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@#Introduction: Neck of femur fractures are quite common fractures in the elderly. Though a lot is spoken about the various modes of management of these fractures across different age groups, hardly any literary support mentioning their distribution, location and pattern can be found. In this study, we aim to find whether the Singh index, as a marker of osteoporosis on digital radiographs, can predict the location of neck of femur fractures in the elderly population. Materials and methods: We accessed 556 fractured hip radiographs in our institution over the past 5 years (2015- 2020) and correlated with the Singh index, as a marker of degree of osteoporosis, on pre-operative pelvis digital radiographs. Mid coronal CT cuts were also corroborated with the radiographic findings. A control group was set up and 361 radiographs were evaluated in the study group. Results: A total of 124 transcervical fractures (73%) were in Singh index 4, while 76 subcapital fractures (70%) were in Singh index 3. A total of 166 fractures (66%) were found in transcervical region in the age group of 60 to 80 years, while 80 fractures (74%) were in the subcapital region in patients above 80 years. Conclusion: We concluded that transcervical fractures were more common in patients with Singh index 4 (p<0.001) and subcapital more common in patients with Singh index 3(p<0.001). There was also a shift in location of the fractures from the transcervical region to the subcapital region with age above 80 years (p<0.001).
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@#Femoral neck stress fractures are rare in children. To the best of our knowledge, the tension type stress fracture has been reported only twice in the English language literature. We report on a five years follow-up of a 10-year-old boy with this injury which was initially missed. The fracture healed after screw fixation. We highlight the importance of considering stress fracture as a differential diagnosis in a child with chronic hip pain. A careful physical examination and the appropriate imaging will avoid missing the diagnosis.
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Background: Femoral neck fracture in elderly continues to pose a treatment dilemma. Associated co-morbidities and high mortality (1-year mortality of 25–30% and only 25% survivorship at 10 years) often skews the surgical decision. The underlying treatment goal is minimum revision and maximum functional outcome. Lack of clear guidelines is reflected by the continued debates regarding their management namely osteosynthesis vs arthroplasty; hemiarthroplasty vs total hip arthroplasty, unipolar vs bipolar and cemented vs uncemented. A review of joint registries, uniformly suggest that cemented fixation in elderly patient results in early mobilization, less residual pain and the lowest risk of revision. We analyzed clinical outcome of cemented monoblock hemi-arthroplasty (modified design) in femoral neck fracture in elderly.Methods: Total 94 cemented hemiarthroplasty, performed since January 2009, with a minimum follow up of 3 years are included in the study. Mean modified Haris Hip score at 2 years, 3 years and in the last follow up was 88 (72-91), 84 (70-89) and 81 (65-86) respectively. Acetabular erosion was noted in three patients (3.19%) (one was symptomatic) and aseptic loosening in another two patients (2.12%). Major complications such as deep wound infection, dislocation or peri-prosthetic fracture were not noted in any patient.Results: Result of the present study is consistent to marginally superior when compared to cemented Thompson monoblock and the cemented bipolar prostheses. We attribute this to routine use of cement in the elderly osteoporotic bone along with design modification of the monoblock stem. Long term result of THA is marginally (not statistically significant) better compared to hemiarthroplasty. However, it is associated with prolonged surgery, more blood loss and higher dislocation rate. The rates of dislocation following THA, bipolar and unipolar arthroplasty were 11%, 3%, and 2% respectively.Conclusions: Cemented monoblock hemiarthroplasty is effective and viable option in displaced femoral neck fracture in elderly in terms of excellent functional outcome, low reoperation without adversely affecting morbidity and mortality. Being cost effective procedure this may be considered as first line surgical option especially in socio-economically disadvantaged section of the society.
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Introduction: The femoral neck anteversion can be defined as the angle between femoral bicondylar plane and aplane passing through the centre of the neck and head of femur. Adult femoral anteversion has been documentedat the range between 7-16 degrees.This angle is widely recognized as an important factor for hip stability. Thepresent study aimed to evaluate the normal anteversion range in adult Indian femur which would be of great helpin explorative orthopedic procedures and in designing of hip prosthesis.Materials and Methods: Study conducted in 202 femurs of 94 male (48 right and 46 left) and 108female bones (52right and 56 left). And the angle was measured using Kingsley Olmsted Method.Observation and Results: The mean value of anteversion angle of femurwas 7.61 degrees for male and 12.71degrees for females.Mean anteversion angle for both male and female femur was 10.37 degrees. Retroversionwas observed in 10 femurs(5%) and neutral version was observed in12 femurs (5.9%).Conclusion:Determining the anteversion angle is crucial for the diagnostic and therapeutic planning of patientswith various pathologies such as hip development dysplasias, cerebral palsy, varum thigh, flat thigh,epiphysiolysis, congenital club foot, congenital dislocation of the hipand other development abnormalities.Statistical analysis revealed sexual dimorphism in anteversion in Indians being greater among females thanmales
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Introduction: Incidence of displaced fracture neck of femuris high and there is lack of consensus over the definitivetreatment of such fractures as the incidence of complicationsespecially avascular necrosis remains very high. Objective ofthe study was to evaluate the incidence of avasular necrosisand its pattern in displaced fracture neck of femur managedwith osteosynthesisMaterial and methods: This study was a prospective studyconducted in Bone & Joint Hospital, Srinagar from 2003 to2018 on patients with displaced fracture neck of femur. Closereduction was done on traction table using Whitman’s Methodand reduction was confirmed under C Arm and was labelledsatisfactory using Lowell’s S Method and fixation was doneusing 3 Cannulated Screws of 6.5mm.Results: 118 patients {70 males and 48 females} with meanage 42.5 years {range 18 to 55 years} presented late in ourhospital which resulted in a delay in fixation from 24 hrs to7 days post trauma. Patients were followed till 2018 for aminimum period of 10 years.Conclusion: Our study suggest same AVN rates as of otherstudies if fixation is done within a period of one week.
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Background: The fracture neck of femur is one of the commonest fractures in elderly. With life expectancy increasing with each decade, our society is becoming increasingly an active geriatric society, with significant number of hospitalized and nursing home patients with femoral neck fractures and their sequelae. Selection of the type of prosthesis is very important in hemiarthroplasty as different types are available. Since the last two decades, bipolar replacements of the femoral head have gained popularity for treating femoral neck fractures. Aim & Objective – To assess and analyse the results of management of fracture neck of femur with bipolar hemiarthroplasty. Methods: After obtaining ethical committee approval and informed consent from patient, detailed history of patient was taken with particular emphasize on mode of injury and associated medical illness. On the day of surgery , under anesthesia and patient in lateral position, following strict aseptic precautions, either lateral (Hardinge) or Posterior (Southern-Moore) approach incision made, tissues dissected, joint capsule incised and femoral head extracted with the help of cork screw. Then the appropriate size of prosthesis with cement was seated. The wound was closed meticulously in layers. Knee flexion, isotonic quadriceps exercises were started from 1st or 2nd post op day and patients were mobilized with walker as tolerated. Patients are educated on different position of legs that should be avoided in the postoperative period. Follow up was done after 6 weeks and for further at 3 months, 6 months & 1 year .Result: In our series, at the end of final follow-up, there was no evidence of loosening, radiolucent zones, distal migration or subsidence of prosthesis. The patient with Periprosthetic fracture healed and is weight bearing fully with no pain. One patient who had moderate heterotopic ossification had still has some mild pain occasionally. Conclusion: we conclude that bipolar hemiarthroplasty produces good functional outcomes with minimal complications for displaced intracapsular femoral neck fractures and has several advantages; these results are comparable to the other studies.
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Background: Fracture neck of femur occurs infrequently in young patients compared to geriatric age groups. The occurrence in the younger age group is associated with high-energy trauma and more complications. The study was conducted to compare the results of two fixation techniques in management of fracture neck of femur in young age group patients. Methods: A total of 60 patients included in this prospective randomized trial were divided into two groups. Group I includes patients managed by multiple hip screws with fibular graft and group II includes patients managed by multiple hip screws alone. Assessment of fixation was done on basis of Harris Hip score at 6 week and 3 monthly intervals. Results: According to Garden's classification, a total of 40 (66.67%) cases were of type III, out of which 24 patients were in group I and 16 were in group II. The rest 20 (33.33%) patients were of type IV with 6 cases ingroup I and 14 cases in group II. In our study, functional outcome was calculated according to Harris hip score. In Group I we got 21 patients (70%) with excellent result, 7 patients (23.33%) with good result and 2 patients were failure cases. In Group II 17 patients (56.67%) got excellent outcome, 9 patients (30%) good outcome and 4 were failure cases.Conclusion: The study showed that there was no significant difference in any of the procedures and either of the technique could be employed depending on user experience and skills.
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Background: Fractures of neck of femur are a major cause of morbidity and mortality in elderly population. Intertrochanteric fractures in elderly people are usually comminuted and unstable because of osteoporosis. Unstable intertrochanteric fractures in elderly patients are associated with high rates of morbidity and mortality2 although the results have improved with the use of Bipolar Hemi-Arthroplasty. Methods: All the patients were selected from among the admissions in the Department of Orthopaedics, MNR Medical college and hospital, Mediciti institute of medical sciences, Archana hospital, Hyderabad, from june 2013 to 2015 May. Cemented bipolar hemiarthroplasty (Non modular bipolar hip prosthesis of OSIM) with or without greater and lesser trochanter fixation by tension band wiring was done. The follow up was carried out at 6 weeks, 3 months, 6 months, and 1 year. The results were evaluated using Harris Hip Score Rating. Results: The average age of patients in our series was 65 years with a range of 60 years to 75 years. Out of 70 patients 42 (60%) were female and 28 (40%) male. Left side is more commonly involved with 38 patients (54%) than right side (46%). The average duration of hospital stay was 10 days, with a range of 10-25 days. Out of 70 patients 35 (50%) had excellent outcome, 14(20%), 14(20%), 7(10%), had good fair and poor outcomes respectively. Conclusion: Cemented bipolar hemi-arthroplasty with anatomical reconstruction of trochanteric region preserves abductor mechanism thus allowing early mobilization, safe early weight bearing on the injured hip and had a relatively low rate of complications.
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Objective To evaluate the potential high risk factors of femoral head necrosis after femoral neck surgery in adult patients. Methods From January 2009 to October 2014,390 patients with femoral neck fractures in our hospital were treated with multiple hollow compression screws. All patients were followed up for 12 to 60 months. Then retrospectively analyzed the incidence rates of femoral head nec-rosis and the clinical data about age,gender,fracture side,Garden index,fracture shift condition,internal medicine complications,whether to do lower limb preoperative traction,restoration method,postoperative load time and whether take out hollow compression screw internal fixa-tion,so as to explore the higher risk factors for femoral head necrosis. Results Among the 390 cases,352 cases got followed up. There were 45 cases of them ended with nonunionand 49 cases ended with femoral head necrosis. The univariate regression analysis results showed that the age,fracture shift condition,internal medicine complications,postoperative load time and Garden index,whether take out internal fixation were risk factors for femoral head necrosis (P<0. 05). The multi-factor results showed that aged from 40 to 60 years old,transfered fracture, seriously complications,time of loading less than 3 mouths,Ⅲ and Ⅳ Garden index,take out internal fixation were the high risk factors for femoral head necrosis (P<0. 05). Conclusion Patients who aged from 40 to 60 years old and having transfered fracture,seriously complica-tion,early weight bearing,high Garden index and internal fixation take-out would increase the risk of femoral head necrosis.
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This study was undertaken to investigate the outcome of traumatic intracapsular neck of femur fractures treated with total hip arthroplasty (THA). Patients aged ? 60 years who underwent THA for traumatic intracapsular neck of femur fractures from January 2005 to March 2009 were included in the study. Telephone or personal interviews were conducted. There were 49 patients identified within the study period. The mean age was 74.12 years. Most patients were females (81.6%), with a male: female ratio of 1: 4.4. In total, 29 patients were available for outcome scoring. The one-month mortality rate was 4.1%, and the one-year mortality rate was 20.5%. Of the 29 patients 82.8% obtained a Zukerman Functional Outcome Score of good (80 ?100) and 13.8% obtained a score of fair (60 ?80). THA for the treatment of traumatic neck of femur fractures in elderly is a good option with 96.6% of patients obtaining a satisfactory functional outcome, with acceptable morbidity and mortality statistics.
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[Objective]To discuss the curative effect of using the DHSN and the sartorial-pedicled ilium bone graft in treating the fracture of neck of femur among young people.[Method]A total of 46 cases of the fracture of neck of femur treated with the DHSN and the sartorial-pedicled ilium bone graft were followed up for 1～8 years.The position of fracture or the area of bony defect was filled with the sartorial-pedicled ilium bone.[Result]The clinical results were assessed according to the functional rehabilitation.So,there were excellent results of 23 hips,good of 19 hips and poor of 4 hips in this study and the satisfactory rate was 91%.There were 44 cases reached osteal healing.The average healing time was 8 months and the average time of taken out was 14 moaths.[Conclusion]In treating the fracture of neck of femur among young people,the DHSN and the sartorial-pedicled ilium bone graft have the advantage of firm fixation and highly healing rate.
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The bipolar endoprosthesis was first reported by Giliberty, as well as Bateman in 1974. There were several reports indicating less acetabular erosion in bipolar endoprosthesis than in unipolar, Even if there was a problem of dislocation and valgus position of cup of initial design, the prosthesis of nowadays is useful in failed total hips with erosion of the acetabulum as well as hip with normal acetabular cartilage. The authors reviewed and analysed 44 cases of cementless bipolar endoprosthesis (Self Centering Universal Hip replacement utilizing the Tri-Lock total hip femoral stem), operated at the department of orthopaedic surgery, Hanyang University Hospital from June 1984 to May 1987. The following results were obtained. 1. There were 18 males and 25 females. 2. 22 cases were idiopathic avascular necrosis with relatively good acetabulum, 21 cases of fracture of femoral neck and 1 case of metastatic adenocarcinoma. 3. Average operation time eas 1 hour and 10 minutes and average amount of transfusion; 650cc. 4. We used 42 Watson-Jones approach and 2 Charnley's. 5. The common size of metal cup was 45–53mm in men and 43–47mm in women. 6. The size of prosthetic femoral head was equal to normal head in 16 cases, larger than normal in 14 cases, smaller than normal in 14 cases. 7. There were 2 case of intraoperative undisplaced fracture of femur and one case of heterotopic ossification. 8. There were motion of outer and inner bearing when the extremity was abducted and adducted on serial roentgenogram during a period between 2 years and 5 years. 9. Average Harris hip rating score was 38.5, preoperatively and 95.2, postoperatively.