The management of displaced femoral neck fractures: a narrative review

Sekeitto, Allan Roy; Sikhauli, Nkhodiseni; Jagt, D.R. van der; Mokete, Lipalo; Pietrzak, J

doi:10.1302/2058-5241.6.200036

Cited by 24 publications

(14 citation statements)

References 51 publications

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“…With the increase of life expectancy and development of medical technology, the incidence of this injury would rise year by year. It is estimated that the number of femoral neck fractures worldwide will over 3.9 million by 2050 1,2,4,5 . Owing to advanced age and concomitant underlying diseases (heart disease, diabetes mellitus, pulmonary disease, cerebrovascular disease) or limb immobilization after trauma, elderly patients with femoral neck fractures are prone to developing various complications after non-operative treatment, such as painful bed sores, deep vein thrombosis and depression, which would make the already poor prognosis further exacerbated 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients

Zhu

Deng

et al. 2022

Orthopaedic Surgery

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Objective To investigate whether four‐screw fixation in rhombic configuration could improve the clinical outcomes and decrease the complication rate compared with three‐screw fixation in inverted triangle configuration in elderly patients with nondisplaced femoral neck fractures. Method From January 2018 to January 2019, 91 elderly patients with nondisplaced femoral neck fractures who were treated with a cannulated screw system were reviewed retrospectively. The inverted triangle configuration was applied in 51 patients and rhombic configuration in 40 patients. The demographic and perioperative information of the patients were extracted from medical records and surgical records. Variables including incision size, surgical blood loss, surgical time, fluoroscopy time, hospital stays, fracture union time, postoperative visual analogue scale (VAS) scores, and complications were compared between the two groups. Also, Harris hip score at the final follow‐up was used to evaluate the functional outcomes. Results All patients were followed up from 24 to 36 months, with an average of 29.75 months. The average age of patients was 72.37 ± 7.16 years. No significant differences were found between the two groups with regard to patients' age, gender, affected side, Garden classification, Pauwels classification and comminution of posterior wall (P > 0.05). We found shorter incision size (P < 0.001), less blood loss (P = 0.020), less surgical time (P = 0.026), and shorter fluoroscopy time (P < 0.001) in inverted triangle configuration group. However, shorter hospital stays (P = 0.001) and fracture union time (P = 0.002) were found in the rhombic configuration group. The VAS scores were lower in the rhombic configuration group at the first (P < 0.001) and third months (P = 0.010), but no significant difference was found at the sixth month (P = 0.075). Meanwhile, the total complication rate was relatively lower in the rhombic configuration group compared to the inverted triangle configuration group (P = 0.041). Harris hip score presented no significant difference between the two groups at final follow‐up (P = 0.078). No wound infection or cortical perforation occurred in either group. Conclusion Four‐screw fixation in rhombic configuration was superior to three‐screw fixation in inverted triangle configuration in the treatment of nondisplaced femoral neck fractures in elderly patients in terms of less early postsurgical pain, shorter fracture union time, and lower complication rate.

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Section: Introductionmentioning

confidence: 99%

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients

Zhu

Deng

et al. 2022

Orthopaedic Surgery

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“…In previous studies, the mortality has been reported to range between 12 and 37% within 1 year of the injury [ 1 , 2 ]. With the aging of the general population and development of medical technology, the incidence of FNF will be increasing exponentially and the number has been estimated to be over 3.9 million worldwide by 2050 [ 3 , 4 ]. Therefore, it is imperative to identify and correct the modifiable risk factors contributing to mortality to explore the optimal personalized therapy [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Low lymphocyte-to-C-reactive protein ratio relates to high 1-year mortality in elderly patients undergoing hemiarthroplasty for displaced femoral neck facture

et al. 2022

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Objective Lymphocyte-to-C-reactive protein (CRP) ratio (LCR) is a novel biomarker for predicting poor prognosis in many diseases. This study aims to analyze the association between preoperative LCR and 1-year mortality in elderly patients with displaced FNF undergoing hemiarthroplasty. Methods Between May 2017 and May 2019, a retrospective study including 364 elderly patients undergoing hemiarthroplasty for displaced FNF was performed. LCR was defined as the ratio of preoperative lymphocyte count to CRP level. The optimal cutoff value of LCR was determined by receiver operating characteristic curve, and all patients were categorized into low-LCR group and high-LCR group accordingly. The relationship between LCR and 1-year mortality was evaluated by using univariate and multivariate Cox regression analysis. Furthermore, the complications within 30 days after surgery, length of hospital stay, and perioperative red blood cell transfusion were also analyzed stratified by LCR. Results A total of 47 patients (12.9%) died within 1-year follow-up after surgery. The optimal cutoff value for LCR was 30,560 (specificity 76.6% and sensitivity 63.4%). Low-LCR (≤ 30,560) group had a higher mortality rate than high-LCR group (23.53% vs. 5.21%, P < 0.001). In multivariate analysis, low LCR, hypoalbuminemia, and Age-Adjusted Charlson Comorbidity Index ≥ 6 were identified as independent predictors for 1-year mortality. Moreover, low level of LCR was associated with high rate of total complications (19.6% vs. 11.4%, P = 0.029), perioperative transfusions (37.9% vs. 27.0%, P = 0.027), and longer hospital stay (7.84 ± 2.40 vs. 7.30 ± 2.32, P = 0.031). Conclusions The low level of preoperative LCR can effectively predict 1-year mortality and 30-day total complications after surgery in elderly patients with displaced FNF undergoing hemiarthroplasty.

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“…The treatment of FNF depends not only on the classi cation of fractures, but also on age (7,8). In this study, patients with FNF were classi ed by new AO classi cation in different age groups.The purpose is to observe the proportion of new AO classi cation in FNF patients and provide reference for improving the upper age limit of IF treatment.…”

Section: Introductionmentioning

confidence: 99%

Distribution Characteristics of New AO Classification in Different Age Groups of Patients with Femoral Neck Fracture

Jiang

Feng

Huang

et al. 2022

Preprint

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Objective: Femoral neck fractures(FNFs) patients from 2018 to 2020 were classified according to the new AO classification. To observe the proportion of new AO classification and provide reference for improving the upper age limit of internal fixation(IF) treatmentMethods: In this study, patients with femoral neck fracture hospitalized in Xi 'an Honghui Hospital from January 2018 to January 2021 were divided into four groups according to age: the young group (≤44 years old), the middle-aged group (45-59 years old),the young elderly group (60-74 years old), and the elderly group (≥75 years old) to analyze age,sex,side,injury mechanism,new AO classification and other features . A total of 2071 patients were included for analysis.Results: There were 742 males (35.8%) and 1,329 females (64.2%).There were 1,106 patient s(53.4%) on the left side and 965 on the right side (46.6%).There were 1781 patients of low energy injury (86%) and 290 patients of high energy injury (14%), and the main injury mechanism was falling.The number of patients with femoral neck fracture in each year was 719 patients in 2018, 694 patients in 2019, and 661 patients in 2020, respectively. The number of patients showed a decreasing trend year by year, and the gender ratio and injury mechanism showed no significant trend of change. In the age group, the proportion of the young group was increasing year by year.Among the new AO classification, there were 1023 patients of B1.3, accounting for the highest proportion of 49.4%.The proportion of B2.2 was the highest in the young group (32.4%) .B1.3 and B2.2 were the main types in the middle-aged group, accounting for 31.7% and 32.0, respectively.B1.3 was dominant in the young elderly and elderly group (47.1% and 63.4%, respectively).Conclusion: The new AO classification is more detailed and practical. 1/3 of the fracture types of middle aged and young elderly people may achieve satisfactory results through IF.Level of evidence: III.

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The management of displaced femoral neck fractures: a narrative review

Cited by 24 publications

References 51 publications

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients

Low lymphocyte-to-C-reactive protein ratio relates to high 1-year mortality in elderly patients undergoing hemiarthroplasty for displaced femoral neck facture

Distribution Characteristics of New AO Classification in Different Age Groups of Patients with Femoral Neck Fracture

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