Challenges in the Treatment of Femoral Neck Fractures in the Nonelderly Adult

Davidovitch, Roy I.; Jordan, Charles J.; Egol, Kenneth A.; Vrahas, Mark

doi:10.1097/ta.0b013e3181c428ce

Cited by 102 publications

(82 citation statements)

References 40 publications

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“…Various explanations have been elaborated, including high energy trauma and its correlation with dislocated fractures in the young adult. The rate of osteonecrosis ranges from 12% to 86% [23–27]. Gautam et al [26], while operating on 25 young adults on an ordinary table using the traditional Watson-Jones approach, described three cases of osteonecrosis (12%).…”

Section: Discussionmentioning

confidence: 99%

Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients

Schwartsmann¹,

Jacobus

Spinelli

et al. 2014

ISRN Orthopedics

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Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. Study Type: therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients

Schwartsmann¹,

Jacobus

Spinelli

et al. 2014

ISRN Orthopedics

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“…Any diagnostic or therapeutic strategy for ONFH is best introduced in the early stage of the disease before the condition becomes irreversible [Petrigliano et al, 2007;Kramer et al, 2009;Davidovitch et al, 2010]. The procedure most commonly used to treat early-stage ONFH is core decompression of the hip through the greater trochanter, which involves drilling several small holes in diseased, necrotic bone.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Osteonecrosis of the Femoral Head with VEGF<sub>165</sub> Transgenic Bone Marrow Mesenchymal Stem Cells in Mongrel Dogs

Hang

Wang

Guo

et al. 2011

Cells Tissues Organs

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We evaluated the efficacy of vascular endothelial growth factor 165 (VEGF₁₆₅) transgenic bone marrow mesenchymal stem cells (BMSCs) for the repair of early-stage osteonecrosis of the femoral head (ONFH) in mature mongrel dogs. This animal model was surgically established by femoral neck osteotomy and subsequent repinning. Twenty-seven dogs (54 hips) were divided into 3 equal-sized groups: a pCI-neo-VEGF₁₆₅ BMSC group, a pCI-neo BMSC group and a core decompression-alone group. The lipofectamine was used to introduce the VEGF₁₆₅ gene into the BMSCs. After core decompression, transgenic and non-transgenic autologous BMSCs were implanted. Therapeutic efficacy, including new bone formation and neovascularization in the femoral head, was examined by computed radiography, single-photon emission computed tomography, histological and histomorphometric analysis and immunofluorescent staining for von Willebrand factor in pathological sections. The femoral osteotomy site healed completely by the 4th week after the osteotomy surgery and regions of histologically evident osteonecrosis were found 12 weeks later. A regular arrangement of trabeculae and obvious bone regeneration were observed in the animals receiving implanted VEGF-transgenic BMSCs. The quantity of newly generated capillaries was significantly increased in the pCI-neo-VEGF₁₆₅ BMSC group, but there was no significant difference between the pCI-neo BMSC group and the core decompression-alone group. These results demonstrated that VEGF₁₆₅ transgenic autologous BMSCs enhanced bone reconstruction and blood vessel regeneration in the ONFH model. Compared with non-transgenic BMSCs, this approach could provide advanced benefits in the treatment of ONFH.

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“…The reported incidence of nonunion after internal fixation of femoral-neck fracture is about 10-30% [1][2][3]. Broadly, two types of treatment can be offered following nonunion: joint salvage or prosthetic replacement (hemiarthroplasty or total hip arthroplasty).…”

Section: Introductionmentioning

confidence: 99%

Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft

Sen

Trıpathy²,

Goyal³

et al. 2011

International Orthopaedics (SICOT)

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Angle blade plate provides rigid stability and offloads any shearing force over the fibular graft when used for revision internal fixation in aseptic femoral-neck nonunion. Thus, the fibular graft only serves the purpose of osteogenesis and stimulates the surrounding host cells to promote healing at the nonunion site. We recommend the angle blade plate and autogenous fibular graft as a viable option for hip-joint salvage in revision internal fixation of aseptic femoral-neck nonunion.

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Challenges in the Treatment of Femoral Neck Fractures in the Nonelderly Adult

Cited by 102 publications

References 40 publications

Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients

Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients

Treatment of Osteonecrosis of the Femoral Head with VEGF<sub>165</sub> Transgenic Bone Marrow Mesenchymal Stem Cells in Mongrel Dogs

Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft

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