Complications following young femoral neck fractures

Slobogean, Gerard P.; Sprague, Sheila; Scott, Taryn; Bhandari, Mohit

doi:10.1016/j.injury.2014.10.010

Cited by 305 publications

(228 citation statements)

References 34 publications

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“…A recent metaanalysis reported the incidence of ON to be 14.3 % (range 10 to 25 %) in this population [1,33]. Liu et al showed through digital subtraction angiography that the rate of ON after a femoral neck fracture was directly linked to the number of vessels crossing the fracture line [34•].…”

Section: Vascular Interruptionmentioning

confidence: 99%

Pathophysiology and risk factors for osteonecrosis

Shah

Racine

Jones

et al. 2015

Curr Rev Musculoskelet Med

229

150

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Osteonecrosis, also known as avascular necrosis or AVN, is characterized by a stereotypical pattern of cell death and a complex repair process of bone resorption and formation. It is not the necrosis itself but rather the resorptive component of the repair process that results in loss of structural integrity and subchondral fracture. Most likely, a common pathophysiological pathway exists involving compromised subchondral microcirculation. Decreased femoral head blood flow can occur through three mechanisms: vascular interruption by fractures or dislocation, intravascular occlusion from thrombi or embolic fat, or intraosseous extravascular compression from lipocyte hypertrophy or Gaucher cells. In this review, we emphasize etiologic relationships derived mostly from longitudinal cohort studies or meta-analyses whose causal relationships to osteonecrosis can be estimated with confidence. Understanding risk factors and pathophysiology has therapeutic implications since several treatment regimens are available to optimize femoral head circulation, interrupt bone resorption, and preserve the subchondral bone.

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Section: Vascular Interruptionmentioning

confidence: 99%

Pathophysiology and risk factors for osteonecrosis

Shah

Racine

Jones

et al. 2015

Curr Rev Musculoskelet Med

229

150

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“…Although its pathogenesis is poorly understood, it is generally accepted that various traumatic and non-traumatic insults compromise the already precarious circulation of the femoral head, leading to bone marrow and osteocyte death—and eventually collapse of the necrotic segment (Mont and Hungerford 1995). It mostly affects young adults, causing considerable morbidity (Slobogean et al 2015). The annual incidence of ONFH in the USA is estimated to be 15,000–20,000 cases (Vail and Covington 1997).…”

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confidence: 99%

The role of “cell therapy” in osteonecrosis of the femoral head

et al. 2015

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Background and purposeThe value of core decrompression for treatment of osteonecrosis of the femoral head (ONFH) is unclear. We investigated by a literature review whether implantation of autologous bone marrow aspirate, containing high concentrations of pluripotent mesenchymal stem cells, into the core decompression track would improve the clinical and radiological results compared with the classical method of core decompression alone. The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR).Patients and methodsAll randomized and non-randomized control trials comparing simple core decompression with autologous bone marrow cell implantation into the femoral head for the treatment of ONFH were considered eligible for inclusion. The methodological quality of the studies included was assessed independently by 2 reviewers using the Cochrane Collaboration tool for assessing risk of bias in randomized studies. Of 496 relevant citations identified, 7 studies formed the basis of this review.ResultsThe pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08–0.6; p = 0.02). The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3–1.02; p = 0.06).InterpretationOur findings suggest that implantation of autologous mesenchymal stem cells (MSCs) into the core decompression track, particularly when employed at early (pre-collapse) stages of ONFH, would improve the survivorship of femoral heads and reduce the need for hip arthroplasty.

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“…Compared with the two cannulated screw con gurations, the internal xation FNS showed lower peak stresses of the femoral head and smaller displacements of the femur and internal implant in the treatment of Pauwels type III femoral neck fractures. In addition, when the Pauwels angle and loads increased, the stresses and displacements of the femoral head and 26 . Several biomechanical studies 21,27,28 have revealed that the cannulated screw method of xation is not the best choice for vertical femoral neck fractures in young adults.…”

Section: Discussionmentioning

confidence: 98%

Finite element analysis of a new internal fixation implant for Pauwels type III femoral neck fractures

Fan¹,

Su²,

Zhou³

et al. 2020

Preprint

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Background The optimal treatment strategy for Pauwels type III femoral neck fractures remains controversial. A new internal fixation femoral neck system (FNS) for the treatment of femoral neck fractures was developed, and we compared the mechanical efficiency of the internal fixation FNS with that of two cannulated screw configurations for the treatment of Pauwels type III femoral neck fractures. Method: In this study, we constructed models of Pauwels type III femoral neck fractures with angles of 50°, 60°, and 70°. Moreover, a fixation model with the FNS and two fixation models with cannulated screws were developed. Under two axial loads, 1400 N and 2100 N, the von Mises stress distributions, maximum von Mises stress, and displacements of the femur and internal fixation components were measured for each fracture group. Result The maximum von Mises stress of internal fixation in the three models was mostly located near the fracture line, and the femoral head region closest to the femoral calcar experienced the maximum amount of stress. As the Pauwels angle and axial loads increased, the stress and displacement of the proximal femoral head and internal fixation component increased in each group. Compared with cannulated screw configurations, the internal fixation FNS showed lower values of peak stress at the femoral head and smaller displacements of the femur and internal implant in the treatment of Pauwels type III femoral neck fractures with Pauwels angles of 50°, 60°, and 70°. Conclusion The newly developed internal fixation FNS provided improved biomechanical stability for the treatment of Pauwels type III femoral neck fractures, which indicated that the internal fixation FNS may be a new option for the treatment of vertical femoral neck fractures.

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Complications following young femoral neck fractures

Cited by 305 publications

References 34 publications

Pathophysiology and risk factors for osteonecrosis

Pathophysiology and risk factors for osteonecrosis

The role of “cell therapy” in osteonecrosis of the femoral head

Finite element analysis of a new internal fixation implant for Pauwels type III femoral neck fractures

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