Femoral Fractures Research Articles

From healthy to osteoporotic: Exploring how bone quality alters implant performance in Pauwels type III fracture.

Osteoporosis compromises bone strength, making bone more susceptible to fractures. Decreased bone density heightens susceptibility to femoral neck fractures. The study investigated the impact of bone density on implant performance across three categories of bone quality: healthy, osteopenic, and osteoporotic. The effectiveness of three commonly used implant types (Femoral Neck System, Dynamic Condylar Screw, and Dynamic Hip Screw, where later two equipped with an anti-rotational screw) was evaluated through finite element analysis for treating Pauwels type III fracture. The bone geometry and material properties were based on a subject-specific CT data. The density and Young's modulus of bone elements were adjusted to simulate osteopenic and osteoporotic bone. FE models were developed and the peak loading values for normal walking and stair climbing conditions were considered. Stability and performance of the implant were assessed using bone strain, implant stress, deformation and rotation of the femoral head, micromotion at the interfaces, strain shielding, and risk of implant cut-out. Except for DCS with AR-screw and FNS implants under stair climbing conditions in weaker bone qualities, the implant stress remained within the yield limit of Ti-alloy. The comprehensive assessment identified DHS2 as the preferred implant option for treating such fractures, even in poor bone quality. The risk of cut-out risk was up to 3.9% higher in DCS2 and 6.3% higher in FNS implanted models than in DHS2. The effect of change in bone quality was comparatively less in DHS2 implants than the other two types.

Medial cortical reduction does not influence outcomes in geriatric intertrochanteric femur fractures treated with proximal femoral nail

BACKGROUND In intertrochanteric fractures, the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse. AIM To analyze the concept of medial cortical reduction (MCR) and its clinical and radiological association in geriatric intertrochanteric femur fractures. METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study. Based on the degree of MCR, they were divided into positive, neutral, or negative MCR groups. The demographic baseline characteristics, postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6, 12 and 24 weeks post-surgery. Functional outcomes such as modified Harris Hip Score (HHS) and time to full-weight bearing were also analyzed. RESULTS 47 patients (Male: Famale 35:12) with mean age of 65.8 ± 4.2 years were included in this study. Twenty-two cases had neutral support, nine had negative support, and sixteen had positive support in the medial cortex post-operatively. Baseline characteristics of the three groups were comparable. No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups. The modified HHS was not found to be significant between the groups (P = 0.883) as that of the time to full weight bearing (P = 0.789). CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse. Future randomized controlled trials are needed to validate the findings noted in the study.

Accuracy of artificial intelligence in prediction of osteoporotic fractures in comparison with dual-energy X-ray absorptiometry and the Fracture Risk Assessment Tool: A systematic review

BACKGROUND Osteoporotic fractures, whether due to postmenopausal or senile causes, impose a significant financial burden on developing countries and diminish quality of life. Recent advancements in artificial intelligence (AI) algorithms have demonstrated immense potential in predicting osteoporotic fractures. AIM To assess and compare the efficacy of AI models against dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool (FRAX) in predicting fragility fractures. METHODS We conducted a literature search in English using electronic databases, including PubMed, Web of Science, and Scopus, for studies published until May 2024. The keywords employed were fragility fractures, osteoporosis, AI, deep learning, machine learning, and convolutional neural network. The inclusion criteria for selecting publications were based on studies involving patients with proximal femur and vertebral column fractures due to osteoporosis, utilizing AI algorithms, and analyzing the site of fracture and accuracy for predicting fracture risk using SPSS version 29 (Chicago, IL, United States). RESULTS We identified 156 publications for analysis. After applying our inclusion criteria, 24489 patients were analyzed from 13 studies. The mean area under the receiver operating characteristic curve was 0.925 ± 0.69. The mean sensitivity was 68.3% ± 15.3%, specificity was 85.5% ± 13.4%, and positive predictive value was 86.5% ± 6.3%. DXA showed a sensitivity of 37.0% and 74.0%, while FRAX demonstrated a sensitivity of 45.7% and 84.7%. The P value for sensitivity between DXA and AI was < 0.0001, while for FRAX it was < 0.0001 and 0.2. CONCLUSION This review found that AI is a valuable tool to analyze and identify patients who will suffer from fragility fractures before they occur, demonstrating superiority over DXA and FRAX. Further studies are necessary to be conducted across various centers with diverse population groups, larger datasets, and a longer duration of follow-up to enhance the predictive performance of the AI models before their universal application.

Magnesium-based implants accelerate femoral fracture healing through promoting histone lactylation-mediated osteoclastogenesis inhibition.

Magnesium-based implants accelerate femoral fracture healing through promoting histone lactylation-mediated osteoclastogenesis inhibition.

Risk of Venous Thromboembolism in Pediatric Patients with Surgically Treated Lower-Extremity Fractures: A Propensity-Matched Cohort Study.

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a substantial cause of morbidity and mortality among hospitalized patients. Although rare in the general pediatric population, VTE remains a potential concern in hospitalized children, particularly those with lower-extremity (LE) fractures. With this study, we aimed to determine the risk of VTE in pediatric patients with surgically treated LE fractures through a retrospective, propensity-matched, cohort analysis. The TriNetX Research Network, encompassing data from >80 health-care organizations and >120 million patient records, was utilized for this retrospective cohort study comparing 3 age-based cohorts (children [age of <14 years], adolescents [age of 14 to 17 years], and adults [age of ≥18 years]) who underwent surgical treatment of LE fractures between January 1, 2003, and January 1, 2023. A total of 634,880 patients with surgically treated LE fractures were included; 13.3% were children, 5.6% were adolescents, and 81.1% were adults. Propensity-score matching was used to compare VTE incidence across cohorts, resulting in 3 independent matched comparisons. Overall, the incidence of VTE (either DVT or PE) was 0.2% in children, 1.0% in adolescents, and 4.1% in adults. Adults had a significantly higher risk of developing DVT (risk ratio [RR]: 17.0; 95% confidence interval [CI]: 14.5 to 20.0) and PE (RR: 21.8; 95% CI: 17.0 to 28.1) compared with children. Similarly, adolescents had a higher risk of DVT (RR: 3.5; 95% CI: 2.7 to 4.4) and PE (RR: 3.1; 95% CI: 2.2 to 4.4) compared with children. The incidence of VTE varied by fracture location, with femoral and knee joint (incidence: 0.5% in children, 2.5% in adolescents) and pelvic and hip joint (incidence: 1.2% in children, 2.8% in adolescents) fractures presenting the highest risk across all age groups. The incidence of VTE in a large cohort of pediatric patients undergoing surgical treatment of LE fractures was higher in adolescents than in children. These findings may warrant prophylactic VTE measures in adolescents undergoing surgical treatment of femoral or pelvic fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Functional Outcomes for Elderly Patients After ORIF for Distal Femur Fractures Are Similar to Outcomes for Patients After Primary Total Knee Arthroplasty.

The long-term clinical outcomes after open reduction and internal fixation (ORIF) for distal femoral fractures, both native and periprosthetic, are not yet well established in the literature. We used the clinically validated Western Ontario and McMaster Universities Arthritis Index (WOMAC) score to make the functional outcomes after ORIF comparable with the well-characterized results achieved after total knee arthroplasty (TKA) for osteoarthritis. After long-term clinical follow-up and prospectively collected WOMAC scores were obtained, pain, stiffness, and function were evaluated for 68 elderly patients with distal femur fractures (34 periprosthetic, 34 native; median follow-up time, 2.43 years). Although pain and stiffness scores were significantly lower than those achieved after TKA, functional and total WOMAC scores were similar. Pain and function continued to improve with greater time to follow-up. Although 32% (22/68) of patients had a return to the operating room (3 for infection, 11 for nonunion, and 7 for implant prominence), total WOMAC scores at long-term follow-up were not different for the patients who returned to the operating room. Although stiffness may persist for some patients, the functional outcomes after this procedure are similar to outcomes for patients after primary TKA. The rate of fracture-related re-operations was 32%, but was not associated with poor clinical outcomes. The 91% rate of good to excellent outcomes seen in our cohort suggests ORIF is likely to provide a favorable result for distal femur fractures, both native and periprosthetic, among elderly patients. [Orthopedics. 2025;48(3):xxx-xxx.].

Proximal Hip Fracture: Does Canal Width Matter?

Background/Objectives: Proximal femur fractures are common in the older population and are related to bone quality. Our work evaluates bone parameters from pelvic anteroposterior (AP) radiographs in patients with trochanteric and sub-capital fractures to determine if there are predictive morphology parameters for each fracture type. Methods: Data from 237 medical records were extracted from patients who arrived at our hospital with trochanteric and sub-capital femoral fractures. Descriptive data and radiological evaluation of the calcar-to-canal ratio (CCR), cortical thickness index (CTI), and Dorr classification were measured by two observers and statistically evaluated. Results: A total of 202 patients were found to be eligible for the study. The mean patient age was 81.41 ± 7.27 years old. The mean age of the trochanteric group was significantly higher than that of the sub-capital group (p = 0.005). There were no statistically significant differences in gender and comorbidities. The CCR showed significance, but the CTI and Dorr classification did not show a significant difference (p = 0.001, p = 0.78, and p = 0.98). A high degree of reliability was shown for all measurements. The ICC for CTI and CCR was p = 0.791 and p = 0.770 (p &lt; 0.001), and Cronbach’s alpha was 0.815 and 0.796, respectively. Logistic regression was found to be significant in predicting 60.4% of correct forecasts with an odds ratio of 0.011 and 95% confidence interval (p = 0.001). For CTI, the correct forecasting rate was 48%, with an odds ratio of 0.615 (p = 0.78). Conclusions: We found that, out of the measured parameters, the CCR stood out as important, showing that higher CCR levels are linked to an increased likelihood of trochanteric fractures.

A China-Based exploration of surgical timing for polytrauma with a focus on fracture reconstruction

BackgroundFor patients with severe polytrauma and fractures, early fracture reconstruction surgery under stable conditions can significantly reduce pulmonary and other complications. However, premature surgical intervention may heighten infection risk, adversely affecting the patient’s prognosis. Consequently, determining the optimal timing of surgery is crucial for patients with multiple traumatic injuries. Given China’s healthcare context, this study will assess injury severity and perform definitive fracture reconstruction at specified post-trauma intervals. Postoperative infection rates, including wound infections, other complication incidences, hospital stay duration, treatment costs, and long-term outcomes will be observed and compared to identify the optimal timing for surgical intervention. This study also aims to develop effective polytrauma management models. By applying accessible criteria and choosing suitable timing for fracture reconstruction, we can better assess patient conditions, reduce complications, and minimize the surgery’s “second hit” effect, addressing an important research gap regarding optimal surgical timing for polytrauma in China.MethodsThis study collected data on 200 patients treated at our hospital between March 2023 and March 2024, with an average age of 47.24 ± 16.56 years and an average Injury Severity Score (ISS) of 25.85 ± 13.35. A total of 250 fractures received definitive fixation in the initial surgery, including femoral fractures (n = 75), spinal fractures (n = 46), pelvic ring fractures (n = 49), tibial fractures (n = 25), acetabular fractures (n = 12), humeral fractures (n = 12), and other fractures (n = 5) (including clavicle, radius and ulna, calcaneus, and patella). Among these patients, 151 underwent single-fracture reconstruction, 42 had two fractures reconstructed, and 5 had three fractures treated during the first surgery. The study protocol excluded patients with absolute contraindications, including bacteremia and infections near the surgical site. Additional inclusion criteria required stable vital signs (temperature < 38.5 °C with a downward trend, systolic blood pressure > 100 mmHg, stable traumatic brain injury status) and blood routine (white blood cell count < 22.0 × 10⁹/L with a neutrophil percentage < 90%, both trending downward; platelet count > 50 × 10⁹/L; hemoglobin > 90 g/L). Based on these criteria, historical cohorts were identified and assigned to either an experimental group or a control group. Observed outcomes included postoperative complications, wound healing grades, inflammatory markers, changes in vital signs, length of hospital stay, costs, and long-term follow-up results.ResultsAmong the patients, 97 underwent surgery after meeting the specified criteria for fracture reconstruction, while 103 received surgery without meeting these criteria. Patients who met the surgical criteria demonstrated superior outcomes, with lower complication rates (including pneumonia and respiratory distress syndrome), improved surgical incision healing, faster postoperative consciousness recovery, shorter overall and ICU stays, reduced hospitalization costs, greater joint mobility at the 9-month follow-up, and higher quality of life assessments compared to those who did not meet the criteria. Among patients who met the criteria, those with spinal fractures experienced better quality of life outcomes, and those with femoral fractures showed improved fracture healing.ConclusionsFor polytrauma patients with fractures, performing surgery once surgical requirements are met results in fewer early postoperative pulmonary complications, quicker recovery of consciousness, lower wound infection rates, shorter hospital and ICU stays, reduced costs, and improved postoperative outcomes. This protocol is safe and effective for most polytrauma patients requiring fixation, particularly those with mechanically unstable femoral, pelvic, acetabular, or spinal fractures.

Risk factors associated with mortality in elderly patients receiving hemiarthroplasty for femoral neck fractures

BackgroundTo investigate the risk factors for mortality in elderly patients who underwent hemiarthroplasty for femoral neck fractures over a five-year follow-up period.MethodsA retrospective analysis of clinical data from 80 elderly patients treated with hemiarthroplasty between January 2015 and December 2018. Kaplan–Meier survival analysis was conducted, and both univariate and multivariate logistic regression analyses identified independent mortality risk factors, including age, preoperative mobility, BMI, cardiovascular comorbidities, and fracture type.ResultsOf the 80 patients, 38 (47.5%) died within the follow-up period. Kaplan–Meier analysis showed significantly reduced survival in patients with cardiovascular comorbidities, unstable fractures (Garden III and IV), and limited pre-fracture mobility (p < 0.05). Univariate analysis identified age, pre-fracture mobility, BMI, cardiovascular comorbidities, and fracture type as significant factors associated with mortality (p < 0.05). Multivariate analysis confirmed age, pre-fracture mobility, cardiovascular comorbidities, and unstable fractures as independent mortality predictors (p < 0.05).ConclusionsAdvanced age, limited mobility before fracture, cardiovascular comorbidities, and unstable fractures significantly increase mortality risk in elderly patients undergoing hemiarthroplasty. Tailored fracture management and optimized cardiovascular care could improve survival.

Classification and segmentation of hip fractures in x-rays: highlighting fracture regions for interpretable diagnosis

ObjectiveTo develop an artificial intelligence (AI) system capable of classifying and segmenting femoral fractures. To compare its performance against existing state-of-the-art methods.MethodsThis Institutional Review Board (IRB)-approved retrospective study did not require informed consent. 10,308 hip x-rays from 2618 patients were retrieved from the hospital PACS. 986 were randomly selected for annotation and randomly split into training, validation, and test sets at the patient level. Two radiologists segmented and classified femoral fractures based on their location (femoral neck, pertrochanteric region, or subtrochanteric region) and grade, using the Evans and Garden scales for neck and pertrochanteric regions, respectively. A YOLOv8 segmentation convolutional neural network (CNN) was trained to generate fracture masks and indicate their class and grade. Classification CNNs were trained in the same dataset for method comparison.ResultsOn the test set, YOLOv8 achieved a Dice coefficient of 0.77 (95% CI: 0.56–0.98) for segmenting fractures, an accuracy of 86.2% (95% CI: 80.77–90.55) for classification and grading, and an AUC of 0.981 (95% CI: 0.965–0.997) for fracture detection. These metrics are on par with or exceed those of previously published AI methods, demonstrating the efficacy of our approach.ConclusionsThe high accuracy and AUC values demonstrate the potential of the proposed neural network as a reliable tool in clinical settings. Further, it is the first to provide a precise segmentation of femoral fractures, as indicated by the Dice scores, which may enhance interpretability. A formal evaluation is planned to further assess its clinical applicability.Critical relevance statementThe proposed system offers high granularity in fracture classification and is the first to segment femoral fractures, ensuring interpretability.Key PointsWe present the first AI method that segments and grades femoral fractures.The method classifies fractures with fracture location and type.High accuracy and interpretability promise utility in clinical practice.Graphical

Feasibility study on measuring anteversion angle of acetabular prosthesis after total hip arthroplasty using arbitrary point method

To explore the reliability and accuracy of the arbitrary point method for measuring the anteversion angle of acetabular prosthesis after total hip arthroplasty (THA) based on pelvic X-ray films. The clinical data of 23 patients (25 hips) who underwent THA between December 2018 and September 2023 and met the selection criteria were retrospectively analyzed. Among them, there were 16 males and 7 females, with an average age of 57.6 years (range, 34-81 years); 13 hips had THA on the left side and 12 on the right side. There were 19 cases (21 hips) of osteonecrosis of the femoral head, 2 cases (2 hips) of femoral neck fractures, 1 case (1 hip) of developmental dysplasia of the hip, and 1 case (1 hip) of osteoarthritis. After THA, all patients underwent X-ray examination and CT scan. Three physicians measured the anteversion angle of acetabular prosthesis using the arbitrary point method and the CT measurement method respectively, and repeated the measurements three times. The results of the two measurement methods were compared, and the intraclass correlation coefficient (ICC) was employed to assess the reproducibility of the methods. The anteversion angles of acetabular prosthesis were (15.87±7.73)° measured by the arbitrary point method, and (15.31±7.89)° measured by CT measurement method. There was no significant difference between the two methods ( t=1.515, P=0.143). The ICC of the measurement results by the arbitrary point method for the three physicians were 0.97 ( P<0.001), 0.96 ( P<0.001), and 0.96 ( P<0.001), respectively; and the ICC of the measurement results by CT method were 0.93 ( P<0.001), 0.93 ( P<0.001), and 0.94 ( P<0.001), respectively. The arbitrary point method for measuring the anteversion angle of acetabular prosthesis after THA based on pelvic X-ray film is easy to operate, accurate, and has high reproducibility.

Clinical study of double-channel core decompression combined with medullary cavity irrigation for non-traumatic osteonecrosis of femoral head

To compare the effects of double-channel core decompression (CD) combined with medullary cavity irrigation with those of simple CD on progression of collapse and clinical outcomes in non-traumatic osteonecrosis of the femoral head (ONFH). A retrospective analysis was conducted on the clinical data of 19 patients (30 hips) with non-traumatic ONFH who underwent double-channel CD combined with medullary cavity irrigation and admitted between January 2024 and October 2024 (CD+irrigation group). According to a 1: 2 ratio, 54 patients (60 hips) who underwent simple CD and were matched in terms of age, gender, and body mass index (BMI) were included as the control (CD group). There was no significant difference in baseline data such as age, gender, BMI, affected side, ONFH type, preoperative Association Research Circulation Osseous (ARCO) stage, bone marrow edema stage, visual analogue scale (VAS) score for pain, and Harris score between the two groups ( P>0.05). The postoperative discharge time and occurrence of complications were recorded for both groups. The VAS scores before operation and at discharge after operation were compared, and the differences between pre- and post-operation (change values) were calculated for intergroup comparison. The Harris scores before operation and at discharge and 3 months after operation were also compared. During follow-up, X-ray film, CT, and MRI were performed for reexamination. The ARCO stage and bone marrow edema stage were evaluated at 3 months after operation and compared with those before operation to determine whether there was radiological progression or relief. All incisions in both groups healed by first intention after operation, with no infection, femoral neck fracture, or other operation-related complications. All patients were followed up, and the follow-up time of the CD+irrigation group was (146.8±27.7) days, and that of the CD group was (164.3±48.2) days; there was no significant difference between the two groups ( t=1.840, P=0.069). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). At discharge after operation, the VAS score of the CD+irrigation group was significantly lower than that of the CD group ( P<0.05), and the change value was significantly higher than that of the CD group ( P<0.05). The Harris scores at discharge and 3 months after operation in the CD+irrigation group were significantly higher than those in the CD group ( P<0.05). The Harris score gradually increased with time, and the differences between different time points were significant ( P<0.05). Radiological reexamination showed that there was no significant difference in the ARCO stage and the incidence of radiological progression between the two groups at 3 months after operation ( P>0.05); however, the bone marrow edema stage and the degree of bone marrow edema relief in the CD+irrigation group were better than those in the CD group, with significant differences ( P<0.05). Double-channel CD combined with medullary cavity irrigation can significantly alleviate hip joint pain and improve joint function in patients with non-traumatic ONFH, reduce the degree of bone marrow edema in the femoral head, and delay the progression of ONFH.

A New Modification of Classification of Traumatic Patients with Pelvic Fracture

Background/Purpose: In recent years, the occurrence of pelvic fractures resulting from high-energy trauma has been steadily rising due to the accelerated advancement of the transportation sector. These types of which are associated with high rates of mortality and disability. This study aims to show essential viewpoints regarding quadrilateral plate fracture and classification. Method: During the period from September 2022 to December 2023, data collected from two hospitals in Xianning city, China, including patients diagnosed with pelvic fractures. Moreover, the patients were included in the analysis after applying specific inclusion and exclusion criteria. The collected data, including age, gender, mechanism of injury, follow-up time, operation time, associated diseases, and associated fractures, were analyzed using SPSS version 22. Applied a modified classification method, and incorporating details about bilateral fractures, proximal femur fractures, and sacrum abnormalities. Result: This study included 60 patients with a mean age of 49.5 ± 12.3 years, comprising 32 males and 28 females. The majority of fractures caused by traffic accidents (71.7%), followed by falls (28.3%). The mean follow-up time was 8.9 ± 2.3 months. Diabetes, hypertension, heart failure, and dementia were among the associated diseases, with diabetes being the most common (68.3%). Unilateral abnormalities observed in 63.9% of patients, while bilateral abnormalities were seen in 36.1%. Conclusion: The APQ-SF classification plays an essential role in treatment planning through assessing the stability of the pelvic fracture, enabling effective anatomical reduction and rigid internal fixation. Moreover, can reduce the need for expensive 3D printing for fracture assessment, making the treatment approach more efficient and cost-effective.

Femoral Fracture During Neonatal Circumcision: An Unusual and Avoidable Complication

Neonatal circumcision is a common surgical procedure. Although complications occur, femoral fracture is rarely reported. A 10-day old boy presented with swelling of the right thigh and irritability four hours after circumcision. He was said to have been forcefully restrained at both thighs during the procedure because anaesthesia was not given. Clinical and radiologic evaluation showed a fracture of right femur. The fracture was treated by Gallows traction along with care of the circumcision wound. He did well and was discharged home after 16 days. Neonatal femoral fractures are rare and usually due to birth injury. Femoral fracture occurring during circumcision is rare and avoidable. Training and retraining of personnel involved in circumcision regarding the techniques of the procedure, appropriate analgesia and safety points are crucial to avoiding such complication.

Study of Functional Outcome of Displaced Tibial Shaft Fracture in Children Treated with Titanium Elastic Nailing System

Introduction: Fractures of tibia are the most common pediatric long bonefracture after forearm and femur fractures. Pediatric tibia fractures are usuallytreated conservatively with closed reduction and cast application; however,operative treatment may be necessary in case of failure of conservativetreatment, open fractures, polytrauma and compartment syndrome. Amongthe various surgical methods, closed reduction and fixation with titanium elasticnailing system is widely used. Methods: This single-centric prospective observational study in 30 patientsat Nepal Medical College Teaching Hospital on period from January 2022to December 2022. Patients included in the study were treated by closedreduction and internal fixation with titanium elastic nailing system and followedfor a period of 6 months. The functional outcome was evaluated on the basisof Flynn’s criteria at the end of 6 months and graded as excellent, satisfactoryand poor. Results: In this study of 30 patients, 21 (70%) cases were male and 9 (30%) werefemale. Mean age of the patient was 8.3 ±1.915 years. Right side (63.4%) wasmore common than left (36.6%) while oblique pattern of fracture (56.7%) wasmost common type. There were no significant limb length discrepancy andother major complications. The outcome according to Flynn’s criteria wasexcellent in 26 (86.66%) cases and satisfactory in 4 (13.33%) cases. Conclusions: Titanium Elastic Nailing System is an effective method of treatmentof displaced tibial shaft fractures in children. It has excellent functional outcomewith minimal complications.

Fatal Hip Fractures From Accidental Falls From a Ground-Level Fall.

Accidental femur fractures in older adults are a public health concern with a considerably high rate of mortality and morbidity. We performed a retrospective review of all deaths reported to the Connecticut Office of Chief Medical Examiner (OCME) over a 5-year period that involved a femur fracture resulting from a ground-level fall. Data on cause of death, contributing conditions, age, ethnicity, sex, comorbidities, and interval between surgery and death were extracted. There were 470 deaths caused by a hip fracture due to a ground-level fall. The majority were woman (n = 312 or 66.1%) and White (n = 435 or 95.8%). The median age of the study population was 89 years (interquartile range [IQR] = 83-94). The locations of the falls were predominantly in homes (59.8%) or skilled nursing facilities (SNFs) (26.8%). Complications following surgery occurred with 259 (87.2%) of the 297 patients who underwent surgical repair. Contributing conditions to death occurred in 76.1% of patients (n = 359), with the most common being heart disease, dementia, chronic obstructive pulmonary, and diabetes mellitus (DM). The median survival interval after injury was 9 days (IQR = 4-21 days). The Area Deprivation Index (ADI) was not associated with sex, race, medical conditions determined to have contributed to death, whether the patient underwent surgery, or with any surgical complication. This study demonstrates the important role of medicolegal death investigation in producing accurate death certifications that can inform stakeholders about risk factors and comorbidities that may enhance the overall management of hip fractures in an ageing population.

Comparative study of rhBMP-2 assisted femoral neck system and cannulated screws in femoral neck fractures: clinical efficacy and psychological status

This study investigated the clinical efficacy and psychological effects of the femoral neck system (FNS) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) and cannulate compression screw (CCS) in treating unstable femoral neck fractures in young adults. We conducted a retrospective analysis of clinical data from 61 patients with femoral neck fractures who met our selection criteria and were admitted to our hospital between December 2019 and 2022. Patients were divided into two groups based on their internal fixation. Group A received hollow compression screw fixation, whereas Group B underwent FNS combined with rhBMP-2 fixation. We recorded preoperative and last follow-up scores on the self-rating depression scale (SDS) and self-rating anxiety scale (SAS), along with surgery duration, intraoperative fluoroscopy frequency, blood loss, postoperative recovery, and complication rates for both groups. Routine postoperative radiographs were used to evaluate fracture reduction and internal fixation, while Harris scores were used to assess hip joint function. Both groups were followed up for 7–38 months, averaging 25.25 ± 7.62 months. However, intraoperative blood loss was significantly lower in Group A than in Group B, and Group A experienced significantly more fluoroscopy sessions (P < 0.05). In Group A, complications included six cases of nail retraction, three cases of femoral neck shortening, four cases of femoral head necrosis, and one case of bone nonunion. At the last follow-up, femoral neck shortening differed significantly from that in the healthy side (P < 0.05), as did femoral eccentricity (P < 0.05). In Group B, there were three cases of femoral neck shortening, including one nonunion, and four cases of femoral head necrosis. No significant differences in femoral neck shortening were observed compared to the healthy side (P > 0.05), and no significant change was seen in femoral eccentricity from the first to the last follow-up (P > 0.05). Preoperatively, no significant differences in femoral neck shortening and eccentricity were found between the two groups (P > 0.05). Both groups demonstrated good recovery in hip joint function. However, there were significant differences preoperatively and in the last follow-up SDS and SAS scores (P < 0.05). The combination of FNS and rhBMP-2 for treating femoral neck fractures is minimally invasive and easy to perform and offers greater stability. This approach promotes fracture healing with minimal irritation to surrounding muscles and soft tissues, facilitating early weight-bearing and functional rehabilitation. Both surgical methods effectively enhance the psychological well-being of patients with femoral neck fractures who experience anxiety and depression, thereby improving their quality of life and achieving satisfactory short-term therapeutic outcomes.

Intra-Individual Differences of the Femoral Cortical Thickness Index in Elderly Patients with a Proximal Femoral Fracture

Background/Objectives: Osteoporosis is prevalent in the elderly and increases fracture risk. Bone density is commonly assessed using dual-energy X-ray absorptiometry (DEXA). The femoral cortical thickness index (CTI) also provides indirect information for osteoporosis. It remains unclear whether there are intra-individual differences and if a correlation to fracture risk of the CTI in fractured femora results due to fracture related malrotation during X-rays. The aim of this study was to investigate the individual bilateral CTI in patients with proximal femoral fractures. Methods: A retrospective analysis of 200 surgically treated patients (100 trochanteric, 100 femoral neck fractures) was performed. Measurements included the bilateral CTI at 10 and 15 cm below the lesser trochanter. Analysis of the correlation of those examinations, in comparison to the contralateral CTI at 15 cm, and correlation of the CTI with the body mass index (BMI) and age was performed. Results: Results showed significant differences (p &lt; 0.001) in bilateral CTIs for both fracture types at 15 cm with a strong inter-rater reliability (ICC &gt; 0.9). There was no significant correlation between age and CTI, as well as BMI and CTI in both cohorts (p &gt; 0.1). Sex-specific subgroup analyses revealed that females exhibited significant differences in CTI between fractured and non-fractured sides (p &lt; 0.001). Conclusions: In conclusion, CTI, and the modified CTI at 15 cm below the lesser trochanter in fractured proximal femora, is lower compared to the non-fractured side. The femoral CTI could help in daily clinical routines and circumstances, where more detailed risk prediction tools are lacking.

Early surgical fixation of proximal femur fractures under active direct oral anticoagulation (DOAC) therapy does not increase the postoperative blood loss. Results from a prospective cohort study with a matched-pair analysis

IntroductionThis study aims to investigate whether early surgery in patients under active DOAC (direct oral anticoagulation) therapy with trochanteric, proximal femur fractures leads to higher postoperative blood loss.Material and methodsA prospective cohort study on DOAC patients with trochanteric, proximal femur fractures undergoing early surgery (≤ 24 h) was conducted. Propensity score matching with a retrospective control group of DOAC patients with trochanteric, proximal femur fractures undergoing delayed surgery (> 24 h) was performed for comparison. Key outcome measurements included peri- and postoperative blood loss, transfusion rates, time to surgery and hospital length of stay (LOS).ResultsNo differences in the median blood loss in patients undergoing early surgery vs. delayed surgery on postoperative day 1 (1078.35 ml (IQR 745.86) vs. 1120.79 ml (IQR 928.50); p = 0.824) or postoperative day 3 (1592.39 ml (IQR 1304.91) vs. 1339.73 ml (IQR 735.57); p = 0.165) was seen. No differences in the rate of blood transfusion (72.5% vs. 68.1%; p = 0.576) or the number of transfused red blood cells (RBCs) (2 units (IQR 2) vs. 2 units (IQR 3); p = 0.567) were detected. A significantly longer median time to surgery, and a significantly longer LOS was seen in the delayed surgery group (p < 0.001). No difference in the rates of perioperative complications was detected between both groups.ConclusionEarly surgery of trochanteric, proximal femur fractures within 24 h under active DOAC therapy does not increase postoperative blood loss or the need for postoperative blood transfusions but leads to a significantly shorter length of stay.Level of evidenceIIb

Predicting mechanical complications in proximal femoral nailing for elderly patients: a radiological scoring system based on a single-centre retrospective cohort with 586 cases

BackgroundProximal femoral nailing (PFN) is a preferred treatment for intertrochanteric femoral fractures in elderly patients due to its minimally invasive nature and early mobilisation benefits. However, mechanical complications such as implant failure, cutout, and reduction collapse remain significant challenges. This study introduces the targeted surgical score (TSS), a novel scoring system designed to predict and mitigate mechanical complications by evaluating modifiable surgical factors.MethodsA retrospective analysis of 586 patients aged 65 and older treated with PFN between 2015 and 2022 was conducted. Data on demographic characteristics, fracture classifications, and surgical parameters were collected. Radiographic assessments included tip-apex distance (TAD) and lag screw positioning for implant placement quality, medial and anterior cortical support (MCS and ACS), and fracture alignment in both AP and lateral planes for reduction quality. Each parameter was scored, resulting in a cumulative TSS ranging from 0 to 8. Logistic regression and ROC curve analysis were performed to evaluate the predictive capacity of TSS.ResultsThe average TSS was 4.06 ± 2.22 in the complication group and 6.14 ± 1.56 in the non-complication group (p < 0.001). A one-point increase in TSS was associated with a 44.9% reduction in complication risk (OR 0.551; p < 0.001). Independent risk factors included lag screw placement (non-central superior quadrants), inadequate cortical support in AP and lateral planes (MCS and ACS), and TAD (≥ 25 mm). The TSS demonstrated relatively good discriminative ability with an AUC of 0.768.ConclusionTSS may aid in predicting and mitigating mechanical complications while potentially guiding surgical applications in PFN, but further prospective multicentre validation is required. While certain parameters of TSS could be considered intraoperatively, its full implementation may be more practical for postoperative risk assessment.