The effect of surgical technique on cognitive function in elderly patients with hip fractures: Proximal femoral nailing versus hemiarthroplasty

Proximal femoral nail (PFN) fixation is the gold standard for unstable intertrochanteric fractures. [1] However, dangerous sports, traffic accidents, and falls may lead to femoral re-injuries. Although rare, re-injury may occur after surgery, which may result in pain, dyskinesia, and even PFN breakage. In a study, the prevalence of PFN breakage was reported as <3.3%. [2] Removal of broken PFNs is quite challenging for many orthopedists. To date, surgeons have described many methods to remove broken intramedullary nails. [3][4][5][6] However, these methods have certain limitations, making the removal of broken nails difficult. Moreover, many devices have been developed, but none of them can be conveniently used at different sites of nail breakage.In this article, we describe an easy, inexpensive, and rapid technique to remove broken femoral Proximal femoral nail (PFN) fixation is a technique widely used to treat various femoral fractures, but femoral re-injury may occur, leading to PFN breakage. Broken nail removal, particularly removal of the distal broken nails, is usually challenging. Herein, we describe a feasible approach to successfully remove broken femoral intramedullary nails in three sites (proximal, middle, and distal section) of the PFN. Three patients required surgery for PFN breakage. We performed a novel technique using minimal exposure and a cerclage wire to remove the PFN fragment, which a distal knot on the wire was applied to hold the PFN fragment, and the removal trajectory was completed through the minimal exposure, a distal femoral bone window, and the marrow cavity. We successfully operated these three patients and removed the PFN fragments rapidly and effectively. In conclusion, this novel technique is rapid, feasible, and cost-effective, and can also be promising in removing intramedullary nail breakages in other long bones.

Section: Discussionmentioning

confidence: 99%

A novel feasible technique for rapid removal of broken proximal femoral nails: A case series

Wen

Chen

et al. 2023

“…[ 1 ] Surgical treatment of femoral neck fracture includes open reduction and internal fixation, femoral head replacement, and total hip replacement. [ 2 ] Due to poor biomechanical stability and failure to bear weight early after surgery, patients may have refracture, internal fixation failure, and ischemic necrosis of the femoral head. [ 3 ] In particular, once the femoral head necrosis occurs, it would be an irreversible complication and, therefore, the femoral head ischemic necrosis is also known as the deathless cancer.…”

Section: Introductionmentioning

confidence: 99%

Preoperative computed tomography morphological characteristics of displaced femoral neck fractures

Feng

Zhang

et al. 2023

Objectives This study aims to investigate the morphological classification of preoperative computed tomography (CT) in patients with femoral neck fracture treated by hollow nail. Patients and methods Between January 2014 and December 2021, a total of 34 patients (23 males, 11 females; mean age: 51.97±11.80 years; range, 18 to 85 years) with displaced femoral neck fracture according to Garden classification (Stage Ⅲ-Ⅳ) were included in this study. The preoperative CT data of the patients with femoral neck fractures treated with a hollow screw were collected. According to the morphological characteristics of femoral neck fracture, the slope angle of CT, three-dimensional reconstruction, the lateral upward angle of coronal position, the opening angle, the head-back tilt angle and the head backward distance ratio in horizontal position were measured. Results According to the study of CT morphology, femoral neck fracture was classified into varus separated type 1, varus separated type 2, and valgus impacted type. The mean slope angle was 52.95°±10.36°, the mean lateral upward angle was 15.45°±5.59°, the mean head-back tilt angle was 33.89°±11.20°, the mean head backward distance ratio was 0.822±0.114, and the mean forward opening angle was 23.82°±6.11° in varus separated type 1. The mean slope angle was 65.72°±3.36°, the mean head-back tilt angle was 18.44°±5.18°, and the mean head backward distance ratio was 0.460±0.181 in varus separated type 2. The mean head-back tilt angle was 18.65°±12.54° and the mean head backward distance ratio was 0.362 in valgus impacted type. For varus separation type, the proportion of male patients (93.75%), high-energy injuries (56.25%), and Garden type 4 fractures (87.50%) was higher than that of valgus impacted type (38.89%, 11.11%, and 5.56%, respectively), indicating a statistically significant difference (p<0.01). The amount of intraoperative blood loss, head-back tilt angle, and backward distance ratio of patients with varus separation were higher than those of patients with valgus impaction, indicating a statistically significant difference (p<0.01). Conclusion The morphology of preoperative CT of femoral neck fracture treated with hollow screw can be divided into varus separated type and valgus impacted type. This fracture classification can guide the intraoperative reduction and improve the quality of reduction. The functional exercise is reasonably guided by evaluating prognosis according to the classification characteristics.

“…Therefore, hip fractures have high mortality and disability rates, tremendously diminishing the patientsʼ quality of life and increasing their social and medical burdens. [1][2][3] Femoral neck fractures are the most common form of hip fractures [4,5] and mostly treated by internal fixation with cannulated compression screws in the clinical practice.…”

mentioning

confidence: 99%

A prediction model for osteonecrosis of femoral head after internal fixation with multiple cannulated compression screws for adult femoral neck fractures

Jin,

Chen,

Wang

et al. 2023

Objectives This study aims to investigate the high-risk factors for osteonecrosis of the femoral head (ONFH) after internal fixation with multiple cannulated compression screws for adult femoral neck fractures and to construct a prediction model. Patients and methods Between from January 2012 and December 2020, a total of 268 patients (138 males, 130 females; mean age: 53±10 years; range, 23 to 70 years) with ONFH who had complete follow-up data were included. Closed reduction in combination with open reduction were performed. All patients received internal fixation with multiple cannulated compression screws and were assigned to ONFH and non-ONFH groups. Logistic regression model was utilized to identify independent risk factors for postoperative ONFH, followed by constructing a nomogram prediction model. The predictive ability of the model was evaluated by receiver operating characteristic curve, Hosmer-Lemeshow test, and calibration curve. Results Multivariate analysis revealed that older age (odds ratio [OR]: 2.307, 95% confidence interval [CI]: 1.295-4.108], Charlson Comorbidity Index (CCI) ≥2 (OR: 2.214, 95% CI: 1.035-4.739), fracture displacement (OR: 2.426, 95% CI: 1.122-5.247), unsatisfactory reduction (OR: 2.629, 95% CI: 1.275-5.423), postoperative removal of internal fixation implant (OR: 2.200, 95% CI: 1.051-4.604) were independent risk factors for postoperative ONFH (p<0.05). The nomogram prediction model constructed based on these clinical characteristics showed high predictive value (AUC=0.807) and consistency (p>0.05). Conclusion Age, comorbidity index, fracture type, reduction quality and postoperative removal of internal fixation implant are of utmost importance for postoperative ONFH in patients with femoral neck fractures. The established nomogram prediction model can accurately predict the occurrence of postoperative ONFH.