Diagnosis Of Femoral Neck Fracture Research Articles

Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture.

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm fluoroscopy to place the screw freehand and requires several guide wire adjustments, which increases the operation time and radiation exposure. Repeated drilling can also cause damage to the blood supply and bone quality of the femoral neck, which can be followed by complications such as screw loosening, nonunion, and femoral head necrosis. In order to make fixation more precise and reduce the incidence of complications, our team applied robot-assisted orthopedic surgery for screw placement using the femoral neck system to modify the traditional procedure. This protocol introduces how to import a patient's X-ray information into the system, how to perform screw path planning in software, and how the robotic arm assists in screw placement. Using this method, the surgeons can place the screw successfully the first time, improve the accuracy of the procedure, and avoid radiation exposure. The whole protocol includes the diagnosis of femoral neck fracture; the collection of intraoperative X-ray images; screw path planning in the software; precise placement of the screw under the assistance of the robotic arm by the surgeon; and verification of the implant placement.

A Comparison of Postoperative Pain and Narcotic Prescriptions in Patients Undergoing Total Hip Arthroplasty Electively or for Femoral Neck Fracture

AbstractThe opioid epidemic has forced orthopaedic surgeons to reevaluate prescribing patterns and led hospitals to develop postoperative opioid-sparing protocols for patients undergoing total hip arthroplasty (THA). The purpose of this study was to investigate patient-reported pain and narcotic requirements in patients undergoing THA for fracture (F-THA) or nonfracture diagnoses (THA-E). A retrospective analysis was performed on patients who underwent primary THA at a single academic institution between January 2013 and December 2020. Patients with postoperative opioid prescription and Visual Analog Scale (VAS) pain score data were included. Patients who underwent primary THA with a diagnosis of femoral neck fracture (THA-F) were matched 1:1 with patients without primary fracture diagnoses (THA-E) using nearest-neighbor propensity-score matching. Operative time, length of stay (LOS), discharge disposition, 90-day readmission rates, 90-day opioid prescription amounts (quantified by morphine milligram equivalents [MME]), and daily postoperative VAS pain scores (averaged over 24-hour periods) were compared. A total of 8,714 patients met inclusion criteria (THA-E: 8,362; THA-F: 352). The THA-F group was older and had a higher proportion of females and a lower mean body mass index than the THA-E group. There were 331 THA-F patients successfully matched to 331 THA-E patients. Operative time (113.6 ± 41.3 vs. 914.9 ± 32.6 minutes, p < 0.001) and LOS (2.90 ± 2.82 vs. 2.32 ± 1.44 days, p < 0.001) were longer in fracture patients. The THA-F demonstrated equivalent pain scores at 0 to 24 and 48 to 72 hours postoperatively but had slightly higher pain scores at 24 to 48 hours postoperatively (4.04 ± 1.67 vs. 3.71 ± 1.65, p = 0.028). Ninety-day opioid prescriptions were higher in the THA-E group (median [interquartile range], 150.0 [93.3–300.0] vs. 100.0 [40.0–200.0] MME, p = 0.034). In multivariate regression, a diagnosis of fracture was not associated with changes in MME administration. Patients undergoing primary THA electively and for femoral neck fractures can expect similar postoperative pain scores, though fracture patients may require less narcotics postoperatively. All patients should continue to be counseled preoperatively on the dangers and side effects of prolonged opioid use.

Do We Care About Nutritional Support in Patients Hospitalized with a Diagnosis of Femoral Neck Fracture?

ÖzetAmaç: Femur boyun kırıkları (FBK), proksimal femurun intrakapsüler bölgesinde oluşan kırıklardır. Femur proksimalindeki kırıkların insidansı yaşla doğru orantılı olarak artış gösterir. FBK yüksek mortalite ve morbiditeye neden olan kırıklardır. Yetersiz beslenme de bu hastaların sorunlarından biridir. Bu çalışmada FBK nedeni ile hastanemize yatışı yapılan hastalarda gerekli beslenme takibinin öneminin ortaya konulması amaçlandı.Gereç ve Yöntemler: Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi’ne 2017-2018 yılları arasında FBK tanısı ile yatan hastalara ait veriler retrospektif olarak hasta dosyası ve hastane otomasyon sisteminden tarandı. Çalışmaya 229 hasta dâhil edildi. Hastaların yatış tanıları, yaşve cinsiyeti, albümin, C-reaktif protein (CRP), lenfosit tahlilleri değerlendirildi. Hastanemiz otomasyon sisteminde her yatan hasta için yapılan nutrisyon risk skorlamasına (NRS-2002) bakıldı. Nutrisyon desteği için, beslenme destek ekibinden (BDE) konsültasyon istenip-istenmediğine bakıldı.Bulgular: Çalışmaya dâhil edilen hastaların ortalama yaşları 74 olarak bulundu. Hastaların %79.3’ü 65 yaş üstündeyken, %20.97’si 65 yaş altıydı. Hastaların %65.1`inin albümin, %24.5`inin lenfosit, %88.2`sinin ise CRP değeri normal aralıklar dışında olduğu tespit edildi. Hastaların albümin ve yaş değişkeni arasında negatif yönde, istatistiksel açıdan %41`lik anlamlı bir ilişki vardı (p<0.05). NRS-2002`ye bakıldığında ise %94.8`i hesaplanmamış olarak görüldü. Hastaların hiçbirinden BDE›den konsültasyon istenmediği görüldü.Sonuç: Kalça kırığı hastalarının perioperatif beslenme desteğinin göz önünde bulundurulması hastalarda morbidite ve mortaliteyi azaltıp, yaşam kalitesini iyileştirebilir. Biz, çalışmamızda beslenme desteğine daha çok önem verilmesinin gerekliliğini ortaya koyduk.

Relationship between the neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio and deep venous thrombosis (DVT) following femoral neck fractures in the elderly.

PurposeThis study aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR) was associated with deep venous thrombosis (DVT) following femoral neck fractures in the elderly.MethodThis was a retrospective cohort study and used data extracted from the hospitalization electronic medical record and the laboratory biomarker reports. Patients were included if they were aged above 60 years with a definite diagnosis of femoral neck fracture caused by low-energy trauma. Duplex ultrasound scanning was routinely performed to detect the potential DVT. Two independent multivariate logistic regression models were constructed to identify the association of NLR or PLR with the risk of DVT.ResultsA total of 708 patients with femoral neck fractures were included, and 112 were found to have DVT, indicating an incidence rate of 15.8%. There were significant differences across five subgroups for NLR or PLR, in terms of age (p = 0.020, 0.006), white blood cell (p < 0.001, =0.006), hemoglobin (p < 0.001, <0.001), and albumin (p < 0.001, <0.001). BMI was tested to be significantly different across subgroups for NLR (p = 0.030) and prevalence of cerebrovascular disease for PLR (p = 0.014). The multivariate analyses demonstrated that not NLR but PLR in Q3 (range, 179–238) was associated with an increased risk of DVT, and the risk for the latter was 1.86 (95%CI, 1.07–3.36).ConclusionWe concluded that a PLR value of 179–238 was associated with a 1.86-fold increased risk of DVT after femoral neck fracture. This study paves the way toward further exploration of inflammatory/immune biomarkers with the risk of DVT in the elderly with trauma.

Prevention of postoperative anemia in hip hemiarthroplasty for femoral neck fractures: comparison between local haemostatic agents.

Tranexamic acid and fibrin sealant have been shown to be effective in reducing the need for transfusion after hip fracture surgery. The aim of this study was to evaluate the efficacy of local haemostatic agents to reduce the need of postoperative transfusion in elederly patients after hip hemiarthroplasty. All patients admitted to our institution with a diagnosis of proximal femur fracture from September 2018 to March 2021 were involved. Inclusion criteria were: diagnosis of femoral neck fracture, classified as AO 31B2-3, surgical treatment with hip hemiarthroplasty, hemoglobinemia on admission > 8 gr/dL. Patients were divided in four groups. EVICEL was used on 25 patients, TRANEX was used on 52 patients, standard hemostatic care was used on 73 patients, while post-surgical drain was used on 21 patients. 3 patients were transfused in the EVICEL group while 26 patients were transfused in the control group (p 0,0404), there was also statistical significant difference in the need of perioperative transfusion between EVICEL group and drain group with 10 patients transfused (p 0,0102). Statistical significant differences was found about haemoglobin variation in the first post-operative day between TRANEX group and control group (p 0,000155) and between TRANEX group and drain group (p 0,013) and also between TRANEX group and control group in the third post-operative day (p 0,0004). This study demonstrates that the use of both fibrin sealant or TXA can reduce total blood loss and the need of transfusions in geriatric population with intracapsular femur fracture.

Protocolised MRI as an adjunct to CT in the diagnosis of femoral neck fracture in high energy ipsilateral femoral shaft fractures – A break-even analysis

BackgroundIn high-energy femoral shaft fractures (FSFs), ipsilateral femoral neck fractures (FNFs) can be missed by conventional trauma computed topography (CT) imaging, resulting in increased treatment costs and patient complications. Preliminary evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol can identify these occult fractures and be feasibly implemented in the trauma setting. This study aims to establish the economic break-even point for implementing such an MRI protocol in all high-energy FSFs. MethodsWe used an adapted break-even economic tool to determine whether the costs of a targeted MRI protocol can be offset by cost-savings achieved through prevention of missed fractures (thus avoiding prolonged admission and re-operation). Sensitivity analyses were performed to demonstrate reliability of the economic modelling across a range of assumptions. ResultsAssuming a baseline of FNFs missed on CT of 12%, an MRI cost of £129 and cost of treating each missed FNF of £2457.5, the equation yielded a break-even rate of 7% and absolute risk reduction (ARR) of 5%, indicating that for every 100 FSFs, MRI would need to diagnose 5 of the 12 missed FNF to be economically viable (number needed to treat (NNT)=20). Economic viability was maintained even at double the cost of MRI, while increasing the cost of treating each complication served to reduce the ARR further, increasing cost-savings. ConclusionA rapid, limited-sequence MRI protocol to exclude occult ipsilateral FNFs in all high-energy FSFs appears to be economically justified measure. Further research exploring the feasibility of such a protocol, as well as the role of intra-operative fluoroscopy in this context, is required.

SP5.2.3 Protocolised MRI as an Adjunct to CT in the Diagnosis of Femoral Neck Fracture in High Energy Ipsilateral Femoral Shaft Fractures – a Breakeven Analysis

Abstract Background In high-energy femoral shaft fractures, ipsilateral femoral neck fractures can be missed by conventional trauma computed-topography (CT) imaging, resulting in increased treatment costs and patient complications. Evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol can identify these occult fractures and be feasibly implemented in the trauma setting. This study aims to analyse the economic viability of implementing a such an MRI protocol for all high-energy femoral shaft fractures. Methods We used an adapted break-even economic tool to determine whether the costs of an MRI protocol can be offset by cost-savings achieved through prevention of missed fractures (thus avoiding prolonged inpatient admission, re-operation and implant costs). Sensitivity analyses were performed to demonstrate the reliability of the economic modelling across a range of assumptions. Results Assuming a baseline of hip fractures missed on CT of 12%, an MRI cost of £129 and cost of treating each missed hip fracture of £2633.5, the equation yielded a breakeven rate of 7% and absolute risk reduction (ARR) of 5%, indicating that for every 100 femoral shaft fractures, MRI would need to diagnose 5 of the 12 missed hip fractures to be economically viable (NNT=20). Economic viability was maintained even at double the cost of MRI, while increasing the cost of treating each complication served to reduce the ARR further, increasing cost effectiveness. Conclusion A rapid, limited-sequence MRI protocol to exclude occult ipsilateral hip fractures in all femoral shaft fractures would be an economically justified measure.

Functional and radiological results of the surgical treatment of pediatric femoral neck fractures

Aim: Our aim in this study was to evaluate the demographic data on femoral neck fractures, postoperative complications, and functional and radiological results following its surgical treatment in the pediatric age group. Pediatric femoral neck fractures often occur after high-energy trauma and seen rarely.Methods: Twenty-six patients who underwent surgery after the diagnosis of femoral neck fracture in our clinic between 2012 and 2019 were examined. Demographic data, trauma mechanism, accompanying injuries, and postoperative complications of the patients were recorded from our registry system. Functional radiological evaluation was performed using Ratliff criteria.Results: The mean age of the participants in the study was 11.11 (3–16) year, and the mean follow-up time was 29.34 (12-60) months. According to Ratliff criteria, 18 patients (69.2%) achieved good, 6 patients achieved (23.1%) moderate, and 2 patients achieved (7.7%) poor results after surgery. Avascular necrosis was observed in 5 patients (19.2%) in total. Avascular necrosis did not occur in 10 patients who underwent surgery within first 6 hours. Avascular necrosis occurred in 5 (31.25%) out of 11 patients who underwent surgery after 6 hours. This result was statistically significant (p = 0.049). Of the 5 patients with avascular necrosis, 3 were female and 2 were male. The clinical and radiological results were evaluated according to the Ratliff criteria, and the results were found to be worse in females than in men. There was a statistically significant difference between the genders (p=0.029).Conclusion: Although femoral neck fractures are rare injuries in the pediatric age group, they are important due to the high risk of complications. The most important complication is avascular necrosis. Results are better males than in females. The results of surgical treatments aimed at anatomical reduction in the shortest possible time are satisfactory.

Clinical outcomes and affecting factors of ipsilateral femoral neck and shaft fractures - Multination, multicenter analysis

BackgroundThis study aimed to evaluate the clinical outcomes of ipsilateral femoral neck and shaft fractures and identify the risk factors associated with missed diagnosis of femoral neck fractures and clinical outcomes of this fracture. MethodsThe ipsilateral femoral neck and shaft fractures from seven centers were retrospectively reviewed. Data on injury mechanism, fracture pattern, and fracture classification; surgical factors including fixation method; and timing of detection of femoral neck fracture were analyzed. The clinical outcomes, complications, and the incidence of avascular necrosis of the femoral head (AVNFH) were reviewed. Risk factors for missed femoral neck fracture and complications were analyzed. ResultsIn total, 74 patients with an average age of 43.6 years were included. Of the femoral shaft fractures, 56.8% were type A, 21.6% were type B, and 21.6% were type C. Sixteen patients had an open fracture of the femoral shaft. Femoral neck fracture was initially missed in 27% patients and the timing of delayed diagnosis was at an average of 11.1 days after injury. For detecting femoral neck fractures, minimal displacement of the femoral neck fracture was a risk factor, whereas computed tomography (CT) was a protective factor. The incidence of AVNFH was 6.8% at an average of 36.8 months after injury. The AVNFH group had more displaced femoral neck fractures at the time of surgery, but there was no difference in the timing of diagnosis compared to non-AVNFH group. The femoral shaft showed considerable healing problems, with an average union time of 29.7 weeks and a 20.2% nonunion rate. ConclusionIpsilateral femoral neck and shaft fractures had a high rate of missed diagnosis, especially in minimally displaced fractures; however, CT was a protective factor. AVNFH occurred in 6.8% and was related to femoral neck fracture displacement, but not delayed diagnosis. The femur nonunion rate was high, which warrants attention.

Comparative Interrupted Time Series Analysis of Long-term Direct Medical Costs in Patients With Hip Fractures and a Matched Cohort: A Large-database Study.

Comparative Interrupted Time Series Analysis of Long-term Direct Medical Costs in Patients With Hip Fractures and a Matched Cohort: A Large-database Study.

External Validation of Deep Learning Algorithm for Detecting and Visualizing Femoral Neck Fracture Including Displaced and Non-displaced Fracture on Plain X-ray.

This study aimed to develop a method for detection of femoral neck fracture (FNF) including displaced and non-displaced fractures using convolutional neural network (CNN) with plain X-ray and to validate its use across hospitals through internal and external validation sets. This is a retrospective study using hip and pelvic anteroposterior films for training and detecting femoral neck fracture through residual neural network (ResNet) 18 with convolutional block attention module (CBAM) + + . The study was performed at two tertiary hospitals between February and May 2020 and used data from January 2005 to December 2018. Our primary outcome was favorable performance for diagnosis of femoral neck fracture from negative studies in our dataset. We described the outcomes as area under the receiver operating characteristic curve (AUC), accuracy, Youden index, sensitivity, and specificity. A total of 4,189 images that contained 1,109 positive images (332 non-displaced and 777 displaced) and 3,080 negative images were collected from two hospitals. The test values after training with one hospital dataset were 0.999 AUC, 0.986 accuracy, 0.960 Youden index, and 0.966 sensitivity, and 0.993 specificity. Values of external validation with the other hospital dataset were 0.977, 0.971, 0.920, 0.939, and 0.982, respectively. Values of merged hospital datasets were 0.987, 0.983, 0.960, 0.973, and 0.987, respectively. A CNN algorithm for FNF detection in both displaced and non-displaced fractures using plain X-rays could be used in other hospitals to screen for FNF after training with images from the hospital of interest.

Functional and radiological outcome of Ipsilateral neck with shaft of femur fracture

Background: The incidence of ipsilateral neck of femur with shaft of femur fracture was around 1-9%.The diagnosis of femoral neck fractures are frequently missed during initial assessment due to more focus of femoral shaft fractures. There are hardly any literature regarding outcomes of ipsilateral neck and femur shaft fractures. The purpose of this study is to evaluate the clinical outcome and complications following management of Ipsilateral neck and shaft of femur fracture by various fixation methods. Materials and Method: This is a prospective study done at Sri Ramachandra Medical College between April 2015 to Dec. 2018 in Department of Orthopaedics. The Inclusion Criteria were patients above eighteen years having ipsilateral neck with shaft of femur fracture. The exclusion criteria were Isolated shaft or neck of femur fracture and patients who lost followup and open fractures. We had fifteen patient who had full follow up. The minimum follow up was taken as one year. Patients age group were between 24 years to 58 years with an average of 40 years. All the patients were followed by Modification of wilde et al Neer scoring system for outcome. Results: We had excellent results in five patients, seven patients had good and 3 patients had fair results. There was no poor result in any of our cases. In our study 67% of the cases had no complications. The Average time of union of the fracture was 25 weeks. All the fractures were united in our study. Conclusion: We were able to obtain satisfactory results with minimum complication rate. We were able to achieve excellent results in terms of neck union and shaft union. In Ipsilateral neck and shaft fractures, most neck of femur fractures are undisplaced or minimally displaced. Keywords: Neck of femur, Shaft femur, Ipsilateral, Nonunion, Fracture.

Análise comparativa do nível de dependência funcional de idosos submetidos a artroplastia de quadril: estudo transversal

INTRODUÇÃO: A Artoplastia de Quadril (AQ) é um procedimento cirúrgico realizado em casos de fratura de colo do fêmur (FF) e osteoartrose de quadril (OQ), e é responsável por causar danos funcionais aumentando o nível de dependência funcional do idivíduo idoso. OBJETIVO: analisar o nível de dependênciaonentre idosos que foram submetidos a AQ. MÉTODOS: indivíduos idosos internados na enfermaria traumato-ortopédica do Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA) foram avaliados quanto ao seu nível de dependência funcional através da Medida de Independência Funcional (MIF) e quanto ao nível de dor por meio da Escala Visual Analógica (EVA), tanto no pré quanto no pós-operatório de AQ. Os voluntários foram divididos em grupo A, com diagnóstico de (OQ), e grupo B, com diagnóstico de (FF). O teste t não pareado foi utilizado para comparar os resultados no pré e pós-operatório, adotando-se nível de significância p&lt;0,05. RESULTADOS: um total de 46 idosos compuseram a amostra, 17 (37%) do sexo masculino e 29 (63%) do sexo feminino. O grupo A apresentou menor nível de dependência funcional no pré-operatório em comparação aos sujeitos do grupo B, porém, a avaliação da dor revelou índices maiores para o grupo A no pré-operatório. A análise comparativa dos resultados da EVA no pré e pós-operatório se mostrou estatisticamente significante para ambos os grupos. Os resultados da MIF para o grupo A não foram estatisticamente significantes, para o grupo B, porém, os domínios autocuidados, mobilidade, locomoção e total apresentaram valores estatisticamente significantes. CONCLUSÃO: O grupo A apresentou maiores médias na EVA no pré-operatório e menor nível de dependência funcional pela MIF em comparação ao grupo B, este apresentou as maiores médias de idade e maior presença de co-morbidades.

Clinical and Radiographic Outcomes of Pediatric Femoral Neck Fractures

Aim: The aim of this study was to evaluate the clinical and radiological results of pediatric femoral neck fractures and compare the results with the literature.Methods: We retrospectively reviewed patients with the diagnosis of femoral neck fracture who were treated between 2005 and 2012. 14 patients (6 girls, 8 boys) were found in compliance with the follow-up and with a minimum follow-up of 1 year. Causes of the fracture and types of the treatment were investigated from our medical records. Delbet-Colonna classification was used to determine the type of the fractures. At the last follow-up, femoral neck shaft angle (FNSA) and range of motion (ROM) of the affected hip were measured. Outcome was scored according to Ratliff’s assessment criteria. Avascular necrosis (AVN) was classified according to Ratliff’s AVN classification system. Results: The mean age of patients was 9.9 years and the mean follow-up was 35 months. According to Delbet-Colonna classification; 1 patient was type I (7.1%), 4 were type II (28.6%), 8 were type III (57.2%) and 1 was type IV (7.1%). Eight of 14 fractures were displaced (57.2%) and six were non-displaced (42.8%). Eleven of 14 patients had good (78.6 %), 1 had fair (7.1%) and 2 had poor (14.3%) results according to Ratliff’s assessment criteria. According to Ratliff’s AVN classification, 2 patients had Type-III (14.2 %) and 1 had Type-I AVN (7.1 %). Conclusion: According to our results, we recommend anatomical reduction (close or open) and stable internal fixation for the treatment of pediatric femoral neck fractures.

What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study.

Hip dislocation after treatment of a femoral neck fracture with a hemiarthroplasty remains an important problem in the treatment of hip fractures, but the associations between patient factors and surgical factors, and how these factors contribute to dislocation in patients who have undergone bipolar hemiarthroplasty through an anterolateral approach for femoral neck fracture currently are only poorly characterized. We evaluated patients with bipolar hemiarthroplasty dislocation after surgery for femoral neck fracture treated through an anterolateral approach and asked: (1) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dislocations? (2) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dissociations? A review of hospital records for patients who underwent bipolar hip hemiarthroplasty for femoral neck fracture at one hospital between July 2004 and August 2014 was conducted. During that time, 1428 patients were admitted with a diagnosis of femoral neck fracture; 508 of these patients underwent bipolar hip hemiarthroplasty, of whom 61 died and 23 were lost to followup during the first year, leaving 424 (83%) available for analysis. The remainder of the patients during that time were treated with internal fixation (512), unipoloar hip arthroplasty (17), or THA (391). For each patient with dislocation, we selected five control patients from the cohort according to sex, age (± 3 years), and year of entry in the study to eliminate some confounding factors. We recorded patient characteristics regarding demographics, medical comorbidities, Katz score, American Society of Anesthesiologists score, Mini-Mental State Examination (MMSE) score, and anesthesia type. Medical comorbidities included diabetes, chronic pulmonary disease, heart disease, neuromuscular diseases, and dementia. Univariate analyses were used to search for possible risk factors. Conditional logistic regression analyses on dislocation or dissociation were performed to estimate hazard rates (HRs) and corresponding 95% CIs with covariates of a probability less than 0.1 in univariate analysis. In this cohort, there were 26 dislocations including four that were also dissociations. The proportion of patients experiencing a dislocation was 6% (26 of 424). The mean interval from surgery to dislocation was 56 weeks (range, 0-433 weeks), and 18 dislocations (69%) occurred within 3 months after surgery. Three variables were independently associated with an increased risk of hip dislocation: dementia (HR, 3.51; 95% CI, 1.19-10.38; p = 0.02), discrepancy of offset (HR, 1.72; 95% CI, 1.15-2.58; p = 0.008), and lower MMSE score (HR, 0.93; 95% CI, 0.88-0.98; p = 0.007). The proportion of patients experiencing a dissociation was 0.9% (four of 424). The result of conditional logistic regression for dissociation showed that cup size smaller than 43 mm was the risk factor (HR = 513.05). However, there was no statistical difference with the probability equaling 0.47. After the anterolateral approach for treatment of femoral neck fracture using bipolar hemiarthroplasty, 6% of hips dislocated and 0.9% experienced dissociation. Cognitive dysfunction and discrepancy of offset were independent risk factors associated with an increased risk of prosthetic dislocation. The small cup without a safety ring may be the risk factor of dissociation. Discrepancy of offset should be avoided during the operation by performing an accurate femoral osteotomy and choosing an adequate femoral stem neck length. For patients with cognitive dysfunction and a small cup, suturing the joint capsule during the operation and reinforcing protective measures after surgery might reduce the occurrence of dislocation and dissociation, however a study addressing this is necessary to confirm this. Level III, therapeutic study.

Operative Mortality After Arthroplasty for Femoral Neck Fracture and Hospital Volume.

Background:The purpose of the present study is to use a statewide, population-based data set to identify mortality rates at 30-day and 1-year postoperatively following total hip arthroplasty (THA) and hemiarthroplasty (HA) for displaced femoral neck fractures. The secondary aim of the study is to determine whether arthroplasty volume confers a protective effect on the mortality rate following femoral neck fracture treatment.Methods:New York’s Statewide Planning and Research Cooperative System was used to identify 45 749 patients older than 60 years of age with a discharge diagnosis of femoral neck fracture undergoing THA or HA from 2000 through 2010. Comorbidities were identified using the Charlson comorbidity index. Mortality risk was modeled using Cox proportional hazards models while controlling for demographic and comorbid characteristics. High-volume THA centers were defined as those in the top quartile of arthroplasty volume, while low-volume centers were defined as the bottom quartile.Results:Patients undergoing THA for femoral neck fracture rather than HA were younger (79 vs 83 years, P < .001), more likely to have rheumatoid disease, and less likely to have heart disease, dementia, cancer, or diabetes (all P < .05). Thirty-day mortality after HA was higher (8.4% vs 5.7%; P < .001) as was 1-year mortality (25.9% vs 17.8%; P < .001). After controlling for age, gender, ethnicity, and comorbidities, risk of mortality following THA was 21% lower (hazard ratio [HR] 0.79; P = .003) at 30 days and 22% lower (HR 0.78; P < .001) at 1 year than HA. Patients undergoing THA at high-volume arthroplasty centers had improved 1-year mortality when compared to those undergoing THA at low-volume hospitals (HR 0.55; P = .008).Conclusions:Based on this large, population-based study, there is no basis to assume THA carries a greater mortality risk after hip fracture than does standard HA, even when accounting for institutional volume of hip arthroplasty.

Unstable hip arthroplasties. A prospective cohort study on seventy dislocating hips followed up for four years.

Dislocating hip prosthesis remains a substantial clinical problem. The aim of this study is to describe the risk of recurrent instability after a primary dislocation of primary hip arthroplasty performed for osteoarthritis (OA) or femoral neck fracture (FNF). Seventy patients (male/females: 25/45; mean age 77 [range 46-94]) with dislocating hip arthroplasties were included in a prospective cohort study and followed for four years. Radiographs and all surgical records were reviewed. We compared stable hips to those who either continued to dislocate or were revised due to recurrent instability (unstable group). Forty-two hips (60 %) had episodes of recurrent instability leading to repeated closed reductions or major revision surgery and were classified as unstable. A diagnosis of FNF and cognitive dysfunction (OR 9.3 [95 % CI 1.4-64.1]) or postoperative radiological discrepancies such as leg-lengthening and offset reduction increased the risk of further instability (OR 13.5 [95 % CI 1.3-148.1]). The surgical approach at primary surgery and ASA class did not significantly influence the risk of continued instability. Patients with a FNF and cognitive dysfunction or with sub-optimal postoperative radiographs after hip arthroplasty surgery are at high risk of recurrent instability after a primary dislocation. For hip fracture patients, all efforts should be made to avoid the first dislocation.

Comparison of Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) in Femoral Neck Fractures of Elderly Patients

Femoral neck fracture is a common problem among the elderly. There is no cure for these fractures until now. Internal fixation, hemi arthroplasty and total arthroplasty are widely used methods for treating these fractures. The purpose of this study was to compare two techniques of arthroplasty and total hemiarthroplasty in femoral neck fractures in the elderly. This clinical trial had been performed among the elderly over 65 years with a diagnosis of femoral neck fracture, hip replacement surgery. They were randomly assigned to two groups (n = 50) of hemiarthroplasty and total hip arthroplasty. Duration of surgery, intraoperative blood loss, and duration of hospitalization were analyzed. Patients Follow up were performed once a month for six months and then quarterly for a year after study. Hip function of patients were assessed using the Harris hip score in the fourth and twelve months after surgery. The rate of intraoperative bleeding and the mean duration of surgery was lower in hemiarthroplasty than THA group (P = 0.01). The mean pain score in patients with total hip arthroplasty after 6month was 38 and after 12 months was 43. In Hemiarthroplasty group, the pain intensity score after 6 months was 40 and after 12 month was 42 (P = 0.04). Average functional score and activity of hip joint in total arthroplasty group was 31.5 (47-5) after six months, and 35.3 (47-8) in yearly follow up, and in hemiarthroplasty group, it was 28 (45-5) and 32 (47-8), respectively (P = 0.028). This study results shows that treatment of femoral neck fractures in elderly through total hip arthroplasty surgery lead to a better results in terms of knee function and also less pain and fewer complications in the one-year follow-up.

Diagnosis of Femoral Neck Fracture Associated With Femoral Shaft Fracture

Femoral neck fractures that are associated with femoral shaft fractures have historically been associated with high rates of missed diagnosis. Despite the potentially serious consequences of a missed femoral neck fracture, little work has been conducted to rigorously evaluate the ability of commonly used imaging studies to detect such fractures. Our hypothesis was that axial-view computed tomography is superior to plain radiography at detecting femoral neck fractures. Blinded assessment of a randomized image set that included axial-view computed tomographic scans of the pelvis, anteroposterior-view radiographs of the pelvis, and anteroposterior-view radiographs of the femur. Academic trauma center. Twenty-eight patients who had femoral shaft fractures with femoral neck fractures and 60 patients who had femoral shaft fractures without femoral neck fractures. Images that were stripped of demographic data were independently viewed in random order on computer workstations by 5 trauma fellowship-trained orthopaedic surgeons who were blinded to treatment and diagnosis. Sensitivity, specificity, positive post-test probability, and 1 minus negative post-test probability were calculated for diagnosing femoral neck fracture based on each image type. Interobserver reliability showed "substantial agreement" (kappa > 0.65) for all imaging modalities, indicating that the surgeons had a high level of agreement. All 3 imaging sets had high specificity (>94%) and 1 minus negative post-test probability (>95%) but had poor sensitivity (<65%) and positive post-test probability (<58%). False positives and false negatives were equally likely for all imaging modalities (P > 0.2). Plain radiography and computed tomography have rates of missed femoral neck fractures that are similar and substantial, with a sensitivity of only 56%-64%. Our data emphasize the importance of intraoperative and postoperative imaging in detecting nondisplaced femoral neck fractures in association with femoral shaft fractures.

Monitoring progress in the management of hip fractures in South Australia, Australia

The aim of this study was to assess trends in hip fracture rates and outcomes following hospitalisation for hip fracture. Hip fracture admissions increased over the study period. Men fared worst in terms of higher absolute mortality. Refracture rates and male health outcomes require further attention. The aim of this study was to assess trends in hip fracture rates and outcomes following hospitalisation for hip fracture in South Australia (SA). Analysis of routinely collected, linked hospital separations data, of patients admitted to public and private hospitals in SA with a principal diagnosis of femoral neck fracture between July 2002 and June 2008 was done. Main outcome measures include number and rates of hospital admissions, 30-day in-hospital and 1-year mortality following a first hip fracture and subsequent event rates, by age and sex. Unadjusted hip fracture admissions increased in SA from 2002 to 2008 by 20 %, age-standardised (adjusted) admission rates increased overall (+5 %, p = 0.215) and significantly amongst males (+26 %, p = 0.001), while there was no change among women (−1 %, p = 0.763). Within 1 year of a hip fracture, 7 % had broken another bone (5 % had refractured a hip). At 1 year post-fracture, unadjusted mortality was consistently and considerably higher amongst men compared to women (33 versus 19 %, p < 0.001). Age-standardised mortality from admission to 1 year fell but not statistically significantly by 15 % in women (p = 0.131) and 8 % in men (p = 0.510). Women had a reduction in age-standardised in-hospital mortality over time (p = 0.048); there was a non-significant decline in men (p = 0.080). Hip fracture admissions in SA increased over the study period and this appears to be driven by an increase in admissions amongst men. Men fared worst in terms of higher absolute mortality. There is some evidence to suggest refracture rates and male health outcomes require further attention.