Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits

Neglected or late presenting femoral neck stress fractures are often associated with varus deformity, with potential risks of nonunion and osteonecrosis. We proposed a surgical technique whereby a wedge osteotomy was performed at the basal part of the neck, on the tensile surface, keeping the inferomedial femoral neck as a hinge. The femoral shaft was abducted to close the osteotomy site and it was fixed with three cannulated cancellous screws. Three military recruits who presented with neglected femoral neck stress fracture with varus deformity were operated on with the proposed modified femoral neck valgus osteotomy. All the fractures united without any complications and the patients resumed their professional activity.     

Displaced fatigue fractures of the femoral shaft

For this study, all displaced fatigue fractures of the femoral shaft treated during a 20-year period at a national military hospital were analyzed. Ten previously healthy male recruits sustained displaced femoral shaft fatigue fractures, the incidence being 1.5 per 100,000 person-years in military service. The median age of the patients was 19 years (range, 18-20 years). None had any previous fatigue fractures. The median body mass index was normal. Before the fracture displacement, nine recruits experienced thigh or knee pain for 1 to 6 weeks. Six of the 10 fractures were located in the distal third of the diaphysis. Only one fracture occurred in the proximal third. Six fractures showed a noncomminuted, oblique, or oblique-transverse configuration. Five fractures were treated using an intramedullary nail, four fractures with a dynamic compression plate, and one with a dynamic condylar screw-plate. The bone at the site of fracture proved to be abnormally brittle. In six patients this resulted in additional comminution intraoperatively. Two reoperations were necessary to exchange a nail and a screw because of technical faults. The median time to solid bony union was 3.5 months (range, 3-5 months). The recruits returned to light duty military service 6 weeks postoperatively, on the average. Two were exempted from military service for 2 years. Displacement is a rare, highly undesirable consequence of fatigue osteopathy of the femoral shaft among young recruits during basic military training. Preventive methods should focus on early, effective detection of developing fatigue fractures to avoid a displaced fracture, with subsequent prolonged morbidity and possible complications. Gentle handling of the bone during the fracture fixation procedure is imperative because of the extraordinary brittleness of the fracture fragments.     

Subchondral fatigue fracture of the femoral head in military recruits

BACKGROUND: Subchondral stress fracture of the femoral head is a rare condition that usually occurs as an insufficiency fracture in people with poor bone quality. We evaluated the clinical characteristics of subchondral fatigue fractures of the femoral head that occurred in young, healthy military recruits. METHODS: Between January 1998 and November 2001, seven subchondral fatigue fractures of the femoral head were treated in five patients. The characteristics of this condition were ascertained by assessing the clinical course as well as radiographs, bone scintigrams, and magnetic resonance images. RESULTS: All patients were male military recruits in their early twenties in whom pain had developed within five months after recruitment. Definite abnormal findings were observed on the initial radiographs of four hips in three patients, and the femoral head was markedly collapsed in two of these four hips. Bone scintigrams were made of five hips in four patients, and all of them showed increased radionuclide uptake in the femoral head. In all affected hips, magnetic resonance images demonstrated a localized or diffuse bone-marrow-edema pattern in the femoral head and/or neck. A subchondral fracture line (a magnetic resonance crescent sign) was identified in all hips. In the patients who did not have collapse of the femoral head, the pain decreased gradually and disappeared completely within six months, with correspondingly improved findings on sequential magnetic resonance images. The patients with femoral head collapse were treated with total hip arthroplasty or an iliac bone strut graft. CONCLUSIONS: When a military recruit or an athlete reports hip pain, a diagnosis of subchondral fatigue fracture of the femoral head should be considered.     

Displaced femoral neck fractures treated with the Gouffon pin

Summary One hundred fractures of the neck of the femur, Garden stage III or IV, were treated with Gouffon pins during a three year period. Seventy-nine were followed from 24 to 52 months. Union occurred in 59 fractures. Eighteen fractures did not unite and 2 became redisplaced within the first week. Avascular necrosis was noted on radiographs in 14 of the 59 united fractures. A higher pin migration rate was found in Garden stage IV fractures, and in the failures.

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Résumé Cent fractures du col du fémur de degré Garden III ou IV ont été traitées par broches de Gouffon pendant une période de trois ans. Soixante-dix-neuf ont été suivies de 24 à 52 mois. La consolidation a été obtenue dans 59 cas. Dixhuit fractures n'ont pas consolidé et deux se sont redéplacées au cours de la première semaine. Une image radiologique de nécrose de la tête fémorale a été notée dans 14 des 59 fractures consolidées. La migration des broches s'est montrée particulièrement fréquente dans les fractures de degré IV de Garden et dans les échecs.

     

Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness

The optimal treatment for displaced femoral neck fractures in elderly patients is a matter of controversy. Four surgical options are well supported in the orthopaedic literature: reduction with internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty. Based on a review of the outcomes literature regarding treatment of femoral neck fractures and a cost-effectiveness analysis, an algorithm for surgical treatment of displaced femoral neck fractures in elderly patients is presented. Cost-effectiveness analysis of these four surgical treatment options shows that arthroplasty is the most cost-effective treatment when complication rate, mortality, reoperation rate, and function are evaluated during a 2-year postoperative period. These data were strongly supported by a two-way sensitivity analysis that varied the effectiveness of the interventions and the costs. Literature derived outcome studies show that elderly patients with displaced femoral neck fractures achieve the best functional results with a well healed femoral neck without osteonecrosis after reduction and internal fixation. Achieving this result may be difficult, and it is not as cost effective as arthroplasty.     

Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases

Background Stress fracture of the femoral neck (SFFN) is one of the severe complications of military training. Displaced SFFN may result in avascular necrosis of the femoral head (AVNFH). The purpose of this study was to evaluate the results of surgical treatment of the displaced SFFN.Methods Forty-two patients with displaced SFFN requiring internal fixation were treated with compression hip screw (17 cases) or multiple cancellous screws (25 cases). Forty-two patients were followed for an average of 5.6 years after operation. At the follow-up evaluation, routine radiographs were used to evaluate the fracture alignment and healing, and bone scan was used for fractures that were suspected of AVNFH. The functional assessments described by Arnold et al. were used to evaluate the functional results of surgical treatment.Results Seven (28%) of the 25 patients treated with multiple cancellous screws developed AVNFH during the period of follow-up. Of these seven patients, five were treated with prosthetic replacement and two treated with core decompression and bone graft. Three (17.6%) of the 17 patients treated with compression hip screw had AVNFH, and they were all treated with prosthetic replacement. The mean duration between fracture and surgery was significantly longer in patients with AVNFH (5.9 days) than in patients without AVNFH (1.9 days)(P<0.05). Five (71.4%) of the seven patients who presented a varus alignment of the femoral neck developed AVNFH later, and only five (14.3%) of the 35 patients who presented with anatomic or valgus alignment of the femoral neck developed AVNFH during the period of follow-up. Of the 42 patients, 30 (71.4%) had good functional results, four (9.5%) had acceptable and eight (19%) had poor results at the end of evaluation.Conclusion Delayed treatment and postoperative varus alignment were major factors contributing to AVNFH in our series. Early treatment and anatomical fixation of displaced SFFN are essential for diminishing the risk of AVNFH development.     

Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty

The incidence of femoral neck fracture among the elderly in the United States is expected to increase dramatically because of the anticipated explosion in the population aged 65 years and older, increased life expectancy, and the rising incidence of osteoporosis. The resulting public health implications may be significant, with annual hospital admissions resulting from hip fracture projected to increase to 700,000 by 2050, and with annual spending on hip fracture care expected to exceed 15 billion dollars within a few years. The decision to perform internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA must be based on patient mental status, living arrangement, level of independence and activity, and bone and joint quality.     

Displaced radial neck fractures in children

Forty-eight children with displaced fractures of the radial neck were studied. Five types of injury were seen, that associated with a valgus strain being the most common. Good results were obtained in just over one-half of the cases. It is concluded that treatment of these fractures should be by closed means whenever possible. It is generally unwise to attempt operative correction unless the radial head remains displaced or the residual angulation approaches 45 degrees. Open reduction should be checked by intraoperative radiographs. Internal fixation is seldom necessary and has its complications. Late manipulation of the fracture causes additonal trauma and the results are bad. Avascular necrosis and radio-ulnar synostosis were the two most disabling complication encountered.     

Displaced femoral neck fractures in young adults treated with closed reduction and internal fixation

This article describes the effect of closed reduction and internal fixation with 3 different screw configurations for acute completely displaced femoral neck fractures in young adults. From 2001 to 2006, 136 patients (age range, 20-50 years) who had acute unilaterally completely displaced femoral neck fractures were evaluated retrospectively. All fractures were managed with closed reduction and internal fixation with 3 cannulated screws. The follow-up period was 55 months on average (range, 36-90 months). One hundred twenty-two patients were available for final evaluation of union condition and late complication. Twenty-three patients (18.9%) had nonunion, 15 (12.3%) had fixation failure, and 21 (17.2%) had avascular necrosis of the femoral head. The average duration from injury to surgery was 18.4 hours in the union group and 23.3 hours in the nonunion group, with no statistical significance (P=.196). The average duration from injury to surgery was 17.3 hours in the avascular necrosis of the femoral head group and 22.3 hours in the non-avascular necrosis of the femoral head group, with no statistical significance (P=.155). Vertical- and separated-type screw configurations resulted in a significantly higher nonunion rate (P=.001 and P=.0017, respectively) than parallel configuration. The complication rate in treating completely displaced femoral neck fractures with internal fixation in young adults is high, and screw configuration may further affect results.     

Recurrent stress fractures in military recruits. One-year follow-up of 66 recruits

Of 66 recruits who sustained stress fractures during basic training and returned to training after a period of rest, seven (10.6%) suffered recurrent fractures within one year. None of the recurrences was at the original anatomical site. All of the recruits with recurrent stress fractures had had at least one of their initial stress fractures in the femur. This suggests that a femoral stress fracture carries a high risk of recurrence at other sites.     

Wellmerling复位技术治疗移位股骨颈骨折

股骨颈骨折内固定前准确复位非常重要。我院自1990年以来应用Ｗｅｌｌｍｅｒｌｉｎｇ股骨颈骨折复位技术并加以改进,治疗移位的股骨颈骨折37例,取得了满意效果。1　材料与方法1.1　病例资料　本组37例,男21例,女16例,年龄15～90岁。左髋22例,右髋15例。头下型14例,经颈型17例,基底型6例。按照Ｇａｒｄｅｎ分型,Ⅲ型13例,Ⅳ型24例。1.2　复位方法　采用Ｗｅｌｌｍｅｒｌｉｎｇ方法〔1〕复位,患者仰卧在复位台上,放置会阴柱,双下肢平行,双足放置在足板上并结牢。患肢在外展位,调整双下肢牵引不使骨盆倾斜,进一步牵引患肢,使其超过健肢064ｃｍ…     

Displaced femoral neck fractures in the young: significance of posterior comminution and raised intracapsular pressure

Background  

Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Various factors affect the outcome; with AVN (avascular necrosis) and non-union primarily contributing to adverse results in such patients. To identify factors affecting outcome of displaced fracture NOF, a prospective cohort study was carried out in the setting of a tertiary care centre in developing country.     

新兵集训致股骨颈应力性骨折3例并文献复习

股骨颈应力性骨折十分少见,在所有青年人群应力性骨折中发病率接近5%。这种骨折在运动员、入伍新兵和代谢系统疾病患者中相对常见。由于治疗过程中存在的并发症,股骨颈应力性骨折的治疗方法仍然存在争议。本院收治了3例4侧新兵战士发生股骨颈应力性骨折的病例,3例患者均已排除可能导致病理性骨折的相关代谢性疾病,如骨质疏松症、糖尿病等。3例患者经闭合复位空心钉内固定术治疗后正常出院。平均随访时间1年半,最长达3年,随访期间未发现患肢出现股骨头坏死、骨性关节炎的表现。对于新兵出现逐渐加重的非特异性髋部疼痛等症状应引起足够重视,避免发生股骨颈应力性骨折,尽可能降低伤退役率。对于有移位的股骨颈应力性骨折,应早期积极的手术治疗,以达到更好的预后。     

Osteosynthetically-treated intracapsular femoral neck fractures

AIM OF THE STUDY: Treatment of intracapsular femoral neck fractures, especially in elder patients, has been a topic of ongoing discussion. This study analyzes the results of 97 osteosynthetically-treated femoral neck fractures. It had to be proved whether the Dynamic Martin Screw (DMS) represents an alternative to the already existing implantation devices. Until now no systematic results have been reported on this topic. METHODS: Over a period of seven years, 389 patients with femoral neck fractures were treated. In 101 of these patients operations with preserved femoral heads were carried out. In order to ensure stabilization, compression screw stabilization (3 AO cancellous screws) was performed in 4 cases, the Dynamic Hip Screw (DHS) in 34 cases and the DMS in 63 cases. Observation criteria used in this retrospective study were osseous consolidation, pseudarthritis rate, complications involved with implantations, aseptic femoral head necrosis, as well as operating time. Period of observation was on average 8.5 years, with 65 years being the average age of the patients. MAIN RESULTS: Head necrosis was identified in 6 of 34 cases (17.6%) for the DHS group and 12 of 63 cases (19%) for the DMS group (p=0.95). Operating time was significantly reduced with the DMS procedure (p=0.035). CONCLUSIONS: The DMS can be seen as an alternative implantation device for stabilizing medial intracapsular femoral neck fractures. In comparison with the DHS, the operating time could be significantly reduced.