Stress fractures of the femoral neck in runners: a review.

A systematic review, following strict inclusion criteria, identified 32/48 low and 16/48 high-performance runners with stress fractures of the femoral neck. Surgical treatment was performed in 33/48 cases and was significantly higher (p = 0.009) in high-performance runners. Among the 28/48 runners who resumed running, there were significantly more lower-performance runners (23/32) than higher-performing runners (5/16) (p = 0.012) and significantly more non-displaced (22/30) than displaced fractures (6/18) (p = 0.014). Complicated cases showed significantly less favourable follow-up results (p = 0.036). A significantly shorter (p = 0.032) diagnostic time for evaluation occurred with a previous history of a stress fracture or a relevant comorbidity. Stress fractures of the femoral neck represent an incisive incident for runners, and early consideration in the differential diagnosis of hip pain is required to avoid potential long-term sequelae and suboptimal function.

Retrograde femoral nailing in elderly patients: outcome and functional results.

Functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years (mean, 86 years) with 36 fractures, comprising 15 (41.7%) shaft and 21 (58.3%) distal fractures; overall, 7 (19.4%) periprosthetic fractures occured. Twenty-two (62.9%) of 35 patients were evaluated at a mean 16.5-month follow-up with the Lyshom-Gillquist score and the SF-8 questionaire. Primary union rate was 97.8%, with no significant differences in duration of surgery, bone healing, mobilization, and weight bearing among different fracture types; periprosthetic fractures revealed a significantly delayed mobilization (P=.03). Complications occured significantly more often among distal femoral fractures (P=.009), including all revision surgeries. The most frequently encountered complication was loosening of distal locking bolts (n=3). Lysholm score results were mainly influenced by age-related entities and revealed fair results in all fractures (mean in the femoral shaft fracture group, 78.1 vs mean in the distal femoral fracture group, 74.9; P=.69), except in the periprosthetic subgroup, which had good results (mean, 84.8; P=.23). This group also had increased physical parameters according to SF-8 score (P=.026). No correlation existed between SF-8 physical parameters and patient age or surgery delay, whereas a negative correlation existed between patient age and SF-8 mental parameters (P=.012). Retrograde femoral intramedullary nailing is commonly used in elderly patients due to reliable bone healing, minimal soft tissue damage, and immediate full weight bearing. It also offers a valid alternative to antegrade nailing in femoral shaft fractures.