Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes: Analysis of the prospective multi-center study of hip fracture outcomes in China (SHOC)

Slobogean, Gerard P.; Stockton, David J.; Zeng, Bingfang; Wang, Dong; Ma, Baotong; Pollak, Andrew N.

doi:10.1016/j.injury.2017.06.013

Cited by 93 publications

(72 citation statements)

References 18 publications

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“…Thus, less than 25% had fully recovered [57], 35% had not returned to work [59] and the use of walking aids increased from 11 to 35% [56]. On average, patients needed about 50 % more time performing the Timed Up and Go test and the SF-36 (PCS) was about half of a non-injured population [54]. One-third had only fair to poor Oxford hip scores after 12 months [51].…”

Section: Surgical Outcomementioning

confidence: 99%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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Nonelderly hip fracture patients have gathered little scientific attention, and our understanding of the group may be biased by patient case-mix and lack of follow-up. Preconceptions may thwart adequate investigation of bone health and other comorbidities. This literature review focusses on who these patients between 20 and 60 years are, how to treat them and how to evaluate the outcome. 2-11% of the hip fractures occur in non-elderly, equally common in men and women. Every second to forth patient smoke, have chronic diseases, and abuse alcohol. Poor self-rated health, sleep disturbances, low cognitive function and education are associated with increased hip fracture risk in young adults. Bone health is poorly investigated, but literature suggest young patients to have lower bone mineral density regardless of trauma mechanism. Studies contradict on whether surgery within 8-12 h reduce the risk of avascular necrosis in femoral neck fractures (FNF). Based on rationality, surgery ought to be performed promptly, in order to reduce pain and permit rehabilitation. There is no convincing support from the existing literature to use open reduction. Good reduction is mandatory, preferably using a closed reduction technique. The failure rate following internal fixation of displaced FNF in younger patients can be as high as 59%. In some cases a displaced FNF is better treated with a primary arthroplasty; in case of rheumatoid arthritis or osteoarthritis for example. Complications after extracapsular fractures vary from 6 to 23%. The relatively few studies looking at functional outcome in non-elderly use a multitude of outcome measures, precluding comparisons. Many non-elderly patients seem not to fully recover. While some non-elderly hip fracture patients are healthy individuals sustaining high energy trauma, others have low-energy fractures and comorbidities including reduced bone strength (either as a primary or secondary condition). i.e. non-delaying medical optimization, proper surgical technique, bone health investigation and secondary fracture prevention is necessary. Younger hip fracture patients are at risk of permanent loss of function, and negative socioeconomic and psychological consequences. High-energy trauma does not exclude the presence of osteopenia. A hip fracture in adulthood and middle-age is very seldom caused by bad luck only!

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Section: Surgical Outcomementioning

confidence: 99%

Hip fractures in the non-elderly—Who, why and whither?

Rogmark

Kristensen

Viberg

et al. 2018

Injury

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“…al. showed that more than 10 mm telescoping of the hip screw resulted in disfunction of gluteus muscle power, which can lead to the inability to walk [10]. In our study, although three of the six "loss of reduction" cases could walk before fracture, two of them were unable to walk for a year.…”

Section: Discussionmentioning

confidence: 51%

Complications of femoral neck fracture fixation using a sliding hip screw with a side plate device in patients older than 65 years

Mitsugi

Miyamoto

Izumi

et al. 2020

Preprint

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BackgroundA majority of femoral neck fractures are indicated for surgical treatment within the scope of applicable guidelines. However, the reported overall complication rate in elderly patients one year after hip fracture fixation was 33.3%. The purpose of this study was to clarify the incidence of complications one year after femoral neck fracture fixation using a sliding hip screw with a side plate device in elder than 65-year-old patients.MethodsWe studied the results of 115 cases of the internal fixation for femoral neck fractures in patients older than 65 years of age using the Twins device (HOYA Technosurgical Corporation, Tokyo, Japan). We could follow up 39 of these 115 cases at one year after fixation and retrospectively investigated complications in these patients. Research outcomes were mortality, surgical site infection (SSI), loss of reduction, aseptic necrosis, late segmental collapse (LSC), nonunion, periprosthetic fracture, reoperation, and recovery of walking ability.ResultsThe patients consisted of 13 men and 26 women (mean age 80.5 years, range 65-104 years). Mortality was observed in four cases (14.2%), SSI in one case (2.5%), loss of reduction in six cases (15.4%), aseptic necrosis in seven cases (17.9%), LSC in three cases (7.6%), nonunion in eight cases (20.5%), periprosthetic fracture in three cases (7.6%), and reoperation was performed in seven cases (17.9%), respectively. In 28 cases, the patients could walk independently before injury; this decreased to 19 cases after injury (67.9%).ConclusionsIn our study, the incidence of loss of reduction rate and periprosthetic fracture rate were relatively high. Other complications of the Twins device evaluated were equivalent to those reported previously.

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“…However, the stability of intertrochanteric fractures involving medial wall injury was not universally affected; medial wall injury accounted for (97.4%) of the patients with posterior-medial fractures, but the radiographic results in patients with type III, IV, and V fractures suggested that the fracture type was relatively stable. HHS function scores indicated a signi cant difference between type I fracture and other fracture classi cations, which also con rmed that neck shortening signi cantly reduced Harris hip scores 18,21,23,5 . Moreover, the postoperative HHS function score of type II fracture with the same posterior-medial involvement was satisfactory.…”

Section: Discussionmentioning

confidence: 65%

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

Ren

et al. 2020

Preprint

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Background: The purpose of this study was to analyze the fracture patterns of different posterior-medial wall types of intertrochanteric fractures by 3-D fracture-mapping technique and to further assess their clinical utility.Methods: In a retrospective analysis of interochanteric fractures treated in a large trauma center, fractures were classified into predesigned groups based on 3D-CT imaging techniques, and a 3-D template of the intertrochanteric region was graphically superimposed on the fracture line. Fracture characteristics were then summarized based on fracture-mapping. Finally, radiographic parameters, function, and range of motion were recorded in different fracture classification states.Results: A total of 348 intertrochanteric fractures were included. There were 111 patients (31.9%) in the posterolateral + posteromedial + medial group, with the most severe fracture displacement (typically characterized by fragmentation of the posteromedial wall into three isolated fragments). There were 102 cases (29.3%) in the posterolateral + posteromedial + simple medial group, and the most common fracture feature was a complete fragment posteromedially. A total of 81 cases (23.3%) were classified into the posterolateral + medial group, with the medial fracture line extending the anterior fracture line but leaving the lesser trochanter intact. In the isolated medial group of 33 cases (9.5%), the fracture type was similar to type IV, but the integrity of the greater trochanter was ensured. In the posteromedial + medial group of 12 cases (3.4%), the fracture was characterized by an interruption when the fracture line of the anterolateral wall extended to the posteromedial wall, often resulting in a complete isolated fragment posteromedially and medially. There were 9 patients (2.6%) in the isolated posterolateral group. In addition, we found significantly different radiographic scores and range of motion scores between groups.Conclusions: This morphometric study helps us to further characterize posterior-medial fracture patterns of intertrochanteric fractures, which may be closely related to different clinical outcomes. Further studies are needed to verify the reliability of this classification scheme in clinical application.Study Design: Crossover Study Design; Level of evidence, 3.

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Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes: Analysis of the prospective multi-center study of hip fracture outcomes in China (SHOC)

Cited by 93 publications

References 18 publications

Hip fractures in the non-elderly—Who, why and whither?

Hip fractures in the non-elderly—Who, why and whither?

Complications of femoral neck fracture fixation using a sliding hip screw with a side plate device in patients older than 65 years

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

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