Time to internal fixation of femoral neck fractures in patients under sixty years—does this matter in the development of osteonecrosis of femoral head?

Razik, Fathima; Alexopoulos, Anastasia‐Stefania; El-Osta, Bassel; Connolly, Michelle; Brown, Ashley; Soueid, Hassan; Ravikumar, Kasetti

doi:10.1007/s00264-012-1619-1

Cited by 65 publications

(60 citation statements)

References 24 publications

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“…With the change of diet (especially alcohol addiction), increase in traffic accidents (most result in femoral-neck fracture), and abuse of pain-killer drugs or immunosuppressive drugs (commonly glucocorticoids), and so on, the morbidity of ONFH presents an apparently rising tendency, and most are young and middle-aged patients [1][2][3]. If not treated in time, it will greatly affect the patient's life.…”

Section: Introductionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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Purpose To investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by grafting a vascularized greater trochanter flap combined with a free iliac flap, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH without total hip arthroplasty (THA) surgery. Method Our research included a total of 60 patients (66 hips) who accepted hip-preserving surgery by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering because of ONFH (most were Association Research Circulation Osseous (ARCO) stage III patients) from January, 2006 to December, 2010. A Harris Hip Score was obtained during follow-ups, evaluating the clinical efficacy, X-rays were taken regularly for image assessing, and the SF-36 scale was used for estimating quality of life. Terminal observation time was considered when patients had symptom-dependant indications for performing another hip-preserving surgery or THA surgery. Results Fifty-eight patients (64 hips) were eventually contacted by telephone for an out-patient clinic return visit, with a mean follow-up time of 35.8 months (varied from 12 months to 60 months), but two patients lost contact for various reasons. The demographic data were as follows: there were 16 ARCO IIIA cases, 22 ARCO IIIB cases, and 26 ARCO IIIC cases, respectively. Postoperative X-rays revealed a well-repaired necrotic area of the femoral head and improvement of femoral-acetabulum coverage. The last follow-up mean Harris Hip Score was 86.56±7.38 (excellent results reached 87.50 %), which were greatly improved compared to 50.95±6.86 pre-operatively. Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) scores were enhanced from 42± 13 pre-operatively to 78±11, while the postoperative mental component summary (MCS) scores (76±11) largely increased in contrast to pre-operative scores (51±10), with both target indices having statistical significance (p=0.005, p=0.01), signifying hugely improvement of the quality of life of the patients. A correlation was found between Harris Hip Score and all dimensions of SF-36 scale (r=0.32-0.72), especially closely correlated with physical functioning (PF), role-physical (RP) and bodily pain (BP) in PCS aspect (r= 0.72, p < 0.01; r = 0.58, p < 0.01; r = 0.65, p < 0.01, respectively). Conclusion There is definite curative efficacy for the treatment of ONFH with an hip-preserving operative approach by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering. This kind of operative approach reconstructs the biological stability of femoral head, which promotes repair of necrotic areas and indirectly preserves the femoral head of patients and a majority of hip function. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundam...

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Section: Introductionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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“…The mechanism for the development of osteonecrosis of the femoral head is believed to be related to the stress generated from the formation of a hollow space after necrosis and the lack of mechanical support of the subchondral bone [18][19][20]. Therefore, based on this principle, researchers have designed a variety of support devices to mechanically support the femoral head and have achieved certain effects from devices such as the tantalum rod [21] and the titanium alloy support device [22].…”

Section: Introductionmentioning

confidence: 99%

Umbrella-shaped, memory alloy femoral head support device for treatment of avascular osteonecrosis of the femoral head

Wen-xiong

Pan

et al. 2013

International Orthopaedics (SICOT)

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Purpose Avascular necrosis (AVN) of the femoral head is a common orthopaedic disease that is difficult to treat. The purpose of this study was to explore the preliminary efficacy of a self-designed umbrella-shaped memory alloy femoral head support device in the treatment of adult patients with avascular osteonecrosis of the femoral head. Methods The minimally-invasive approach involved curettage of the necrotic tissue of the femoral head, and a selfdesigned umbrella-shaped, memory alloy femoral head support device was implanted into the collapsed necrotic area to support the collapsed femoral head. Autologous iliac bone and artificial bone were implanted into the support device for the treatment of adult patients with avascular osteonecrosis of the femoral head. Results The clinical device was used in ten patients and 18 hip joints. The support device failed in one hip joint, which subsequently underwent joint replacement surgery, and the remaining 17 implanted devices were followed up for four to 19 months. The 17 postoperative hip joints were evaluated using the percent-efficacy evaluation method for avascular osteonecrosis of the femoral head in adult patients, and the efficacy rate was 82.35 %. ConclusionThe umbrella-shaped femoral head support device can be used in Ficat stage I, stage II, and stage III adult patients with avascular osteonecrosis of the femoral head.

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“…On the contrary there are studies that found that the rates of non-union and avascular necrosis were not statistically different between those treated within 12 to 24 hours from the time of injury from those treated thereafter. [6][7][8]10 In our study we aim to address these disparities and study the effect of delayed fixation on union by reducing the confounding factors affecting the outcome. Patients treated with open reduction were also not included in this study.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 But other variables such as use of closed or open reduction, 8,9,15,16,17 the role of capsulotomy, [11][12][13]17 timing of surgery [4][5][6][7][8][9][10] and age group 60-70 years 17 still remains controversial. The method of fixation remains a less controversial variable.…”

Section: Introductionmentioning

confidence: 99%

“…Reported rates of non-union ranges from 6 to 59% and reported rates of avascular necrosis ranges from 12% to 86%. [1][2][3][4] Variables that have been postulated to affect the outcome include quality of reduction or fixation of the fracture 3,5,6, timming of surgery [4][5][6][7][8][9][10] and elevated intracapsular pressure. [11][12][13] Variables which are not in control of surgeon includes vascular damage from initial neck fracture, fracture classification, 14 quality of bone and posterior communition 9 and delay in seeking medical attention.…”

Section: Introductionmentioning

confidence: 99%

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Results of Delayed Fixation of Displaced Femoral Neck Fractures in Adults: A Retrospective Clinical Study

Pal¹,

Choubey²

2015

jemds

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Femoral neck fractures in young adults still remains a challenge due to high rates of nonunion and avascular necrosis associated with it. Traditionally fracture neck of femur are treated as emergency operations but in our set up there is usually a delay in treating them. This paper evaluates the effect of timings of surgery on healing of fracture and functional outcome. METHODS: This retrospective study was conducted in Department of Orthopaedics & Traumatology, Bundelkhand Medical College, Sagar from November 2012 to May 2015 during which 34 cases were evaluated and treated with closed reduction and internal fixation. Only physiological young patients between the ages of 15 to 65 years with Garden's grade III & IV were included. Fractures associated with any pathological process or associated with other ipsilateral lower limb fractures were excluded. Patients treated with open reduction were also not included in this study. RESULTS: Out of 34 patients only 3 patient could be operated within 48 hours. The average delay in admission of patient was 4 days and average duration from injury to operation was 8.5 days. Non-union rates overall was 38.2%, for those operated within a week was 35.7% and for those operated after was 40%. If non-union due to mal reduction were excluded the rates were 19.2%, 10% and 25% respectively. CONCLUSION: In the treatment of fracture neck of femur quality of reduction proves to be the single most important variable affecting the outcome if operated within a week appears to be less significant variable if reduction was within acceptable range as non-union rate of only 14.2% was recorded. Thus good results can be achieved even after 48 hours though after a week non-union rates were high which suggests that after a week fibrosis around the fracture and hip and proximal migration of the distal fragment necessitate other open reduction or procedures such as intertrochanteric osteotomy or bone grafting in order to achieve union.

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Time to internal fixation of femoral neck fractures in patients under sixty years—does this matter in the development of osteonecrosis of femoral head?

Cited by 65 publications

References 24 publications

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Umbrella-shaped, memory alloy femoral head support device for treatment of avascular osteonecrosis of the femoral head

Results of Delayed Fixation of Displaced Femoral Neck Fractures in Adults: A Retrospective Clinical Study

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