Factors predicting healing complications in femoral neck fractures: 138 patients followed for 2 years

Nilsson, Lars; Johansson, Anna; Strömqvist, Björn

doi:10.3109/17453679308994564

Cited by 49 publications

(23 citation statements)

References 14 publications

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“…Of the moderately displaced fractures there were 9 reoperations due to femoral head necrosis, 11 due to local pain, 2 due to loss of position of implant without fracture displacement, 1 due to new fracture around the implant, and 9 due to infection and hematoma. Parameters thought to be associated with risk of reoperation (Alberts and Jervaeus 1990, Nilsson et al 1993, Kaehrle et al 2001) were entered into a logistic regression model, but only fracture type had a significant influence on risk of reoperation ( Figure 1) by a factor of 2.4 (1.5-3.8).…”

Section: Resultsmentioning

confidence: 99%

Outcome of undisplaced and moderately displaced femoral neck fractures

Bjørgul

Reikerås

2007

Acta Orthopaedica

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Background The optimal treatment for femoral neck fracture is a matter of controversy. We compared the outcome of displaced fractures with good healing potential (moderately displaced fractures) to the outcome of undisplaced fractures treated by internal fixation with 2 parallel screws.Methods In a consecutive series of hip fracture patients, the rates of reoperation and mortality for 225 undisplaced fractures were compared to those for 241 moderately displaced fractures. The patients were followed for 1-6 years.Results The total rate of reoperation was 19% (9% because of healing complications) for the undisplaced fractures and 33% (20% because of healing complications) for the moderately displaced fractures. Fracture displacement was the main predictor of reoperation. There was no difference in mortality between the groups, and patient-related background parameters (rather than fracture displacement) were the main predictors of mortality. Interpretation Undisplaced fractures should be treated by internal fixation. The best treatment for moderately displaced fractures remains to be determined.

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Section: Resultsmentioning

confidence: 99%

Outcome of undisplaced and moderately displaced femoral neck fractures

Bjørgul

Reikerås

2007

Acta Orthopaedica

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“…On the other hand, some authors have recommended internal fixation for younger patients (Parker and Tagg 2002). Several studies have shown that the degree of initial displacement prognosticates failure, and others have found that comminution of the femoral calcar, size of the head and varus angulation affect healing (Alho et al 1991, Nilsson et al 1993.…”

mentioning

confidence: 99%

Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: A prospective study of 683 patients treated with hemiarthroplasty or internal fixation

Bjørgul

Reikerås

2006

Acta Orthopaedica

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Background Studies have shown that the degree of initial displacement and also comminution of the femoral calcar, size of the head and varus angulation are prognostic of failure in displaced femoral neck fracture. We have applied these radiographic criteria in order to select patients who would benefit from internal fixation as opposed to primary hemiarthroplasty, and this prospective study was conducted in order to monitor the results of this strategy.Methods 683 displaced fractures of the femoral neck were treated with internal fixation or primary hemiarthroplasty based on the proposed radiographic criteria in a prospective consecutive study, and the patients were followed for 1-6 years. We treated 228 fractures with internal fixation and 455 by bipolar hemiprosthesis. The choice of operation was based on clinical evaluation of the patient and assessment of the assumed healing potential of the fracture, as determined by radiographic evaluation. Revision and mortality were primary endpoints.Results 54 (24%) of the patients originally treated by osteosynthesis were revised, whereas 9 (2%) of the patients treated with hemiarthroplasty had revision surgery. There were no significant differences in mortality between the groups at 30, 120 or 365 days.Interpretation Even when treating only the fractures with the assumed best healing potential with internal fixation, the results are inferior to hemiarthroplasty.

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“…In the present study, an anterior position of the screw was an adverse factor. Fracture displacement and comminution and high age of the patient are risk factors (Alho et al 1991, 1992, Nilsson et al 1993. Our starting point for observations was the 3-month follow-up examination.…”

Section: Discussionmentioning

confidence: 99%

“…Internal fixation of displaced femoral neck fracture in the elderly remains a widely used treatment. Although failures resulting in secondary prosthesis replacement are frequent, the method has yielded satisfactory overall results in large series of patients (Barnes et al 1976, Stappaerts 1985, Nilsson et al 1988, 1993, Rehnberg and Olerud 1989. The alternative-primary prosthesis replacement-is also associated with complications (Skinner et al 1989, Parker 1992) and costs more (SGreide et al 1980, Rodriguez et al 1987.…”

Section: Internally Fixed Femoral Neck Fracturesmentioning

confidence: 99%