OBJECTIVE To evaluate the clinical effect of total hip joint replacement and hemiarthroplasty in treatment of fracture of femoral neck in old patients. METHODS One hundred and ten cases with femoral neck fracture in the aged, 70 to 106 years old, from Aug 1990 to Aug 1999 were reviewed, 96 cases were followed up, among which 52 cases received total hip joints replacement and the other 44 cases received hemiarthroplasty. All of the 96 cases were followed up for 15 to 112 months, averaged 51 months, and were evaluated in operation procedures, post-operative recovery and joint function according to Harris Scoring. RESULTS The operation time of total hip joints replacement was 20 minutes longer, bleeding volume was 120 ml larger, and post-operative drainage was 140 ml more, in average, than those in hemiarthroplasty. There was no obvious difference between the two types of operation in bed-resting time, length of stay and hospitalizing costs. According to Harris Scoring, there were 38 cases of excellent in hemiarthroplasty (86.4%) and 48 cases of excellent in total hip joints replacement (92.3%). CONCLUSION Both of the artificial joint replacements are reasonable choices for treatment of fracture of femoral neck in old patients, but total hip joints replacement is recommendable for those comparatively younger patients with good systematic status, and hemiarthroplasty is a good option for those elderly with some systematic diseases.
ObjectiveTo investigate the clinical e cacy of hip arthroplasty in treating intracapsular femoral neck fracture in elderly patients. MethodsFrom January 2010 to December 2012, 198 patients with intracapsular femoral neck fractures (Garden Ⅲ and Ⅳ ), aged between 65 and 85 years old were selected to be treated with hip arthroplasty. Clinical evaluation including Harris hip score, Barthel index, postoperative complications and activities of daily living were performed. ResultsThe patients were followed up for an average time of 15.6 months. At the follow-up time of 12 months, the Harris scores were 85-98, averaging 94.5; the Barthel indexes were 86-97, averaging 94.0. The main postoperative complications were subcutaneous fat necrosis (3 cases), deep venous thrombosis of lower limbs (2 cases), bedsores (2 cases), pulmonary infection (4 cases), dislocation (2 cases) and pain (4 cases). More than 95% of the patients had a satisfactory treatment and recovered activities of daily living. ConclusionHip arthroplasty reduces postoperative complications caused by prolonged bed rest and helps the patients get back to normal activities of daily living early, so it is an effective method to treat intracapsular femoral neck fractures and is suitable for widespread clinical application.
Objective To design a new type of three-dimensional honeycomb guide for percutaneous cannulated screw placement in femoral neck fracture and evaluate its effectiveness. Methods The clinical data of 40 patients with femoral neck fracture who met the selection criteria between June 2019 and December 2020 were retrospectively analyzed. According to different intraoperative positioning methods, they were divided into control group (20 cases, free hand positioning screws) and study group (20 cases, new guide assisted positioning screws). There was no significant difference in gender, age, side, cause of injury, Garden classification, and time from injury to operation between the two groups (P>0.05). The operation time, fluoroscopy times, guide needle puncture times, and fracture healing time of the two groups were recorded. The hip function was evaluated by Harris score at last follow-up. At immediate after operation, the following imaging indexes were used to evaluate the accuracy of screw implantation distribution: screw spacing, screw coverage area, distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation. Results All operations were successfully completed, and the guide needle did not penetrate the femoral neck cortex. There was no significant difference in operation time and fluoroscopy times between the two groups (P>0.05); the guide needle puncture times in the study group was significantly less than that in the control group (t=8.209, P=0.000). Imaging detection at immediate after operation showed that the screw spacing and screw coverage area in the study group were significantly greater than those in the control group (P<0.05); the distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation were significantly smaller than those in the control group (P<0.05). All patients were followed up 7-25 months, with an average of 19.3 months. There was no significant difference in follow-up time between the two groups (t=−0.349, P=0.729). There were 2 cases of fracture nonunion in the control group and 1 case in the study group, and the other fractures completely healed. One case of osteonecrosis of the femoral head occurred in the control group. During the follow-up, there was no complication such as vascular and nerve injury, venous thrombosis, screw penetration, withdrawal, breakage, and refracture, etc. There was no significant difference in fracture healing time and Harris score at last follow-up between the two groups (P>0.05). ConclusionThe new three-dimensional honeycomb guide has the advantages of simple structure and convenient use. It can reduce the puncture times of the guide needle and effectively improve the accuracy distribution of cannulated screw implantation.
ObjectiveTo investigate the short- and medium-term effectiveness of percutaneous compression plate (PCCP) internal fixation for femoral neck fractures in the elderly.MethodsThe clinical data of 32 elderly patients with femoral neck fracture treated with PCCP internal fixation between January 2012 and January 2019 were retrospectively analyzed. All of them were traumatic fractures. The causes of injury were falling in 20 cases, traffic accident in 7 cases, and falling from height in 5 cases. According to Garden classification, there were 7 cases of type Ⅱ, 15 cases of type Ⅲ, and 10 cases of type Ⅳ; there were 12 cases with Singh index level Ⅳ, 14 cases with level Ⅴ, and 6 cases with level Ⅵ; the bone mineral density of femoral neck was 0.610-0.860 g/cm2 (mean, 0.713 g/cm2). The time from injury to operation was 3-14 days, with an average of 5.8 days. Patients began to weight-bear gradually within 3 days postoperatively. The operation time, intraoperative blood loss, hospitalization stay, fracture reduction (Garden alignment index), fracture healing, failure of internal fixation, femoral neck shortening, and osteonecrosis of the femoral head were observed; hip function recovery was evaluated by Harris score.ResultsThe operation time was 35-135 minutes (mean, 73.4 minutes), the intraoperative blood loss was 75-385 mL (mean, 116.4 mL), the hospitalization stay was 3-15 days (mean, 8.3 days). At 1 week after operation, the Garden alignment index of fracture reduction was grade Ⅰ in 25 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 1 case. One case of superficial infection of the incision occurred after operation, and no early complications such as deep vein thrombosis in the lower extremities, pulmonary embolism, or bedsores occurred. All the patients were followed up 2.1-4.0 years, with an average of 2.7 years. Except for 2 cases of delayed union (displaced trans-neck and subhead fractures), no nonunion of fracture and failure of internal fixation occurred, the fracture healing time was 4-8 months, with an average of 4.9 months. Femoral neck shortening occurred in 12 cases (37.5%); osteonecrosis of the femoral head occurred in 3 cases (9.4%), all of which were displaced trans-neck and subhead fractures, of which 2 cases received total hip arthroplasty and the other received conservative treatment. The Harris scores of the hip joint at 3 months, 2 years after operation and at last follow-up were significantly improved when compared with those before operation (P<0.05); there was no significant difference between each time point after operation (P>0.05). At last follow-up, the hip joint function was evaluated according to Harris score, the results were excellent in 15 cases, good in 12 cases, and fair in 5 cases, with an excellent and good rate of 84.4%. There was no significant difference in postoperative hip function composition among patients with different ages, Garden classification, Singh index, and Garden alignment index (P>0.05).ConclusionFor elderly patients with femoral neck fractures without severe osteoporosis and with relatively good physical conditions, PCCP internal fixation can achieve satisfactory short- and medium-term effectiveness, but there is a certain risk of osteonecrosis of the femoral head.
Objective To compare the efficacy and safety of dynamic hip screw (DHS) + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults. Methods PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, SinoMed, Wanfang, and Chongqing VIP database were searched for the literature related to the comparison between DHS + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults from the establishment of databases to 2022. RevMan 5.3 software was used for meta-analysis. Results Finally, 25 clinical studies were included, including 8 randomized controlled trials and 17 observational studies, 5 in English and 20 in Chinese. There were a total of 2099 patients, including 989 in the DHS + anti-rotation screw group and 1110 in the cannulated screw group. The meta-analysis results showed that the incidence of bone nonunion [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.17, 0.48)], incidence of femoral head necrosis [OR=0.48, 95% CI (0.27, 0.88)], failure rate of internal fixation [OR=0.28, 95% CI (0.15, 0.51)] in the DHS + anti-rotation screw group were lower than those in the cannulated screw group (P<0.05). The surgical duration [mean difference (MD)=9.91, 95% CI (6.78, 13.05)], incision length [MD=1.25, 95% CI (0.15, 2.35)], and Harris score [MD=6.77, 95% CI (4.66, 8.88)] in the DHS + anti-rotation screw group were higher than those in the cannulated screw group (P<0.05). There was no statistically significant difference in intraoperative bleeding volume, Visual Analogue Scale score, hospital stay, and fracture healing time between the two groups (P>0.05). The incidence of bone nonunion in the DHS + anti-rotation screw group after Pauwels type Ⅲ fracture [OR=0.16, 95% CI (0.05, 0.50)] was lower than that in the cannulated screw group (P<0.05), and there was no statistically significant difference in the incidence of femoral head necrosis between the two groups (P>0.05). Conclusions For femoral neck fracture in adults, DHS + anti-rotation screw can reduce the incidence of bone nonunion, femoral head necrosis, and internal fixation failure compared with cannulated screw alone, and has a higher Harris score, but the surgical duration and incision are longer. Overall, DHS + anti-rotation screw are better at reducing the incidence of complications than cannulated screws alone.
Objective To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. MethodsThe clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. Results The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients’ CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion (P>0.05), but correlated with the incidence of osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P>0.05). Conclusion CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.
ObjectiveTo investigate and analyze the effectiveness of internal fixation with the two different cannulated screw implanting methods of rhomboid and inverted triangle in the treatment of femoral neck fracture in young adults.MethodsThe clinical data of 38 young adults with femoral neck fracture who met the selection criteria between January 2018 and August 2019 were retrospectively analyzed. According to the different methods of cannulated screw implanting, the patients were divided into two groups, 19 cases in each group. The trial group was treated with closed reduction and cannulated screw rhombic distribution internal fixation, while the control group was treated with closed reduction and cannulated screw inverted triangular distribution internal fixation. There was no significant differences in patients’ gender, age, cause of injury, Garden classification of fracture, and time from injury to operation between the two groups (P>0.05). The fracture healing time, the incidence of nonunion, femoral neck shortening, and femoral head necrosis were recorded and compared between the two groups; the effectiveness was evaluated by Harris score and visual analogue scale (VAS) score at last follow-up.ResultsThe incisions of the two groups healed by first intention. All patients were followed up 12-24 months with an average of 15.5 months. There were 1 case of fracture nonunion and 2 cases of shortening of femoral neck in the trial group; while there were 2 cases of fracture nonunion, 1 case of necrosis of femoral head, and 6 cases of femoral neck shortening in the control group; the difference in the incidence of complications (15.8% vs. 47.4%) between the two groups was significant (χ2=4.385, P=0.036). The remaining 18 cases in the trial group and 17 cases in the control group all achieved osteonal union, and the healing time was (14.8±1.6) weeks and (15.9±1.3) weeks, respectively, showing no significant difference between the two groups (t=1.265, P=0.214). At last follow-up, Harris score and VAS score of the trial group were 88.9±4.3 and 1.1±0.7, respectively, while those of the control group were 86.9±5.9 and 1.3±0.9, respectively, showing no significant difference (t=0.603, P=0.550; t=1.152, P=0.257). Hip function was evaluated in accordance with Harris score, the results were excellent in 12 cases, good in 6 cases, and fair in 1 case in the trial group, the excellent and good rate was 94.74%; the results were excellent in 10 cases, good in 7 cases, and fair in 2 cases in the control group, the excellent and good rate was 89.47%; there was no significant difference in the excellent and good rate between the two groups (χ2=0.368, P=0.544).ConclusionThe short-term effectiveness of the two kinds of cannulated screw implanting methods is clear, rhomboid fixation of 4 screws has strong stability with stress distribution, which can effectively reduce the incidence of femoral neck shortening, fracture nonunion, femoral head necrosis, and other complications.
OBJECTIVE To summarize the clinical results of hollow compression screw in treatment of fracture of neck of femur in the aged. METHODS: From November 1993 to October, 1998, 52 aged patients with several types of fracture of neck of femur were treated; among them, there were 25 males and 27 females aged from 60 to 83 years (70 years on average). There were 48 cases of fresh fracture and 4 cases of old fracture. Forty-two cases were performed closed reduction internal fixation, 10 cases with open reduction internal fixation. RESULTS: All the patients could sit by themselves 4 to 6 days after operation, and could walk with a crutch 10 to 15 days after operation. The mobility of hip joint was nearly normal 4 weeks after operation. All the patients were followed 26 to 84 months, 48.5 months on average. Bone union was achieved in 50 cases, nonunion in 2 cases. The average healing time was 4.7 months. There were no other complications, such as ankylosis and muscular atrophy, but ischemic necrosis in 3 cases. CONCLUSION: This method has following advantages, convenient manipulation, less injury, stable fixation, and the short-term recovery, which avoid some common complications. It is a reliable method worthy of popularizing.
ObjectiveTo summarize the patterns and research progress of the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter, and to provide a common language among orthopedic surgeons for scientific exchange.MethodsAccording to related literature and authors own experiences concerning the anatomic border between femoral neck and trochanter region, the intertrochanteric line (or intertrochanteric belt) and its capsularligament attachment footprint, fracture patterns, and treatment strategies were reviewed and analyzed.ResultsWith the rapid growing of geriatric hip fractures, an increased incidence was noted in recent years regarding the proximal femoral comminuted fractures that involving ipsilateral intracapsular neck and extracapsular trochanter regions simultaneously. But the concept of femoral neck combined with trochanter fractures was ambiguous. Based on the anatomic type of femoral neck fracture, the location of fracture center, and the ability to achieve direct inferior calcar or anteromedial cortex-to-cortex apposition and buttress, we classified these complex fractures into 3 sub-types: ① Segmental femoral neck fractures (two separate fracture centers at subcapital and trochanteric region respectively); ② Femoral neck fracture (trans-cervical) with extension to the supero-lateral trochanteric region (fracture center in femoral neck); ③ Trochanteric fracture with extension to the medio-inferior femoral neck region (fracture center in trochanter, comminuted basicervical fracture, or variant type of comminuted trochanter fracture). For treatment strategy, surgeons should consider the unique characteristics of femoral neck and trochanter, usually with combined fixation techniques, or arthroplasty supplemented with fixation.ConclusionCurrently there is no consensus on diagnosis and terminology regarding the concomitant ipsilateral fractures of femoral neck and trochanter. Further studies are needed.