures in geriatric patients are associated with increased morbidity and mortality. This study investigates Brain Natriuretic Peptide immunoassay levels taken at the time of hospital admission in predicting cardiac complications and mortality in geriatric patients with a proximal femur fracture. Methods A single-site prospective cohort study at a large tertiary care, level 1 trauma centre was conducted on all consecutive geriatric patients aged greater than 60 years who sustained a proximal femur fracture. Investigators collected Brain Natriuretic Peptide levels from venous blood samples on admission to the Emergency Department. The main outcome measurements were inpatient cardiovascular complications, and all-cause mortality at 30-day, 90-day, one-year, and nine-years. Results Over a one-year period, 112 patients were enrolled. The average age was 82.7 years, and the average follow up was 6 years and 6 months (range, 2 days to 9 years). No patients were lost to follow up. There were 44 new or exacerbations of pre-existing cardiac complications requiring management recorded in 30 (26.8%) patients. Mortality at 30 days was 9.8%, 90 days was 16.1%, and one year was 24.1%, with deceased patients having a statistically significant elevated Brain Natriuretic Peptide immunoassay on hospital admission. The Kaplan-Meier graph demonstrated a trend towards increasing Brain Natriuretic Peptide and adverse survivorship risk. The Charlson Comorbidity Index was statistically significant in predicting overall survival probability. Conclusion Brain Natriuretic Peptide immunoassay on hospital admission may be utilised to identify patients at risk of cardiac complications and mortality to guide further investigations, operative planning, the consent process, and post-operative monitoring.
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Affiliation(s)
- Helena Franco
- Cairns Base Hospital, Orthopaedic Department, Cairns, Queensland, Australia
- Bond University, Gold Coast, Queensland, Australia
| | - Chris Wainwright
- Mackay Hospital, Orthopaedic Department, Mackay, Queensland, Australia
| | - Jonathan Chernilo
- Gold Coast University Hospital, Orthopaedic Department, Gold Coast, Queensland, Australia
- Dr Luis Calvo MacKenna Children's Hospital, Orthopaedic Department, Providencia, Chile
| | - Ezekiel S.L. Tan
- Gold Coast University Hospital, Orthopaedic Department, Gold Coast, Queensland, Australia
| | - William O'Callaghan
- Cairns Base Hospital, Orthopaedic Department, Cairns, Queensland, Australia
- Gold Coast University Hospital, Orthopaedic Department, Gold Coast, Queensland, Australia
- The Orthopaedic Research Institute of Queensland (ORIQL), Pimlico, Queensland, Australia
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Golub IJ, Ng MK, Conway CA, Vakharia RM, Cannada LK, Kang KK. How does sleep apnea impact outcomes following primary total hip arthroplasty for femoral neck fractures: a matched-control analysis. Arch Orthop Trauma Surg 2023; 143:295-300. [PMID: 34287701 DOI: 10.1007/s00402-021-04070-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cross-sectional studies have demonstrated that the prevalence of sleep apnea (SA) to be increasing within the United States. While studies have shown the association of SA and its association on complications following elective orthopedic procedures, well-powered studies investigating its impact in a traumatic setting are limited. The purpose of this study was to determine whether SA patients undergoing primary total hip arthroplasty (THA) for femoral neck fractures have higher rates of: (1) hospital lengths of stay (LOS); (2) readmissions; (3) complications; and (4) healthcare expenditures. METHODS The 100% Medicare Standard Analytical Files was queried from 2005 to 2014 for patients who sustained femoral neck fractures and were treated with primary THA. The study group consisted of patients with concomitant diagnoses of SA, whereas patients without SA served as controls. Study group patients were matched to controls in a 1:5 ratio by age, sex, and various comorbid conditions. Demographics of the cohorts were compared using Pearson's chi-squared analyses, and multivariate logistic regression analyses were used to calculate the odds (OR) of the effects of SA on postoperative outcomes. A p value less than 0.006 was considered to be statistically significant. RESULTS The final query yielded 24,936 patients within the study (n = 4166) and control (n = 20,770) cohorts. SA patients had significantly longer in-hospital LOS (6 vs. 5 days, p < 0.0001) but similar readmission rates (24.12 vs. 20.50%; OR: 1.03, p = 0.476). SA patients had significantly higher frequency and odds of developing medical complications (72.66 vs. 43.85%; OR: 1.57, p < 0.0001), and higher healthcare costs ($22,743.79 vs. $21,572.89, p < 0.0001). CONCLUSION SA is associated with longer in-hospital LOS, higher rates of complications and healthcare expenditures. This study is vital as it can allow orthopaedists to educate patients with SA on the potential complications which may occur following their procedure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ivan J Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Charles A Conway
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA.
| | | | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
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Haddad B, Hamdan M, Al Nawaiseh M, Aldowekat O, Alshrouf MA, Karam AM, Azzam MI, AR Altamimi A, Abu Shokor M. Femoral neck shaft angle measurement on plain radiography: is standing or supine radiograph a reliable template for the contralateral femur? BMC Musculoskelet Disord 2022; 23:1092. [PMID: 36514028 PMCID: PMC9749307 DOI: 10.1186/s12891-022-06071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Neck-shaft angle (NSA) is of paramount importance to orthopedic surgeons due to its implications for various pathologies of the hip and femur. The primary aim of the study was to establish if NSA measurement may be affected by imaging position (standing and supine) and provide evidence regarding whether the contralateral NSA can be used as a template. The secondary aim was to determine a reference value and precisely understand the effects of sex on NSA measurement. MATERIALS AND METHODS We measured bilateral NSA in a retrospective study of 200 standing and 200 supine anteroposterior pelvis radiographs that met the inclusion criteria, while paying special attention to bilateral hip symmetry. The overall inter-rater reliability was 0.688 (CI 0.128-0.851). Matching was performed according to sex (exact matching) and age. Paired t-test, Pearson correlation coefficient, and independent sample t-test were used (p < 0.01). RESULTS A total of 400 pairs of femoral necks were reviewed, comprising of 200 males and 200 females. In the upright radiograph, the overall mean NSA was 131.21° ± 4.72°. There was no significant difference between right and left femur NSA among the patients (p = 0.95). On both sides, male NSA was higher than female NSA (p < 0.001). In supine radiograph, the overall mean NSA for the supine position was 133.06° ± 5.71°. There was a significant difference between NSA of the right and left femur among the patients in the supine position (p < 0.001). On supine radiographs there was no statistically significant difference between male and female NSA (p = 0.85). CONCLUSION Our findings indicated no significant variability in upright radiographs between the right and left NSA. In contrast, significant asymmetry between the right and left NSA was found in the supine radiographs. However, this study does not provide definitive clinical evidence, and further clinical-oriented research is required. LEVEL OF EVIDENCE Level III; retrospective comparative study.
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Affiliation(s)
- Bassem Haddad
- grid.9670.80000 0001 2174 4509Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Hamdan
- grid.9670.80000 0001 2174 4509Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Al Nawaiseh
- grid.9670.80000 0001 2174 4509Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Osama Aldowekat
- grid.9670.80000 0001 2174 4509Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Ali Alshrouf
- grid.9670.80000 0001 2174 4509The School of Medicine, The University of Jordan, Amman, 11942 Jordan
| | - Abdulrahman M. Karam
- grid.9670.80000 0001 2174 4509The School of Medicine, The University of Jordan, Amman, 11942 Jordan
| | - Muayad I. Azzam
- grid.9670.80000 0001 2174 4509The School of Medicine, The University of Jordan, Amman, 11942 Jordan
| | - Anas AR Altamimi
- grid.33801.390000 0004 0528 1681Department of Special Surgery Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Muntaser Abu Shokor
- grid.33801.390000 0004 0528 1681Department of Special Surgery Faculty of Medicine, The Hashemite University, Zarqa, Jordan
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Golub IJ, Lam AW, Ciminero ML, Vakharia RM, Cannada LK, Kang KK. Comparison study of patient demographics and risk factors for infections following primary total hip arthroplasty for femoral neck fractures. Arch Orthop Trauma Surg 2022; 142:3779-3786. [PMID: 34748054 DOI: 10.1007/s00402-021-04237-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION While studies have shown favorable outcomes in the treatment of femoral neck fractures with the utilization of total hip arthroplasty (THA), adverse events, such as infections, can still occur. Therefore, the aims of this study were to 1) compare baseline demographics and 2) identify risk factors associated with developing either surgical site infections (SSIs) or peri-prosthetic joint infections (PJIs). MATERIALS AND METHODS A retrospective analysis of patients who underwent primary THA for femoral neck fractures were queried from the Medicare database. The inclusion criteria consisted of patients developing SSIs within 90 days or PJIs within 3 years following the index procedure. The query yielded 2502 patients who developed infections in the form of either SSIs (n = 987) or PJIs (n = 1515) out of 57,191 patients treated for femoral neck fractures with primary THA. Primary endpoints were to compare baseline demographic profiles and determine risk factors associated with developing infections. Multivariate binomial logistic regression analyses were performed to determine the odds (OR) of developing infections. A p value less than 0.001 was considered to be statistically significant. RESULTS Patients who developed either infections were found to be significantly different when compared to patients who did not develop infections. SSI (10 vs. 8, p < 0.0001) and PJI (9 vs. 5, p < 0.0001) patients both had significantly higher mean Elixhauser Comorbidity Index (ECI) scores compared to their counterparts. The regression model found the greatest risks for developing SSIs included hypertension (OR 1.63, p = 0.001), pathologic weight loss (OR 1.58, p < 0.0001), and iron deficiency anemia (IDA) (OR 1.48, p < 0.0001), whereas IDA (OR 2.14, p < 0.0001), pathologic weight loss (OR 1.75, p < 0.0001), and rheumatoid arthritis (OR 1.57, p < 0.0001) increased the odds for PJIs. CONCLUSION This study can be utilized by orthopedic surgeons and other healthcare professionals to adequately educate these patients of the complications which may occur following their surgery.
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Affiliation(s)
- Ivan J Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Aaron W Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Matthew L Ciminero
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA.
| | | | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
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Nan C, Ma L, Liang Y, Li Y, Ma Z. Mechanical effects of sagittal variations on Pauwels type III femoral neck fractures treated with Femoral Neck System(FNS). BMC Musculoskelet Disord 2022; 23:1045. [PMID: 36457095 PMCID: PMC9714141 DOI: 10.1186/s12891-022-06016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The spatial position of internal fixation play a role in determining the stability of internal fixations, both in clinical practice and research. Researchers have examined the stability of FNS (Femoral neck system) in the presence of coronal plane changes. In our knowledge, due to the biomechanical limitations of the specimens, there are no mechanical studies on the sagittal variation of FNS. This study aimed to investigate the biomechanical behavior of sagittal variations on Pauwels type III femoral neck fractures treated with FNS through finite element analysis. METHODS Finite element models including Pauwels type III femoral neck fracture and FNS were reconstructed. Five fracture models(superior, central, inferior, anterior, posterior) were created in accordance with the bolt location in the sagittal plane within the femoral head. Equivalent stress, shear stress, and total deformation of each model under the same physiological load were recorded. RESULTS According to the results, the central model exhibited the slightest stress and displacement, with the exception of the superior model. The internal fixation stress of the superior model was smaller than that of the central model. However, the maximum interfragmentary stress, total deformation and shear resistance area of the superior model was larger than that of the central model. CONCLUSIONS Central position of FNS in the sagittal plane allowed axial compression while reducing shear stress of internal fixation and interfragmentary equivalent stress. Off-axis fixation of the femoral neck increased the strain area and total displacement of the bone, raising the risk of fixation failure. Therefore, the central placement of FNS may be a better surgical target in the treatment of femoral neck fractures.
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Affiliation(s)
- Chong Nan
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Liang Ma
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Yuechuang Liang
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Yanjun Li
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China ,Baoding Digital Orthopaedic Key Laboratory, Baoding, 071000 Hebei Province China
| | - Zhanbei Ma
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China ,Baoding Digital Orthopaedic Key Laboratory, Baoding, 071000 Hebei Province China
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Chen ZM, Yang F, Yu S, Shi ZW, Yu X, Chen XJ, Shi L, Wang CH, Pang QJ. [Finite element analysis of optimal selection of cannulated threaded screw for the prevention of femoral neck shortening after internal fixation for femoral neck fracture]. Zhongguo Gu Shang 2022; 35:1042-1048. [PMID: 36415189 DOI: 10.12200/j.issn.1003-0034.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To propose the an optimal screw placement scheme to prevent femoral neck shortening, finite element analysis was used to evaluate the biomechanical outcome of different numbers formed by full threaded screws at different positions in the treatment of femoral neck fractures of Pauwels type Ⅱ. METHODS Recruited for this study was a 55-year-old female volunteer with a weight of 70 kg and a height of 165 cm. CT scan data of her right femur was collected. The models of femoral of Pauwels typeⅡ and fully threaded screw(FTS) and partially threaded screw(PTS) were constructed in three-dimensional modeling software. All these screw placement schemes were divided into eight groups simulated the inverted triangular configuration:three PTSs, an anterosuperior FTS and two PTSs, a posterosuperior FTS and two PTSs, an inferior FTS and two PTSs, an anterosuperior PTS and two FTSs, a posterosuperior PTS and two FTSs, an inferior PTS and two FTSs and three FTSs. All fracture internal fixation models were processed in finite element analysis software. Parameters of postoperative femoral neck length, displacement distribution and peak displacement of screws and VonMises stress distribution and peak stress of screws, the proximal femur and fracture section were collected. RESULTS The maximum VonMises stress of screws was 239.71, 213.44, 199.37, 230.82, 201.63, 215.72, 185.65 and 192.64 MPa, respectively, which was concentrated in the inferior screw near the fracture line. The maximum Von Mises stress of the proximal femur was 269.48, 241.62, 249.43, 269.69, 271.60, 346.64, 236.97 and 439.62 MPa, respectively, which was concentrated in the inferior medial area of subtrochanteric femur. The maximum Von Mises stress of fracture section was 149.12, 143.04, 140.47, 139.63, 139.81, 130.07, 117.77 and 57.89 MPa, respectively, which was concentrated around the partially threaded screw channel instead of the fully threaded screw channel. The maximum displacement of screws was 5.52, 5.43, 5.32, 5.17, 5.05, 5.13, 5.28 and 5.04 mm, respectively, which was along the axis of the femoral neck, and the displacement distribution was concentrated on the tip of the screw. The length of postoperative femoral neck length was 74.69, 74.72, 74.70, 74.70, 74.72, 74.70, 74.72 and 74.74 mm, respectively. CONCLUSION The placement of one anterosuperior partially threaded screw and two fully threaded screws with an inverted triangular distribution can not only meet the sliding compression effect to promote femoral neck healing and ensure the stability of the proximal femur, but also reduce the degree of postoperative femoral neck shortening and reduce the incidence of hip joint dysfunction. This study provides a new optimal screw placement solution for the treatment of femoral neck fractures.
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Affiliation(s)
- Ze-Ming Chen
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Fang Yang
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Sheng Yu
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Ze-Wen Shi
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Xiao Yu
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Xian-Jun Chen
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Lin Shi
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Cheng-Hao Wang
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
| | - Qing-Jiang Pang
- Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China
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Gómez-Palomo JM, Martínez-Crespo A, Víquez-da Silva R, Del Llano-Señarís JE, Zamora-Navas P. [Influence of medical outliers in patients with femoral neck fracture]. J Healthc Qual Res 2022; 37:390-396. [PMID: 35654723 DOI: 10.1016/j.jhqr.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. MATERIAL AND METHOD A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. RESULTS Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). CONCLUSIONS Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.
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Affiliation(s)
- J M Gómez-Palomo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | - A Martínez-Crespo
- Unidad de Cirugía Ortopédica y Traumatología, Hospital de Montilla, Montilla, Córdoba, España
| | - R Víquez-da Silva
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - J E Del Llano-Señarís
- Fundación Gaspar Casal, Madrid, España; Universidad Pompeu Fabra (UPF), Barcelona, España
| | - P Zamora-Navas
- Unidad de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Málaga, España; Universidad de Málaga (UMA), Málaga, España
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48
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Jain A, Bansal H, Mittal S, Kumar A, Trikha V. Intracapsular fracture of the proximal femur in a bilateral above-knee amputee: A case report with technical tips for intraoperative positioning and literature review. Chin J Traumatol 2022; 25:306-310. [PMID: 34600804 PMCID: PMC9459004 DOI: 10.1016/j.cjtee.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/03/2021] [Accepted: 07/31/2021] [Indexed: 02/04/2023] Open
Abstract
Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.
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Affiliation(s)
- Aditya Jain
- Primus Super Specialty Hospital, New Delhi, India
| | - Hemant Bansal
- Department of Orthopaedics, Jay Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- Department of Orthopaedics, Jay Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India,Corresponding author.
| | - Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Vivek Trikha
- Department of Orthopaedics, Jay Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
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49
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van Leent EAP, Schmitz PP, de Jong LD, Zuurmond RG, Vos CJ, van Susante JLC, Somford MP. Complications and survival of conversion to total hip arthroplasty after failed primary osteosynthesis compared to primary total hip arthroplasty in femoral neck fractures. Injury 2022; 53:2853-2858. [PMID: 35236573 DOI: 10.1016/j.injury.2022.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical treatment options for patients with an intracapsular fracture of the femoral neck (FFN) are primary osteosynthesis as a femoral head-spearing technique or primary (hemi)arthroplasty. The most common complications after primary osteosynthesis, such as avascular necrosis (AVN) or non-union, can result in conversion to Total Hip Arthroplasty (cTHA). Data concerning complications and survival rates of cTHA in comparison to primary Total Hip Arthroplasty (pTHA) after FFN are limited due to the absence of well-designed studies. METHODS A multicentre retrospective cohort study was conducted in three Dutch hospitals comparing the rate of postoperative dislocations, periprosthetic fractures, prosthetic joint infections, blood loss during surgery (>1000 mL), postoperative cardiac- and pulmonary complications after pTHA and cTHA in the first year after surgery. As a secondary outcome implant survival of pTHA and cTHA in terms of revision rates was evaluated. RESULTS In total 548 patients were included (pTHA n = 264 and cTHA n = 284) with a mean follow-up of 5 years (±3.5 SD). No significant differences were found in postoperative complications rates. The revision rate in the pTHA group was 7.2% in comparison to 7.7% in the cTHA group (p = 0.81). No difference in the short-term implant survival was found between both groups (p = 0.81). CONCLUSION This study showed no significant differences in terms of postoperative complication rates in the first year after pTHA and cTHA in patients with FFN. Also, no significant difference in short-term implant survival of primary and conversion total hip arthroplasty was found.
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Affiliation(s)
- E A P van Leent
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands.
| | - P P Schmitz
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
| | - L D de Jong
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
| | - R G Zuurmond
- Department of Orthopaedics, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | - C J Vos
- Department of Orthopaedics, Noordwest ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands
| | - J L C van Susante
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
| | - M P Somford
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
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50
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Yoon YC, Kim CH, Kim YC, Song HK. Cephalomedullary Nailing versus Dynamic Hip Screw Fixation in Basicervical Femoral Neck Fracture: A Systematic Review and Meta-Analysis. Yonsei Med J 2022; 63:744-750. [PMID: 35914756 PMCID: PMC9344276 DOI: 10.3349/ymj.2022.63.8.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/07/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Although many studies have reported the use of dynamic hip screws (DHS) and cephalomedullary nailing (CMN) for basicervical femoral neck fracture (BFNF), no clear treatment protocols have been recommended. The present study aimed to compare the surgical outcomes associated with DHS and CMN to determine the appropriate fixation method for BFNF. MATERIALS AND METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published up to January 9, 2021 that compared the treatment outcomes between CMN and DHS in BFNF. The primary outcomes of the present meta-analysis were fracture union time, postoperative cut-out rate, and reoperation rate. RESULTS We included seven studies involving 353 cases of BFNF in our review. Of these, 206 patients were treated using CMN, and DHS were utilized in 147 patients. In a pooled analysis, the DHS group required a longer time to achieve fracture union compared to the CMN group [mean difference (MD): -0.41; 95% confidence interval (CI): -0.70, -0.12; p=0.006; I²=0%]. However, the cut-out and reoperation rates exhibited no statistically significant differences between the DHS and CMN groups [cut-out odds ratio (OR): 0.54; 95% CI: 0.10, 2.82; p=0.47; I²=24%, reoperation rate OR: 0.65; 95% CI: 0.15, 2.86; p=0.57; I²=19%, respectively]. CONCLUSION Stable fixation using DHS and CMN does not show a significant clinical or radiographical difference in BFNF, and the implant can be selected based on the surgeon's preference.
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Affiliation(s)
- Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Incheon, Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong Chan Kim
- Department of Orthopaedic Surgery, Gachon University College of Medicine, Incheon, Korea
| | - Hyung Keun Song
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea.
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