Nonunion Paediatric Femoral Neck Fracture Treatment without Open Reduction

2016 ◽  
Vol 26 (6) ◽  
pp. 608-611 ◽  
Author(s):  
Perajit Eamsobhana ◽  
Kamolporn Keawpornsawan
Keyword(s):  
Femoral Neck ◽  
Open Reduction ◽  
Harris Hip Score ◽  
Coxa Vara ◽  
Fracture Treatment ◽  
X Ray ◽  
Neck Shaft Angle ◽  
Nonunion Site ◽  
Neck Fracture ◽  
Shaft Angle

Objectives Fractures of the proximal femur account for less than 1% of all children's fractures. Because of this, most orthopaedic surgeons lack enough experience in treating them. This adds to the rather high incidence of complications especially nonunion. At the time of this review there is no consensus on which method of treatment of the nonunion is the best. The objective of this study is to present our method of treatment to correct the nonunion without open reduction of the nonunion sites. Method 9 children with nonunion of the proximal femur with an average age of 10.2 years (2-14 years old) were included in the study. There were 7 males and 2 females. All of them underwent at least 1 operation to treat the initial fractures and the nonunion. The nonunion in all these 9 cases was treated with valgus intertrochanteric osteotomy without open reduction of the nonunion site. The healing time of the nonunion, the postoperative neck-shaft angle and the functional outcome were evaluated. Results All the nonunion cases had coxa vara and had bone resorption of the femoral neck with x-ray evidences of avascular necrosis (AVN). Ratliff classification was used to classify the AVN, Ratliff type 3 was found in 4 cases, Ratliff 2 in 1 case and Ratliff 1 in 4 cases. Patients were followed for an average of 68 (range 36-156) months. All patients had x-ray evidence of solid union of the nonunion in an average time of 15.4 (range 13-18) weeks and union of the osteotomy sites within10.6 (range 9-12) weeks. The postoperative neck-shaft angle averaged 135° (range 125°-150°) compared to 98° before the surgery. The increase in the amount of neck-shaft angle was statistically significant (p<0.001). Using Harris Hip Score, 2 patients were graded as excellent, 3 patients were graded as good and 4 patients were graded as fair. Harris Hip Score was significantly improved compared to the preoperative status (p<0.001). Conclusions Nonunion paediatric femoral neck fracture treatment could be successfully treated without open reduction by using valgus intertrochanteric osteotomy. All patients obtained union of the nonunion site and the osteotomy site in this study. Harris Hip Score showed significant improvement. This technique can be used to treat nonunion with associated coxa vara, bone resorption and AVN with satisfactory results even in cases who had received several operations before.

scholarly journals Simultaneous Morscher’s osteotomy and arthroscopic debridement in the management of Legg–Calvé–Perthes disease: a case report and literature review

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. i4-i8
Author(s):  
Batool Bosakhar ◽  
Hassan Baldawi ◽  
Kathy Liu ◽  
Olufemi R Ayeni ◽  
Waleed Kishta
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Femoral Neck ◽  
Perthes Disease ◽  
Labral Repair ◽  
Coxa Vara ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Outcome Tool

Abstract There is a lack of consensus around optimal surgical management for Legg–Calvé–Perthes Disease (LCPD). This case report discusses the benefits of combining arthroscopic femoral neck osteochondroplasty and labral repair with Morscher’s Osteotomy (MO) for LCPD. S.A. is a 17-year-old female diagnosed with LCPD at the age of 6 years and has long-standing right hip symptoms. An arthroscopic femoral neck osteochondroplasty and labral repair followed by MO was performed. The pre-operative and 8 months post-operative International Hip Outcome Tool (iHOT-12) scores were 16.3 and 79.8 out of 100, respectively, indicating better quality-of-life. Also, the femoral neck-shaft-angle (NSA) changed from 120 pre-operative to 138.7 post-operative to represent the correction of coxa vara. The literature review revealed no published reports describing combined MO with hip arthroscopic interventions in managing LCPD. Combined arthroscopic femoral neck osteochondroplasty (with labral repair) and MO provides high patient satisfaction and improves radiographic parameters in patients with LCPD.

scholarly journals Double Intertrochanteric Osteotomy for Trochanteric Overgrowth and a Short Femoral Neck in Adolescents

2016 ◽  
Vol 24 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Turgut Akgul ◽  
Cengiz Şen ◽  
Halil Ibrahim Balci ◽  
Gokhan Polat
Keyword(s):  
Femoral Neck ◽  
Delayed Union ◽  
Developmental Dysplasia ◽  
Intertrochanteric Osteotomy ◽  
Coxa Vara ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Proximal Femoral Focal Deficiency ◽  
Femoral Side

Purpose To review the outcome of Wagner double intertrochanteric osteotomy for trochanteric overgrowth and a short femoral neck in 7 adolescents. Methods Records of one male and 6 females aged 15 to 20 years who underwent modified Wagner osteotomy for trochanteric overgrowth and a short femoral neck by a single senior surgeon were reviewed. The diagnoses were coxa vara (n=2), developmental dysplasia of the hip (n=3), Leg-Calve-Perthes (n=1), and proximal femoral focal deficiency (n=1). Radiological indication for double intertrochanteric osteotomy included a neck-shaft angle (NSA) <120° or a centre trochanter distance (CTD) <28 mm. Function was evaluated using the Children's Hospital Oakland Hip Evaluation Scale (CHOHES). The articulotrochanteric distance (ATD), CTD, NSA, and the distance between the centre of the femoral head and the centre of the acetabulum (MZ) were measured on radiographs. Results The mean follow-up duration was 61 (range, 28–86) months. The ATD improved from 16±11.5 mm to −6.3±10.2 mm (p=0.018), the CTD from 27.9±3.5 mm to 36.4±7.1 mm (p=0.018), the NSA from 112°±24.4° to 131°±16° (p=0.028), the MZ from 12.7±6.5 mm to 7.7±4.2 mm (p=0.028), and the CHOHES score from 62.1±8.7 to 84±9.6 (p=0.017). One patient had delayed union. Two patients had persistent Trendelenburg gait. Two patients declined second-stage surgery for acetabular dysplasia after solving the femoral side problems at the first stage. One of them developed hip arthrosis. Conclusion Double intertrochanteric osteotomy is a viable treatment option for adolescents with trochanteric overgrowth and a short femoral neck.

scholarly journals Treatment of the femoral neck peudoarthrosis in childhood: Case report

2013 ◽  
Vol 141 (3-4) ◽  
pp. 237-241
Author(s):  
Zoran Vukasinovic ◽  
Igor Seslija ◽  
Mladen Pavlovic ◽  
Zorica Zivkovic
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Avascular Necrosis ◽  
Bed Rest ◽  
Primary Treatment ◽  
Femoral Neck Fractures ◽  
Coxa Vara ◽  
X Ray ◽  
Fractures In Children ◽  
Neck Fracture

Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5?year?old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X?ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit?). Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow?up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X?ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults) can prevent the occurrence of femoral neck pseudoarthrosis.

The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

2021 ◽  
pp. 112070002110130
Author(s):  
Leigh-Anne Tu ◽  
Douglas S Weinberg ◽  
Raymond W Liu
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Hip Osteoarthritis ◽  
Volume Ratio ◽  
Femoral Head Coverage ◽  
Neck Shaft Angle ◽  
Hip Arthritis ◽  
Femoral Version ◽  
Shaft Angle ◽  
The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

The Influence of Acetabular Morphology on Prediction of Proximal Femur Fractures Types in an Elderly Population

2017 ◽  
Vol 27 (5) ◽  
pp. 489-493 ◽  
Author(s):  
Abbas Tokyay ◽  
Melih Güven ◽  
Mehmet E. Encan ◽  
Erhan Okay ◽  
Ozgur Akbaba
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Acetabular Index ◽  
Hip Axis Length ◽  
Neck Shaft Angle ◽  
Femur Fractures ◽  
Acetabular Morphology ◽  
Neck Fracture ◽  
Axis Length ◽  
Fracture Types

Introduction The role of proximal femur morphology to the development of certain proximal femur fracture types both femoral neck and trochanteric fractures has been observed. However, the relavance of acetabular morphology to the development of proximal femur fractures is not extensively questioned. Therefore the aim of the study was to determine whether there is a correlation between acetabular morphology and pathogenesis of 2 different hip fracture types after low energy trauma. Methods This retrospective study includes 60 cases (41 women, 19 men) with a proximal femoral fracture after a low energy trauma between July 2012 and December 2014. Acetabular depth and acetabular index were measured on pelvic radiographs. Neck shaft angle, hip axis length and cortical index were measured on pelvic computed tomography scans. All measurements were performed on the contralateral hip. Results Mean age was 77.56 ± 8.99 years (range 61-92 years). No statistically significant difference was found with regard to neck shaft angle, acetabular depth or cortical index measurements between patients with femoral neck fracture and patients with trochanteric femoral fractures (p>0.05). Acetabular index measurement was higher (p = 0.001) and hip axis length measurement was lower (p = 0.001) in trochanteric fracture group as compared to femoral neck fracture. Conclusions The rate of trochanteric femur fractures is higher in patients with high acetabular index, whereas the rate of femoral neck fractures is higher in patients with increased hip axis length.

scholarly journals Hip dislocation following the treatment of femoral neck fracture: Case report

2010 ◽  
Vol 138 (3-4) ◽  
pp. 248-251
Author(s):  
Zoran Vukasinovic ◽  
Igor Seslija ◽  
Borislav Dulic
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Open Reduction ◽  
Weight Bearing ◽  
Young Patients ◽  
Hip Dislocation ◽  
Full Weight Bearing ◽  
Limited Range Of Motion ◽  
Femoral Head Osteonecrosis ◽  
Neck Fracture

Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.

scholarly journals Calcar buttressed screw fixation for femoral neck fracture

2018 ◽  
Vol 5 (1) ◽  
pp. 145
Author(s):  
K. K. Arvind Manoj ◽  
R. Karthik ◽  
A. Vishnu Sankar
Keyword(s):  
Femoral Neck ◽  
Functional Outcome ◽  
Femoral Neck Fracture ◽  
Screw Fixation ◽  
Femoral Neck Fractures ◽  
Fixation Strength ◽  
Harris Hip Score ◽  
Average Period ◽  
Excellent Outcome ◽  
Neck Fracture

<p class="abstract"><strong>Background:</strong> The incidence of neck of femur fracture among elderly population is increasing day by day. Femoral neck fracture has always been an unsolved fracture<strong> </strong>as far as treatment and results are concerned. There are different views regarding the optimal method of internal fixation in femoral neck fractures. Biomechanical data from literature suggest that calcar fixation is superior to central screws placement. This study aims to analyse the functional and radiological outcome of femoral neck fractures treated by calcar buttressed screw fixation described by Filipov as biplane double supported screw fixation.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted in our institution from May 2015 to May 2018.The study included 43 patients (31 male, 12 female) with femoral neck fracture. Three 6.5-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. Patients were followed up for average period of 2 years. Functional outcome was evaluated using Harris Hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Bone union occurred in 40 patients (93%) with average period of 3-4 months.<strong> </strong>51.2% of cases had<strong> </strong>excellent outcome. 23.2% of cases had good and 16.3% of cases had fair outcome. 9.3% of cases ended with poor outcome. Non union was reported in 3 patients (7%) and AVN in one patient. Various factors like age, Garden and Pauwel fracture types, time of presentation and time of surgery were statistically significant to the final functional outcome in our study.</p><p><strong>Conclusions:</strong> By providing additional calcar buttress compared to conventional method, this technique of screw fixation enhances femoral neck fracture fixation strength and reduces the fixation failure. </p>

scholarly journals Sexual Variations of Femoral Neck-Shaft Angle in the Population of Odisha

2021 ◽  
Vol 10 (19) ◽  
pp. 1387-1390
Author(s):  
Rajeev Kumar Kanchan ◽  
Sonali Subhadarsini ◽  
Dharma Niranjan Mishra ◽  
Chinmayi Mohapatra
Keyword(s):  
Femoral Neck ◽  
Ventral Surface ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Legal Cases ◽  
Male And Female ◽  
Neck Shaft Angle ◽  
Femur Neck ◽  
Shaft Angle ◽  
The Right

BACKGROUND The peculiar waddling gait of a female attracts most of the anatomists to measure and compare the neck-shaft angle (NSA) of the femora. The femoral neck shaft angle is greater in women due to greater pelvic breadth and shorter femur. Neck-shaft angle was measured by the angle that the neck makes with the shaft of the femur and it is measured on the ventral surface of femur taking the long axis of femoral neck with the long axis of the proximal end of the femur. It gives information about the race it belongs to and normally measures 120° to 140°. The intention of this study was to establish the femoral neck shaft angle variations in adult male and female for medico-legal and anthropometric studies. METHODS This cross-sectional study was conducted on 84 adult human femora of unknown sex in the anatomy department, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, Odisha, from May 2018 to April 2019. We included all the femora which were free of damage or deformity and fully ossified indicating adult bone. Femora with any pathological changes i.e., cortical bone deterioration, extreme osteophyte activity, osteoarthritis and fracture etc. were excluded from the study. The NSA was measured by protractor and goniometer. RESULTS In the present study the NSA range for the right femur of male was 108° - 135° and for the right femur of females 117° - 135°. The left male femur was 118° - 135° and the left female femur was 120° - 135°. The mean neck shaft angle of male femora was 125.9° and the female femora was 125.7°. These measurements show that the values were more in males than the females. The value of the present study was statistically significant between male and female i.e., P < 0.0001. CONCLUSIONS These measurements are important in the medico-legal cases, reconstructive orthopaedic surgeries, hip replacement surgeries and also while constructing suitable prosthesis. This will also be helpful in the detection of sex by anatomists and forensic experts. KEY WORDS Neck Shaft Angle, Medico-Legal, Anthropometry and Goniometer

Morphometric Study of Femoral Neck-Shaft Angle in Kolar Population and Its Clinical Importance

2019 ◽  
Vol 8 (3) ◽  
pp. 226-232
Author(s):  
Suresh NM ◽  
◽  
Sunitha R ◽  
Aruna N ◽  
Nalini JP ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Clinical Importance ◽  
Morphometric Study ◽  
Neck Shaft Angle ◽  
Shaft Angle

A randomized controlled trial of cemented versus cementless arthroplasty in patients with a displaced femoral neck fracture

2018 ◽  
Vol 100-B (8) ◽  
pp. 1087-1093 ◽  
Author(s):  
B. Barenius ◽  
C. Inngul ◽  
Z. Alagic ◽  
A. Enocson
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Controlled Trial ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Neck Fracture ◽  
Euroqol 5D ◽  
Displaced Fracture

Aims The aim of this study was to compare the functional and radiological outcomes in patients with a displaced fracture of the hip who were treated with a cemented or a cementless femoral stem. Patients and Methods A four-year follow-up of a randomized controlled study included 141 patients who underwent surgery for a displaced femoral neck fracture. Patients were randomized to receive either a cemented (n = 67) or a cementless (n = 74) stem at hemiarthroplasty (HA; n = 83) or total hip arthroplasty (THA; n = 58). Results Early differences in functional outcome, assessed using the Harris Hip Score, the Short Musculoskeletal Functional Assessment score and EuroQol-5D, with better results in cemented group, deteriorated over time and there were no statistically significant differences at 48 months. Two (3%) patients in the cemented group and five (6.8%) in the cementless group underwent further surgery for a periprosthetic fracture. This difference was statistically significant (p = 0.4). No patient underwent further surgery for instability or infection between one and four years postoperatively. The mortality and the radiological outcomes were similar in both groups. Conclusion Patients with a displaced femoral neck fracture treated with an arthroplasty using a cemented or cementless stem had good function and few complications up to four years postoperatively. However, due to the poor short-term functional outcomes in the cementless group, the findings do not support their routine use in the treatment of these elderly patients. Cite this article: Bone Joint J 2018;100-B:1087–93.

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