Surgical Treatment of Femoral Neck Fractures: A Brief Review

Lutnick, Ellen; Kang, Jian; Freccero, David M.

doi:10.3390/geriatrics5020022

Cited by 35 publications

(39 citation statements)

References 70 publications

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“…Elderly patients presenting with non-displaced (Garden I and II) FNF with a posterior tilt of > 20° and those with displaced (Garden III and IV) FNF will preferentially benefit from hip arthroplasty [ 4 – 6 ]. Stable non-displaced (Garden I and II) FNF may be managed with either hip arthroplasty or osteosynthesis [ 7 ], and the optimal treatment for such fractures is still subject to debate [ 6 , 8 ]. Osteosynthesis is associated with higher complication rates than arthroplasty, such as non-union (20 to 35%) [ 9 ], avascular necrosis of the femoral head (23%) [ 10 ] fracture impaction, and consecutive abductor insufficiency (27%) [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes

et al. 2021

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Background Femoral neck fractures (FNF) are frequent in the elderly population, and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the dynamic hip screw system (DHS) are considered gold standards for osteosynthesis. The newly available femoral neck system (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate the short-term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS, and FNS. Methods All the patients of the author’s institution aged ≥ 75 years with a non-displaced (Garden I and II) FNF eligible for osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS, or FNS depending on the surgeon’s preference. Clinical data (age, gender, ASA score, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from the patients’ charts. The radiological analysis assessed the fracture classification, fracture impaction, and proximal femur shortening at 3 and 6 months using the institutional imaging software. Results Baseline characteristics in the TS (n = 32), DHS (n = 16), and FNS (n = 15) groups were similar with respect to age (mean 85 years), gender (female to male ratio 4:1), and ASA score. There were no significant differences across the groups for the need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location, and mortality within 3 months. The duration of surgery was significantly lower in the FNS group (43.3 vs 68.8 min; p < 0.001). The radiological assessment found similar impaction (5.2 mm ± 4.8) and shortening (8.6 mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with a shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multicenter randomized studies are however necessary to confirm these first results.

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Section: Introductionmentioning

confidence: 99%

Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes

et al. 2021

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“…Elderly patients presenting with non-displaced (Garden I-II) FNF with a posterior tilt of >20° and those presenting with displaced (Garden III and IV) FNF will preferentially benefit from hip arthroplasty [6,7,8]. Stable non-displaced (Garden I and II) FNF may be managed with either hip arthroplasty or osteosynthesis [9] and the optimal treatment for such fractures is still subject to debate, depending on several parameters, including the amount of posterior tilt on the axial view [8], [10]. Osteosynthesis is associated with higher complication rates than arthroplasty, such as non-union (20 to 35%) [11], avascular necrosis of the femoral head (23%) [12] fracture impaction and consecutive abductor insufficiency (27%) [13].…”

Section: Introductionmentioning

confidence: 99%

Osteosynthesis of Non-displaced Femoral Neck Fractures in the Elderly Population Using the Femoral Neck System (FNS): Short-term Clinical and Radiological Outcomes

Vázquez¹,

Gamulin²,

Hannouche³

et al. 2021

Preprint

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Background: femoral neck fractures (FNF) are frequent in the elderly population and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the Dynamic Hip Screw system (DHS) are considered gold standards for osteosynthesis. The newly available Femoral Neck System (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate short term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS and FNS. Methods: all the patients of the author’s institution aged ≥ 75y with a non-displaced (Garden I and II) FNF eligible to osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS or FNS depending on surgeon’s preference. Clinical data (age, gender, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from patients’ charts. Radiological analysis assessed fracture classification, fracture impaction and proximal femur shortening at 3 and 6 months using the institutional imaging software.Results: the TS (n=32), DHS (n=16) and FNS (n=15) groups were similar with respect to age (mean 85y) and gender (female: male ratio 4:1). There were no significant differences across groups for need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location and mortality within 3 months. Duration of surgery was significantly lower in the FNS group (43.3 vs 68.8min; p<0.001). Radiological assessment found similar impaction (5,2mm ± 4.8) and shortening (8.6mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion: The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multi-center randomized studies are however necessary to confirm these first results.

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“… 6 However, poorer outcomes have been reported with ORIF in comparison to THA for displaced FNFs. 38 Reoperation rates are four times higher, functional performance is inferior and quality of life is ultimately worse in ORIF as opposed to arthroplasty surgery. Overall, the risk of failure of fixation for displaced FNFs is 39–43%, 7 mostly subsequent to osteonecrosis and nonunion.…”

Section: Managementmentioning

confidence: 99%

The management of displaced femoral neck fractures: a narrative review

et al. 2021

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This article serves to review the existing clinical guidelines, and highlight the most recent medical and surgical recommendations, for the management of displaced femoral neck fractures (FNFs). It stresses the need for multi-disciplinary intervention to potentially improve mortality rates, limit adverse events and prevent further economic liability. Globally, the incidence of FNFs continues to rise as the general population ages and becomes more active. The annual number of FNFs is expected to exceed six million by 2050. The increased burden of FNFs exacerbates the demand on all services associated with treating these injuries. The management of FNFs may serve as an indicator of the quality of care of the geriatric population. However, despite escalating health costs, a significant 30-day and one-year mortality rate, increased rate of peri-operative adverse events and sub-optimal functional clinical outcomes, continued controversy exists over optimal patient care. Much debate exists over the type of surgery, implant selection and peri-operative clinical care and rehabilitation. FNF care models, systematized clinical pathways, formal geriatrics consultation and specialized wards within an established interdisciplinary care framework may improve outcomes, mitigate adverse events and limit unnecessary costs. Cite this article: EFORT Open Rev 2021;6:139-144. DOI: 10.1302/2058-5241.6.200036

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Surgical Treatment of Femoral Neck Fractures: A Brief Review

Cited by 35 publications

References 70 publications

Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes

Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes

Osteosynthesis of Non-displaced Femoral Neck Fractures in the Elderly Population Using the Femoral Neck System (FNS): Short-term Clinical and Radiological Outcomes

The management of displaced femoral neck fractures: a narrative review

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