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Article in Chinese | WPRIM | ID: wpr-879417


OBJECTIVE@#To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors.@*METHODS@#Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(β-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve.@*RESULTS@#There was no significant difference in the levels of serum PINP and β-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation(@*CONCLUSION@#The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.

Female , Femoral Neck Fractures/surgery , Femur Head , Femur Head Necrosis/etiology , Fracture Fixation, Internal/adverse effects , Humans , Male , Osteonecrosis , Retrospective Studies , Risk Factors
Article in Chinese | WPRIM | ID: wpr-879416


OBJECTIVE@#To retrospectively analyze the clinical efficacy of external fixation in the treatment of femoral neck fracture with two different pin layout.@*METHODS@#From April 2000 to April 2018, 140 cases of femoral neck fracture were treated with closed reduction and percutaneous pin external fixation, among them 121 cases were followed up for more than 1 year, including 31 cases in traditional group, 12 males and 19 females, aged 45 to 74(65.4±8.4) years;90 cases in modified group, 39 males and 51 females, aged 12 to 75 (64.5±7.8) years. In traditional group, the first needle was put on the femoral talus, the second and third needles were put under the tension line, and the three needles were not on the same line in the lateral phase; in modified group, the first needle was drilled into the lateralcortex of the femur, obliquely penetrating the distal and proximal end of the femoral talus fracture, and the other two needles were drilled into the medial cortex of the femoral neck and the femoral talus, respectively. The operation time, hospital stay, postoperative ambulation time, femoral neck shortening rate, fracture healing time, fracture healing rate and femoral head necrosis rate of the two groups were observed and compared. Harris hip function score was used one year after operation.@*RESULTS@#These 121 patients were followed-up, the follow up time of traditional group was 13 to 45(30.5±11.4) months;the follow-up time of modified group was 14 to 120(34.5±12.5) months. There was no significant difference in operation time, hospital stay and femoral head necrosis rate between two groups (@*CONCLUSION@#Compared with the traditional group, the modified group has the advantages of lower femoral neck shortening rate, shorter fracture healing time, higher fracture healing rate and higher Harris hip function score.

Adolescent , Adult , Aged , Child , External Fixators , Female , Femoral Neck Fractures/surgery , Fracture Fixation , Fracture Fixation, Internal , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
Article in Chinese | WPRIM | ID: wpr-879415


OBJECTIVE@#To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.@*METHODS@#From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.@*RESULTS@#The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, @*CONCLUSION@#High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.

Aged , Female , Femoral Neck Fractures/surgery , Femur Head Necrosis/surgery , Femur Neck , Fracture Fixation, Internal/adverse effects , Fractures, Comminuted , Humans , Male , Risk Factors
Article in Chinese | WPRIM | ID: wpr-921921


OBJECTIVE@#To compare the clinical efficacy of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position.@*METHODS@#From February 2017 to January 2019, 67 patients underwent hip arthroplasty due to hip diseases, including 21 patients in the minimally invasive group, 12 males and 9 females;there were 10 cases of femoral neck fracture, 5 cases of aseptic necrosis of femoral head and 6 cases of hip osteoarthritis. In the traditional group, 46 cases were treated by traditional posterolateral approach, including 28 males and 18 females;there were 24 cases of femoral neck fracture, 12 cases of aseptic necrosis of femoral head and 10 cases of hip osteoarthritis. All patientsused biological ceramic artificial joint prosthesis. The operation time, intraoperative bleeding, incision length, preoperative and postoperative creatine kinase (CK-NAC), underground activity time, hospital stay, abduction angle and anteversion angle of prosthesis were observed and compared between two groups. Harris scores before operation and 12 months after operation were compared between two groups.@*RESULTS@#All cases were followed up for 14 to 26(18.4±3.6) months. There was no significant difference in intraoperative bleeding, postoperative anteversion and abduction angle between two groups (@*CONCLUSION@#The two approaches of total hip arthroplasty can obtain satisfactory results.OCM approach has less damage and rapid postoperative recovery. It is a reliable surgical approach and can be popularized and used.

Arthroplasty, Replacement, Hip , Female , Femoral Neck Fractures/surgery , Femur Head , Hip Prosthesis , Humans , Male , Operative Time , Retrospective Studies , Supine Position , Treatment Outcome
Article in English | WPRIM | ID: wpr-880655


OBJECTIVES@#To explore the risk factors for femoral neck fracture in elderly population.@*METHODS@#A total of 124 elderly patients (≥60 years old) in hospital for trauma were enrolled, including 71 patients (57%) with femoral neck fracture and 53 non-femoral neck fracture patients (43%). All patients' age, gender, body mass index (BMI), bone mineral density (BMD), thigh length and average circumference were collected. Single factor analysis and multivariate logistic regression analysis were performed to explore whether the above factors were risk factors for femoral neck fracture.@*RESULTS@#Single factor analysis showed that the age, gender, BMI, BMD, thigh length, and average thigh circumference between the 2 groups were statistically different (all @*CONCLUSIONS@#Older age, female, lower BMI index (low body weight), lower BMD (osteoporosis), longer thigh length, and lower average circumference are risk factors for femoral neck fracture in the elderly population.

Absorptiometry, Photon , Aged , Body Mass Index , Bone Density , Female , Femoral Neck Fractures/etiology , Humans , Middle Aged , Osteoporosis , Risk Factors
Article in Spanish | LILACS, BINACIS | ID: biblio-1353895


Las fracturas de cuello femoral son un cuadro habitual para el cirujano traumatológico y cuando se elige realizar una osteosíntesis, son muchos los factores por considerar para conseguir un buen resultado y evitar las complicaciones. En este artículo de actualización, intentamos dar 10 claves para el éxito cuando se opta por la reducción y la osteosíntesis como método terapéutico.

Femoral neck fracture is a pathology that the trauma surgeon usually faces. When he or she decides to perform osteosynthesis, there are many factors to consider in order to achieve a good result and avoid complications. In this update article we seek to offer 10 keys to success when reduction and osteosynthesis are chosen as the therapeutic method.

Femoral Neck Fractures/surgery , Fracture Fixation, Internal , Hip Fractures
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1142103


Introducción: Las fracturas ipsilaterales proximales de fémur ocurren en el 1 al 9% de las fracturas diafisarias. Existen múltiples tratamientos propuestos para dicha asociación lesional. El objetivo de este trabajo es revisar los diferentes métodos de tratamiento propuestos, y comparar sus resultados funcionales y principales complicaciones. Materiales y Métodos: Se utilizaron los buscadores electrónicos: PubMed, Lilacs, Cochrane y Ovid SP. La búsqueda llegó a un total de 1829 trabajos, de los cuales se seleccionaron 21 según criterios de inclusión y exclusión. Discusión: No existe un consenso acerca de cuál es el mejor método de fijación para esta asociación lesional. Esta ocurre en pacientes jóvenes por un mecanismo axial de alta energía cinética y la opción elegida debe buscar la reducción anatómica de la fracturas proximales de fémur. Las complicaciones como la pseudoartrosis de cuello femoral y la necrosis avascular son de difícil manejo en este grupo etario. Conclusión: Las fracturas ipsilaterales proximales y diafisarias de fémur son lesiones que presentan un problema diagnóstico y terapéutico. Hay un subdiagnóstico de las mismas y no existe un implante ideal, ni un consenso de cual es el mejor método de fijación.

Introduction: Ipsilateral proximal femoral fractures ocurred in 1 to 9% of femoral shaft fractures. There are multiple treatments proposed for these injuries. The objetive of the present work is revise the different treatment options and compare their functional results and main complications Materials and methods: A comprehensive literature search was carried out using: Pubmed, Lilacs, Cochrane and OVID SP. Initially there were identified a total of 1829 studies. Only 21 studies remained after inclusion and exclusion were applied. Discussion: There is no consensus about which is the best fixation option for these injuries. These occurred in young patients as a result of a high energy axial trauma, and the selected treatment must achieve anatomic reduction of the proximal femoral fracture. Complications such as femoral neck no-union and avascular necrosis are difficult to manage at this age. Conclusion: Ipsilateral proximal and shaft femoral fractures present diagnostic and therapeutic problems. There is an underdiagnosis of these injuries, and there is no ideal implant or consensus on which is the best fixation method.

Introdução: As fraturas proximais ipsilaterais do fêmur ocorrem em 1 a 9% das fraturas diafisárias. Existem vários tratamentos propostos para essa associação lesional. O objetivo deste trabalho é rever os diferentes métodos de tratamento propostos, e comparar os seus resultados funcionais e principais complicações. Materiais e Métodos: Foram utilizados os buscadores eletrônicos: Pubmed, Lilacs, Cochrane e Ovid SP. A busca chegou a um total de 1829 trabalhos, dos quais foram selecionados 21 segundo critérios de inclusão e exclusão. Discussão: Não há consenso sobre qual é o melhor método de fixação para esta associação lesional. Esta ocorre em pacientes jovens por um mecanismo axial de alta energia cinética e a opção escolhida deve procurar a redução anatômica da fratura proximal do fêmur. Complicações como a pseudoartrose do pescoço femoral e a necrose avascular são de difícil manejo neste grupo etário. Conclusão: As fraturas ...(SUPRIMIR LO PRECEDENTE)Conclusão: As fracturas ipsilaterais proximais e diafisárias do fémur são lesões que apresentam um problema diagnóstico e terapêutico. Há um subdiagnóstico das mesmas e não existe um implante ideal, nem um consenso de qual é o melhor método de fixação.

Humans , Bone Nails/adverse effects , Bone Plates/adverse effects , Bone Screws/adverse effects , Femoral Neck Fractures/surgery , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Treatment Outcome , Fracture Fixation, Internal/adverse effects
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 151-156, jun. 2020. []
Article in Spanish | LILACS, BINACIS | ID: biblio-1125553


Las fracturas de cadera en pacientes con amputación del miembro homolateral son lesiones infrecuentes que representan un reto para el cirujano ortopédico. Presentamos el caso de un hombre de 63 años con amputación supracondílea izquierda, que sufre una fractura de cuello femoral izquierdo por caída de su propia altura. La colocación apropiada del implante es esencial para obtener buenos resultados clínicos posoperatorios. Para la exposición y la colocación del implante se utilizó un clavo de Steinmann en el trocánter mayor. No se observaron complicaciones clínicas ni radiográficas en un seguimiento de 15 meses. Creemos que el empleo del clavo de Steinmann colocado en una correcta posición es una buena alternativa por considerar para poder controlar el miembro al realizar una artroplastia y así disminuir los riesgos de colocar la prótesis en mala posición y el tiempo quirúrgico. Nivel de Evidencia: IV

Hip fractures in patients with ipsilateral limb amputations are uncommon injuries that pose a challenge for orthopedic surgeons. In this article, we present our experience in the treatment of a 63-year man with left transfemoral amputation, who suffered a left femoral neck fracture after a fall from standing height. Proper placement of the prosthesis is essential to achieve good postoperative clinical outcomes. A Steinmann pin was inserted into the greater trochanter to facilitate exposure and component placement. No clinical or radiological complications were detected in a 15-month follow-up. We believe that the correct placement of a Steinmann pin is a good alternative that provides adequate control over the extremity when performing an arthroplasty, thus reducing the risks for prosthesis displacement and shortening the surgical time. Level of Evidence: IV

Middle Aged , Treatment Outcome , Arthroplasty, Replacement, Hip , Femoral Neck Fractures/surgery , Amputation
Rev. bras. ortop ; 55(2): 254-257, Mar.-Apr. 2020. graf
Article in English | LILACS | ID: biblio-1138001


Abstract Bilateral fracture of the femoral neck secondary to seizure is a rare event. The occurrence of these lesions is related to vigorous tonic-clonic muscular contractions and to the use of anticonvulsive medications. Femoral neck fractures in young adults treated with total hip arthroplasty are the exception, and the choice of surgical access should consider several factors; the direct anterior approach is a possibility for total hip arthroplasty. The authors present the case of a 36-year-old male with bilateral fracture of the femoral neck secondary to seizure, and in regular use of phenytoin. Due to the risk of fixation failure and prolonged evolution time, bilateral total hip arthroplasty was the procedure of choice. The choice of the approach should take into consideration the patient's anatomy, material availability, and surgeon's experience. Thus, the greater ease of preparation and positioning of the patient, the shorter hospital stay, the early postoperative rehabilitation, and the mastery of the technique by the surgeon, are possible justifications for the adoption of the direct anterior approach.

Resumo A fratura bilateral do colo do fêmur secundária à crise convulsiva é um evento raro. A ocorrência dessas lesões está relacionada a contrações musculares tônico-clônicas vigorosas e ao uso de medicações anticonvulsivantes. As fraturas do colo do fêmur no adulto jovem tratadas com artroplastia total do quadril são exceção, e a escolha do acesso cirúrgico deve levar em consideração diversos fatores; o acesso anterior direto é uma possibilidade para artroplastia total do quadril. Os autores apresentam o caso de um homem de 36 anos com fratura bilateral do colo do fêmur secundária a crise convulsiva e em uso regular de fenitoína. Devido ao risco de falha da fixação e ao tempo de evolução prolongado, optou-se pela artroplastia total do quadril bilateral. A escolha da via de acesso deve levar em consideração a anatomia do paciente, a disponibilidade de materiais e a experiência do cirurgião. Dessa forma, a maior facilidade de preparo e posicionamento do paciente, o menor tempo de internação, a reabilitação pós-operatória precoce e o domínio da técnica pelo cirurgião são possíveis justificativas para a adoção do acesso anterior direto.

Humans , Male , Adult , Rehabilitation , Seizures , Arthroplasty, Replacement, Hip , Epilepsy , Fractures, Bone , Femoral Neck Fractures , Hip , Length of Stay , Muscle Contraction , Anticonvulsants
Article in Chinese | WPRIM | ID: wpr-827252


OBJECTIVE@#To investigate the clinical effects of dual mobility total hip prosthesis in treating femoral neck fracture patients with hemiplegia.@*METHODS@#A retrospective analysis was performed on 18 patients with femoral neck fracture combined with hemiplegia who underwent dual mobility total hip prosthesis replacement from March 2014 to December 2016. The follow up data of these patients was complete. There were 5 males and 13 females, aged 65 to 70 years old with an average of (66.50±1.38) years. The left side was involved in 12 cases, while the right side in 6 cases. There were 4 cases with Garden Ⅲ type and 14 cases with type Ⅳ. Limb muscle strength of hemiplegia were in grade Ⅳ. The posterior-lateral approach of hip joint was used in surgery for all patients. The implant position, dislocation and loosening of the prosthesis were evaluated by X-ray examination. Harris hip score and the Merle D'aubigne score were used to assess the hip function in the follow up.@*RESULTS@#The operation duration was for 70-90 (81.56±7.48) min and the blood loss during the operation was for 160-200 (170.32± 12.56) ml. No blood was transfused during the operation. Postoperative incisions were healed at the first stage. The follow-up time was for 28-60(36.0±3.5) months. Harris hip score increased from 16.94±0.73 preoperatively to 96.19±1.27 at the final follow-up(<0.05). Merle D 'Aubigne score increased from 3.96±0.06 preoperatively to 16.81±0.63 at the final follow-up(< 0.05). No fracture or nerve or vascular injury were found during the operation. The postoperative X-ray showed that the prosthesis was in good position. No complications such as joint dislocation, dislocation of prosthesis, loosening of prosthesis, fracture around the prosthesis, pain in the front of thethigh, fracture of the self tapping screw in the ilium, and delayed infection occurred in the patients after operation.@*CONCLUSION@#Dual mobility total hip prosthesis has the advantages of both good initial stability and low dislocation rate of the prosthesis, and the clinical application of total hip replacement in hemiplegic femoral neck fracture is satisfactory.

Aged , Arthroplasty, Replacement, Hip , Female , Femoral Neck Fractures , General Surgery , Follow-Up Studies , Hemiplegia , Hip Prosthesis , Humans , Male , Retrospective Studies , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879377


With China's aging society, the number of patients with hemiplegia caused by cerebrovascular accident is increasing gradually. The risk of hip fracture in the first year after the onset of this kind of patients is 4 times higher than that of ordinary people, and most of them occur in the side of hemiplegia. For senile femoral neck fracture, artificial joint replacement is almost the first choice of treatment, with mature operation technology and good curative effect. At present, it is considered that if the muscle strength of hemiplegic side can reach grade III after cerebral vascular accident, hip arthroplasty can be the first choice for hemiplegic patients with hemiplegic femoral neck fracture. However, the situation of hemiplegic patients is different from that of ordinary people. The hemiplegic limbs may have muscle atrophy, muscle strength imbalance, osteoporosis and other problems, which brings difficulties to the formulation of surgical plan. This paper mainly discusses the choice of surgical approach, the use of total hip arthroplasty or hemiarthroplasty, the use of cemented prosthesis or cementless prosthesis, and how to reduce the incidence of postoperative dislocation The purpose is to provide more reference evidence for orthopedic doctors in clinical decision-making.

Arthroplasty, Replacement, Hip , Femoral Neck Fractures/surgery , Hemiarthroplasty , Hemiplegia , Hip Prosthesis , Humans , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-828212


OBJECTIVE@#To explore the risk factors of osteonecrosis of femoral head after internal fixation of femoral neck fracture in young patients, to describe the quality of life of patients with surviving femoral head, and to quantify the predictive factors.@*METHODS@#From January 2013 to December 2016, 172 patients (174 hips) with femoral neck fracture treated by closed reduction and cannulated screw internal fixation were selected for retrospective analysis. The general data of the patients were summarized, including age, gender, body mass index, trauma mechanism, trauma operation interval, trauma season and whether the internal fixation was removed. The imaging data included the Garden classification and Pauwel classification of fractures, femoral head retroversion angle, postoperative fracture reduction, screw distribution. Single factor analysis and multi-factor Logistic regression analysis were carried out to explore the risk factors of femoral head necrosis and internal fixation failure. The patients who survived the internal fixation were followed up. The quality of life of the patients was evaluated by the health survey of SF-36. The Harris score of hip joint function was used to evaluate the hip joint function. The predictors of the quality of life of the patients after the operation of femoral neck fracture were analyzed by multiple linear regression analysis.@*RESULTS@#Total 172 patients(174 hips) were included in the study, 29 patients(16.67%) had necrosis of the femoral head. In multivariate Logistic regression analysis, the significant differences were reduction quality (=0.126, =0.027) and posterior inclination angle (=4.380, =0.010). One hundred and thirty six patients (137 hips) who survived the femoral head were included in the quality of life survey. Harris score was 90.14±7.92, including excellent 96 hips (70.07%), good 28 hips (20.44%), medium 13 hips (9.49%) and poor 0 hip. In SF-36 score, physical health summary (PCS) was 46.12±9.12, mental health summary(MCS) was 50.21±3.97, there was no linear correlation between them (>0.05). In multiple linear regression analysis, the variables with significant difference in PCS were reduction quality and retroversion angle, and the variables with significant difference in MCS were fracture displacement and trauma mechanism.@*CONCLUSION@#Poor reduction quality and posterior inclination angle>15° are the risk factors of femoral head necrosis. The function of hip joint and MCS of patients with femoral neck fracture recovered well, but PCS could not recover to the average level of normal people. The reduction quality and retroversion angle could be used as the predictors of PCS, and the displacement and trauma mechanism of fracture could be used as the predictors of MCS.

Femoral Neck Fractures , Femur Head , Fracture Fixation, Internal , Humans , Osteonecrosis , Quality of Life , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-828207


OBJECTIVE@#To systematically evaluate the clinical efficacy of high-quality direct anterior approach (DAA) and other approaches for the treatment of elderly patients with femoral neck fracture.@*METHODS@#Literatures published in English or Chinese about the direct anterior approach and other approaches for hemiarthroplasty in femoral neck fracture were searched on Cochrane Library, PubMed, EMBASE, Web of science, Wanfang, CNKI databases from their establishment to May 2019. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, and extracted the data. The quality of RCT were evaluated by Cochrane Risk of Bias Assessment Tool, and non-RCT were evaluated by the NOS scale. Meta-analysis was performed using the RevMan 5.3 software.@*RESULTS@#A total of 9 articles were included with 901 cases, in which 429 cases used DAA, and 472 used other approaches. DAA had a significantly lower dislocation rate compared to subgroup of posterior and posterolateral approach [=0.19, 95%CI (0.06, 0.61), =0.005]. No significant differences were found between DAA group and subgroup of direct lateral and anterolateral approach[=1.08, 95%CI(0.20, 5.76), =0.93]. Also there were no relevant differences between the DAA group and control in infection rate[=1.07, 95%CI(0.47, 2.43), =0.88], perioperative fracture rate[=0.95, 95%CI(0.36, 2.50), =0.92], re operation rate[=0.76, 95%CI(0.30, 1.89), =0.55], overall complication rate [=0.88, 95%CI (0.63, 1.22), =0.44], mortality [=1.33, 95%CI (0.84, 2.11), =0.23], operative time[MD=1.43, 95%CI(-5.85, 8.71), =0.70].@*CONCLUSION@#The current evidenceindicates that the DAA was associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty. There was no significant difference in dislocation rate with the lateral and anterolateral approach.

Aged , Antiviral Agents , Arthroplasty, Replacement, Hip , Femoral Neck Fractures , General Surgery , Hemiarthroplasty , Hepatitis C, Chronic , Humans , Reoperation , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879343


OBJECTIVE@#To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly, and to introduce a "shoulder to shoulder" anatomical location marking method for femur.@*METHODS@#From January 2017 to January 2019, 90 elderly patients with femoral neck fracture were treated with hip replacement, including 39 males and 51 females, aged 65 to 96(78.0±7.4) years, 56 cases of total hip and 34 cases of hemi hip. According to garden classification, there were 7 cases of typeⅡ, 63 cases of type Ⅲ and 20 cases of type Ⅳ. The patients were divided into three groups according to different measurement methods:contralateral contrast method (group A) of 19 cases, shuck test method (group B) of 28 cases, and "shoulder to shoulder" anatomical marker localization method (Group C) of 43 cases. The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging.@*RESULTS@#All patients completed the operation successfully. After total hip arthroplasty, the length of lower limbs in group A was(12.9±8.6) mm, and that in group B was(10.3±4.4) mm. After hemiarthroplasty, the length of lower limbs in group A was (13.2±7.2) mm, group B was (8.7±3.5) mm, and group C was (6.3±2.8) mm; the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1) mm in group A, (9.6±4.0) mm in group B and (6.6±2.6) mm in group C. The results of factorial analysis of variance showed that the differences among the three groups were statistically significant (@*CONCLUSION@#The "shoulder to shoulder" anatomic localization marking method can reduce the length of lower limbs simply, effectively and accurately in the elderly patients with femoral neck fracture hip replacement.

Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip , Female , Femoral Neck Fractures/surgery , Hemiarthroplasty , Humans , Leg Length Inequality/surgery , Lower Extremity , Male , Treatment Outcome
Chinese Journal of Traumatology ; (6): 356-362, 2020.
Article in English | WPRIM | ID: wpr-879658


PURPOSE@#By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event.@*METHODS@#The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: "total hip arthroplasty", "hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration' stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event.@*RESULTS@#This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.@*CONCLUSION@#Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.

Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Femoral Neck Fractures/surgery , Follow-Up Studies , Hemiarthroplasty/methods , Humans , Male , Postoperative Complications/epidemiology , Reoperation/statistics & numerical data , Surgical Wound Infection/epidemiology , Thromboembolism/epidemiology , Time Factors , Treatment Outcome
Acta ortop. mex ; 33(6): 411-415, nov.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1345071


Resumen: El tratamiento de un paciente con amputación supracondílea femoral bilateral, y que ha sufrido una fractura de cuello femoral, es un evento poco común tanto para el cirujano ortopédico como para el equipo de rehabilitación. Presentamos un caso, en el cual se discuten diferentes dificultades en su tratamiento, elección de implante y regreso a sus actividades diarias. Se trata de un joven con diagnóstico de amputación traumática bilateral supracondílea, con fractura de cuello femoral, tratado mediante artroplastía total de cadera primaria no cementada. La evaluación de la funcionalidad de la prótesis total de cadera con escala de Houghton fue al cabo de 12 meses, se obtuvo una puntuación final de 9 puntos, los cuales son el resultado de una rehabilitación satisfactoria.

Abstract: The treatment of a patient with amputation above the knee who has suffered a femoral neck fracture is a challenge for both the orthopedic surgeon and the rehabilitation team. We present a case, in which different difficulties are discussed in their treatment, choice of implant and return to their daily activities. The clinical case of a young man diagnosed with supracondylar bilateral traumatic amputation, with fracture of the femoral neck, treated by total non-cemented hip arthroplasty is presented. The functionality of the total hip prosthesis with Houghton scale after 12 months, obtaining a final score of 9 points which are the result of a satisfactory rehabilitation.

Humans , Male , Female , Arthroplasty, Replacement, Hip , Femoral Neck Fractures/surgery , Treatment Outcome , Amputation , Knee Joint
Acta ortop. mex ; 33(4): 241-246, jul.-ago. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1284947


Resumen: Introducción: La hemiartroplastía bipolar (HA) es una alternativa para el tratamiento de las fracturas desplazadas de cuello femoral en pacientes de edad avanzada con baja demanda funcional y comorbilidades asociadas. El objetivo fue describir la funcionalidad en pacientes mayores de 65 años con fracturas intracapsulares de cadera tratados con HA. Material y métodos: Revisión retrospectiva de pacientes mayores de 65 años entre Enero de 2012 y Mayo de 2017. Se evaluó con la escala de Harris (HHS) y Oxford a los seis meses y al año posterior a la cirugía. Se documentaron las complicaciones y la mortalidad durante el primer año postquirúrgico. Resultados: 48 casos (12 hombres; 36 mujeres), edad promedio de 80.8 ± 7.7 años. Comorbilidades más frecuentes: hipertensión arterial (77.1%), osteoporosis (37.5%), diabetes (33.3%) e hipotiroidismo (29.2%). El porcentaje de complicaciones postoperatorias asociadas fue de 8.3% (cuatro casos). La mediana del HHS a los seis y 12 meses fue de: 90.5 (DE: 77.5-96.0) y 96 (DE: 92-98), respectivamente. La escala de Oxford fue de 45.5 (DE: 38.5-48.0) a los seis meses y de 47.0 (DE: 43.5-48) al año postoperatorio. El 4.2% (dos casos) fallecieron durante el primer año postquirúrgico y ninguno estuvo asociado al procedimiento. Discusión: La HA ofrece buenos resultados funcionales en pacientes mayores de 65 años, con una tasa baja de complicaciones. En nuestra serie y en el corto plazo no se observó mortalidad asociada al procedimiento quirúrgico.

Abstract: Introduction: Bipolar hemiarthroplasty is an alternative for the treatment of displaced femoral neck fractures in elderly patients with low functional demand and associated comorbidities. The goal was to describe functionality in patients over 65 years of age with intracapsular fractures of the hip. Material and methods: Retrospective review of patients over 65 years of age between January 2012 and May 2017. It was evaluated with the Harris Hip Score (HHS) and Oxford scale at six months and the year after surgery. Complications and mortality were documented during the first post-surgical year. Results: 48 cases (12 men; 36 women), average age of 80.8 ± 7.7 years. Most common diseases: high blood pressure (77.1%), osteoporosis (37.5%), diabetes (33.3%) hypothyroidism (29.2%). The percentage of associated postoperative complications was 8.3% (four cases). The median HHS at six and 12 months was: 90.5 (DE: 77.5-96.0) and 96 (DE: 92-98), respectively. The Oxford scale was 45.5 (DE: 38.5-48.0) at six months and 47.0 (DE: 43.5-48.0) per postoperative year. 4.2% (two cases) died during the first post-surgical year and none were associated with the procedure. Discussion: HA provides good functional outcomes in patients over 65 years of age, with a low rate of complications. No mortality associated with the surgical procedure was observed in our series and in the short term.

Humans , Male , Female , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip , Femoral Neck Fractures , Hemiarthroplasty/methods , Hip Fractures/surgery , Retrospective Studies , Treatment Outcome
Rev. bras. ortop ; 54(4): 408-415, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042432


Abstract Objectives To evaluate the factors that influence the outcome of osteosynthesis after closed reduction of the fracture of the femoral neck in young adult patients. Methods A retrospective study was conducted, reviewing the data of patients operated in a large orthopedic hospital from 2003 to 2011; a total of 81 patients met the inclusion criteria. The time interval between the fracture and the surgery, the initial fracture deviation, the quality of the reduction, and the placement of the implant were evaluated. Results The present study observed a strong relationship between the quality of the reduction and therapeutic success. The degree of the initial deviation and the time elapsed between the initial trauma and the osteosynthesis did not influence the surgical outcome regarding bone consolidation. The correct positioning of the implants was associated with a satisfactory evolution in the postoperative period. Conclusion The quality of the reduction and the positioning of the implants are factors that influence the results of osteosynthesis in fractures of the femoral neck in young adult patients.

Resumo Objetivos Avaliar os fatores que influenciam o resultado da osteossíntese pela redução fechada da fratura do colo femoral nos pacientes jovens. Métodos Foi feito um estudo retrospectivo com revisão dos dados dos pacientes operados em um hospital ortopédico de grande porte, de 2003 a 2011, com um total de 81 pacientes que atenderam aos critérios de inclusão. O intervalo de tempo entre a fratura e a cirurgia, o desvio inicial da fratura, a qualidade da redução e o posicionamento dos implantes foram os fatores avaliados. Resultados O estudo encontrou forte relação entre a qualidade da redução e o sucesso terapêutico. O grau de desvio inicial e o tempo entre o trauma inicial e a osteossíntese não influenciaramo desfecho cirúrgico emrelação à consolidação óssea. O correto posicionamento dos implantes mostrou relação com a evolução satisfatória no pós-operatório dos pacientes. Conclusão A qualidade da redução e o posicionamento dos implantes são fatores que influenciamoresultadodaosteossíntesenafraturadocolodofêmurnopacienteadultojovem.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Pseudarthrosis , Femoral Neck Fractures , Femur Head Necrosis , Femur Neck
Rev. bras. ortop ; 54(3): 288-294, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013718


Abstract Objective The aim of the present study was to evaluate the practices and preferences of Brazilian orthopedic surgeons for the treatment of femoral neck fractures in middleaged patients. Methods A survey containing 10 images of femoral neck fractures was sent to a group of 100 orthopedic surgeons, all of them members of the Brazilian Society of Orthopedics and Traumatology. The questionnaire asked the treatment option for cases of nondisplaced and displaced fractures of the femoral neck in middle-aged patients, that is, those between 50 and 69 years old. Descriptive and inferential statistical analyzes were performed using the chi-squared (χ2) and the Fisher exact tests. The level of significance was 5%. Results The survey was answered by 78% of the orthopedic surgeons invited to participate in the study. There was no significant difference in the treatment method distribution between generalists and specialists (p = 0.16) in the sample of nondisplaced femoral neck fractures. There was a highly significant difference in the treatmentmethod distribution between generalists and specialists (p < 0.0001) in the sample of displaced fractures of the femoral neck. Conclusion Preservation of the femoral head through multiple cannulated screws fixation is the treatment of choice for nondisplaced femoral neck fractures for both

Resumo Objetivo O objetivo do presente estudo foi avaliar as práticas e preferências dos cirurgiões ortopédicos brasileiros para o tratamento da fratura do colo do fêmur no paciente de meia idade. Métodos Foi elaborado um questionário contendo 10 imagens de fraturas do colo do fêmur enviado a um grupo de 100 ortopedistas, todos membros titulares da Sociedade Brasileira de Ortopedia e Traumatologia. No questionário, foi perguntada a opção de tratamento para casos de fratura não desviada e desviada do colo do fêmurempacientes de meia idade, caracterizados como aqueles comidades entre 50 e 69 anos. Foramrealizadas análises estatísticas descritiva e inferencial, pelos testes de qui-quadrado (χ2) e exato de Fisher. O critério de determinação de significância adotado foi o nível de 5%. Resultados O questionário foi respondido por 78% dos ortopedistas convidados a participar do presente estudo. Observou-se que não existe diferença significativa na distribuição do método de tratamento entre as avaliações de generalistas e especialistas (p = 0,16) na amostra de fraturas não desviadas do colo do fêmur. Observou-se que existe diferença altamente significativa na distribuição do método de tratamento entre as avaliações de generalistas e especialistas (p < 0,0001) na amostra de fraturas desviadas do colo do fêmur. Conclusão A preservação da cabeça femoral por meio da fixação com múltiplos parafusos canulados é o tratamento de escolha para as fraturas não desviadas do colo do fêmur, tanto para os generalistas quanto para os especialistas. Idade cronológica e/ ou fisiológica baixas são os principais fatores para esta tomada de decisão. Nos casos em que a fratura do colo do fêmur encontra-se desviada, a substituição da cabeça femoral é a preferência para os dois grupos de ortopedistas (generalistas e especialistas). Nesta situação, os especialistas preferem a artroplastia total do quadril (ATQ) e os generalistas a artroplastia parcial do quadril (APQ).

Arthroplasty , Bone Screws , Femoral Neck Fractures , Femur
Rev. baiana saúde pública ; 43(3): 502-522, 20190303.
Article in Portuguese | LILACS | ID: biblio-1252602


A artroplastia de quadril (AQ) é um procedimento custo-efetivo empregado para o tratamento de condições como a osteoartrose de quadril e fraturas de acetábulo e de colo femoral em idosos. Este artigo objetiva descrever a oferta de AQ no SUS e analisar aspectos relativos à realização desse procedimento, entre 2016 e 2018, no estado do Rio de Janeiro. Trata-se de um estudo descritivo, no qual foram incluídas as unidades hospitalares que efetuaram, pelo SUS, pelo menos um tipo de AQ entre 2016 e 2018 no estado do RJ. O perfil das unidades foi construído utilizando a ferramenta TABNET do CNES. Verificou-se que 69 unidades hospitalares realizaram pelo menos uma AQ no período. Parte substancial dessas unidades localiza-se na Região Metropolitana I, não é habilitada em alta complexidade em ortopedia e traumatologia, são municipais e pertencem ao tipo "Geral I com UTI". As unidades que mais realizaram AQ foram as estaduais e as especializadas com UTI. No período, houve decréscimo no número total de AQ realizadas, especialmente artroplastias emergenciais e de alta complexidade. As unidades hospitalares, em todas as regiões, contam com a equipe mínima de profissionais, exceto terapeuta ocupacional e fisiatra. Mesmo enfrentando um contexto de crise, as unidades estaduais destacaram-se na realização do procedimento. Considerando que o Brasil já apresenta defasagem assistencial, a variação negativa no número de AQ, em especial as emergenciais, merece atenção, pois pode indicar maior dificuldade de acesso da população ao procedimento.

Hip arthroplasty (HA) is a cost-effective procedure to treat conditions such as hip osteoarthritis and acetabulum and femoral neck fractures in the older adults. This article describes the supply of HA in the SUS and analyzes aspects related to the performance of this procedure between 2016 and 2018, in the state of Rio de Janeiro (RJ), Brazil. This is a descriptive study that included the hospital units that performed at least one type of HA by SUS between 2016 and 2018 in the state. The units' profiles were built using CNES TABNET tool. Results showed that 69 hospital units in the state performed at least one HA during the period. A substantial part of these units are located in the Metropolitan Region I, are not highly qualified in orthopedics and traumatology, are municipal and belong to the type "General I with ICU" (Intensive Care Unit). The units that most performed HA were state units and specialized with ICU. In the period, the total number of HA performed decreased, especially among emergency and high complexity arthroplasties. Hospital units in all regions have the minimum staff, except for occupational therapist and physiatrist. Even facing a crisis context, the state units stood out in the procedure. Considering that Brazil already has a care gap, the negative variation in the number of HA, especially the emergency ones, deserves attention, since it may indicate greater difficulty for the population to access the procedure.

La artroplastia de cadera (AC) es un procedimiento rentable empleado para tratar afecciones como la osteoartritis de cadera y las fracturas de acetábulo y de cuello femoral en los ancianos. Este artículo tiene como objetivo describir la oferta de AC en el Sistema Único de Salud (SUS) y analizar los aspectos relacionados con el desempeño de este procedimiento, en el período entre 2016 y 2018, en el estado de Río de Janeiro (RJ). Este es un estudio descriptivo, llevado a cabo con unidades hospitalarias que habían realizado mediante el SUS, al menos, un tipo de AC, entre 2016 y 2018, en el estado de RJ. El perfil de las unidades se construyó con la herramienta CNES TABNET. Se encontró que 69 unidades hospitalarias en el estado realizaron al menos una AC durante el período. Una parte importante de estas unidades están ubicadas en la región metropolitana I, no están altamente calificadas en ortopedia y traumatología, son municipales y pertenecen al tipo "General I con UCI". Las unidades que más realizaron AC fueron estaduales y especializadas con UCI. En el período, hubo una disminución en el número total de AC realizadas, especialmente artroplastias de emergencia y de alta complejidad. Las unidades hospitalarias en todas las regiones tienen el personal mínimo, excepto el terapeuta ocupacional y el fisiatra. Incluso frente a un contexto de crisis, las unidades estaduales se destacaron en la realización del procedimiento. Teniendo en cuenta que Brasil ya tiene una brecha de atención, la variación negativa en el número de AC, sobre todo los de emergencia, merece atención, ya que puede indicar una mayor dificultad para que la población acceda al procedimiento.

Arthroplasty , Unified Health System , Osteoarthritis, Hip , Arthroplasty, Replacement, Hip , Femoral Neck Fractures , Femur Neck , Hospital Units