scholarly journals The Effect of Anatomical Reduction on Functional Outcomes in Femoral Neck Fracture: A Novel Modified Garden Index

Cureus ◽  
2021 ◽  
Author(s):  
Anil Agar ◽  
Ali Utkan
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Functional Outcomes ◽  
Anatomical Reduction ◽  
Neck Fracture

scholarly journals Clinical Observation and Finite Element Analysis of Cannulated Screw Internal Fixation in the Treatment of Femoral Neck Fracture Based on Different Reduction Quality

2021 ◽  
Author(s):  
Gan Zhao ◽  
Ming Liu ◽  
bin Li ◽  
haizhong Sun ◽  
Biaofang Wei
Keyword(s):  
Finite Element ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Cannulated Screw ◽  
Anatomical Reduction ◽  
Significant Difference ◽  
Reduction Group ◽  
Neck Fracture ◽  
Time From Injury

Abstract Objective: Femoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation.Methods: Retrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018.According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference.Results: A total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification and follow-up time among the three groups (P > 0.05).However, there was significant difference in harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05).Conclusion: Both positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.

scholarly journals Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gan Zhao ◽  
Ming Liu ◽  
Bin Li ◽  
Haizhong Sun ◽  
Biaofang Wei
Keyword(s):  
Finite Element ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Cannulated Screw ◽  
Anatomical Reduction ◽  
Significant Difference ◽  
Reduction Group ◽  
Neck Fracture ◽  
Time From Injury

Abstract Objective Femoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction, and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation. Methods Retrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018. According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group, and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months, and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening, and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference. Results A total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification, and follow-up time among the three groups (P > 0.05). However, there was significant difference in Harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05). Conclusion Both positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.

Hip resurfacing arthroplasty for patients with inflammatory arthritis: a systematic review

2017 ◽  
Vol 28 (1) ◽  
pp. 11-17
Author(s):  
Kyle W. Morse ◽  
Edwin P. Su
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Functional Outcomes ◽  
Inflammatory Arthritis ◽  
Hip Resurfacing ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Hip Resurfacing Arthroplasty ◽  
Resurfacing Arthroplasty ◽  
Neck Fracture

Introduction: Modern metal-on-metal hip resurfacing arthroplasty has led to decreased revision rates and high implant survival rates as compared to prior generations of resurfacing. Many of the series that report on resurfacing outcomes focus upon patients treated with a diagnosis of osteoarthritis. Patients with inflammatory arthritis such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are also treated in these series, however, their outcomes following resurfacing are underreported. The aim of this study was to determine complications that may occur following hip resurfacing in patients with inflammatory arthritis. A secondary aim was to determine functional outcomes following resurfacing. Methods: A search was performed in MEDLINE (PubMed/OVID), Cochrane Library, and Google Scholar. 5 studies met eligibility criteria. This review includes 196 hips; 120 had a diagnosis of AS or seronegative spondyloarthropathy and 76 had a diagnosis of RA or juvenile RA. 8 revisions were reported at a mean time of 64.2 (8.67-275.58) weeks. Results: Femoral neck fracture was the most common indication for revision, occurring in 3.06% of all hips at 34.5 weeks (16.0-52.0). 2 infections, 2 reports of acetabular radiolucency, and no dislocations were reported. The University of California at Los Angeles score, Harris Hip Score, and Range of Motion were the most common functional outcomes measured, which increased in the majority of studies following resurfacing. Conclusions: Femoral neck fracture was the most common reason for revision in patients with inflammatory arthritis following resurfacing and there were no dislocations reported. Following resurfacing, these patients have improved functional outcomes.

Reverse fracture displacement direction closed reduction technique (RCRT) for the treatment of valgus impacted femoral neck fracture

2020 ◽  
Author(s):  
QiuLiang Zhu ◽  
Maohua Yan ◽  
Bin Xu ◽  
Jun Ma
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Closed Reduction ◽  
Simple Procedure ◽  
Fracture Site ◽  
Anatomical Reduction ◽  
Fracture Displacement ◽  
Displacement Direction ◽  
Neck Fracture ◽  
Reduction Methods

Abstract Background Impacting locked in fracture site of valgus impacted femoral neck fracture may be the difficulty to achieve anatomical reduction. The aim of this article is to introduce a novel technique to successful complete anatomical reduction. Methods After identify the fracture classification and displace direction. Two 2.0 mm diameter kirschners wire were inserted crossing the femoral head and fixed into acetabular bone. under the continuous image guiding and monitoring, reversing fracture displacement direction with internal rotation and abduction of the hip to complete the closed reduction. results anatomical reduction was achieved in X-ray and CT data postoperative. conclusions This technique provides anatomical reduction, simple procedure, and few interference of internal environment of hip and fracture site in valgus impacted femoral neck fracture.

Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up

2008 ◽  
Vol 149 (11) ◽  
pp. 493-503 ◽  
Author(s):  
Andor Sebestyén ◽  
Imre Boncz ◽  
Ferenc Tóth ◽  
Márta Péntek ◽  
József Nyárády ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fracture ◽  
Neck Fracture

A csípőtáji törésekhez idős korban magas halálozás társul. A szakirodalomban kevés a nagy beteganyagot feldolgozó, országos kiterjedésű ellátórendszer adatain alapuló feldolgozás. Célkitűzés: A tanulmány célja a 60 év feletti akut, monotraumás combnyaktöröttek primer ellátását követő halálozások vizsgálata havonta és évente ötéves utánkövetéssel, valamint a különböző rizikófaktoraik halálozásra gyakorolt hatásainak értékelése az egyes időperiódusokban. Módszer: Az adatok az Országos Egészségbiztosítási Pénztár adatbázisából származnak. Az értékelés bázisát a fekvőbeteg-ellátást végző intézményekből combnyaktörés primer műtéti ellátását követően 2000. évben emittált betegek képezik. Bemutatjuk az átlagos évenkénti, havonkénti és heti halálozási arányokat, valamint rizikótényezők szerinti alakulásukat havonként és évenként. A rizikótényezők és a halálozás kapcsolatának értékelése logisztikus és Cox-regressziós analízissel történik. Eredmények: A tanulmányban 3783 fő került elemzésre. Átlagéletkoruk 77,97 (SD 8,52) év. A halálozás az első héten 1,71%, 30 napon belül 8,99%, az első évben 30,74%, öt év alatt 61,88% volt. A halálozás havi szinten az első 5 hónapig mutat csökkenést, éves szinten az első év után stagnál. A rizikófaktorok közül a férfinem és a magasabb életkor öt évig, a kísérőbetegségek hatásai a negyedik évig, a laterális combnyaktöréstípus és a 12 órán túli ellátás két évig, a korai lokális szövődmények egy évig, a hétvégi ellátások az első hónapban eredményeznek magasabb halálozási kockázatot. Az országos és egyetemi ellátásokat követően az első évben alacsonyabb a halálozási kockázat. Következtetések: A csípőtáji törések managementjében a halálozások csökkentése érdekében hangsúlyozzuk a 12 órán belüli ellátás, a törési típusnak megfelelő módszerválasztás, a hét minden napján történő azonos ellátási feltételek biztosítása, az ellátások centrumokba történő szervezése, a beteg általános állapotának és kísérőbetegségeinek megfelelő akut ellátás és az utókezelések fontosságát.

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