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Shahzad MG, Dawood MH, Hussain K, Gul S, Sultan SA, Zarar M. Age-stratified analysis of delayed fixation outcomes of femoral neck fracture among adults: A retrospective study at a tertiary care trauma center. J Int Med Res 2025; 53:3000605251336110. [PMID: 40305141 PMCID: PMC12046147 DOI: 10.1177/03000605251336110] [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: 10/13/2024] [Accepted: 02/25/2025] [Indexed: 05/02/2025] Open
Abstract
ObjectiveThis study investigated the delayed fixation outcomes of femoral neck fractures stratified by age and surgical delay in adult patients at a tertiary care trauma center.MethodA retrospective study was conducted involving patients with femoral neck fractures admitted to the orthopedic ward of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma between January 2019 and March 2023. Participants aged 18-60 years who underwent delayed surgery (>48 h) were included. Data on patient demographics, fracture and surgical characteristics, and outcomes were analyzed. This study utilized chi-square or Fisher's exact tests to compare outcomes between patients stratified by surgical delays as well as age.ResultsAmong 108 participants, 63.9% were aged 18-30 years and 36.1% were aged 31-60 years. Avascular necrosis was predominantly observed in older patients who underwent surgery within 7 days (P = 0.001), whereas other complications such as nonunion and infection were more prevalent in patients aged 18-30 years whose surgery was delayed by >7 days (P = 0.303). Patients who underwent surgery within 7 days had shorter length of hospital stay and faster return to work in both age groups (P < 0.05), whereas those aged 18-30 years experienced the opposite when surgery was delayed beyond 7 days.ConclusionsSurgical fixation within 7 days leads to better recovery and fewer complications in adults with femoral neck fractures, whereas delayed surgery provides acceptable outcomes. Age-specific protocols are key to optimizing results.
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Affiliation(s)
- Muhammad Gulfam Shahzad
- Department of Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Pakistan
| | | | - Kazim Hussain
- Department of Orthopedic Surgery, Russells Hall Hospital, United Kingdom
| | - Shakeel Gul
- Department of Orthopedic Surgery, Creek General Hospital, Pakistan
| | - Syed Akmal Sultan
- Department of Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Pakistan
| | - Musab Zarar
- Department of Orthopedic Surgery, Creek General Hospital, Pakistan
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Mueller T, Weiß B, Wirth T, Fernandez FF. Risk factors of avascular femoral head necrosis after a pediatric femoral neck fracture: a 15-year follow up and an adjustment to the Delbet classification. Eur J Trauma Emerg Surg 2025; 51:28. [PMID: 39833491 DOI: 10.1007/s00068-024-02728-z] [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: 07/29/2024] [Accepted: 10/04/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Pediatric femoral neck fractures (PFNF) are rare but associated with a high rate of serious complications such as avascular femoral head necrosis (AVN). Major risk factors and prognostic tools for an AVN are still unclear. As AVN is a devastating complication, this study aims to evaluate the predictors for AVN following a PFNF. MATERIAL AND METHODS All patients that suffered a PFNF or an AVN following a PFNF in the last 15 years that were treated at a university-level hospital with a minimum of 12 months follow-up were included in this retrospective study. Patients with a pathological fracture or closed epiphysis were excluded. Radiological outcome was evaluated based on Ratcliff criteria. The association of possible risk factors such as age, gender, traumatic mechanism, fracture type, degree of dislocation, time to surgery or type of surgical intervention with AVN was analyzed. Since not all fractures could be assigned to an exact fracture type, a new fracture type was included in the subgroup analyses. RESULTS We included 37 patients in the study population. The mean age at the time of the diagnosis was 11.5 years (ranging 5-16 years). Mean follow-up was 30 months. 75% of the cases were diagnosed on the day of the trauma. Nine patients had a delayed diagnosis of which eight had a previous neurological disease (eg. cerebral palsy). A previous illness was significantly associated with a late diagnosis (p < 0.001). 17 patients suffered a high velocity trauma. 35 patients were treated operatively, the majority with a closed reduction (81%) and an internal fixation with cannulated screws (75%). In 24 patients (65%) an additional puncture of the hip joint was performed. Ten patients developed AVN, two of them ultimately had to be treated with a total hip arthroplasty. Female gender was associated with AVN, though not significantly (p = 0.051). A Delbet type IV injury and a high velocity trauma were significantly associated with an AVN (p = 0.020, p = 0.030 respectively). A type IIR fracture was significantly more likely to develop AVN compared to a Delbet type II fracture. Age, polytrauma, degree of dislocation, time to diagnosis, time to surgery and type of treatment was found were not significantly associated with AVN. CONCLUSION Neurologically impaired patients are prone to a late diagnosis of a femoral neck fracture, mainly due to both cognitive and motor impairments. High velocity trauma is a significant risk factor for developing AVN. In contrast to literature, a Delbet type IV fracture was significantly associated with AVN. A type IIR fracture has a higher possibility to develop AVN than a normal Delbet type II fracture. As the incidence of pediatric femoral neck fractures is low, the size of a study population is limited. Nevertheless, AVN is still a life altering complication leading to additional surgical treatments, hospital stays and impairment of daily life activities. Therefore, further research is needed to better understand the mechanisms of underlying risk factors and to develop strategies for the prevention and management of AVN in the pediatric population. Hence multicenter studies with a bigger study population are crucial.
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Affiliation(s)
- Taina Mueller
- Orthopedic Clinic Olgahospital, Klinikum Stuttgart, Kriegsbergstraße 62, 70173, Stuttgart, Germany.
| | - Barbara Weiß
- Orthopedic Clinic Olgahospital, Klinikum Stuttgart, Kriegsbergstraße 62, 70173, Stuttgart, Germany
| | - Thomas Wirth
- Orthopedic Clinic Olgahospital, Klinikum Stuttgart, Kriegsbergstraße 62, 70173, Stuttgart, Germany
| | - Francisco F Fernandez
- Orthopedic Clinic Olgahospital, Klinikum Stuttgart, Kriegsbergstraße 62, 70173, Stuttgart, Germany
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Chen H, Wu G, Cao S, Ma S, Huang F, Yang P, Li Y, Zhong H. Clinical outcomes of open reduction and internal fixation combined with sartorius muscle iliac bone graft transplantation for displaced femoral neck fractures in middle-aged and young adults: a retrospective analysis of 24 cases. BMC Musculoskelet Disord 2024; 25:1011. [PMID: 39696202 PMCID: PMC11654411 DOI: 10.1186/s12891-024-08165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 12/06/2024] [Indexed: 12/20/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical outcomes and complications of open reduction and internal fixation (ORIF) combined with sartorius muscle iliac bone graft transplantation (SIBFT) in the treatment of displaced femoral neck fractures in middle-aged and young adults. METHODS A retrospective analysis was performed on 26 patients under the age of 60 with displaced femoral neck fractures (Pauwels III or Garden III-IV) treated at our institution between April 2019 to July 2022. All patients underwent open reduction and internal fixation (ORIF) through the Smith-Petersen (S-P) approach, augmented with a sartorius muscle iliac bone graft transplantation.The fractures were secured with either three cannulated screws or three cannulated screws combined with a medial support steel plate. Postoperative follow-ups were scheduled at 1, 2, 3, 6, and 12 months to record bone healing time, complications, and assess Harris Hip Scores. RESULTS Two patients were lost to follow-up, resulting in 24 patients who completed the follow-up with an average duration of 25.7 months. Bone healing was observed in 95.8% (23/24) of the patients, with a mean healing time of 5.0 months. Avascular necrosis of the femoral head occurred in 8.3% (2/24) of the patients after fracture healing. Harris Hip Score at the last follow-up was 89.75 (range 73-98). CONCLUSION Our preliminary results suggest that ORIF combined with sartorius muscle iliac bone graft transplantation for the treatment of displaced femoral neck fractures in middle-aged and young adults achieved satisfactory clinical outcomes.
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Affiliation(s)
- Hongfen Chen
- Department of Orthopedics, The Fifth Affiliated Hospital, Southern Medical University, Guangdong, 510900, China
| | - Gen Wu
- Department of Spine Surgery, Wuhan Fourth Hospital, Wuhan, 430000, China
| | - Shenglu Cao
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Sushang Ma
- Department of Orthopedics, The Fifth Affiliated Hospital, Southern Medical University, Guangdong, 510900, China
| | - Feng Huang
- Department of Orthopedics, The Fifth Affiliated Hospital, Southern Medical University, Guangdong, 510900, China
| | - Pengfei Yang
- Department of Orthopedics, The Fifth Affiliated Hospital, Southern Medical University, Guangdong, 510900, China
| | - Yihan Li
- Department of Orthopedics, The Second Hospital of Xiangya Medical School, Central South University, Changsha, 410000, China.
| | - Hua Zhong
- Department of Orthopedics, The Fifth Affiliated Hospital, Southern Medical University, Guangdong, 510900, China.
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Najafi A, Azarsina S, Hadavi D, Arkian R, Hatamian S, Chaghamirzayi P. Management strategies for neglected simultaneous bilateral femoral neck fractures: Case report and literature review. Int J Surg Case Rep 2024; 124:110332. [PMID: 39341163 PMCID: PMC11465213 DOI: 10.1016/j.ijscr.2024.110332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/16/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Simultaneous bilateral femoral neck fractures are rare and challenging, often occurring due to high-energy trauma in younger adults or low-energy trauma compounded by metabolic issues in elderly populations. Neglected cases, particularly in the context of narcotic addiction and limited access to healthcare, present unique management dilemmas. This study aims to contribute insights into the clinical presentation, management strategies, and outcomes of two neglected simultaneous bilateral femoral neck fractures. CASE PRESENTATION We present two cases: a 65-year-old woman and a 45-year-old man, both with a history of narcotic addiction, who presented with neglected simultaneous bilateral femoral neck fractures. Both cases demonstrated significant pain and functional impairment necessitating surgical intervention. CLINICAL DISCUSSION Treatment involved one-stage bilateral hip hemiarthroplasty, which successfully restored function without postoperative complications during follow-up periods of 14 and 16 months. Discussion includes the challenges of diagnosing and managing neglected fractures in vulnerable populations, emphasizing the importance of early recognition and tailored surgical approaches. CONCLUSION Our study suggests the efficacy of one-stage bilateral hip hemiarthroplasty in managing neglected simultaneous bilateral femoral neck fractures due to narcotic addiction. However, variability in outcomes across different surgical techniques highlights the need for individualized treatment plans based on patient-specific factors.
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Affiliation(s)
- Arvin Najafi
- Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Salman Azarsina
- Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Dorsa Hadavi
- Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sevak Hatamian
- Anesthesiology and Special Care, Clinical Research Development Unit of Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Pouria Chaghamirzayi
- Clinical Research Development Unit of Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran.
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Bhattarai A, Subedi D, Bhandari J, Homagain S, Paudel S, Ghimire J. Neglected volar Barton fracture in adult managed in a rural setting: a case report. Ann Med Surg (Lond) 2024; 86:2330-2334. [PMID: 38576909 PMCID: PMC10990390 DOI: 10.1097/ms9.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Barton fractures are distal radius fractures that extend through the dorsal aspect of the articular surface, with associated dislocation of the radiocarpal joint. They are extremely unstable and require open reduction and internal fixation (ORIF). Delayed presentation is often encountered with difficulty in achieving reduction, and more extensive surgery may be needed. Here, we present a case of a 3-week-old neglected volar Barton fracture of the right wrist treated with the conventional method in a rural setting. CASE PRESENTATION A 32-year-old gentleman was initially denied surgical intervention for a distal radius fracture he sustained after a motor vehicle accident and was discharged with a long arm slab plus analgesics represented in the outpatient department and agreed upon surgical intervention after his condition did not improve with conservative treatment. The trans-FCR (flexor carpi radialis) approach was used for surgery under the brachial plexus block. The fragment was reduced by applying pressure volarly into the distal radius and was confirmed with imaging. A K-wire (Kirschner) was used to temporarily hold the fragment. A volar distal radius locking plate was used to buttress the distal fragment. Final fixation was made using altogether six screws. The wrist was splinted in a short dorsal slab. Skin sutures were removed after 2 weeks, and an active assisted range of motion of the wrist was begun after 6 postoperative weeks. DISCUSSION Volar Barton is an uncommon subset of intra-articular fractures and typically results from damage sustained at high speeds. The general agreement for neglected fractures is that 'fractures that are not handled or mishandled resulting in treatment delay, worsening of the fracture and even a disability' are to be considered neglected fractures. Rebuilding the damaged anatomy properly and enabling a prompt, problem-free recovery of hand function are the main objectives of treatment. As conservative therapy is often ineffective and rife with side effects, including early osteoarthrosis, deformity, subluxation, and instability, stabilization and anatomic reduction by surgery is the key to managing these fractures. Plating is one of the therapeutic modalities among various therapeutic modalities depicted in the literature that enables shorter time of immobilization and early restoration of wrist function through direct anatomic repair and stable internal fixation. In our case, the callus was relatively immature, and the original fracture site could easily be cleared. Also, there was no significant soft tissue shortening, and the volar fragment had not migrated proximally, in contrast to what is expected in prolonged neglected cases. Hence, the intraoperative reduction was possible, and the fracture was fixed with a volar locking plate as usual. CONCLUSION Given the modest tissue shortening and young callus, such cases may be treated as conventional Barton's fractures and managed using conventional means of fixation with locking buttress plates. However, it makes sense to prepare for potential malreduction by carrying K wires and wrist distractions. To restore complete function to the injured wrist, adequate physiotherapy and postoperative splinting are essential components of postoperative rehabilitation.
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Putra DP, Mustamsir E, Phatama KY, Pradana AS, Pratama YA. The effectiveness ORIF for neglected periprosthetic femoral fractures after hemiarthroplasty: A case report. Int J Surg Case Rep 2024; 115:109285. [PMID: 38266366 PMCID: PMC10832499 DOI: 10.1016/j.ijscr.2024.109285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Periprosthetic fractures are a growing concern due to the increasing frequency of primary joint replacement surgery, with total hip arthroplasty being the most common. The incidence of periprosthetic fractures after revision surgery ranges from 4 to 11 %, with up to 30 % reported after knee revision surgery. This case report aims to describe the treatment of an 81-year-old woman suffering from neglected periprosthetic femoral fracture post hemiarthroplasty. CASE PRESENTATION An 81-year-old woman with a history of hemiarthroplasty surgery and hypertension was admitted to the ER with pain in her right thigh. She had a middle shaft femoral fracture and was scheduled for open reduction and internal fixation. Despite being fully conscious and having an average pulse rate and blood pressure, she had cardiomegaly and congestive pulmonum. Unfortunately, this patient did not receive appropriate medical treatment after it occurred for 1 month. After surgery, we evaluated the implant, and the implant stabilized the fracture. After 1-3 months after surgery, the LEFS (The Lower Extremity Functional Scale) score was found that the score increase significantly after surgery. CLINICAL DISCUSSION The Vancouver classification system manages periprosthetic fractures by assessing location, stability, and bone quality. Type A fractures involve the trochanter, while type B fractures are diaphyseal and can extend distally. ORIF is used for subtype B1 fractures, but newer techniques offer shorter operating times and fewer complications. CONCLUSION From this study, we can conclude that even though neglected cases procedure with ORIF promises a good outcome based on clinical evaluation.
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Affiliation(s)
- Domy Pradana Putra
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Edi Mustamsir
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Krisna Yuarno Phatama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Ananto Satya Pradana
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Yudit Alfa Pratama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
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Ruangsillapanan N, Rattanakitkoson T, Chanhom N, Chinvattanachot G, Piyapromdee U, Leownorasate M. Reliability of Modified Pauwels Angle in Preoperative Plain X-ray and Intraoperative Fluoroscope in Young Femoral Neck Fracture Fixation. Indian J Orthop 2023; 57:1290-1295. [PMID: 37525742 PMCID: PMC10386982 DOI: 10.1007/s43465-023-00913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 05/21/2023] [Indexed: 08/02/2023]
Abstract
Purpose This research aims to evaluate the reliability of modified Pauwels angle in preoperative plain X-ray and intraoperative fluoroscope. Method This study included 48 male and 18 female patients with an average age of 36.95 years. Seven observers contributed to this study by measuring the modified Pauwels types and angles on 66 anterior-posterior (AP) views from preoperative radiographs and intraoperative fluorography. Intra-observer and inter-observer reliability was calculated using Fleiss's kappa and intraclass correlation coefficient (ICC). Results The results showed that the intra-observer reliability for the modified Pauwels type using Kappa coefficient in preoperative and intraoperative assessments was 0.584 and 0.823, respectively. The inter-observer reliability for preoperative and intraoperative evaluations was 0.467 and 0.753 for all observers, 0.647 and 0.783 for specialized trauma orthopedists, and 0.41 and 0.752 for the residents. The modified Pauwels angle assessment in intra-observers using ICC was 0.804 preoperatively and 0.943 intraoperatively. The inter-observer for preoperative and intraoperative assessments was 0.675 and 0.834 for all observers, 0.977 and 0.982 for specialized trauma orthopedists, and 0.622 and 0.823 for residents. The difference between preoperative and intraoperative modified Pauwels angles was 9.75 ± 6.76 (p < 0.05). Eleven patients had their modified Pauwels type changed, which altered the implant selection in 8 patients. Conclusion The modified Pauwels angle together with type assessment has excellent reliability for implant selection when implemented intraoperatively, and at least two specialized trauma orthopedists should evaluate the fracture lines.
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Affiliation(s)
- Naruepol Ruangsillapanan
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Tana Rattanakitkoson
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Napaj Chanhom
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Guntarat Chinvattanachot
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Urawit Piyapromdee
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
| | - Manoon Leownorasate
- Maharat Nakhon Ratchasima Hospital, 49 Chang Phueak Road, Nai Mueang Subdistrict, Mueang Nakhon Ratchasima District, Nakhon Ratchasima, 30000 Thailand
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Fard SB, Jamshidi SMMM, Hoveidaei AH, Razzaghof M, Mortazavi SJ. Nonunion following valgus subtrochanteric osteotomy for neglected femoral neck fracture: A case report. Int J Surg Case Rep 2023; 103:107905. [PMID: 36652819 PMCID: PMC9860415 DOI: 10.1016/j.ijscr.2023.107905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Femoral neck fractures account for roughly half of the two million hip fractures that occur each year worldwide. There is a high rate of neglected cases and potential complications such as nonunion or avascular necrosis (AVN) in developing countries. More than 30 % of patients may experience non-union following a femoral fracture. There is no consensus on the best neglected femoral neck fracture treatment. CASE PRESENTATION A 30-year-old female known case of rheumatoid arthritis came with a neglected femoral neck fracture to our center. We salvaged the viable hip by subtrochanteric valgus osteotomy and fixation by angled blade plate (ABP). After eight months, she returned with left hip pain and nonunion of the fracture and osteotomy sites. We refixed the fracture with a longer ABP together with autografting of both sites. After two years, she had complete union, full hip range of motion, and painless ambulation. CLINICAL DISCUSSION Subtrochanteric valgus osteotomy is susceptible to nonunion especially in patients with medical comorbidities. CONCLUSION Careful selection of osteotomy site and appropriate fixation device might prevent of non-union.
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Affiliation(s)
| | | | - Amir Human Hoveidaei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S.M. Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author at: Department of Orthopedic Surgery, Imam University Hospital, End of Keshavarz Blvd, Tehran 1419733141, Iran.
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Lin G, Yang D, Sui W. Clinical Effect of Open Reduction and Internal Fixation for Femoral Neck Fracture in Young Adults and Related Factors of Femoral Head Necrosis. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:2974830. [PMID: 36238824 PMCID: PMC9553415 DOI: 10.1155/2022/2974830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/27/2022] [Indexed: 11/18/2022]
Abstract
Objective The purpose of this article is to analyze the clinical effect of open reduction and internal fixation on femoral neck fracture in young adults and to explore the related factors of femoral head necrosis. Methods The subjects were young and middle-aged femoral neck fracture patients admitted to our hospital from July 2019 to July 2021. 90 patients were randomly divided into two groups according to different treatment methods. The control group (n = 45) was treated with open reduction and internal fixation with hollow nails, while the observation group (n = 45) was treated with closed reduction and internal fixation with hollow nails. The clinical effects and adverse reactions of the two groups and the risk factors of avascular necrosis of femoral head were analyzed. Results Compared with the control group, the operation time of the observation group was significantly shortened (P < 0.05), the amount of bleeding during the operation was significantly reduced (P < 0.05), and the incidence of total adverse reactions was significantly reduced (P < 0.05). The HSS score and Harris score of the two groups were significantly decreased after treatment (P < 0.05), but there was no significant difference in the above scores between the two groups before and after treatment (P > 0.05). The related risk factors of necrosis included gender, Garden classification, time from injury to operation, and time of weight bearing after operation (P < 0.05) but not related to age and cause of injury (P > 0.05). Conclusion Open and closed reduction and internal fixation can effectively treat femoral neck fracture in young adults. The risk factors of adverse reactions of osteonecrosis include gender, Garden classification, time from injury to operation, and weight-bearing time after operation.
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Affiliation(s)
- Guanghui Lin
- Department of Orthopaedics, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Sciences, Xiangyang, Hubei 441021, China
| | - Dongliang Yang
- Department of Orthopaedics, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Sciences, Xiangyang, Hubei 441021, China
| | - Wei Sui
- Department of Orthopaedics, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Sciences, Xiangyang, Hubei 441021, China
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Wu Y, Song M, Peng G, Xu Y, Li Y, Wei M, Tang H, Lv Q, Wang T, Cai X. Muscle pedicle bone flap transplantation for treating femoral neck fracture in adults: a systematic review. J Orthop Surg Res 2021; 16:304. [PMID: 33964938 PMCID: PMC8106223 DOI: 10.1186/s13018-021-02448-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background This systematic review was conducted to gather available evidence on the effectiveness of muscle pedicle bone flap transplantation in adult patients with femoral neck fractures. Methods Databases such as PubMed, EMBASE, IEEE, Web of Science, and Cochrane library were searched from their dates of inception until March 2021. Two reviewers independently selected the interventional studies on the assessment of the effectiveness of muscle pedicle bone flap transplantation for femoral neck fractures; data extraction and assessment of the methodological quality as per the Institute of Health Economics quality appraisal checklist were also performed by the reviewers. The effectiveness and complication outcomes were assessed by calculating the average rates. Results Overall, 20 studies with 1022 patients were included in this review. Notably, the methodologic quality of the included studies was typically poor. The average effective rates were as follows: good, 73.4%; fair, 15.4%; and poor, 10.9%. Moreover, the average nonunion rate, average avascular necrosis rate, average collapse rate, and the overall reoperation rate were 9.0%, 6.7%, 4.7%, and 7.3%, respectively. Conclusions This systematic review of heterogeneous studies with varying number of patients and varying surgical techniques indicated that muscle pedicle bone flap transplantation provides promising results with low rates of avascular necrosis and nonunion. Nevertheless, further controlled studies are required to ascertain the effectiveness of muscle pedicle bone flap transplantation in treating femoral neck fracture.
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Affiliation(s)
- Yipeng Wu
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Muguo Song
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Guangliang Peng
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Yongqing Xu
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China.
| | - Yang Li
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China.
| | - Mingjie Wei
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Hui Tang
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Qian Lv
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Teng Wang
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Xingbo Cai
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
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Song J, Zhang G, Liang J, Bai C, Dang X, Wang K, He C, Liu R. Effects of delayed hip replacement on postoperative hip function and quality of life in elderly patients with femoral neck fracture. BMC Musculoskelet Disord 2020; 21:487. [PMID: 32709227 PMCID: PMC7382034 DOI: 10.1186/s12891-020-03521-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For various reasons, some elderly patients with femoral neck fracture undergo delayed surgical treatment. There is little information about the effect of delayed treatment on postoperative hip function and quality of life. The aim of this study was to investigate the effect of delayed hip arthroplasty on hip function, quality of life, and satisfaction in patients with femoral neck fractures. METHODS Forty-seven patients with femoral neck fracture and hip replacement delayed over 21 days served as the delayed group (D group). Patients with femoral neck fracture, matched 1:1 for age and sex, and hip replacement within 7 days served as the control group (C group). The Harris hip score (HHS) and health-related quality of life (HRQoL) were assessed before surgery and 3 months, 6 months and 1 year postoperatively. The satisfaction questionnaires were completed by the patients themselves at the last follow-up. RESULTS The HHS in the C group was lower than that in the D group (32.64 ± 9.11 vs. 46.32 ± 9.88, P < 0.05) before surgery but recovered faster after surgery. The HHS in the D group was lower than that in the C group 1 year postoperatively (85.2 ± 3.80 vs. 89.8 ± 3.33, P < 0.05). The patients' quality of life changed similarly to their HHS. The HHS 1 year after surgery was related to the preoperative HHS in group D (rs = 0.521, P < 0.01). Patients in the D group showed significantly higher satisfaction scores than those in the C group (P < 0.05). CONCLUSIONS Hip function in patients with femoral neck fracture surgery delayed over 21 days recovered more slowly than that in those who underwent surgery within 7 days. However, they were more satisfied with the surgery. Moderate hip movement to ameliorate the lower limb muscle atrophy was recommended for patients facing a temporary inability to undergo surgery.
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Affiliation(s)
- Jidong Song
- Department of Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, NO.157, Xiwu Road, Xi’an, Shaanxi 710004 People’s Republic of China
| | - Gensheng Zhang
- 3201 Hospital of Xi’an Jiaotong University Health Science Center, Xi’an Jiaotong University, Hanzhong, Shaanxi Province 723000 People’s Republic of China
| | - Jialin Liang
- Department of Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, NO.157, Xiwu Road, Xi’an, Shaanxi 710004 People’s Republic of China
| | - Chuanyi Bai
- Department of Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, NO.157, Xiwu Road, Xi’an, Shaanxi 710004 People’s Republic of China
| | - Xiaoqian Dang
- Department of Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, NO.157, Xiwu Road, Xi’an, Shaanxi 710004 People’s Republic of China
| | - Kunzheng Wang
- Department of Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, NO.157, Xiwu Road, Xi’an, Shaanxi 710004 People’s Republic of China
| | - Caiyou He
- Department of Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, NO.157, Xiwu Road, Xi’an, Shaanxi 710004 People’s Republic of China
| | - Ruiyu Liu
- Department of Orthopaedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, NO.157, Xiwu Road, Xi’an, Shaanxi 710004 People’s Republic of China
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12
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Hegazy M, Basha N, Elbarbary H, Ali EMA, Khalifa AH, Mohamed MT, Diab NM, Zein AB, Abdelazeem AH, Fawaz K, Ahmed AM, Barakat AS. Treatment of non-united femoral neck fracture by a novel subtrochanteric angulation lateral translation valgus osteotomy (SALVA osteotomy). INTERNATIONAL ORTHOPAEDICS 2020; 44:2421-2430. [PMID: 32533333 DOI: 10.1007/s00264-020-04527-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The ideal treatment of non-united and neglected fracture neck femur in the young adult still remains unclear and is characterized by many biological and biomechanical challenges. METHODS Twenty-one patients with non-united or neglected fracture neck femur aged between 19 and 50 years were treated by a novel subtrochanteric valgus osteotomy and were followed up for a mean of 26.7 months. Patients were assessed by radiological parameters, the Harris Hip Score, Oxford Knee Score, and Askin Bryan Criteria to categorize the overall outcome of the patients at 24 months. Other outcome measures included the occurrence of AVN, adductor lever arm, leg length discrepancy, and mechanical implant failure. RESULTS All patients treated with the SALVA osteotomy consolidated and displayed a marked improvement of functional and radiological outcome measures. Nevertheless, there were 2 mechanical failures in patients with marked osteopenia and three developed AVN. CONCLUSIONS In patients with un-united/neglected fracture neck femur, SALVA osteotomy appears to be reliable and reproducible. It also restores the abductor lever arm and improves the leg length discrepancy. Technically less demanding conversion to arthroplasty remains still possible prospectively.
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Affiliation(s)
- Mohamed Hegazy
- Orthopedics and Trauma Department, Cairo University, Cairo, Egypt
| | - Naguib Basha
- Orthopedics and Trauma Department, Cairo University, Cairo, Egypt
| | - Hassan Elbarbary
- Orthopedics and Trauma Department, Cairo University, Cairo, Egypt
| | | | | | | | - Nader M Diab
- Orthopedics and Trauma Department, Cairo University, Cairo, Egypt
| | - Abou Bakr Zein
- Orthopedics and Trauma Department, Cairo University, Cairo, Egypt
| | | | - Khaled Fawaz
- Orthopedics and Trauma Department, Cairo University, Cairo, Egypt
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13
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Gao H, Xing D, Liu Z, Zheng J, Xiong Z, Gong M, Liu L. The effect of bone morphogenetic protein 2 composite materials combined with cannulated screws in treatment of acute displaced femoral neck fractures. Medicine (Baltimore) 2020; 99:e18976. [PMID: 32028406 PMCID: PMC7015652 DOI: 10.1097/md.0000000000018976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The risk of avascular necrosis (AVN) and nonunion after treatment of displaced femoral neck fractures is increased in patients aged <60 years. Therefore we established a new protocol for closed reduction and internal fixation (CRIF) using cannulated screws combined with bone morphogenetic protein 2 (BMP-2) composite materials to treat acute femoral neck fractures.This study enrolled 78 patients with acute femoral neck fractures between April 2014 and September 2016. We treated 46 patients with a mean age of 43.8 years in study group. These patients were treated by CRIF combined with BMP-2 composite materials. In control group, there were 32 patients with a mean age of 42.09 years. The patients were treated by CRIF without BMP-2. The duration between presentation and surgery, operative time, Harris score and complications were recorded.In study group, 43 patients were followed up with an average of 31.3 months. One patient suffered nonunion and three patients presented AVN. In control group, 28 patients were followed up with an average of 32.3 months, the rate of AVN and fracture nonunion were 25% (7/28) and 21.4% (6/28) respectively, significantly higher than those in study group (P < .05).Acute displaced femoral neck fractures can be treated with CRIF and BMP-2 composite materials in a minimally invasive manner. This technique was reproducible and had fewer complications.
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Affiliation(s)
| | | | | | | | | | | | - Lan Liu
- Medical Department, The Second Hospital of Shandong University, Shandong Province, Peoples Republic of China
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14
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Toro G, Moretti A, Paoletta M, De Cicco A, Braile A, Panni AS. Neglected femoral neck fractures in cerebral palsy: a narrative review. EFORT Open Rev 2020; 5:58-64. [PMID: 32071774 PMCID: PMC7017596 DOI: 10.1302/2058-5241.5.190019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a 'neglected femoral neck fracture' (NFNF).Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and motor impairments. However, considering the high prevalence of fractures in these patients, the incidence of NFNF in this population is probably underestimated, and this condition might result in persistent hip or abdominal pain.Several techniques are available for the treatment of NFNF (i.e. muscle pedicle bone graft, fixation with fibular graft, valgisation osteotomy), but most of them could affect motor function.Motor function must be preserved for as long as possible, in order to enhance the quality of life of CP patients.After discussing published NFNF cases in CP patients and available treatment options, a practical approach is proposed to facilitate the orthopaedic surgeon to both early identify and appropriately manage these challenging fractures. Cite this article: EFORT Open Rev 2020;5:58-64. DOI: 10.1302/2058-5241.5.190019.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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15
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Impaction Bone Grafting and Valgus Osteotomy: A Technical Trick for the Treatment of Femoral Neck Nonunions. J Orthop Trauma 2019; 33:e403-e408. [PMID: 31259803 DOI: 10.1097/bot.0000000000001564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoral neck nonunions in young adults is among the most challenging problems to treat. This is due to their inherent problems, such as neck resorption, increase in fracture gap, sclerosis of fracture margins, and avascular necrosis. Hip salvage in these cases, although challenging, is recommended in the Asian subcontinent where social and religious activities require squatting and sitting cross-legged. Muscle pedicle grafts and other vascularized bone grafting techniques are preferred treatment options, but they are technically demanding and require advanced microsurgical skills. Valgus osteotomy, although successful in certain cases, has a high failure rate in patients with poor bone stock. We present a simple technique of valgus subtrochanteric osteotomy, impaction bone grafting, and stabilization with a sliding hip screw. Here, we describe in detail about the surgical technique and present the clinical outcomes in 44 patients, with a mean follow-up of 3.4 years and a union rate of 95.5%.
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16
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17
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Wu Y, Zhang C, Wu J, Han Y, Wu C. Angiogenesis and bone regeneration by mesenchymal stem cell transplantation with danshen in a rabbit model of avascular necrotic femoral head. Exp Ther Med 2019; 18:163-171. [PMID: 31258650 PMCID: PMC6566092 DOI: 10.3892/etm.2019.7556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/03/2017] [Indexed: 12/27/2022] Open
Abstract
The present study aimed to explore the potential of combined treatment with mesenchymal stem cells (MSCs) and danshen for angiogenesis and bone regeneration in a rabbit model of avascular necrosis of femoral head (ANFH). A rabbit model of ANFH was established using the Shwartzman reaction with methylprednisolone and Escherichia coli endotoxin injection. Magnetic resonance imaging (MRI) and histopathological examination were used to evaluate the rabbit model of ANFH. The rabbits were randomly divided into the danshen group, the MSCs group, the danshen combined with MSCs group and the model group (treated with physiological saline). The expression level of monocyte chemoattractant protein-1 (MCP-1) and stromal cell-derived factor-1 (SDF-1) were determined by reverse transcription polymerase chain reaction (RT-PCR). The expression level of bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF) were detected by immunofluorescence and the mRNA expression of BMP-2 and VEGF were detected by RT-PCR. Typical osteonecrosis occurred in the rabbit model of ANFH, which indicated that the model was successfully established. MCP-1 and SDF-1 were significantly increased in the model group compared with the normal group (P<0.05). Following the administration of MSCs and Salvia miltiorrhiza (danshen), MSCs labeled with 5-bromo-2-deoxyuridine were observed to be gathered in the necrotic area. The increased migration of MSCs to the necrotic area may be due to the upregulated expression of the chemokines MCP-1 and SDF-1. ANFH treated with danshen combined with MSCs may promote revascularization by increasing the expression of VEGF and BMP-2 in the femoral head, promoting re-ossification and revascularization. Danshen combined with the transplantation of MSCs may be regarded as a novel therapy for the treatment of ANFH in a clinical setting.
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Affiliation(s)
- Yungang Wu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Chunwu Zhang
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Jianjing Wu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yan Han
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Chunlei Wu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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18
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Gumustas S, Tosun HB, Isyar M, Serbest S, Oznam K, Bulut G. Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study. Pan Afr Med J 2018; 30:112. [PMID: 30364439 PMCID: PMC6195237 DOI: 10.11604/pamj.2018.30.112.13643] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 05/25/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction Femur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method. Methods Files of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by Ficat-Arlet classification system whereas acetabular fractures and hip functionality was evaluated by Letournel and Judet system, which is based on direct graph of fracture line. Results Mean age at the time of surgery for 31 cases included in the study was 40.04 ± 9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to Judet System, 67.7% of cases showed excellent/good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P>0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications. Conclusion Because of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.
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Affiliation(s)
- Seyitali Gumustas
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Haci Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Isyar
- Medicalpark Bahcelievler, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Kadir Oznam
- Istanbul Medipol University School of Medicine, Department of Orthopaedic and traumatology, 34214, Istanbul, Turkey
| | - Güven Bulut
- Dr Lutfi Kirdar Kartal Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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19
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Wang XJ, Zhang ZH, Li L, Su YX, Wei L. Quadratus femoris muscle pedicle bone flap transplantation in the treatment of femoral neck fracture for Chinese young and middle-aged patients: A systematic review and meta-analysis. Chin J Traumatol 2017; 20:347-351. [PMID: 29198718 PMCID: PMC5832484 DOI: 10.1016/j.cjtee.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/09/2017] [Accepted: 08/19/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus AO hollow compression screw fixation in the treatment of femoral neck fracture for Chinese young and middle-aged patients. METHODS Case-controlled studies (CCTs) were used to compare the two operative methods in the treatment of femoral neck fractures. Data were retrieved from the Cochrane Library, Pubmed Database, CNKI, Chinese Biomedical Database. Wanfang Data published during the period of January 2005 to December 2014. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical Software Revman 5.0 was used for data-analysis. RESULTS Eight articles were included in the meta-analysis. The results showed that there was statistical significance in the rate of fracture healing [OR = 5.43, 95% CI (2.89, 10.20), p < 0.05], the rate of good function of hip joint [OR = 5.12, 95% CI (3.21, 8.17), p < 0.05], the rate of femoral head necrosis [OR = 4.21, 95% CI (2.02, 8.76), p < 0.05], the time of fracture healing [WMD = -46.85, 95% CI (-65.13, -28.56), p < 0.05] between the two groups. CONCLUSIONS For the treatment of femoral neck fractures, the transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw; fixation is superior to the AO hollow compression screw fixation in terms of the rate; of fracture healing, the rate of good function of hip joint, the rate of femoral head; necrosis and the time of fracture healing.
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Affiliation(s)
- Xiao-Jian Wang
- Department of Orthopedics, Affiliated People's Hospital of Shanxi Medical University, Taiyuan 030012, China,Department of Orthopedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030009, China,Corresponding author. Department of Orthopedics, Affiliated People's Hospital of Shanxi Medical University, Taiyuan 030012, China.Department of OrthopedicsAffiliated People's Hospital of Shanxi Medical UniversityTaiyuan030012China
| | - Zhi-Hua Zhang
- Department of Orthopedics, Affiliated People's Hospital of Shanxi Medical University, Taiyuan 030012, China
| | - Lu Li
- Department of Orthopedics, Affiliated People's Hospital of Shanxi Medical University, Taiyuan 030012, China
| | - Yun-Xing Su
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030009, China
| | - Lei Wei
- Department of Orthopedics, Affiliated People's Hospital of Shanxi Medical University, Taiyuan 030012, China
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20
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Toro G, Moretti A, Toro G, Tirelli A, Calabrò G, Toro A, Iolascon G. Surgical treatment of neglected hip fracture in children with cerebral palsy: case report and review of the literature. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:317-323. [PMID: 29354160 PMCID: PMC5762222 DOI: 10.11138/ccmbm/2017.14.3.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CASE A clinical case of a 15-year-old cerebral palsy child with a Sandhu type 2 neglected femoral neck fracture is presented. The patient was treated using cannulated screws and cancellous bone graft augmented with mesenchymal stem cells. At 6 months after the surgery complete fracture healing was observed. CONCLUSION To early diagnose this fractures, it is mandatory to perform a comprehensive clinical and radiological evaluation including also a second level imaging. The use of cannulated screws with cancellous bone graft and MSCs is a viable treatment option in these patients.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella Toro
- Unit of Radiology and Nuclear Medicine, “Santa Maria della Speranza” Hospital, Battipaglia (SA), Italy
| | | | - Giampiero Calabrò
- Unit of Orthopaedics and Traumatology, “Martiri del Villa Malta” Hospital, Sarno (SA), Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, “Martiri del Villa Malta” Hospital, Sarno (SA), Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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21
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DHS osteosynthesis with internal bone grafting in unstable delayed presented intracapsular neck femur fractures. Injury 2017; 48 Suppl 2:S44-S49. [PMID: 28802420 DOI: 10.1016/s0020-1383(17)30493-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to assess fracture union and complications following use of dynamic hip screw (DHS) with internal bone grafting in treatment of unstable delayed presented intracapsular neck femur fractures in patients younger than 65 years of age. MATERIAL AND METHODS Thirty two patients with displaced intracapsular neck femur fractures(Garden III and IV, Pauwels III, with comminution) with delayed presentation (15-60 days) in the 45-65 year age group (mean 54.4±10.2 years) were included in this study. All patients were treated with dynamic sliding hip screw with closed cancellous bone grafting through a tunnel of a triple reamer. The average time to union was 3.8 months (3-5 months). Satisfactory union was achieved in all patients except two. One case developed avascular necrosis of the femoral head. Other complications were coxa vara in two, shortening of less than 10mm in three cases but there were no cases of infection or implant failure. Excellent results were achieved in 27, good/fair in 4 and poor in 1 patient. CONCLUSION Osteosynthesis with DHS and primary cancellous bone grafting in indicated cases is a simple, providing biological stimulation for early union. Failure in a particular case can be treated with any appropriate second procedure.
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22
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Khani GMK, Hafeez K, Bux M, Rasheed N, Ahmed N, Anjum MP. Use of fibular bone graft and cancellous screw fixation in the management of neglected femur neck fractures in young patients. Int J Health Sci (Qassim) 2017; 11:7-10. [PMID: 29114187 PMCID: PMC5669514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To present the clinical outcome of patients with neglected femur neck fracture treated with fibular bone graft. METHODS During May 2010-February 2013, 15 patients younger than 35 years of age with neglected fracture neck of femur were managed with non-vascularized fibular graft and cannulated screws. Fractures were classified according to Sandhu Classification. Hip function was assessed using Harris hip score. RESULTS Fifteen patients with mean age of 28.67 years were managed. Mean period of delay from injury to presentation was 3.07 months. Mean follow-up was 18.5 months. Union was achieved in 13 cases. 2 patients developed nonunion with progression of avascular necrosis (AVN). Patients with healed fracture did not show radiological signs of AVN till the past follow-up. Functional status was evaluated at 6 months according to Harris hip score and was poor in 2 patients, fair in 2 patients, good in 6 patients, and excellent in 5 patients. CONCLUSION Fibular graft along with two cancellous screws proved to be an effective technique in our cases with neglected femur neck fractures.
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Affiliation(s)
- Ghulam Mustafa Kaim Khani
- Department of Orthopaedics, Dow International Medical College, Dow University of Health Sciences (Ojha Campus), Karachi, Pakistan
| | - Kamran Hafeez
- Consultant Orthopaedic Surgeon, Buraidah Central Hospital, Buraidah, Al-Qaseem Region, Saudi Arabia,Address for correspondence: Dr. Kamran Hafeez, Consultant Orthopaedic Surgeon, Buraidah Central Hospital, Buraidah, Al-Qaseem Region, Saudi Arabia. Phone: +966535853411. E-mail:
| | - Muhammad Bux
- Department of Orthopaedics, Lyari General Hospital, Karachi, Pakistan
| | - Nusrat Rasheed
- Department of Orthopaedics, Dow International Medical College, Dow University of Health Sciences (Ojha Campus), Karachi, Pakistan
| | - Naveed Ahmed
- Department of Orthopaedics, Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - M. Perwez Anjum
- Department of Orthopaedics, Dow International Medical College, Dow University of Health Sciences (Ojha Campus), Karachi, Pakistan
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Tripathy SK, Sen RK, Goyal T. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review. Indian J Orthop 2016; 50:345-351. [PMID: 27512214 PMCID: PMC4964765 DOI: 10.4103/0019-5413.185587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ramesh Kumar Sen
- Department of Orthopaedics, Fortis Hospital, Mohali, Punjab, India
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Management of a neglected femoral neck fracture in a limb affected by poliomyelitis - a case report. Hip Int 2016; 21:267-9. [PMID: 21484748 DOI: 10.5301/hip.2011.6510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2010] [Indexed: 02/04/2023]
Abstract
Neglected femoral neck fractures are difficult to treat successfully without resorting to total hip arthroplasty. Baksi described a tensor fascia lata muscle pedicle bone graft procedure for such cases. Management of such fractures following poliomyelitis presents additional challenges. We present a case of a neglected femoral neck fracture in a young adult with late sequelae of poliomyelitis managed by Baksi's procedure. At final follow up at 2 years the patient was able to walk without aids and had returned to his job.
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Salgotra K, Kohli S, Vishwakarma N. Short-term Results of Muscle-Pedicle Bone Grafting with Tensor Fascia Lata for Delayed Femoral Neck Fractures; Case Series and Literature Review. Bull Emerg Trauma 2016; 4:101-104. [PMID: 27331067 PMCID: PMC4897991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/06/2016] [Accepted: 02/25/2016] [Indexed: 06/06/2023] Open
Abstract
Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft) and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG) using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7%) men and 1 (14.3%) women among the patients. Overall 5 (71.5%) patients had transcervical and 2 (28.5%) had subcapital fractures. At the end of 6 months, 6 (85.7%) patients were pain free and on plain radiographs fracture union was noted. One (14.3%) patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures.
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Affiliation(s)
- Kuldip Salgotra
- Department of Orthopedics, Mahatma Gandhi Mission (MGM), University of Heath Sciences, Mumbai, India
| | - Sarabjeet Kohli
- Department of Orthopedics, Mahatma Gandhi Mission (MGM), University of Heath Sciences, Mumbai, India
| | - Nilesh Vishwakarma
- Department of Orthopedics, Mahatma Gandhi Mission (MGM), University of Heath Sciences, Mumbai, India
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Cui L, Zhuang Q, Lin J, Jin J, Zhang K, Cao L, Lin J, Yan S, Guo W, He W, Pei F, Zhou Y, Weng X. Multicentric epidemiologic study on six thousand three hundred and ninety five cases of femoral head osteonecrosis in China. INTERNATIONAL ORTHOPAEDICS 2015; 40:267-76. [PMID: 26660727 DOI: 10.1007/s00264-015-3061-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Osteonecrosis of femoral head (ONFH) is a common joint disease with high morbidity in mainland China. We performed a retrospective case investigation based on the widest range of patients ever to reveal the demographic and clinical characteristics of ONFH in mainland China. METHODS We collected data from hospitalized patients of nine large tertiary hospitals in China, focusing on the aetiology of ONFH. Medical records and self-design questionnaires were used to collect data. We determined the patients' aetiology according to established guidelines and categorized patients into different subgroups. We further analysed the underlying illness of the steroid-induced osteonecrosis of femoral head. RESULTS A total of 6,395 patients with complete medical records were included in the study. The age (mean ± SD) of the patients was 46.45 ± 13.80 years. Males dominate with 70.1 % of all ONFH patients. In all the ONFH patients, 24.1 % are steroid induced, 30.7 % are alcoholic, 16.4 % are traumatic and 28.8 % are idiopathic. Among steroid-induced osteonecrosis of femoral head patients, 546 patients have autoimmune disorder (46.63 %), which is the most common underling illness, among these, the most common disease is systemic lupus erythematosus (SLE). CONCLUSIONS The most common age when ONFH occurs is between 40 and 50 years old. Male patients developed ONFH 3.4 years earlier than female patients. The number of the male patients is greater than the female, reaching the overall gender proportion of 7:3. Autoimmune disease is the primary cause of steroid-induced ONFH, among which SLE is the most common disease.
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Affiliation(s)
- Liqiang Cui
- Department of Orthopaedics, Peking Union Medical College Hospital, No.1 Shuai-fu-yuan, Wang-fu-jing, Beijing, 100730, China
| | - Qianyu Zhuang
- Department of Orthopaedics, Peking Union Medical College Hospital, No.1 Shuai-fu-yuan, Wang-fu-jing, Beijing, 100730, China
| | - Jin Lin
- Department of Orthopaedics, Peking Union Medical College Hospital, No.1 Shuai-fu-yuan, Wang-fu-jing, Beijing, 100730, China
| | - Jin Jin
- Department of Orthopaedics, Peking Union Medical College Hospital, No.1 Shuai-fu-yuan, Wang-fu-jing, Beijing, 100730, China
| | - Ke Zhang
- Department of Orthopaedics, Peking University Third Hospital, North Garden Rd No. 49, Haidian District, Beijing, 100191, China
| | - Li Cao
- Department of Orthopaedics, The First Teaching Hospital of Xinjiang Medical University, South Liyushan street No. 137, Wulumuqi, Xinjiang Province, 830054, China
| | - Jianhao Lin
- Department of Orthopaedics, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Shigui Yan
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Qingchun street No. 79, Hangzhou, Zhejiang Province, 310003, China
| | - Wanshou Guo
- Department of Orthopaedics, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Wei He
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No. 16 Airport Street, Guangzhou, 510405, China
| | - Fuxing Pei
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37, Guoxue Street, Wuhou district, Chengdu, Sichuan, 610041, China
| | - Yixin Zhou
- Department of Orthopaedics, Beijing Jishuitan Hospital, No. 31 Eastern Xinjiekou Street, Xicheng district, Beijing, 100035, China
| | - Xisheng Weng
- Department of Orthopaedics, Peking Union Medical College Hospital, No.1 Shuai-fu-yuan, Wang-fu-jing, Beijing, 100730, China.
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Minkalis AL, Vining RD. What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2015; 59:300-310. [PMID: 26500365 PMCID: PMC4593036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain. CASE PRESENTATION A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6-12 months and was located in the right low back. Milder pain was also reported in the right hip. Low back and hip pain were both aggravated by weight-bearing activities. An evidence-based diagnostic evaluation revealed little indication for a primary pain source originating from low back structures. Radiographs revealed bilateral osteonecrosis with evidence of left femoral head collapse. CONCLUSION Hip osteonecrosis may have contributed to an atypical presentation of low back pain due to aberrant localization of pain and/or combined with altered biomechanical loading of musculoskeletal structures.
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Affiliation(s)
- Amy L. Minkalis
- Research Clinician, Evidence-Based Clinical Practice Scholar, Graduate Research Fellow, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Robert D. Vining
- Associate Professor and Senior Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
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Lin S, Zhang CQ, Jin DX. Combination of modified free vascularized fibular grafting and reverse Less Invasive Stabilization System (LISS) for the management of femoral neck nonunion in patients thirty years of age or younger. Injury 2015; 46:1551-6. [PMID: 26077662 DOI: 10.1016/j.injury.2015.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/10/2015] [Indexed: 02/02/2023]
Abstract
Femoral neck nonunion (FNN) is a potential complication in patients with displaced femoral neck fractures, occurring in 33%. This may lead to early hip dysfunction or arthroplasty. Combination of modified free vascularized fibular grafting (FVFG) and a reverse LISS may provide a reasonable means to salvage a painless, functional and native hip. Between August 2010 and August 2012, sixteen patients with femoral neck nonunion were treated with a combined procedure involving modified free vascularized fibular grafting and a reverse LISS. The average age of them is 20.3 years (range 12.0-28.0 years). After removing old implants, the nonunion site was debrided, reduced and fixed with a LISS. The fibular grafts were compacted into a trough in the femoral neck. The Harris Hip score system was used to assess hip function and anteroposterior and frog-lateral hip roentgenograms were used to evaluate bone healing. All femoral neck nonunion healed without severe complications. The mean follow-up time was 32.9 months (range 23.0-47.0 months) and the average union time was 7.6 months (range 5.0-10.0 months). All coxa vara deformities and retroversions of the femoral head were corrected. The Harris hip scores (HHS) were improved 36.6 points on average (59.6 points preoperatively to 96.2 points postoperatively). No incidences of osteonecrosis of the femoral head were observed. The combined modified FVFG and reverse LISS plating is a suitable procedure for the management of femoral neck nonunion in patients younger than 30 years, especially for those patients with a revision history.
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Affiliation(s)
- Sen Lin
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai 200233, PR China
| | - Chang-qing Zhang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai 200233, PR China.
| | - Dong-xu Jin
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai 200233, PR China.
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Triple attack technique for non-union of femoral neck fractures. INTERNATIONAL ORTHOPAEDICS 2015; 40:807-12. [PMID: 26105761 DOI: 10.1007/s00264-015-2808-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to describe the technique and clinical results following the utilization of biomechanical and biological means for adequate fracture healing in management of non-union of the neck of femur while preventing distortion of normal hip biomechanics. METHODS Twenty-two patients with non-united fractures of femoral neck in adults were treated with what was termed the 'triple attack' procedure. This constituted iliac autogenous bone grafting, valgus subtrochanteric osteotomy together with static fixation across the non-union fracture site of the neck to avoid delayed femoral neck shortening. RESULTS All patients were classified as Pauwel's type III fractures. The mean time interval between the last operation and the current procedure was 4.6 months. Average operative time was 58.6 minutes. Patients were followed up for an average of 43.6 months. Complete union was achieved in all cases at an average of 4.3 months. Significant improvement of all radiological parameters was noticed together with the Harris hip score from an average of 21.2 pre-operatively to 89.6 at the last follow-up. CONCLUSION The present study provides encouraging clinical and functional results to suggest that this newly described procedure ('triple attack') might be a valuable option in the management of non-united femoral neck fractures.
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Lin D, Zuo S, Li L, Wang L, Lian K. Treatment of neglected femoral neck fractures using the modified dynamic hip screw with autogenous bone and bone morphogenetic protein-2 composite materials grafting. Indian J Orthop 2015; 49:342-6. [PMID: 26015636 PMCID: PMC4443418 DOI: 10.4103/0019-5413.156211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The neglected femoral neck fracture is one where there has been a delay of more than 30 days to seek medical help from the time of the original injury. Salvage procedures, such as osteotomy and other treatment options such as vascularized and nonvascularized bone grafts have high failure rates and arthroplasty procedures are not ideal, given the patient's young age and higher levels of activity. We designed a hollow bone graft dynamic hip screw (Hb-DHS) (modified DHS, Hb-DHS) for use in neglected femoral neck fractures. This study evaluates the efficacy and safety of the modified dynamic hip screw (DHS) with autogenous bone and bone morphogenetic protein 2 (BMP-2) composite materials grafting for the treatment of the neglected femoral neck fractures. MATERIALS AND METHODS A prospective study was carried out in twenty patients of neglected femoral neck fractures treated with the modified DHS with autogenous bone and BMP-2 composite materials grafting between July 2007 and February 2010. There were 14 men and 6 women with a mean age of 29.6 years (range 19-42 years). The mean time from injury to surgery was 9.7 weeks (range 6-16 weeks). The operation time, intraoperative blood loss, fracture healing time, Harris scoring for hip function and complications were recorded to evaluate treatment effects. RESULTS The mean operation time was 75.8 min (range 55-100 min) with mean intraoperative blood loss volume of 105 mL (range 70-220 mL). The mean time to union was 17 weeks (range 12-24 weeks). One patient did not achieve union, and two patients had avascular necrosis of the femoral head. This patient with nonunion underwent intertrochanteric osteotomy. In patients with avascular necrosis one required total hip arthroplasty, the other did not require intervention at the last followup. A total of 14 patients (70%) had excellent results, 2 (10%) had good, 1 (5%) had moderate and 3 (15%) had poor results. CONCLUSION The modified DHS with autogenous bone and BMP-2 composite materials grafting for the treatment of neglected femoral neck fractures waseffective and had less complications.
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Affiliation(s)
- Dasheng Lin
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Shenjia Zuo
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Lin Li
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Lei Wang
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Kejian Lian
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China,Address for correspondence: Dr. Kejian Lian, Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China. E-mail:
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Pauyo T, Drager J, Albers A, Harvey EJ. Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop 2014; 5:204-217. [PMID: 25035822 PMCID: PMC4095012 DOI: 10.5312/wjo.v5.i3.204] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/17/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.
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Zhang L, Zhang L, Lan X, Xu M, Mao Z, Lv H, Yao Q, Tang P. Improvement in angiogenesis and osteogenesis with modified cannulated screws combined with VEGF/PLGA/fibrin glue in femoral neck fractures. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:1165-1172. [PMID: 24435526 DOI: 10.1007/s10856-013-5138-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/28/2013] [Indexed: 06/03/2023]
Abstract
Angiogenesis is essential for bone healing. Vascular endothelial growth factor (VEGF) is regarded as one of the most potent antigenic cytokines; however, there have been very few studies that have previously investigated the effects of VEGF on bone healing in a femoral neck fracture model. Thus, the aim of the present study was to test both the angiogenic and osteogenic properties of a VEGF/poly-lactic acid glycolic acid (PLGA) delivery system for the treatment of femoral neck fractures. VEGF/PLGA microspheres were prepared by the double emulsion solvent-evaporation method and in vitro VEGF release was quantified by an ELISA assay. Then the preparation of femoral neck fracture model and internal fixation were performed, and the effect of the VEGF/PLGA microspheres on bone healing was determined by X-ray, radionuclide bone scanning, and histomorphometric evaluation. The release of VEGF from the VEGF/PLGA microspheres was sustained for at least 42 days in vitro, and suspension of the delivery system in fibrin glue further slowed this VEGF release rate. In dogs, revascularization of the fractured femoral heads was significantly improved by a local injection of VEGF/PLGA/fibrin glue, and the quality and speed of fracture healing were significantly improved in the Experimental group than in the Control group. Our study confirmed that the VEGF/PLGA delivery system offers good angiogenic and osteogenic properties for the treatment of canine femoral neck fractures.
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Affiliation(s)
- Licheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
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Abstract
BACKGROUND Nonunion and avascular necrosis (AVN) of the femoral head remains one of the major complications following femoral neck fractures. Despite various surgical techniques and internal fixation devices, the incidence of nonunion and AVN has remained unsolved. Neglected nonunion of femoral neck fracture is common in the developing world. Treatment options include rigid internal fixation with or without bone grafting, muscle pedicle bone graft, valgus osteotomy of the proximal femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO). MATERIALS AND METHODS Over a period of 35 years (1974-2008), 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008), All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years). Results were analyzed in terms of radiological union at six months. Average followup was five years and six months. RESULTS Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°). Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore's pins. These were reopened and cancellous screws were inserted in the same tracks. CONCLUSIONS Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.
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Affiliation(s)
- Jairamchander Pingle
- Department of Orthopaedics, Apollo Health City, Jubilee Hills, Hyderabad, India,Address for correspondence: Dr. Jairamchander Pingle, 8-2-293/82/A, Plot no. 1005, Road No 50, Jubilee hills, Hyderabad - 500 033, India. E-mail:
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Elmi A, Tabrizi A, Rouhani A, Mirzatolouei F. Long-term follow-up results of delayed fixation of femoral neck fractures in adults. Trauma Mon 2013; 18:8-11. [PMID: 24350142 PMCID: PMC3860650 DOI: 10.5812/traumamon.11275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 12/04/2022] Open
Abstract
Background Femoral neck fractures are urgent injuries that require precise reduction and stable fixation. In some cases, however, early treatment is not possible. Objectives The present study aimed to evaluate long-term results of delayed fixation of femoral neck fractures using cannulated screws. Patients and Methods This retrospective descriptive-analytical study was conducted on 26 patients with femoral neck fractures. The patients were treated through a closed reduction and fixation method using cannulated screws. Patients were followed up for at least five years and the rate of complications was determined. Results In this study, 26 patients with mean age of 34.3 years were assessed. Average time interval from injury to surgery was 46.4 ± 12.2 hours; 18 patients (69%) were operated on with more than 36 hours of delay. Incidence of AVN and nonunion was reported in 10 (38.4%) and 3 (11.5%) patients, respectively. Conclusions Time plays an important role in treatment results of femoral neck fractures. To treat the fractures, closed reduction and fixation using cannulated screws may still be the best option.
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Affiliation(s)
- Asghar Elmi
- Department of Orthopedics and Trauma Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Ali Tabrizi
- Department of Orthopedics and Trauma Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding author: Ali Tabrizi, Department of Orthopedics and Trauma Surgery, Orthopedic Surgery Center, Shohada Educational Hospital, Golshahr St., Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel.: +98-9148883851, Fax: +98-4113363846, E-mail:
| | - Alireza Rouhani
- Department of Orthopedics and Trauma Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Fardin Mirzatolouei
- Department of Orthopedic Surgery, Motahari Hospital, Urumieh University of Medical Sciences, Urumieh, IR Iran
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Role of muscle pedicle bone graft as an adjunct to open reduction and internal fixation in the management of neglected and ununited femoral neck fracture in young adults: a prospective study of 17 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1185-91. [PMID: 24318307 DOI: 10.1007/s00590-013-1384-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
AIM To evaluate the role of quadratus femoris muscle pedicle bone grafting along with open reduction and internal fixation in the treatment of neglected and ununited femoral neck fractures in young adults. MATERIALS AND METHODS Young adults within the age group of 15-45 years with ununited, old neglected fractures of femoral neck were included in the study. All patients underwent quadratus femoris muscle pedicle bone grafting along with open reduction and internal fixation. The post-operative complications and functional recovery was assessed using Charnley's modification of Merle D'Aubigne and Postel hip scoring. RESULTS A total of 17 patients were included in the study. The average time of union following the procedure was found to be approximately 8 months. There were two cases of delayed union and no cases of avascular necrosis. Ten patients (58.8%) had excellent or very good post-operative functional results and 6 patients (35.3%) had good or satisfactory results. CONCLUSION Muscle pedicle bone grafting is a useful adjunct to open reduction and internal fixation for ununited femoral neck fractures. It achieves good final functional results comparable with other methods, but requires greater expertise.
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Li Z, Chen W, Su Y, Zhang Q, Hou Z, Pan J, Zhang Y. The application of closed reduction internal fixation and iliac bone block grafting in the treatment of acute displaced femoral neck fractures. PLoS One 2013; 8:e75479. [PMID: 24040414 PMCID: PMC3769404 DOI: 10.1371/journal.pone.0075479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 08/19/2013] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF) with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting. METHODS From December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females) with a mean age of 44.8 years (range, 20-64 years). There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females) with a mean age of 46.3 years (range, 23-64 years). There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting. RESULTS In study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months). All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100). In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months). The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68) and 16.2% (11/68), respectively, significantly higher than those in study group (both P<0.05). The mean Harris score in control group was 83.8 (41-100), significantly lower than that in study group (P<0.05). CONCLUSION Acute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.
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Affiliation(s)
- Zhiyong Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Yanling Su
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Qi Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Jinshe Pan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
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Patterns of isotope uptake in sequential postoperative bone scan in undisplaced femoral-neck fractures. INTERNATIONAL ORTHOPAEDICS 2013; 37:1541-5. [PMID: 23812576 DOI: 10.1007/s00264-013-1983-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We aimed to investigate the changing pattern of isotope uptake in the sequential bone scan test for the prediction of osteonecrosis of the femoral head in patients with an undisplaced femoral-neck fracture. METHODS Fifty-four cases of sequential bone scan for nondisplaced femoral-neck fracture treated by internal fixation with cannulated screws between 2000 and 2009 were retrospectively studied. The mean follow-up period was 4.2 years. The first postoperative bone scan was performed two weeks postoperatively in all patients. Second, third, and fourth follow-up bone scans were performed at one to six months, 12-18 months, and 18-24 months postoperatively. RESULTS Mean femoral-head ratio (FHR) in the first postoperative bone scan was 0.99. Although it was under 1.0 in 38 patients (70.4 % of the 54 patients), only one patient developed osteonecrosis of the femoral head. The others showed hot uptake in their second follow-up bone scan. Mean FHRs in the second, third, and fourth postoperative bone scans were 1.69, 1.29, and 1.05, respectively, and there were significant statistical differences in each follow-up period (P = 0.035). In addition, there were unique patterns of isotope uptake with the passage of time, such as cold uptake in the early stage, hot uptake in a couple of months, and iso-uptake in the late stage. CONCLUSIONS Early postoperative bone scan results should not be over interpreted when predicting osteonecrosis of the femoral head.
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Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures. J Clin Orthop Trauma 2013; 4:58-69. [PMID: 26403626 PMCID: PMC3880501 DOI: 10.1016/j.jcot.2013.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/30/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Femoral neck fractures in young adults is an unsolved problem and neglected femoral neck fractures presents more challenge to the orthopaedics surgeon if femoral head salvage is attempted. We reviewed the operative results of neglected femoral neck fractures in young adults with fixation with dual fibular bone grafting Purpose of study was evaluation of epidemiological, clinical, functional, rehabilitative outcome and complications in such patients. METHODS Twentyeight patients in age group 18-50 years were operated having fracture neck femur by dual fibular bone grafting in the Department of Orthopaedics, S.N. Medical College, Agra in (May 2005-February 2008) and divided into two groups. Group A: comprised of 8 patients treated by dual fibular bone grafting alone and Group B: comprised of 18 patients treated by dual fibular bone grafting with single cancellous hip screw. RESULTS All the patients of the present series were having neglected intracapsular fracture, neck femur which were treated by dual fibular bone grafting with or without cancellous hip screw fixation. Majority of the patients had good to fair result according to Larson method with average time of union 16 weeks. All patients had useful range of movement at hip. Satisfactory union was achieved in all patients except two. CONCLUSION Double bone grafting is a simple and cost effective modality of treatment for late femoral neck fracture with good results. It is a stable and biological method of fixation with preservation of natural femoral head with fewer complications.
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Gadegone WM, Ramteke AA, Lokhande V, Salphade Y. Valgus intertrochanteric osteotomy and fibular strut graft in the management of neglected femoral neck fracture. Injury 2013; 44:763-8. [PMID: 23063702 DOI: 10.1016/j.injury.2012.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 09/07/2012] [Accepted: 09/19/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE A prospective study of neglected femoral neck fractures in mostly young patients was conducted to evaluate whether our technique of valgus intertrochanteric osteotomy with fibular strut grafting and osteosynthesis with dynamic hip screw and double-angle side plate can facilitate union with consistent satisfactory clinical outcomes. METHODS Forty-one consecutive patients (27 males, 14 females) of neglected femoral neck fractures treated between April 2002 and December 2009 were studied. The average age of patients was 45.41 years (±11.67, range 20-62 years). The average interval since injury was 14 weeks (±10.21, range 4-44 weeks). The cases were evaluated radiographically and clinically. RESULTS The average follow-up period was 32.5 months (±8, range 24-54 months). Radiographically union was seen in 39 patients at the nonunion site. The average time to radiographic union was 16.82 weeks (±3 weeks, range 12-24 weeks). Average Harris Hip Score (HHS) was 19.9 (±7.9, range 10-35) preoperatively and 90.9 (±10.35, range 62-100) at the latest follow-up. At that time clinical outcomes were excellent in 31, good in four, fair in three and poor in three patients. CONCLUSION Our mechanobiological surgical technique is reproducible with radiographic union achieved in 95.12% cases (39 patients) at the nonunion site and consistent excellent or good functional outcome in 85% of patients over a 32-month average follow-up. We recommend this procedure for neglected femoral neck fractures.
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Affiliation(s)
- Wasudeo M Gadegone
- Department of Orthopaedics & Traumatology, Chandrapur Multispeciality Hospital, Mul Road, Chandrapur, India.
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Fang T, Zhang EW, Sailes FC, McGuire RA, Lineaweaver WC, Zhang F. Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2013; 133:1-10. [PMID: 23076656 DOI: 10.1007/s00402-012-1627-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vascularized fibular grafting (VFG) has been initiated to treat avascular necrosis of the femoral head (ANFH) since the late 1970s. There are a number of review articles updating the use of VFG to treat the ANFH. None of them applied statistical analysis for combining results from different studies to obtain a quantitative estimate of the overall effect and potential harm of VFG in comparison to other treatment. METHODS Several electronic databases were searched to find studies using VFG to treat ANFH. The outcomes sought included Harris Score, failure rate (conversion to total hip arthroplasty (THA) and/or femoral head collapse), and complications rate. Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored. RESULTS The clinical results of 69.0 % of VFG-treated patients and 25.0 % of non-VFG-treated patients were good to excellent (OR 0.13; p < 0.01). The conversion rate to THA of VFG-treated and that of other methods treated hips was 16.5 % and 42.6 % (OR 0.19; p < 0.001). Collapse rate of VFG-treated and that of non-VFG-treated hips was 16.7 % and 63.6 % (OR 0.09; p < 0.05). The complication rate of VFG-treated and that of other methods treated patients was 23.8 % and 8.9 % (OR 3.44; p = 0.09). For Steinberg stage I, II ANFH, failure rate of VFG-treated and that of non-VFG-treated hips was 9.8 % and 40.2 % (OR 0.17; p < 0.001). For Steinberg stage II, III ANFH, failure rate of VFG-treated and that of non-VFG-treated hips was 16.5 % and 42.8 %, respectively (OR 0.17; p < 0.001). CONCLUSIONS VFG is a justified method that can prevent the ANFH from progressing to collapse, and that can retard or avoid hip replacement, especially in the hips of Steinberg stage I, II, and III.
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Affiliation(s)
- Taolin Fang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
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Ayoub MA, Gad HM. Neglected neck femur fractures in adolescents and young adults: factors predicting the surgical outcome. J Orthop Sci 2013; 18:93-100. [PMID: 23096949 DOI: 10.1007/s00776-012-0323-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/02/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neglected femoral neck fracture in young adults is an intriguing problem. This retrospective study tried to solve that challenge through open reduction, cannulated screw internal fixation, autogenous iliac bone and bone marrow grafting. METHODS Thirty-six cases were studied; they were classified according to Sandhu et al.'s classification. Twenty cases were type I and 16 cases were type II fractures; the mean age was 26.8 years; fracture neglect averaged 44.6 days. Twenty cases had posterior comminution and 16 cases had anterior comminution. All cases had open reduction, cannulated screw internal fixation, autogenous iliac bone and bone marrow grafting. The Harris hip score and Matta et al. grading system were applied for functional and radiological evaluation, respectively. RESULTS The average postoperative follow-up was 25.3 months; 94.4 % of the cases had solid union in a mean of 19.6 weeks. Functionally, the Harris hip score averaged 87.8 points. Nonunion, avascular necrosis and coxa vara complicated two, two and four cases, respectively. Fair and poor radiological results were related to coxa vara and avascular necrosis, respectively. Nonunion was significantly related to posterior comminution, type II neglected fracture, and a neglect of more than 45 days. Age groups more than 30 years old and postoperative neck-shaft angles <140° were significantly associated with late-onset radiological healing and nonunion. CONCLUSIONS Cannulated screw osteosynthesis augmented by autogenous bone and bone marrow grafting is a simple, easy-to-perform surgical procedure with encouraging clinical outcomes for selected patients complaining of that difficult problem.
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Affiliation(s)
- Mostafa A Ayoub
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University Hospital, University of Tanta, Al-Geish Street, Tanta, Egypt.
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Gao YS, Zhu ZH, Chen SB, Cheng XG, Jin DX, Zhang CQ. Injury-to-surgery interval does not affect the occurrence of osteonecrosis of the femoral head: a prospective study in a canine model of femoral neck fractures. Med Sci Monit 2012; 18:BR259-64. [PMID: 22739725 PMCID: PMC3560783 DOI: 10.12659/msm.883203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is controversial whether an early reduction and internal fixation can reduce the occurrence of femoral neck fracture-induced osteonecrosis of the femoral head (ONFH). This prospective study was designed to reflect the relationship between injury-to-surgery interval (ISI) and traumatic ONFH based on a canine model of femoral neck fractures. Material/Methods Twenty-four dogs were equally divided randomly into 3 groups. A lateral L-shape approach centered left great trochanter was used for exposure of the femoral neck. A low-speed drill was used for making displaced fractures in the narrow femoral neck, with the femoral head kept in situ with ligamentum teres intact. In Group A, the fracture was immediately reduced and fixed with 3 parallel pins; while the operation was done 3 days later in Group B, and 3 weeks later in Group C. Another 2 dogs had their fractures untreated. Postoperatively, all dogs were fed separately and received regular x-ray examination. Left femoral heads were harvested for histological examination with a postoperative follow-up of 3.5 months. Results The canine model of femoral neck fractures could be achieved successfully. Radiological signs of post-fracture ONFH could not be detected at intervals of 2 weeks, 4 weeks, 1 month and 2 months. Histologically, there were 2 cases with ONFH in Group A, 1 case in Group B, and 2 cases in Group C. The difference had no statistical significance. For untreated fractures, obvious ONFH could be found radiologically. Conclusions A shorter ISI may not reduce the incidence of fracture-induced ONFH, which suggests that intrinsic factors play an important role in the occurrence of ONFH.
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Affiliation(s)
- You-Shui Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Tripathy SK, Sen RK, Goyal T. Reply to comment on Sen et al.: Osteosynthesis of femoral-neck nonunion with angled blade plate and autogenous fibular graft. INTERNATIONAL ORTHOPAEDICS 2012; 36:1321-1322. [PMID: 22278399 PMCID: PMC3353072 DOI: 10.1007/s00264-012-1489-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/09/2012] [Indexed: 02/05/2023]
Affiliation(s)
- Sujit Kumar Tripathy
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
- Department of Orthopaedics, Friarage Hospital, Northallerton, United Kingdom DL6 1JG
| | - Ramesh Kumar Sen
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Tarun Goyal
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
- Freeman Hospital, Newcastle, UK
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Kapoor A, Deety LV, John VZ, Devadoss S, Devadoss A. Management of neglected femoral neck fractures and nonunions using a novel triple surgery combination: an Indian experience. INT J LOW EXTR WOUND 2012; 11:49-58. [PMID: 22334596 DOI: 10.1177/1534734612438056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study describes a 2- to 13-year follow-up of a novel technique for osteosynthesis of neglected femoral neck fractures and nonunions that combines internal fixation with the benefits of fibular grafting and valgus angulation osteotomy. Twenty-three patients were treated by the "3-in-1" surgery, which consisted of osteosynthesis with a dynamic hip screw, nonvascularized fibular grafting, and valgus osteotomy, between January 1996 and June 2009. Union was achieved in all patients at an average of 5.4 months. The average shortening was 0.9 cm. Although avascular necrosis was seen in 4 patients, 2 of them still had good functional scores. Excellent and good hip functional scores were seen in 18 patients. Well-executed surgeries combining biomechanics and biology can ensure union in neglected femoral neck fractures and nonunions provided an adequate length of the neck and proximal fragment is present and there is no subchondral collapse.
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Affiliation(s)
- Amit Kapoor
- Institute of Orthopedic Research and Accident Surgery, Madurai, India
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Gao YS, Ai ZS, Zhu ZH, Yu XW, Zhang CQ. Injury-to-surgery interval does not affect postfracture osteonecrosis of the femoral head in young adults: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:203-9. [DOI: 10.1007/s00590-012-0948-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/20/2012] [Indexed: 02/08/2023]
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Abstract
PURPOSE To assess treatment outcomes in adults with neglected femoral neck fractures, and propose a treatment protocol based on bone quality measured by the Singh index. METHODS 16 men and 6 women aged 18 to 48 (mean, 33) years presented with neglected (>3 weeks old) femoral neck fractures. Those with good bone quality (Singh index, >3) underwent closed reduction and valgus osteotomy and fixation with 120º double angle blade plates (group 1, n=8), whereas those with poor bone quality (Singh index, >3) and/or communition of the posterior femoral neck underwent fibular grafting and internal fixation with one or two 7-mm cannulated cancellous screws (group 2, n=14). Functional outcome was assessed at the 6-month follow-up, according to modified Askin and Bryan criteria. RESULTS The mean delay in surgery was 12 (range, 4-21) weeks. Patients were followed up for a mean of 19 (range, 12-24) months. The mean time to union was 20 (range, 12-52) weeks. The mean time to full weight bearing was 18 (range, 12-40) weeks. All patients achieved bone union except one in group 1 who had non-union and breakage of the blade plate at week 20 and underwent total hip arthroplasty. Other complications included slippage of fibular graft (n=1), delayed union (n=1), avascular necrosis of the femoral head (n=2), limb length discrepancy (n=3), and superficial infection (n=1). Functional outcome was excellent in 2 patients, good in 17, and poor in 3. CONCLUSION Valgus osteotomy and double angle blade plate fixation, and fibular grafting and cancellous screw fixation appeared to be appropriate treatments for neglected femoral neck fractures in adults.
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Affiliation(s)
- Gurvinder Singh Kainth
- Department of Orthopaedics, Maulana Azad Medical College and associated Lok Nayak Hospital, Delhi, India
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[Hip dislocation following the treatment of femoral neck fracture--case report]. SRP ARK CELOK LEK 2010; 138:248-51. [PMID: 20499511 DOI: 10.2298/sarh1004248v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. CASE OUTLINE A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in iclinical findings a shorter leg and limited range of motion in the hip--altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. CONCLUSION As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.
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Abstract
Fracture displacement, a high Pauwels angle, and delayed presentation decrease the potential for healing of femoral neck fractures. In the young individual, head preservation is paramount. Valgus intertrochanteric osteotomy may increase the healing potential of femoral neck fractures in the presence of those detrimental factors. Ten patients younger than 60 years of age with delayed presentation of displaced Pauwels III femoral neck fractures were treated by osteosynthesis and valgus intertrochanteric osteotomy fixed by dynamic hip screws. All osteotomies and nine fractures united with one case developing avascular necrosis.
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