Displaced femoral neck fractures in patients 60 years of age or younger: results of internal fixation with the dynamic locking blade plate

Kalsbeek, J H; Walsum, A. D. P. van; Vroemen, J.P.A.M.; Janzing, H; Winkelhorst, J.T.; Bertelink, B P; Roerdink, W.H.

doi:10.1302/0301-620x.100b4.bjj-2016-1098.r3

Cited by 21 publications

(17 citation statements)

References 39 publications

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“…The results of this study showed a failure rate of 4% [13]. Another recent prospective cohort study of 106 patients of 60 years and younger with displaced FNF demonstrated a DLBP related failure rate of 13.2% [14]. However, randomized controlled trials are needed to provide high-level evidence to determine the value of DLBP.…”

Section: Introductionmentioning

confidence: 65%

Study protocol for the DEFENDD trial: an RCT on the Dynamic Locking Blade Plate (DLBP) versus the Dynamic Hip Screw (DHS) for displaced femoral neck fractures in patients 65 years and younger

Kalsbeek

Roerdink

Krijnen

et al. 2020

BMC Musculoskelet Disord

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Background: The Dynamic Locking Blade Plate (DLBP) was recently introduced for fixation of displaced femoral neck fractures (FNF) and has been well received. Although the results of this implant in young patients are promising, the DLBP has not yet been compared to a standard device such as the Dynamic Hip Screw (DHS). The aim of this study is to compare the clinical outcome and costs of displaced FNF treated with internal fixation by means of either the DLBP or the DHS in patients up to 65 years of age. We hypothesize that the DLBP is superior compared to the DHS in terms of revision surgery rate, union rate, incidence of avascular necrosis and implant related failure. Methods: The DEFENDD (DisplacEd Femoral Neck fractures Dlbp versus Dhs) trial is a multicentre randomized controlled trial that will include 266 patients of 18-65 years with a displaced FNF. Patients will be randomized to receive either a DLBP or a DHS with a 1:1 allocation using a random block size, stratified for centre. Clinical follow up will last 1 year and questionnaires will be obtained up to 2 years. The main outcome parameter is the incidence of revision surgery within 1 year, due to either non-union, avascular necrosis (AVN) or cut out of the implant. Secondary study parameters are the incidence of avascular necrosis, non-union, (implant related) complications, functional outcome, elective removal of the implant and health-related quality of life and costs.Discussion: The outcome of the DEFENDD trial will provide high-level evidence of which implant is favourable for the treatment of femoral neck fractures in young patients (≤65 years).

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Section: Introductionmentioning

confidence: 65%

Study protocol for the DEFENDD trial: an RCT on the Dynamic Locking Blade Plate (DLBP) versus the Dynamic Hip Screw (DHS) for displaced femoral neck fractures in patients 65 years and younger

Kalsbeek

Roerdink

Krijnen

et al. 2020

BMC Musculoskelet Disord

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“…Stable internal fixation achieved with static compression of the fracture surfaces plays a key role in the treatment of femoral neck fractures . This is in contrast with diaphyseal long‐bone fractures, where cyclic fracture‐site micromotion is a desirable phenomenon to stimulate callus formation .…”

Section: Discussionmentioning

confidence: 99%

“…Stable internal fixation achieved with static compression of the fracture surfaces plays a key role in the treatment of femoral neck fractures. 4,8 This is in contrast with diaphyseal long-bone fractures, where cyclic fracture-site micromotion is a desirable phenomenon to stimulate callus formation. 30 Although stability is the primary goal of treatment, in vivo data on the stability of femoral neck fractures stabilized under internal fixation is still scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Displaced fractures are best treated with a prosthetic replacement in elderly patients . Fracture reduction and stable internal fixation are indicated in select groups of patients …”

mentioning

confidence: 99%

“…5,6 Fracture reduction and stable internal fixation are indicated in select groups of patients. 7,8 The importance of stable fixation in the treatment of femoral neck fractures has been emphasized, but some uncertainty remains regarding the optimal fixation method, warranting further studies. [9][10][11][12] One major obstacle when designing randomized clinical trials (RCTs) of hip fracture patients is the lack of accurate methods to evaluate fixation stability and fracture healing.…”

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confidence: 99%

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Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

Finnilä

Moritz

Strandberg

et al. 2018

Journal Orthopaedic Research

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We examined the feasibility of radiostereometric analysis (RSA) in the assessment of the initial stability of internally fixed femoral neck fractures. The study included 16 patients (mean age 73 years). During surgery, multiple RSA‐beads were inserted on both sides of the fracture. Radiographs for RSA were taken in the supine position within the first 3 days and 6, 12, 24, and 52 weeks after surgery. To detect any inducible motion at the fracture‐site, radiographs for RSA were taken with the patient resting or applying a load through the fracture. Fracture loading was achieved by the patient pressing the ipsilateral foot as much as tolerated on a force plate while providing a counterforce through both hands. Micromotion exceeding the precision values of RSA (≥0.3 mm for the translation vector and/or ≥1.2 degrees for the rotation vector) was considered significant. Permanent three‐dimensional fracture‐site displacement was also recorded. Voluntary loading induced fracture‐site micromotion, which exhibited a dichotomous distribution. In patients with uncomplicated fracture union, inducible micromotion was detectable only at baseline—if at all. Conversely, fractures that developed a nonunion were characterized by the continuation of inducible micromotion beyond baseline. Permanent fracture‐site displacement was, on average, nearly an order of magnitude greater than the inducible micromotion. Fracture unions were characterized by the cessation of permanent fracture‐site displacement by 12 weeks. Nonunions presented as outliers in permanent fracture‐site displacement. Large‐scale studies are warranted to evaluate whether the detection of inducible micromotion beyond baseline could serve as an indicator of insufficient fixation stability. © 2018 The Authors. Journal of Orthopaedic Research ® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.

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Surgical Technique: Open Reduction for Displaced Femoral Neck Fractures

Fithian¹,

Williams²,

Lucas³

2021

Hip Arthroscopy and Hip Joint Preservation Surgery

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Displaced femoral neck fractures in patients 60 years of age or younger: results of internal fixation with the dynamic locking blade plate

Cited by 21 publications

References 39 publications

Study protocol for the DEFENDD trial: an RCT on the Dynamic Locking Blade Plate (DLBP) versus the Dynamic Hip Screw (DHS) for displaced femoral neck fractures in patients 65 years and younger

Study protocol for the DEFENDD trial: an RCT on the Dynamic Locking Blade Plate (DLBP) versus the Dynamic Hip Screw (DHS) for displaced femoral neck fractures in patients 65 years and younger

Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

Surgical Technique: Open Reduction for Displaced Femoral Neck Fractures

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