Factors associated with avascular necrosis of the femoral head and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation

Schweitzer, Daniel; Melero, Patricio; Zylberberg, Alejandro; Salabarrieta, Julian; Urrutia, Julio

doi:10.1007/s00590-011-0936-1

Cited by 32 publications

(20 citation statements)

References 22 publications

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“…In the present study we observed that nonunion rate was 16%, which shows resemblance to the studies in literature. However, on the contrary to these studies [ 4 , 22 , 27 - 30 ], we observed that femoral head necrosis rate was much lower (6.4%). Schweitzer et al reported that femoral head necrosis rates in patients range from 50 to 65 years old are more when compared to younger patients, and this is not related to timing of the surgery.…”

Section: Discussioncontrasting

confidence: 99%

“…When literature is reviewed, it is maintained that the relation between nonunion and femoral head necrosis was not fully understood [ 26 ]. In literature, there are some studies indicating when an early intervention is required, through which methods a full anatomic reduction and stable fixation could be obtained and whether capsulotomy or joint aspiration in order to diminish pressure in the capsule, yet they have not achieved a consensus [ 4 , 22 , 27 - 30 ]. Also, cultural characteristics, race, nutrition and age are some of the predictive factors in femoral neck fractures [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Gümüştaş¹,

Tosun²,

Isyar³

et al. 2018

Pan Afr Med J

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IntroductionFemur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method.MethodsFiles of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by Ficat-Arlet classification system whereas acetabular fractures and hip functionality was evaluated by Letournel and Judet system, which is based on direct graph of fracture line.ResultsMean age at the time of surgery for 31 cases included in the study was 40.04 ± 9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to Judet System, 67.7% of cases showed excellent/good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P>0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications.ConclusionBecause of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Gümüştaş¹,

Tosun²,

Isyar³

et al. 2018

Pan Afr Med J

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show abstract

“…There is strong evidence in the literature that increasing age is associated with impaired fracture healing [ 2 , 21 , 22 ]. Femoral neck HR decreased with age, both in displaced (p < 0.001) and non-displaced (p < 0.003) fractures [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among patients under age 60, just 7 of 106 had fracture nonunion (HR = 93.4%); among patients age 70 to 80 years, 84 of 337 had nonunion (HR = 75.1%) [ 2 ]. In a separate study, patients with displaced femoral neck fracture who developed nonunion were significantly older than patients with normal healing [ 21 ]. Nevertheless, in a third study, age was not identified as a predictor of nonunion in 202 patients with intracapsular femoral neck fracture [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

A cohort study of 4,190 patients treated with low-intensity pulsed ultrasound (LIPUS): findings in the elderly versus all patients

Zura

Mehta

Rocca

et al. 2015

BMC Musculoskelet Disord

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BackgroundPatient age is one of many potential risk factors for fracture nonunion. Our hypothesis is that older patients (≥60) with fracture risk factors treated with low-intensity pulsed ultrasound (LIPUS) have similar heal rate (HR) to the population as a whole. We evaluate the impact of age in conjunction with other risk factors on HR in LIPUS-treated patients with fresh fracture (≤90 days old).MethodsThe Exogen Bone Healing System is a LIPUS device approved in 1994 to accelerate healing of fresh fracture. After approval, the FDA required a Post-Market Registry to assess performance. Patient data collected from October 1994 until October 1998 were individually reviewed and validated by a registered nurse. Four distinct data elements were required to report a patient: date fracture occurred; date treatment began; date treatment ended; and a dichotomous outcome of healed v. failed, by clinical and radiological criteria. Data were used to calculate two derived variables; days to treatment (DTT) and days on treatment (DOT). Every validated fresh fracture patient with DTT, DOT, and outcome is reported.ResultsThe validated registry had 5,765 patients with fresh fracture; 73% (N = 4,190) are reported, while 13% of patients were lost to follow-up, 11% withdrew or were non-compliant, and 3% died or are missing outcome. Among treatment-compliant patients, HR was 96.2%. Logistic estimates of the odds ratio for healing are equivalent for patients age 30 to 79 years and all age cohorts had a HR > 94%. Open fracture, current smoking, diabetes, vascular insufficiency, osteoporosis, cancer, rheumatoid arthritis, and prescription NSAIDs all reduced HR, but older patients (≥60) had similar HRs to the population as a whole. DTT was significantly shorter for patients who healed (p < 0.0001).ConclusionsComorbid conditions in conjunction with aging can reduce fracture HR. Patients with fracture who used LIPUS had a 96% HR, whereas the expected HR averages 93%. Time to treatment was significantly shorter among patients who healed (p < 0.0001), suggesting that it is beneficial to begin LIPUS treatment early. Older patients (≥60) with fracture risk factors treated with LIPUS exhibit similar heal rates to the population as a whole.

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“…In relatively young adults, it often results from high-energy injury, and its incidence is much less common than in elderly patients. The most frequently encountered complications after surgery are loss of reduction, fracture nonunion and avascular necrosis of the femoral head [1][2][3][4][5][6][7][8][9][10][11]. In the elderly, hemiarthroplasty is frequently performed to obtain post-operative stability and an early return of mobility.…”

Section: Introductionmentioning

confidence: 99%

Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients

Wang

Yang

Shen

et al. 2015

Injury

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Factors associated with avascular necrosis of the femoral head and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation

Abstract: Patients between 53.5 and 65 years presented a higher risk of AVN. A primary arthroplasty should be considered in this subgroup.

Cited by 32 publications

References 22 publications

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

A cohort study of 4,190 patients treated with low-intensity pulsed ultrasound (LIPUS): findings in the elderly versus all patients

Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients

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