Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Objective To compare the therapeutic effect of cannulated screws fixation at different time points through different reduction methods on the heal ing of displaced femoral neck fractures. Methods From January 1997 to September 2007, 240 patients with displaced femoral neck fracture were treated, including 121 males and 119 females aged 22-79 years old (average 56 years old). All cases were fresh and close fractures. According to the fractured part, there were 133cases of subcapital fracture, 64 of transcervical fracture and 43 of basal fracture. According to Garden classification, there were 105 cases of type III and 135 of type IV. Cannulated screws fixation was performed on all the patients, and the time from injury to operation was 6 hours to 7 days. Fifty-five cases received closed reduction and 59 cases received l imited open reduction as emergency treatment, while 65 cases received closed reduction and 61 cases received l imited open reduction as selective operation. Different groups were compared in terms of the heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation. Results There was no significant difference between the closed reduction and the l imited open reduction in terms of operation time and bleeding volume (P gt; 0.05). Postoperatively, all wounds healed by first intention, no infection was observed, avascular necrosis of femoral head occurred in 44 cases, and the rate of avascular necrosis of femoral head in the l imited open reduction at emergency group was less than that of other 3 groups (P lt; 0.01). All the patients were followed up for 12-72 months (average 38 months), 193 cases got fracture heal ing at 10-23 months after operation (average 14 months). For the closed reduction as emergency operation group, the l imited open reduction as emergency operation group, the closed reduction as selective operation group, and the l imited open reduction as selective operation group, the heal ing rate of fracture was 74.55%, 91.53%, 69.23% and 86.89%, respectively; the excellent and good rate of reduction was 73.73%, 94.92%,70.77% and 91.80%, respectively; the excellent and good rate of fixation was 76.36%, 93.22%, 73.85% and 88.52%, respectively. The heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation in the l imited open groups were higher than that of the closed reduction groups (Plt; 0.01), and there was no significant difference between the emergency operation groups and the selective operational groups (Pgt; 0.05). Conclusion The reduction methods have significant influences on the heal ing of fractures after cannulated screws fixation of the displaced femoral neck fracture, and the operation time has no obvious effect on fracture heal ing.
【Abstract】 Objective To evaluate the cl inical outcome of free vascularized fibular associated with il iac graft intreatment of old femoral neck fracture. Methods From January 1994 to January 1997, 76 cases of old femoral neck fracture were treated with free vascularized fibular associated with il iac graft, including 54 males and 22 females, aging from 24 to 48 years with an average of 31.5 years. All of these fractures resulted from injury. There were 20 cases of Garden II, 41 of Garden III and 15 of Garden IV. Based on the location of fracture, there was 26 cases of subcapital, 42 cases of transcervical and 8 cases of basal. Sixty-five cases were treated with internal fixation, 7 cases with skin traction and 4 just with staying in bed. Their Harris score were from 52 to 72 with an average of 65.6. The time from injury to operation was 2-24 months. The size of free vascularized fibular was 6-8 cm and il iac graft was 3.0 cm×2.0 cm×1.5 cm. Results In 76 cases, 68 were followed up and all fractures healed within 4 to 6 months with an average of 5.2 months. The increased density in femoral head was observed 1 year after operation. After 10 years of operation, normal hip function was achieved in 63 cases（followed up 10.1 -12.4 years with theaverage as 10.5 years); the Harris score was 87.5 (84 to 94). The structure of femoral head was normal and the grafted fibular and il iac bone healed with the femoral, no elapse or cyst occurred. Five cases had been compl ied with total hip replacement for femoral head necrosis or other. Conclusion Free vascularized fibular associated with il iac graft is a good method to treat old femoral neck fracture.
ObjectiveTo compare the effectiveness of percutaneous compression plate (PCCP) and hollow compression screw in the treatment of displaced femoral neck fractures. MethodsBetween January 2010 and June 2014, 70 patients with displaced femoral neck fractures were randomly divided into 2 groups. After reduction, fracture was fixed with PCCP in 35 cases (group A) and with hollow compression screw in 35 cases (group B). There was no significant difference in the gender, age, cause, side and type of fractures, time from injury to operation, associated disease, pre-operative Harris score and visual analogue scale (VAS) score between 2 groups (P > 0.05). The operation time, intra-operative blood loss, fracture healing time, fracture reduction quality, time of rehabilitation and weightloading; complication, post-operative Harris score and post-operative VAS score were compared between 2 groups. ResultsThe incisions healed by first intention. All patients were followed up 13-34 months (mean, 23.7 months). There were significant differences in operation time, intra-operative blood loss, and fracture healing time between 2 groups (P < 0.05). There was no significant in the fracture reduction quality between 2 groups (P > 0.05). Avascular necrosis of the femoral head occurred in 2 cases of group A after operation (fracture reduction quality: grade IV); and avascular necrosis of the femoral head occurred in 4 cases of group B after operation (fracture reduction quality: grade I in 2 cases, grade Ⅱ in 1 case, grade Ⅲ in 1 case, and grade IV in 1 case), nonunion in 1 case, and screw loosening in 3 cases; and there was significant difference in the incidence of bone nonunion and avascular necrosis of the femoral head between 2 groups (χ2=-3.997, P=0.046). Difference was significant in fracture reduction quality in the patients with avascular necrosis of the femoral head and nonunion between 2 groups (χ2=1.991, P=0.047). The time of rehabilitation and weight-loading of group A was significantly earlier than that of group B (P < 0.05); the Harris and VAS scores of group A were significantly better than those of group B at 12 months after operation (P < 0.05). ConclusionPCCP for treatment of displaced femoral neck fractures has better static stability and better sliding dynamic pressure effect than hollow compression screw, and it can provide earlier rehabilitation and weight-loading postoperatively and obviously decrease the incidence of bone nonunion and avascular necrosis of the femoral head, but avascular necrosis of the femoral head still occur in patients with poor reduction or comminuted fracture.
Objective To investigate the clinical efficacy of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. Methods A retrospective analysis was made on the clinical data of 20 femoral neck fracture patients treated by computer-assisted cannulated screw internal fixation system based on error correction method between January 2014 and October 2015 (trial group), and 36 femoral neck fracture patients undergoing traditional manual surgery with closed reduction by cannulated screw fixation in the same period (the control group). There was no significant difference in gender, age, injury cause, side of fracture, types of fracture, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion, fracture healing time, fracture healing rate, and Harris hip score were compared between 2 groups. Results All incisions healed by first intention after operation, and no complication of blood vessel and nerve injury occurred. The operation time of trial group was significantly longer than that of control group (t=2.290,P=0.026), however, the intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion of trial group were significantly less than those of control group (t=–10.650,P=0.000;t=18.320,P=0.000;t=–16.625,P=0.000). All patients were followed up 12-18 months (mean, 14.7 months). X-ray films showed that fracture healing was obtained in 2 groups, showing no significant difference in fracture healing time between 2 groups (t=0.208,P=0.836). No complication of ischemic necrosis of femoral head occurred during follow-up period. At last follow-up, the Harris hip score was 87.05±3.12 in trial group and was 86.78±2.83 in control group, showing no significant difference (t=0.333,P=0.741). Conclusion Computer-assisted cannulated screw internal fixation surgery based on error correction method for femoral neck fractures is better than traditional manual surgery in decreasing intraoperative radiation and surgical trauma during operation.
Objective To discuss the effectiveness of intramedullary nail fixation with selective cable wiring in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture. Methods Between June 2012 and December 2015, a total of 19 patients with ipsilateral femoral neck fracture and subtrochanteric fracture underwent closed reduction of femoral neck fracture and intramedullary nail fixation combined with selective cable wiring. There were 5 males and 14 females with a median age of 52 years (range, 35-77 years). The cause of injury included traffic accident injury in 17 cases and falling injury in 2 cases. According to Garden classification for femoral neck fractures, 7 cases were rated as type Ⅱ, 8 as type Ⅲ, and 4 as type Ⅳ. Femoral subtrochanteric fractures were classified by Seinsheimer classification, with 9 cases as type Ⅱ, 5 as type Ⅲ, 3 as type Ⅳ, and 2 as type V. The interval from injury to operation ranged from 2 to 7 days with an average of 3.7 days. Results The operation time was 58-125 minutes (mean, 82.4 minutes) and the intraoperative blood loss was 225-725 mL (mean, 289.5 mL). All incisions achieved healing by first intention and no early complication such as infection was observed. All patients were followed up 12-18 months (mean, 13.9 months). At 1 month after operation, the tip apex distance was 9-23 mm (mean, 15.2 mm). All patients achieved bone union with the healing time of 18-42 weeks (mean, 27.4 weeks). One case of hip varus and femoral neck re-displacement (femoral neck shaft angle was 122°) occurred at 3 months after operation, which achieved bone union at 42 weeks after operation. Five patients complained of postoperative pain with the visual analogue scale (VAS) score of 1-3 (mean, 1.8), which did not influence normal life. A total of 16 patients recovered preoperative hip function. During follow-up, no fracture nonunion, femoral head necrosis, implant failure, screw cut-out, and loosening of cable wiring was observed. The Harris hip score (HSS) was 72-92 (mean, 82.8) at last follow-up and 15 patients (78.9%) achieved good hip function. Conclusion Intramedullary nail fixation combined with selective cable wiring was effective in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture.
ObjectiveTo evaluate the short-term effectiveness of arthroscopic surgery combined with direct anterior approach for hip diseases.MethodsA retrospective study was performed on 23 cases with hip diseases (23 hips), who were treated with the arthroscopic surgery combined with direct anterior approach, between January 2015 and December 2016. There were 9 males and 14 females, aged from 27 to 49 years (mean, 38.6 years). There were 11 cases of posterior dislocation of the hip associated with femoral head fracture (Pipkin typeⅠ) and 7 cases of femoral neck fracture (Garden type Ⅳ). And the interval between injury and operation was 2-8 days (mean, 4.3 days). Five cases were osteonecrosis of femoral head at precollapse stage which were rated as stageⅡA according to Association Research Circulation Osseous (ARCO) classification system. The disease duration was 3-8 months (mean, 5.9 months). The preoperative Harris hip score, Oxford Hip Score (OHS), Postel score, and visual analogue scale (VAS) were 57.3±8.2, 11.2±3.6, 3.2±1.5, and 7.2±1.3, respectively.ResultsAll the wounds healed primarily. Lateral femoral nerve injury occurred in 3 cases. All patients were followed up 8-19 months (mean, 15.6 months). Bone union achieved in all patients after 14-19 weeks (mean, 15.8 weeks) and no secondary osteoarthritis or heterotopic ossification occurred. At last follow-up, the Harris hip score (92.5±5.3), OHS (36.5±5.9), and Postel score (14.2±2.6) were significantly higher than preoperative scores (t=45.274, P=0.000; t=36.586, P=0.000; t=32.486, P=0.000), and VAS score (1.8±0.9) was significantly lower than preoperative score (t=21.314, P=0.000).ConclusionArthroscopic surgery combined with direct anterior approach for hip diseases can effectively relieve pain, improve hip function, and obtain the satisfactory short-term effectiveness.
Objective To compare the short-term clinical outcomes of secondary total hip arthroplasty (THA) after failure of internal fixation with primary THA in elderly patients with displaced femoral neck fractures, and explore the best treatment for displaced femoral neck fractures in the elderly. Methods A total of 300 elderly patients with displaced femoral neck fractures from January 2011 to January 2015 were retrospectively enrolled in this study, of whom 150 underwent primary THA and 150 underwent secondary THA after failure of internal fixation. The operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative ambulation time, length of postoperative hospitalization, incidence of postoperative complications, and score of postoperative hip joint function were compared between the two groups. Results Compared with those in the secondary THA group, in the primary THA group, the operation time was shorter [(54.7±15.3) vs. (70.1±23.4) minutes], the intraoperative bleeding volume was less [(116.9±35.0) vs. (131.7±44.5) mL], the postoperative ambulation was earlier [(1.0±0.3) vs. (1.8±0.6) days], the length of postoperative hospitalization was shorter [(12.0±2.9) vs. (15.2±3.1) days], and the differences were all statistically significant (P<0.05); but there was no statistically significant difference in the incidence of postoperative complications or the Harris scores at 3, 6, 12, and 24 months after operation (P>0.05). Conclusion The secondary THA for femoral neck fracture is more difficult, with longer stay in hospital, but the short-term clinical efficacy is similar to that of the primary THA.
ObjectiveTo systematically review the postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture.MethodsCochrane Library, PubMed, Embase, China Biology Medicine Database, Chongqing VIP China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Database were searched to collect randomized controlled trials of postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture from inception to January 2018. A systematic review was performed to compare the postoperative deep infection, superficial wound infection, pneumonia infection, and urinary tract infection between cemented and cementless hemiarthroplasty. Analyses were conducted using Review Manager version 5.2.0 software.ResultsA total of 11 studies were included in the Meta-analysis, including 1 533 patients. There was no significant difference in the incidence of deep infection [odds ratio (OR)=1.62, 95% confidence interval (CI) (0.66, 3.94), P=0.29], superficial wound infection [OR=1.17, 95%CI (0.56, 2.47), P=0.68], pneumonia infection [OR=0.73, 95%CI (0.47, 1.13), P=0.16], or urinary tract infection [OR=1.10, 95%CI (0.65, 1.86), P=0.73] between the two groups.ConclusionWhen selecting a fixation method for hemiarthroplasty to treat eldly patients with femoral neck fracture, infection-related postoperative complications are not the determinant factor to consider.
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.