Meta analysis of different methods used for joint preserving procedures in the management of delayed, neglected and non-united femoral neck fractures in young adults

Elzohairy, Mohamed Mansour; Eid, Abdelsalam

doi:10.1177/1460408616645612

Cited by 3 publications

(8 citation statements)

References 24 publications

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“…Femoral neck fracture is one of the most common hip fractures in children, along with the intertrochanteric region type. A delayed presentation of femoral neck fracture is defined as a delay of 48 h-20 days between injury to diagnosis, while in neglected fractures, the delay is more than 21 days based on Manjunath, or more than 30 days based on Sandhu et al [1], [2], [7].…”

Section: Discussionmentioning

confidence: 99%

Fibular Strut Graft with Cannulated Hip Screw of Neglected Femoral Neck Fracture in a Young Adult: A Case Report

Kristian,

Pramana,

Dwipayana

et al. 2023

Open Access Maced J Med Sci

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BACKGROUND: Neglected femoral neck fractures in young adults (age <60) pose a major challenge in terms of appropriate treatments for each specific condition. AIM: The objective of this case report is to explain the presentation of neglected femoral neck fractures and its clinical consequences and to discuss the management of the disease. CASE PRESENTATION: This case presents a 14-year-old male with neglected displaced fracture of femoral neck, which was successfully managed by closed reduction and internal fixation with two cannulated screws and non- vascularized fibular strut graft. CONCLUSION: Femoral neck fractures in young adults are considered as a rare fracture case, eventually it was associated with serious complications. The management of this type of fractures in children is challenging, particularly that of a neglected fracture. Fibular strut graft with two cannulated hip screws for neglected femoral neck fractures in children considered to be cost-effective and technically less demanding as well as associated with good outcomes.

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Section: Discussionmentioning

confidence: 99%

Fibular Strut Graft with Cannulated Hip Screw of Neglected Femoral Neck Fracture in a Young Adult: A Case Report

Kristian,

Pramana,

Dwipayana

et al. 2023

Open Access Maced J Med Sci

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“…Anatomical reduction and stable internal fixation are essential for achieving the goals of treatment in this young population, allowing preservation of the femoral head while minimising the rates of nonunion and osteonecrosis [ 1 ]. A delayed presentation of fracture of the femoral neck is one where there is a delay of 48 hours to 20 days between injury and diagnosis; whereas, in a neglected fracture, this delay is more than 21 days [ 2 ]. One of the most difficult fractures to treat in young people is the neglected fracture, which has the most at stake [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The two major complications of femoral neck fractures are avascular necrosis (AVN) of the femoral head and nonunion. Nonunion has a reported incidence of 10–34% [ 2 , 3 ]. Subtrochanteric valgus osteotomy fixed with an angle blade plate or a dynamic condylar screw has been the treatment of choice over recent years [ 1 , 3 , 4 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Fixator-Assisted Nailing for Femur Neck Fracture Nonunion: A Case Series Study

Hashem

Altuwaijri

2022

Advances in Orthopedics

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Background. Femoral neck fractures in young adults tend to be a result of high-energy trauma with a common pattern of Pauwels type III fracture, and they require timely and meticulous diagnosis and management. The objective of this study was to assess the clinical and radiological outcomes of the fixator-assisted nailing technique for managing femur neck fracture nonunion. Methods. This was a case series study of 16 patients with nonunion femoral neck fractures treated via a fixator-assisted nailing technique. Our inclusion criteria comprised the inclusion of any patient between the ages of 14 and 60 years old with a neglected neck of femur fracture or nonunion of the femur neck. In addition, we only included patients without further posttreatment trauma and without known metabolic diseases. The conditions that were excluded from this study included hip joints with preexisting osteoarthritis, radiographic evidence of avascular necrosis of the femoral head, and associated ipsilateral acetabulum fracture or fracture-dislocation. The fracture characteristics that were selected for the fixator-assisted nailing (FAN) technique were clear signs of pseudoarthrosis (such as sclerosis, clear fracture line defects, and failure of implants), in addition to evidence of varus malalignment. All fractures were Pauwels type III. Radiographs of the pelvis with both hips and a posteroanterior (PA) view of the injured hip were taken. Full weight bearing was allowed in all the patients from the first day postoperatively. Physical therapy was started for pain reduction modalities, stretching, and abductor strengthening. Results. Union of the femur neck fracture and osteotomy site was achieved in all patients. An excellent functional status after four months of follow-up was found based on a modified Harris hip score questionnaire. At follow-up, no patient was suffering from pain or flexion contracture. Preoperative limb length discrepancy (LLD) (cm) was 1.8 ± 0.8 cm and postoperative was 0 ± 0.1 cm, p < 0.001 . Preoperative neck-shaft angle (NSA) (o) was 85.6 ± 4.4 and postoperative was 126.9 ± 2.5, p < 0.001 . Preoperative Pauwels angle (o) was an average of 50.4 ± 5.9 and postoperative was 31.3 ± 2.5, p < 0.001 . Conclusion. Our study indicates that FAN has a high success rate in young patients with nonunited femoral neck fractures.

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“…It is usually advocated that fracture reduction and fixation should be performed as a surgical emergency in an attempt to restore the precarious blood supply to the femoral head and prevent complications such as non-union and avascular necrosis [1][2][3][4] . A delayed presentation of fracture of the femoral neck is one where there is a delay of 48 hours to 20 days between injury and diagnosis, whereas in a neglected fracture, this delay is in excess of 21 days [7] . The main complications of such injuries are a vascular necrosis (AVN) of the femoral head and non-union of the fracture with reported average incidences of 15% for AVN and 12% for non-union [6,7] .…”

Section: Introductionmentioning

confidence: 99%

“…A delayed presentation of fracture of the femoral neck is one where there is a delay of 48 hours to 20 days between injury and diagnosis, whereas in a neglected fracture, this delay is in excess of 21 days [7] . The main complications of such injuries are a vascular necrosis (AVN) of the femoral head and non-union of the fracture with reported average incidences of 15% for AVN and 12% for non-union [6,7] .…”

Section: Introductionmentioning

confidence: 99%

A prospective study of functional outcome of intracapsular femoral neck fractures with delayed presentation in young adults

Kumar¹,

Easwar²,

Ashwin³

2021

Int. J. Orthop. Sci.

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Objectives: To assess the functional and radiological outcome of intracapsular femoral neck fractures with delayed presentation in young adults treated with cannulated cancellous screws. Methods: A prospective study included 21 patients with intracapsular neck of femur fractures who presented after 24 hours of injury but within 3 weeks of injury for which closed reduction and fixation was done with cannulated cancellous screws in Sanjay Gandhi Institute of trauma and orthopedics, Bangalore from May 2018 to December 2019. Patients were followed up at 6 weeks, 3 months, 6 months and 12 months. Clinical outcome was assessed using Modified Harris hip score and radiological assessment was done using x rays. Results: In our study we analysed the following parameters especially age, fracture type according to Garden and Pauwel, time of presentation, timing of surgery. In our study we found that patients with Pauwels type 3 (23.81%) and Gardens type 4 (42.86%) had low hip scores compared to others. 85% patients were pain free, 80% had good mobility post surgery. Incidence of non union was 2 out of 21 cases. The Modified Harris Hip Score evaluated at maximum follow-up of our patients averaged 90.13 with the maximum score being 96 and the minimum score being 67.8. Overall, 10 patients (47.62%) achieved excellent result, 6 patients (28.57%) achieved good result, 3 patients (14.29%) achieved fair result and 2 patients (9.48%) achieved poor result. 76.19% of the patients achieved either excellent or good results. According to radiographic evaluation AP view xray of pelvis with hip in 15 degree internal rotation, radiological parameters such as fracture union, non union changes, avascular necrosis of head, arthritic changes in the joint were analysed. Fracture union was seen in 19 patients (90.48%) and non union in 2 patients (9.52%). AVN changes were seen in 3 patients (14.29%). Average time of union was less than 3 months in 8 patients (44.4%), 3 to 4 months in 5 patients (27.7%), 4to 5 months in 4 patients (22.2%) and in one patient (5.55%) union achieved at 6 months. Conclusion:We conclude that canulated cancellous screw fixation is a viable option of treatment for fractures of intracapsular neck of femur in young adults with delayed presentation, showing excellent to good functional outcome and early radiological union with minimal complications.

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Meta analysis of different methods used for joint preserving procedures in the management of delayed, neglected and non-united femoral neck fractures in young adults

Cited by 3 publications

References 24 publications

Fibular Strut Graft with Cannulated Hip Screw of Neglected Femoral Neck Fracture in a Young Adult: A Case Report

Fibular Strut Graft with Cannulated Hip Screw of Neglected Femoral Neck Fracture in a Young Adult: A Case Report

Fixator-Assisted Nailing for Femur Neck Fracture Nonunion: A Case Series Study

A prospective study of functional outcome of intracapsular femoral neck fractures with delayed presentation in young adults

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