Neck Of Femur In Adults Research Articles

To Evaluate Functional Outcomes of Dynamic Hip Screw with Derotation Screw versus Cannulated Cancellous Screw in Basicervical Fracture Neck of Femur in Adults

To Evaluate Functional Outcomes of Dynamic Hip Screw with Derotation Screw versus Cannulated Cancellous Screw in Basicervical Fracture Neck of Femur in Adults

A study of clinical, functional and radiological outcome of unipolar versus bipolar hemiarthroplasty in displaced fracture neck of femur in adults

Displaced neck of femur fracture in adults and its complications are responsible for a significant amount of morbidity and mortality. Unipolar and bipolar hemiarthroplasty helps in early mobilization of the patient as well as prolongs their productive life. 50 patients with intracapsular fracture neck of femur were included in this study. 25 patients were treated with unipolar hemiarthroplasty and 25 patients with bipolar hemiarthroplasty, respectively. Patients belonging to both the groups were evaluated for functional outcome by using the Harris Hip Score. Patients were also evaluated radiologically. Our overall mean Harris hip score pre-operatively for unipolar hemiarthroplasty was 37.5 and bipolar hemiarthroplasty was 41, which increased to a score of 88.2 for unipolar and 90.2 for bipolar hemiarthroplasty. While the overall clinical outcomes were closely comparable, the functional hip score was slightly better in the bipolar group. In our series we had 35% excellent result in the Bipolar whereas we had 15% excellent result in the unipolar Hemiarthroplasty group.

Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review

Introductions: Avascular necrosis and non-union are common but when the neck of femur fracture in adult is neglected, the chances of complications rises. Among various treatment options, we report the outcome of free fibular strut graft along with two cannulated hip screws in neglected fracture neck of femur.
 Methods: The outcome analysis of ‘fibular strut graft and two cannulated hip screws’ was conducted in patients with fracture neck of femur who presented at least three weeks after the time of injury, during August 2008 to December 2017, at Lumbini Zonal Hospital and Lumbini Hospital Technical College, Butwal, Nepal. All adult patients aged 18 to 60 years were included. Outcome variables were healing of fracture (union, delayed union, non-union), avascular necrosis and Harris Hip Score (HHS).
 Results: Out of 20 fractures, 17 (85%) united uneventfully, 2 (10%) had delayed union and 1 (5%) nonunion. We had 3 (15%) avascular necrosis of femoral head. The HHS was excellent in 8 (40%), good in 4 (20%), fair in 6 (30%) and poor in 2 (10%).
 Conclusions: Fibular Strut graft with two hip screws resulted in fracture union and improved hip functions in patients with neglected fracture of neck of femur.

Result of cancellous screw fixation in fracture neck of femur in adults

Background: Cancellous screw fixation is commonly performed procedures for the management of fracture neck of femur in adults. Cancellous screw fixation is associated with high percentage of excellent and good results and is associated with reduced invasion and short operative time.Objectives 1. To study the incidence of fracture neck of femur according to various grades of Garden’s classification.2. To study the quality of life after screw fixation using Modified Harris Hip Scoring (MHHS) system.3. To evaluate the results of screw fixation in various grades of Garden’s classification. Patients and Methods: Adult patients ranging from 20-50 years those suffering from fracture neck of femur were treated by cancellous screw fixation. The study was carried out to evaluate the immediate and early results of cancellous screw fixation for intracapsular fracture neck of femur in young adults.Results: Study conducted on 50 patients of both sex and age between 20 yrs and 50 yrs within the period of 2 years those suffering from fracture neck of femur and treated by cancellous screw fixation and follow up was done at 6 weeks, 3 months, 6 months and 9 months and Modified Harris Hip Score was noted. Data was tabulated and statistically analysed.Conclusions: Our study showed 76% having excellent results, 18% having good results, 2% having fair and 4% poor results. It was found that there is correlation between initial displacement and the final functional scores. In our study, undisplaced fractures (grade I and II) consistently showed excellent and good results whereas displaced fractures (grade III and IV) were associated with fair and poor results also.

Functional outcome of intracapsular fracture of neck of femur-osteosynthesis by cannulated cancellous screw fixation in adults

Introduction: Fractures of neck of femur have always presented great challenges to the orthopaedic surgeons. This remains, even today, an unsolved fracture as far as treatment and results are concerned. Results depend upon the extent of injury, timing of surgery and adequacy of reduction and fixation. Fixation with cannulated cancellous screws is usually adequate for femoral neck fractures. Lateral cortex plays a very important role in screw fixation. Aims and objectives: To study the effectiveness of cannulated cancellous screw fixation for treatment of fracture of neck of femur in adults. Materials and methods: This study was conducted at NRI Institute of Medical Sciences, Visakhapatnam, AP from March 2016 to February 2019. The patients with intracapsular fracture of neck of femur are evaluated with pre-operative X-rays of pelvis with both hips and X-ray of the concerned hip joint both in anteroposterior and lateral views and their outcome was evaluated postoperatively after fixation with cancellous screws. The outcome is evaluated in terms of pain relief, extent of ambulation achieved after surgery. The classifications we followed are Pauwel’s and Garden’s classification of fracture of neck of femur. The patients were followed up to one year to assess the functional outcome. Observation and results: A good result was obtained in 66.1% of the patients, excellent in 23.2%, fair in 3.8% and poor result in 6.9% of the patients. Complications such as Non-union & avascular necrosis in one case, Non-union and Extrusion of screws in one case, Cut through of screws into articular surface leading to painful joint in one case. Most of the cases of intracapsular neck of femur were in the age group of 31-40 years. There was male preponderance as shown in this study (69%). Conclusion: By the usage of multiple cannulated cancellous lag screws, compression effect at the fracture site is achieved, it also avoids re-displacement and rotations. The implant occupies less volume in the small-sized femoral necks of South Indian patients allowing better osteosynthesis of intracapsular fracture of neck of femur. Multiple cannulated cancellous screw fixation for intracapsular fracture of neck of femur is an easy, safe & useful procedure with encouraging results.

Classification of fracture neck of femur

There are numerous classification systems for fracture neck of femur in adults. A fracture classification is proposed either for taxonomical purpose, characterization, guiding intervention, or predicting outcomes of intervention. The classifications described in this chapter are needed to decide on choice of implant, stability, acceptability of reduction, vascularity and long term prognosis.

P233 Long-term Impact Of Inhaled Corticosteroids On Bone Mineral Density And Fracture Risk In Patients With Asthma: Systematic Review And Meta-analysis

Background A recent meta-analysis of 16 randomised controlled trials (RCTs) and 7 observational studies demonstrated a modest but statistically significant increase in fracture risk with inhaled corticosteroid (ICS) use in chronic obstructive pulmonary disease. However, it is not clear whether ICS use has similar skeletal adverse effects in patients with asthma. We aimed to evaluate the association between ICS and fractures and changes in bone mineral density when used for >12 months in asthma. Methods We initially searched MEDLINE and EMBASE in July 2013, and performed an updated PubMed search in June 2014. We used a combination of search terms involving drug name and adverse effects of interest, and we also hand-searched reference lists of existing systematic reviews and trial reports. We selected RCTs and controlled observational studies of any ICS vs non-ICS control treatment for asthma (at least 52 weeks duration). Meta-analysis of odds ratios was conducted using RevMan 5.3 with the primary outcome measure being fracture events. We also analysed mean differences in bone mineral density (gram per cm squared) using inverse variance method. Heterogeneity was assessed using the I2 statistic. Results We selected nine RCTs and 11 observational studies for the meta-analysis. There was no significant association between ICS and fractures in children in one RCT, or in a pooled analysis of two observational studies, (OR 1.02, 95% CI 0.94–1.10). No significant fracture risk in adults was reported in 4 observational studies (pooled OR 1.09, 95% CI 0.45–2.62). Meta-analysis of bone mineral density at the lumbar spine did not show significant reductions with ICS use in children (three RCTs and three observational studies), or in adults (three RCTs and four observational studies). Similarly, meta-analysis of bone mineral density at the neck of femur in adults did not demonstrate significant reductions compared to control (three RCTs and four observational studies). Conclusion In our systematic review of 20 studies, use of ICS for >12 months in patients with asthma was not associated with statistically significant adverse effects on bone mineral density or fractures.

Nurse administered fascia iliaca compartment block for pre-operative pain relief in adult fractured neck of femur

Summary Aim To assess the efficacy of fascia iliaca compartment block (FICB) administered by pain specialist nurses to relieve pain after fractured neck of femur in adults. Method Approval was obtained to train two pain nurses on how to perform FICB. Exclusion criteria were set out and adhered to. 30 ml of 0.25% plain bupivacaine was given to establish the block. Pain score using the visual analogue scales was documented pre-block and then at 15 min, 2 h, 8 h and 24 h after the block. Results Eleven male and 24 female patients aged 62–102 years had the block. The pain score at presentation for all the patients was 8–10. Fifty-four, 72.7, 77.4 and 80% of the patients had a pain score of 4 or less at 15 min, 2 h, 8 h and 24 h, respectively, after the block. The frequency for the additional analgesics varied between 0 and 2 times in 24 h post-block. There were no reported complications as a result of the procedure. Conclusion FICB provided pain relief after fractured neck of femur in more than 70% of patients and can be successfully performed by other trained health care providers without anaesthetic background.

Uncemented Austin–Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture neck of femur—Comparison of complications and patient satisfaction

Austin-Moore and Thompson monobloc prostheses are both commonly used for hemiarthroplasty for displaced fractures of the neck of femur in adults. There is an ongoing debate about, which of these prostheses should be preferred. We present a comparison of two groups of patients with this fracture treated using cemented Thompson prosthesis and uncemented Austin-Moore prosthesis. Mortality, morbidity and patient satisfaction in the two groups were compared. Cemented Thompson hemiarthroplasty was associated with significantly better patient satisfaction scores. There was no difference in the mortality rates and hospital stay. Patients preferred cemented unipolar Thompson hemiarthroplasty over the uncemented unipolar Austin-Moore hemiarthroplasty. A larger randomised prospective trial is needed to confirm this finding.