Prediction of fixation failure in femoral neck fractures: Comminution and avascularity studied in 40 patients

Alho, A; Benterud, Jan G; Müller, Carl; Husby, Torstein

doi:10.3109/17453679308993655

Cited by 13 publications

(6 citation statements)

References 13 publications

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“…They went further to show that patients who had fracture of femoral neck with posterior cortical disruption were more likely to end up with revision surgery, usually joint replacement, either bipolar or total hip. This was also observed by other authors such as Frangakis 17 , Scheck 18,19 in his papers in 1959 and 1980, and more recently, by Alho et al 20 in 1993. In our study, we noticed that the incidence of avascular necrosis in the presence of posterior comminution is almost 2.5 times more compared to those without posterior comminution.…”

Section: Discussionsupporting

confidence: 78%

Cannulated Screw Fixation For Femoral neck Fractures : A 5-year experience In A Single Institution

Khoo¹,

Haseeb²,

Singh³

2014

MOJ

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Cannulated screw fixation is a widely accepted surgical method for management of fractures of the neck of femur especially in patients with poor premorbid conditions, minimally displaced fractures and those from a younger age group. A five year retrospective study was carried out in 53 consecutive patients between 2006 to 2010 to determine the pattern of injuries, management, outcomes and the associated predictive factors.All the patients underwent cannulated screw fixation, with 37 (69.8%) having had surgery within 24 hours and the remaining 16 (30.2%) 24 hours after the initial injury. All patients were followed up to union of fractures and complications thereafter if any. Good outcome was observed in 43 (81.1%) patients leaving only 10 (18.9%) patients with a poor outcome, of whom nine developed avascular necrosis (90%) and one non-union (10%). We found no significant relationship between the incidence of avascular necrosis and age of patient, fracture displacement, numbers of cannulated screws used, fracture reduction acceptability and anatomical location of the fracture. The time interval from injury to surgery and the presence of posterior comminution did seem to influence the rate of avascular necrosis but due to the small number of patients, was not statistically significant.We conclude that cannulated screw fixation is a viable option of treatment for fractures of the neck of femur.Key Wordsfemoral neck fractures, screw fixation

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Section: Discussionsupporting

confidence: 78%

Cannulated Screw Fixation For Femoral neck Fractures : A 5-year experience In A Single Institution

Khoo¹,

Haseeb²,

Singh³

2014

MOJ

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“…However, the presence of comminution of the calcar can be associated with a lower resistance to displacement and a lower failure to axial load within the first 3 months postoperatively, necessitating supplemental fixation. 29 This was demonstrated by the work of Kauffman et al 30 who conducted a cadaveric study with osteoporotic bone and demonstrated the enhanced biomechanical strength of placing a fourth cancellous screw in the treatment of femoral neck fractures with posterior comminution.…”

Section: Fixationmentioning

confidence: 97%

“…29,36 Thus, in light of its stimulatory effects on cortical and cancellous bone formation, bone mass, and compressive strengths, 59,60 Skripitz and Aspenberg 61,62 investigated the ability of PTH to enhance orthopaedic implant fixation. Stainless steel screws were inserted into the tibiae of adult male rats who went onto receive either 60 mg/kg of PTH or saline injections 3 times a week for 1, 2, or 4 weeks.…”

Section: Parathyroid Hormonementioning

confidence: 99%

Can We Improve Fixation and Outcomes in the Treatment of Femoral Neck Fractures? The Use of Pharmaceuticals

Little¹,

Einhorn²

2009

Journal of Orthopaedic Trauma

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Femoral neck fracture rates are on the rise with an estimated 500,000 occurring annually by 2040. Despite the mainstay of open reduction and internal fixation, nonunion rates of up to 33% have been reported for displaced femoral neck fractures. Recently, increasing attention has been focused upon the role of osteobiologics to stimulate fracture repair. This article looks at the role of these anabolic compounds and discusses their potential future roles in augmenting the treatment of this condition.

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“…Several variables have been associated with failure of fixation. These include patient demographics such as increased age, 15 male gender, 31 and decreased bone mineral density; 22,44 or fracture characteristics such as the presence of comminution [31][32][33] or fracture displacement 12,20,38 and quality of reduction. 11,12,[15][16][17][18][19][20][21]41 (Table 4).…”

Section: Relevant Literaturementioning

confidence: 99%

“…9,25,26 The rationale for these guidelines is based primarily on anatomic data, 27,28 biomechanical data, 22,29,30 and clinical case series. 13,20,26,[31][32][33][34][35][36][37] Previous case series have not uniformly evaluated a comprehensive list of potential clinical and radiographic variables associated with fixation failure. Given the continued debate regarding the optimal implant in the management of femoral neck fractures and the high fixation failure rates associated with internal fixation, our study aimed to identify those modifiable variables associated with fixation failure in a series of patients treated with multiple cannulated screws for displaced and undisplaced femoral neck fractures.…”

mentioning

confidence: 99%

The Value of Washers in Cannulated Screw Fixation of Femoral Neck Fractures

Zlowodzki

Weening

Petrisor

et al. 2005

Journal of Trauma: Injury, Infection &Amp; Critical Care

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This study confirms previous findings in the literature that increased age, a displaced fracture type, and poor reduction increase the risk of fixation failure. Contradictory to current belief, there was no significant association between the distance of the inferior screw to the inferior/medial femoral neck cortex and fixation failure. A novel finding of the present study is that the use of washers significantly decreases the risk of fixation failure.

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Prediction of fixation failure in femoral neck fractures: Comminution and avascularity studied in 40 patients

Cited by 13 publications

References 13 publications

Cannulated Screw Fixation For Femoral neck Fractures : A 5-year experience In A Single Institution

Cannulated Screw Fixation For Femoral neck Fractures : A 5-year experience In A Single Institution

Can We Improve Fixation and Outcomes in the Treatment of Femoral Neck Fractures? The Use of Pharmaceuticals

The Value of Washers in Cannulated Screw Fixation of Femoral Neck Fractures

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