Rate Of Femoral Head Necrosis Research Articles

Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study

BackgroundRobots are being used in a wide range of surgical procedures. However, in clinical practice, the efficacy of orthopedic robotic-assisted treatment of femoral neck fractures is still poorly reported, particularly in terms of screw placement accuracy, femoral neck fracture healing rates and postoperative functional recovery. Moreover, there is a lack of comparative analysis between robot-assisted surgery and traditional surgical approaches.PurposeThe purpose of this study was to compare the clinical outcomes of patients with femoral neck fractures treated with TiRobot-assisted hollow screw fixation with those of patients with femoral neck fractures treated with traditional surgical approaches.MethodsThis study included 112 patients with femoral neck fracture who were treated from March 2017 to October 2021 with percutaneous hollow screw internal fixation. These included 56 cases in the TiRobot-assisted surgery group and 56 cases in the standard surgery group. After at least 1 year of follow-up, the treatment outcomes of the two groups were compared, including the amount of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, the length of hospital stay, the accuracy rate of screw placement, the final Harris Hip Score, the fracture healing rate, and the rate of femoral head necrosis. Statistical analysis software was used to process and analyze the result.ResultsThe TiRobot-assisted group had a statistically significant improvement over the control group in terms of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, length of hospital stay, accuracy of screw placement and incidence of femoral head necrosis (P < 0.05). There was no statistically significant difference in time to surgery, final Harris hip score and fracture healing rate (P > 0.05).ConclusionThis study shows that TiRobot-assisted surgery has the advantages of short hospital stay, high safety, minimally invasive, high success rate of nail placement, and can reduce the amount of intraoperative radiation and the incidence of femoral head necrosis, thus achieving satisfactory clinical outcomes, and is worthy of clinical promotion.

Prevention of sclerosis around cannulated screw after treatment of femoral neck fractures with bioceramic nails: a finite element analysis

PurposeConventional cannulated screws (CS) are the main treatment method for femoral neck fractures (FNF). However, the rate of femoral head necrosis remains high after FNF treatment. The study aimed to compare the biomechanical features of different internal fixation materials for the treatment of Pauwel type III FNF to explore new strategies for clinical management.MethodsA new material was prepared by applying casting, freeze drying and sintering process. The independently developed calcium magnesium silicate ceramic powder and hydrogel solution were evenly mixed to obtain a high-viscosity bio-ink, and a bioceramic nail (BN) with high mechanical strength and high fracture toughness was successfully prepared. Four internal fixations were developed to establish the Pauwel type III FNF and healed fracture finite element models: A, three CSs; B, three BNs; C, two BNs and one CS; D, one BN and two CSs. Von Mises stress and displacement of the implants and femur were observed.ResultsThe measured Mg content in ceramic powder was 2.08 wt%. The spectral data confirmed that the ceramic powder has high crystallinity, which coincides with the wollastonite-2 M (PDF# 27–0088). The maximum von Mises stresses for the four models were concentrated in the lower part of the fracture surface, at 318.42 Mpa, 103.52 MPa, 121.16 MPa, and 144.06 MPa in models A, B, C, and D, respectively. Moreover, the maximum Von-mises stresses of the implants of the four models were concentrated near the fracture end at 243.65 MPa (A) and 58.02 MPa (B), 102.18 MPa (C), and 144.06 MPa (D). The maximum displacements of the four models were 5.36 mm (A), 3.41 mm (B), 3.60 mm (C), and 3.71 mm (D). The displacements of the three models with BNs were similar and smaller than that of the triple CS fracture model. In the fracture healing models with and without three CSs, the greatest stress concentration was scattered among the lowest screw tail, femoral calcar region, and lateral femur shaft. The displacement and stress distributions in both models are generally consistent. The stress distribution and displacement of the three healed femoral models with BNs were essentially identical to the healing models with three CSs. The maximum von Mises stresses were 65.94 MPa (B), 64.61 MPa (C), and 66.99 MPa (D) while the maximum displacements of the three healed femoral models were 2.49 mm (B), 2.56 mm (C), and 2.49 mm (D), respectively.ConclusionsBioceramic nails offer greater advantages than conventional canulated screws after femoral neck fractures. However, the combination of bioceramic nails and CSs is more clinically realistic; replacing all internal fixations with bioceramic nails after the healing of femoral neck fractures can solve the problem of sclerosis formation around CSs and improve bone reconstruction by their bioactivity.

Femoral head necrosis rate and risk factors after internal fixation of femoral neck fracture:a Meta-analysis

To study the incidence and risk factors of osteonecrosis of the femoral head (ONFH) after internal fixation in adult patients with femoral neck fracture (FNF) after 2000, and identify high-risk population of ONFH. PubMed, Medline, The Cochrane Library, CNKI, Wanfang and VIP Database were searched to collect all the literatures on ONFH and related risk factors after internal fixation of FNF from January 1th 2000 to July 1th 2020. Study extraction was performed according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literatures extraction, management and data entry, and R Studio 3.6.5 software was used for Meta-analysis. Subgroup analysis, sensitivity analysis and publication bias detection were used to explore the sources of heterogeneity and the reliability of the evaluation results. A total of 16 studies with 5521 patients were included. Meta-analysis showed that the incidence of ONFH after internal fixation for adult FNF was 14.5% [95% CI(0.126-0.165)]. Fracture displacement[OR=0.27, 95%CI(0.21-0.35)] and reduction quality [OR=0.15, 95%CI(0.09-0.27)] were related risk factors for ONFH. The results of subgroup rate analysis showed that the non-displaced fracture necrosis rate was 6.2%[95%CI(0.051-0.077)] and the displaced fracture necrosis rate was 20.4% [95%CI(0.166-0.249)];the good reduction fracture necrosis rate was 8.3%[95%CI(0.072-0.095)] and the poor reduction fracture necrosis rate was 35.5%[95%CI(0.233-0.500)]. The included literatures have good consistency and no publication bias. After 2000, the total incidence of ONFH after internal fixation of adult FNF has decreased, while the necrosis rates of patients with displaced fracture and poor reduction are still at a high level. The interval between injury and surgery was not analyzed in this study because of the inconstant division in the original literature.

Comparison of clinical efficacy of two different pin arrangements for external fixation of femoral neck fracture

To retrospectively analyze the clinical efficacy of external fixation in the treatment of femoral neck fracture with two different pin layout. From April 2000 to April 2018, 140 cases of femoral neck fracture were treated with closed reduction and percutaneous pin external fixation, among them 121 cases were followed up for more than 1 year, including 31 cases in traditional group, 12 males and 19 females, aged 45 to 74(65.4±8.4) years;90 cases in modified group, 39 males and 51 females, aged 12 to 75 (64.5±7.8) years. In traditional group, the first needle was put on the femoral talus, the second and third needles were put under the tension line, and the three needles were not on the same line in the lateral phase; in modified group, the first needle was drilled into the lateralcortex of the femur, obliquely penetrating the distal and proximal end of the femoral talus fracture, and the other two needles were drilled into the medial cortex of the femoral neck and the femoral talus, respectively. The operation time, hospital stay, postoperative ambulation time, femoral neck shortening rate, fracture healing time, fracture healing rate and femoral head necrosis rate of the two groups were observed and compared. Harris hip function score was used one year after operation. These 121 patients were followed-up, the follow up time of traditional group was 13 to 45(30.5±11.4) months;the follow-up time of modified group was 14 to 120(34.5±12.5) months. There was no significant difference in operation time, hospital stay and femoral head necrosis rate between two groups (P>0.05). There were significant differences between two groups in the time of going to the ground, shortening rate of femoral neck, fracture healing time, fracture healing rate and Harris functional score of the hip 1 year after operation (P<0.05). Compared with the traditional group, the modified group has the advantages of lower femoral neck shortening rate, shorter fracture healing time, higher fracture healing rate and higher Harris hip function score.

Platelet-rich plasma combined with core decompression and bone grafting in the treatment of non traumatic necrosis of femoral head in ARCO stageⅡ

To observe the clinical effect of platelet rich plasma (PRP) combined with β tricalcium phosphate bioceramic bone in the treatment of non traumatic necrosis of the femoral head in ARCO stageⅡ. From January 2017 to December 2018, 100 patients (160 hips) with ARCO stageⅡnon traumatic necrosis of the femoral head were divided into PRP group and control group. In PRP group, 50 patients (80 hips), 22 males and 28 females, aged from 18 to 65 (43.47± 7.23) years, with a course of 4 to 18 (15.8±2.9) months, underwent core decompression and bone grafting combined with PRP implantation. There were 50 cases (80 hips) in the control group, including 27 males and 23 females, aged 20 to 63 (45.72± 7.43) years, and the course of disease was 6 to 19 (14.9±3.8) months. Hip X-ay film was followed up after operation. Harris score and VAS score were used to evaluate the curative effect, and the survival rate of hip joint was recorded. All patients had good wound healing, no infection, thrombosis and other complications. All patients were followed up for 12 to 14 (12.0±0.4) months. Twelve months after operation, the image expression of PRP group was better than that of control group(P<0.05). Harris hip score and VAS score of pain at twelve months after operation were 89.98±6.17 and 1.68±1.02 in PRP group and 81.62±5.62 and 2.52±1.13 in control group, respectively. The survival rate of 96.25% in PRP group was significantly higher than 86.25% in control group. The postoperative score of two groups was higher than that before operation(P<0.05), but PRP group was better than control group at any time point statistical significance (P<0.05). Platelet-rich plasma(PRP) combined with artificialbone for core decompression and bone grafting can change the situation of simple artificial bone implantation and uncertain curative effect, improve the success rate of this operation, effectively reduce the collapse rate of femoral head necrosis in the early and middle stage, delay or even avoid hip replacement.

Study on the risk factors for the misdiagnosis of femoral head osteonecrosis

To evaluate the status and risk factors for the misdiagnosis of femoral head osteonecrosis, providing the basis for accurate diagnosis of osteonecrosis of femoral head. The data of 314 hospitalized patients were collected from March 2015 to March 2016, and the risk factors for osteonecrosis of femoral head were analyzed by Logistic regression model. Misdiagnosis was defined that the diagnosis given on the first time was different from that on the second time or that given by expert group with the same symptoms and signs. The general data, predisposing factors, time of onset, hospital visits, clinical manifestations, X-ray film of hip joint, MRI and other data were statistically analyzed. Total 127 patients experienced misdiagnosis (up to 40.8%). Among them, the patients with osteonecrosis of femoral head misdiagnosed as other diseases accounted for 77.2% and the patients with other diseases misdiagnosed osteonecrosis of femoral head accounted for 22.8%. Statistical analysis showed that the predisposing factors, history of glucocorticoid and alcohol intake, diseased lower limb, pained lower limb, hidden disease attack, the level of first reception hospital and expert were significantly related with the misdiagnosis of femoral head osteonecrosis based on the logistic regression model (P<0.05) . The relationship between misdiagnosis and gender, age, primary disease taking glucocorticoid, approach and time of glucocorticoid use, the type of alcohol, drinking time had no statistical significance(P>0.05). The Logistic regression analysis showed that the hidden disease attack(OR=3.059) and level of first reception expert(OR=2.778) were the high risk factors associated with the misdiagnosis in which the femoral head necrosis was misdiagnosed as other diseases(P<0.01), and glucocorticoid intake history was the low risk factors(OR=0.387)(P<0.05). The Logistic regression analysis showed that the level of first reception expert (OR=3.573) was the high risk factor associated with the misdiagnosis in which the other diseases were misdiagnosed as necrosis of femoral head. Misdiagnosis rate of femoral head necrosis is high. Hidden disease attack and low level of first reception expert are the high risk factors associated with the misdiagnosis in which the femoral head necrosis was misdiagnosed as other diseases, however, glucocorticoid intake history is the protective factor of misdiagnosis. Low level of first reception expert is the high risk factor associated with the misdiagnosis in which other diseases were misdiagnosed as necrosis of femoral head.

Quadratus femoris muscle pedicle bone flap transplantation in the treatment of femoral neck fracture for Chinese young and middle-aged patients: A systematic review and meta-analysis

PurposeTo compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus AO hollow compression screw fixation in the treatment of femoral neck fracture for Chinese young and middle-aged patients. MethodsCase-controlled studies (CCTs) were used to compare the two operative methods in the treatment of femoral neck fractures. Data were retrieved from the Cochrane Library, Pubmed Database, CNKI, Chinese Biomedical Database.Wanfang Data published during the period of January 2005 to December 2014. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical Software Revman 5.0 was used for data-analysis. ResultsEight articles were included in the meta-analysis. The results showed that there was statistical significance in the rate of fracture healing [OR = 5.43, 95% CI (2.89, 10.20), p < 0.05], the rate of good function of hip joint [OR = 5.12, 95% CI (3.21, 8.17), p < 0.05], the rate of femoral head necrosis [OR = 4.21, 95% CI (2.02, 8.76), p < 0.05], the time of fracture healing [WMD = −46.85, 95% CI (−65.13, −28.56), p < 0.05] between the two groups. ConclusionsFor the treatment of femoral neck fractures, the transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw; fixation is superior to the AO hollow compression screw fixation in terms of the rate; of fracture healing, the rate of good function of hip joint, the rate of femoral head; necrosis and the time of fracture healing.

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

Short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in middle-aged and elderly patients

To evaluate the feasibility and short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in the middle-aged and elderly patients. A retrospective analysis was made on the clinical data of 13 patients with femoral neck fracture undergoing fixation with polyaxial locking plates between September 2013 and June 2015 (group A) and 13 patients with femoral neck fracture undergoing fixation with three cannulated screws in the same period (group B). There was no significant difference in gender, age, side, cause of injury, Garden type, type of fracture position, type of Pauwels angle, Singh index, time between injury and operation, and preoperative complications between 2 groups ( P>0.05). The femoral neck shortening at 1 year postoperatively, and fracture nonunion, femoral head necrosis, and Harris hip score at last follow-up were compared between 2 groups. The follow-up time was (19.23±3.98) months in group A and (18.00±3.61) months in group B, showing no significant difference between 2 groups ( t=2.063, P=0.417). No femoral head necrosis occurred in group A, but head necrosis occurred in 1 case of group B, and hemiarthroplasty was performed. There was no significant difference in the rate of femoral head necrosis between 2 groups ( χ2=0.000, P=1.000). Bone union was obtained in the other patients of 2 groups. The Harris hip score of group A (85.23±2.95) was significantly higher than that of group B (81.92±3.64) at last follow-up ( t=2.064, P=0.018). No infection or internal fixation failure occurred in 2 groups. One case had pain at the outer thigh at 1 month after operation in group A, but pain relief was achieved at 3 months after operation. At 1 year after operation, no femoral neck shortening occurred in group A, but degree I, II, and III femoral neck shortening was observed in 3, 2, and 8 cases of group B, respectively, showing significant difference between 2 groups ( Z=-4.714, P=0.000). Although fixation with polyaxial locking plate for femoral neck fracture in the middle-aged and elderly patients has similar femoral head necrosis rate to fixation with cannulated screws, it has advantages in preventing neck shortening and improving hip joint function after operation.

Meta-analysis of quadratus femoris muscle pedicle bone flap transplantation in the repair of femoral neck fracture for young and middle-aged patients

Objective To compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients. Methods Case-controll studies comaring the quadratus femoris muscle pedicle bone flap transplantation with hollow compression screw fixation in the repair of femoral neck fracture were retrieved from CNKI, Chinese Biomedical Database, Wanfang Data and manually (from January, 2005 to December, 2014). Methodological quality of the trials was critically assessed, and relevant data were extracted. Statidtical software Revman 5.0 was used for data-analysis. Results Eight articles were included in the meta-analysis. The results showed that, compared the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation with hollow compression screw fixation,there were statidtical significance in the rate of fracture healing [OR= 5.43, 95%CI(2.89, 10.20), P < 0.05], the rate of good function of hip joint [OR= 5.12, 95%CI(3.21, 8.17), P < 0.05], the rate of femoral head necrosis [OR= 4.21,95%CI(2.02,8.76), P < 0.05], the time of fracture healing [WMD=-46.85, 95%CI(-65.13, -28.56), P < 0.05]. Conclusion The transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw fixation is superior to the hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients in regards to the rate of fracture healing, the rate of good function of hip joint, the rate of femoral head necrosis, the time of fracture healing. Key words: Femoral neck fracture; Quadratus femoris muscle pedicle bone flap; Hollow compression screw fixation; Meta-analysis

Oblique and non-oblique cannulated screwing for senile femoral neck fractures: a comparative study

Objective To compare the clinical outcomes between oblique and non-oblique fixation with cannulated screws for femoral neck fractures in the elderly patients. Methods Totally 189 patients of over 65 years old were treated for femoral neck fracture from June 2007 to October 2013 at our department. Oblique fixation with cannulated screws was used in 130 cases. They were 43 males and 87 females with an average age of 77.8±7.5 years. According to Garden classification, 40 cases were of Garden types I and Ⅱ(undisplaced fractures), and 90 of Garden types Ⅲ and Ⅳ (displaced fractures). Of them 26 were Pauwells type Ⅲ. Non-oblique fixation with cannulated screws was conducted in 59 cases. They were 24 males and 35 females with an average age of 75.5±8.2 years. According to Garden classification, 12 cases were of Garden types I and Ⅱ (undisplaced fractures), and 47 of Garden types Ⅲ and Ⅳ (displaced fractures). Of them, 15 were Pauwells type Ⅲ. The fracture union, postoperative complications, rate of reoperation and Harris scores at the last follow-up were compared between the 2 groups. Results All the 189 patients were followed up for 10 to 38 months (average, 17.4 months). The oblique fixation led to a union rate of 99.2% (129/130), a fixation failure rate of 3.1% (4/130) and a femoral head necrosis rate of 2.3% (3/130), which were not significantly different from those resulted from the non-oblique fixation [98.3% (58/59), 10.2% (6/59) and 5.1% (3/59) respectively] (P>0.05). However, the rate of femoral neck shortening [35.4% (46/130)] and the reoperation rate [3.1% (4/130)] in the oblique fixation group were significantly lower than those in the non-oblique fixation group [50.8% (30/59) and 15.3% (9/59) respectively] (P<0.05). The mean Harris hip score at the last follow-up for the oblique fixation(75.7±14.3) was significantly higher than that for the non-oblique fixation (70.8±16.7) (P<0.05). Conclusion As oblique cannulated screwing can reduce the rates of femoral neck shortening and reoperation to some extent, it may be a better fixation choice than the non-oblique cannulated screwing for femoral neck fracture in elderly patients. Key words: Femoral neck fractures; Fracture fixation, internal; Bone nails; Aged

Treatment of Garden III and IV fractures of the femoral neck in young adults with vascularized bone flap graft

Objective To compare open reduction and cannulated screws combined with ascending branch of lateral femoral circumflex artery iliac bone flap with closed reduction and cannulated screw fixation for the treatment of displaced femoral neck fracture in young adults.Methods From January 1992 to January 2007,totally 204 cases of displaced femoral neck fracture were treated.Group A:one hundred and three cases were treated with open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch of lateral femoral circumflex artery.Garden classification:type Ⅲ.68 cases,type Ⅳ:35 cases.Group B:one hundred and one cases,treated with closed reduction and three cannulated screw fixation.Garden classification:type Ⅲ in 62 cases and type Ⅳ in 39 cases.Results Two groups were followed up for 5-15 years.The healing time of group A was (73 ±21.2) days,including 4 cases of nonunion fracture (3.9％) and 5 cases of femoral head avascular necrosis occurred (4.9％) ; The healing time of group B was (89 ± 12.5) days,including 12 cases of nonunion fracture (11.9％) and 18 cases of femoral head avascular necrosis occurred (17.8％).The healing time,the rate of nonunion of fracture and the rate of femoral head necrosis were significantly different of these 2 groups.Conclusion The treatment of open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch in young adults can effectively prevent nonunion of fractures and osteonecrosis of the femoral head. Key words: Displaced femoral neck fracture; Lateral femoral circumflex artery; Iliac bone flap; Osteonecrosis of the femoral head

Design and clinical application of a quantitative scale for adult femoral neck fractures

Objective To evaluate the consistency and clinical value of a self-designed quantitative scale used in treatment of adult femoral neck fractures.Methods Seven hundred patients with femoral neck fracture were reviewed who had been treated in our hospital from January 2007 to April 2010.Five hundred and two patients were included in this study according to the inclusion criteria of our self-designed quantitative scale.All the 502 cases were divided into 4 groups according to their scale scores and actual treatment:low score internal fixation group(LSIF)(281 cases),total hip replacement group(THA)(94 cases),hemiarthroplasty group(HA)(119 cases),and high score internal fixation group(HSIF)(8 cases).Each group was further divided into a consistency sub-group and an inconsistency sub-group according to the consistency between their actual treatments and scale scores.The operative time,blood loss,blood transfusion,infection rate,re-operation rate,mortality rate,Harris hip score were compared between the consistency sub-group and inconsistency sub-group in LSIF,THA and HA groups respectively.Results The 502 patients were followed up for 1.0 to 4.5 years(average,3.2 years).The Kappa value of 0.549(P =0.000)by the consistency test indicated the quantitative scale was consistent with actual clinical treatments.In the LSIF group,the nonunion rate,femoral head necrosis rate and re-operation rate in the consistency sub-group were significantly lower than in the inconsistency sub-group(1.2％ vs.17.9％,7.4％ vs.33.3％,7.0％ vs.41.0％,respectively),but the Harris hip score were significantly higher(86.4 ±9.9 vs.74.8 ± 10.8)(P ＜0.05).In the THR group,the revision rate and Harris hip score were significantly different between the consistency sub-group and the inconsistency sub-group,favoring the former(1.6％ vs.18.2％,92.0 ± 6.3 vs.85.9 ± 11.6,respectively)(P ＜0.05).In the HA group,the revision rate in the consistency sub-group(5.5％)was significantly lower than in the inconsistency sub-group(18.8％)(x2 =4.746,P =0.029).Conclusion Since our self-designed quantitative scale is an instrument highly consistent with clinical treatments,it is of great value in surgical decision-making for treatment of adult femoral neck fractures. Key words: Femoral neck fractures; Research design; Adult

Intra-articular steroid therapy for inflammatory rheumatic diseases in children and adolescents

In addition to systemic medication,physiotherapy, and operative measures, intraarticular therapy with corticosteroids (iaST) is a well established treatment for juvenile idiopathic arthritis (JIA). IaST is indicated in children whose inflamed joints do not respond sufficiently to systemic antiarthritic drugs and is normally carried out under in-patient conditions. Triamcinolone hexacetonide (TH) is the drug of choice for iaST because of its well documented, long-lasting effects. In younger children or those who require simultaneous injections into multiple joints, a short general anesthesia is useful, while single injections in older children can be administered after topical application of a local anesthetic. Intensive physiotherapy after iaST is important for regaining mobility lost due to the arthritis, and 2 or 3 days of post-injection rest should be adhered to after iaST of joints of the lower extremities. Several studies demonstrate long-lasting remission in the majority of the injected joints in JIA patients, with good pain-relief, improved mobility, and a significant delay in further joint destruction in comparison with joints in which the synovitis could not be adequately controlled. Various sub-types of JIA have been shown to respond differently to iaST. Intraarticular steroids can also be used to treat coxitis, since recent data failed to show a subsequent increase in the rate of femoral head necrosis. Septic arthritis, the most feared complication after iaTH, seems to be extremely rare in children. Other complications, like periarticular calcifications or subcutaneous atrophy, also occur only rarely, provided the steroid is injected correctly. The present data indicate that iaST is an effective and safe treatment for JIA. The therapeutic approach to children with JIA is multidisciplinary, and these young patients should be treated in specialised centres.

Comparing the Rate of Femoral Head Necrosis of Two Different Treatments of Congenital Dislocation of the Hip

We examined 120 patients with 140 congenital dislocations of the hip joint for femoral head necrosis. Of these, 77 hips were reduced with a Hoffmann-Daimler brace and the patients were subsequently placed in a spica cast in Lange position after a period in the Lorenz position. The hips of 43 patients were reduced the same way but were retained in a spica as described by Fettweis. The Lorenz group showed 10 grade II and III femoral head necroses, whereas there was only one grade III necrosis in the Fettweis group. The results were compared with the collected statistics of the German survey of congenital dislocation of the hip.