Neck Fractures In Elderly Patients Research Articles

The use of uncemented stems in femoral neck fractures in elderly patients: A comparative study of 671 cases

IntroductionThe use of cemented stems in elderly patients is associated with the risk of intraoperative embolic complications. Uncemented stems eliminate this risk, but their use is controversial because of the risk of mechanical complications, with estimated subsidence between 3.6 and 30% and periprosthetic fractures between 2.1 and 11% at 6 weeks. A retrospective multicenter comparative study was conducted using a propensity score analysis to evaluate mechanical performances of uncemented stems in femoral neck fractures in elderly patients to (1) compare the risk of mechanical complications and (2) assess the use of metaphyseal-anchored stems for this indication. HypothesisThere is no difference in the risk of mechanical complications, intraoperatively or postoperatively, between these stems. Materials and methodsWe conducted a multicenter retrospective comparative study including 358 uncemented and 313 cemented stems. The mean age was 84.5 years [83.9–85.1]. The inclusion criteria were patients 70 years and older and a follow-up of at least 6 weeks. The primary endpoint was a composite endpoint comprised of stem subsidence≥2mm or periprosthetic fracture (up to 3 months postoperatively). The secondary endpoints were infection, stem subsidence≥2mm, and operative time. These endpoints were analyzed using a propensity score to control confounding factors. A secondary analysis used the same endpoints to compare metaphyseal-anchored (short stems) versus Corail-like stems. ResultsAfter adjusting for the propensity score, we found 11.17% mechanical complications in the uncemented group (n=40, 5.59% subsidence, and 5.59% fractures) versus 13.42% for the cemented group (n=42, 7.99% subsidence, and 5.43% fractures). There was no statistically significant difference between the 2 values (Odds Ratio [OR]=0.64 [95% Confidence Interval [CI]: 0.14–2.85] [p=0.7]). The mortality rate due to cement embolism was 1%. There was no difference in the rate of subsidence (OR=0.55 [95% CI: 0.02–12.5] [p=0.7]), periprosthetic fracture (OR=0.65 [95% CI: 0.13–3.12] [p=0.7]) or infection (OR=0.71 [95% CI: 0.32–1.55] [p=0.4]). However, the operative times were longer in the cemented group (p=0.03 for hemiarthroplasties [mean additional time 16minutes] and p=0.02 for total hip arthroplasties [mean additional time 22minutes]). No difference was observed between the metaphyseal-anchored (short stems) and Corail-like stems regarding operative time, rate of infection, and rate of stem subsidence or periprosthetic fractures. DiscussionThis is one of the first studies to highlight cemented stem subsidence when used for femoral neck fractures in elderly patients. Using uncemented stems in this indication is still warranted, especially since they do not bring about more mechanical complications in the first few months. Metaphyseal-anchored short stems seem to give the same results as “standard” stems. However, these findings need to be assessed in the longer term. Level of evidenceIII; retrospective comparative study.

Early clinical outcomes of bipolar hemiarthroplasty for femoral neck fractures in elderly patients using the OCM approach: a retrospective study.

This study aims to assess the early clinical outcomes of bipolar hemiarthroplasty for treating femoral neck fractures in elderly patients aged 75 and above using the Orthopädische Chirurgie München (OCM) approach. A retrospective analysis was conducted on a cohort of 95 elderly patients who underwent bipolar hemiarthroplasty for Garden Type III and IV femoral neck fractures between January 2020 and December 2022. The participants were categorized into two groups according to the surgical approach used: the OCM approach and the posterior-lateral approach (PLA). The average follow-up duration was 11.20 ± 2.80 months for the OCM group and 11.12 ± 2.95 months for the PLA group, with both groups ranging from 6 to 18 months. Clinical outcomes assessed included surgical duration, incision length, postoperative hospital stay, time to ambulation, hemoglobin levels, serum creatine kinase (CK) levels, C-reactive protein (CRP) levels, pain (assessed using the Visual Analogue Scale, VAS), and functional recovery (evaluated through Harris hip scores). Additionally, complications such as intraoperative and postoperative fractures, deep vein thrombosis, wound infection, nerve injury, postoperative dislocation, leg length discrepancy, and Trendelenburg gait were monitored. There was no significant difference in the surgical duration between the OCM and PLA groups. However, the OCM group exhibited shorter incision lengths, reduced postoperative hospital stays, and earlier ambulation times compared to the PLA group. Significantly lower intraoperative blood loss, smaller decreases in hemoglobin levels on postoperative days 1 and 3, lesser hidden blood loss, and decreased levels of CK and CRP were observed in the OCM group. Pain levels, measured by VAS scores, were lower, and Harris hip scores, indicating functional recovery, were higher at 2 and 6 weeks postoperatively in the OCM group than in the PLA group. The incidence of complications, such as periprosthetic fractures, intramuscular venous thrombosis, hip dislocations, Trendelenburg gait, and leg length discrepancies, showed no significant differences between the groups. The OCM approach for bipolar hemiarthroplasty in patients aged 75 and above with femoral neck fractures offers significant early clinical benefits over the traditional PLA, including faster recovery, reduced postoperative pain, and enhanced early functional recovery.

Posterior Approach and Inferior Capsulotomy in Bipolar Hemiarthroplasty for Femoral Neck Fractures: Comparison with Superior Capsulotomy.

Hemiarthroplasty is frequently used to treat displaced femoral neck fractures in elderly patients, but it has a higher risk of postoperative dislocation. We introduced the posterior approach and inferior capsulotomy (PAICO) to enhance joint stability after bipolar hemiarthroplasty for femoral neck fracture. We evaluated whether the PAICO would have a lower dislocation rate than the conventional posterior approach with superior capsulotomy. From January 2021 to December 2021, we prospectively recruited 25 patients (25 hips) aged 50 years or older who underwent bipolar hemiarthroplasty for femoral neck fractures due to low-energy trauma as the PAICO group. We compared the PAICO group with a historical control group who had undergone hemiarthroplasty in 7 institutes between 2010 and 2020. The primary endpoint was dislocation within 1 year after the surgery. We compared data from the PAICO group with the data from the historical control group from the Korean Hip Fracture Registry which was carried out in South Korea. A total of 25 patients (25 hips) were enrolled in the present study; 3,477 patients (3,571 hips) who underwent bipolar hemiarthroplasty were reviewed as the historical control group. In the PAICO group, we observed no dislocation, whereas the dislocation rate in the control group was 1.3%. In patients with displaced femoral neck fractures, the PAICO approach demonstrated comparable results in operation time and complication rates when compared to bipolar hemiarthroplasty using superior capsulotomy. Notably, there were no observed cases of dislocation among patients who underwent the PAICO approach. We recommend this PAICO approach to surgeons using the posterior approach, hoping to prevent dislocation in bipolar hemiarthroplasty.

Effects of Total Hip Replacement and Femoral Head Replacement in the Treatment of Femoral Neck Fractures in Elderly Patients and Their Impacts on Hip Joint Function

Objective: To explore the therapeutic value of total hip replacement and femoral head replacement in elderly patients with femoral neck fractures. Methods: 30 elderly patients with femoral neck fractures were sampled from January 2019 to August 2023 and randomly divided into two groups. Total hip replacement was adopted in the research group, and femoral head replacement was performed in the control group. The surgical indicators, quality of life, hip replacement, Harris hip score, and surgical complications were compared between the groups. Results: The operation time of the research group was longer than that of the control group, and the intraoperative blood loss and postoperative drainage volume were higher than those of the control group, P < 0.05; the SF-36 (36-Item Short Form Health Survey) score of the research group was higher than that of the control group, P < 0.05; the Harris scores of various hip joints of the research group were higher than those in the control group, P < 0.05; the femoral neck fracture complication rate in the research group was lower than that in the control group, P < 0.05. Conclusion: Both total hip replacement and femoral head replacement can improve hip joint function in treating femoral neck fractures in elderly people. However, total hip replacement has better long-term efficacy and can enhance patients’ quality of life and reduce postoperative complications.

Surgical drain has no benefits in hemiarthroplasty for femoral neck fractures in elderly patients

Femoral neck fracture is a common osteoporotic fracture in elderly patients and is effectively managed with arthroplasty. However, the benefits and risks of a surgical drain after arthroplasty in these patients are still debatable. Hence, we conducted this study to investigate the necessity of a surgical drain after hemiarthroplasty in elderly patients with femoral neck fracture. This study enrolled elderly patients (aged ≥ 70 years) who underwent cementless bipolar hemiarthroplasty for femoral neck fracture between April 2016 and December 2021. The patients were divided into two groups; the control group (199 patients) with a surgical drain after surgery performed between April 2016 and June 2020 and the study group (134 patients) with no surgical drain between July 2020 and December 2021. The demographics, perioperative data, and postoperative complications were compared between the two groups. Estimated blood loss, perioperative transfusion volume and rate, and length of hospital stay were significantly lower in the study group than in the control group (p < 0.001, p < 0.001, p = 0.008, and p < 0.001, respectively). Although there were no significant intergroup differences in the length of intensive care unit stay and in-hospital, 1-month, and 1-year mortalities, the incidence of postoperative medical complications was significantly lower in the study group than the control group (p = 0.001). A surgical drain may be unnecessary after hemiarthroplasty in elderly patients with femoral neck fracture considering less blood loss and transfusion, lower incidence of postoperative medical complications, and shorter hospital stay in the study group with no surgical drain.

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

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

Comparison of functional outcome between Bipolar Hemiarthroplasty and total Hip Arthroplasty for displaced femoral neck fractures in elderly patients

Objectives: The intention of this study to compare functional outcomes between Total Hip Arthroplasty and Bipolar Hemi Arthroplasty for displaced femoral neck fracture after 3 months and 1 year from injury in elderly patients. Methods: Prospectively 43 patients were enrolled in this study, ages more than 60, twenty-four of them managed by Total Hip Arthroplasty, and 19 were managed by Bipolar Hemi Arthroplasty. These patients were followed up postoperatively for one year, at (3 and 12 months), to compare functional outcomes using Haris Hip Score. Results: Duration of operation was significantly higher in Total Hip Arthroplasty (98.54 min) versus (62.63 min) in the Bipolar Hemi Arthroplasty group, and intra-operative blood loss also considerably higher in Total Hip Arthroplasty (322.5 ml) than Bipolar Hemi Arthroplasty (178.42 ml). Regarding complications, there is no difference between the two groups; however, the incidence of mortality higher in the Bipolar Hemi Arthroplasty population. Average Haris Hip Score, pain and the motion were significantly better after three months and one-year follow-up in the Total Hip Arthroplasty group. The function was nearly the same at both groups after three months but after one-year of follow-up function significantly better (p-value &lt;0.5) in the Total Hip Arthroplasty patients.Conclusion: Total Hip Arthroplasty provides better functional outcomes after three months and one year of follow-up than Bipolar Hemi Arthroplasty when used to manage femoral neck fracture for active old age patients. Bipolar Hemi Arthroplasty may be suitable for older inactive patients with narrow life expectancy with multiple comorbiditie

Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Patients: Twelve-Month Risk of Revision and Dislocation in an Instrumental Variable Analysis of Medicare Data.

There is practice variation in the selection of a total hip arthroplasty (THA) or a hemiarthroplasty (HA) for the treatment of displaced femoral neck fractures in elderly patients. Large data sets are needed to compare the rates of rare complications following these procedures. We sought to examine the relationship between surgery type and secondary hip surgery (revision or conversion arthroplasty) at 12 months following the index arthroplasty, and that between surgery type and dislocation at 12 months, among elderly Medicare beneficiaries who underwent THA or HA for a femoral neck fracture, taking into account the potential for selection bias. We performed a population-based, retrospective study of elderly (>65 years of age) Medicare beneficiaries who underwent THA or HA following a femoral neck fracture. Two-stage, instrumental variable regression models were applied to nationally representative Medicare medical claims data from 2017 to 2019. Of the 61,695 elderly patients who met the inclusion criteria, of whom 74.1% were female and 92.2% were non-Hispanic White, 10,268 patients (16.6%) underwent THA and 51,427 (83.4%) underwent HA. The findings from the multivariable, instrumental variable analyses indicated that treatment of displaced femoral neck fractures with THA was associated with a significantly higher risk of dislocation at 12 months compared with treatment with HA (2.9% for the THA group versus 1.9% for the HA group; p = 0.001). There was no significant difference in the likelihood of 12-month revision/conversion between THA and HA. The use of THA to treat femoral neck fractures in elderly patients is associated with a significantly higher risk of 12-month dislocation, as compared with the use of HA, although the difference may not be clinically important. A low overall rate of dislocation was found in both groups. The risk of revision/conversion at 12 months did not differ between the groups. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of percutaneous compression plate to parallel screws in the treatment of nondisplaced femoral neck fractures in elderly patients: a prospective, randomized study.

The optimal internal fixation for non-displaced femoral neck fractures remains controversial. This study aimed to compare the clinical results of the percutaneous compression plate (PCCP) with parallel screws (PS) in treating femoral neck fractures in elderly patients. A total of 218 patients who underwent internal fixation were randomized to receive either a percutaneous compression plate (PCCP group) or parallel screws (PS group) using a computerized random sequence generator which was used to assign the order of randomization. Patients were assessed by the operating time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stay, the time to full weight-bearing, reduction quality, fracture healing time, Harris hip score, and postoperative complications. There was no significant difference between PCCP and PS groups regarding operative time, intraoperative blood loss, hemoglobin level drop, postoperative hospital stays, reduction quality, and Harris hip score (p > 0.05). The time to full weight-bearing and the fracture healing time in the PCCP group were shorter than those in the PS group (p < 0.05). The overall complication rates were slightly lower in the PCCP compared to the PS patients, but there was no significant difference (p > 0.05). However, the implant failure rate was significantly higher in the PS group compared to the PCCP group (p < 0.05). The present study suggests that the PCCP is superior to the parallel screws fixation in the treatment of non-displaced elderly femoral neck fractures in terms of earlier full weight-bearing, shorter fracture healing time, and lower implant failure rate. Therefore, it may be a better therapeutic strategy for non-displaced femoral neck fractures in elderly patients.

Comparative outcome assessment of total hip arthroplasty versus bipolar hemiarthroplasty in intracapsular neck of femur fracture in old age

Background: This prospective study aimed to compare the outcomes of total hip replacement (THR) and bipolar hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods: A total of 30 patients aged over 60 years with femoral neck fractures were included in the study, with 15 patients receiving a bipolar prosthesis and patients receiving THR between June 2021 and January 2023. The patients were followed up for 6 months postoperatively, with functional analysis conducted using the modified Harris hip score. Results: The results showed that the modified Harris hip score was significantly higher in the THR group compared to the bipolar prosthesis group at day 1, 3, 6 and 12 months postoperatively. Pain levels were similar between the two groups at all follow-up intervals. Gait and range of motion were significantly higher in the THR group compared to the bipolar prosthesis group at all-time points. Conclusions: Based on the short-term functional outcomes of this study, THR appears to be a preferable option over bipolar prosthesis for managing femoral neck fractures in elderly.

A lower canal fill rate and unreestablished vertical femoral offset may increase the risk of the postoperative periprosthetic fractures after cementless bipolar hemiarthroplasty for femoral neck fractures in elderly patients.

Periprosthetic fractures (PPFs) is one of the major causes of failure of hip arthroplasty with cementless stem; however, studies on the incidence and risk factors of PPFs after cementless hemiarthroplasty for femoral neck fractures (FNFs) are lacking. This retrospective study included patients who underwent cementless bipolar hemiarthroplasty for displaced intracapsular FNFs. The demographic data were reviewed, Dorr classification was used to describe morphology of the femur, radiological parameters were measured including stem-shaft angle, canal fill ratio (CFR), canal flare index (CFI), morphologic cortical index (MCI), canal calcar ratio (CCR), and vertical and horizontal femoral offset. The sample comprised 10 men and 46 women (affected hip: left, 38; right, 18). The mean patient age was 82.82±10.61 (range, 69-93) years, and the mean hemiarthroplasty to PPFs time was 26.28±14.04 (range, 6.54-47.77) months. Seven (12.28%) patients had PPFs. A significant relationship was found between the incidence of PPF and CFR (p = 0.012), patients had a significantly smaller femoral stem CFR (0.76%±0.11%) than controls (0.85%±0.09%). The PPFs group had a significant shorter and unreestablished vertical femoral offset (p = 0.048). A smaller femoral stem CFR associated with a potentially unacceptably high PPFs risk in uncemented hemiarthroplasty for displaced FNFs may result from mismatched prosthesis and bone dimensions in the elderly population, especially when accompanied by a poorly reestablished vertical femoral offset. With increasing evidence of the benefits of cemented fixation, a cemented stem for the treatment of displaced intracapsular FNFs is recommended for such a elderly frail population.

Functional assessment of bipolar hemiarthroplasty versus total hip replacement in trans cervical neck fracture of femur in elderly patients a prospective observational study

Background: Bipolar hemiarthroplasty and total hip arthroplasty are widely accepted methods of treatment for displaced femoral neck fracture in elderly patients. This study is to compare the functional outcomes of bipolar hemiarthroplasty and total hip arthroplasty in such patients. Methods: This is a prospective study in which data of all patients with age more than 60 with trans cervical neck of femur fracture undergoing total hip arthroplasty and bipolar hemiarthroplasty in a tertiary care centre in Mumbai is studied. They were followed up and compared with the Modified Harris Hip Score. The results were compared between the two groups for statistical significance. Results: There was a significant difference seen in pain and gait at 6 and 12 months between two groups with better scores in the total hip arthroplasty group. Better functional activities were seen at 3 and 6 months in the total hip arthroplasty group. A significant difference was seen in the Total Modified Harris Hip Score at 3, 6 and 12 months and was better in the total hip arthroplasty group as compared to the hemiarthroplasty group. Conclusions: Bipolar hemiarthroplasty is the preferred approach after a displaced femoral neck fracture in the elderly population, but due to potential complications like inguinal pain and low functional outcome, total hip replacement should be considered as the first line of surgical management for the neck of femur fracture in such patients. It has been found to have a good functional outcome, fewer gait disturbances and less post-operative pain.

Comparison of the early clinical efficacy of the SuperPath approach versus the modified Hardinge approach in total hip arthroplasty for femoral neck fractures in elderly patients: a randomized controlled trial

PurposeTo investigate the clinical efficacy and advantages of the SuperPath approach for total hip arthroplasty in the treatment of femoral neck fractures in the elderly population.MethodsFrom February 2018 to March 2019, 120 patients were randomly divided into two groups with 60 patients each: the SuperPath group and the conventional group. The results evaluated included the general operation situation, serum markers, blood loss, pain score, hip function and prosthesis location analysis.ResultsThere was no demographic difference between the two groups. Compared with the conventional group, the SuperPath group had a shorter operation time (78.4 vs. 93.0 min, p = 0.000), a smaller incision length (5.8 vs. 12.5 cm, p = 0.000), less intraoperative blood loss (121.5 vs. 178.8 ml, p = 0.000), a shorter hospitalization time (8.0 vs. 10.8 days, p = 0.000) and less drainage volume (77.8 vs. 141.2 ml, p = 0.000). The creatine kinase level in the SuperPath group was significantly lower than that in the conventional group, while there was no difference in the C-reactive protein level and erythrocyte sedimentation rate level. The visual analog scale score was lower one month postoperatively, and the Harris hip score was higher three months postoperatively in the SuperPath group (p < 0.05). There was no difference in the cup abduction angle or anteversion angle of the two groups.ConclusionWe found better clinical efficacy after using the SuperPath approach with less muscle damage, less postoperative pain and better postoperative function than after using the modified Hardinge approach.Trial registration The randomized clinical trial was retrospectively registered at the Chinese Clinical Trial Registry on 31/12/2020 (ChiCTR-2000041583, http://www.chictr.org.cn/showproj.aspx?proj=57008).

Femoral Neck Fractures in Elderly Patients With Coxarthrosis and High Dislocation: The Application of Conservative Treatment.

In this study, our aim was to evaluate the results obtained by conservative treatment of femoral neck fracture in patients with untreated Crowe type 4 coxarthrosis with high dislocation. This was was a retrospective study done at the Orthopaedics and Traumatology Clinic in a secondary care public hospital between 2002 and 2022, in Türkiye. Femur neck fractures were evaluated in six patients who had untreated Crowe type 4 coxarthrosis with high dislocation. In the study, we had six patients with undiagnosed developmental dysplasia of the hip (DDH) who suffered femoral neck fractures. The youngest among these patients was 76 years old. Conservative treatment (bed rest, analgesics, non-steroidal anti-inflammatory drugs, and, if needed, opiates and low molecular weight heparin for antiembolic treatment) was found to reduce Harris Hip Score (HHS) and Visual Analogue Scale (VAS) scores significantly (p<0,05). Stage 1 sacral decubitus ulcer occurred in two (33.3%) patients. Patients acquired daily activity capacity similar to their situations before fracture within five to six months. None of the patients suffered embolisms and there was no union in the fracture line of the patients. Conclusion:Based on our data, we think that conservative treatment is a remarkable option for these patients, as the complication risks are low and positive results can be obtained. Thus, we may conclude that conservative treatment can be considered in femoral neck fractures of elderly patients with DDH.

Blood-Transfusion Risk Factors after Intramedullary Nailing for Extracapsular Femoral Neck Fracture in Elderly Patients

Extracapsular femoral neck fractures (eFNF) are the third most common type of fracture in traumatology. Intramedullary nailing (IMN) is one of the most frequently used ortho-pedic treatments for eFNF. Blood loss is one of the main complications of this treatment. This study aimed to identify and evaluate the perioperative risk factors that lead to blood transfusion in frail patients with eFNF who undergo IMN. From July 2020 to December 2020, 170 eFNF-affected patients who were treated with IMN were enrolled and divided into two groups according to blood transfusion: NBT (71 patients who did not need a blood transfusion), and BT (72 patients who needed blood transfusion). Gender, age, BMI, pre-operative hemoglobin levels, in-ternational normalized ratio (INR) level, number of blood units transfused, length of hospital stay, surgery duration, type of anesthesia, pre-operative ASA score, Charlson Comorbidity Index, and mortality rate were assessed. Cohorts differed only for pre-operatively Hb and surgery time (p < 0.05). Patients who have a lower preoperative Hb level and longer surgery time have a high blood-transfusion risk and should be closely followed peri-operatively.

Outcomes of Uncemented Bipolar Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients with Cardiac Dysfunction

Objectives: Cementless hemiarthroplasty is advised because it reduces the risk of morbidity and mortality in older individuals who use cement. For older patients with high-risk clinical issues who had femoral neck fractures, we assessed the effectiveness of cementless hemiarthroplasty. Materials and Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. 48 patients, including 19 male and 29 female, with an average age of 88-years. using cementless hemiarthroplasty to treat patients with femoral neck fractures. 30 patients (62%) had porous-coated femoral stems, while 18 patients had modular femoral revision stems (38 percent). All patients had bipolar femoral heads. Following surgery, the follow-up radiologically was performed at yearly intervals. Results: The average number of followup years was 4.2. There were no hospital-related deaths among the patients. Six patients (12%) experienced medical difficulties during the period of follow-up, and 4-patients (8%) passed away. Due to acetabular degradation, only the 2 hips were changed to the total hip replacements. One patient was scheduled for a femoral revision due to a sinking of greater than 3 mm. No patients developed heterotopic ossification or acetabular protrusion. The HHA (Harris-hip average) score is 84. One patient experienced dislocation (2 percent). Practical Implication: The advantages of the cemented technique seem to be offset by its mortality risk and the advantages of the cementless option by its increased morbidity. Thus, in some of these very elderly morbid patients the orthopedic surgeon is faced with a dilemma regarding the correct surgical choice, which should be one that can promise pain relief and rapid resumption of function and, at the same time, prevent mortality and reduce morbidity Conclusion: An appropriate form of therapy for fractures in femoral neck in older individuals with risk of clinical issues, particularly those of the cardiopulmonary character, is cementless hemiarthroplasty. With this technique, after cemented hemi-arthroplasty the risk of fat embolism and hypotension is reduced. Keywords: Uncemented Bipolar Hemiarthroplasty, Uncemented Femoral Prosthesis, Hemiarthroplasty In Elderly, Cardiac Dysfunction, Femoral Neck Fracture.

The Influence of a Modified 3rd Generation Cementation Technique and Vaccum Mixing of Bone Cement on the Bone Cement Implantation Syndrome (BCIS) in Geriatric Patients with Cemented Hemiarthroplasty for Femoral Neck Fractures.

Background and Objectives: Cemented hemi arthroplasty is a common and effective procedure performed to treat femoral neck fractures in elderly patients. The bone cement implantation syndrome (BCIS) is a severe and potentially fatal complication which can be associated with the implantation of a hip prosthesis. The aim of this study was to investigate the influence of a modified cementing technique on the incidence of BCIS. Material and Methods: The clinical data of patients which were treated with a cemented hip arthroplasty after the introduction of the modified 3rd generation cementing technique were compared with a matched group of patients who were treated with a 2nd generation cementing technique. The anesthesia charts for all patients were reviewed for the relevant parameters before, during and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1,2, or 3 depending on the severity of hypotension, hypoxia loss of consciousness. Results: A total of 92 patients with complete data sets could be included in the study. The mean age was 83 years. 43 patients (Group A) were treated with a 2nd and 49 patients (Group B) with a 3rd generation cementing technique. The incidence of BCIS grade 1,2, and 3 was significantly higher (p = 0,036) in group A (n = 25; 58%) compared to group B (n = 17; 35%). Early mortality was higher in group A (n = 4) compared to group B (n = 0). Conclusions: BCIS is a potentially severe complication with a significant impact on early mortality following cemented hemiarthroplasty of the hip for the treatment of proximal femur fracture. Using a modified 3rd generation cementing technique, it is possible to significantly reduce the incidence of BCIS and its associated mortality.

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

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

A localization method for guide pin insertion points in the treatment of femoral neck fracture with closed reduction and percutaneous cannulated screw fixation.

BackgroundClosed reduction and percutaneous cannulated screw fixation is the preferred surgical method for treating femoral neck fractures in elderly patients under 70 years old. The key to the operation is the precise insertion of the guide pin after the successful reduction. However, there is no universally accepted standard for the localization of the guide pin insertion point. This study introduces our invention of a localization method for guide pin insertion points.MethodsWe used fluoroscopic frequency, operative time, union rates, and complications to retrospectively evaluate the treatment and outcome of femoral neck fractures using our localization method for guide pin insertion points. The study included ten patients treated at Affiliated Hospital of Shandong University of Traditional Chinese Medicine between 2010 and 2014 for femoral neck fracture using our localization method for guide pin insertion points.ResultsOur results showed that the mean number of fluoroscopies was 5 (range, 4–8), and the mean operative time was 32 minutes (range, 25–51 minutes). All 10 patients achieved union at an average of 3.4 months (range, 2.8–6.2 months) without complications after the operation. The average follow-up time was 13.2 months (range, 12.2–16 months). The treatment of femoral neck fracture with our localization method for guide pin insertion points resulted in satisfactory curative efficacy without complications.ConclusionsOur localization method offers distinct advantages, including the accuracy and simplicity of the operation, a low rate of complications, and adequate biomechanical stability. As such, it provides a feasible method for clinical treatment.

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients.

ObjectiveTo investigate whether four‐screw fixation in rhombic configuration could improve the clinical outcomes and decrease the complication rate compared with three‐screw fixation in inverted triangle configuration in elderly patients with nondisplaced femoral neck fractures.MethodFrom January 2018 to January 2019, 91 elderly patients with nondisplaced femoral neck fractures who were treated with a cannulated screw system were reviewed retrospectively. The inverted triangle configuration was applied in 51 patients and rhombic configuration in 40 patients. The demographic and perioperative information of the patients were extracted from medical records and surgical records. Variables including incision size, surgical blood loss, surgical time, fluoroscopy time, hospital stays, fracture union time, postoperative visual analogue scale (VAS) scores, and complications were compared between the two groups. Also, Harris hip score at the final follow‐up was used to evaluate the functional outcomes.ResultsAll patients were followed up from 24 to 36 months, with an average of 29.75 months. The average age of patients was 72.37 ± 7.16 years. No significant differences were found between the two groups with regard to patients' age, gender, affected side, Garden classification, Pauwels classification and comminution of posterior wall (P > 0.05). We found shorter incision size (P < 0.001), less blood loss (P = 0.020), less surgical time (P = 0.026), and shorter fluoroscopy time (P < 0.001) in inverted triangle configuration group. However, shorter hospital stays (P = 0.001) and fracture union time (P = 0.002) were found in the rhombic configuration group. The VAS scores were lower in the rhombic configuration group at the first (P < 0.001) and third months (P = 0.010), but no significant difference was found at the sixth month (P = 0.075). Meanwhile, the total complication rate was relatively lower in the rhombic configuration group compared to the inverted triangle configuration group (P = 0.041). Harris hip score presented no significant difference between the two groups at final follow‐up (P = 0.078). No wound infection or cortical perforation occurred in either group.ConclusionFour‐screw fixation in rhombic configuration was superior to three‐screw fixation in inverted triangle configuration in the treatment of nondisplaced femoral neck fractures in elderly patients in terms of less early postsurgical pain, shorter fracture union time, and lower complication rate.