Femoral Neck Research Articles

Biomechanical changes in the proximal femur before and after removal of femoral neck system

BackgroundAs an innovative internal fixation system, FNS (femoral neck system) is increasingly being utilized by surgeons for the treatment of femoral neck fractures. At present, there have been numerous finite element analysis experiments studying the immediate stability of FNS and CSS in treating femoral neck fractures. However, there is scarce mechanical analysis available regarding the effects post internal fixation removal. This study aimed to investigate the alterations in mechanical parameters of the proximal femur before and after the removal of FNS (femoral neck system), and to assess potential distinctions in indicators following the extraction of CSS (Cannulated Screws).MethodsA proximal femur model was reconstructed using finite element numerical techniques. The models for CSS and FNS were formulated utilizing characteristics and parametric definitions. The internal fixation was combined with a normal proximal femur model to simulate the healing state after fracture surgery. Within the framework of static analysis, consistent stress burdens were applied across the entirety of the models. The total deformation and equivalent stress of the proximal femur were recorded before and after the removal of internal fixation.ResultsUnder the standing condition, the total deformation of the model before and after removing CSS was 0.99 mm and 1.10 mm, respectively, indicating an increase of 12%. The total deformation of the model before and after removing FNS was 0.65 mm and 0.76 mm, respectively, indicating an increase of 17%. The equivalent stress for CSS and FNS were 55.21 MPa and 250.67 MPa, respectively. The average equivalent stress on the cross-section of the femoral neck before and after removal of CSS was 7.76 MPa and 6.11 MPa, respectively. The average equivalent stress on the cross-section of the femoral neck before and after removal of FNS was 9.89 MPa and 8.79 MPa, respectively.ConclusionsThe retention of internal fixation may contribute to improved stability of the proximal femur. However, there still existed risks of stress concentration in internal fixation and stress shielding in the proximal femur. Compared to CSS, the removal of FNS results in larger bone tunnels and insufficient model stability. Further clinical interventions are recommended to address this issue.

Predictors of low and very low bone mineral density in long-term childhood acute lymphoblastic leukemia survivors: Toward personalized risk prediction.

Cohorts of childhood acute lymphoblastic leukemia (cALL) survivors reaching adulthood are increasing. Approximately 30% of survivors meet criteria for low bone mineral density (BMD) 10years after diagnosis. We investigated risk factors for low BMD in long-term cALL survivors. We recruited 245 cALL survivors from the PETALE (Prévenir les effets tardifs des traitements de la leucémie aiguë lymphoblastique chez l'enfant) cohort, who were treated with the Dana Farber Cancer Institute protocols, did not experience disease relapse or hematopoietic stem cell transplants, and presented with more than 5years of event-free survival. Median time since diagnosis was 15.1years. Prevalence of low DXA-derived BMD (Z-score ≤-1) ranged between 21.9% and 25.3%, depending on site (lumbar spine (LS-BMD), femoral neck (FN-BMD), and total body (TB-BMD), and between 3.7% and 5.8% for very low BMD (Z-score ≤-2). Males had a higher prevalence of low BMD than females for all three outcomes (26%-32% vs. 18%-21%), and male sex acted as a significant risk factor for low BMD in all models. Treatment-related factors such as cumulative glucocorticoid (GC) doses and cranial radiation therapy (CRT) were associated with lower BMDs in the full cohort and in females at the FN-BMD site. Low and very low BMD is more prevalent in male cALL survivors. Male sex, high cumulative GC doses, CRT, risk group, and low body mass index (BMI) were identified as risk factors for low BMD. A longer follow-up of BMD through time in these survivors is needed to establish if low BMD will translate into a higher risk for fragility fractures through adulthood.

TIME TO SURGERY FOR NECK OF FEMUR FRACTURES IN SOUTHLAND FOR PATIENTS PRESENTING DIRECTLY TO A REFERRAL HOSPITAL VERSUS TRANSFERRAL FROM PERIPHERAL HOSPITAL: A MATCHED COHORT STUDY

IntroductionThe Te Whatu Ora Southern catchment area covers the largest geographical region in New Zealand (over 62,000 km2) creating logistical challenges in providing timely access to emergency neck of femur (NOF) fracture surgery. Current Australian and New Zealand guidelines recommend that NoF surgery be performed within 48 hours of presentation. The purpose of this study was to compare the outcomes for patients with NoF fractures who present directly to a referral hospital (Southland Hospital) compared to those are transferred from rural peripheral centres.MethodsA retrospective cohort study identified 79 patients with NoF who were transferred from rural peripheral centres to a referral hospital for operative management between January 2011 to December 2020. This cohort was matched 1:1 by age and sex to patients with NoF who presently directly to the referral hospital over the same period. The primary outcome was to compare time to surgery between the groups and secondary outcomes were to compare length of hospital stay, complication rates and mortality rates at 30-days and 1-year.ResultsThe mean delay in transfer time from peripheral centres was 11.5 ± 6.4 h. The mean time to surgery was higher, but not significantly different (p=0.155), for patients transferred from peripheral centres compared to patients presenting directly to the referral hospital (30.7 ± 16.5 h vs. 26.8 ± 17.2 h, respectively). However, rates of surgery within 48 h were similar between the patients transferred from peripheral centres and patients presenting directly to the referral hospital (8.8% vs 7.6%, p>0.999). There were no significant differences in complication rates, length of stay or 30-day or 1-year mortality between the groups.Discussion and ConclusionSignificant delays in transfer from peripheral centres to the referral hospital were identified, averaging 11.5 h. There was a strong trend towards increased time to surgery for patients transferred from peripheral centres. Early transfer of patients with NoF to a referral hospital should continue to be made a high priority.

Treatment of femoral neck fractures using actis stem: complication rate in 188 uncemented hemiarthroplasties.

Cemented hemiarthroplasty (HA) is preferred in treating dislocated femoral neck fractures in elderly, osteoporotic patients, since uncemented HA was associated with mechanical complications more frequently. Cementation can conversely cause cardiopulmonary complications, leading to demand on safe, uncemented implants addressing osteoporosis. This study is set up as a retrospective feasibility study on the use of an uncemented, collared wedge implant (Actis®, DePuy Synthes, Warsaw, IN), for HA in elderly patients, focusing on complication rate. From 1,194 patients, treated with HA in two study centers between 2017-2022, 188 received Actis® uncemented stem with bipolar head. Complete follow-up were retrospectively collected in all patients. In 188 patients (f: 64.9%; age: 83.1 ± 7.7a) included, no case of intra-operative mortality was recorded. 2day mortality was 1.1%, 30day mortality was 7.4% and 1year mortality was 28.2%. 2 (1.1%) intra-operative fractures did not receive surgical revision, 3 (1.6%) post-operative periprosthetic fractures caused separate admission and revision. 2 cases (1.1%) of early infection required surgical revision. Our data provide proof of concept, that Actis® Stem allows an alternative, uncemented treatment option for displaced femoral neck fractures with HA. In case of preoperative or intraoperative medial cortical bone defects, stability of this implant is deteriorated.

Short-term results after total hip arthroplasty using dual-mobility acetabular cup on geriatric patients with femoral neck fracture

The rate of femoral neck fractures (FNF) increases exponentially with age, meanwhile in geriatric patients they are associated with high levels of functional deficiency and mortality. Studies find that hip arthroplasty is a method of choice for treatment of displaced FNF. One option regarding the increased risk of postoperative dislocation in these patients is the dual-mobility acetabular cup (DMAC). The aim of our study is to assess the functional outcome, joint stability and complication rate after total hip arthroplasty (THA) using DMAC in geriatric patients with FNF. In the study were included 390 patients with a mean follow-up period of 31.2 months. No cases of dislocation or intraprosthetic dislocation were encountered. Displaced FNF can successfully be treated with THA using DMAC, as it provides excellent stability and function, as well as low risk of revision surgery.

Extra-articular hip resection with maintenance of pelvic continuity in malignant tumours of the proximal femur with articular invasion.

Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection. We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease. Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.

A PROSPECTIVE STUDY OF SURGICAL MANAGEMENT OF FRACTURE NECK OF FEMUR IN ADULTS WITH CEMENTED BIPOLAR HEMIARTHROPLASTY

Objectives: Displaced femoral neck fractures are frequently treated with bipolar hemiarthroplasties. There is little long-term data regarding bipolar hemiarthroplasty. This study aims to know the clinical efficacy of bipolar hemiarthroplasty in fractured neck femur in old age people. Patients are assessed postoperatively for pain, limp, and functional activities, and a Harris hip score is used to evaluate the results. Methods: This is a prospective study that included patients who underwent bipolar hemi replacement arthroplasty. A total 40 number of patients treated with bipolar prosthesis were assessed during our study. Both males and females were included in the study. We obtained all proper consent from patients during the study from a tertiary care hospital. Results: In this study, a sample of 20 patients with fractures of the neck of the femur with displacement, communication, and neck resorption above 50 years old were surgically treated with hemiarthroplasty using a bipolar endoprosthesis. Postoperatively, bipolar hemiarthroplasty allows for early mobilization, pain alleviation, and a high degree of activity while posing little risks. Conclusion: When compared to Austin Moore’s prosthesis, bipolar hemiarthroplasty had fewer complications, such as acetabular erosion and anterior thigh pain. As a result of these findings, we believe that bipolar hemiarthroplasty is the best treatment for intracapsular fracture neck femur.

Functional and Radiological Outcomes of Surgically Treated Coxa-vara in Children.

Coxa vara is a condition in which the neck-shaft angle of the femur decreases below its normal value (<110 degrees) based on age. The deformity can be primarily caused by a congenital defect of the femoral neck cartilage or by secondary causes related to skeletal dysplasia, trauma, infection, and pathological bone disorders. The surgical treatment aims to restore the normal anatomy, thereby improving the mechanics and function of the hip joint. Generally, the HE angles should be corrected to <35 to 40 degrees, converting the shear forces into compressive forces. Our study aims to report the surgical outcome of coxa vara with various pathologies using radiographic measurement and functional scoring. Thirty-eight hips in 28 patients who underwent surgery for treatment of coxa-vara from 2013 to 2022 were included. Radiographic parameters like Hilgenreiner-epiphyseal angle and neck-shaft angle were assessed preoperatively and at the latest follow-up. Harris hip score was used for functional outcome. The mean age was 11.13 (5 to 18). The average follow-up was 48 (ranging from 24 to 96) months. The mean preoperative neck-shaft angle was 82 degrees, and the Hilgenreiner-epiphyseal angle was 71 degrees. At the latest follow-up, the mean neck-shaft angle was 127 degrees, and the Hilgenreiner-epiphyseal angle was 33 (P<0.001). The Harris hip score improved from 63 preoperatively to 92 at the latest follow-up (P<0.001). There was no recurrence of deformities at the mean follow-up of 37.87 months. Four complications occurred with k-wire fixation in whom revalgus osteotomy was done. Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to >110 degrees to prevent deformity recurrence. The majority of the patients reported improvement in hip function. However, a longer-term follow-up is required to determine further outcomes regarding the recurrence of the deformity.

Association of schizophrenia with fracture‐related femoral neck displacement: A cross‐sectional retrospective study

AbstractAimFracture‐related femoral neck displacement is more likely in patients with schizophrenia because of delayed diagnosis, as these patients frequently have less severe fracture‐associated subjective symptoms. This study aimed to investigate the association of schizophrenia with the risk of fracture‐related femoral neck displacement in hospitalized patients.MethodsWe retrospectively analyzed the medical records of patients with femoral neck fractures treated between April 2013 and March 2018 at a single institution. Multivariate logistic regression was used to explore the relationship between schizophrenia and fracture‐related femoral neck displacement after adjusting for risk factors.ResultsWe compared 30 and 194 patients with and without schizophrenia, respectively. The prevalence of fracture‐related displacement was 80.0% in patients with schizophrenia and 62.4% in the controls (p = 0.06). After adjusting for confounding variables, schizophrenia significantly correlated with fracture‐related femoral neck displacement (odds ratio: 4.74, 95% confidence interval: 1.09–20.60, p = 0.0378).ConclusionsSchizophrenia is associated with a higher risk of severe femoral neck fracture. To improve outcomes and alleviate the societal burden of femoral neck fractures, early radiographic assessment and surgical intervention for femoral fractures are essential for patients with schizophrenia, even in those without pain symptoms.

Management of Combined Fracture Neck of Femur and Femoral Deformity in Osteogenesis Imperfecta Patient: A Case Report

Management of Combined Fracture Neck of Femur and Femoral Deformity in Osteogenesis Imperfecta Patient: A Case Report

Fracture risk and bone health in adrenal adenomas with mild autonomous cortisol secretion/subclinical Hypercortisolism: a systematic review, meta-analysis and meta-regression.

Adrenal adenomas/incidentalomas with mild autonomous cortisol secretion (MACS)/subclinical hypercortisolism (SH) are often associated with metabolic syndrome, glucocorticoid-induced osteoporosis and fractures. In this background, the present systematic review and meta-analysis aimed to collate the available evidence and provide a summary of effect of MACS/SH on bone health in terms of fractures, osteoporosis/osteopenia, microarchitecture, and bone turnover. PubMed/MEDLINE, Embase, and Web of Science databases were systematically searched for observational studies reporting prevalence of fractures, osteoporosis/osteopenia or data on bone microarchitecture/bone turnover markers (BTMs). Following literature search, 16 observational studies were included. Pooled prevalence of any fractures (vertebral and non-vertebral), vertebral fractures and osteoporosis/osteopenia in MACS/SH were 43% [95% confidence intervals (CI): 23%, 62%], 45% (95% CI: 22%, 68%) and 50% (95% CI: 33%, 66%), respectively. On meta-regression, age, sex, 24-hour urinary free cortisol and dehydroepiandrosterone-sulfate did not predict fracture risk. The likelihood of any fractures [odds ratio (OR) 1.61; 95% CI: 1.18, 2.20; p = 0.0026], vertebral fractures (OR 2.10; 95% CI: 1.28, 3.45; p = 0.0035) and osteoporosis/osteopenia (OR 1.46; 95% CI: 1.15, 1.85; p = 0.0018) was significantly higher in adrenal adenomas and MACS/SH than non-functional adrenal adenomas. Subjects with MACS/SH had significantly lower bone mineral density (BMD) at lumbar spine [mean difference (MD) -0.07 gm/cm2; 95% CI: -0.11, -0.03; p = 0.0004) and femoral neck (MD -0.05 gm/cm2; 95% CI: -0.08, -0.02; p = 0.0045) than their non-functional counterparts. Limited data showed no significant difference in BTMs. Publication bias was observed in the pooled prevalence of any fractures, vertebral fractures and pooled MD of femoral neck BMD. To conclude, people with adrenal adenomas/incidentalomas and MACS/SH are at 1.5 to 2-fold higher likelihood of fractures and osteoporosis/osteopenia compared to non-functional adrenal adenomas and should routinely be screened for bone disease. Nevertheless, considering the modest sample size of studies and evidence of publication bias, larger and high-quality studies are required (CRD42023471045).

Association of osteoporotic fractures of femoral neck and femoral neck geometric parameters in native Chinese women

BackgroundAlthough it is generally believed that the femoral neck fracture is related to the femoral neck geometric parameters (FNGPs), the association between the risk of osteoporotic fracture of the femoral neck and FNGPs in native Chinese women is still unclear.MethodsA total of 374 female patients (mean age 70.2 ± 9.32 years) with osteoporotic fracture of the femoral neck, and 374 non-fracture control groups were completely matched with the case group according to the age ratio of 1:1. Using DXA bone densitometer to measured eight FNGPs: the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compressive strength index (CSI) at the narrowest point of the femoral neck.ResultsCompared with the control group, the average values of OD (2.9%), ED (4.5%), and BR (26.1%) in the patient group significantly increased (p = 0.015 to < 0.001), while CSA (‒15.3%), CT (‒18.2%), SM (‒10.3%), CSMI (‒6.4%), and CSI (‒10.8%) significantly decreased (all p < 0.001). The prevalence of osteoporosis in the lumbar spine, femoral neck, and total hip was, respectively, 82%, 81%, and 65% in fracture patients. Cox proportional hazard model analysis showed that in the age adjusted model, the fracture hazard ratio (HR) of CSA, CT, BR, SM, and CSI significantly increased (HRs = 1.60‒8.33; 95% CI = 1.08‒16.6; all p < 0.001). In the model adjusted for age and femoral neck BMD, HRs of CT (HRs = 3.90‒8.03; 95% CI = 2.45‒15.1; all p < 0.001) and BR (HRs = 1.62‒2.60; 95% CI = 1.20‒5.44; all p < 0.001) were still significantly increased.ConclusionThese results suggest that the majority of osteoporotic fractures of the femoral neck of native Chinese women occur in patients with osteoporosis. CT thinning or BR increase of FNGPs may be independent predictors of fragility fracture of femoral neck in native Chinese women unrelated to BMD.

Low reoperation rate after fixation of displaced femoral neck fractures with the femoral neck system (FNS).

Operative fixation of femoral neck fractures (FNFs) remains challenging. Complications are not infrequent, especially in displaced patterns. Numerous fixation techniques have been previously described in the literature; however, there remains a paucity of data regarding outcomes of these injuries treated with the femoral neck system (FNS). Patients with a displaced FNF (OTA/AO 31B) treated with the FNS at a single level 1 academic trauma center between 1/1/2019 and 1/1/2023 were identified. Radiographs were reviewed to assess fracture displacement, location, and characteristics. Patient records were further reviewed to assess for complications, reoperations, and osseous union. Forty-three patients (65% male) with 44 FNFs were identified with a mean age of 35.0years (range, 13-61years). Two patients developed a deep infection requiring surgical debridement, four patients underwent a total hip arthroplasty, and one patient underwent a valgus intertrochanteric osteotomy for nonunion. There were three cases of femoral head AVN. Mean follow-up was 482.5days among all patients, and 36 fractures had at least 6months of follow-up or reached bony union. Here, we present a series of patients treated with the FNS for internal fixation and report a 18% reoperation rate. This is lower than the average rate that has been previously reported in similar patient populations in the literature treated with alternative methods of internal fixation. Thus, the FNS appears to be a safe and effective option for treatment of these injuries.

Lifetime cost of surgical treatment for canine hip osteoarthritis is less than conservative management in dogs under eight years of age.

To determine the lifetime cost of 3 treatments for canine hip osteoarthritis: (1) conservative management, (2) femoral head and neck excision (FHNE), or (3) total hip replacement. We hypothesized that FHNE would be the least expensive treatment at all ages. Cost estimates from 11 private and academic referral centers from 8 randomly chosen cities across the US. Costs of surgeries were collected from practices in 8 US cities. The literature was used to determine expected postoperative costs. For conservative management, costs of pain medications and diet were obtained by use of online pharmacies. A 4.5% inflation adjustment was used for costs in subsequent years. For a dog aged 1 to 7 years, FHNE had the lowest lifetime cost. Total hip replacement had the second lowest cost until age 4, after which conservative management was lower. For dogs > 8 years, conservative management was the most cost-effective. For dogs presenting with clinical signs at or under 1 year of age, the perceived benefits of total hip replacement may not be financially prohibitive if lifetime cost of care is considered. Femoral head and neck excision was also less expensive than long-term conservative management. This can help veterinarians inform owners on costs of treatments over the lifetime of their pet. This type of analysis is limited to financial costs alone and does not account for differences in outcomes, as these are not well established. It should be expanded in the future as better data on outcomes and impacts of care become available.

A commentary on 'Trends and benefits of early hip arthroplasty for femoral neck fracture in China: a national cohort study'.

A commentary on 'Trends and benefits of early hip arthroplasty for femoral neck fracture in China: a national cohort study'.

Treatment Failure After Repair of Displaced Femoral Neck Fractures in Patients compared by “Decade of Life”: An Analysis of 565 Cases in Adults Less than 60 Years Old

OBJECTIVES: To study the results of displaced femoral neck fractures (FNFs) in adults less than 60 years of age by comparing patients, injury, treatment, and the characteristics of treatment failure specifically according to patients’ age at injury, i.e. by their “decade of life” (i.e. “under 30” [29 years and younger], “the 30’s” [30 to 39 years], “the 40’s” [40 to 49 years], and “the 50’s” [50 to 59 years]). METHODS: Design: Multicenter retrospective comparative cohort series Setting: 26 North American Level 1 Trauma Centers. Patient Selection Criteria: Skeletally mature patients aged 18 to 59 with operative repair of displaced FNFs. Outcome Measures and Comparisons: Main outcome measures were treatment failures (fixation failure and/or nonunion, osteonecrosis, malunion, and the need for subsequent major reconstructive surgery (arthroplasty or proximal femoral osteotomy). These were compared across decades of adult life through middle age (&lt;30 years old, 30 to 39 years, 40 to 49 years, and 50-59 years). RESULTS: Overall, treatment failure was observed in 264 of 565 (47%) of all hips. The mean age was 42.2 years, 35.8% of patients were female, and the mean Pauwels’ angle was 53.8°. Complications and the need for major secondary surgeries increased with each increasing decade of life assessed: 36% failure occurred in 36% of patients ages &lt;30 years, 40% in the 30’s, 48 in the 40’s, and 57% in the 50’s, respectively; p &lt;0.001). Rates of osteonecrosis increased with decades of life (under 30’s and 30’s vs. 40’s vs. 50’s developed osteonecrosis in 10%, 10%, 20%, and 27% of hips, p &lt;0.001), while fixation failure and/or nonunion only increased by decade of life to a level of trend (p =0.06). Reparative methods varied widely between decade-long age groups, including reduction type (open vs. closed, p&lt;0.001), reduction quality (p=0.030), and construct type (cannulated screws (CS) vs. fixed angle devices,p=0.024), while some variables evaluated did not change with age group. CONCLUSIONS: Displaced FNFs in young and middle-aged adults are a challenging clinical problem with a high rate of treatment failure. Major complications and the need for complex reconstructive surgery increased greatly by decade of life with the patients in their 6th decade experiencing osteonecrosis at the highest rate seen among patients in the decades studied. Interestingly, treatments provided to patients in their 50’s were notably different than those provided to younger patient groups. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

ASSESSING RISK FACTORS FOR OSTEOPOROSIS AND FRACTURES AT DIFFERENT SITES: LUMBAR VERTEBRAE VERSUS NECK OF FEMURS IN A LARGE COHORT. A CROSS-SECTIONAL STUDY

Osteoporosis can cause significant disability and cost to health services globally. We aim to compare risk fractures for both osteoporosis and fractures at the L1-L4 vertebrae (LV) and the neck of femurs (NOFs) in patients referred for DEXA scan in the North-West of England.Data was obtained from 31546 patients referred for DEXA scan in the North-West of England between 2004 and 2011. Demographic data was retrospectively analysed using STATA, utilising chi-squared and t-tests. Logistical models were used to report odds ratios for risk factors included in the FRAX tool looking for differences between osteoporosis and fracture risk at the LV and NOFs.In a study involving 2530 cases of LV fractures and 1363 of NOF fractures, age was significantly linked to fractures and osteoporosis at both sites, with a higher risk of osteoporosis at NOFs compared to LV. Height provided protection against fractures and osteoporosis at both sites, with a more pronounced protective effect against osteoporosis at NOFs. Weight was more protective for NOF fractures, while smoking increased osteoporosis risk with no site-specific difference. Steroids were unexpectedly protective for fractures at both sites, with no significant difference, while alcohol consumption was protective against osteoporosis at both sites and associated with increased LV fracture risk. Rheumatoid arthritis increased osteoporosis risk in NOFs and implied a higher fracture risk, though not statistically significant compared to LV. Results summarised in Table 1.Our study reveals that established osteoporosis and fracture risk factors impact distinct bony sites differently. Age and rheumatoid arthritis increase osteoporosis risk more at NOFs than LV, while height and steroids provide greater protection at NOFs. Height significantly protects LV fractures, with alcohol predicting them. Further research is needed to explore risk factors’ impact on additional bony sites and understand the observed differences’ pathophysiology.For any figures or tables, please contact the authors directly.

Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18-59 Years Old: An Analysis of 565 Cases Treated at 26 Level One Trauma Centers

OBJECTIVES: To determine the difference in failure rates of surgical repair for displaced femoral neck fractures in patients less than 60 years of age according to fixation strategy. METHODS: Design: Retrospective, comparative cohort study Setting: 26 level 1 North American trauma centers Patient Selection Criteria: Patients less than 60 years of age with a displaced femoral neck fracture (OTA 31-B2, B3) undergoing surgical repair from 2005 to 2017 Outcome Measures and Comparisons: Patient demographics, injury characteristics, repair methods utilized, and treatment failure (nonunion/ failed fixation, avascular necrosis, and need for secondary surgery) were compared according to fixation strategy. RESULTS: Five hundred and sixty-five patients met inclusion criteria and were studied. The mean age was 42 years, 36% were female, and the average Pauwels’ angle of fractures was 55°. There were 305 patients treated with multiple cannulated screws (MCS) and 260 treated with a fixed-angle (FA) construct. Treatment failures were 46% overall, but was more likely to occur in MCS constructs vs. FA devices (55% vs. 36%, p&lt;0.001). When FA constructs were sub-stratified, the use of a sliding hip screw (SHS) with addition of a medial femoral neck buttress plate (FNBP) and “antirotation” (AR) screw demonstrated better results than either FNBP or AR screw alone or neither with the lowest overall construct failure rate of 11%(p&lt;0.036) CONCLUSIONS: Historically used fixation constructs for femoral neck fractures (e.g. multiple cannulated screws and sliding hip screw) in young and middle-aged adults performed poorly compared to more recently proposed constructs, including those utilizing a medial femoral neck buttress plate and an anti-rotation screw. Fixed angle constructs outperformed multiple cannulated screws overall, and augmentation of fixed angle constructs with a medial femoral neck buttress plate and antirotation screw improved the likelihood of successful treatment. Surgeons should prioritize fixation decisions when repairing displaced femoral neck fractures in patients.

ESTIMATING THE RISK OF POSTOPERATIVE PERIPROSTHETIC FEMORAL FRACTURES AFTER TOTAL HIP ARTHROPLASTY ASSOCIATED WITH COMMONLY USED IMPLANTS: AN ANALYSIS OF NATIONAL HEALTH DATA FROM ENGLAND

Current estimates of periprosthetic fracture risk associated with femoral implants is mostly limited to revision only estimates and does not accurately represent stem performance. The aim of this study was to estimate the risk of surgically treated post-operative periprosthetic femoral fracture (POPFF) more accurately associated with frequently used femoral implants used for total hip arthroplasty (THA).A cohort study of patients who underwent primary THA in England between January 1, 2004, and December 31, 2020. Periprosthetic fractures were identified from prospectively collected revision records and national procedure coding records. Survival modelling was used to estimate POPFF incidence rates, adjusting for potential confounders. Subgroup analyses were performed for patients over 70 years, with non-osteoarthritic indications, and neck of femur fracture.POPFF occurred in 0.6% (5100/809,832) of cases during a median (IQR) follow up of 6.5 (3.9 to 9.6) years. The majority of POPFF were treated with fixation after implantation of a cemented stem. Adjusted patient time incidence rates (PTIR) for POPFF varied by stem design, regardless of cement fixation. Cemented composite beam stems (CB stems) demonstrated the lowest risk of POPFF. Collared cementless stems had an equivalent or lower rate of POPFF versus the current gold standard polished taper slip cemented stem.POPFF account for a quarter of all revisions following primary THA. Cemented CB stems are associated with the lowest POPFF risk. Stem design is strongly associated with POPFF risk, regardless of the presence of cement. Surgeons, policymakers, and patients should consider these findings when recommending femoral implants in those most at risk of POPFF.

Low avascular necrosis rates in femoral neck fractures: efficacy of cannulated screw fixation.

Cannulated screw fixation for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 5-40% of fixed intracapsular fractures. This study aims to assess the outcomes, particularly the AVN rate, associated with current surgical techniques within our unit. We conducted a single-center cross-sectional study, manually searching operative records between July 14, 2014, and December 1, 2018, identifying patients with intracapsular fractured neck of femur fixed with cannulated screws, with a minimum of two years follow-up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN, non-union, post-operative metalwork infection, and screw penetration of the head. Additionally, fracture pattern and displacement, screw configuration, reduction techniques, and adequacy of reduction were recorded, with radiographs independently analyzed by four orthopedic surgeons. Fifty-six patients were included; average age of 67 years (range 30-100). Forty-two patients (75%) sustained displaced fractures and 14 patients (25%) had undisplaced fractures. Two (4%) patients developed AVN, with no cases of non-union, post-operative metalwork infection or screw penetration of the head. Eight patients (14%) sustained a high-energy injury, though none of these patients developed AVN. All fractures required closed reduction; no open reductions performed. Twenty-seven (64%) of reductions were adequate. Our observed AVN rate is notably lower than the widely reported figures, even among a significant proportion of displaced fractures that were fixed. This study underscores that with adequate fixation, cannulated screws represent an excellent option for treating intracapsular neck of femur fractures, even in cases of displaced fracture patterns with imperfect reduction.