Internally fixed femoral neck fractures: Early prediction of failure in 203 elderly patients with displaced fractures

Alho, A; Benterud, Jan G; Solovieva, Svetlana

doi:10.3109/17453679909011252

Cited by 46 publications

(32 citation statements)

References 16 publications

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“…The decision to reoperate was made by an orthopedic surgeon based on clinical evaluation of the patient and also an assessment of the radiographs. No formal guidelines were used, but secondary malalignment of the screws and protrusion of the screws by more than 20 mm were considered indicative of nonunion (Alho et al 1999). Reoperations, including the reason for the reoperation, were reported in the study.…”

Section: Methodsmentioning

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: Methodsmentioning

confidence: 99%

Outcome of undisplaced and moderately displaced femoral neck fractures

Bjørgul

Reikerås

2007

Acta Orthopaedica

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“…The scientific evidence is, however, conflicting. In studies of older age groups, no ill effects of either age or sex were found (Nilsson et al 1988, Alberts and Jervaeus1990, Strömqvist et al 1992, Alho et al 1999. Osteoporosis is more prevalent in older age groups and appears to be related to an increased risk of nonunion after internal fixation (Hedstrom 2004).…”

mentioning

confidence: 97%

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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“…A incidência de pseudartrose na fratura do colo do fêmur ocorre de 10% a 59% dos casos (12)(13)(14)(15)(16)(17)(18) . Não existe critério definitivo para concluir se a fratura evoluiu para pseudartrose, mas o tempo mínimo de seis meses deve ser considerado.…”

Section: Discussionunclassified

“…Alho et al (18) , revisando 203 casos, descreveram fatores preditivos da não união: mudança de posição dos parafusos, mudança do traço da fratura e extrusão de parafusos maior que 20 mm. Na presente série nove pacientes chegaram ao hospital sem nenhum tratamento prévio e, portanto, o diagnóstico foi evidente, mas a média de tempo até o diagnóstico final foi de 6,5 meses.…”

Section: Discussionunclassified

Osteotomia valgizante para pseudartrose do colo do fêmur: relato de 32 casos

et al. 2009

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Objetivo: Avaliar a consolidação pós-osteotomia osteotomia valgizante do fêmur no tratamento do pseudartrose do colo femoral. Método: Durante 15 anos (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) InTRODUÇÃOA pseudartrose junto com a necrose avascular da cabeça femoral são as principais complicações da fratura do colo do fêmur.Sem dúvida a consolidação da pseudartrose com preservação da cabeça femoral é a alternativa biológica que pode oferecer o melhor resultado a longo prazo se o paciente for jovem. Entretanto se o paciente for idoso, acima de 65 anos, baseando-se na literatura é consensual que a artroplastia total do quadril pode oferecer um resultado mais promissor, pois elimina em um só tempo as duas principais complicações da alternativa biológica: a reincidência de pseudoartrose e a necrose asséptica da cabeça femoral.O objetivo do presente estudo é avaliar a consolidação da osteotomia valgizante na pseudoartrose do colo do fêmur.

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Internally fixed femoral neck fractures: Early prediction of failure in 203 elderly patients with displaced fractures

Cited by 46 publications

References 16 publications

Outcome of undisplaced and moderately displaced femoral neck fractures

Outcome of undisplaced and moderately displaced femoral neck fractures

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

Osteotomia valgizante para pseudartrose do colo do fêmur: relato de 32 casos

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