Contemporary management of femoral neck fractures: the young and the old

Forsh, David A.; Ferguson, Tania A.

doi:10.1007/s12178-012-9127-x

Cited by 28 publications

(42 citation statements)

References 73 publications

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“…Other factors need to be considered in the decision-making process, and in earlier reports these factors have included the Garden grade of the fracture, the time interval between injury and treatment, and, most importantly, the physiological age discussed recently by Forsh and Ferguson. 37 The current authors' found no statistically significant association between Gar-den grading of the fracture and AVN. This contrasts numerous earlier reports showing a significant relationship between the degree of fracture displacement and subsequent AVN.…”

Section: Fracture Of the Neck Of Femur In Adultscontrasting

confidence: 57%

“…36 Another common argument is that osteoporosis in the physiologically older group affords poor purchase of internal fixation devices and increases the failure rates. 37 However, in 1 study that objectively examined this claim, no correlation was found between bone mineral density and the clinical outcome of the fracture. 38 The claim that arthroplasty is better in the presence of osteoporosis has also been challenged by the finding of Kobayashi et al 39 that reduced bone density is an independent risk factor for implant loosening following primary total hip arthroplasty.…”

Section: Fracture Of the Neck Of Femur In Adultsmentioning

confidence: 99%

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PET/CT Study of Temporal Variations in Blood Flow to the Femoral Head Following Low-energy Fracture of the Femoral Neck

Kumar¹,

Belehalli²,

Ramachandra³

2014

Orthopedics

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Earlier studies on femoral neck fractures have assessed the blood flow in either the pre- or postoperative period and information is lacking regarding changes in vascular flow to the femoral head after injury. Sixty-two adults with low-energy intracapsular femoral neck fractures were studied prospectively. Mean patient age was 57.2 years (range, 45-82 years). All patients underwent positron emission tomography/computed tomography (PET/CT) prior to surgical intervention and 6 weeks after internal fixation. Internal fixation was done using cannulated cancellous titanium screws and serial follow-up radiographs were obtained (at monthly intervals for the first 3 months followed by 3 monthly intervals between radiographs up to 2 years). On the preoperative PET/CT, 13 patients showed intact vascularity, 31 showed total loss of vascularity, and 18 showed partial loss of vascularity of the femoral head. The 6-week postoperative PET/CT scan showed recovery of blood supply in 23 of the 31 patients with total loss of vascularity and 15 of the 18 patients with partial loss of vascularity of the femoral head. Eleven of 62 patients had total or partial avascularity at the 6-week postoperative PET/CT scan and all 11 patients showed evidence of avascular necrosis on plain radiographs at the end of 2 years. The association between the vascular status of the femoral head at 6 weeks and avascular necrosis at the end of 2 years was statistically significant (P<.001). This study shows that the femoral head undergoes temporal variations in blood flow following femoral neck fracture. Decreased or absent vascularity is seen in approximately 75% of the fractures and 80% of the femoral heads with initial vascular compromise seem to regain blood flow within 6 weeks. Thus, prognostication about vascularity based on single-point preoperative imaging is difficult. The 6-week postoperative PET/CT scan seems to be reliable in predicting the future status of the femoral head. However, decision making regarding hemiarthroplasty or internal fixation at the time of injury may have to depend on factors other than the preoperative vascular status of the femoral head.

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Section: Fracture Of the Neck Of Femur In Adultscontrasting

confidence: 57%

Section: Fracture Of the Neck Of Femur In Adultsmentioning

confidence: 99%

PET/CT Study of Temporal Variations in Blood Flow to the Femoral Head Following Low-energy Fracture of the Femoral Neck

Kumar¹,

Belehalli²,

Ramachandra³

2014

Orthopedics

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“…This is so that the broken surface of the bone can be uniformly subjected to force, has enough stability, and the fixation strength is maximized. It is a commonly used surgical method for femoral neck fractures at present. The placement direction and position of cannulated screw during operation are closely related to whether the fracture is re‐displaced after operation, whether the fracture fixation is stable, and whether the fracture is healed or not.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Femoral Neck Fractures with Cannulated Screw Invasive Internal Fixation Assisted by Orthopaedic Surgery Robot Positioning System

Wang

Lan

2019

Orthopaedic Surgery

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Objective To investigate the clinical efficacy and advantages of cannulated screw internal fixation assisted by the orthopaedic surgery robot positioning system in the treatment of femoral neck fractures. Methods The clinical data of 128 patients with femoral neck fractures which had been treated with cannulated screw internal fixation from January 2016 to July 2018 were retrospectively analyzed. Among them, 63 patients were treated with cannulated screw assisted by orthopedic robot positioning system (orthopaedic surgery robot group), and 65 patients were treated with traditional cannulated screw (traditional surgery group). The operation time, number of intraoperative fluoroscopy, number of guide needle placements, and the amount of operative blood loss were compared between the two groups. The success rate of one‐time nail placement and the fracture healing rate were calculated. Fracture healing and internal fixation were observed. The hip joint function was evaluated by the Harris hip score 1 year after operation. Results All patients were followed up for 12 to 24 months. The operation time was 65.70 ± 9.87 min in the robot group and 73.74 ± 9.78 min in the traditional group. The number of intraoperative fluoroscopy was 13.67 ± 4.39 times in the robot group and 17.09 ± 4.02 times in the traditional group. The number of guide needle placements was 9.95 ± 3.72 times in the robot group and 13.78 ± 4.39 times in the traditional surgery group. The success rate of one‐time nail placement was 100% (63/63) in the robot group and 49.23% (32/65) in the traditional group. The amount of operative blood loss was 15.25 ± 6.21 mL in the robot group and 25.51 ± 6.97 mL in the traditional group. Compared with the traditional group, the robot group had shorter operation time, less fluoroscopy, less needle placement, less bleeding, and higher success rate of one‐time nail placement. There was a significant difference between the two groups (P < 0.05). In the robot group, there was no infection, loosening of internal fixation, fracture displacement, and osteonecrosis of femoral head during the follow‐up period. The fracture healing rate was 100% (63/63). In the traditional group, there were two cases of loosening of internal fixation and one case of osteonecrosis of femoral head during the follow‐up period. The fracture healing rate was 100% (65/65). All patients were evaluated for hip joint function 1 year after operation. The Harris hip score in the robot group was 86.86 ± 4.74, and the Harris hip score in the traditional surgery group was 83.08 ± 5.44. Compared with the traditional group, the Harris hip score in the robot group was higher than that in the traditional group. There was significant difference between the two groups (P < 0.05). The excellent and good rate were 92.06% (58/63) in the robot group and 80% (52/65) in the traditional group. There was no significant difference between the two groups (P > 0.05). Conclusion Cannulated screw internal fixation assisted by the orthopaedic surgery robot positioning system is ...

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“…Better outcomes have been observed for total hip arthroplasty in the functional elderly versus hemiarthroplasty for the cognitively impaired elderly. 30,31 Intertrochanteric and Subtrochanteric Fractures These fractures are typically similar to femoral neck fractures, and similarly dangerous, with a 6-month mortality rate of 10% to 30%. The intertrochanteric region includes from below the femoral neck to above the lesser trochanter.…”

Section: Femoral Neck Fracturesmentioning

confidence: 99%