Displaced Femoral Neck Fractures Research Articles

Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians

BackgroundHip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians.MethodsA retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 – 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination.ResultsThere was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015).ConclusionThere is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds.Trial registrationNot necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.

Analysis of cognitive status during rehabilitation after hip arthroplasty associated with pre-existing knee arthroplasty on the same leg: Case Presentation

Abstract: Introduction: Hip arthroplasty conducted through either cemented or cementless pros-theses must alleviate pain and restore joint mobility and muscle strength. The main goal is to restore mobility, stability and to maintain ADL (Activities of Daily Living) within normal parameters. Current surgical techniques allow for state-of-the-art surgeries to be performed. Yet, the postoper-ative course is strongly influenced by both pre-and postoperative psychological factors, as well as by associated diseases. Materials and Methods: We present the case of a 79-year-old female patient from Iasi, a retired yet still physically active gym teacher who was admitted an emergency to the Orthopedics Clinic of the ”Sf. Spiridon” Emergency Hospital with a displaced left femoral neck fracture resulting from same-level fall. The patient had for 6 years a Scorpio-Stryker cemented knee prosthesis on the same leg. Through surgical intervention, a cementless bipolar Lépine prosthesis was inserted into the left hip. Then, the patient presented to the Department of Physical Medicine and Rehabilitation of the Iasi Clinical Railroad Hospital to receive an adequate post-operative rehabilitation program. Results: The psychosocial factors have been analyzed with the help of various recent and spe-cialized psychological scales. The obtained results confirm the fact that these factors significantly influence the rehabilitation of prosthesis-wearing patients. Conclusion: Our study emphasizes the psychological impact on standing and walking rehabilita-tion in a patient with two prostheses on the same motor axis.

Acetabular erosion after bipolar hip hemiarthroplasty for femoral neck fracture in elderly patients: a retrospective study.

The choice between total hip arthroplasty (THA) and hemiarthroplasty (HA) to treat displaced femoral neck fractures, particularly among the elderly, is still controversial. Acetabular erosion consists of a late multifactorial process that may happen after hip HA resulting in significant postoperative burden. This study aims to investigate the impact of acetabular erosion progress after hip HA in patients over 70 years old. This is a 5-year (2013-2018) retrospective study including consecutive series of patients >70 years who were treated with bipolar hip HA for femoral neck fractures. Patients were categorised into 3 groups for analysis (A = 70-75 years, B = 75-80 years, C = >80 years). The study enrolled a total number of 813 patients who met the inclusion criteria. We assessed acetabular erosion through radiological examinations and measured functional deterioration using the modified Harris Hip Score (mHHS) at 6 and 12 months follow-up. Our comprehensive investigation extended over a maximum period of 5 years. The correlation of patients' characteristics and HA features on erosion progress was assessed. There were no significant differences in sex distribution, injury side, BMI, ASA score, bipolar head diameter, mHHS and leg-length discrepancy among the groups (p > 0.05). During the follow-up period, acetabular erosion with consequential conversion to THA was observed in 6.13%, 4.22% and 1.96% for Groups A, B and C respectively (p = 0.009). A statistically significant difference of acetabular erosion was observed in Group A compared to patients of Group C. Age constitutes a significant factor of acetabular wear after HA in the elderly. The higher rate of acetabular wear in patients <75 years suggests that THA is a more viable option, as HA is for patients >80 years old.

Direct Anterior versus Posterior Approach for Total Hip Arthroplasty Performed for Displaced Femoral Neck Fractures.

To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in geriatric patients with displaced femoral neck fractures (FNF). Retrospective Cohort Study. Multicenter Healthcare Consortium. 709 patients > 60 years of age with acute displaced FNF between 2009 and 2021. THA using either DAA or PA. Rates of postoperative complications including dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. Secondary outcome measures included ambulation capacity at discharge, ambulation distance with inpatient physical therapy, discharge disposition, and narcotic prescription quantities (morphine milligram equivalents [MME]). Through a multivariable regression analysis, DAA was associated with significantly shorter operative time ​​(B = -6.89 minutes; 95% CI, -12.84 to -0.93; P = 0.024), lower likelihood of blood transfusion during the index hospital stay (aOR = 0.54; 95% CI, 0.27 to 0.96; P = 0.045), and decreased average narcotic prescription amounts at 90 days (B = -230.45 MME; 95% CI, -440.24 to -78.66; P = 0.035) postoperatively. There were no significant differences in medical complications, dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. When comparing the DAA versus PA for THA performed for displaced FNF, DAA was associated with shorter operative time, a lower likelihood of blood transfusion, and lower 90-day postoperative narcotic prescription amounts. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Open reduction and internal fixation of irreducible displaced femoral neck fracture with femoral Neck System: a preliminary study

BackgroundMost displaced femoral neck fractures can achieve satisfactory anatomical reduction by closed reduction, but there are still some that cannot reset satisfactorily after closed reduction, and open reduction are required. Such fractures that cannot be repositioned successfully by closed reduction are called irreducible displaced femoral neck fractures in this study. The objective of our study was to evaluate the efficacy of direct anterior incision with the Femoral Neck System in the treatment of irreducible displaced femoral fractures.MethodsA total of 16 young and middle-aged patients with irreducible displaced femoral neck fractures involving Garden type III and IV were treated using Femoral Neck System fixation by open reduction through Direct Anterior Approach between January 2020 to September 2021. Functional outcomes and postoperative complications were assessed during follow-up. Clinical outcomes were evaluated by the Hip Harris score. The postoperative reduction was evaluated by the Garden Index. Observe postoperative complications.ResultsAll patients were followed up with a mean follow-up time of 21.1(12–30) months, and according to radiological results, all patients achieved fracture healing, with a mean healing time of 4.25 months. All 16 patients received grade Garden I and II reductions, and there was no significant difference in the anteroposterior Garden reduction index between the first day after surgery (166.13 ± 5.61) and the 12th month after surgery(164.94 ± 4.49) (P>0.05) and no significant difference in lateral Garden index between the first day after surgery(171.06 ± 4.46) and the 12th month after surgery(169.38 ± 3.98) (P<0.05). According to the Hip Harris score scale, 13 patients received excellent and 3 patients received good. The postoperative Hip Harris Score(17.19 ± 4.8) was significantly higher than the preoperative score(92.19 ± 3.4), and the difference was statistically significant (P < 0.05). No or mild femoral neck shortness occurred in 12 (75%) patients, moderate shortening occurred in 3 (18.75%) patients, and severe shortening occurred in 1 (6.25%) patient. None of the patients experienced femoral head necrosis, fracture nonunion, or incision infection. One patient developed deep venous thrombosis of the lower extremity.ConclusionsThe Direct Anterior Approach combined with Femoral Neck System is an excellent treatment for irreducible displaced femoral neck fracture and achieved good functional outcomes and anatomical reduction with low complications.

The different strategies in treating displaced femoral neck fractures: mid-term surgical outcome in a register-based cohort of 1,283 patients aged 60-69 years.

In patients around retirement age controversy exists as to whether to treat displaced femoral neck fracture (dFNF) with internal fixation (IF) or arthroplasty. An arthroplasty in this age group may need revision due to a long expected remaining lifetime. IF carries a higher risk of early failure but a maintained native hip if healing occurs. We aimed to determine the cumulative 5-year rate of conversion to arthroplasty after IF and implant revision after primary total hip arthroplasty (THA), respectively. In this longitudinal cohort study, patients aged 60-69 years registered with a dFNF in the Swedish Fracture Register (SFR) 2012-2018 were cross-referenced with available data from the Swedish Arthroplasty Register (SAR) until December 31, 2019. Conversion to arthroplasty or revision were analyzed utilizing competing risk, with death as competing event. At 5 years, the cumulative rate of conversion to arthroplasty after IF was 31% (95% confidence interval [CI] 26-37). For primary THA, the 5-year rate of revision was 4.0% (CI 2.8-5.8). The 5-year mortality did not differ, being 20% (CI 16-27) and 23% (CI 20-28) after IF and THA, respectively. Regression analyses did not identify any risk factors for conversion arthroplasty based on the variables in the register. A follow-up of 5 years catches most reoperations after IF, resulting in a 31% conversion rate. The 4% revision rate at 5 years after primary THA should be seen as an intermediate result, as late complications may occur.

Total hip arthroplasty versus hemiarthroplasty in the treatment of active elderly patients over 75 years with displaced femoral neck fractures: a retrospective study

BackgroundFemoral neck fractures are associated with substantial morbidity and mortality for older adults. Total hip arthroplasty (THA) and hemiarthroplasty (HA) are widely used in elderly patients with displaced femoral neck fractures (DFNF), but there is still controversy refering to the optimal chose for the management of DFNF in active elderly patients.MethodsThis is a retrospective cohort study that incorporates medical record review with an outcomes management database. 73 patients who underwent HA and 66 patients who underwent THA were identified from January 2015 to December 2017. Data of age, gender, BMI, comorbidity status, operation time, blood loss, hospitalization time, in-hospital complication were collected and analyzed. Clinical follow-up and radiographic examinations were performed at approximately five years, and hip complications, Harris Hip Score (HHS) and EuroQol-5 Dimensions (EQ-5D) were assessed.ResultsPreoperative general data of sex, age, BMI and charlson comorbidity score of THA group(n=55) has no statistically significant difference with that of HA group. Patients treated by THA had significantly longer operation time (105.5 vs 76.7 minutes; P < 0.001), more blood loss (524.1 vs 350.1 ml; P < 0.001) and longer hospitalization time (15.8 vs 13.8 days; P < 0.001). There was no significant differences between two groups in complications (32.7% vs 25.8%, P=0.432). No patients died during the hospitalization. After five years, only 33 patients in the THA group and 34 patents in the HA group were still alive, and the fraction surviving were not statistically significant between two groups (60.0% vs 54.8%, P> 0.05). The differences in hip function in favor of THA appeared to increase after the five-year follow-up, and the difference was significant in terms of the total Harris hip score (81.3 vs 73.1, P < 0.001) as well as in the dimensions of pain (38.9 vs 35.9, P=0.033), function (33.7 vs 29.2, P=0.001), absence of deformity (4.0 vs 3.9, P=0.023) and range of motion (4.6 vs 4.2, P=0.008). There was no significant differences between groups in hip dislocation rate (6.1% vs 0.0%, P=0.239). The erosion rate of hip joint in the THA group was significantly lower than that of the HA group (0.0% vs 26.5%, P=0.002). The health-related quality of life, according to EQ-5D index score, was found to be higher (0.69 vs 0.63, P= 0.001) in the THA group than the HA group after five years.ConclusionTHA may be a preferred management option for active elderly patients over 75 years. The more extensive surgery of THA is not associated with higher in-hospital complication rate or mortality rate. These patients can benefit from THA in terms of hip function and quality of life.Trial registrationNo.

Displaced Geriatric Femoral Neck Fractures: A Retrospective Comparison of Total Hip Arthroplasties Versus Hemiarthroplasty.

Controversary exists around the best surgical management for traumatic geriatric displaced femoral neck fractures. The study objective was to compare outcomes among those managed with a total hip arthroplasty (THA) to those managed with a hemiarthroplasty (HA). This retrospective matched cohort study included geriatric hip fractures (≥65y/o) admitted 7/1/16-3/31/20. Patients were matched on having an advanced directive, pre-existing dementia, and age. Outcomes included: time to surgery, length of stay (LOS), blood loss volume, and discharge destination. THAs were compared to HAs; an alpha of <.05 indicated statistical significance. There were 191 patients: 86% were treated with HA and 14% with THA. Most (40%) were 80-89years old, 66% were female, and 92% were white. After matching, the groups were well balanced on demographics and baseline characteristics with 27 patients/arm. The median time to surgery was 23hours for both arms, P = .38. The LOS was significantly longer for those managed with a HA when compared to those managed with a THA, 5.6 vs 4.0days, P = .001. The median blood loss volume was significantly lower for HAs than for THAs, but the difference was small, 100 vs 120mL, P = .02. Patients managed with a HA were less likely to be discharged home than those managed with a THA, 22% vs 70%, P = .005. While patients managed with a THA had significantly more blood loss than those managed with a HA, the difference in blood loss was small and not clinically relevant. Those managed with a THA experienced a significantly shorter LOS and were more likely to be discharged home than patients managed with a HA. Among a healthier, younger geriatric population, THA may lead to shortened LOS and improved discharge destinations when compared to HA for treatment of femoral neck fractures.

261 Bilateral Femoral Neck Stress Fractures in an Active Adolescent Female: A Case Report

Abstract Bilateral femoral neck stress fractures are uncommon injuries in adolescents. We present such a case in a 15-year-old athletic female with no preceding trauma or underlying metabolic bone abnormality. The patient presented to Accident and Emergency with a three-week history of left buttock and lateral thigh pain and one-week history of right lateral thigh pain. The pain developed during physical activity and was relieved upon rest. Activities included running, dancing, and attendance at a six-week cadet marching course. Simple analgesia did not alleviate the pain. History revealed low caloric intake and previous secondary amenorrhea. The patient was previously managed by the General Practitioner and physiotherapist for suspected atypical sciatica. Physical examination showed a minimally antalgic gait and pain on palpation of the left groin. Both hips had full range of motion. Bone profile was normal. Radiographic films were initially interpreted as normal, however, formal reporting revealed sclerotic appearances to both femoral necks and a subtle break in the left femoral neck cortex. MRI confirmed the diagnosis of a complete displaced left femoral neck fracture and incomplete right inferomedial femoral neck fracture. Trace bilateral hip joint effusions were noted. The patient underwent bilateral fixation with cannulated screws. One-month post-operative, she engaged in walking and swimming without pain. Radiographic appearances were satisfactory. Early radiographic changes associated with stress fractures are subtle. This case highlights the importance of prompt formal radiological reporting and the early use of MRI as a diagnostic tool, particularly in patients with risk factors.

Cannulated screws versus dynamic hip screw versus hemiarthroplasty versus total hip arthroplasty in patients with displaced and non-displaced femoral neck fractures: a systematic review and frequentist network meta-analysis of 5703 patients.

Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS) fixation, dynamic hip screw (DHS) fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA) in terms of surgical and functional outcomes, reoperation and postoperative complications. We searched PubMed, The Cochrane Library, Clinical trials, CINAHL, and Embase for randomized controlled trials (RCTs) or quasi-RCTs up to 31 July 2022. A frequentist network meta-analysis was performed to assess the comparative effects of the four operative procedures, using fixed-effects and random-effects models. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. A total of 33 RCTs with 5703 patients were included in our network meta-analysis. CS fixation was best in terms of operation time (CS: MD = - 57.70, 95% CI - 72.78; - 42.62; DHS: MD = - 53.56, 95% CI - 76.17; - 30.95; HA: MD = - 20.90, 95% CI - 30.65; - 11.15; THA: MD = 1.00 reference) and intraoperative blood loss (CS: MD = - 3.67, 95% CI - 4.44; - 2.90; DHS: MD = - 3.20, 95% CI - 4.97; - 1.43; HA: MD = - 1.20, 95% CI - 1.73; - 0.67; THA: MD = 1.00 reference). In life quality and functional outcome, measured at different time points with EQ-5D and the Harris Hip Score (HHS), THA ranked first and HA second (e.g. EQ-5D 2years postoperatively: CS: MD = - 0.20, 95% CI - 0.29; - 0.11; HA: MD = - 0.09, 95% CI - 0.17; - 0.02; THA: MD = 1.00 reference; HHS 2years postoperatively: CS: MD = - 5.50, 95% CI - 9.98; - 1.03; DHS: MD = - 8.93, 95% CI - 15.08; - 2.78; HA: MD = - 3.65, 95% CI - 6.74; - 0.57; THA: MD = 1.00 reference). CS fixation had the highest reoperation risk, followed by DHS fixation, HA, and THA (CS: OR = 9.98, 95% CI 4.60; 21.63; DHS: OR = 5.07, 95% CI 2.15; 11.96; HA: OR = 1.60, 95% CI 0.89; 2.89; THA: OR = 1.00 reference). In our cohort of patients with displaced and non-displaced femoral neck fractures, HHS, EQ-5D, and reoperation risk showed an advantage of THA and HA compared with CS and DHS fixation. Based on these findings, we recommend that hip arthroplasty should be preferred and internal fixation of femoral neck fractures should only be considered in individual cases. a systematic review of randomized controlled trials. PROSPERO on 10 August 2022 (CRD42022350293).

Site-Specific Differences in Bone Mineral Density of Proximal Femur Correlate with the Type of Hip Fracture.

The aim of this study was to investigate whether site-specific differences in bone mineral density (BMD) of proximal femur correlate with the type of hip fracture using quantitative computed tomography. Femoral neck (FN) fractures were classified as nondisplaced or displaced subtypes. Intertrochanteric (IT) fractures were classified as A1, A2, or A3. The severe hip fractures were identified as displaced FN fractures or unstable IT fractures (A2 and A3). In total, 404 FN fractures (89 nondisplaced and 317 displaced) and 189 IT fractures (76 A1, 90 A2, and 23 A3) were enrolled. Areal BMD (aBMD) and volumetric BMD (vBMD) were measured in the regions of total hip (TH), trochanter (TR), FN, and IT of the contralateral unfractured femur. IT fractures exhibited lower BMD than FN fractures (all p ≤ 0.01). However, unstable IT fractures had higher BMD compared with stable ones (p < 0.01). After adjusting for covariates, higher BMD in TH and IT were associated with IT A2 (A1 vs. A2: odds ratios (ORs) from 1.47 to 1.69, all p < 0.01). Low bone measurements were risk factors for stable IT fractures (IT A1 vs. FN fracture subtypes: ORs from 0.40 to 0.65, all p < 0.01). There are substantial site-specific differences in BMD between IT fractures A1 and displaced FN fractures. Higher bone density was associated with unstable IT fracture when compared with stable ones. The understanding of biomechanics of various fracture types could help to improve the clinical management of these patients.

Total Hip Arthroplasty or Hemiarthroplasty for Displaced Femoral Neck Fractures?: Commentary on an article by Mina Tohidi, MD, FRCS(C), PhD, et al.: "Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture. A Propensity-Score-Matched Cohort Study".

Commentary This Canadian study involves a subject of continued controversy1,2. It describes the outcomes of a large matched group of patients ≥60 years old with a displaced femoral neck fracture treated with total hip arthroplasty (THA) or hemiarthroplasty (HA). The 2 groups had similar revision and readmission rates, but those treated with THA had higher dislocation rates. Patients treated with HA had higher mortality rates, but they tended to be older and had higher rates of dementia and institutionalization. These findings are not new or unexpected, so what are surgeons to take away from this study? The major strength of this study is the use of a well-matched cohort with a large sample size (9,224). Most previous studies involved far fewer patients or performed meta-analyses of such studies3. Its major weakness is that surgeon and technical factors could not be taken into account. Who performs the surgery and how it is done are very important but were not captured in the data. In clinical practice, a femoral neck fracture is a devastating but common injury. Treatment should be based on shared decision-making involving the surgeon and the patient, family, or individual who has the power of attorney. These other individuals will ultimately rely heavily on the surgeon’s recommendations. The surgeon should clearly explain why a particular treatment is being recommended, along with the specific risks and benefits involved with each treatment. There are also many confounding factors that can influence the surgeon’s recommendation. These can include surgeon experience and comfort with the procedure, as well as institutional support for performing it at less than convenient hours (holidays, weekends). Age, comorbidities, anticipated life expectancy, approach, femoral component head size, use of a dual-mobility construct, bone quality, and use of cement all need to be taken into account. An institutionalized patient with Parkinson disease will be treated very differently from an active 70-year-old who lives at home. Some studies have not found significant differences between these 2 treatments, or have questioned the clinical importance of better quality-of-life scores after THA than after HA4. However, the pendulum is clearly swinging toward the use of THA for this injury5,6. This study provides further evidence that THA is a reasonable treatment for many displaced femoral neck fractures, but reinforces the need to consider factors that will reduce dislocation rates.

Displaced Versus Nondisplaced Femoral Neck Fractures: Is Arthroplasty the Answer for Both?

BackgroundTraditionally, nondisplaced geriatric femoral neck fractures (FNFs) have undergone operative fixation, while displaced geriatric FNFs have undergone hip arthroplasty. The purpose of this study was to evaluate differences between outcomes in patients with nondisplaced (Garden I and II) fractures and displaced (Garden III and IV) fractures that were treated with arthroplasty. MethodsThis was a retrospective review of patients who had a minimum of 1 year follow-up from nine academic medical centers who underwent arthroplasty for FNFs between 2010 and 2020. Chi-square, Fisher’s Exact, and t-tests were used to compare demographics and outcomes between patients who had a displaced fracture and those who had a nondisplaced fracture. We included 1,620 patients, with 131 in the nondisplaced cohort and 1,497 in the displaced cohort. The mean follow-up in the study was 26.4 months. Both groups were similar in terms of demographic variables. ResultsAt 1-year follow-up, the overall reoperation rate was 7% and was not different between patients who had nondisplaced compared to displaced FNFs who underwent arthroplasty. Heterotopic ossification (HO) was significantly higher in displaced (23.6%) versus nondisplaced fractures (11.7%) (P = .0021). Operative times and blood loss were higher in nondisplaced than displaced fractures that underwent arthroplasty. ConclusionHip arthroplasty is an excellent treatment option for nondisplaced and displaced geriatric FNFs with relatively low and similar reoperation rates at 1 year. Compared to previously published reoperation rates of internal fixation of nondisplaced FNFs, hip arthroplasty is a reasonable treatment option for nondisplaced FNFs to potentially decrease reoperations in a frail patient population.

COMPARISON OF FUNCTIONAL OUTCOMES BETWEEN UNCEMENTED UNIPOLAR AND CEMENTED BIPOLAR HEMIARTHROPLASTY FOR INTRACAPSULAR NECK FEMUR FRACTURES IN ELDERLY

Background: Femoral neck fractures (FNF) are a growing problem in our ageing society and have been associated with high morbidity and mortality. Hemiarthroplasty is the most commonly used treatment for displaced femoral neck fractures in the elderly. There is limited evidence in the literature of functional outcome with cemented implants compared to AMP in aged more than 70 years. Hence an attempt is made to compare the outcome with unipolar vs cemented bipolar prosthesis for displaced fracture neck of femur in patients aged more than 70years. Ours is a prospective comparative st Materials And Method: udy conducted, involving 40 patients with short term follow up of one year. Elderly patients above 70 years of age, with displaced fracture neck of femur were included. 20 patients were operated with Austin Moore Prosthesis (AMP) and 20 with bipolar prosthesis. The functional hip score was assessed using Harris Hip Score (HHS). The statistical software SPSS 15.0 (Statistical Package for Social Sciences) was used for the analysis of our data. In our study, Result: mean duration of surgery in uncemented group was 70 minutes and mean duration of surgery in cemented group was 82 minutes. On the basis of HHS the results were at 6 weeks follow up we had 70.2 for uncemented group and 77.5 for cemented group and in the last follow up at 6 months, we found HHS 84.2 for uncemented group and 85.6 for cemented group. There were 3 complications in cemented as a cement reaction and 2 supercial infection one in cemented and other in uncemented group. Both cemented Conclusion: and uncemented prostheses can be recommended according to our study because they were equally good regarding functional outcome and health-related quality of life, contrary to the generalized and limited published evidence. The seeming advantages of shorter duration of surgery and potentially less blood loss with the uncemented implant are of little importance compared with the important ndings of equivalent functional results. Both implants may be used with good results after displaced femoral neck fractures.

Comparing Outcomes of Total Hip Arthroplasty for Displaced Neck of Femur Fractures in Elderly Patients Utilizing Dual Mobility Cups and Conventional Implants: A Single Center Retrospective Study of 129 Patients.

Studies comparing the use of total hip arthroplasty (THA) with conventional implants and hemiarthroplasty for displaced femoral neck fractures (DFNF) have reported better patient satisfaction scores and outcomes in the former, but also significant dislocation rates (6.9-13%).The total hip arthroplasty with dual mobility cup (THA-DMC) design is mechanically proven to increase the hip range of motion and jump distance to dislocation relative to conventional implants. Despite its potential benefit, clinical studies analyzing the use of THA-DMC in the treatment of DFNF in comparison to conventional THA within the Asian population are still limited. Our study aims to compare the rate of complications and functional outcomes between the 2 implants in the treatment of DFNF. This was a retrospective cohort study conducted in a single tertiary care institution. From January 2015 to May 2020, data from 129 consecutive patients who satisfied the inclusion criteria and underwent either a THA or THA-DMC for DFNF were collected and divided into 2 groups. All patients received a standardized post-operative treatment and follow-up regime. Both groups of patients were assessed for post-operative complications such as dislocation, peri-prosthetic fractures, surgical site infections, medical complications. Their functional outcomes as well as patient-reported outcome scores were also assessed via the SF-36 score and Oxford hip score questionnaires at 6months and 1year. A total of 42 patients with dual mobility implants and 87 patients with conventional implants were recruited. There was no dislocation in the THA-DMC group while there were 4 cases (4/87, 4.6%) of dislocation in the THA group. Regarding post-operative function, both groups had comparable functional outcomes. There were no statistically significant differences between the patient-reported outcome scores (Oxford hip score and SF-36) at 6months and 1year. We report promising short-term outcomes utilizing dual mobility implants in total hip arthroplasty for the treatment of DFNFs.

AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline.

AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline.

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures.

This study aimed to define the distribution and frequency of fracture lines and bone defects in displaced femoral neck fractures (DFNFs) using a three-dimensional (3D) mapping technique, and to investigate the factors associated with the area of bone defects in patients with DFNFs. The data of 256 adult patients with DFNFs were retrospectively reviewed. Multiplanar reconstructions of the DFNFs were made using computed tomography (CT) images, and the DFNF fragments were virtually reduced to match a 3D model of the femoral neck. Subsequently, 3D mapping was performed by graphically superimposing all of the fracture lines and bone defects onto a femoral neck template. The 3D mappings were independently examined by two orthopedic surgeons, and the interobserver agreement was analyzed. For intraobserver analysis, one of the surgeons measured the mappings twice more, and the intraclass correlation coefficients (ICCs) were calculated. A linear regression analysis was conducted to explore bone defect area-related factors. The cohort comprised 141 (55%) patients with left hip injuries and 115 (45%) patients with right hip injuries. On the 3D maps, the dense zones of the fracture lines were largely observed from the superior to the posterior part of the femoral neck, while the dense zone of the bone defect was primarily concentrated in the posterior part of the femoral neck. Only a few dense zones were located in the anterior and inferior parts of the femoral neck. An overlapping region between the fracture line and the bone defect was located in the 2.5th to 4.5th (5th) part of the 1/10 of the superior (posterior) femoral neck length. Both the fracture line and bone defect mapping techniques had good intra- and inter-observer reliability, with ICCs of 0.879 (0.977) and 0.780 (0.974), respectively. Garden type and age were positively correlated with bone defects, while simplified AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification was negatively associated with bone defects. The fracture lines and bone defects of the DFNFs were mainly located in the superior and posterior parts of the femoral neck, while an overlapping region was observed in the subcapital area of the femoral neck. 3D mapping is a reliable method for searching for DFNF features, and separately studying fracture lines and bone defects can further elucidate the morphology of these fractures. Bone defects in patients with DFNFs were associated with Garden type, simplified AO/OTA classification, and age.

Comparison of Hemiarthroplasty and Total Hip Arthroplasty in Elderly Patients with Displaced Femoral Neck Fractures

Background and Aim: Hemiarthroplasty (HA) and total hip arthroplasty (THA) are the two alternate surgical interventions required for displaced femoral neck fractures in elderly patients. Though THA is superior in certain aspects such as hip pain, reoperation rate and function but had higher dislocation rate compared to HA. The present study aimed to compare the hemiarthroplasty and total hip arthroplasty in elderly patients with displaced femoral neck fractures. Patients and Methodology: This retrospective cohort study was conducted on 20 displaced femoral neck fractures patients in the Department of Orthopedic QAMC/ BVH Bahawalpur from January 2021 to August 2022. Prior to start of study, ethical approval was taken from the institute research and ethical committee. Written informed consent was obtained from each individual. Patients aged &gt;60 years and had femoral neck fractures were enrolled. Rheumatoid arthritis in fracture hip patients, non-ambulatory patients, and pathological fracture patients were excluded. Patients were categorized into two groups; group-I patients undergoing hemiarthroplasty and group-II patients undergoing total hip arthroplasty. Post-operative complications such as fracture, medical issues, dislocation, surgical site infection, and mortality (1 year) were assessed in both groups. Harris Hip Score (HHS) was used for the assessment of function outcome at one month, three months, six months, and twelve months. SPSS version 25 was used for data analysis. Results: Of the total 20 femoral neck fractures patients, 10 patients underwent hemiarthroplasty and 10 underwent total hip arthroplasty. The overall mean age was 69.44±7.91 years. Demographic details or baseline features were almost similar in both groups. During follow-ups, patients who underwent total hip arthroplasty (group-II) had higher Harris hip score than group-I patients. The mean HHS score in group-I patients were 61.53, 68.24, 70.81, and 76.16 at follow-up visit after one month, three months, six months, and twelve months respectively while In group-II, the mean HHS score were 66.23, 69.82, 73.25, and 78.92 respectively. Conclusion: Our study concluded that total hip arthroplasty in elder patients with femoral neck fractures provided better hip functional outcome and lower morbidity and mortality as compared to hemiarthroplasty group. THA could be considered as priority based treatment modality for femoral neck fractures patients than HA due to higher Harris hip scores and lesser complications. Keywords: Femoral neck fractures, Hemiarthroplasty, Total hip arthroplasty

Comparison of the Short-Term Outcomes of Cementless Bipolar Hemiarthroplasty and Cementless Total Hip Arthroplasty for Displaced Femoral Neck Fractures in the Elderly

Purpose: Displaced femoral neck fracture (DFNF) in elderly patients are frequently managed by hip replacement. However there is no consensus on bipolar hemiarthroplasty (BHA), which has a lower dislocation rate, less blood loss and shorter operative time, while total hip arthroplasty (THA) provides better functional and long term outcomes. This study aimed to evaluate patient function and complications following both BHA and THA in an elderly population who presented with DFNF. Methods: A prospective, randomized controlled trial comparing BHA and THA for DFNF treatment was performed. Patients over 60 years of age with DFNF (Garden’s classification types 3 and 4) participated in this study, while patients with preexisting hip conditions and impaired cognitive function were excluded from the study. All operations were performed by a single surgeon using the same techniques the posterior approach. Demographic data, intraoperative blood loss, operative time, and morbidity and mortality statistics were collected. Patients were followed up at 1, 3, 6 and 12 months and their functional scores were calculated according to the Harris hip score. Statistical analyses were performed to the intention-to-treat principle. Results: The cohort comprised 75 patients, with 38 patients in the BHA group (mean age 76.7 years) and 37 patients in the THA group (mean age75.7 years). The mean operative times for the BHA and THA groups were 40.76 and 51.08 minutes respectively. The average intraoperative blood loss was 200 cc and 279.7 cc, respectively. The mean hospital stay was 5.07 days for the BHA group and 4.92 days for the THA group. The mean Harris hip scores at 1, 3, 6 and 12 months in the BHA group were 71.5, 78, 85 and 86, respectively, while in those in the THA group were 71, 79, 85.5 and 88 respectively. Statistically, there were no significant difference between the two groups. Morbidities including fractures and dislocations, and mortality rates, also showed no statistically significant difference. Conclusions: Harris hip score, dislocation, length of hospital stay and mortality rate at one year is not statistically different between group. Blood loss and operative time were significantly lower in the BHA group than in the THA group.

Do the Number, Size, and Position of Partially Threaded Screws Affect the Radiological Healing of Surgically Treated Displaced Femoral Neck Fractures? A Review of 136 Children.

Background and Objectives: The quantity, size, and position of implants might affect the fracture healing process of surgically treated displaced pediatric femoral neck fractures (PFNFs). The aim of this retrospective multicenter study was to evaluate the correlation between the time needed to achieve radiological union and the number, size, and location of the partially threaded cannulated screws (PTCSs) in children with displaced PFNFs. Materials and Methods: A retrospective review of 136 children (mean age: 10.6 ± 3.8 years) with displaced PFNFs treated by two (n = 103) or three (n = 33) PTCSs was carried out. Student’s t-tests, one-way ANOVA, Cox regression analysis, and multiple linear regression analyses were performed to investigate the variables affecting the time needed to achieve radiological fracture healing according to the number, size, and position of PTCSs, as assessed on plain radiographs. Results: A total of 132 hips achieved union at an average of 3.2 ± 1.6 months after the initial surgery. The time needed to achieve union in the patients treated with two or three PTCSs was comparable (p = 0.36). Among the fractures treated by two PTCSs, the time needed to achieve union did not correlate with the size of the implant (p = 0.122), or with the angulation between the PTCSs on anterior–posterior (p = 0.257) and lateral radiographs (p = 0.547). The time needed to achieve union in the fractures that were fully compressed by the implants was similar to the partially compressed fractures (p = 0.08). Conclusions: The number, size, and position of the PTCSs do not affect the radiological healing in the children with displaced PFNFs treated surgically.