Acute Femoral Neck Fracture Research Articles

Separation of the Christiansen prosthetic components following dislocation of hemiarthroplasty for hip fracture.

During the period from April 1980 to July 1982 a total of 148 patients with acute femoral neck fractures had primary hemiarthroplasties with the Christiansen trunnion-bearing endoprosthesis. Dislocations occurred in six patients (4 per cent). Five of these required reoperation due to separation of the femoral head in relation to the stem or of the plastic head and the metallic cap of the prosthetic head.

Survival patterns following primary prosthetic replacement for acute femoral neck fractures in the elderly.

Theoretical statistical models have been used to study survival patterns following primary prosthetic replacement for acute femoral neck fractures in the elderly with special emphasis on the nature of the potential excess mortality following trauma and operation. The chances of our patients surviving given periods of time are well below those of the standard population. The excess mortality has been quantified using the proportional hazard model. The high death rate for our patients is limited to the first 4-6 postoperative months, thereafter the death rate is similar to that of the standard population. Similarly we can show that mortality following surgery is primarily dependent on the age of the patient. Survival probability and expected longevity have been calculated for different age groups. The relative longevity expected for patients below the age of 70 is very good compared with a very reduced expected longevity for patients older than 90 years. The practical consequences of our findings are discussed.

Acetabular protrusion following endoprosthetic hip surgery: a multifactorial study.

Acetabular protrusion was found in 56 out of 211 patients fitted with a hemiprosthesis. The indication for operation was acute femoral neck fracture or failure following a previous internal fixation. A number of radiological variables were analysed with respect to their possible association with preoperative, operative and follow-up variables. After a preliminary screening of variables a deeper analysis was performed by fitting log-linear models to the data. Our analysis showed that the development of protrusion has a significant association with follow-up time. A previous hip operation was also significantly associated with the development of protrusion. This may be an indication for total hip replacement in some patients who now receive a hemiprosthesis as a secondary operation. Acetabular protrusion was significantly associated with the development of postoperative pain, while the other clinical symptoms and signs lacked any direct association with protrusion. Although acetabular protrusion and loosening of the prosthetic stem showed a significant association the analysis indicated that pain was primarily due to protrusion.

Primary Thompson Prosthesis for Acute Femoral Neck Fractures

Two hundred fifty cases of F.R. Thompson endoprosthesis replacement without methylmethacrylate in acute femoral neck fractures between 1969 and 1973 were reviewed. Follow-up evaluation was obtained in 94 patients averaging 4.8 years postoperative utilizing the Harris hip questionnaire. None of the patients were personally examined, but each was interviewed and rated for pain, function, and satisfaction with the hip surgery. The average Harris score was 63 points giving 56% overall satisfactory results. Pain relief was satisfactory in 85% of cases. Functional results were 71% fair or better, and 90% were satisfied with the overall results. Mortality at one year postoperative was 23%. Incidence of deep wound infection was 2% and prosthesis dislocation was 1%. Both infection rate and dislocation rate were higher in posterior exposure compared to anterior lateral surgical approach. The lack of methylmethacrylate cement apparently did not delay postoperative ambulation, as 60% of all patients were discharged within 4 weeks of fracture. The indications for methylmethacrylate with the Thompson endoprosthesis is an unanswered question and requires further investigation.

Primary prosthetic replacement in acute femoral neck fractures

This paper reports a retrospective study of acute femoral neck fractures in 123 patients treated by primary prosthetic replacement. The average age in our patient population was 80.5 years. A Christiansen trunnion-bearing hip prosthesis (Christiansen, 1969 and 1974) was used in all patients except one. The prosthesis was cemented to the femoral shaft. The postoperative mortality rate was low, and the mortality rate was 8.7 per cent. The patients were examined between 6 months and 3 1 2 years after operation. Excellent or good results according to Stinchfield's hip assessment system (Stinchfield et al., 1957) were obtained in 82 per cent of the patients. We suggest that primary prosthetic replacement in acute femoral neck fractures in elderly patients is a safe and valuable procedure. However, a definite conclusion concerning this therapy cannot be drawn before a prospective study comparing the results of internal fixation and primary prosthetic replacement is made.

Endoprostheses in the Treatment of Femoral Neck Fractures

Summary Primary treatment of an acute femoral neck fracture should be by a method that gives the lowest morbidity and mortality yet produces a good result in the majority of cases. This method would seem to be closed stable reduction and, if it fails, eventually open reduction followed by adequate internal fixation. Certain types of fractures are exceptions in which primary femoral head replacement seems to be the treatment of choice. Other indications for femoral head replacement are the complications of femoral neck fractures, that is, avascular necrosis with late segmental collapse and nonunion when significantly symptomatic. The use of scintimetry in the early recognition and evaluation of these complications certainly will play an increasing role as more experience is gained with its use. When deciding upon a femoral head replacement, the surgeon must always keep in mind the multiple associated complications that can occur at the time of surgery or later in the postoperative period. Deep infection is one of the most serious. If recognized early, it may be controlled by adequate antibiotic and surgical treatment, avoiding femoral head replacement. Nevertheless the long term results tend to be poorer than in uninfected cases. Irreparable damage is done to soft tissues and bone by delay or failure to recognize and fully diagnose the infection and resulting postponement of proper corrective treatment. Many such cases, however, may be salvaged later by adequate antibiotic therapy and further surgical revision, including the use of cemented total hip replacement in selected cases. As a general rule, the more elaborate the reconstructive procedure selected, the better the functional result will be but the greater the risk of recurrence or continuation of the infection. The efficacy of cementing the femoral head prosthesis with methyl-methacrylate is under current study. A smooth stemmed prosthesis should be used and placed in an acetabulum that has normal articular cartilage. Loosening and migration of the femoral stem are significantly reduced by cementing, although an increase in the erosion of the acetabular cartilage seems to occur. Total hip replacement in acute femoral neck fractures should be limited to cases in which the acetabulum is diseased or in which there is cartilage damage. The best long term results in the treatment of acute femoral neck fractures seem still to lie in the method that yields healing of the fracture with the patient's own viable femoral head.

Use of hip prosthesis in femoral neck fractures.

A follow-up study of 90 patients with femoral neck fractures treated with intramedullary stem hip prostheses from 1954 through 1958 revealed that 74 patients had excellent or good results. From this experience it was felt that the use of a prosthesis in an acute femoral neck fracture is indicated in patients chronologically or physiologically over 70 years of age and in younger patients with severe physical or mental disability. Full weight-bearing was encouraged 2 to 3 weeks postoperatively. This facilititates care in the hospital, shortens the period of hospitalization, and allows most patients practically to regain the prefracture state of activity in a much shorter time than do patients treated by hip nailing.