Garden Classification Research Articles

Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis

BackgroundAlthough the risk factors associated with osteonecrosis of femoral head (ONFH) after internal fixation of femoral neck fracture (IFFNF) have been frequently reported, the results remain controversial. Therefore, its related risk factors were systematically evaluated and meta-classified in this study.MethodsLiterature on risk factors of ONFH caused by IFFNF was retrieved in PubMed, Embase and Cochrane Library due June 2019. Review Manager 5.3 software was applied to data synthesis, and Stata 13.0 software was adopted for analyses of publication bias and sensitivity.ResultsA total of 17 case-control studies with 2065 patients were included. The risk of ONFH after IF was 0.40-fold higher in patients with Garden III-IV FNF than that in patients with Garden I-II (OR: 0.40, 95%CI: 0.29–0.55). The risk of OFNH with retained IF was uplifted by 0.04 times (OR: 0.04, 95%CI: 0.02–0.07). There was nonsignificant relationship between gender and ONFH after IFFNF (OR: 1.27, 95%CI: 0.84–1.94). Moreover, ONFH after IFFNF presented no association with age (OR:1.66, 95%CI: 0.89–3.11), injury-operation interval (OR:1.29, 95%CI: 0.82–2.04), fracture reduction mode (OR:1.98, 95%CI: 0.92–4.26), preoperative traction (OR:1.69, 95%CI: 0.29–9.98) and mechanism of injury (OR:0.53, 95%CI: 0.06–4.83). Egger’s and Begg’s tests indicated a publication bias (P = 0.001).ConclusionIt was demonstrated that Garden classification and retained IF were important influencing factors of ONFH after IFFNF. Gender, age, injury-operation interval, fracture reduction mode, preoperative traction and the mechanism of ONFH were irrelevant to the complication.

Evaluation of Kangli hollow screws with sliding compression locking plate system for treatment of femoral neck fractures

Objective To evaluate Kangli hollow screws with sliding compression locking plate system (KHS) in the treatment of femoral neck fractures. Methods From February 2015 to October 2016, 47 femoral neck fractures were treated at Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. They were 30 men and 17 women, aged from 26 to 68 years (average, 43.5 years). According to the Pauwels classification, there were 24 cases of type Ⅰ, 16 cases of type Ⅱ and 7 cases of type Ⅲ; according to the Garden classification, there were 23 cases of type Ⅱ, 19 cases of type Ⅲ and 5 cases of type Ⅳ. All the fractures were immobilized with KHS after closed reduction or open reduction (3 cases). The fracture union time, femoral head necrosis and femoral neck shortening were observed after operation. The Harris scores were used to evaluate therapeutic effects at the final follow-up. Results All the patients were followed up for an average of 29.7 months (from 22 to 39 months). All the fractures obtained solid bony union after 9 to 15 weeks(average, 12.2 weeks). Femoral head necrosis occurred in one case (2.1%). Femoral neck shortening ≤ 5 mm was observed in 6 cases and femoral neck shortening >5 mm <10 mm in 2 cases, giving a total shortening rate of 17.0%. The Harris scores at the final follow-up ranged from 77 to 98 points, averaging 92.2 points. There were 42 excellent, 3 good and 2 moderate cases, giving an excellent and good rate of 95.7%. Conclusion KHS can lead to excellent therapeutic effects in the treatment of femoral neck fractures. Key words: Femoral neck fractures; Fracture fixation, internal; Bone plates; Therapeutic effect

Role of austin moore prosthesis in intracapsular fracture neck of femur in elderly

Background: In elderly people neck of femur fractures are common. For which hemiarthroplasty is most popular surgery doing by an orthopaedic surgeon. Usually hemiarthroplasty can perform either with unipolar or bipolar prosthesis. Purpose: The aim of this study is to know the outcome of unipolar prosthesis in elderly patients presented with fracture neck of femur.Materials and Methods: From October 2014 to October 2016, 30 patients aged above 60 years who were admitted in the department of orthopaedics in R.L Jalappa Hospital, kolar were included. Functional outcome were assessed with Harish Hip Score.Results: The study included 53% females and 47% males. 47% were in the age group of 70-79, followed by 43%, 10% were 60 to 69 years and 80-89 years age groups respectively. Left sided hip fracture was 57% which is more than Right sided hip fracture 43%. Fracture was classified as per Garden classification, Type IV were 14, Type III 12 and Type II 4. Most commonly used prosthesis size was 47 ranged from 39 to 49.After 6 months follow-up outcome analyzed by Harris hip score and found to be Excellent 47%, Good 27%, fair 20% and poor in 6.6%. 13% of the study subjects had complication like superficial infections and bed sore which was treated with regular dressings and antibiotics.Conclusion: Austin Moore prosthesis gives a better function, safe operation, lesser pain and improved gait function outcome even in elderly with significant medical problems.

FEMORAL NECK FRACTURE TREATED WITH CANNULATED SCREWS: IS REDUCTION THE KEY POINT?

Background: In middle-aged patients, treatment of femoral neck fractures is still debated between osteosynthesis and replacement. Describing predictive factors is essential to choose the appropriate treatment for each patient. The aim of this study was to describe risk factors for avascular necrosis (AVN) of the femur head in patients with femoral neck fractures treated with three cannulated screws. Methods: We conducted a retrospective study of 91 patients between January of 2011 and February of 2017. Fractures were classified according to Garden and Pauwels classifications, fracture displacement was measured in millimetres (mm), quality of reduction was classified as anatomical or not anatomical; all post-operative radiographs were classified with Garden Alignment Index (GAI). Demographic data were recorded and analyzed. Results: AVN was found in six cases (6.6%). The Garden Classification ([Formula: see text]), GAI classification ([Formula: see text]), fracture displacement in mm ([Formula: see text]) and anatomical reduction ([Formula: see text]) were significantly associated with AVN. The most important risk factor for AVN was suboptimal reduction in axial view evaluated with GAI ([Formula: see text]). One case of AVN occurred in patients with GAI considered excellent (71.42%); no AVN occurred in patients with anatomical reduction (47.2%). Conclusions: Anatomical reduction in patients with femoral neck fractures treated with cannulated screws is mandatory. The degree of displacement before surgery influences the outcome but post-operative anatomical reduction, especially in the lateral view, is the most important predictive factor for the outcome: decreasing the Lateral Garden Angle (LGA) from 180∘increases significantly the risk for AVN.

Оцінка колекційного фонду рослин роду Dahlia Cav. у Кременецькому ботанічному саду

У статті здійснено оцінку колекційного фонду роду Dahlia Cav. Кременецького ботанічного саду. Мета роботи – аналіз колекційного фонду роду Dahlia Cav. Кременецького ботанічного саду, оцінка декоративних показників та опрацювання головних напрямів збагачення, утримання колекції й подальше впровадження в озеленення. В основу роботи покладено матеріали інтродукційних досліджень 2018 р. Фенологічні спостереження проведено за загальноприйнятою методикою в ботанічних садах.В Україні вона відома з кінця ХVIII ст. Починаючи з 50-х років ХIХ ст., дослідження розпочали в Національному ботанічному саду ім. М. М. Гришка НАН України. На сьогодні вивченням сортів роду Dahlia займаються Г. Музичук, А. Дорошенко. Колекція нараховує 231 сорт.Колекцію жоржин у ботанічному саду Львівського національного університету ім. Івана Франка започатковано в 70-х рр. минулого сторіччя. Основним джерелом отримання сортового матеріалу були ботанічні сади Білорусі, Прибалтики, м. Києва та Москви, Польщі. На сьогодні колекція жоржин становить 107 сортів, дослідження проводять Я. А. Федоровська, А. І. Прокопів.Оскільки такі дослідження в Україні є фрагментарними, уважаємо актуальним вивчення та оцінювання декоративних ознак представників роду Dahlia у Кременецькому ботанічному саду. Інтродукцію цього роду розпочато з 2017 р.Для оцінки сортового розмаїття колекційного фонду жоржин використано аналітично-порівняльний метод. В аналізі колекційного фонду дотримувалися садової класифікації жоржини, розробленої М. П. Ященком.Наведено результати щодо розподілу рослин за групами. Відображено сорти колекції за головними кольорами: червоний (R) наявний у трьох культиварів різних садових груп, оранжевий (Or) – у восьми, темно-червоний (DkR) – в одного сорту, лавандовий, фіолетовий (L) – у двох, рожевий (Pk) – у двох, двоколірне забарвлення (Bi) мають вісім сортів, біле (W) – один, жовте (Y) – два, темний бленд (LB і DB) – два сорти. Досліджені сорти жоржин є перспективними для вирощування в умовах культури. Поповнення колекції роду Dahlia залишається основним завданням науково-колекційної роботи як способу збереження й збагачення рослинного різноманіття. Використання жоржин під час озеленення території дачної ділянки відіграє значну роль для досягнення запланованих декоративного та естетичного ефектів.

‘Men as plants increase’: botanical meaning in Shakespeare’s The Winter’s Tale

Much has been learnt about British horticulture in the early years of the seventeenth century in terms of garden design, plant availability and classification. Recently, greater attention has also ...

The influence of the CT scan in the evaluation and treatment of nondisplaced femoral neck fractures in the elderly.

The management of nondisplaced femoral neck fractures (FNFs) has evolved, with emphasis in radiographic features such as posterior displacement. However, the role of advanced imaging in this scenario is still not well defined. Therefore, our objective is to assess the impact of a computed tomography scan (CT) on interobserver agreement (IA) of fracture classification, posterior tilt measurement, and treatment decisions in nondisplaced FNF in elderly patients. Eleven patients with a nondisplaced (Garden 1-2) FNF were assessed by six hip surgeons. On a first stage, fracture classification, posterior tilt, and treatment plan (fixation/arthroplasty) were determined only with clinical information and X-rays. On a second stage, a CT was added. The kappa coefficient ( κ) and intraclass correlation coefficient (ICC) were used to determine IA. IA for Garden classification was only slight in X-rays and with the addition of a CT, with a κ = 0.13 (0-0.28) and 0.18 (0.03-0.33), respectively. Conversely, posterior tilt measurement agreement was excellent in both schemes, with an ICC = 0.92 (0.83-0.98) and 0.92 (0.82-0.98). The IA for the proposed treatment was slight with X-rays ( κ = 0.44; 0.29-0.6), but moderate with the addition of a CT scan ( κ = 0.67; 0.52-0.82). Changes in surgical decision where made in 14 of 66 evaluations with an OR = 1.4 (0.62-3.2) for choosing an arthroplasty if a CT was used. IA for fracture classification and posterior tilt evaluation in nondisplaced FNF was not altered by the usage of a CT. There is improvement in treatment agreement when a CT scan is added to conventional imaging, with changes in treatment in 21% of cases.

Pertinence des classifications Garden, AO, et « simplifiée 2 stades » pour les fractures cervicales vraies du fémur proximal

IntroductionSuccessful treatment starts by accurate classification of pathology, but there is no conclusive, reliable and universally accepted method for classification of intracapsular femoral neck fractures. As a perfect classification should have high intra- and inter-observer agreement, this study aims to access reliability of three classification systems: Garden, AO and simple II stage classification. Materials and methodsFour orthopaedic trauma surgeons (two of them professors) and two senior orthopaedic trauma residents were invited to evaluated 136 blinded anterior-posterior and lateral X-rays of patients with femoral neck fractures. Observers classified fractures according to IV stage Garden, AO and simple II stage classifications. The exercise was repeated after one month on same but randomised X-rays. Cohen kappa was used to measure inter- and intra-observer agreement. Fleiss kappa was used to access multi-rater agreement. ResultsAO classification showed an overall agreement of 0.22 (fair agreement). Garden classification had overall reliability slightly higher than AO, but matching same fair agreement group (0.33). II stage classification provided the highest estimates: from 0.35 (fair agreement) to 0.83 (almost perfect agreement) and multi-rater agreement of 0.50 (moderate agreement). There was seen no difference in intra- and inter-observer agreement between observer groups (professors, trauma surgeons and trauma residents). DiscussionAll three classification systems showed equal adoption among differently experienced observer groups. Despite this finding, IV stage Garden and AO classifications should be avoided in clinical use because of poor reproducibility. Only simple II stage classification showed sufficient intra- and inter-observer reliability. Level of evidenceIV, retrospective study.

The reliability of a Garden, AO and simple II stage classifications for intracapsular hip fractures

IntroductionSuccessful treatment starts by accurate classification of pathology, but there is no conclusive, reliable and universally accepted method for classification of intracapsular femoral neck fractures. As a perfect classification should have high intra- and interobserver agreement, this study aims to access reliability of three classification systems: Garden, AO and simple II stage classification. Materials and methodsFour orthopaedic trauma surgeons (two of them professors) and two senior orthopaedic trauma residents were invited to evaluated 136 blinded anterior-posterior and lateral X-rays of patients with femoral neck fractures. Observers classified fractures according to IV stage Garden, AO and simple II stage classifications. The exercise was repeated after one month on same but randomised X-rays. Cohen kappa was used to measure inter- and intraobserver agreement. Fleiss kappa was used to access multi-rater agreement. ResultsAO classification showed an overall agreement of 0.22 (fair agreement). Garden classification had overall reliability slightly higher than AO, but matching same fair agreement group (0.33). II stage classification provided the highest estimates: from 0.35 (fair agreement) to 0.83 (almost perfect agreement) and multi-rater agreement of 0.50 (moderate agreement). There was seen no difference in intra- and interobserver agreement between observer groups (professors, trauma surgeons and trauma residents) DiscussionAll three classification systems showed equal adoption among differently experienced observer groups. Despite this finding, IV stage Garden and AO classifications should be avoided in clinical use because of poor reproducibility. Only simple II stage classification showed sufficient intra- and interobserver reliability. Level of evidenceIV, Retrospective study.

Locking Plate Fixation with Multiple Telescoping Sliding Screws for Femoral Neck Fractures

Non-displaced femoral neck fractures are mostly treated with internal fixation, while in dis-placed fractures this surgical option is under debate and the benefits are still not clear. The purpose of this study was to identify the factors that affect the treatment of non-displaced and displaced hip fractures using ahead-preserving plate. From August 2011 to May 2015, we reviewed eighty-two adult patients who had sustained undisplaced and displaced intracapsular femoral neck fracture treated with a locking plate system with telescoping sliding screws. Fracture reduction, healing rate and implant related complications were primary objectives. Other complications (e.g. avascular necrosis, nonunion, hematoma, infection) and revision surgery were recorded as well. According to the Garden classification system, atotal of 51.2% fractures were classified as non-displaced (type 1 and 2) and 48.8% were displaced fractures (type 3 and 4). Anatomic reduction was achieved in 58.5% and valgus in 41.5% of patients and it did not influence the healing. Varus reduction was not observed in any case. The total average complication rate was 18.1%, where screw cutout was the most frequent complication (8.5%). The timing of surgery did not affect the healing of femoral neck fractures. Age over 60 years combined with a displaced fracture was associated with impaired healing potential and ahigher complication rate. Revision surgery was performed in 17.1% of patients, mainly those with displaced fractures. 1. The use of a locking plate system with telescoping sliding screws was associated with lower rates of postoperative complications in undisplaced, but also in displaced femoral neck fractures in patients younger 60 years. 2. Patients over 60 years with displaced fractures were more likely to have healing problems and implant failure.

Clinical outcome of enhanced recovery after surgery for hemiarthroplasty for the treatment of femoral neck fractures in elderly patients

To analyze and evaluate the clinical outcomes of enhanced recovery after surgery(ERAS) for hemiarthroplasty for the treatment of femoral neck fractures in elderly patients. From January 2015 to December 2016, 466 patients with femoral neck fractures were admitted in our department. Among them, 154 patients were more than 80 years old, with an average age of (83.9±3.2) years old (ranged, 80 to 96 years old), including 27 males and 127 females. According to Garden classification system, 68 cases were type III and others were type IV. ERAS for hemiarthroplasty were performed for all the patients. The time before operation, blood transfusion rate, complications rate, lenth of stay and Harris score system were evaluated. Among 154 patients, 142 patients were followed up, with an average duration of 24.6 months(ranged, 14 to 38 months). Thirty-two patients (20.8%) completed the operation within 48 hours after admission, 67 patients(43.5%) completed the operation within 72 hours after admission, 76 patients(49.4%) discharged within 48 hours after operation, and the blood transfusion rate was 15.9%. One patient was re-hospitalized because of prosthetic dislocation. The re-hospitalization rate was 0.6%. No other patients were re-hospitalized because of superficial or deep infection or periprosthetic fracture. At the latest follow-up, the Harris hip score was 90.2±7.1, 106 patients got an excellent result, 23 good and 9 fair. ERAS for hemiarthroplasty can effectively shorten hospitalization time, relieve pain, reduce blood transfusion rate, reduce postoperative complications, and do not increase the readmission rate of elderly patients with femoral neck fracture, which can achieve good clinical efficacy.

Morphometrical and biological indicators in definition decorative representatives to the Saintpaulia H. Wendl.

Long-term researches showed that representatives of cultivars of Saintpaulia H. Wendl. are most long flowering plants of family of Gesneriaceae Dumort. in the protected soil of Oles Gonchar Dnepr National University Botanic Garden. The decorativeness of cultivars was determined on morphometric and biological descriptions: to correlation to the diameter of flower with a width and long sheet plate, to the form of flower, double, fringed of edge of petal, and also general proportion of corolla, the phenology of flowering and other. Descriptions of the most perspective cultivars of Saintpaulia getting top marks on the scale of estimation are considered. A brightness, chromaticity, maintenance of these qualities during all life of flower (more than 2 months at some cultivars), beauty and harmoniousness of picture at multicoloured Saintpaulia, was taken into account. Studies and observations were conducted in the stock conservatory of the laboratory of tropical and subtropical plants from 1997 to 2018.We used garden classification of The Special Comity of The African Violet Society of America – AVSA, scale of assessment of economic-biological and decorative features. A complex evaluation of 60 cultivars from the genus Saintpaulia from the laboratory of tropical and subtropical plants of the botanical garden of the DNU was carried out.&#x0D; It is educed, that most showily plants look with flowers, having a size of corolla, equal to the width of sheet plate, or less than her no more, than on one centimeter. Most objects driven to this article respond to this request and have the highest productivity of flowering. The evaluation of ornamental properties and prognosis of the succesful introduction of 20 taxsons (the sorts: EK-Boy Bykov, ЕК-Belaya Koroleva, EK-Zhemchujniy Zephyr, Arctic Frost, Blue Dragon, Kilauea et al) have been given. Perspective for cultivation in closed soil species have been selected. Modern varieties for indoors greenbelt setting have been listed.&#x0D; The got results served in future for creation of scale of cultivars of Saintpaulia and complex estimation of their decorativeness. All studied cultivars are used in an educational process.

The clinical application of a novel method of internal fixation for femoral neck fractures\u2014dynamic locking compression system

BackgroundFemoral neck fractures are the commonly encountered injury in orthopedic practice and result in significant morbidity and mortality. Currently, how to treat femoral neck fractures safely and effectively is still a challenge. The objective of this study is to evaluate the efficiency of dynamic compression locking system for femoral neck fractures.MethodsThis is a retrospective study conducted from May 2015 to October 2016. The study included 36 patients suffering from femoral neck fractures who underwent closed reduction and were fixed using dynamic compression locking system. All surgeries were performed by the same surgeon. The study was conducted by telephone and on-site follow-up. The Garden classification and anatomical site classification were categorized for all patients. We assessed radiographic outcomes of union, femoral neck shortening, screw back-out, and femoral head avascular necrosis. We also evaluated functional outcome using the Harris hip score. Other outcomes included the length of surgery, duration of hospital stay, injury to surgery time, intraoperative hemorrhage, time to clinical bone union, and other fracture complications.ResultsAll patients were followed up 12 to 29 months with an average of 21.58 ± 5.41 months. All cases were caused by falls including 17 males and 19 females with an average age of 65.33 ± 9.30 years old ranging from 53 to 82 years old. Among them, injury to surgery time ranged between 1 and 4 days with an average of 2.58 ± 1.05 days. Duration of hospital stay was 8 to 21 days with an average of 15.33 ± 3.71 days. Intraoperative hemorrhage was 40 to 80 ml with an average of 61.67 ± 12.31 ml. Operation time was from 35 to 80 min with average of 50.25 ± 11.77 min. According to Garden classification, 9 cases (25%) were type II and 27 cases (75%) were type III. According to the anatomical site classification, 8 cases (22.2%) were subcapital femoral neck fractures, 19 cases (52.8%) trans-cervical, and 9 cases (25%) basi-cervical. At present, the follow-up has not found the fracture complications of femoral head avascular necrosis, fracture nonunion, and re-fracture. All patients achieved solid bone union. The mean time of clinical bone union was 3 to 4 months. Among all patients, there were only 3 cases of femoral neck shortening < 5 mm and 1 case of screw back-out = 4 mm. For Harris scoring, average Harris scale at the end of the follow-up was 93.42 ± 3.95 ranging from 85 to 98. There were 32 cases of excellent function scores on the Harris scale and 4 cases of good function scores on the Harris scale. Therefore, the excellent and good rate of Harris hip scores was 100%.ConclusionsFemoral neck dynamic compression locking system for femoral neck fractures in elderly patients can provide effective stability and reduce complications and revision rates.

Clinical observation of closed reduction and compression cannulated screw fixation for the treatment of femoral neck fracture in young and middle-aged patients

To investigate the clinical effect of internal fixation with closed reduction and hollow compression screws for the treatment of femoral neck fracture in young and middle-aged patients. From June 2013 to December 2016, 33 young and middle-aged patients with femoral neck fractures were treated with hollow compression screws fixation including 17 males and 16 females with an average age of 38.5 years old ranged from 19 to 59 years old; 20 cases were on the left side and 13 cases on the right side;the time from injury to operation ranged from 2 to 5 days with an average of 3 days. According to Garden classification, 1 case were type I, 11 cases were type II, 18 cases were type III, 3 cases were type IV. During regular follow-up after operation, through the hip joint X-ray, the healing situation of bone and osteonecrosis were observed. The Harris score was used to evaluate the hip function of the final follow-up. The operation time was from 30 to 50 minutes, the blood loss during operation was 20 to 70 ml. All patients were followed up for 8 to 42 months with an average of 24 months. At the final follow-up, the Harris score of hip joint was excellent in 18 cases, good in 10 cases, fair in 2 cases and poor in 3 cases. Among them, the pain scores were 40.61±5.08, function scores were 38.94±6.78, malformation scores were 3.88±0.69, motion range scores were 3.70±0.64 and the total scores were 87.12±11.98. Thirty cases achieved bone healing, the healing time was 4 to 12 months with an average of 7.5 months, 2 patients occurred with nonunion (Garden type IV), 1 patient with femoral head necrosis (Garden type IV). All patients had no postoperative infection, internal fixation loosening, refracture and other complications. In treating the young and middle-aged patients with femoral neck fracture, closed reduction and hollow compression screw fixation has advantages of simple, stable fixation, less trauma, high rate of fracture healing, osteonecrosis of the femoral head with low risk and satisfactory clinical effect.

Treatment of Pauwels type III femoral neck fractures with modified percutaneous compression plate

To investigate the preliminary effects of modified percutaneous compression plate in treating femoral neck fractures of Pauwels type III. From March 2012 to March 2016, 35 patients with femoral neck fracture were treated by closed reduction and internal fixation with a modified percutaneous compression plate, including 21 males and 14 females with an average age of 45 years old ranging from 23 to 62 years old. The anatomical position of fracture was divided into 8 cases of lower head type, 27 cases of head and neck. According to the Garden classification, there were 8 cases of type II, 18 of type III, and 9 of type IV fractures. All patients were closed injury. The general information, reduction quality, fracture healing time, postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function. All patients were followed up for 15 to 24 months with an average of 20 months. All the incisions were primary healing. The reduction quality of the femoral neck fracture was evaluated according to the Garden's alignment Index, and the quality of reduction was grade I reduction in 29 cases and grade II reduction in 6 cases. No nonunion, femoral avascular necrosis, implant failure and hip varus was observed during follow-up. Harris score was(92.70±4.60) points at final follow-up, the results of the treatment was evaluated as excellent in 26 cases, good in 8 cases, fair in 1 case. No complications such as internal fixation loosening, nail breaking, and heterotopic ossification occurred. Internal fixation with modified percutaneous compression plate has an advantages of decreased trauma, simple operation, rigid fixation, good function outcome, and low risk of complications.

Classifications in Brief: Garden Classification of Femoral Neck Fractures.

Classifications in Brief: Garden Classification of Femoral Neck Fractures.

Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study.

IntroductionFemur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method.MethodsFiles of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by Ficat-Arlet classification system whereas acetabular fractures and hip functionality was evaluated by Letournel and Judet system, which is based on direct graph of fracture line.ResultsMean age at the time of surgery for 31 cases included in the study was 40.04 ± 9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to Judet System, 67.7% of cases showed excellent/good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P>0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications.ConclusionBecause of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.

Tratamento de fraturas deslocadas do colo femoral em pacientes jovens com DHS e associação com a osteonecrose

ObjectiveThe purpose of this study is to evaluate the performance of dynamic hip screw for the treatment of dislocated femoral neck fractures in young patients, focusing on osteonecrosis. MethodsA series of 53 patients with less than 55 years of age were retrospectively evaluated. All patients had dislocated femoral neck fractures (Garden III or IV) and were treated with DHS. Ficat's staging system was used to evaluate avascular necrosis. ResultsThere were 38 (71.7%) males and 15 (28.3%) females, with an overall mean age at the onset of fracture of 41.9 years (±12.8). According to Garden's classification, 21 (39.6%) fractures were classified as type III and 32 (60.4%) were considered totally dislocated, Garden IV. Fracture healing was achieved in 39 patients (73.6%). Thirteen cases of avascular necrosis were observed (24.6%). ConclusionsThe incidence of avascular necrosis in young patients with a displaced femoral neck fractures treated with DHS was 24.6%. No statistically significant association was found between times elapsed to surgery, fracture displacement, and presence of derotation screw with osteonecrosis. Level of evidence IV.

Analysis of risk factors for femoral head necrosis after internal fixation of femoral neck fractures with dynamic hip screw and anti-rotation screw

Objective To explore the influence factors for femoral head necrosis after treatment of femoral neck fractures with dynamic hip screw (DHS) and anti-rotation screw. Methods A retrospective case series analysis was made on the clinical data of 106 cases of femoral neck fractures who had undergone fixation with DHS and anti-rotation screw between May 2010 and May 2015. There were 59 males and 47 females, with an average age of 57.0 years (range, 27-76 years). By Garden classification, there were 27 cases of type Ⅱ, 51 cases of type Ⅲ and 28 cases of type Ⅳ. All cases were divided into femoral head necrosis group (18 cases) and none-necrosis group (88 cases) according to the radiographs of the fractured hip at the follow-up. Univariate analyses and a multivariate logistic regression analysis were made to test whether the following factors were significantly associated with femoral neck necrosis: sex, age, Garden classification, Pauwels classification, Singh index, injury-to-surgery time interval, reduction methods, reduction quality, complete weight-bearing time, implant removal and the time cost of implant removal surgery. Results All the 106 patients obtained a mean follow-up of 49 months (range, 26-76 months). Femoral head necrosis occurred in 18 cases (17.0%). In univariate analyses, Garden classification, reduction quality, implant removal and long time of the implant removal surgery were significantly associated with femoral head necrosis(P<0.01). In multivariate logistic regression analysis, high level of Garden classification(95%CI 0.008, 0.998, P<0.05), implant removal and long time of the implant removal surgery(95%CI 0.000, 0.143, P<0.01) were found to have a significant effect on femoral head necrosis development. Conclusions Fracture displacement, removal of internal fixation and broadening the screw canal, which cand hinder the blood supply of femoral head, will enhance the rate of femoral head necrosis. As a result, it needs prudent consideration to remove internal fixation after internal fixation with DHS combined with anti-rotation screw for femoral neck fractures. When it is difficult to remove the anti-rotation screw, it is better to give up, rather than to force a removal. Key words: Femoral neck necrosis; Femoral neck fractures; Fracture fixation, internal; Bone nails

Effectiveness analysis of surgical treatment of ipsilateral femoral neck fracture and subtrochanteric fracture

To discuss the effectiveness of intramedullary nail fixation with selective cable wiring in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture. Between June 2012 and December 2015, a total of 19 patients with ipsilateral femoral neck fracture and subtrochanteric fracture underwent closed reduction of femoral neck fracture and intramedullary nail fixation combined with selective cable wiring. There were 5 males and 14 females with a median age of 52 years (range, 35-77 years). The cause of injury included traffic accident injury in 17 cases and falling injury in 2 cases. According to Garden classification for femoral neck fractures, 7 cases were rated as type Ⅱ, 8 as type Ⅲ, and 4 as type Ⅳ. Femoral subtrochanteric fractures were classified by Seinsheimer classification, with 9 cases as type Ⅱ, 5 as type Ⅲ, 3 as type Ⅳ, and 2 as type V. The interval from injury to operation ranged from 2 to 7 days with an average of 3.7 days. The operation time was 58-125 minutes (mean, 82.4 minutes) and the intraoperative blood loss was 225-725 mL (mean, 289.5 mL). All incisions achieved healing by first intention and no early complication such as infection was observed. All patients were followed up 12-18 months (mean, 13.9 months). At 1 month after operation, the tip apex distance was 9-23 mm (mean, 15.2 mm). All patients achieved bone union with the healing time of 18-42 weeks (mean, 27.4 weeks). One case of hip varus and femoral neck re-displacement (femoral neck shaft angle was 122°) occurred at 3 months after operation, which achieved bone union at 42 weeks after operation. Five patients complained of postoperative pain with the visual analogue scale (VAS) score of 1-3 (mean, 1.8), which did not influence normal life. A total of 16 patients recovered preoperative hip function. During follow-up, no fracture nonunion, femoral head necrosis, implant failure, screw cut-out, and loosening of cable wiring was observed. The Harris hip score (HSS) was 72-92 (mean, 82.8) at last follow-up and 15 patients (78.9%) achieved good hip function. Intramedullary nail fixation combined with selective cable wiring was effective in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture.