Risk Of Femoral Neck Fracture Research Articles

Integrating real-world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women.

Decline of bone mineral density (BMD) during menopause is related to increased risk of fractures in postmenopausal women, however, this relationship in premenopausal women has not been established. To quantify this relationship, real‐world data (RWD) from the National Health and Nutrition Examination Survey (NHANES), and longitudinal data from the elagolix phase III clinical trials were modeled across a wide age range, and covariates were evaluated. The natural changes in femoral neck BMD (FN‐BMD) were well‐described by a bi‐exponential relationship with first‐order BMD formation (k1) and resorption (k2) rate constants. Body mass index (BMI) and race (i.e., Black) were significant predictors indicating that patients with high BMI or Black race experience a relatively lower BMD loss. Simulations suggest that untreated premenopausal women with uterine fibroids (UFs) from elagolix phase III clinical trials (median age 43 years [minimum 25–maximum 53]) lose 0.6% FN‐BMD each year up to menopausal age. For clinical relevance, the epidemiological FRAX model was informed by the simulation results to predict the 10‐year risk of major osteoporotic fracture (MOF). Premenopausal women with UFs, who received placebo only in the elagolix phase III trials, have a projected FN‐BMD of 0.975 g/cm2 at menopause, associated with a 10‐year risk of MOF of 2.3%. Integration of modeling, RWD, and clinical trials data provides a quantitative framework for projecting long‐term postmenopausal risk of fractures, based on natural history of BMD changes in premenopausal women. This framework enables quantitative evaluation of the future risk of MOF for women receiving medical therapies (i.e., GnRH modulators) that adversely affect BMD.

Prediction of proximal femur fracture risk from DXA images based on novel fracture indexes

ABSTRACT Background: Osteoporosis is the degradation of bone microstructure that increase proximal femur risk of fracture. Current fracture prediction methods are based on the analysis of bone mineral density (BMD). Nevertheless, it has been shown that BMD alone cannot predict with certainty who will have a future hip fracture. The aim of this study was to develop a novel proximal femur fracture index approach including patient-specific geometrical and mechanical properties data to assess the femoral neck fracture risk. Methods: The patient-specific femoral neck geometry and data for the analysis were obtained from DXA scans. The fracture index was built based on a mechanical description of the fracture occurrence under a side fall impact. Results: The current approach predicts with a very good accuracy the fracture risk (TPR = 78%, TNR = 81%) and provided a good agreement with the experimental data, while the DXA-based BMD was less accurate (TPR = 60%, TNR = 56). Our predicted results showed that the proposed bone fracture index, may provide an enhanced diagnostic of proximal fracture risk diagnostic. Conclusions: The index developed here may be used in clinical applications as an enhanced tool to predict fracture risk and contribute to osteoporosis diagnosis based on DXA.

Simulated effects of early menopausal bone mineral density preservation on long-term fracture risk: a feasibility study.

Preventing early menopausal bone loss may substantially reduce the future burden of osteoporosis. We modelled the effects of infrequent zoledronic acid infusions on long-term fracture risk. Data from the Canadian Multicentre Osteoporosis Study (CaMos) were used to determine the expected natural history of femoral neck areal bone mineral density (BMD) and fracture risk (using FRAX®) from ages 50-80 for women with no antiresorptive drug exposures. We modelled the effects of three infusions of zoledronic acid (at ages 50, 55, 60) on long-term fracture risk, assuming this intervention would preserve BMD until age 65 years, followed by losses mirroring early menopausal BMD loss. At age 65, untreated women and zoledronic acid recipients had expected mean (SD) femoral neck T-scores of - 1.5(1.0) and - 0.8(1.0), 10-year major osteoporotic fracture (MOF) risks of 9.8%(5.0) and 8.0%(3.7) and hip fracture risks of 1.7%(2.4) and 0.8%(1.2), respectively. At age 80, untreated women and zoledronic acid recipients had expected femoral neck T-scores of - 1.9(0.9) and - 1.4(0.9), MOF risks of 17.9%(8.2) and 14.9%(6.4) and hip fracture risks of 6.3%(6.2) and 4.4%(4.5), respectively. The expected proportion of women with femoral neck T-score ≤ - 2.5 was 14.9% for untreated women and 3.8% for zoledronic acid recipients at age 65, increasing to 28.1% and 12.0%, respectively, at age 80. Numbers-needed-to-treat to prevent one case of densitometric osteoporosis were 9 at age 65 and 5 at age 80. Infrequent infusions of zoledronic acid, initiated early in menopause, are expected to reduce long-term fracture risk and result in a substantial reduction in the proportion of women with densitometric osteoporosis after age 65.

Comparison of using fractionated and unfractionated heparins after primary hip and knee arthroplasty in patients receiving programmed hemodialysis

INTRODUCTION . The risk of femoral neck fractures in hemodialysis patients is estimated at 25.6 per 1000 people per year. Hip arthroplasty is the treatment choice in these patients. One of the causes of general somatic complications is the significantly more frequent formation of blood clots. PATIENTS AND METHODS . The material for the study was data on 96 hemodialysis patients who underwent primary hip arthroplasty in the period from 2016 to 2019. THE AIM. Сomparison of various algorithms for the use of fractionated and unfractionated heparins after primary hip and knee arthroplasty in patients receiving programmed hemodialysis. RESULTS . The largest number of thrombosis was noted in group 1 (heparin was used only during hemodialysis procedures): in 4 patients (16.6 %), in group 4 (using fractionated heparin both during hemodialysis procedures and on interdialysis days): in 2 patients (8 %). When comparing the volume of the evacuated hematoma, the statistically significant volume was in group 2 (with the use of un fractionated heparin both during dialysis and on interdialysis days), on average 98 ± 52 ml. In the same group, the greatest number of infectious complications was noted: in 5 patients (21.8 %); in group 4: in 2 patients (8 %). CONCLUSION . Conducting thromboprophylaxis in hemodialysis patients after arthroplasty of major joints with fractionated heparins, both during the hemodialysis procedure and on interdialysis days, can reduce the number of thromboembolic complications to 8 % (16.6 % with the traditional method). Affect on the volume of blood loss and blood transfusion not statistically significant. At the same time, there is a significant decrease in the level of potassium by 8.8 %, total cholesterol by 7.3 %, triglycerides by 11.7 % with the daily use of fractionated heparins.

The Effect of Resection Size in the Treatment of Cam-Type Femoroacetabular Impingement in the Typical Patient With Hip Arthroscopy: A Biomechanical Analysis

Background: Arthroscopic osteochondroplasty may improve range of motion and relieve pain in patients with symptomatic hip impingement. Femoral neck fracture is a risk of this procedure because of the weakening of the proximal femur. To our knowledge, there are no biomechanical studies in young human cadaveric bone evaluating the effect of osteochondroplasty on femoral neck strength. Purpose/Hypothesis: The purpose was to evaluate loads to fracture in young human cadavers after resection depths of 25% and 40% at the head-neck junction. We hypothesized that both depths will maintain ultimate loads to failure above previously published loads, as well as above physiologic weightbearing loads. Study Design: Descriptive laboratory study. Methods: Cadaveric proximal femoral specimens (6 matched pairs, under the age of 47 years) were divided into 2 groups: 25% or 40% of the diameter at the head-neck junction was resected. The length of the resection was 2 cm and the width of the resection was determined by the length of the anterolateral quadrant at the head-neck junction in all cases. A compressive load was applied directly to the femoral head. Peak load, stiffness, and energy to fracture were compared between groups. Results: The average peak load to fracture after 25% resection (7347 N) was significantly higher than after the 40% resection (5892 N) (P = .010). The average energy to fracture was also significantly higher in the 25% resection group (30.2 J vs 19.2 J; P = .007). The average stiffness was higher in the 25% group, although not statistically significant (P = .737). Conclusion: Resection depths of 25% and 40% at the anterolateral quadrant of the femoral head-neck junction may be safe at previously described functional loads such as standing and walking in the age range more typically seen in patients undergoing hip arthroscopy. Loads to fracture were significantly higher than previously reported using older cadaveric specimens. Clinical Relevance: Currently, most surgeons limit weightbearing after femoral osteochondroplasty in part because of risk of femoral neck fracture. Given the higher observed loads to fracture, young patients could possibly bear weight sooner after surgery, although postoperative protocols should be individualized based on patient age, weight, bone density, amount of bone resected, concomitant procedures, and potential compliance with activity restrictions.

Impact of Cigarette Smoking on Re-operation and Revision Surgery after Femoral Neck Fracture Treatment

Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.

Trunk Skeletal Muscle Mass and Phase Angle Measured by Bioelectrical Impedance Analysis are Associated with the Chance of Femoral Neck Fracture in Very Elderly People.

BackgroundThe study aimed to investigate the potential association of trunk skeletal muscle mass (tSM) and phase angle measured by bioelectrical impedance analysis (BIA) with the chance of femoral neck fractures in very elderly people.Patients and MethodsThis case-control study enrolled 78 femoral neck fracture patients aged over 75 years (29 males) and 1:2 matched healthy controls. All participants were subjected to BIA examination by specialists. tSM, the corrected values by height squared of tSM (tSMI) and phase angle were compared between fracture patients and controls. Multivariate logistic regression was performed to explore the strength of association of femoral neck fracture with tSM, tSMI, and phase angle.ResultstSM (kg) of fracture patients was significantly lower than those of controls in all participants (women: 13.49±0.42 vs 15.44±0.39, p<0.05; men: 15.30±0.71 vs 17.54±0.78, p<0.05). In the sarcopenic subgroup, fracture patients also got a lower tSM than controls (women: 12.58±0.21 vs 13.62±0.16, p<0.05; men:14.41±0.29 vs 16.07±0.21, p<0.05). The comparison of tSMI between the two groups was similar to that of tSM. Phase angle (°) at 50 kHz in fracture patients was significantly lower than that of controls in women and men (women: 3.70±0.32 vs 4.61±0.21, p<0.05; men: 3.50±0.20 vs 3.84±0.22, p<0.05). Multivariate logistic regression analysis demonstrated higher fracture chance with significantly associated decreased tSM [women: OR (95% CI): 0.78(0.67–0.91); men: 0.74(0.64–0.86)] and tSMI [women: OR (95% CI): 0.72(0.61–0.85); men: 0.69 (0.59–0.81)]. In addition, per 1° increase of phase angle in the trunk could decrease the fracture risk by 14% for women [OR (95% CI): 0.86 0.79–0.94)] and 29% for men [OR (95% CI): 0.71 (0.64–0.79)].ConclusionThis study indicates a decrease in tSM, tSMI, and phase angle measured by BIA is significantly related to the increased chance of femoral neck fracture in people aged over 75 years. Strengthening the mass and strength of trunk skeletal muscles may help reduce the risk of femoral neck fracture in elderly patients.

Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck.

Cortical bone thinning and a rarefaction of the trabecular architecture represent possible causes of increased femoral neck (FN) fracture risk. Due to X-ray exposure limits, the bone microstructure is rarely measurable in the FN of subjects but can be assessed at the tibia. Here, we studied whether changes of the tibial cortical microstructure, which were previously reported to be associated with femur strength, are also associated with structural deteriorations of the femoral neck. The cortical and trabecular architectures in the FN of 19 humans were analyzed ex vivo on 3D microcomputed tomography images with 30.3μm voxel size. Cortical thickness (Ct.Thtibia), porosity (Ct.Potibia) and pore size distribution in the tibiae of the same subjects were measured using scanning acoustic microscopy (12μm pixel size). Femur strength during sideways falls was simulated with homogenized voxel finite element models. Femur strength was associated with the total (vBMDtot; R2=0.23, p<0.01) and trabecular (vBMDtrab; R2=0.26, p<0.01) volumetric bone mineral density (vBMD), with the cortical thickness (Ct.ThFN; R2=0.29, p<0.001) and with the trabecular bone volume fraction (Tb.BV/TVFN; R2=0.34, p<0.001), separation (Tb.SpFN; R2=0.25, p<0.01) and number (Tb.NFN; R2=0.32, p<0.001) of the femoral neck. Moreover, smaller Ct.Thtibia was associated with smaller Ct.ThFN (R2=0.31, p<0.05), lower Tb.BV/TVFN (R2=0.29, p<0.05), higher Tb.SpFN (R2=0.33, p<0.05) and lower Tb.NFN (R2=0.42, p<0.01). A higher prevalence of pores with diameter>100μm in tibial cortical bone (relCt.Po100μm-tibia) indicated higher Tb.SpFN (R2=0.36, p<0.01) and lower Tb.NFN (R2=0.45, p<0.01). Bone resorption and structural decline of the femoral neck may be identified in vivo by measuring cortical bone thickness and large pores in the tibia.

Osteoporosis in Polish Older Women: Risk Factors and Osteoporotic Fractures: A Cross-Sectional Study.

Background: Osteoporosis is a skeletal disease. It is still not known which of the risk factors have the greatest impact on osteoporosis development. The study aimed to determine how the selected osteoporosis risk factors contribute to the development of the disease and to assess the risk of osteoporotic fractures in older women. Methods: A cohort of 99 older females was divided into two groups (with and without osteoporosis). The risk of osteoporosis was determined using assessment forms and bone densitometry data subjected to logistic regression. The risk of osteoporotic fractures was assessed by the FRAX tool (FRAX, Center for Metabolic Bone Diseases, University of Sheffield, UK). Results: The logistic regression analysis showed that the highest risk of developing osteoporosis associated with lifestyle, mainly cigarette smoking (odds ratio: OR = 2.12), past gynecological operations (OR = 1.46), corticosteroid therapies (OR = 1.38). More than half of participants were at a medium risk of femoral neck fractures (over 90% in the osteoporotic group). Conclusion: Most of the Polish women living in care facilities are at medium risk of low-energy fractures. Smoking appeared to have the strongest effect on osteoporosis among analyzed risk factors. The results may contribute to the creation of more appropriate prevention strategies.

Age related changes in the bone microstructure in patients with femoral neck fractures

BackgroundThe risk of femoral neck fracture progressively increases with age. However, the reasons behind this consistent increase in the fracture risk can't be completely justified by the decrease in the bone mineral density. The objective of this study was to analyze the correlation between various bone structural features and age. Study Design & MethodsA total of 29 consecutive patients who suffered an intracapsular hip fracture and underwent joint replacement surgery between May 2012 and March 2013 were included in this study. A 2 cm × 1 cm Ø cylindrical trabecular bone sample was collected from the femoral heads and preserved in formaldehyde. Bone mineral density (BMD), microarchitecture, organic content and crystallography were analyzed using a Dual-energy X-ray absorptiometry scan, micro-CT scan, and high resolution magic-angle-spinning-nuclear magnetic resonance (MAS-NMR), respectively. Statistical correlations were made using Spearman´s or Pearson´s correlation tests depending on the distribution of the continuous variables. ResultsThe mean patient age was 79.83 ± 9.31 years. A moderate negative correlation was observed between age and the hydrogen content in bone (1H), which is an indirect estimate to quantify the organic matrix (r = −0.512, p = 0.005). No correlations were observed between BMD, trabecular number, trabecular thickness, phosphorous content, apatite crystal size, and age (r = 0.06, p = 0.755; r = −0.008, p = 0.967; r = −0.046, p = 0.812; r = −0.152, p = 0.430, respectively). A weak positive correlation was observed between Charlson´s comorbidity index (CCI) and c-axis of the hydroxiapatite (HA) crystals (r = −0.400, p = 0.035). ConclusionThe femoral head relative protein content progressively decreases with age. BMD was not correlated with other structural bone parameters and age. Patients with higher comorbidity scores had larger HA crystals. The present results suggest that the progressive increase in the hip fracture risk in elderly patients could be partially explained by the lower bone protein content in this age group.

MICROSCOPIC STRUCTURE AND MORPHOMETRIC PARAMETRES OF LONG TUBULAR BONES OF SENILE RATS WITH INDUCED HYPERGLYCEMIA

Recent studies have shown that patients with diabetes mellitus are found very often to have pathological changes in the musculoskeletal system. Discussing the development of pathological changes in the bone tissue due to hyperglycemia, it should be noted that many aspects of this problem are still unexplained, and in particular the frequency of bone damage varying in a fairly wide range, the mechanism of reducing bone mineral density that leads to the occurrence of frequent fractures. This article discusses the effects of hyperglycemia on the state of long tubular bones. The goal of our experiment was to study the structural changes in the long tubular bones of senile rats of both sexes with induced hyperglycemia. The period the rats were included into the experiment ranged from 30 to 180 days. During the experiment, various research methods were applied. To perform the histological analysis, we took rat femurs and fixed them in 10% phosphate buffered formalin for 24 hours. Then samples were decalcified in 10% formic acid solution, the materials obtained were embedded in paraffin. The study revealed a gradual thinning of the cortical layer in senile rats that is of great importance due to the fact that there is clinically confirmed increased risk of femoral neck fracture in individuals with type II diabetes. The level of blood glucose throughout the experiment was rather high that indicates the development of chronic hyperglycemia. Having analyzed the data on the effect of hyperglycemia on bone growth parameters and comparing these indicators with the control, we can suggest a delay in longitudinal growth of bones. The results and timing of the experiment show that the degree of changes obtained depends on the duration of the experiment.

Computational modelling of forces acting on the femur in acetabular fractures: A finite element analysis study

BackgroundThe rising incidence of acetabular fractures in the elderly presents an increasing surgical challenge due to patient co-morbidities, complex fracture patterns’ and osteoporotic bone. Of interest in this study are those of the quadrilateral plate, which are more common in elderly patients with osteoporosis. Following such injuries, the weight-bearing surface of the femoral head moves medially. Non-operative management of these fractures can lead to the acetabulum articulating on the femoral neck increasing the risk of subsequent femoral neck fracture as a result of the altered biomechanics.Using finite element analysis (FEA) this study seeks to understand the changing biomechanics of the proximal femur in such instances and to determine if there is a threshold of femoral head medialisation that can predict probability of femoral neck fracture. MethodsA femoral neck FEA model was created from the CT and MRI scans of a healthy hip. Using FEA, the model was used to apply point loading to the femoral head at the anatomical weight bearing area and subsequent lateralization of this point down to the femoral neck-shaft junction. This simulates the changing forces acting on the femur as the head medialises into a fractured acetabulum. ResultsAs the point of contact moved laterally the stress levels within the proximal femur increased steadily, particularly along the superior neck. Bending moment at the medial neck shaft junction also increased. This increase in stress levels can be seen as a corollary for risk of fracture within the femur. ConclusionWith medialisation of the femur into a fractured acetabulum there is a significant change in the stress distribution within the femoral neck. Clinically, this is indicates that patients with such injuries are at an increased risk of femoral neck fractures once they begin to mobilise after the initial injury, a devastating result. This model may be of use to treating surgeons in predicting the risk of femoral neck fracture.

Mechanical Strength of the Proximal Femur After Arthroscopic Osteochondroplasty for Femoroacetabular Impingement: Finite Element Analysis and 3-Dimensional Image Analysis

To examine the influence of femoral neck resection on the mechanical strength of the proximal femur in actual surgery. Eighteen subjects who received arthroscopic cam resection for cam-type femoroacetabular impingement (FAI) were included. Finite element analyses (FEAs) were performed to calculate changes in simulative fracture load between pre- and postoperative femur models. The finite element femur models were constructed from computed tomographic images; thus, the models represented the shape of the original femur, including the bone resection site. Three-dimensional image analysis of the bone resection site was performed to identify morphometric factors that affect strength in the postoperative femur model. Four oblique sagittal planes running perpendicular to the femoral neck axis were used as reference planes to measure the bone resection site. At the transcervical reference plane, both the bone resection depth and the cross-sectional area at the resection site correlated strongly with postoperative changes in the simulated fracture load (R2= 0.6, P= .0001). However, only resection depth was significantly correlated with the simulated fracture load at the reference plane for the head-neck junction. The resected bone volume did not correlate with the postoperative changes in the simulated fracture load. The results of our FEA suggest that the bone resection depth measured at the head-neck junction and transcervical reference plane correlates with fracture risk after osteochondroplasty. By contrast, bone resection at more proximal areas did not have a significant effect on the postoperative femur model strength in our FEA. The total volume of resected bone was also not significantly correlated with postoperative changes in femur model strength. This biomechanical study using FEA suggest that there is a risk of femoral neck fracture after arthroscopic cam resection, particularly when the resected lesion is located distally.

Milk, Daily products and Bone health.Effect of milks and daily products on bone health.

In Japan, nutrition education programs to prevent osteoporosis and osteoporotic fractures have focused primarily on increasing dietary calcium intake and recommended the consumption of milk and dairy products. However, the effect of milk and dairy product consumption on bone density loss or fracture incidence in Japanese has rarely been evaluated in randomized controlled studies. In the present study, we reviewed the literature investigating the consumption of milk and dairy products in relation to bone density and fracture risk. The results showed that milk and dairy product consumption had only a modest effect in the prevention of midlife bone loss and subsequent fractures. However, given that infrequent(once weekly or less)consumption of milk may be associated with an increased risk of femoral neck fracture, and that Japanese generally have a lower calcium intake, it is still necessary to encourage elderly and younger adults to increase their consumption of milk and dairy products to promote bone health.

Characteristics of patients at high risk of femoral neck fractures associated with atypical femoral fractures

Characteristics of patients at high risk of femoral neck fractures associated with atypical femoral fractures

Biomechanical evaluation of a femoral neck fracture implant using a novel test‐stand

AbstractThe ageing society leads to an increased risk of femoral neck fractures. Besides endoprotheses and established head‐conserving implants, the rotation‐stable screw anchor is used for surgical treatment. In this in vitro study, the influence of cemented versus non‐cemented implants is tested. Therefore, a novel test set‐up is used that is capable of simulating the load during gait cycles. Thereby, the transferability to clinical practise shall be increased. Additionally, time‐series data is recorded to evaluate clinically relevant parameters during the applied cyclical load. The results show that the test set‐up enables deeper insight to the implants behaviour during loading, which is of relevance due to the differences that can be observed between the cemented and non‐cemented implant. Additionally, the results are compared to the literature. (© 2017 Wiley‐VCH Verlag GmbH &amp; Co. KGaA, Weinheim)

Femoral osteochondroplasty can be performed effectively without the risk of avascular necrosis or femoral neck fractures in an experimental ovine FAI model.

The experimental induction of cam-type femoroacetabular impingement (FAI) in sheep is established. To tap the full potential of this ovine model, one should be able to perform a femoral osteochondroplasty safely. This study was based on previous cadaver experiments on the blood supply to the ovine femoral head and on the biomechanical strength of the proximal femur following offset creation. We hypothesized that offset creation in this ovine FAI model does not lead to (1) avascular necrosis (AVN) of the ovine femoral head or (2) iatrogenic femoral neck fractures and (3) can be performed effectively. In this experimental, controlled, prospective study nine sheep underwent unilateral FAI induction through an intertrochanteric, varus osteotomy. Seventy days following FAI induction, femoral osteochondroplasty was performed. Sheep were sacrificed after another 140 days. Radiographs, computed tomography (CT) scans and MRI were acquired. Histologic samples were stained with hematoxylin-eosin. (1) The multimodal Association Research Circulation Osseous (ARCO) classification was used for assessment of AVN. (2) Femoral neck fractures were assessed with the multimodal imaging approach. (3) Pre- and postoperative (=after sacrifice) alpha angles and femoral neck diameters were compared. (1) No signs for AVN according to the ARCO classification or (2) for femoral neck fractures were detected. (3) Mean alpha angles and femoral neck diameters decreased significantly (p < 0.001) superiorly by at least 30° respectively 4mm after the offset creation. Femoral osteochondroplasty can be performed effectively and without the risk of AVN or femoral neck fractures in this ovine FAI model.

Predicting Functional Outcomes in Patients with Femoral Neck Fractures Treated by Hemiarthroplasty.

A femoral neck fracture leads to serious health-related, social and economic consequences and, according to the con-temporary doctrine of medical management, should be treated surgically. Data provided by the Agency for Health Technology Assessment and Tariff System indicate that there were 1534 patients with femoral neck fractures treated by arthroplasty with a Moore's endoprosthesis and 4744 with a bipolar endoprosthesis in Poland in 2014. Since the risk of femoral neck fracture increases exponentially with the patient's age, and population aging is undoubtedly a real demographic trend, we believe that there is a need to develop criteria for taking treatment decisions to ensure the best possible outcomes. The aim of this paper is to identify factors influencing the functional outcomes of hemiarthroplasty measured with the Harris Hip Score (HHS) in patients with femoral neck fractures. The first part of study data consisted of clinical data derived from the medical treatment records of 161 patients with femoral neck fractures who were treated by hemiarthroplasty in the Orthopaedic Department of the Regional Hospital in Sieradz in 2009-2011. The age, sex, overall health status of the patients qualified for surgical treatment, time between injury and surgery, type of endoprosthesis, and length of stay at the department were determined. The second part was data from an outcome assessment using the Harris Hip Score (HHS) at two-year follow-up visits of 90 patients of the original group. The mean outcome of all the patients was defined as satisfactory (HHS score of 73.37 points). Examination of one-factor correlations between the outcome and the patient's sex and the type of endoprosthesis revealed significantly superior outcomes in men and patients who received the bipolar endoprosthesis. A multiple factor statistical analysis, which additionally included the variables of patient age and baseline overall health status, demonstrated that only overall health status (ASA score) had a statistically significant effect on the functional outcome of arthroplasty among all factors examined. 1. Evaluation of the quality of life of patients who underwent surgery after femoral neck fractures utilising the Harris Hip Score (HHS) in one-fac-tor correlations (age, sex, type of endoprosthesis, general condition) revealed significantly superior results for men who received the bipolar endo-prosthesis. There was also a moderately strong and negative correlation with the patients' age. 2. The functional outcomes in patients with low energy femoral neck fractures treated with two types of partial hip endoprosthesis at the Ortho-paedic Department of the Regional Hospital in Sieradz, assessed by multiple factor analysis, showed a significant correlation only with the patient's baseline overall health status.

Femoral head necrosis: A finite element analysis of common and novel surgical techniques

BackgroundFemoral head necrosis is a common cause of secondary osteoarthritis. At the early stages, treatment strategies are normally based on core decompression techniques, where the number, location and diameter of the drilling holes varies depending on the selected approach. The purpose of this study was to investigate the risk of femoral head, neck and subtrochanteric fracture following six different core decompression techniques. MaterialsFive common and a newly proposed techniques were analyzed in respect to their biomechanical consequences using finite element analysis. The geometry of a femur was reconstructed from computed-tomography images. Thereafter, the drilling configurations were simulated. The strains in the intact and drilled femurs were determined under physiological, patient-specific, muscle and joint contact forces. FindingsThe following results were observed: i) - an increase in collapse and fracture risk of the femur head by disease progression ii) - for a single hole approach at the subtrochanteric region, the fracture risk increases with the diameter iii) - the highest fracture risks occur for an 8mm single hole drilling at the subtrochanteric region and approaches with multiple drilling at various entry points iv) - the proposed novel approach resulted in the most physiological strains (closer to the experienced by the healthy bone). InterpretationOur results suggest that all common core decompression methods have a significant impact on the biomechanical competence of the proximal femur and impact its mechanical potential. Fracture risk increases with drilling diameter and multiple drilling with smaller diameter. We recommend the anterior approach due to its reduced soft tissue trauma and its biomechanical performance.

Physical Activity for Strengthening Fracture Prone Regions of the Proximal Femur.

Physical activity improves proximal femoral bone health; however, it remains unclear whether changes translate into a reduction in fracture risk. To enhance any fracture-protective effects of physical activity, fracture prone regions within the proximal femur need to be targeted. The proximal femur is designed to withstand forces in the weight-bearing direction, but less so forces associated with falls in a sideways direction. Sideways falls heighten femoral neck fracture risk by loading the relatively weak superolateral region of femoral neck. Recent studies exploring regional adaptation of the femoral neck to physical activity have identified heterogeneous adaptation, with adaptation principally occurring within inferomedial weight-bearing regions and little to no adaptation occurring in the superolateral femoral neck. There is a need to develop novel physical activities that better target and strengthen the superolateral femoral neck within the proximal femur. Design of these activities may be guided by subject-specific musculoskeletal modeling and finite-element modeling approaches.