Surgical treatment options for femoral neck fractures in the elderly

Zelle, Boris A.; Salazar, Luis M.; Howard, Shain; Parikh, Kisan; Pape, Hans-Christian

doi:10.1007/s00264-022-05314-3

Cited by 22 publications

(20 citation statements)

References 99 publications

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“…Standard treatment for FNF is surgical. The surgical treatment can be either internal fixation or arthroplasty, depending on bone quality, fracture severity and patient's age [2]. Over the past decades, great effort has been put into deciphering specific biomechanical characteristics of FNF to develop an optimised fixation construct [3].…”

Section: Introductionmentioning

confidence: 99%

Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review

Davidson

Blum

Harats

et al. 2022

International Orthopaedics (SICOT)

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Introduction The recently developed femoral neck system (FNS) for treatment of femoral neck fractures (FNF), comprises theoretical biomechanical advantages compared to other implants. The aim of this study was to validate the safety and to report outcomes of patients treated with the FNS. Method A retrospective multicentric analysis of patients treated by FNS with a minimum of three months of follow-up. Details analysed from three medical centres were operative duration, estimated blood loss, initial hospitalisation duration, fixation quality as well as complications and reoperation rate. Patients who had revision surgery were compared to all other patients to identify risk factors for failure. In addition, a literature review was performed to analyse data on FNS clinical implementation and patient’s outcomes. The two data sets were combined and analysed. Results One-hundred and two patients were included in this study cohort with an average follow-up of seven months (range 3–27). Ten papers were included in the literature review, reporting data on 278 patients. Overall, 380 patients were analysed. Average age was 62.6 years, 52% of the fractures were classified as Gardens 1–2. Overall, the revision rate was 9.2% (14 patients diagnosed with cut-out of implant, 10 with AVN, 8 with non-union and 8 with hardware removal). For the 102 patients in the cohort risk factors for reoperation included patients age, surgeon seniority and inadequate placement of the implant. Conclusion This study shows that FNS is a safe treatment option for FNF. Intra-operative parameters and failure rates are comparable to previously reported rates for this implant and other frequently used implants.

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Section: Introductionmentioning

confidence: 99%

Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review

Davidson

Blum

Harats

et al. 2022

International Orthopaedics (SICOT)

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“…Operative options for DFNFs include internal fixation and hip arthroplasty; however, the best surgical management for DFNFs remains controversial ( 3 ). Given the complications associated with joint replacement, such as aseptic loosening, and the limited longevity of prostheses, internal fixation is generally prioritized in surgery ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

Wu¹,

Zhu²,

Wei³

et al. 2022

Ann Transl Med

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Background: This study aimed to define the distribution and frequency of fracture lines and bone defects in displaced femoral neck fractures (DFNFs) using a three-dimensional (3D) mapping technique, and to investigate the factors associated with the area of bone defects in patients with DFNFs. Methods:The data of 256 adult patients with DFNFs were retrospectively reviewed. Multiplanar reconstructions of the DFNFs were made using computed tomography (CT) images, and the DFNF fragments were virtually reduced to match a 3D model of the femoral neck. Subsequently, 3D mapping was performed by graphically superimposing all of the fracture lines and bone defects onto a femoral neck template. The 3D mappings were independently examined by two orthopedic surgeons, and the interobserver agreement was analyzed. For intraobserver analysis, one of the surgeons measured the mappings twice more, and the intraclass correlation coefficients (ICCs) were calculated. A linear regression analysis was conducted to explore bone defect area-related factors. Results:The cohort comprised 141 (55%) patients with left hip injuries and 115 (45%) patients with right hip injuries. On the 3D maps, the dense zones of the fracture lines were largely observed from the superior to the posterior part of the femoral neck, while the dense zone of the bone defect was primarily concentrated in the posterior part of the femoral neck. Only a few dense zones were located in the anterior and inferior parts of the femoral neck. An overlapping region between the fracture line and the bone defect was located in the 2.5th to 4.5th (5th) part of the 1/10 of the superior (posterior) femoral neck length. Both the fracture line and bone defect mapping techniques had good intra-and inter-observer reliability, with ICCs of 0.879 (0.977) and 0.780 (0.974), respectively. Garden type and age were positively correlated with bone defects, while simplified AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification was negatively associated with bone defects. Conclusions:The fracture lines and bone defects of the DFNFs were mainly located in the superior and posterior parts of the femoral neck, while an overlapping region was observed in the subcapital area of the femoral neck. 3D mapping is a reliable method for searching for DFNF features, and separately studying fracture lines and bone defects can further elucidate the morphology of these fractures. Bone defects in patients with DFNFs were associated with Garden type, simplified AO/OTA classification, and age.

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“…More than that, different types of surgery also correspond to specific surgical operations. For example, in the field of trauma, the most common operation is fixation repair of limb bone fractures like pelvis acetabulum, femur, and tibia 20–22 . In common internal fixation of femoral neck fractures with hollow nails, 23 internal fixation of femoral intramedullary nails 24 and internal fixation of forearm double fractures, 25 not only the type of plates and screws are necessary elements for successful surgery, but their placement is also an important influencing factor to ensure patient safety and better outcome.…”

Section: Status Of Research On Classification Of Surgical Robotsmentioning

confidence: 99%

“…For example, in the field of trauma, the most common operation is fixation repair of limb bone fractures like pelvis acetabulum, femur, and tibia. [20][21][22] In common internal fixation of femoral neck fractures with hollow nails, 23 internal fixation of femoral intramedullary nails 24 and internal fixation of forearm double fractures, 25 not only the type of plates and screws are necessary elements for successful surgery, but their placement is also an important influencing factor to ensure patient safety and better outcome. Compared to conventional naked eye localization, robotic localization is able to overcome the drawbacks of repeated use of X-imaging fluoroscopy and 2D field of view.…”

Section: Classification Of Surgical Robotsmentioning

confidence: 99%

Advanced surgical tool: Progress in clinical application of intelligent surgical robot

Zhang

Wang

et al. 2022

Smart Medicine

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Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up‐to‐date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.

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Surgical treatment options for femoral neck fractures in the elderly

Cited by 22 publications

References 99 publications

Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review

Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

Advanced surgical tool: Progress in clinical application of intelligent surgical robot

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