Evidence based update: Open versus closed reduction

Ghayoumi, Pouriya; Kandemir, Utku; Morshed, Saam

doi:10.1016/j.injury.2014.10.011

Cited by 55 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The healing of a femoral neck fracture is dependent on the damage to the circulation of the femoral head caused by the trauma at the time of fracture, and also on the biomechanical stability provided by the osteosynthesis devices. Accurate fracture reduction and placement of implants is important for a good outcome [28]. The literature suggests union rates of 85-97% in undisplaced fractures and 70-74% in displaced fractures treated by internal fixation [29].…”

Section: Discussionmentioning

confidence: 99%

Should full threaded compression screws be used in adult femoral neck fractures?

Okçu

Özkayın

Erkan

et al. 2015

Injury

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Should full threaded compression screws be used in adult femoral neck fractures?

Okçu

Özkayın

Erkan

et al. 2015

Injury

View full text Add to dashboard Cite

“…Only one randomised controlled trial has investigated ORIF versus closed reduction internal fixation (CRIF), this without a difference in subsequent nonunion or avascular necrosis [12], but with a higher infection rate following ORIF than CRIF (9.1% vs. 2.1%). Ghayoumi et al [36] reviewed 21 non-randomised studies and confirmed that there was no difference when comparing ORIF with CRIF concerning non-union (14.9% vs 11.6%) and avascular necrosis (17.7% vs. 17.2%), but there was an increased risk of deep wound infection for ORIF (3.9% vs 0.5%). The evidence is of suboptimal quality, including relatively small patient numbers, with just 181 patients in the ORIF versus 612 patients in the CRIF group.…”

Section: For Achieving Anatomical Reduction An Open Reduction and Inmentioning

confidence: 96%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

View full text Add to dashboard Cite

Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome. 2-11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism. Studies contradict on whether surgery within 8-12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%. The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover. While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!

show abstract

“…Proper anatomic reduction and stable internal xation is the key to preserve the femoral head, avoiding avascular necrosis, nonunion, and femur shortening 20 .The Pauwels type-III femoral neck fractures in young adult patients are often the result of high-energy trauma. approximately 70% of the cases of the fracture are combined with communited fractures in the posterior-medial of the femoral neck,which may reduce postoperative xation stability and increase the risk of complications such as nonunion and osteonecrosis 21,22 .moreover,Previous studies have shown that the risk of fracture instability increases signi cantly when the fracture area exceeded 25% of the posterior femoral neck regions 23 .Kauffman et al show that compared with femurs xed with three screws, four screws have signi cantly higher resistance to axial and forward displacement, and the axial destructive force continues to decrease 12 .In our study,all 14 patients were treated with PSTCS according to the femoral neck fracture morphology,all patient achieved a stable xation and did not experience re-displacement of the fracture after the operation during follow-up.The PSTCS can stabilize the fracture end in multiple planes ,placing a pauwels screw through the fracture line at a 90-degree angle may achieve optimal control of the shear force at the fracture end and effectively reduce the occurrence of postoperative internal failure rate.Besides this,in actual clinical practice,the relatively complete and supportable sections of the fracture ends are xed preferentially.It also can reduce the incidence and degree of the femoral neck shortening and the rotation of femoral head caused by excessive compression of the screw in the comminuted fracture part.However,the effect of fracture morphology on internal xation of Pauwels type-III femoral neck fracture is often overlooked by most Orthopedic surgeons in clinical work.Currently, Pauwels classi cation system is still the practical mainstay of femoral neck fracture characterization that help dictate appropriate treatment ,although some scholars believe that Classi cation of intra-capsular hip fractures according to the Pauwels classi cation using the Pauwels angle is unreliable and its use should be avoided 24 .…”

Section: Discussionmentioning

confidence: 99%

Pauwels screw combined inverted triangle cannulated screws for the treatment of Pauwels type-III femoral neck fracture:- a new surgical method based on the morphology of the fracture

Chen

Zhou

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background: Femoral neck fracture is a serious injury in adults with significant functional consequences.Internal fixtion is an established treatment for femoral neck fractures in young adult patients .However, the risk of complications following fixation has plague orthopedists for decades.In all femoral neck fracture ,Pauwels type-III femoral neck fractures with a large vertical shear force were more likely to cause clinical failure.The aim of this study is to intruduce a new surgical technique for the treatment of this fracture according to the morphology of the fracture using the combination of Pauwels screw and inverted triangle cannulated screws(PSTCS)，and report the clinical effects in a prospective cohort of 14 patients.Methods: From June 2017 to June 2019, a total of 14 patients (8 males and 6 females ) with Pauwels type-III femoral neck fracture underwent the surgical treatment of PSTCS according to the morphologyical types of fracture in clinical operation in our department. Patients were allowed to perform contraction exercises of quadriceps femoris on postoperative day1, passive flexion and extension exercises postoperative day 2 onwards, and active flexion and extension exercises postoperative day 7 onwards. Patients were allowed for partial-weight bearing walking postoperative 1month onwards with axillary crutches. After one month AP and lateral radiograph were taken. Full ambulation was permitted until the presence of radiological consolidation.Intraoperative (Operative duration,Blood loss),postoperation(Fracture union time,The Harris Hip Score,Visual analog score) were record for comparison.Results: All patients were followed up for at least 12 months.In the end point of the follow up ,12 of the 14 patients (85.7%)with pauwels type-III femoral neck fractures had achieved satisfactory hip function. Operative duration was a mean of 49.5 ±10.4 minutes.Intraoperative blood loss was between 26 and 110 ml (mean, 44.4±20.6ml) and without intraoperative blood transfusion . The Harris Hip Score was between 64 and 95(mean,87.6±8.9).Fracture healing was observed in all patients according to the X-ray . No internal fixation was loosened or screw cut-out in the follow-up period.The femoral head necrosis was observed in 1 patient in this study. In addition, there was no obvious fracture displacement, femoral neck shortening, or hip varus. Conclusions: The study showed that PSTCS can provide a satisfactory clinical outcomes for treatment of pauwels type-III femoral neck fractures.Most patients (85.7%) achieved good or excellent results with the use of PSTCS,which appears to be a reliable method and provides another choice for this problematic fracture.The new internal fixation method of PSTCS can provide mechanical stability and promote fracture healing

show abstract

Evidence based update: Open versus closed reduction

Cited by 55 publications

References 32 publications

Should full threaded compression screws be used in adult femoral neck fractures?

Should full threaded compression screws be used in adult femoral neck fractures?

Hip fractures in the non-elderly—Who, why and whither?

Pauwels screw combined inverted triangle cannulated screws for the treatment of Pauwels type-III femoral neck fracture:- a new surgical method based on the morphology of the fracture

Contact Info

Product

Resources

About