Femoral Neck In Patients Research Articles

Rational in the Preservation of the Femoral Neck in Patients with High Functional Demands. Always or Almost Always?

Total hip arthroplasty [THA] is a cost-effective treatment for dysplastic or senile osteoarthitis. Arthritis of the hip has traditionally been perceived by the general population as a condition of the elderly, although the incidence in younger patients has been well documented [1,2]. Arthritis of the hip can refer to a number of different disorders of the joint and it may arise from many causes, for example: degenerative joint disease, osteonecrosis, dysplasia, Perthes-like deformity, fractures. Young and active patients have much higher expectations of functional outcome from their hip replacement [work related activity as well as recreational activities]. Wear of a mechanical joint is dependent on its usage. THA may be entertained for young patients with advanced intra-articular disorders that are not amenable to treatment with jointpreserving surgeries [3]. The preferred method of fixation of THA remains controversial. Reported rates of cemented and uncemented THA [4] show rates of wear of 0.12 mm/year for both cemented and uncemented components [5]. Patients under 40 years of age have shown slightly inferior outcome with uncemented components when compared with patients older than 40 years in the same study [6].

Stress Fracture of the Femoral Neck in Patient With Excessive Acetabular Anteversion and Coxa Profunda: A Case Report

The underlying pathomechanisms of stress fracture of the femoral neck remains unclear. Repeated or vigorous exercise or insufficient bone strength was known to be a causing factor. Recently, femoroacetabular impingement (FAI) by abnormal contact between acetabular rim and femoral head-neck is possibly known to cause a stress fracture of femoral neck. We experienced a rare case of stress fracture of femoral neck in 59-year-old patient with increased acetabular anteversion and coxa profunda. Focal or general over-coverage of femoral head by acetabulum which might evoke repeated collision between acetabulum and femoral neck caused stress fracture of femoral neck. J Med Cases. 2013;4(7):474-476 doi: http://dx.doi.org/10.4021/jmc1236w

Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry

To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD(MDCT) values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 × BMD(MDCT) - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 × BMD(MDCT) - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures.

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

INTRODUCTIONInformed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified ‘poor consent’ as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures.METHODSA prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas.RESULTSThe two groups were matched for ASA (American Society of Anesthesiologists)grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p=0.0001).CONCLUSIONSThis study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using pre-printed consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified 'poor consent' as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. A prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas. The two groups were matched for ASA (American Society of Anesthesiologists) grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p = 0.0001). This study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using preprinted consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

Can we apply the McLaughlin criteria to aid decision-making in fractured neck of femur patients?

Can we apply the McLaughlin criteria to aid decision-making in fractured neck of femur patients?

A baseline audit to evaluate the quality of nutritional provision delivered to fractured neck of femur inpatients

Background: Fractured neck of femur patients are often malnutrition (Lumbers et al., 2001). Studies have found 30–50% of patients are malnourished on admission, and dietary intake during recovery in hospital is frequently suboptimal resulting in a deterioration of nutritional status, and impaired recovery. The aim was to baseline the nutritional care given to this patient group, and objectives were set to evaluate initial nutritional screening, nutritional interventions delivered and nutritional monitoring. Methods: Data were collected on all fractured neck of femur patients present on an orthopaedic ward on two separate dates in February 2010. Audit standards were set for clinical care, and data were collected using information from the medical/ nursing notes, as well as from observations made on the ward throughout the day. The audit form was designed to capture data on use of nutrition screening and monitoring, delivery of nutritional care and dietetic referrals. In addition, an estimate of the energy and protein intake of each patient was made for the day of the audit, and this was compared with the estimated requirement based on 125 kJ kg−1 (30 kcal kg−1) and 1g protein kg−1. Results: A total of 33 patients were included, the mean age was 83 years (range 49–94 years), 85% were female, and 24% had dementia. Twenty-seven (81%) patients had an initial Malnutrition Universal Screening Tool (MUST) score (BAPEN, 2003) calculated. It was calculated using a measured weight in 18% of these, and nine patients had a previous weight recorded for score calculation. Of these, 51% (17 patients) were given an initial MUST score of zero, indicating a low risk of malnutrition. First-line nutritional care was poorly documented, and often not observed. Assistance was given to 11 (33%) patients but not all these had a red tray. Fifteen (45%) patients were referred to the dietitian. Of those not referred 74% were taking ≤50% of their daily energy requirement; 78.5% patients referred to the dietitian were seen within two working days of referral. Oral nutritional supplements (ONS) were prescribed for 39% patients; this was following dietetic referral in all cases. Fourteen (42%) patients had food record charts in their notes to monitor food intake, and 60% of patients with a MUST score ≥1 were monitored in this way. Only 14% patients who were inpatients for more that 7 days had weight and MUST score repeated weekly. Twenty-one (63%) patients were getting ≤50% of their daily energy requirement, and 45% patients were getting ≤50% of their daily protein requirement on the day of the audit. Discussion: This audit showed that many of the standards of nutritional care were not met, and many patients were not consuming enough energy or protein on the day of the audit. Although evidence suggests that routine supplements are of benefit in this patient group (Volkert et al., 2006), 61% did not have ONS prescribed. These findings were used to devise a dedicated nutritional care pathway, in the form of a flow diagram, to highlight the importance of nutrition in this patient group throughout their hospital stay, and promote best practice in nutritional assessment, delivery and monitoring, as well as trigger routine blanket ONS twice a day, an extra daily snack, and appropriate dietetic referral. Conclusions: This audit has highlighted nutritional care in this high-risk group of patients and that greater dietetic involvement is needed to improve their nutritional status.

Low bone mass in microscopic colitis

BackgroundMicroscopic colitis presents with similar symptoms to classic inflammatory bowel diseases. Osteoporosis is a common complication of Crohn's disease but there are no data concerning bone metabolism in microscopic colitis.AimsThe aim of the present study was to evaluate bone density and metabolism in patients with microscopic colitis.MethodsFourteen patients microscopic colitis were included in the study, and 28 healthy persons and 28 age and gender matched Crohn's disease patients were enrolled as controls. Bone mineral density was measured using dual x-ray absorptiometry at the lumbar spine, femoral neck and the radius. Serum bone formation and bone resorption markers (osteocalcin and beta-crosslaps, respectively) were measured using immunoassays.ResultsLow bone mass was measured in 57.14% patients with microscopic colitis. Bone mineral density at the femoral neck in patients suffering from microscopic colitis and Crohn's disease was lower than in healthy controls (0.852 ± 0.165 and 0.807 ± 0.136 vs. 1.056 ± 0.126 g/cm2; p < 0.01). Bone mineral density at the non-dominant radius was decreased in microscopic colitis patients (0.565 ± 0.093 vs. 0.667 ± 0.072 g/cm2; p < 0.05) but unaffected in Crohn's disease patients (0.672 ± 0.056 g/cm2). Mean beta-crosslaps concentration was higher in microscopic colitis and Crohn's disease patients than controls (417.714 ± 250.37 and 466.071 ± 249.96 vs. 264.75 ± 138.65 pg/ml; p < 0.05). A negative correlation between beta-crosslaps concentration and the femoral and radius t-scores was evident in microscopic colitis patients.ConclusionsLow bone mass is frequent in microscopic colitis, and alterations to bone metabolism are similar to those present in Crohn's disease. Therefore, microscopic colitis-associated osteopenia could be a significant problem in such patients.

Improving prescribing of antiosteoporosis discharge medication in fractured neck of femur patients: a completed audit cycle

Fracture liaison specialist nurses at our institute, perceived deficiency in the level of prescription of osteoporosis secondary prevention medication on discharge of fractured neck of femur (NOF) patients. This aspect of management was therefore audited over two cycles with the aim of evaluating and improving current practice. A prospectively maintained database was utilized to establish identity, demographic data and specialist nurse treatment recommendation for all fractured NOF patients over an initial 12-month period. Computerized immediate discharge letters were reviewed to identify whether the recommended medication had been prescribed. Following the initial audit, fluorescent drug kardex stickers detailing simple treatment recommendations were introduced, and a second audit cycle was carried out using identical methods over the subsequent 12-month period. Primary audit demonstrated that discharge prescriptions included the recommended secondary prevention medications in 50.9%. Following the introduction of fluorescent drug chart stickers detailing the recommendations, re-audit demonstrated improvement to 84.6%. In conclusion, an improvement in the practice of prescription of osteoporosis medications on discharge was demonstrated following the introduction of fluorescent drug kardex stickers.

Evaluation of Osteoporosis in Hemophilic Arthropathy Patients: Correlation with Disease Severity and Serum Trace Minerals

Objective. To find out the presence of osteoporosis in hemophilic arthropathy patients and its correlation with clinical severity and serum levels of magnesium, copper, and zinc. Methods. Joint score, functional assessment score, bone densitometry, and serum magnesium, copper and zinc were done in twenty male hemophilic arthropathy patients and twenty controls. Results. There was highly significant lower Z scores of lumbar spine and neck of femur in patients versus controls (P < 0.011). Z score of neck of femur correlated negatively with total joint score (P = 0.013) and functional assessment score (P = 0.011). Serum levels of copper and zinc correlated positively with Z score of neck of femur (P = 0.004, P = 0.001, resp.). Conclusion. Osteoporosis represents a frequent concomitant observation in hemophiliacs. Screening of young hemophiliacs for osteoporosis is recommended with measuring serum levels of magnesium, copper, and zinc for better management of the disease.

Can I.V. paracetamol reduce the opiate usage in acute fracture neck of femur patients? A district general hospital experience

Can I.V. paracetamol reduce the opiate usage in acute fracture neck of femur patients? A district general hospital experience

Audit: initial assessment and management of fracture neck of femur patients in the emergency department and the “Fast Track” system

Audit: initial assessment and management of fracture neck of femur patients in the emergency department and the “Fast Track” system

Albumin is a significant predictor of mortality in fractured neck of femur patients whilst age, length of stay and time to operation are not

Albumin is a significant predictor of mortality in fractured neck of femur patients whilst age, length of stay and time to operation are not

Alendronate decreases the fracture risk in patients with prostate cancer on androgen‐deprivation therapy and with severe osteopenia or osteoporosis

To evaluate changes in bone mass and fracture risk in patients with prostate cancer on androgen-deprivation therapy (ADT) and with a basal T-score of >-2.0, who were treated with an oral bisphosphonate, as such patients treated with ADT are at increased risk of bone loss and bone fracture. We selected 61 patients with prostate cancer treated with ADT; 31 were treated with oral alendronate 70 mg once-weekly and a control group of 30 were not. At baseline and 12 months we measured bone mineral density (BMD) of the lumbar spine, femoral neck and total hip by dual-energy X-ray absorptiometry. All patients had severe osteopenia or osteoporosis at baseline. The risk of femoral neck fracture was calculated at baseline and 12 months (Z-score 2.7). Patients treated with alendronate had a significant increase in BMD at the lumbar spine and femoral neck after 1 year of follow-up, with mean (sd) values of 1.06 (0.26) vs 1.01 (0.21) g/cm(2) at baseline (P < 0.001), and 0.75 (0.07) vs 0.73 (0.07) g/cm(2) (P = 0.03), respectively, while the control group had a significant loss of BMD at the total hip of 0.79 (0.14) vs 0.81 (0.13) g/cm(2) (P = 0.03). BMD was significantly improved at the three locations in patients treated with alendronate compared with the control group, with differences at the lumbar spine, femoral neck and total hip of 0.05 (0.07) vs 0.01 (0.10) (P = 0.001), 0.01 (0.04) vs -0.002 (0.03) (P = 0.04) and 0.01 (0.04) vs -0.01 (0.02) g/cm(2), respectively (P = 0.001). Patients treated with alendronate had a significant decrease in the fracture risk at the femoral neck, by -0.54 (1.29) (P = 0.04) after 1 year of follow-up. Treatment with once-weekly 70 mg alendronate significantly improved the BMD at the lumbar spine and femoral neck in patients with prostate cancer with severe osteopenia or osteoporosis and on ADT, and significantly decreased the risk of femoral neck fracture.

Antibiotic usage in fractured neck of femur patients with Clostridium Difficile associated diarrhoea

Antibiotic usage in fractured neck of femur patients with Clostridium Difficile associated diarrhoea

Role of valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate in the management of neglected and ununited femoral neck fracture in young patients

BackgroundHead preservation is the mainstay of management in younger patients with neglected or ununited intracapsular fracture neck of femur. Very few reports have dealt with the results of valgus intertrochanteric osteotomy and fixation with dynamic hip screw in such cases. In this prospective study, we have tried to evaluate the role of valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate in neglected or ununited intracapsular fracture neck of femur in patients below 60 years of age and whose time since injury is equal to or more than 3 weeks.Materials and methodsWe treated 16 such cases with valgus intertrochanteric osteotomy and fixation achieved with dynamic hip screw and 120° double angle barrel plate, with mean age of 36.4 years. The cases were evaluated radiologically and clinically at a mean of 19 months.ResultsIn 14 of the 16 patients, the fracture went on to satisfactory union after an average of 14.7 weeks (10–26.7 weeks). The average Harris hip score increased from 66.6 points (range 55–75 points) before surgery to 88 points (range 75–95 points). All the patients with united fractures were able to sit cross-legged, squat and do one-leg stance. Pain and limitation of motion improved remarkably. Two patients had unfavourable outcome; both had cut-through of the implant, out of the head.ConclusionsValgus intertrochanteric osteotomy is a very cheap and effective procedure to achieve union in neglected and ununited fracture neck femur in young patients. We propose fixation with dynamic hip screw and 120° double angle barrel plate as it provides additional compression and, with valgus osteotomy, improved stability of internal fixation, with few complications.

Impact of operative delay in fracture neck of femur patients on clopidogrel

Impact of operative delay in fracture neck of femur patients on clopidogrel

Bone Graft for Large Bone Cysts of the Femoral Neck in Patients on Hemodialysis

Pathologic fracture of the femoral neck from an amyloid bone cyst in patients on long-term hemodialysis causes substantial morbidity. For patients with a bone cyst occupying more than 1/2 of the neck width, we have performed prophylactic internal fixation with an autogenous iliac bone graft. We describe our surgical technique and present clinical results from consecutively surgically treated patients. We determined whether our procedure successfully induced healing of the bone cyst, thus preventing a problematic sequel of fracture. From 1990 to 2003, 14 hips in 12 patients were treated, and the clinical results from these patients were retrospectively reviewed. One patient died 3 months after surgery; the remaining patients were followed for at least 3 years. In those 11 patients, bony healing was achieved in all cases with no recurrence of the cystic lesion. Considering the comparatively unsatisfactory results of internal fixation for pathologic fracture and THA for patients receiving long-term hemodialysis, our procedure gives surgeons another option for treating this difficult problem.

Fracture neck of femur in haemophilia A – experience from a cohort of 11 patients from a tertiary centre in India

We describe here the management of eleven patients with fracture neck of femur. Excepting one patient all had severe haemophilia A. Nine patients were less than 50 years of age. Eight out of eleven patients had fracture after trivial trauma. Nine patients had closed reduction and one patient open reduction. The patient with non union had a Valgus osteotomy. All fractures united. The average time to union was 11 weeks (range:8-16). We followed either a low dose intermittent or a low dose continuous infusion factor support protocol for the management of these patients. The median dose of factor support was 252 u/kg (range: 136-580). The average duration of factor support was 9 days (range: 7-10). Two patients had aggravation of pre existing knee stiffness following post operative immobilisation. No other major complication was observed in this cohort of patients. To conclude, management of fracture neck of femur in patients with haemophilia is no different from general population if an adequate haemostasis is achieved.

Has the provision of evening trauma lists improved the time to operation for fracture neck of femur patients?

Has the provision of evening trauma lists improved the time to operation for fracture neck of femur patients?