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Zhang X, Du X, Xiang J, Shu Q, Huang H, Guo Y, Wang T, Hu Y, He J. Effective treatment of non-union after internal fixation of femoral neck fracture using integrated traditional Chinese and western medicine. Explore (NY) 2025; 21:103095. [PMID: 39671973 DOI: 10.1016/j.explore.2024.103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 11/21/2024] [Accepted: 12/04/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND Hip fractures, particularly femoral neck and intertrochanteric fractures, represent approximately 6.37 % of all fractures, with incidence rates showing an upward trend annually. CASE PRESENTATION This report presents a case of a 55-year-old female with a femoral neck fracture who underwent internal fixation. One-year post-surgery, the patient continued to experience hip pain, and computed tomography (CT) scans revealed non-union of the fracture. The patient received an integrated treatment approach combining traditional Chinese and Western medicine, involving the alternating administration of osteopeptide tablets and Guijia Jiangu capsules, a proprietary herbal formulation. No additional pharmacological or surgical interventions were employed. Seven months after initiating the treatment, digital radiography (DR) examinations showed that the fracture had largely healed. At the seven-month follow-up, and nearly four years thereafter, the patient reported no discomfort in the hip region. Subsequent DR examinations revealed no signs of avascular necrosis of the femoral head, and no adverse events were noted. The internal fixation device was removed five years post-fracture. CONCLUSION The results indicate that integrated traditional Chinese and Western medicine may effectively treat non-union after internal fixation of femoral neck fractures, though further studies are warranted to confirm these outcomes.
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Affiliation(s)
- Xianzhe Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China; Department of Orthopaedics, Nanchong Hospital of Traditional Chinese Medicine, Nanchong 637000, China
| | - Xiaoming Du
- Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
| | - Jie Xiang
- Department of Orthopaedics, Nanchong Hospital of Traditional Chinese Medicine, Nanchong 637000, China
| | - Qifa Shu
- Department of Orthopaedics, Nanchong Hospital of Traditional Chinese Medicine, Nanchong 637000, China
| | - Haoyun Huang
- Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
| | - Yi Guo
- Department of Orthopaedics, Nanchong Hospital of Traditional Chinese Medicine, Nanchong 637000, China
| | - Tao Wang
- Department of Orthopaedics, Nanchong Hospital of Traditional Chinese Medicine, Nanchong 637000, China
| | - Yimei Hu
- Department of Orthopaedics, Hospital of Chengdu University of TCM, Chengdu 610000, China.
| | - Junzhi He
- Department of Orthopaedics, Sichuan Tianxiang Orthopedic Hospital, Chengdu 610000, China.
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Lindahl J, Gänsslen A, Madsen JE, Krappinger D. Comparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications. Arch Orthop Trauma Surg 2024; 144:4587-4593. [PMID: 39384630 DOI: 10.1007/s00402-024-05557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 10/11/2024]
Abstract
Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure. Fracture classifications should be simple and easy to use, comprehensive, and radiographically and anatomically based, resulting in a hierarchical alphanumeric order of types and subtypes and thereby allow adequate treatment decisions based on a high degree of inter- and intraobserver reliability. In 2018 a new AO/OTA pelvic ring fracture and dislocation classification was published that combined the most commonly used "historical" classification schemes, e.g. the Tile/AO classification and the classification according to Young and Burgess. Compared with these older classifications, several relevant changes were integrated in the 2018 edition. The changes between the AO/OTA 1996/2007 and 2018 classifications were analysed in detail. Overall, several problems were identified regarding the type-B pelvic ring injury classification. These changes may result in difficulties in classifying pelvic ring injuries and thereby prevent relevant comparisons between former and future clinical studies on pelvic injuries.Level of Evidence: V.
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Affiliation(s)
- Jan Lindahl
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Axel Gänsslen
- Trauma Department, Hannover Medical School, Hannover, Germany
- Department of Trauma and Orthopedics, Johannes Wesling Hospital, Minden, Germany
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dietmar Krappinger
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Innsbruck, Austria
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Gänsslen A, Tonetti J, Pohlemann T. Algorithms in acetabular fracture classifications. Arch Orthop Trauma Surg 2024; 144:4655-4665. [PMID: 39441365 DOI: 10.1007/s00402-024-05599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 09/23/2024] [Indexed: 10/25/2024]
Abstract
Acetabular fractures are still challenging fractures. Fracture classification is the basis for understanding these injuries and to gain treatment and to choose a fracture type-based treatment concept. Using a systematic step-wise concept of fracture analysis, based on specific radiographic lines on standard X-rays allow even less experienced surgeons to get a correct classification of the elementary and associated fracture types of Letournel's classification. Algorithmic analysis of the iliopectineal line, (anterior column involvement), ilioischial line (posterior column involvement), presence of a posterior wall fragment, fracture lines involving the iliac wing and inferior ramus, and the spur sign (representing associated both column fractures) allow for approximately 80-90% correct classifications using standard X-rays when integrating these lines into an algorithm. Especially, T-shaped fractures, ABC and ACPHT fractures may be difficult to classify. Thus, advanced imaging, such as CT scans with multiplanar reconstruction and 3D reconstructions is additionally recommended.
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Affiliation(s)
- Axel Gänsslen
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany.
- University Hospital, Johannes Wesling Hospital, Minden, Germany.
| | - Jerome Tonetti
- Department of Orthopaedic and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg/Saar, Germany
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Maqungo S, Nicol A, Laubscher M, Williams K, Graham S, Henry M, Kauta N, Berry K. Intracapsular neck of femur fractures secondary to civilian gunshot injuries: an inter- and intra-observer agreement study on classification and treatment using the AO/OTA classification. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2981-2986. [PMID: 38844564 PMCID: PMC11377358 DOI: 10.1007/s00590-024-04015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/31/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE Numerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-velocity civilian gunshots wounds (GSWs). Our secondary objective was to test the reliability of the AO/OTA classification system in guiding surgeon treatment choices for these fractures. PATIENTS AND METHODS Eighteen reviewers (six orthopaedic traumatologists, six general orthopaedic surgeons and six junior orthopaedic fellows) were given a set of 25 plain radiographs and CT scans of femur neck fractures secondary to GSW. For each clinical case, all reviewers selected a classification as well as treatment option from a list of given options. Inter-observer reliability was measured at the initial classification. The exercise was repeated 10-12 weeks later by the same 18 reviewers to test intra-observer reliability. RESULTS The Fleiss kappa values indicate only slight agreement amongst raters, across all experience levels, for both injury classification and treatment. Intra-observer agreement was fair across all experience levels for both injury classification and treatment. CONCLUSION The AO/OTA classification showed only slight reliability in classification of gunshot fractures of the femur neck. With only fair reliability, it also failed to guide surgical treatment thus rendering its routine use in daily clinical practice of questionable value.
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Affiliation(s)
- Sithombo Maqungo
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA.
- Trauma Care & Injury Prevention, Division of Global Surgery, University of Cape Town, Cape Town, RSA.
| | - Andrew Nicol
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA
- Trauma Unit, Division of General Surgery, University of Cape Town, Cape Town, RSA
| | - Maritz Laubscher
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA
| | - Kaylin Williams
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA
| | - Simon Graham
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA
- Liverpool Orthopaedic and Trauma Service, Liverpool University Teaching Hospital Trust, Liverpool, UK
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Oxford Trauma and Emergency Care, University of Oxford, Oxford, UK
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michelle Henry
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA
- Centre for Higher Education Development, University of Cape Town, Cape Town, RSA
| | - Ntambue Kauta
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA
| | - Kirsty Berry
- Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA
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Ridha M, Al-Jabri T, Stelzhammer T, Shah Z, Oragui E, Giannoudis PV. Osteosynthesis, hemiarthroplasty, total hip arthroplasty in hip fractures: All I need to know. Injury 2024; 55:111377. [PMID: 38324951 DOI: 10.1016/j.injury.2024.111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Recent data from the UK's National Hip Fracture Database (NHFD) demonstrate an upward trajectory in the incidence of hip fractures, a trend which is expected to persist. In 2023 alone, the NHFD reported 72,160 cases, underscoring the prevalence of these injuries. These fractures are associated with significant morbidity, mortality, and economic costs. National guidelines for the surgical management of these fractures are established, although the implementation of total hip arthroplasty (THA) as a primary treatment modality varies. This review offers a narrative synthesis of contemporary literature on hip fractures, focusing on epidemiology, classification systems, and treatment options, with a particular emphasis on the outcomes of THA.
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Affiliation(s)
- Mohamed Ridha
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, London, Stanmore, HA7 4LP, UK
| | - Talal Al-Jabri
- Trauma and Orthopaedic Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Thomas Stelzhammer
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Zameer Shah
- Department of Orthopaedics, Guy's and St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Emeka Oragui
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd., London SW10 9NH, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, UK; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
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Charles T, Bloemers N, Kapanci B, Jayankura M. Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures. World J Orthop 2024; 15:22-29. [PMID: 38293256 PMCID: PMC10824065 DOI: 10.5312/wjo.v15.i1.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/15/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1% to 17%. This serious complication is associated with increased morbidity and mortality rates. Approaches to this surgery are still debated, with no consensus regarding the superiority of any single approach. AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches (PL) for hip hemiarthroplasty after femoral neck fractures. METHODS This is a comparative, retrospective, single-center cohort study conducted at a university hospital. Between March 2008 and December 2018, 273 patients (a total of 280 hips) underwent bipolar hemiarthroplasties (n = 280) for displaced femoral neck fractures using either the PL (n = 171) or the minimally invasive direct anterior approach (DAA) (n = 109). The choice of approach was related to the surgeons' practices; the implant types were similar and unrelated to the approach. Dislocation rates and other complications were reviewed after a minimum follow-up of 6 mo. RESULTS Both treatment groups had similarly aged patients (mean age: 82 years), sex ratios, patient body mass indexes, and patient comorbidities. Surgical data (surgery delay time, operative time, and blood loss volume) did not differ significantly between the groups. The 30 d mortality rate was higher in the PL group (9.9%) than in the DAA group (3.7%), but the difference was not statistically significant (P = 0.052). Among the one-month survivors, a significantly higher rate of dislocation was observed in the PL group (14/154; 9.1%) than in the DAA group (0/105; 0%) (P = 0.002). Of the 14 patients with dislocation, 8 underwent revision surgery for recurrent instability (posterior group), and one of them had 2 additional procedures due to a deep infection. The rate of other complications (e.g., perioperative and early postoperative periprosthetic fractures and infection-related complications) did not differ significantly between the groups. CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate (< 1%) than the PL.
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Affiliation(s)
- Tatiana Charles
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Nicolas Bloemers
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Bilal Kapanci
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Marc Jayankura
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
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Dust T, Hartel MJ, Henneberg JE, Korthaus A, Ballhause TM, Keller J, Ohlmeier M, Maas KJ, Frosch KH, Krause M. The influence of 3D printing on inter- and intrarater reliability on the classification of tibial plateau fractures. Eur J Trauma Emerg Surg 2023; 49:189-199. [PMID: 35941251 PMCID: PMC9925517 DOI: 10.1007/s00068-022-02055-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Tibial plateau fractures continue to be a challenging task in clinical practice and current outcomes seem to provide the potential for further improvement. Especially presurgical understanding of the orientation of fracture lines and fracture severity is an essential key to sufficient surgical treatment. The object of this study was to evaluate the reliability of modern axial CT-based classification systems for tibial plateau fractures. In addition, the diagnostic-added value of 3D printing on the classification systems was investigated. METHODS 22 raters were asked to classify 22 tibial plateau fractures (11 AO B- and 11 AO C-fractures) with the AO, the 10-Segment and the Revisited Schatzker classification in a three-step evaluation: first only using CT scans, second with 3D volumetric reconstructions and last with 3D-printed fracture models. Inter- and intraobserver agreement and the subjective certainty were analyzed. Statistics were done using kappa values, percentage match and a univariant one-way analysis of variance. RESULTS The AO classifications interobserver percentage match and kappa values improved for all raters and recorded an overall value of 0.34, respectively, 43% for the 3D print. The 10-Segment classification interobserver agreement also improved with the 3D-printed models and scored an overall kappa value of 0.18 and a percentage match of 79%. Equally the Revisited Schatzker classification increased its values to 0.31 and 35%. The intraobserver agreement showed a moderate agreement for the AO (0.44) and Revisited Schatzker classification (0.42) whereas the 10-Segment classification showed a fair agreement (0.27). Additionally, the raters changed their classification in 36% of the cases after evaluating the fracture with the 3D-printed models and the subjective certainty regarding the decisions improved as categories of self-reliant diagnostic choices were selected 18% (p < 0.05) more often after using the 3D-printed models. CONCLUSION Based on the measured outcomes it was concluded that the new classification systems show an overall slight to fair reliability and the use of 3D printing proved to be beneficial for the preoperative diagnostics of tibial plateau fractures. The 10-Segment classification system showed the highest percentage match evaluation of all classification systems demonstrating its high clinical value across all levels of user experience.
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Affiliation(s)
- Tobias Dust
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Julian-Elias Henneberg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alexander Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Tobias Malte Ballhause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Keller
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Malte Ohlmeier
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Kai-Jonathan Maas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Hackl S, von Rüden C, Weisemann F, Klöpfer-Krämer I, Stuby FM, Högel F. Internal Fixation of Garden Type III Femoral Neck Fractures with Sliding Hip Screw and Anti-Rotation Screw: Does Increased Valgus Improve Healing? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1573. [PMID: 36363531 PMCID: PMC9699387 DOI: 10.3390/medicina58111573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 10/26/2023]
Abstract
Background and Objectives: The aim of this study was to compare the effect of valgus versus anatomic reduction on internal fixation of Garden type III femoral neck fractures using the sliding hip screw (SHS) and anti-rotation screw (ARS) regarding the radiographic and therapeutic outcome. Patients and Methods: A retrospective case-controlled study was performed in a level I trauma center. All patients between 2006 and 2020 aged younger than 70 years with a Garden type III femoral neck fracture and a Kellgren-Lawrence score under grade III stabilized using SHS and ARS were identified. One-hundred and nine patients were included, with a group distribution of sixty-eight patients in group A (anatomic reduction) and forty-one patients in group B (valgus reduction). Results: Mean age was 55 years, and the mean Kellgren-Lawrence score was 1 in both groups. Mean femoral neck angle was 130.5 ± 3.8° in group A and 142.8 ± 4.3° in group B (p = 0.001), with an over-correction of 12° in group B. Tip-apex distance was 10.0 ± 2.8 mm in group A versus 9.3 ± 2.8 mm in group B (p = 0.89). Healing time was 9 weeks in group A compared to 12 weeks in group B (p = 0.001). Failure rate was 4.4% in group A and 17.1% in group B (p = 0.027). Conclusions: Anatomic reduction of Garden type III femoral neck fractures in patients younger than 70 years treated using SHS and ARS resulted in significantly lower failure rates and shorter healing times than after valgus reduction. Therefore, it can be recommended to achieve anatomic reduction.
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Affiliation(s)
- Simon Hackl
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christian von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | | | - Isabella Klöpfer-Krämer
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
- Institute for Biomechanics, BG Unfallklinik Murnau, 82418 Murnau, Germany
| | - Fabian M. Stuby
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
| | - Florian Högel
- Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
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Addressing posterior tilt displacement during surgery to lower failure risk of sub-capital Garden types 1 and 2 femoral fractures. Arch Orthop Trauma Surg 2022; 142:1885-1893. [PMID: 33959801 DOI: 10.1007/s00402-021-03900-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Sub-capital femoral fractures (SCFF) are impacted or non-displaced in Garden types 1 and 2, respectively. Non-surgical treatment is protected weight-bearing combined with physiotherapy and radiographic follow-up in selected patients. Traditionally, in situ pinning is the surgical treatment of choice. The aim of this study was to estimate whether the valgus deformity in Garden types 1 and 2 (AO classification 31B1.1 and 31B1.2) SCFF is a virtual perception of a posterior tilt deformity and if addressing this deformity improves patients' outcomes. MATERIALS AND METHODS The records of 96 patients with Garden Types 1 and 2 SCFF treated in tertiary medical center between 1/2014 and 9/2017 were retrospectively reviewed. They all had preoperative hip joint anteroposterior and lateral radiographic views. 75 patients had additional computed tomography (CT) scans. Femoral head displacement was measured on an anteroposterior and axial radiograph projections and were performed before and after surgery. Preoperative 3D reconstructions were performed for a better fracture characterization, and assessment of the imaging was performed by the first author. RESULTS The average age of the study cohort was 73 years (range 28-96, 68% females). There were 58 right-sided and 38 left-sided fractures. Ninety patients had Type 1 and six patients had Type 2 fractures. The average preoperative posterior tilt was 15 degrees and the average valgus displacement was 10 degrees on plain radiographs compared to 28 degrees and 11 degrees, respectively, on CT scans. Posterior tilt was found with a virtual perception as valgus-impacted fractures. The postoperative posterior tilt was corrected to an average of 3 degrees and the valgus displacement to 5 degrees. CONCLUSION CT provides an accurate modality for measuring femoral head displacement and fracture extent. The posterior tilt displacement should be addressed during surgery to lower failure risk and the need for additional procedures. IRB APPROVAL TLV-0292-15. LEVEL OF EVIDENCE IV.
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Cai Z, Zhang Z, Ren L, Piao C, Xiang L. Does Garden type I incomplete femoral neck fracture really exist in older adults? To evaluate the stability and consistency of Garden classification. BMC Surg 2022; 22:276. [PMID: 35840959 PMCID: PMC9287860 DOI: 10.1186/s12893-022-01722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate classification of femoral neck fracture (FNF) is crucial for treatment plan and therapeutic outcomes. Garden classification is commonly used in the clinic, but its stability and consistency remain controversial. The aim of this study was to evaluate the stability and consistency of Garden classification based on X and CT images, and to analyze whether it is valid for Garden I in the elderly. METHODS X-ray and CT images from 886 elderly patients with FNF were collected, four orthopaedic surgeons and four radiologists evaluated these images independently, and determined the fracture type based on Garden classification. Three months later, The exercise was repeated and the results were compared based on 4 types Garden classification (I, II, III and IV) and 3 types Garden classification (I + II, III and IV). Kappa was used to measure inter- and intraobserver agreement. The patients with Garden I incomplete FNF confirmed by 8 observers together based on images combined with medical history were compared with the intraoperative results. RESULTS Four types Garden classification, there was little consistency inter- and intraobservers (Kappa from 0.18 to 0.43) based on X-ray images, while professors consistency (0.56 to 0.76) was higher than residents (0.28 to 0.35) based on CT. 3 types Garden classification showed almost perfect agreement inter- and intraobservers, which ranged from 0.76 to 0.90. Totally 52 patients were diagnosed as Garden I, 38 of whom underwent arthroplasty. All surgical cases showed complete fracture during operation. CONCLUSIONS There was low consistency and repeatability in 4 types Garden classification (I, II, III and IV), while 3 types Garden classification (I + II, III and IV) had high consistency among observers. In the elderly, all undisplaced femoral neck fracture may be Garden II, no Garden I.
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Affiliation(s)
- Zhencun Cai
- Department of Orthopaedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Liaoning, Shenyang, China.
| | - Zelin Zhang
- Department of Orthopaedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Liaoning, Shenyang, China
| | - Lixuan Ren
- Department of Orthopaedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Liaoning, Shenyang, China
| | - Chengzhe Piao
- Department of Orthopaedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Liaoning, Shenyang, China
| | - Liangbi Xiang
- Department of Orthopaedics Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
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Bae J, Yu S, Oh J, Kim TH, Chung JH, Byun H, Yoon MS, Ahn C, Lee DK. External Validation of Deep Learning Algorithm for Detecting and Visualizing Femoral Neck Fracture Including Displaced and Non-displaced Fracture on Plain X-ray. J Digit Imaging 2021; 34:1099-1109. [PMID: 34379216 DOI: 10.1007/s10278-021-00499-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/08/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022] Open
Abstract
This study aimed to develop a method for detection of femoral neck fracture (FNF) including displaced and non-displaced fractures using convolutional neural network (CNN) with plain X-ray and to validate its use across hospitals through internal and external validation sets. This is a retrospective study using hip and pelvic anteroposterior films for training and detecting femoral neck fracture through residual neural network (ResNet) 18 with convolutional block attention module (CBAM) + + . The study was performed at two tertiary hospitals between February and May 2020 and used data from January 2005 to December 2018. Our primary outcome was favorable performance for diagnosis of femoral neck fracture from negative studies in our dataset. We described the outcomes as area under the receiver operating characteristic curve (AUC), accuracy, Youden index, sensitivity, and specificity. A total of 4,189 images that contained 1,109 positive images (332 non-displaced and 777 displaced) and 3,080 negative images were collected from two hospitals. The test values after training with one hospital dataset were 0.999 AUC, 0.986 accuracy, 0.960 Youden index, and 0.966 sensitivity, and 0.993 specificity. Values of external validation with the other hospital dataset were 0.977, 0.971, 0.920, 0.939, and 0.982, respectively. Values of merged hospital datasets were 0.987, 0.983, 0.960, 0.973, and 0.987, respectively. A CNN algorithm for FNF detection in both displaced and non-displaced fractures using plain X-rays could be used in other hospitals to screen for FNF after training with images from the hospital of interest.
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Affiliation(s)
- Junwon Bae
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Sangjoon Yu
- Department of Computer Science, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea. .,Machine Learning Research Center for Medical Data, Hanyang University, Seoul, Republic of Korea.
| | - Tae Hyun Kim
- Department of Computer Science, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea. .,Machine Learning Research Center for Medical Data, Hanyang University, Seoul, Republic of Korea.
| | - Jae Ho Chung
- Machine Learning Research Center for Medical Data, Hanyang University, Seoul, Republic of Korea.,Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Department of HY, College of Medicine, KIST Bio-Convergence, Hanyang University, Seoul, Republic of Korea
| | - Hayoung Byun
- Machine Learning Research Center for Medical Data, Hanyang University, Seoul, Republic of Korea.,Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Myeong Seong Yoon
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Dong Keon Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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12
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Wu C, Ning B, Xu P, Song J, Wang D. Efficacy and complications after delayed fixation of femoral neck fractures in children. J Orthop Surg (Hong Kong) 2020; 28:2309499019889682. [PMID: 31833450 DOI: 10.1177/2309499019889682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. METHODS The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet's classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27-240 h). According to Garden's classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed (n = 9) or open (n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. RESULTS The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet's type II, 12.5%) and in three in the open reduction group (one Delbet's type I, 50%; two Delbet's type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. CONCLUSIONS The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.
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Affiliation(s)
- Chunxing Wu
- Department of Pediatric Orthopedics, Children's Hospital of Fudan University, Shanghai, China
| | - Bo Ning
- Department of Pediatric Orthopedics, Children's Hospital of Fudan University, Shanghai, China
| | - Ping Xu
- Department of Pediatric Orthopedics, Children's Hospital of Fudan University, Shanghai, China
| | - Jun Song
- Department of Pediatric Orthopedics, Children's Hospital of Fudan University, Shanghai, China
| | - Dahui Wang
- Department of Pediatric Orthopedics, Children's Hospital of Fudan University, Shanghai, China
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13
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Bartolotta RJ, Belfi LM, Ha AS. Breaking Down Fractures of the Pelvis and Hip. Semin Roentgenol 2020; 56:39-46. [PMID: 33422181 DOI: 10.1053/j.ro.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Roger J Bartolotta
- Weill Cornell Medical College, New York, NY; Department of Radiology, NewYork-Presbyterian Hospital, New York, NY.
| | - Lily M Belfi
- Weill Cornell Medical College, New York, NY; Department of Radiology, NewYork-Presbyterian Hospital, New York, NY
| | - Alice S Ha
- Department of Radiology, University of Washington, Seattle, WA
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14
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Bali K, Smit K, Ibrahim M, Poitras S, Wilkin G, Galmiche R, Belzile E, Beaulé PE. Ottawa classification for symptomatic acetabular dysplasia assessment of interobserver and intraobserver reliability. Bone Joint Res 2020; 9:242-249. [PMID: 32566146 PMCID: PMC7284290 DOI: 10.1302/2046-3758.95.bjr-2019-0155.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims The aim of the current study was to assess the reliability of the Ottawa classification for symptomatic acetabular dysplasia. Methods In all, 134 consecutive hips that underwent periacetabular osteotomy were categorized using a validated software (Hip2Norm) into four categories of normal, lateral/global, anterior, or posterior. A total of 74 cases were selected for reliability analysis, and these included 44 dysplastic and 30 normal hips. A group of six blinded fellowship-trained raters, provided with the classification system, looked at these radiographs at two separate timepoints to classify the hips using standard radiological measurements. Thereafter, a consensus meeting was held where a modified flow diagram was devised, before a third reading by four raters using a separate set of 74 radiographs took place. Results Intrarater results per surgeon between Time 1 and Time 2 showed substantial to almost perfect agreement among the raters (κappa = 0.416 to 0.873). With respect to inter-rater reliability, at Time 1 and Time 2 there was substantial agreement overall between all surgeons (Time 1 κappa = 0.619; Time 2 κappa = 0.623). Posterior and anterior rating categories had moderate and fair agreement at Time 1 (posterior κappa = 0.557; anterior κappa = 0.438) and Time 2 (posterior κappa = 0.506; anterior κappa = 0.250), respectively. At Time 3, overall reliability (κappa = 0.687) and posterior and anterior reliability (posterior κappa = 0.579; anterior κappa = 0.521) improved from Time 1 and Time 2. Conclusion The Ottawa classification system provides a reliable way to identify three categories of acetabular dysplasia that are well-aligned with surgical management. The term ‘borderline dysplasia’ should no longer be used. Cite this article: Bone Joint Res. 2020;9(5):242–249.
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Affiliation(s)
- K Bali
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - K Smit
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - M Ibrahim
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - S Poitras
- Physiotherapy Program, School of Rehabilitation, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - G Wilkin
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - R Galmiche
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - E Belzile
- Division of Orthopaedic Surgery, University of Laval, Québec, Canada
| | - P E Beaulé
- University of Ottawa, Ottawa, Canada; Head, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
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15
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Lutnick E, Kang J, Freccero DM. Surgical Treatment of Femoral Neck Fractures: A Brief Review. Geriatrics (Basel) 2020; 5:E22. [PMID: 32244621 PMCID: PMC7345750 DOI: 10.3390/geriatrics5020022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022] Open
Abstract
Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty.
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Affiliation(s)
- Ellen Lutnick
- Jacobs School of Medicine and Biomedical Sciences, 955 Main St., Buffalo, NY 14203, USA;
| | - Jeansol Kang
- Boston University School of Medicine, Department of Orthopaedics, 850 Harrison Ave. Dowling 2N, Boston, MA 02118, USA;
| | - David M. Freccero
- Boston University School of Medicine, Department of Orthopaedics, 850 Harrison Ave. Dowling 2N, Boston, MA 02118, USA;
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16
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Rauer T, Boos M, Neuhaus V, Ellanti P, Kaufmann RA, Pape HC, Allemann F. Inter- and intraobserver agreement of three classification systems for lateral clavicle fractures - reliability comparison between two specialist groups. Patient Saf Surg 2020; 14:4. [PMID: 31911821 PMCID: PMC6945566 DOI: 10.1186/s13037-019-0228-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although of great value in the management of lateral clavicle fractures, substantial variation in their classification exists. We performed a retrospective study to address the inter- and intraobserver reliability of three different classification systems for lateral clavicle fractures. METHODS Radiographs of 20 lateral clavicle fractures that represented a full spectrum of adult fracture patterns were graded by five experienced radiologists and five experienced trauma surgeons according to the Orthopaedic Trauma Association (OTA), the Neer, and the Jäger/Breitner classification systems. This evaluation was performed at two different time points separated by 3 months. To measure the observer agreement, the Fleiss kappa coefficient (κ) was applied and assessed according to the grading of Landis and Koch. RESULTS The overall interobserver reliability showed a fair agreement in all three classification systems. For the OTA classification system, the interobserver agreement showed a mean kappa value of 0.338 ranging from 0.350 (radiologists) to 0.374 (trauma surgeons). Kappa values of the interobserver agreement for the Neer classification system ranged from 0.238 (trauma surgeons) to 0.276 (radiologists) with a mean κ of 0.278. The Jäger/Breitner classification system demonstrated a mean kappa value of 0.330 ranging from 0.306 (trauma surgeons) to 0.382 (radiologists).The overall intraobserver reliability was moderate for the OTA and the Jäger/Breitner classification systems, while the overall intraobserver reliability for the Neer classification system was fair.The kappa values of the intraobserver agreements showed, in all classification systems, a wide range with the OTA classification system ranging from 0.086 to 0.634, the Neer classification system ranging from 0.137 to 0.448, and a range from 0.154 to 0.625 of the Jäger/Breitner classification system. CONCLUSIONS The low inter- and intraobserver agreement levels exhibited in all three classification systems by both specialist groups suggest that the tested lateral clavicle fracture classification systems are unreliable and, therefore, of limited value. We should recognize there is considerable inconsistency in how physicians classify lateral clavicle fractures and therefore any conclusions based on these classifications should be recognized as being somewhat subjective.
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Affiliation(s)
- Thomas Rauer
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Matthias Boos
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Valentin Neuhaus
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Prasad Ellanti
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | | | - Hans-Christoph Pape
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, Zurich, Switzerland
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17
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Dolatowski FC, Frihagen F, Bartels S, Opland V, Šaltytė Benth J, Talsnes O, Hoelsbrekken SE, Utvåg SE. Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am 2019; 101:136-144. [PMID: 30653043 DOI: 10.2106/jbjs.18.00316] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elderly patients with a displaced femoral neck fracture treated with hip arthroplasty may have better function than those treated with internal fixation. We hypothesized that hemiarthroplasty would be superior to screw fixation with regard to hip function, mobility, pain, quality of life, and the risk of a reoperation in elderly patients with a nondisplaced femoral neck fracture. METHODS In a multicenter randomized controlled trial (RCT), Norwegian patients ≥70 years of age with a nondisplaced (valgus impacted or truly nondisplaced) femoral neck fracture were allocated to screw fixation or hemiarthroplasty. Assessors blinded to the type of treatment evaluated hip function with the Harris hip score (HHS) as the primary outcome as well as on the basis of mobility assessed with the timed "Up & Go" (TUG) test, pain as assessed on a numerical rating scale, and quality of life as assessed with the EuroQol-5 Dimension-3 Level (EQ-5D) at 3, 12, and 24 months postsurgery. Results, including reoperations, were assessed with intention-to-treat analysis. RESULTS Between February 6, 2012, and February 6, 2015, 111 patients were allocated to screw fixation and 108, to hemiarthroplasty. At the time of follow-up, there was no significant difference in hip function between the screw fixation and hemiarthroplasty groups, with a 24-month HHS (and standard deviation) of 74 ± 19 and 76 ± 17, respectively, and an adjusted mean difference of -2 (95% confidence interval [CI] = -6 to 3; p = 0.499). Patients allocated to hemiarthroplasty were more mobile than those allocated to screw fixation (24-month TUG = 16.6 ± 9.5 versus 20.4 ± 12.8 seconds; adjusted mean difference = 6.2 seconds [95% CI = 1.9 to 10.5 seconds]; p = 0.004). Furthermore, screw fixation was a risk factor for a major reoperation, which was performed in 20% (22) of 110 patients who underwent screw fixation versus 5% (5) of 108 who underwent hemiarthroplasty (relative risk reduction [RRR] = 3.3 [95% CI = 0.7 to 10.0]; number needed to harm [NNH] = 6.5; p = 0.002). The 24-month mortality rate was 36% (40 of 111) for patients allocated to internal fixation and 26% (28 of 108) for those allocated to hemiarthroplasty (RRR = 0.4 [95% CI = -0.1 to 1.1]; p = 0.11). Two patients were lost to follow-up. CONCLUSIONS In this multicenter RCT, hemiarthroplasty was not found to be superior to screw fixation in reestablishing hip function as measured by the HHS (the primary outcome). However, hemiarthroplasty led to improved mobility and fewer major reoperations. The findings suggest that certain elderly patients with a nondisplaced femoral neck fracture may benefit from being treated with a latest-generation hemiarthroplasty rather than screw fixation. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Filip C Dolatowski
- Department of Orthopaedic Surgery (F.C.D., S.B., and S.E.U.) and Health Services Research Unit (J.S.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frede Frihagen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stefan Bartels
- Department of Orthopaedic Surgery (F.C.D., S.B., and S.E.U.) and Health Services Research Unit (J.S.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vidar Opland
- Department of Orthopaedic Surgery, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Jūratė Šaltytė Benth
- Department of Orthopaedic Surgery (F.C.D., S.B., and S.E.U.) and Health Services Research Unit (J.S.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ove Talsnes
- Department of Orthopaedic Surgery, Elverum Hospital, Innlandet Hospital Trust, Elverum, Norway
| | | | - Stein Erik Utvåg
- Department of Orthopaedic Surgery (F.C.D., S.B., and S.E.U.) and Health Services Research Unit (J.S.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Mandell JC, Wrobel WC, Laur O, Shah N, Robinson-Weiss C, Weaver MJ, Khurana B. A simplified classification of proximal femoral fractures improves accuracy, confidence, and inter-reader agreement of hip fracture classification by radiology residents. Emerg Radiol 2018; 26:179-187. [DOI: 10.1007/s10140-018-1660-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
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19
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Internal Fixation of Nondisplaced Intracapsular Hip Fractures in Older Patients. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Kim HJ, Lee SJ, Hyun JK, Kim SY, Kim TU. Influence of Hip Fracture on Knee Pain During Postoperative Rehabilitation. Ann Rehabil Med 2018; 42:682-689. [PMID: 30404417 PMCID: PMC6246861 DOI: 10.5535/arm.2018.42.5.682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate whether fracture type, surgical procedure, or fracture grade affect knee pain during postoperative rehabilitation after a hip fracture. Methods We conducted a retrospective case-controlled study of 139 patients during postoperative rehabilitation after surgery for hip fractures. Patients were divided into two groups: patients experiencing knee pain during the first week of postoperative rehabilitation, and patients without knee pain. We compared the types of fracture, surgical procedure, and fracture grade between the two groups. Results We enrolled 52 patients (37.4%) with knee pain during the first weeks of postoperative rehabilitation. For type of fracture, knee pain was more common with intertrochanteric fracture than with femur neck fracture (48.8% vs. 21.1%, respectively; p=0.001). For the surgical procedure, there was no significant difference between the groups. For the fracture grade, the grades classified as unstable fractures were more common in the group of intertrochanteric fracture patients with knee pain than in those without knee pain (74.1% vs. 36.4%, respectively; p=0.002). Conclusion Intertrochanteric fracture affected knee pain after hip fracture surgery more than did femur neck fracture, particularly in unstable fractures. Furthermore, there was no difference in each fracture type according to the surgical procedure. Careful examination and management for knee pain is needed in patients with hip fracture surgery.
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Affiliation(s)
- Hee-Ju Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea.,Department of Nanobiomedical Science & WCU Research Center, Dankook University, Cheonan, Korea.,Institute of Tissue Regeneration Engineering, Dankook University, Cheonan, Korea
| | - Seo-Young Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Tae Uk Kim
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea
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21
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Rizkalla J, Jeffers M, Salama P, Rizkalla M. Electromagnetic simulation for diagnosing damage to femoral neck vasculature: A feasibility study. J Orthop 2018; 15:997-1003. [PMID: 30228775 DOI: 10.1016/j.jor.2018.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/25/2018] [Indexed: 11/18/2022] Open
Abstract
Background Femoral neck fractures are common injuries managed by orthopedic surgeons across the world. From pediatrics to geriatrics, disruption of the blood supply to the femoral neck is a well-recognized source of morbidity and mortality, oftentimes resulting in avascular necrosis of the femoral head. This devastating complication occurs in 10-45% of femoral neck fractures. Therefore, it is vital for orthopedic surgeons provide efficient treatment of this injury, in order to optimize the patient's potential outcome and prevent long-term sequelae. Methods In this study, the anatomy of the proximal femur, including femoral metaphysis, femoral neck, vasculature, and femoral head, were simulated in COMSOL Finite Element Analysis (FEA) software. Electric fields were generated in a fashion that exploited disruptions within the vasculature of the femoral neck. This study was aimed at developing an alternative imaging modality for narrowing or disrupting the femoral neck's vasculature. The variables used for investigation included: frequency, penetration depth, and magnitude of the electrical energy. These variables, when combined, allowed for enhanced simulated visualization of the vasculature of the femoral neck and theoretically expedited diagnosis of obvious, or occult, femoral neck injury. Results Simulated blood vessels were developed in two-dimensions: the phi direction (circular), and z-direction. Two different frequencies, 3 GHz, and 5 GHz were considered, with 100-J energy pulses within blood vessels of 2.54 mm in diameter. The fat surrounding the bone to the outside surface body was simulated at 0.25 inch (0.65 cm). An additional model, with layered fat and skin above the vessels, was simulated at 2000J and successfully able to visualize the femoral neck's blood vessels. Results showed a distinguished E field across the blood boundary of nearly 170 V/M. Conclusions The electric field simulation data within the Phi and Z directions promises the feasibility of a subsequent practical model.
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Affiliation(s)
- James Rizkalla
- Baylor University Medical Center, Dallas, TX, United States
| | - Matthew Jeffers
- Department of Electrical and Computer Engineering, Indiana University Purdue University Indianapolis (IUPUI), 723 West Michigan Street, Indianapolis, Inn, 46202, United States
| | - Paul Salama
- Department of Electrical and Computer Engineering, Indiana University Purdue University Indianapolis (IUPUI), 723 West Michigan Street, Indianapolis, Inn, 46202, United States
| | - Maher Rizkalla
- Department of Electrical and Computer Engineering, Indiana University Purdue University Indianapolis (IUPUI), 723 West Michigan Street, Indianapolis, Inn, 46202, United States
- Integrated Nanotechnology Development Institute (INDI), IUPUI, United States
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Internal Rotation Traction Radiograph Improves Proximal Femoral Fracture Classification Accuracy and Agreement. AJR Am J Roentgenol 2018; 211:409-415. [PMID: 29894220 DOI: 10.2214/ajr.17.19258] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study is to assess the clinical utility of internal rotation traction radiography in the classification of proximal femoral fractures. MATERIALS AND METHODS The study cohort included 78 consecutive patients who were surgically treated for a proximal femoral fracture and for whom preoperative physician-assisted internal rotation traction radiographs of the fractured hip were obtained in addition to standard radiographs. Two radiologists who were blinded to clinical information independently classified each fracture without the traction view and then with the traction view. The radiologists also reported their confidence (expressed as a percentage) in their classifications. The reference standard was the consensus interpretation of intraoperative C-arm fluoroscopic images by two orthopedic surgeons and one radiologist. Classification accuracy was compared using the McNemar test. Subjective confidence and confidence-weighted accuracy were compare using paired t tests. Agreement with the reference standard and interreader agreement were calculated using the kappa statistic and were compared using the z-test after bootstrapping was performed to obtain the standard error. RESULTS With the traction view, the pooled accuracy increased from 44.9% to 72.4%, subjective confidence increased from 87% to 94%, and confidence-weighted accuracy increased from 51.7% to 74.3% (p < 0.001). With the traction view, the kappa statistic for agreement with the reference standard increased from 0.530 to 0.791 and from 0.381 to 0.625 for the two readers, and interreader agreement increased from 0.480 to 0.678 (p < 0.001). CONCLUSION The addition of an internal rotation traction radiographic view significantly improves radiologist accuracy and confidence as well as interreader agreement in the classification of proximal femoral fractures, all of which would be expected to best guide appropriate surgical management.
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Bielza R, Mora A, Zambrana F, Sanjurjo J, Sanz-Rosa D, Thuissard IJ, Arias E, Neira M, Gómez Cerezo JF. Impact of a patient blood management program within an Orthogeriatric care service. Transfus Apher Sci 2018; 57:517-523. [PMID: 29871842 DOI: 10.1016/j.transci.2018.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/23/2018] [Accepted: 05/25/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patient blood management (PBM) performs multidisciplinary strategies to optimize red blood cell (RBC) transfusion. Orthogeriatric share care models (surgeon and geriatrician manage the patient together from admission) have the goal of improving outcomes in hip fracture patients. MATERIAL AND METHODS A prospective observational study was conducted. Patients aged ≥70 years undergoing hip fracture (HF) surgery were consecutively included. When admitted on the orthogeriatric service a PBM protocol was applied based on: perioperative antithrombotic management, intravenous iron sucrose administration and restrictive transfusion criteria. Risk factors, clinical and functional effects of transfusion and its requirements were assessed to audit our model. RESULTS A total of 383 patients participated (women, 78.8%; median age, 86 (82-90) years). 210 patients (54.8%) were transfused. Age (OR = 1.055, 95% CI 1.017-1.094; p = 0.004) and Hemoglobin (Hb) level on admission (OR = 0.497, 95% CI 0.413-0.597; p < 0.001) were found to be significant risk factors for transfusion. Transfusion increased length of stay (b = 1.37, 95% CI 0.543-2.196; p = 0.001) but did not have an effect on other variables. DISCUSSION The PBM program established within an orthogeriatric service showed positive outcomes in terms of clinical complications, mortality, delirium or functional recovery in transfused patients, whereas it did not impact on shorter length of stay. The risk of transfusion on admission was predicted with the lower Hb levels on admission, along with the age of the patients. New measurements as homogenous restrictive transfusion criteria, a single-unit RBC transfusion and the assessment of the intravenous iron efficacy are need to be applied as a result of the high transfusion requirements.
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Affiliation(s)
- Rafael Bielza
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain.
| | - Asunción Mora
- Department of Hematology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain
| | - Francisco Zambrana
- Department of Oncology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain
| | - Jorge Sanjurjo
- Department of Orthopedics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain
| | - David Sanz-Rosa
- School of Doctoral Studies & Research, Universidad Europea, Madrid, Spain
| | - Israel J Thuissard
- School of Doctoral Studies & Research, Universidad Europea, Madrid, Spain
| | - Estefanía Arias
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain
| | - Marta Neira
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain
| | - Jorge Francisco Gómez Cerezo
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain
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Bielza R, Fuentes P, Blanco Díaz D, Moreno RV, Arias E, Neira M, Birghilescu AM, Sanjurjo J, Escalera J, Sanz-Rosa D, Thuissard IJ, Gómez Cerezo JF. [Assessment of clinical complications and their associated factors in hip-fracture patients in an Acute Geriatric Orthopaedic Unit]. Rev Esp Geriatr Gerontol 2018; 53:121-127. [PMID: 29486947 DOI: 10.1016/j.regg.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/13/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly. MATERIAL AND METHODS A prospective, observational and analytical study was conducted on 383 consecutive patients admitted to the unit during the years 2013 and 2014. Clinical complications were defined according to recommendations supported by the AOTrauma Network (International Network of Traumatologists for the Study of Osteosynthesis). RESULTS A total of 273 patients (71.28%) showed some clinical complication. The main ones were, delirium (55.4%), renal failure (15.4%), and cardiac complications (12.3%). An ASA III-IV score of OR = 1.962 (95% CI; 1.040-3.704, P=.038), lower Barthel index at discharge (b = -3.572, 95% CI -0.866 to -0.104, P=.01), the increase in pre-operative stay (OR = 1.165, 95% CI 1.050-1.294, P=.004) and an increased length of stay (b = 2.663, 95% CI 3.522-0.325; P<.001) were factors associated with clinical complications. CONCLUSIONS Delirium, renal failure, and cardiac complications were the most frequent complications according the new recommendations. An ASA III-IV score, worse functional status at discharge, prolonged pre-operative period, and increased length of stay, were risk factors associated with clinical complications. Cardiac, pulmonary, and gastrointestinal complications were the main causes of mortality in the unit.
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Affiliation(s)
- Rafael Bielza
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España.
| | - Paola Fuentes
- Servicio de Geriatría, Hospital Naval A. Nef, Escuela de Medicina sede Viña del Mar, Facultad de Medicina, Universidad Andrés Bello, Viña del Mar, Valparaíso, Chile
| | - David Blanco Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Ricardo Vicente Moreno
- Servicio de Rehabilitación, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Estefanía Arias
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Marta Neira
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Ana M Birghilescu
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Jorge Sanjurjo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Javier Escalera
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - David Sanz-Rosa
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Israel J Thuissard
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Jorge F Gómez Cerezo
- Servicio de Medicina Interna-Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
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Lee YK, Moon KH, Kim JW, Ha YC, Lee MH, Koo KH. Learning Curve of Internal Fixation for Nondisplaced Femoral Neck Fractures: A Cumulative Sum Analysis. Clin Orthop Surg 2018; 10:9-13. [PMID: 29564041 PMCID: PMC5851860 DOI: 10.4055/cios.2018.10.1.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/22/2017] [Indexed: 01/30/2023] Open
Abstract
Background The purpose of this study was to determine whether there is a learning curve for internal fixation for nondisplaced femoral neck fractures using the cumulative sum (CUSUM) technique. We applied the CUSUM technique in monitoring performance of a single surgeon in internal fixation for nondisplaced femoral neck fractures. Methods Fifty consecutive patients who underwent internal fixation for nondisplaced femoral neck fractures were evaluated retrospectively. Loss of fixation within 6 months postoperatively was considered as failure of treatment. Patients were stratified into the early experience group (cases 1 to 25) and the late experience group (cases 26 to 50). The CUSUM method was used to analyze the learning curve. Results There was no failure of treatment during study period. The operation time became shorter with experience. Using the CUSUM analysis to plot the learning curve, there was no significant learning curve observed for multiple pinning for nondisplaced femoral neck fractures. Conclusions The CUSUM analysis revealed there was no obvious learning curve to become proficient at internal fixation for nondisplaced femoral neck fractures, if technical principles were followed during the procedure.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Ho Moon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Woo Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung-Ho Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Ghoshal A, Enninghorst N, Sisak K, Balogh ZJ. An interobserver reliability comparison between the Orthopaedic Trauma Association's open fracture classification and the Gustilo and Anderson classification. Bone Joint J 2018; 100-B:242-246. [DOI: 10.1302/0301-620x.100b2.bjj-2017-0367.r1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims To evaluate interobserver reliability of the Orthopaedic Trauma Association’s open fracture classification system (OTA-OFC). Patients and Methods Patients of any age with a first presentation of an open long bone fracture were included. Standard radiographs, wound photographs, and a short clinical description were given to eight orthopaedic surgeons, who independently evaluated the injury using both the Gustilo and Anderson (GA) and OTA-OFC classifications. The responses were compared for variability using Cohen’s kappa. Results The overall interobserver agreement was ĸ = 0.44 for the GA classification and ĸ = 0.49 for OTA-OFC, which reflects moderate agreement (0.41 to 0.60) for both classifications. The agreement in the five categories of OTA-OFC was: for skin, ĸ = 0.55 (moderate); for muscle, ĸ = 0.44 (moderate); for arterial injury, ĸ = 0.74 (substantial); for contamination, ĸ = 0.35 (fair); and for bone loss, ĸ = 0.41 (moderate). Conclusion Although the OTA-OFC, with similar interobserver agreement to GA, offers a more detailed description of open fractures, further development may be needed to make it a reliable and robust tool. Cite this article: Bone Joint J 2018;100-B:242–6.
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Affiliation(s)
- A. Ghoshal
- John Hunter Hospital, Lookout
Road, New Lambton Heights NSW 2305, Australia
| | - N. Enninghorst
- John Hunter Hospital and University of
Newcastle, Lookout Road, New
Lambton Heights NSW 2305, Australia
| | - K. Sisak
- John Hunter Hospital, Lookout
Road, New Lambton Heights NSW 2305, Australia
| | - Z. J. Balogh
- John Hunter Hospital and University of
Newcastle, Lookout Road, New
Lambton Heights NSW 2305, Australia
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Kazley JM, Banerjee S, Abousayed MM, Rosenbaum AJ. Classifications in Brief: Garden Classification of Femoral Neck Fractures. Clin Orthop Relat Res 2018; 476:441-445. [PMID: 29389800 PMCID: PMC6259691 DOI: 10.1007/s11999.0000000000000066] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Jillian M Kazley
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Fonseca LLD, Nunes IG, Nogueira RR, Martins GEV, Mesencio AC, Kobata SI. Análise da reprodutibilidade das classificações de Lauge‐Hansen, Danis‐Weber e AO para as fraturas de tornozelo. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Fonseca LLD, Nunes IG, Nogueira RR, Martins GEV, Mesencio AC, Kobata SI. Reproducibility of the Lauge-Hansen, Danis-Weber, and AO classifications for ankle fractures. Rev Bras Ortop 2017; 53:101-106. [PMID: 29367914 PMCID: PMC5771788 DOI: 10.1016/j.rboe.2017.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/03/2017] [Indexed: 12/24/2022] Open
Abstract
Objective This study evaluated the reproducibility of the three main classifications of ankle fractures most commonly used in emergency clinical practice: Lauge-Hansen, Danis-Weber, and AO-OTA. The secondary objective was to assess whether the level of professional experience influenced the interobserver agreement for the classification of this pathology. Methods The study included 83 digitized preoperative radiographic images of ankle fractures, in anteroposterior and lateral views, of different adults that had occurred between January and December 2013. For sample calculation, the estimated accuracy was approximately 15%, with a sampling error of 5% and a sampling power of 80%. The images were analyzed and classified by six different observers: two foot and ankle surgeons, two general orthopedic surgeons, and two-second-year residents in orthopedics and traumatology. The Kappa statistical method of multiple variances was used to assess the variations. Results The Danis-Weber classification indicated that 40% of the agreements among all observers were good or excellent, whereas only 20% of good and excellent agreements were obtained using the AO and Lauge Hansen classifications. The Kappa index was 0.49 for the Danis-Weber classification, 0.32 for Lauge Hansen, and 0.38 for AO. Conclusion The Hansen-Lauge classification presented the poorest interobserver agreement among the three systems. The AO classification demonstrated a moderate agreement and the Danis-Weber classification presented an excellent interobserver agreement index, regardless of professional experience.
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Affiliation(s)
- Lucas Lopes da Fonseca
- Departamento de Ortopedia e Traumatologia, Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil
| | - Icaro Gusmão Nunes
- Departamento de Ortopedia e Traumatologia, Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil
| | - Rodrigo Reis Nogueira
- Departamento de Ortopedia e Traumatologia, Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil
| | | | - Antônio Cesar Mesencio
- Serviço de Ortopedia, Instituto de Previdência dos Servidores do Estado de Minas Gerais, Hospital da Previdência, Belo Horizonte, MG, Brazil
| | - Sílvia Iovine Kobata
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Zhao J, Ma XL, Ma JX, Sun L, Lu B, Wang Y, Xing GS, Wang Y, Dong BC, Xu LY, Kuang MJ, Fu L, Bai HH, Ma Y, Jin WL. TET3 Mediates Alterations in the Epigenetic Marker 5hmC and Akt pathway in Steroid-Associated Osteonecrosis. J Bone Miner Res 2017; 32:319-332. [PMID: 27627619 DOI: 10.1002/jbmr.2992] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 01/10/2023]
Abstract
Steroid-associated osteonecrosis (SAON) is one of the common complications of clinical glucocorticoid (GC) administration, with osteocyte apoptosis appearing as the primary histopathological lesion. However, the precise mechanism underlying SAON remains unknown. Epigenetic modification may be a major cause of SAON. Recently, cumulative research revealed that Ten-Eleven Translocation (TET) proteins can catalyze the conversion of 5-methylcytosine (5mC) to 5-hydroxymethylcytosine (5hmC) and then alter the epigenetic state of DNA. Here, we report that TET3-5hmC was upregulated in the femoral head tissues of SAON patients and MLO-Y4 cells with dexamethasone (Dex) treatment. Knockdown of TET3 in MLO-Y4 cells decreased 5hmC enrichment and rescued Dex-induced apoptosis. Meanwhile, the local intramedullary injection of TET3 siRNA in Sprague-Dawley rats abrogated GC-induced osteocyte apoptosis, histopathological changes, abnormal MRI signals, and bone microstructure declines in the femoral head in vivo. Moreover, a hydroxymethylated DNA immunoprecipitation (hMeDIP)-chip analysis of Dex-treated osteocytes revealed 456 different 5hmC-enriched genes. The Akt pathway was found to mediate the functional effect of Dex-induced dynamic 5hmC change; this was further verified in clinical samples. The loss of TET3 in MLO-Y4 cells abrogated Dex-induced Akt signaling pathway inhibition. Therefore, our data for the first time identify the effect of TET3-5hmC on the Akt pathway and the necessity of this signaling cascade in SAON, identifying a new potential therapeutic target. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jie Zhao
- Tianjin Medical University General Hospital, Tianjin, China.,Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Xin-Long Ma
- Tianjin Medical University General Hospital, Tianjin, China.,Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Jian-Xiong Ma
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Lei Sun
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Bin Lu
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Ying Wang
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Guo-Sheng Xing
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Yan Wang
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Ben-Chao Dong
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Li-Yan Xu
- Tianjin Medical University General Hospital, Tianjin, China.,Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Ming-Jie Kuang
- Tianjin Medical University General Hospital, Tianjin, China.,Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Lin Fu
- Tianjin Medical University General Hospital, Tianjin, China.,Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Hao-Hao Bai
- Institute of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Yue Ma
- Department of Instrument Science and Engineering, Key Lab. for Thin Film and Microfabrication Technology of Ministry of Education, School of Electronic Information and Electronic Engineering, Shanghai Jiao Tong University, Shanghai, China.,National Centers for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei-Lin Jin
- Department of Instrument Science and Engineering, Key Lab. for Thin Film and Microfabrication Technology of Ministry of Education, School of Electronic Information and Electronic Engineering, Shanghai Jiao Tong University, Shanghai, China.,National Centers for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
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Bandyopadhyay O, Biswas A, Bhattacharya BB. Classification of long-bone fractures based on digital-geometric analysis of X-ray images. PATTERN RECOGNITION AND IMAGE ANALYSIS 2016. [DOI: 10.1134/s1054661816040027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Turgut A, Kumbaracı M, Kalenderer Ö, İlyas G, Bacaksız T, Karapınar L. Is surgeons' experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:601-605. [PMID: 27889406 PMCID: PMC6197310 DOI: 10.1016/j.aott.2015.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/15/2015] [Accepted: 11/11/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate whether surgeons' experience affect inter- and intra-observer reliability among mostly used classification systems for femoral neck fractures. MATERIAL AND METHODS A power point presentation was prepared with 107 slides which were antero-posterior radiographs of each femoral neck fracture. Five residents, 5 orthopaedic surgeons and 5 senior orthopaedic surgeons reviewed this presentation and classified the fractures according to Garden, Pauwels and AO classifications. The order of the slides was changed and reviews were repeated after 3 months. Fleiss kappa and intraclass correlation coefficient values were calculated to evaluate inter and intra-observer reliability. RESULTS Garden and AO classifications' inter-observer reliabilities were similar and higher than Pauwels classification. Among three experience groups, the inter-observer reliability for Garden classification was highest in senior surgeon group, the interobserver reliability for AO classification was highest in surgeon group, and interobserver reliability of Pauwels classification was highest in low experienced groups (residents and surgeons). Intra-observer reliability was highest for Garden and lowest for Pauwels classifications. Surgical experience was found to be not effective for intraobserver reliability. CONCLUSION Both Garden and AO classifications were more reliable than Pauwels classification. Surgical experience was not significantly important on these three classification systems' evaluation. LEVEL OF EVIDENCE Level IV, Diagnostic study.
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Affiliation(s)
- Ali Turgut
- Tepecik Eğitim ve Araştırma Hastanesi, İzmir, Turkey.
| | | | | | - Gökhan İlyas
- Tepecik Eğitim ve Araştırma Hastanesi, İzmir, Turkey
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Dela Rosa TL, Vance MC, Stern PJ. Radiographic Optimization of the Eaton Classification. ACTA ACUST UNITED AC 2016; 29:173-7. [PMID: 15010167 DOI: 10.1016/j.jhsb.2003.09.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Accepted: 09/04/2003] [Indexed: 10/26/2022]
Abstract
Thumb basal arthritis is evaluated using the Eaton classification. However, the shape and orientation of the trapezium do not allow easy visualization of this bone. The purpose of this study was to determine if the intra- and interobserver reliability of the Eaton classification could be improved using a combination of X-rays. Six hand surgeons independently evaluated 40 sets of X-rays. First, the X-rays were staged using the posterior–anterior and lateral views of the wrist, and then using just the Bett’s (Gedda’s) view. Subsequently, all three views were evaluated together. The process was repeated at least 1 week later. Intra- and interobserver reliability was measured using kappa statistics. Results show a trend toward increased reliability when the three views are used. Agreement between the stages using the posterior–anterior and lateral X-rays and the Bett’s view was only fair. With three views, intraobserver reproducibility is good while interobserver reliability is moderate.
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Affiliation(s)
- T L Dela Rosa
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Han S, Oh M, Yoon S, Kim J, Kim JW, Chang JS, Ryu JS. Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT. Nucl Med Mol Imaging 2016; 51:49-57. [PMID: 28250858 DOI: 10.1007/s13139-016-0443-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/23/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. METHODS We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. RESULTS Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2-10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. CONCLUSIONS According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.
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Affiliation(s)
- Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minyoung Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seokho Yoon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Wan Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea
| | - Jae-Suk Chang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hartel MJ, Mandani SM, Nuechtern J, Stiel N, Lehmann W, Rueger JM, Grossterlinden LG. On-table decision-making in intracapsular hip fracture surgery: mid-term results of a pilot study. Arch Orthop Trauma Surg 2016; 136:913-9. [PMID: 27155882 DOI: 10.1007/s00402-016-2469-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION At the present time, it is generally recommended to use hip replacement in dislocated fractures to avoid failure after internal fixation. A problem is that previous research has demonstrated that observers have problems in discriminating between dislocated and undislocated fractures. A possible solution to this problem would be to use arthroplasty in the majority of the cases. However, this also means that many fractures with the potential for uneventful healing would be replaced. MATERIALS AND METHODS In the current investigation, the mid-term outcome was recorded for patients with intracapsular hip fractures who were treated with either internal fixation or arthroplasty. A novel treatment algorithm was employed. After careful exclusion of cases with known risk factors for failure after internal fixation, a technique called on-table decision was used to identify suitable patients for internal fixation. RESULTS A total of 72 patients with intracapsular hip fractures were studied with a median follow-up time of 12 months (IQR 8-15.25 months). Nineteen (19) patients (26 %) were excluded in the selection process, leaving 53 (74 %) for on-table decision-making. Thirty patients (42 %) were identified as suitable for internal fixation and gave anatomically stable closed reductions. Two of these patients (7 %) exhibited non-unions and one (3 %) avascular necrosis. CONCLUSIONS The mid-term outcome after internal fixation is promising. The careful selection process may be helpful in identifying fracture patterns for which internal fixation may be considered as a safe and less invasive alternative to hip arthroplasty.
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Affiliation(s)
- Maximilian J Hartel
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Shahab Maafi Mandani
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jakob Nuechtern
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Norbert Stiel
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes M Rueger
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lars G Grossterlinden
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Nelson KP, Edwards D. A measure of association for ordered categorical data in population-based studies. Stat Methods Med Res 2016; 27:812-831. [PMID: 27184590 DOI: 10.1177/0962280216643347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ordinal classification scales are commonly used to define a patient's disease status in screening and diagnostic tests such as mammography. Challenges arise in agreement studies when evaluating the association between many raters' classifications of patients' disease or health status when an ordered categorical scale is used. In this paper, we describe a population-based approach and chance-corrected measure of association to evaluate the strength of relationship between multiple raters' ordinal classifications where any number of raters can be accommodated. In contrast to Shrout and Fleiss' intraclass correlation coefficient, the proposed measure of association is invariant with respect to changes in disease prevalence. We demonstrate how unique characteristics of individual raters can be explored using random effects. Simulation studies are conducted to demonstrate the properties of the proposed method under varying assumptions. The methods are applied to two large-scale agreement studies of breast cancer screening and prostate cancer severity.
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Affiliation(s)
- Kerrie P Nelson
- 1 Department of Biostatistics, Boston University, Boston, USA
| | - Don Edwards
- 2 Department of Statistics, University of South Carolina, South Carolina, USA
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Andersen MF, Jakobsen T, Bensen AS, Krarup N. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture. SICOT J 2015; 1:26. [PMID: 27163081 PMCID: PMC4849254 DOI: 10.1051/sicotj/2015028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: Acute displaced femoral neck fractures are often treated with cemented hemiarthroplasty (HA). There is increasing evidence that total hip arthroplasty (THA) may be a better alternative, but the degree to which the fixation of the femoral stem used affects the outcome is not fully known. The aim of this study is to compare rates of operative complications and implant survival following THA treatment of displaced femoral neck fractures with either a cemented or an uncemented femoral stem. Methods: The study consists of two groups of patients (N = 334), who were treated for a displaced femoral neck fracture with THA at the Regional Hospital of Viborg during 2007–2012. The first group (50.9%) had uncemented (Corail®) stem while the second group (49.1%) had cemented (Exeter®) stem implanted. Nearly all patients had uncemented dual mobility cup (Saturne®) as acetabular component and were followed up to three months postoperatively. Data regarding rates of implant survival and operative complications were obtained by retrospective review of medical records. Results: We found a statistically significant difference regarding rates of postoperative reoperation with 1.2% (95% CI 0.005–0.03) for cemented and 5.9% (95% CI 0.02–0.09) for uncemented stem (p = 0.02). The main causes for reoperation were peri-prosthetic fractures and deep infections. There was no difference regarding dislocation or peroperative complications. Rates of dislocation were 4.3% (95% CI 0.012–0.07) for cemented and 3.5% (95% CI 0.008–0.06) for uncemented stem (p = 0.72). Rates of peroperative complications were 6.1% (95% CI 0.024–0.1) for cemented and 8.2% (95% CI 0.04–0.12) for uncemented stem (p = 0.1). Discussion: Our results indicate that cemented femoral stem is superior to cementless when rates of reoperation are compared.
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Affiliation(s)
- Michelle Fog Andersen
- Department of Orthopaedic Surgery, The Regional Hospital in Viborg Heibergs Allé 4 8800 Viborg Denmark
| | - Thomas Jakobsen
- Department of Orthopaedic Surgery, The Regional Hospital in Viborg Heibergs Allé 4 8800 Viborg Denmark ; Orthopaedic Research Unit, Aarhus University Hospital Tage-Hansens Gade 2 8000 Aarhus C Denmark
| | - Anne S Bensen
- Department of Orthopaedic Surgery, Odense University Hospital Sdr. Boulevard 29 5000 Odense C Denmark
| | - Niels Krarup
- Department of Orthopaedic Surgery, The Regional Hospital in Viborg Heibergs Allé 4 8800 Viborg Denmark
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Fu X, Xu GJ, Li ZJ, Du CL, Han Z, Zhang T, Ma X. Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures. Medicine (Baltimore) 2015; 94:e1393. [PMID: 26426607 PMCID: PMC4616870 DOI: 10.1097/md.0000000000001393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to employ a new three-dimensional (3D) reconstruction and modeling method to measure displacement of undisplaced femoral neck fractures (Garden stages I and II). We also aimed to evaluate the effectiveness of the Garden classification for determining the displacement of undisplaced femoral neck fractures. A total of 120 consecutive patients with undisplaced femoral neck fractures were enrolled between 2012 and 2014, including 60 within the Garden I group and 60 within the Garden II group. The displacements of the femoral head center (d1) and the lowest point of the fovea capitis femoris (d2) and rotational displacement of the femoral head (α) in the 3D model were measured with 3D computed tomography reconstruction and modeling. Five observers, trauma surgeons, were asked to found the centers of the femoral heads and the deepest points of the foveae. The intraobserver and inter-observer agreements were calculated using Fleiss' kappa. The inter-observer and intra-observer kappa values were 0.937 and 0.985, respectively. Current method has good reliability. We discovered that many participants in our study had been misclassified by an anterior-posterior radiograph as having an "incomplete" fracture. In incomplete fracture of Garden stage I group, the average displacements d1 and d2 were 3.69 ± 1.77 mm and 14.51 ± 1.91 mm, respectively. The mean α was 4.91° ± 2.49°. For impacted fracture of Garden stage I, significant spatial displacement in the impacted fractures was observed (d1: 6.22 ± 3.36 mm; d2: 10.30 ± 5.73 mm; and α: 17.83° ± 10.72°). Similarly, significant spatial displacement was observed among the Garden stage II group (d1: 7.16 ± 4.58 mm; d2: 12.95 ± 8.25 mm; and α: 18.77° ± 9.10°). There was no significant difference in α, d1, and d2 between impacted fracture and Garden stage II groups (P > 0.05). However, significant differences were found between incomplete fracture and Garden stage II groups (P < 0.05). Our findings suggest that 3D reconstruction and modeling may be a better tool for assessing femoral neck fractures than the Garden classification. Undisplaced femoral neck fractures showed variable degrees of displacement and were not undisplaced, stable fractures. Garden classification for undisplaced femoral neck fractures has certain limitations.
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Affiliation(s)
- Xin Fu
- From the Department of Orthopedics, Tianjin Hospital, Tianjin, P.R. China (XF, G-JX, ZH); Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, P.R. China (Z-JL, TZ); and Department of Orthopedics, Binzhou Medical University Hospital, Shandong, P.R. China (C-LD)
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Minimally invasive surgery for femoral neck fractures using bone cement infusible hollow-perforated screw in high-risk patients with advanced cancer. Surg Oncol 2015; 24:226-31. [DOI: 10.1016/j.suronc.2015.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/22/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Li M, Cole PA. Anatomical considerations in adult femoral neck fractures: how anatomy influences the treatment issues? Injury 2015; 46:453-8. [PMID: 25549821 DOI: 10.1016/j.injury.2014.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
Femoral neck fractures in physiologically young adults are relatively uncommon. The reported incidence of avascular necrosis and nonunion rates remain relatively high despite the advancement in understanding and surgical management. Understanding the normal femoral neck anatomy and its relationship to presenting fracture pathology in young adults could help to lessen reported high complication rates to provide better clinical outcomes.
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Affiliation(s)
- Mengnai Li
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St Paul, MN 55101, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter A Cole
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St Paul, MN 55101, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
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Factors predicting secondary displacement after non-operative treatment of undisplaced femoral neck fractures. Arch Orthop Trauma Surg 2015; 135:243-249. [PMID: 25550094 DOI: 10.1007/s00402-014-2139-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We quantified the risk and the time of occurrence of secondary fracture displacement in non-operatively treated femoral neck fractures in our clinic, as well as investigated potential predicting patient- and fracture-related factors. METHODS The records of 593 patients with femoral neck fractures from January 2000 to December 2009 were reviewed. Sixty-one patients [mean age 83.0 years (SD 9.9)] with undisplaced femoral neck fractures initially received non-operative treatment. The occurrence and the time of secondary fracture displacement were documented, as well as demographics and radiological parameters. Radiographs were evaluated independently by two surgeons. Multivariable regression and Kaplan-Meier survival analyses were used. RESULTS Thirty-four (55.7 %) fractures showed secondary displacement occurring within the first 12 weeks after initiation of non-operative treatment. Twenty (38 %) fractures originally classified as Garden I were found to be Garden II. The risk of secondary displacement was three times higher (RR = 2.8; 95 % CI 1.7-4.8, p < 0.001) for these fractures in comparison with those confirmed as Garden I. Patients with a history of previously diagnosed osteoporosis were at a higher risk of secondary displacement as well (RR = 1.3; 95 % CI 1.0-1.5). CONCLUSIONS Non-operative treatment of femoral neck fractures is a treatment option, but only in well-selected cases. The majority of secondary displacements were associated with initial misdiagnosis using the Garden classification. For Garden II, primary surgical treatment is likely a better option, and therefore careful application of the Garden classification in this context is essential.
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Freitas A, Azevedo BAS, Souza RRD, Costa HID, Maciel RA, Souto DRDM. Mechanical analysis of femoral neck fracture fixation in synthetic bone. ACTA ORTOPEDICA BRASILEIRA 2014; 22:155-8. [PMID: 25061423 PMCID: PMC4108699 DOI: 10.1590/1413-78522014220300914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE: To analyze statistically results obtained between biomechanical assays on fixation of femoral neck fracture type Pauwels III, on synthetic bone, using 7.5 mm non parallel cannulated screws and control group. METHODS: Ten synthetic bones from a national brand were used. Test group: fixation of 70(o) tilt femoral neck osteotomy was performed using three 7.5 mm non parallel cannulated screws. We analyzed the resistance of this fixation with 5 mm of displacement, and rotational deviation (phase 1) and with 10 mm offset (phase 2). Control group: the models were tested in their integrity until the femoral neck fracture occurred. RESULTS: the values of the test group in phase 1, in sample 1-5 had a mean of 517N and SD = 96N. Rotational deviations showed a mean of 3.79° e SD = 2. 03°. In phase 2, mean was 649N and SD = 94N. The values of the maximum load in the control group were: 1544N, 1110N, 1359N, 1194N, 1437N; respectively. Statistical analysis between the groups showed a statistically significant lower value in the test group. CONCLUSION: the analysis of mechanical resistance between the groups has determined statistically significant value for the test group. Level of Evidence III, Case-control Study.
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Lakstein D, Hendel D, Haimovich Y, Feldbrin Z. Changes in the pattern of fractures of the hip in patients 60 years of age and older between 2001 and 2010. Bone Joint J 2013; 95-B:1250-4. [DOI: 10.1302/0301-620x.95b9.31752] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to identify changing trends in the pattern of distribution of the type and demographics of fractures of the hip in the elderly between 2001 and 2010. A retrospective cross-sectional comparison was conducted between 179 fractures of the hip treated in 2001, 357 treated in 2006 and 454 treated in 2010. Patients aged < 60 years and those with pathological and peri-prosthetic fractures were excluded. Fractures were classified as stable extracapsular, unstable extracapsular or intracapsular fractures. The mean age of the 179 patients (132 women (73.7%)) treated in 2001 was 80.8 years (60 to 96), 81.8 years (61 to 101) in the 357 patients (251 women (70.3%)) treated in 2006 and 82.0 years (61 to 102) in the 454 patients (321 women (70.1%)) treated in 2010 (p = 0.17). There was no difference in the gender distribution between the three study years (p = 0.68). The main finding was a steep rise in the proportion of unstable peritrochanteric fractures. The proportion of unstable extracapsular fractures was 32% (n = 57) in 2001, 35% (n = 125) in 2006 and 45% (n = 204) in 2010 (p < 0.001). This increase was not significant in patients aged between 60 and 69 years (p = 0.84), marginally significant in those aged between 70 and 79 years (p = 0.04) and very significant in those aged > 80 years (p < 0.001). The proportion of intracapsular fractures did not change (p = 0.94). At present, we face not only an increasing number of fractures of the hip, but more demanding and complex fractures in older patients than a decade ago. This study does not provide an explanation for this change. Cite this article: Bone Joint J 2013;95-B:1250–4.
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Affiliation(s)
- D. Lakstein
- E. Wolfson Medical Center, Orthopaedic
Department, Holon 58100, Israel
| | - D. Hendel
- E. Wolfson Medical Center, Orthopaedic
Department, Holon 58100, Israel
| | - Y. Haimovich
- E. Wolfson Medical Center, Orthopaedic
Department, Holon 58100, Israel
| | - Z. Feldbrin
- E. Wolfson Medical Center, Orthopaedic
Department, Holon 58100, Israel
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Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res 2013; 471:2691-702. [PMID: 23640205 PMCID: PMC3705035 DOI: 10.1007/s11999-013-3020-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 04/22/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral neck fractures (FNFs) comprise 50% of geriatric hip fractures. Appropriate management requires surgeons to balance potential risks and associated healthcare costs with surgical treatment. Treatment complications can lead to reoperation resulting in increased patient risks and costs. Understanding etiologies of treatment failure and the population at risk may decrease reoperation rates. QUESTIONS/PURPOSES We therefore (1) determined if treatment modality and/or displacement affected reoperation rates after FNF; and (2) identified factors associated with increased reoperation and timing and reasons for reoperation. METHODS We reviewed 1411 records of patients older than 60 years treated for FNF with internal fixation or hemiarthroplasty between 1998 and 2009. We extracted patient age, sex, fracture classification, treatment modality and date, occurrence of and reasons for reoperation, comorbid conditions at the time of each surgery, and dates of death or last contact. Minimum followup was 12 months (median, 45 months; range, 12-157 months). RESULTS Internal fixation (hazard ratio [HR], 6.38) and displacement (HR, 2.92) were independently associated with increased reoperation rates. The reoperation rate for nondisplaced fractures treated with fixation was 15% and for displaced fractures 38% after fixation and 7% after hemiarthroplasty. Most fractures treated with fixation underwent reoperation within 1 year primarily for nonunion. Most fractures treated with hemiarthroplasty underwent reoperation within 3 months, primarily for infection. CONCLUSIONS Overall, hemiarthroplasty resulted in fewer reoperations versus internal fixation and displaced fractures underwent reoperation more than nondisplaced. Our data suggest there are fewer reoperations when treating elderly patients with displaced FNFs with hemiarthroplasty than with internal fixation.
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Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. J Orthop Trauma 2013; 27:386-90; discussion 390-1. [PMID: 23287762 DOI: 10.1097/bot.0b013e318281da6e] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze factors influencing the reoperation rate due to fracture healing complications after internal fixation of Garden I and II femoral neck fractures with special reference to a new validated method assessing the preoperative posterior tilt on lateral radiographs. DESIGN Prospective cohort study. SETTING Level II trauma center. PATIENTS A consecutive cohort of 382 hips in 379 patients who underwent internal fixation for a Garden I or II femoral neck fracture. INTERVENTION The posterior tilt in preoperative radiographs was analyzed with a new validated method. A Cox regression analysis was used to evaluate factors associated with reoperation due to fracture healing complications. Age, gender, cognitive function, ASA classification, time to surgery, and the posterior tilt were tested as independent factors in the model. MAIN OUTCOME MEASURES Reoperation rate due to fracture healing complications with a minimal follow-up of 5 years. Reoperation data were validated against the National Board of Health and Welfare's national registry using unique Swedish personal identification numbers. RESULTS The overall reoperation rate was 19% (72 of 382 hips) and the reoperation rate due to fracture healing complications was 12% (45 of 382 hips). The posterior tilt had no influence on the risk for reoperation due to fracture healing complication, nor had the age, gender, cognitive function, ASA classification, or the time to surgery. CONCLUSIONS Preoperative posterior tilt measurement on lateral radiographs cannot be used as a discriminator for fracture healing complications in Garden I and II femoral neck fractures. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Bhandari M, Chiavaras MM, Parasu N, Choudur H, Ayeni O, Chakravertty R, Bains S, Hak A, Sprague S, Petrisor B. Radiographic union score for hip substantially improves agreement between surgeons and radiologists. BMC Musculoskelet Disord 2013; 14:70. [PMID: 23442540 PMCID: PMC3599458 DOI: 10.1186/1471-2474-14-70] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
Background Despite the prominence of hip fractures in orthopedic trauma, the assessment of fracture healing using radiographs remains subjective. The variability in the assessment of fracture healing has important implications for both clinical research and patient care. With little existing literature regarding reliable consensus on hip fracture healing, this study was conducted to determine inter-rater reliability between orthopedic surgeons and radiologists on healing assessments using sequential radiographs in patients with hip fractures. Secondary objectives included evaluating a checklist designed to assess hip fracture healing and determining whether agreement improved when reviewers were aware of the timing of the x-rays in relation to the patients’ surgery. Methods A panel of six reviewers (three orthopedic surgeons and three radiologists) independently assessed fracture healing using sequential radiographs from 100 patients with femoral neck fractures and 100 patients with intertrochanteric fractures. During their independent review they also completed a previously developed radiographic checklist (Radiographic Union Score for Hip (RUSH)). Inter and intra-rater reliability scores were calculated. Data from the current study was compared to the findings from a previously conducted study where the same reviewers, unaware of the timing of the x-rays, completed the RUSH score. Results The agreement between surgeons and radiologists for fracture healing was moderate for “general impression of fracture healing” in both femoral neck (ICC = 0.60, 95% CI: 0.42-0.71) and intertrochanteric fractures (0.50, 95% CI: 0.33-0.62). Using a standardized checklist (RUSH), agreement was almost perfect in both femoral neck (ICC = 0.85, 95% CI: 0.82-0.87) and intertrochanteric fractures (0.88, 95% CI: 0.86-0.90). We also found a high degree of correlation between healing and the total RUSH score using a Receiver Operating Characteristic (ROC) analysis, there was an area under the curve of 0.993 for femoral neck cases and 0.989 for intertrochanteric cases. Agreement within the radiologist group and within the surgeon group did not significantly differ in our analyses. In all cases, radiographs in which the time from surgery was known resulted in higher agreement scores compared to those from the previous study in which reviewers were unaware of the time the radiograph was obtained. Conclusions Agreement in hip fracture radiographic healing may be improved with the use of a standardized checklist and appears highly influenced by the timing of the radiograph. These findings should be considered when evaluating patient outcomes and in clinical studies involving patients with hip fractures. Future research initiatives are required to further evaluate the RUSH checklist.
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Affiliation(s)
- Mohit Bhandari
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
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Chen W, Li Z, Su Y, Hou Z, Zhang Q, Zhang Y. Garden type I fractures myth or reality? A prospective study comparing CT scans with X-ray findings in Garden type I femoral neck fractures. Bone 2012; 51:929-932. [PMID: 22884722 DOI: 10.1016/j.bone.2012.07.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 07/24/2012] [Accepted: 07/25/2012] [Indexed: 12/27/2022]
Abstract
The Garden type I femoral neck fracture is defined as an incomplete fracture of the neck of the femur as seen on the antero-posterior (AP) radiograph of the injured hip. The diagnosis of incomplete femoral neck fractures has decreased in recent years with the development of improved radiographic imaging. We hypothesized that incomplete femoral neck fractures seen on radiographs are in fact complete fractures on computed tomography (CT). The study aims to test this hypothesis by comparing CT scan images to X-ray findings in patients diagnosed with Garden type I femoral neck fractures. From January 2008 to October 2010, our management of femoral neck fractures included a CT scan of the injured hip for all Garden type I fractures. CT findings were reported by a musculoskeletal radiologist. A classification of the fracture was performed by an orthopedic surgeon. Eight hundred and twenty five femoral neck fractures were admitted during the study period. Seventeen of these fractures (2.1%) were considered incomplete based on radiographic evaluation. In 17 cases (100%), the CT scan demonstrated a complete fracture extending through the medial cortex. Subsequently, all 17 fractures were fixed with standard cannulated screw technique on a fracture table. Secondary displacement occurred in one patient prior to fixation. All fractures healed well and no avascular necrosis was noted. In summary, our study shows that incomplete femoral neck fractures identified on X-rays are actually complete fractures based on CT scans. If confirmed by a larger study population, our findings can simplify the Garden classification by eliminating an inaccurate subcategory. The clinical implications are that Garden type I fractures should all likely be fixed with cannulated screws and with an effort to prevent displacement during treatment.
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Affiliation(s)
- Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
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