scholarly journals Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Kevin Moerenhout ◽  
Georgios Gkagkalis ◽  
G.-Yves Laflamme ◽  
Dominique M. Rouleau ◽  
Stéphane Leduc ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Treatment Options ◽  
Primary Treatment ◽  
Review Of The Literature ◽  
Total Hip ◽  
Femoral Neck Stress Fracture ◽  
Type 3

Femoral neck stress fractures (FNSFs) can be treated conservatively or surgically, depending on initial displacement and patient condition. Surgical treatment options include internal fixation, with or without valgus osteotomy or hip arthroplasty, either hemi or total. The latter is mainly considered when initial treatment fails. A review of the literature shows that total hip arthroplasty (THA) is only considered as primary treatment in displaced fractures (type 3) in low-demand patients. We present a case of successive bilateral FNSF in a young active patient, where a THA was performed on one side, after failed internal fixation, and where it was chosen as primary treatment on the other side after failed conservative treatment.

Combination of CRP with NLR is a sensitive tool for screening fixation-related infection in patients undergoing conversion total hip arthroplasty after failed internal fixation for femoral neck fracture

2021 ◽  
pp. 1-7
Author(s):  
Hong Xu ◽  
Jin-Wei Xie ◽  
Li Liu ◽  
Duan Wang ◽  
Ze-Yu Huang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Sensitivity And Specificity ◽  
Hip Arthroplasty ◽  
Lymphocyte Ratio ◽  
Total Hip ◽  
Sensitive Tool ◽  
Neck Fracture

Aims Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture. Methods We retrospectively included 340 patients who underwent conversion THA after internal fixation for femoral neck fracture from January 2008 to September 2020. Those patients constituted two groups: noninfected patients and patients diagnosed with FRI according to the 2013 International Consensus Meeting Criteria. Receiver operating characteristic (ROC) curves were used to determine maximum sensitivity and specificity of these two preoperative ratios. The diagnostic performance of the two ratios combined with preoperative CRP or ESR was also evaluated. Results The numbers of patients with and without FRI were 19 (5.6%) and 321 (94.4%), respectively. Areas under the ROC curve for diagnosing FRI were 0.763 for MLR, 0.686 for NLR, 0.905 for CRP, and 0.769 for ESR. Based on the Youden index, the optimal predictive cutoffs were 0.25 for MLR and 2.38 for NLR. Sensitivity and specificity were 78.9% and 71.0% for MLR, and 78.9% and 56.4% for NLR, respectively. The combination of CRP with MLR showed a sensitivity of 84.2% and specificity of 94.6%, while the corresponding values for the combination of CRP with NLR were 89.5% and 91.5%, respectively. Conclusion The presence of preoperative FRI among patients undergoing conversion THA after internal fixation for femoral neck fracture should be determined. The combination of preoperative CRP with NLR is sensitive tool for screening FRI in those patients.

scholarly journals Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Medicina ◽  
2013 ◽  
Vol 49 (3) ◽  
pp. 22
Author(s):  
Jaunius Kurtinaitis ◽  
Narūnas Porvaneckas ◽  
Giedrius Kvederas ◽  
Tomas Butėnas ◽  
Valentinas Uvarovas
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Significant Difference ◽  
Surgery Rates

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

scholarly journals Surgical Treatment of Femoral Neck Fractures: A Brief Review

Geriatrics ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 22
Author(s):  
Ellen Lutnick ◽  
Jeansol Kang ◽  
David M. Freccero
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Traumatic Injury ◽  
Femoral Neck Fractures ◽  
Geriatric Population ◽  
Total Hip ◽  
The Difference

Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty.

scholarly journals Intracapsular fractures of the femoral neck: Internal fixation or arthroplasty

2015 ◽  
Vol 62 (1) ◽  
pp. 65-68
Author(s):  
M. Bogosavljevic ◽  
B. Ristic ◽  
D. Stranojlovic ◽  
Z. Pavlov ◽  
D. Stokic ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Type I ◽  
Non Union ◽  
Total Hip ◽  
Type Iii ◽  
Type Iv ◽  
Medial Cortex

Objective: Significant advances in the surgical treatment of intracapsular fractures of the femoral neck began in the mid-twentieth century, because of the better understanding of the characteristics and biomechanics of the fractures. The aim of this study is to precisely identify the characteristics of the fractures, that will be taken into account in the individualization of treatment of intracapsular fractures of the femur. Materials and Methods: We analyzed, in a retrospective study, 148 patients with intraarticular fractures of the femoral neck from the registry of the Orthopaedic Department in Pozarevac, in the period from 2009 to 2014. Fractures were classified by the modified Garden?s classification. Garden type III fractures were divided into two sub-types. Garden type IIIa included fractures in which the distance between the fragments of the medial cortex was less than ? the diameter of the femoral neck. Garden type III b included fractures in which the distance of the medial cortex of the fracture fragments was larger than ? the diameter of the femoral neck. Patients with the Garden type I fracture (6 cases), Garden type II ( 22 cases), Garden type IIIa (35 cases) and Garden type IV (5 cases) were treated by closed reduction and internal fixation. Patients with Garden type IIIb (28 cases) and Garden type IV (52 cases) were treated by primary total hip replacement. Results : All fractures in patients with the fracture Garden type I (6 cases) and Garden type II (22 cases) have healed and avascular necrosis did not occur. In the group of patients with the Garden type III b fracture, 3 patients with non-union were treated with total hip arthroplasty. In the same group in two patients avascular necrosis occurred. In the group of patients with the Garden type IV fracture who were treated by closed reduction and inter- nal fixation (5 cases), two patients with non-union were treated with total hip arthroplasty. In patients with Garden sub-type III b, in the time of monitoring we found 4 dislocations after primary total hip arthroplasty. One patient underwent acetabular revision in the same group. In the group of patients with Garden type IV fracture, we found 7 dislocations after total hip arthroplasty and two patients underwent acetabular revision surgery. Conclusion: Our results indicate that fractures Garden type I, II and Garden type III a can be successfully treated with internal fixation. Fractures Garden type III b and IV should be treated by primary hip arthroplasty, because of internal fixation of these fractures lead to unsatisfactory results.

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