Surgical treatment of undisplaced femoral neck fractures in the elderly

Lee, Yih-Shiunn; Huang, Chien-Rae; Liao, Wen-Yun

doi:10.1007/s00264-006-0243-3

Cited by 64 publications

(55 citation statements)

References 23 publications

(22 reference statements)

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“…It provides controlled compression at the fracture which further enhances the union rate. Also, the functional status of our patient according to Harris Hip Score system at 6 th and 12 th postoperative month was found to be "Good" which is almost similar to various other studies [33][34][35] .…”

Section: Discussionsupporting

confidence: 88%

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Kandel

Pathak

Singh

et al. 2016

International Journal of Orthopaedics

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nonunion, implant cut out, joint infection, delayed union and varus deformity was not observed in any of these patients. Moreover, Harris Hip Score showed good functional outcome. CONCLUSION: Fixation of DHS with minimal invasive technique for stable hip fracture has good functional outcome in cost effective way with fewer incidences of complications resulting in great advantage over the conventional method of fixation. INTRODUCTIONHip fractures are leading cause of death and disability among the elderly. Proximal femoral fracture accounts 30% of all hospital admissions with mortality of 15-20% worldwide. Among these, trochanteric fractures are around four times more with female predominance. Treatment goals for these populations include early rehabilitation, restoration of the anatomic alignment of the proximal part of femur and maintenance of fracture reduction [1][2][3][4] . Though resistance augmented Baixauli plates, Medroff plates, trochanteric stabilizing plates, percutaneous compression plates and intra medullary devices are focused on unstable inter-trochantric fracture, it is now almost universally accepted that internal fixation is the best method in which fixation with Dynamic Hip Screw (DHS) is considered as the standard one [5][6][7][8][9] . In the last decade, minimal invasive DHS (MIDHS) technique offered a better outcome compared to conventional approach, while maintaining equal fixation stability. The experimental basis of minimal invasive surgery is based on the fact that nutrient artery gives 2/3 rd of the blood supply to the bone, and 1/3 rd comes from the periosteum inflow [3] . So, this study which was conducted to ascertain the short term

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Section: Discussionsupporting

confidence: 88%

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Kandel

Pathak

Singh

et al. 2016

International Journal of Orthopaedics

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“…1 The procedure is minimally invasive, operative time is short, and the necessity for blood transfusion is low. 2,3 Furthermore, this treatment enables patients to undergo early rehabilitation. The implants used allow sliding or additional impaction at the fracture site.…”

Section: Introductionmentioning

confidence: 99%

Diminished abductor muscular strength in patients with valgus-impacted femoral neck fractures treated by internal fixation: Clinical study and biomechanical considerations

Noda

Saegusa

Takahashi

et al. 2017

Journal of Orthopaedic Surgery

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Background: Valgus-impacted femoral neck fractures treated with internal fixation occasionally result in unsatisfactory postoperative locomotive function, partially due to muscle shortening and a decrease in the moment arm. This study quantifies the degree of diminished abduction strength both clinically and biomechanically. Methods: Fifteen patients were enrolled in this study. Twelve patients with fracture healed in valgus-impacted position were further evaluated. Muscular strength around hip was examined, and values between the nonoperated and operated side were compared and analyzed. For the biomechanical study, two three-dimensional models were prepared: model I (control model without displacement) and model II (simulated malunion of a 15 valgus-impacted fracture). Two sets of hip flexion angles in each of the models were simulated with flexion angles of 0 and 23 . Results: Mean and standard deviation values for muscle strength from the nonoperative/operative side among the valgus group are as follows: flexion strength was 9.2 + 4.0/9.2 + 3.2, extension strength was 5.8 + 2.8/6.1 + 3.2, abduction strength at 0 was 9.1 + 3.7/7.4 + 3.6, abduction strength at 10 was 6.7 + 3.0/5.5 + 2.2, and knee extension strength was 15.3 + 6.2/15.1 + 6.0 (kgf). When comparing values between the nonoperative and operative sides, statistical significance was only observed in abduction strength (p < 0.01). The biomechanical models prove that valgus impaction decreases the moment arm by approximately 10% at both flexion angle. Conclusions: A significant decrease in abductor strength at 0 and 10 was observed in the valgus-healed group. This may be related to a decrease in the moment arm. Further research should be done to define the acceptable limit of deformity for the satisfactory postoperative functioning.

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“…Osteonecrosis of the femoral head occurs in about 10 % of cases of nondisplaced femoral-neck fracture [4]. Early diagnosis and prediction of osteonecrosis of the femoral head are highly important when determining the treatment plan in terms of the patient's best interest and medical cost [7].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the advances in surgical techniques, femoral-neck fracture frequently results in complications such as nonunion and avascular necrosis (AVN), and osteonecrosis of the femoral head has been reported in about 5.8 % (from 1.6 % to 22.5 %) of nondisplaced fractures [1][2][3][4]. Osteonecrosis of the femoral head occurs when femoral-neck fracture results in rupture or kinking of the blood vessels running from the femoral neck to the femoral head and consequently, insufficient blood-flow [5].…”

Section: Introductionmentioning

confidence: 99%

Patterns of isotope uptake in sequential postoperative bone scan in undisplaced femoral-neck fractures

Yoon

Kim

Yoon

2013

International Orthopaedics (SICOT)

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Purpose We aimed to investigate the changing pattern of isotope uptake in the sequential bone scan test for the prediction of osteonecrosis of the femoral head in patients with an undisplaced femoral-neck fracture. Methods Fifty-four cases of sequential bone scan for nondisplaced femoral-neck fracture treated by internal fixation with cannulated screws between 2000 and 2009 were retrospectively studied. The mean follow-up period was 4.2 years. The first postoperative bone scan was performed two weeks postoperatively in all patients. Second, third, and fourth followup bone scans were performed at one to six months, 12-18 months, and 18-24 months postoperatively. Results Mean femoral-head ratio (FHR) in the first postoperative bone scan was 0.99. Although it was under 1.0 in 38 patients (70.4 % of the 54 patients), only one patient developed osteonecrosis of the femoral head. The others showed hot uptake in their second follow-up bone scan. Mean FHRs in the second, third, and fourth postoperative bone scans were 1.69, 1.29, and 1.05, respectively, and there were significant statistical differences in each follow-up period (P=0.035). In addition, there were unique patterns of isotope uptake with the passage of time, such as cold uptake in the early stage, hot uptake in a couple of months, and iso-uptake in the late stage.Conclusions Early postoperative bone scan results should not be over interpreted when predicting osteonecrosis of the femoral head.

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Surgical treatment of undisplaced femoral neck fractures in the elderly

Cited by 64 publications

References 23 publications

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur

Diminished abductor muscular strength in patients with valgus-impacted femoral neck fractures treated by internal fixation: Clinical study and biomechanical considerations

Patterns of isotope uptake in sequential postoperative bone scan in undisplaced femoral-neck fractures

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