Femoral Neck Fractures In Adults Research Articles

Assessment of Surgical Treatment Results of Adult Traumatic Femoral Neck Fracture

Background & aim: Femoral Neck Fracture (FNF) is one of the most common that, causing problems and complications for patients. The purpose of the present study is to investigate surgical treatment results of traumatic femoral neck fracture in adults under 60 years.

A prediction model for osteonecrosis of femoral head after internal fixation with multiple cannulated compression screws for adult femoral neck fractures.

This study aims to investigate the high-risk factors for osteonecrosis of the femoral head (ONFH) after internal fixation with multiple cannulated compression screws for adult femoral neck fractures and to construct a prediction model. Between from January 2012 and December 2020, a total of 268 patients (138 males, 130 females; mean age: 53±10 years; range, 23 to 70 years) with ONFH who had complete follow-up data were included. Closed reduction in combination with open reduction were performed. All patients received internal fixation with multiple cannulated compression screws and were assigned to ONFH and non-ONFH groups. Logistic regression model was utilized to identify independent risk factors for postoperative ONFH, followed by constructing a nomogram prediction model. The predictive ability of the model was evaluated by receiver operating characteristic curve, Hosmer-Lemeshow test, and calibration curve. Multivariate analysis revealed that older age (odds ratio [OR]: 2.307, 95% confidence interval [CI]: 1.295-4.108], Charlson Comorbidity Index (CCI) ≥2 (OR: 2.214, 95% CI: 1.035-4.739), fracture displacement (OR: 2.426, 95% CI: 1.122-5.247), unsatisfactory reduction (OR: 2.629, 95% CI: 1.275-5.423), postoperative removal of internal fixation implant (OR: 2.200, 95% CI: 1.051-4.604) were independent risk factors for postoperative ONFH (p<0.05). The nomogram prediction model constructed based on these clinical characteristics showed high predictive value (AUC=0.807) and consistency (p>0.05). Age, comorbidity index, fracture type, reduction quality and postoperative removal of internal fixation implant are of utmost importance for postoperative ONFH in patients with femoral neck fractures. The established nomogram prediction model can accurately predict the occurrence of postoperative ONFH.

Effects of Technical Errors on the Outcomes of Operatively Managed Femoral Neck Fractures in Adults Less than 50 Years of Age.

To evaluate the effect of technical errors (TEs) on the outcomes after repair of femoral neck fractures in young adults. Multicenter retrospective clinical study. 26 North American Level 1 Trauma Centers. Skeletally mature patients younger than 50 years of age with 492 femoral neck fractures treated between 2005 and 2017. Operative repair of femoral neck fracture. The association between TE (malreduction and deviation from optimal technique) and treatment failure (fixation failure, nonunion, malunion, osteonecrosis, malunion, and revision surgery) were examined using logistic regression analysis. Overall, a TE was observed in 50% (n = 245/492) of operatively managed femoral neck fractures in young patients. Two or more TEs were observed in 10% of displaced fractures. Treatment failure in displaced fractures occurred in 27% of cases without a TE, 56% of cases with 1 TE, and 86% of cases with 2 or more TEs. TEs were encountered less frequently in treatment of nondisplaced fractures compared with displaced fractures (39% vs. 53%, P < 0.001). Although TE(s) in nondisplaced fractures increased the risk of treatment failure and/or major reconstructive surgery (22% vs. 9%, P < 0.001), they were less frequently associated with treatment failure when compared with displaced fractures with a TE (22% vs. 69% P < 0.001). TEs were found in half of all femoral neck fractures in young adults undergoing operative repair. Both the occurrence and number of TEs were associated with an increased risk for failure of treatment. Preoperative planning for thoughtful and well-executed reduction and fixation techniques should lead to improved outcomes for young patients with femoral neck fractures. This study should also highlight the need for educational forums to address this subject. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fracture mapping of adult femoral neck fractures with three dimensional computed tomography.

Femoral neck fractures (FNFs) are a commonly encountered injury in orthopaedic practice. It is essential that surgeons recognize specific fracture patterns to effectively manage these fractures. The purpose of this study was to analyze the fracture morphology of FNFs by three-dimensional (3D) mapping of the fracture. The fracture line location and distribution of 120 FNFs were identified using computed tomography reconstructions. After segmentation and virtual reduction, the fracture line was revealed. The femoral neck region was divided into zones according to anatomical localization, and the zones through which the fracture lines passed were recorded. All fracture lines are superimposed on the standard model to create fracture mapping. A total of 120 patients with FNFs were analyzed. The mean age of the patients was 67 (18-96) years. Of all patients, 59 were male, and 61 were female. The most affected region was Zone 4. The least affected region was Zone 6. The displacement in Zone 1 and Zone 4 was found to be significantly higher. The displacement in patients under 65years was found to be significantly higher. Zone 2 and Zone 5 involvement was significantly higher in patients under 65years. The fracture map showed fracture patterns of FNFs. It was found that fracture displacement and transcervical region involvement were more common in patients under 65years. It was also found that the displacement rate was high in fractures of the subcapital region.

Survivability of the Femoral Neck System for the treatment of femoral neck fractures in adults.

Hip fractures are common injuries in the elderly, with an incidence that continues to rise. The femoral neck system (FNS) recently emerged as a novel treatment option for femoral neck fractures, but long-term survivability of the implant remains uncertain. The purpose of this study is to evaluate survivability of the FNS and assess risk factors for implant failure. One hundred five adult patients who received the FNS (DePuy Synthes, Raynham, MA) for femoral neck fractures (AO/OTA 31B) were included. Surgeries were performed within a regional hospital system comprising 18 facilities. All patients had a minimum follow-up of 1year. The primary outcome measures were cumulative incidence of implant failure and 1-year mortality, including risk factor analysis. Twelve implants failed at a follow-up ranging from 17days to 8months, and 7 failed within 90days. Cumulative incidence of implant failure was 2% at 30days, 7% at 90days, 12% at 6months, and 13% at 1year. Causes of implant failure included cut-out (n = 5), non-union (n = 4), peri-implant fracture (n = 2), and avascular necrosis (n = 1). Univariate Cox regression identified Pauwels type III fractures and an increasing AP Parker ratio as significant risk factors for failure. Pauwels type III fractures showed a 5.48 times higher risk compared to Pauwels types I & II. Every 10% increase in AP Parker ratio increased risk of failure by 2.39 times. The 1-year mortality rate was 21%, and univariate logistic regression identified age as the only risk factor (odds ratio = 3.71). The incidence of implant failure and 1-year mortality rate in this study suggests that the FNS can provide reliable fixation compared to rates in the literature, but complications are not uncommon. Avoiding Pauwels type III fractures and optimizing implant placement appear crucial to preventing implant failure. Therapeutic Level IV.

Surgical Fixation with Cannulated Screws in the Adult Femoral Neck Fractures

Aim: Femoral neck fractures are common injuries in orthopedic practice and result in significant morbidity and mortality. They are fractures in the intra-capsule area of the proximal femur. They usually occur in the elderly patient group. However, younger age groups could also experience femoral neck fractures as a result of high-energy traumas. The aim of the present study was to compare with the literature the outcomes in adult patients for whom surgical fixation was performed after femoral neck fracture using cannulated screws in our clinic.Materials and Methods: The study included patients for whom surgical fixation was performed for femoral neck fractures using cannulated screws between August 2010 and August 2012. Fracture non-union, delayed union, avascular necrosis and arthrosis were evaluated in patients. Avascular necrosis evaluation was performed using Ficat and Arlet classification. Functional outcomes were evaluated using Harris hip score.Results: The average follow-up period of our patients was 32 months (range: 24-48 months). Follow-ups indicated that 16 patients recovered without problems, walked with a double wand starting from about the third month with respect to the bone union status and full union was achieved in an average of six months. Non-union was observed in four patients. Ficat and Arlet avascular necrosis classification showed that four patients had avascular necrosis. The average time for these patients to be admitted to surgery was seven days. Five of our patients developed superficial wound infections. Antibiotic treatment and wound care were applied to our patients. When the patients were evaluated based on Harris hip score numerical rating chart, it was found that excellent outcomes were obtained in five patients, very good results in eight patients, good results in four patients, moderate results in two patients and poor results in one patient.Conclusion: Femoral neck fractures are a common type of injury in orthopedic practice and they result in significant morbidity and mortality when treated inappropriately. In order to reduce the rate of bone non-union, avascular necrosis or other complications that could be observed in patients who underwent surgical fixation after femoral neck fractures, and appropriate and acceptable reduction of femoral neck fracture should be realized as soon as possible, and stable fixation should be achieved.

Correlation between Abnormal Gait Pattern With Femoral Neck Stress Fracture In Athletes: A Systematic Review

Backgrounds: Stress fractures are common overuse injuries in the lower extremities. Repetitive episodes of high-intensity or extended-duration axial load to the leg place the bone at risk of stress-related injury. The femoral neck is an uncommon location for stress fracture (less than 5% of all stress fractures). Fracture location, type, and grade permits generic dichotomized classification of “low-risk” and “high-risk” fractures. Tension-side femoral neck stress fractures are considered “high-risk” because of their potential for displacement, nonunion, and avascular necrosis if displaced. Fractures in locations prone to these 3 outcomes are categorized as “high risk.” These include anterior tibial cortex, medial malleolus, talar neck, dorsal tarsal navicular, proximal fifth metatarsal metaphysis, tension side patella, and tension side of the femoral neck. The risk of avascular necrosis following treatment of displaced femoral neck fractures in adults may be as high as 45%. In runners, pain typically begins with onset of weight bearing early in the run. Pain may progressively increase and does not remit until the run ends. In some athletes, the desire to train or perform may supersede the pain. This may lead to disastrous consequences if a femoral neck stress fracture completes itself and displaces. This paper describes side effects abnormal gait pattern to femoral neck stress fractures in athlete. Methods: Our trial was an international, expertise-based, randomized, controlled trial. Details of the trial objectives and design have been published previously. Additional information about the eligibility criteria, interventions, follow-up, outcome definitions, and statistical analysis. To identify studies pertaining to the clinical results about Correlation between Abnormal Running Gait Pattern and Femoral Neck Stress Fracture, we reviewed the Cochrane, Pubmed, Embase databases for relevant articles published up to July 2022. We also reviewed the references of all identified articles to identify additional studies. Search terms were as follows: femoral neck stress fracture, femoral fracture, running gait. Following the PICOS (Participants, Interventions, Comparisons, Outcomes and Study design) principle, the key search terms included (P) patients were runner with FNSFs; (I) patients were running as a recreational sport, and or professional athlete; (C/O) the outcomes including sign and symptoms, femoral neck stress fracture, length of rehabilitation, time to get back in early performance in sport; (S) RTC, cohort study, or case control study. Results: A total of 13 RCTs, meta- analysis and systematic review correlation abnormal running gait with femoral neck stress fractures. Discussions: There are correlations between abnormal running gait with femoral neck fractures, because abnormal running gait with high intense could make bone stress injury. However, bone stress injury at neck femoral is one of many factors that commonly happen become a femoral neck stress fractures. Conclusions: Abnormal running gait combining with high intense training are etiology of bone stress injuries in athletes. Bone stress injuries in femoral neck could possibly become femoral neck stress fractures.

Efficacy of the femoral neck system in femoral neck fracture treatment in adults: A systematic review and meta-analysis.

Controversy remains around the available choices for the internal fixation of a femoral neck fracture. The femoral neck system (FNS) was developed in 2018 and has been widely applied since then as it can provide rigid fixation stability with less damage to the bone mass around the fracture. However, no systematic reviews and meta-analyses have investigated the efficacy of the FNS in comparison with that of traditional internal fixation in the treatment of femoral fractures. To assess the efficacy of the FNS in comparison with that of cannulated compression screws (CCS) in the treatment of femoral fractures through systematic review and meta-analysis. Five electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang) were searched from the earliest publication date to December 31, 2021. Reference Citation Analysis (https://www.referencecitationanalysis.com/) was used to check the results and further analyze the related articles. Controlled trials were included if the FNS was applied for the femoral neck fracture in adults and if it was compared with CCS for the achievement of internal fixation. The measurement outcomes included the required operation time, observed patient's blood loss, extent of fracture healing, patient's Harris Hip score (HHS) at the last follow-up, and records of any complications (such as failure of internal fixation, femoral neck shortness, avascular necrosis of the femoral head, and delayed union or nonunion). Ten retrospective controlled studies (involving 711 participants) were included in this meta-analysis. The meta-analysis showed that compared with CCS, use of the FNS could not decrease the operation time [standardized mean difference (SMD): -0.38, 95% confidence interval (CI): -0.98 to 0.22, P = 0.21, I 2 = 93%), but it could increase the intraoperative blood loss (SMD: 0.59, 95%CI: 0.15 to 1.03, P = 0.009, I 2 = 81%). The pooled results also showed that compared with CCS, the FNS could better promote fracture healing (SMD: -0.97, 95%CI: -1.65 to -0.30, P = 0.005, I 2 = 91%), improve the HHS at the last follow-up (SMD: 0.76, 95%CI: 0.31 to 1.21, P = 0.0009, I 2 = 84%), and reduce the chances of developing femoral neck shortness (OR: 0.29, 95%CI: 0.14 to 0.61, P = 0.001, I 2 = 0%) and delayed union or nonunion (OR: 0.47, 95%CI: 0.30 to 0.73, P = 0.001; I 2 = 0%) in adult patients with femoral neck fractures. However, there was no statistically significant difference between the FNS and CCS in terms of failure of internal fixation (OR: 0.49, 95%CI: 0.23 to 1.06, P = 0.07, I 2 = 0%) and avascular necrosis of the femoral head (OR: 0.46, 95%CI: 0.20 to 1.10, P = 0.08, I 2 = 0%). Compared with CCS, the FNS could decrease the chances of developing femoral neck shortness and delayed union or nonunion in adults with femoral neck fractures. Simultaneously, it could accelerate fracture healing and improve the HHS in these patients.

The use of the femoral neck system (FNS) leads to better outcomes in the surgical management of femoral neck fractures in adults compared to fixation with cannulated screws: A systematic review and meta-analysis.

Intracapsular femoral neck fractures are challenging to treat, with outcomes depending on the quality of reduction, and the stability of fixation. Cannulated cancellous screws (CCS) are the most commonly used implants to fix these fractures, but failure rates are significant. The recently introduced femoral neck system (FNS) may be a better option than CCS fixation and this review attempts to compare the results. Four electronic databases were searched for eligible articles that had comparative data on the outcomes of fixation of adult femoral neck fractures with FNS and CCS. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% confidence intervals. Eight studies with 509 cases having a mean age of 50.8years were included for final analysis. FNS was found to be associated with significantly reduced complication rates (p < 0.001), decreased incidence of postoperative femoral neck shortening (p < 0.001), quicker time to fracture union (p = 0.002), and better functional outcome scores (p < 0.001) compared to cannulated screws. FNS was also associated with a shorter operating time (mean difference 6.65min) although not statistically significant (p = 0.24). CCS group had significantly reduced mean blood loss (p < 0.001). The available literature supports FNS as a better option for adult femoral neck fractures, with a lower complication rate, quicker union, and better clinical outcomes. Level 3.

Biplane double supported screw fixation for femoral neck fracture in young adults: A prospective cohort study

IntroductionAchieving accurate anatomic reduction and stable internal fixation is mandatory in the management of femoral neck fractures (FNF) in adults. The spatial configuration and direction of the screws have been reported to provide stability to the fracture. The study's goal is to analyse the clinico-radiological outcome of the newer biplane double-supported screw fixation (BDSF) technique in the Indian cohort. Materials and methodsPatients with isolated FNFs underwent osteo-synthesis by BDSF technique. Radiological outcome was evaluated by time to union and fracture healing on plain radiographs. Clinical outcome was measured using the Harris hip score (HHS) at 1, 3, 6, and 12 months after surgery. The pain reduction was measured using the VAS score. ResultsTwenty-seven patients with a mean age of 37.33 ± 9.84 years (24–55 years) were followed up for at least 12 months (12–31 months). The mean HHS at 12 months was 94.81 ± 8.18 (range: 68–100). Twenty-five patients were able to achieve radiological union within a mean time of 14.60 ± 4.69 weeks (range: 8–28). The overall complication rate was found to be 18.51% (5 out of 27 patients). Individual complications were non-union (2 patients; 7.4%), AVN (3 patients; 11.11%), and screw back out with femoral neck shortening (4 patients; 14.81%). ConclusionScrew configuration using the BDSF technique provides a good union rate with minimum complications. The majority of patients resulted in a good (HHS >80) to excellent functional outcome. Based on the clinico-radiological outcome obtained, we conclude that this technique is effective in the fixation of FNF in adults. Level of studyLevel II.

Femoral Neck Fracture Treated with Dynamic Hip Screw System with De-rotation Screw Versus Cannulated Hip Screws

Background: Fracture neck of femur has always presented a great challenge to orthopedic surgeons due to its nature of going into non-union and osteonecrosis of femoral head even with the best fixation method and adequate reduction. Treatment of fracture neck of femur varies according to patient’s age and fracture pattern. Purpose of this study was to compare the outcome of DHS with side plate and de-rotation screw with multiple cannulated hip screws in fracture neck of femur in adult.&#x0D; Materials and methods: This quasi-experimental study was carried out in the Department of Orthopedic Surgery, Chittagong Medical College Hospital from July 2017 to June 2019. Sixty patients age limit between 18 to 55 years, with (AO/OTA 31-B) fracture was taken by purposive sampling technique as per set criteria and were treated either by DHS with side plate and de-rotation screw or by cannulated hip screws. Harris Hip Score was used for evaluation of functional outcome of surgery. &#x0D; Results: In this study, out of 60 patients, male (83%) were more than female (17%), maximum age incidence was found in 26-36 years age group (30%), left side involvement was 51.7% and right side was 48.3%. Over 60% incidence was due to RTA. Functional outcome was 68% excellent and 24% good in DHS with de-rotation screw group and 55.6% good and 25.9% excellent in cannulated hip screw group according to Harris Hip Score. Only 6.7% had soft tissue infection, 13.3% had deep seated infection and delayed union, 10% had non-union and hip stiffness and 6.7% had AVN in DHS with de- rotation screw group and 10% had soft tissue infection, 6.7% had deep seated infection and delayed union, 13.33% had non-union and hip stiffness and 10% had AVN in cannulated hip screw group. Mean ± SD radiological union time in DHS with de-rotation screw group was 12.5 ± 1.225 weeks and in cannulated hip screw group was 13.61 ± 1.559 weeks.&#x0D; Conclusion: The functional outcome of fixation by DHS with de-rotation screw was better than fixation by cannulated hip screw for femoral neck fracture in adults.&#x0D; JCMCTA 2022 ; 33 (1) : 112-117

Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers.

To assess the operative results of femoral neck fractures (FNFs) in young adults in a large multicenter series, specifically focusing on risk factors for treatment failure. Large multicenter retrospective cohort series. Twenty-six North American Level 1 trauma centers. Skeletally mature patients younger than 50 years with displaced and nondisplaced FNFs treated between 2005 and 2017. Operative repair of FNF. The main outcome measure is treatment failure: nonunion and/or failed fixation, osteonecrosis, malunion, and need for subsequent major reconstructive surgery (arthroplasty or proximal femoral osteotomy). Logistic regression models were conducted to examine factors associated with treatment failure. Of 492 patients with FNFs studied, a major complication and/or subsequent major reconstructive surgery occurred in 45% (52% of 377 displaced fractures and 21% of 115 nondisplaced fractures). Overall, 23% of patients had nonunion/failure of fixation, 12% osteonecrosis type 2b or worse, 15% malunion (>10 mm), and 32% required major reconstructive surgery. Odds of failure were increased with fair-to-poor reduction [odds ratio (OR) = 5.29, 95% confidence interval (CI) = 2.41-13.31], chronic alcohol misuse (OR = 3.08, 95% CI = 1.59-6.38), comminution (OR = 2.63, 95% CI = 1.69-4.13), multiple screw constructs (vs. fixed-angle devices, OR = 1.95, 95% CI = 1.30-2.95), metabolic bone disease (OR = 1.77, 95% CI = 1.17-2.67), and increasing age (OR = 1.03, 95% CI = 1.01-1.06). Women (OR = 0.57, 95% CI = 0.37-0.88), Pauwels angle ≤50 degrees (type 1 or 2; OR = 0.64, 95% CI = 0.41-0.98), or associated femoral shaft fracture (OR = 0.19, 95% CI = 0.10-0.33) had lower odds of failure. FNFs in adults <50 years old remain a difficult clinical and surgical problem, with 45% of patients experiencing major complications and 32% undergoing subsequent major reconstructive surgery. Risk factors for complications after treatment of displaced FNFs were numerous. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

In the fixation of adult femoral neck fractures, does percutaneous hematoma drainage have an effect on bone union?

Background/Aim: Major blood circulation of the femur head is provided by retrograde flow from the medial femoral circumflex artery. The biggest problem here is uncertainty that the fracture hematoma disrupts the feeding of the femoral head. The aim of this study was to evaluate the effect on bone union of percutaneous hematoma punction in femoral neck fractures in patients aged

Internal fixation using fully threaded cannulated compression screws for fresh femoral neck fractures in adults

ObjectivesInternal fixation with multiple cannulated compression screws is an optional treatment for femoral neck fracture. Recently, fully threaded cannulated compression screws (FTCCS) have been introduced to fix fresh femoral neck fractures (FNF). The purpose of this study was to investigate the effectiveness of FTCCS.Patients and methodsPatients with FNF fixed by multiple FTCCS from February 1st, 2014 to August 31st, 2017 were included in this study. They were followed for at least 12 months postoperatively. Nonunion, osteonecrosis of the femoral head (ONFH), fixation failure, reoperation, and femoral neck shortening (FNS) were used to evaluate the outcomes. Risk factors including age, sex, fracture side, fracture displacement, fracture stability, fixation configuration, and screw numbers were analyzed.ResultsA total of 113 patients including 67 males and 46 females with an average age of 48.4 ± 13.4 years were included. The mean duration of follow-up was 27.1 months (range: 12–51 months). The incidence of nonunion, ONFH, fixation failure, and reoperation was 15.9%, 22.1%, 8.8%, and 24.8%, respectively. The rates of nonunion and reoperation were significantly higher in displaced fractures and unstable fractures. And patients with an unstable fracture had a higher risk of internal fixation failure. The median length of FNS was 2.9 mm (interquartile range: 0.9–6.5 mm, range: 0–17.5 mm). Age was a significant risk factor for FNS.ConclusionsThe screw fixation method with FTCCS provided encouraging clinical results which may be a rational choice for the treatment of fresh FNF. Displaced fractures and unstable fractures were attributed to the higher incidence of complications.Trial registration: ChiCTR, ChiCTR1800017200. Registered 17 July 2018-Retrospectively registered, http: www.chictr.org.cn/showprojen.aspx?proj=29182.

Functional outcomes and perceived quality of life following fixation of femoral neck fractures in adults from 18 to 69years using dynamic hip screw (DHS) and an additional anti-rotation screw- a retrospective analysis of 53 patients after a mean follow-up time of 4years.

The purpose of the study was to explore the functional outcome after osteosynthesis with dynamic hip screw (DHS) for adults up to 69years, and identify potential predictive indicators of either positive impact on quality of life or increase the incidence of complications. Out of 85 patients 53 could be contacted, 36 were followed up clinically and radiologically, 17 patients could be interviewed by phone. All fractures have been treated by osteosynthesis with DHS and one additional anti-rotation screw. Functional outcome and quality of life were measured with use of Harris Hip Score (HHS) and Short Form 12 Health Survey (SF 12). The mean values were compared to two random sample t tests and ANOVA for independent random samples. The connection between an aim variable and selected variables of influence was examined by regression analysis. The mean HHS showed good functional results with 88 points (median 95.6). Good or excellent results were achieved in 80.4% of cases. The current investigation also delivers promising results with regard to the complication rate: avascular femoral head necrosis (AVN) in 11.3% of cases (n = 6), 9.4% showed non-union (n = 5) and cut out (n = 3) occurred in 5.7%. A secondary conversion to hip arthroplasty (n = 7) had a strong negative impact on everyday life (HHS = 63.3 points, Physical Health Summary Score SF-12 = 34.9 points). The results of this study are promising showing uncomplicated fracture healing in 84.9% of intracapsular femoral neck fractures and a low incidence of complications after osteosynthesis with DHS in patients aged up to 69years. The quality of the fracture reduction achieved in the axial view and a small tip apex index after an osteosynthetically treated femoral neck fracture with DHS are significant predictive indicators for complications. Diabetes, age > 65years, osteoporosis, ASA III may also be significant factors for worse results, but showed no statistical significance in our analysis.

A STUDY TO EVALUATE CLINICAL OUTCOMES IN PATIENTS OF AGE BELOW 50 YEARS WITH INTRACAPSULAR FRACTURE OF NECK OF FEMUR TREATED BY CANNULATED CANCELLOUS SCREW FIXATION

Intracapsular femoral neck fractures are commonly seen in the elderly population after a trivial fall. However, femoral neck fractures in adults younger than 50 are uncommon and often result from high-energy trauma. They account for only 2-3% of all femoral neck fractures. It is crucial to understand and contrast the differences between elderly and young adult patients to evaluate and treat femoral neck fractures. Characteristic differences are seen for the osseous and vascular anatomy, the mechanism of injury, associated injuries, fracture pattern, and treatment goals. Femoral neck fractures in young adults are associated with higher incidences of femoral head osteonecrosis and nonunion. The rate of osteonecrosis reported in the literature ranges from 12-86% in young patients after femoral neck fracture. This devastating complication may lead to the collapse of the femoral head and subsequent osteoarthritis. Reoperation and salvage procedures such as osteotomy have high failure rates, and arthroplasty procedures are not ideal given the young age and higher activity levels. This study attempts to evaluate the internal xation of intracapsular fracture of the neck of the femur with multiple cannulated cancellous lag screws. Patients selected for this surgery were between 15 to 50 years old with intracapsular fracture of neck of femur who were admitted and treated in Kurnool Medical College and Hospital, Kurnool, A.P., from October 2019 to October 2021.

Epidemiology, classification, treatment, and mortality of adult femoral neck and basicervical fractures: an observational study of 40,049 fractures from the Swedish Fracture Register

BackgroundAlthough femoral neck fractures (FNFs) are common in orthopedic departments, optimal treatment methods remain in dispute. There are few large nationwide studies, including basicervical FNFs (bFNFs), on epidemiology, treatment, and mortality. This nationwide study aims to describe the epidemiology, fracture classification, current treatment regimens, and mortality of undisplaced and minimally displaced (Garden I–II, uFNF), displaced (Garden III–IV, dFNF) and bFNFs in adults.MethodsAll FNFs, including bFNFs with a registered injury date between 1 April 2012 and 31 December 2020, were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, injury mechanism, fracture classification, primary treatment, and seasonal variation were analyzed.ResultsSome 40,049 FNFs were registered in the SFR. The mean age of the patients in the register was 80.3 (SD 11) years and 63.8% (25,567) were female. Of all FNFs, 25.0% (10,033) were uFNFs, 63.4% (25,383) dFNFs, and 11.6% (4,633) bFNFs. Non-surgical treatment was performed in 0.6% (261) of the patients. Internal fixation (IF) (84.7%) was the main treatment for uFNFs and arthroplasty (87.3%) for dFNFs. For bFNFs, IF (43.8%) and hip arthroplasty (45.9%) were performed equally often. Of the 33,105 patients with a 1-year follow-up mortality at 1-year was 20.6% for uFNF, 24.3% for dFNF, and 25.4% for bFNF.ConclusionThe main treatment of uFNFs is IF with screws or pins. Hip arthroplasty is the predominant treatment for dFNF. bFNF are more common than previously reported and treated with IF or arthroplasty, depending on patient age. These results may help health care providers, researchers and clinicians better understand the panorama of FNFs in Sweden.Level of EvidenceIV, retrospective cohort study.

Intraoperative monitoring of femoral head perfusion in adult femoral neck fractures.

Objectives:To validate a novel intraoperative method of quantifying femoral head perfusion in adult patients with femoral neck fractures and to determine whether the lack of a perfusion waveform correlates with the development of osteonecrosis, nonunion, or reoperation.Design:Prospective cohort.Setting:Level 1 trauma center.Patients/Participants:Nineteen patients with 20 acute femoral neck fractures treated with hip-preserving surgical fixation. All patients underwent intraoperative quantification of femoral head perfusion.Intervention:Intraoperative quantification of femoral head perfusion pressure and waveform utilizing an intracranial pressure monitor.Main outcome measurements:Radiographic union, avascular necrosis, revision surgery.Results:Nineteen patients (8 male, 11 female, average age 56 ± 21 years) with 20 femoral neck fractures were enrolled. Eight fractures were stable (Garden 1-2/OTA B1.1–1.3) and 12 were unstable (Garden 3-4/OTAB2.1–3.3). A waveform was present in 12 of 20 cases. The average pressures were systolic 36.8 mm Hg, diastolic 30.8 mm Hg, pulse pressure 6.0 mm Hg. A perfusion waveform was significantly associated with advanced age (P = 0.02) and accompanied by trend toward stable fracture patterns. There were 4 deaths during the 1-year follow-up period (20%), and there were 5 conversions to total hip arthroplasty (25%). There was no significant association between revision surgery or death with the absence of a waveform.Conclusions:Our study demonstrated the feasibility of a relatively low cost, minimally invasive, technique to quantify femoral head perfusion. In our limited sample, the absence of perfusion did not correlate with our main outcomes; however, the trend toward correlation with increased fracture displacement was as expected. A larger cohort of patients will be needed to detect a significant difference between those with and without a perfusion waveform with regards to our primary outcomes. Further study is needed to delineate the role such data may play in medical decision making at the time of index surgery.Level of Evidence:Prognostic Level II.

Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: a preliminary comparative study

BackgroundThe femoral neck system (FNS) may be a valid alternative for treating femoral neck fractures, but few studies have compared the outcomes between FNS and cannulated cancellous screws. This study aimed to compare the clinical efficacy and complications of FNS with those of inverted cannulated cancellous screws (ICCS) for the treatment of femoral neck fractures in adults.MethodsThis retrospective study evaluated patients with femoral neck fractures who underwent FNS or ICCS internal fixation between June 2019 and January 2020. The operative time, intraoperative blood loss, number of fluoroscopies, length of surgical incision, length of hospital stay, time to fracture healing, and other indicators were compared between the two groups. The incidence of complications such as nonunion, avascular necrosis of the femoral head, loosening of the internal fixation, and shortening of the femoral neck during follow-up was also assessed in both groups.ResultsAmong the 92 patients included, 47 and 45 patients were categorized into the FNS and ICCS groups, respectively. Follow-up ranged from 14 to 24 months. There were no significant between-group differences in sex, age, side of the injured limb, and type of fracture and in operative time, intraoperative blood loss, incision length, and length of hospital stay (all P > 0.05). The incidence of complications such as fracture nonunion, avascular necrosis of the femoral head, and screw loosening was also comparable between the two groups. However, the number of fluoroscopies was significantly lower in the FNS group than in the ICCS group (P < 0.05). The fracture healing time was also significantly lower in the FNS group than in the ICCS group (P < 0.05). Furthermore, the femoral neck shortening and Harris hip score at the last follow-up were significantly better in the FNS group than in the ICCS group (P < 0.05).ConclusionsFNS for femoral neck fractures improves hip functional recovery and reduces the femoral neck shortening rate and fluoroscopy exposure postoperatively. Thus, FNS can be an alternative to ICCS for the treatment of femoral neck fractures.

Blood biomarkers related to osteonecrosis of femoral head by internal fixation after Garden I femoral neck fracture: a cohort study

Background: Internal fixation is currently considered the gold standard in treatment for femoral neck fractures in adults. However, osteonecrosis of the femoral head (ONFH) after internal fixation would occur in quite proportion of patients with femoral neck fracture, even in Garden I femoral neck fracture. The purpose of this study was to determine the association between the blood biomarkers (serum albumin, pre-albumin, total protein and total lymphocyte count) and ONFH following internal fixation of Garden I femoral neck fracture in adults. Method: This is a single center cohort study, in which each patient who sustained a Garden I femoral neck fracture had been treated with internal fixation, and had adequate preoperative blood examinations. The serum albumin was categorized as ≥ 40g/L or < 40g/L. The pre-albumin was categorized as ≥ 22mg/dL or < 22mg/dL. The total protein was categorized as ≥ 65g/L or < 65 g/L. The total lymphocyte count was categorized as ≥1.1× 109 /L or <1.1×109 /L. Multivariate cox proportional hazards analysis was used to assess the association between blood markers and the osteonecrosis of femoral head during the 2-years follow-up period controlling the confounders. Result: A total of 10 cases of ONFH were identified. Multivariate Cox regression analysis revealed that low total lymphocyte count and hypertension state were significant independent risk factors for ONFH after internal fixation for Garden I femoral head fractures. Conclusion: Blood biomarkers were potential predictors for ONFH after internal fixation Garden I femoral neck fractures. We suggest that routine laboratory tests might can be used to assist surgeons to identify patients at great risk of ONFH.