An evaluation of closed reduction techniques for femoral neck fractures

Seven different reduction techniques have been tested in the treatment of displaced femoral neck fractures using the fracture table. Wellmerling's technique is preferred because of its utility, predictable results, and flexibility in treatment alternatives.     

Improved operations for femoral neck fracture: A radiographic evaluation

A radiographic investigation was undertaken to determine whether an increased interest in femoral neck fractures improved the operative result. In 1977, all femoral neck fractures were operated on by any of 30 surgeons of the orthopedic department, but in 1981 all fractures were operated on by one of six specially devoted surgeons. Preoperative fracture classification was performed with three parameters and proved equal in the 1977 and 1981 groups of 105 and 114 fractures, respectively. The quality of fracture reduction, determined with four parameters, was improved somewhat. The position of the nail(s), also determined with four parameters, improved considerably. The technical result was better in Garden IV fractures than in Garden III fractures.

An increased interest in femoral neck fracture treatment improved reduction and fixation.     

Improved operations for femoral neck fracture. A radiographic evaluation

A radiographic investigation was undertaken to determine whether an increased interest in femoral neck fractures improved the operative result. In 1977, all femoral neck fractures were operated on by any of 30 surgeons of the orthopedic department, but in 1981 all fractures were operated on by one of six specially devoted surgeons. Preoperative fracture classification was performed with three parameters and proved equal in the 1977 and 1981 groups of 105 and 114 fractures, respectively. The quality of fracture reduction, determined with four parameters, was improved somewhat. The position of the nail(s), also determined with four parameters, improved considerably. The technical result was better in Garden IV fractures than in Garden III fractures. An increased interest in femoral neck fracture treatment improved reduction and fixation.     

Screw positions in femoral neck fractures: Comparison of two different screw positions in cadavers

To evaluate the influence of different screw positions on the stability of fixation in femoral neck fractures, 30 cadaveric proximal femora were osteotomized and fixed with 2 cannulated screws. The proximal screw was placed either with a posterior cortical support in the femoral neck or centrally, supported only by cancellous bone. The distal screw rested on the femoral calcar. The specimens were tested in bending, using the force at 2 and 5 mm deflection at the osteotomy site and at fracture, as an expression of the stability of fixation. The test sequences were recorded on a x-y plotter and on videotape. Bone density measurements were made at the femoral neck, Ward's triangle, and the trochanter region.

Our findings indicate that a posterior position with cortical support for the proximal screw, compared to a central screw position with only cancellous bone support, increases the stability of femoral neck fractures.     

切开复位与闭合复位治疗移位型股骨颈骨折的疗效比较

目的 比较切开复位与闭合复位内固定治疗移位型股骨颈骨折(Garden Ⅲ、Ⅳ型)的疗效.方法 回顾件分析1998年1月至2006年6月收治且状得完整随访的122例成人移位型股骨颈骨折患者资料,根据复位方式不同分为两组:闭合复位组73例,男42例,女31例;平均年龄(56.2±2.4)岁;骨折Garden分型:Ⅲ型43例,Ⅳ型30例.切开复位组49例,男30例,女19例;平均年龄(57.5±3.1)岁;骨折Garden分型:Ⅲ型27例,Ⅳ型22例.对比分析两组患者的骨折复位质量、内固定置人满意率、骨折不愈合发生率及股骨头缺血性坏死率.结果 122例患者术后获20～101个月(平均50.3个月)随访.闭合复位组骨折复位质量:Ⅰ级39例,Ⅱ级19例,Ⅲ级或Ⅳ级15例;开放复位组Ⅰ级38例,Ⅱ级9例,Ⅲ级或Ⅳ级2例,两组比较差异有统计学意义(x2=9.519,P=0.010).两组患者术后内同定置人满意率分别为86.3%(63/73)、87.8%(43/49),骨折不愈合发牛率分别为8.2%(6/73)、6.1%(3/49),两组比较筹异均无统计学意义(P>0.05).切开复位组股骨头缺血性坏死率(10.2%)低于闭合复位组(27.4%),差异有统计学意义(x2=5.320,P=0.021).结论 对于移位型股骨颈骨折,切开复位内固定并不会增加术后股骨头缺血性坏死的发生率.对闭合复位失效或骨折移位明显的患者,及时行切开复位内固定是非常有必要的.

Abstract：

Objective To compare the clinical effects of open reduction and closed reduction in treatment of the displaced femoral neck fractures(Garden types Ⅲ and Ⅳ). Methods The clinic data of 122 patients who had been treated for displaced femoral neck fractures in our hospital from January 1998 to June 2006 were included for the present respective analysis.Of them,73 cases were treated with closed reduetion and 49 with open reduction.In the closed reduction group,there were 42 men and 31 women(mean age,56.2±2.4 years),and 43 cases of Garden Ⅲ and 30 eases of Garden Ⅳ.In the open reduction group,there were 30 men and 19 women(mean age,57.5±3.1 years),and 27 cases of Garden Ⅲ and 22 cases of Garden Ⅳ.The 2 groups were compared in reduction quality.satisfactory fixation,ratio of nonunion and ratio of femoral avascular necrosis. Results The 122 patients received a mean follow-up of 50.3 months (from 20 to 101 months).The reduction quality was rated as grade Ⅰ in 39 cases,as gradeⅡin 19 cases,as grade Ⅲ or Ⅳ in 15 cases in the closed group,and as grade Ⅰ in 38 cases,as grade Ⅱ in 9 cases,as grade Ⅲ or Ⅳ in 2 eases in the open group.The differences between the 2 groups were significant(x2=9.519,P=0.010).There were no significant differences between the 2 groups in satisfactory fixation(86.3%venus 87.8%)or in nonunion ratio(8.2%versus 6.1%)(P>0.05).The ratio of femoral avascular necrosis for the open reduction group(10.2%)was significantly lower than that for the closed reduction group (27.4%)(x2=5.320,P=0.021). Conclusion Since open reduction can lower the ratio of femoral avascular necrosis for displaced femoral neck fractures,it is essential to perform timely open reduction when closed reduction fails or the fracture is obviously displaced.     

切开复位与闭合复位治疗移位型股骨颈骨折的疗效比较

Objective To compare the clinical effects of open reduction and closed reduction in treatment of the displaced femoral neck fractures(Garden types Ⅲ and Ⅳ). Methods The clinic data of 122 patients who had been treated for displaced femoral neck fractures in our hospital from January 1998 to June 2006 were included for the present respective analysis.Of them,73 cases were treated with closed reduetion and 49 with open reduction.In the closed reduction group,there were 42 men and 31 women(mean age,56.2±2.4 years),and 43 cases of Garden Ⅲ and 30 eases of Garden Ⅳ.In the open reduction group,there were 30 men and 19 women(mean age,57.5±3.1 years),and 27 cases of Garden Ⅲ and 22 cases of Garden Ⅳ.The 2 groups were compared in reduction quality.satisfactory fixation,ratio of nonunion and ratio of femoral avascular necrosis. Results The 122 patients received a mean follow-up of 50.3 months (from 20 to 101 months).The reduction quality was rated as grade Ⅰ in 39 cases,as gradeⅡin 19 cases,as grade Ⅲ or Ⅳ in 15 cases in the closed group,and as grade Ⅰ in 38 cases,as grade Ⅱ in 9 cases,as grade Ⅲ or Ⅳ in 2 eases in the open group.The differences between the 2 groups were significant(x2=9.519,P=0.010).There were no significant differences between the 2 groups in satisfactory fixation(86.3%venus 87.8%)or in nonunion ratio(8.2%versus 6.1%)(P>0.05).The ratio of femoral avascular necrosis for the open reduction group(10.2%)was significantly lower than that for the closed reduction group (27.4%)(x2=5.320,P=0.021). Conclusion Since open reduction can lower the ratio of femoral avascular necrosis for displaced femoral neck fractures,it is essential to perform timely open reduction when closed reduction fails or the fracture is obviously displaced.     

Cortical screw support in femoral neck fractures: A radiographic analysis of 87 fractures with a new mensuration technique

In 87 femoral neck fractures, operated on with 2 von Bahr screws and followed for up to 2 years, the positions of the fixating screws were determined with a new mensuration technique which compensates for the variations in hip rotation in routine radiographs. The union rate of the fractures was related to the position of the screws. A posterior placement of the proximal screw and an inferior placement of the distal screw in both the femoral head and neck improved the outcome substantially.     

脆性股骨颈骨折的股骨颈皮质厚度和骨密度改变

目的 研究脆性股骨颈骨折的股骨颈皮质骨厚度和骨密度变化。方法 对76例病人行股骨近端CT扫描,骨质疏松性股骨颈骨折组42 例,非骨折组34 例。取对侧（正常侧）股骨小转子顶点上方20mm（T20）平面CT横截面影像,计算T20长径和股骨颈寛径皮质比率,作为评估皮质厚度的指标;用DXA测量股骨颈骨密度,了解骨质疏松程度。结果 T20长径皮质比率：骨质疏松性股骨颈骨折组：（17.57±3.54）% ;非骨折组：（21.64±3.75）%（P =0.000）;T20股骨颈宽径皮质比率：骨质疏松性股骨颈骨折组：（25.98±5.51）%;非骨折组：(32.89±5.74)%（P=0.000）。骨密度：骨折组：0.590±0.084 g/cm2 ;非骨折组：0.698±0.138g/cm2, , P <0.000。结论 股骨颈皮质变薄和骨密度降低是导致脆性股骨颈骨折重要因素,T20长径皮质比率和T20股骨颈宽径皮质比率是观察股骨颈皮质骨变化的有效指标。     

Stability of fixation in femoral neck fractures: Comparison of four fixation devices in vivo and in cadavers

On human cadaveric femora, internal fixation of cervical osteotomies was performed with four different devices. With the use of a lever, a static force was applied through the acetabulum to the osteotomy site. Motion at the osteotomy site was measured by two strain gauges. The compression force necessary to inhibit motion at the osteotomy site during the fixation procedure was measured. This force was lower with a hook pin than with the other devices.

During surgery in 12 patients with displaced femoral neck fractures, the forces holding the fracture surfaces together were measured with a dynamometer. The force at which widening of the fracture gap was observed by fluoroscopy was recorded. In seven fractures, the mean compression force was 110 (60-170) N. The remaining five fractures did not open up when pressures of up to 200 N were applied. These forces were always greater than the hook pin forces measured in the cadaver experiments, but often less than the forces obtained with the other devices.     

Displacement in femoral neck fractures: A numerical analysis of 200 fractures

We measured the proximal-distal and anterior-posterior displacements of the femoral head in 200 femoral neck fractures. The numerical data were compared with the Garden classification. The average displacement of the Stages I and II fractures were almost equal. Moreover, the displacement of the Stage III fractures did not differ from the displacement of the Stage IV fractures. The Garden Stages I and II fractures displayed a more posterior position of the femoral head than did the normal hips. The femoral heads of Stages III and IV were situated more posterodistally than those of the Stages I and II fractures. Classification of femoral neck fractures into two groups without (Stages I and II) and with (Stages III and IV) proximal displacement is probably sufficient for clinical use.     

Rotational strength of the femoral neck: Computed tomography in cadavers

The mean bone density of the femur at different levels was determined by means of quantitative computed tomography (QCT) in 50 pairs of normal cadaveric femora and related to the rotational strength of the femoral neck. All the femora fractured vertically and spirally in the neck. The bone-mass-related measures at different levels were calculated from QCT densities and volumes. Cancellous bone was defined with threshold limits ranging from 50-500 Hounsfield units (HU), and attenuation values exceeding 500 HU were assessed as cortical bone. The recorded QCT mass-related measures of cortical and cancellous bone separately and as total bone masses gave significant right/left correlations. Correlations were found between the ultimate torsional strength of the femoral neck and QCT recordings of bone mass at all the femoral levels. The best correlations were demonstrated between the rotational strength of the femoral neck and the total bone-mass-related measures in the femoral shaft and condylar area.

Bone mass of the femur measured by computed tomography may become useful as an index of the mechanical strength of the femoral neck.     

Functional and radiological outcome after delayed fixation of femoral neck fractures in pediatric patients

Background  

Complications that develop after femoral neck fracture in children—especially osteonecrosis—have been retrospectively attributed to inadvertent delayed fixation and fracture type. Prospective evaluation of results after delayed fixation of femoral neck fractures in children beyond the first 24 h is not reported in the literature and requires evaluation to increase our understanding of the procedure and improve fixation methods. Also, the role of capsular decompression in initial management needs to be elucidated.     

重视对股骨颈骨折的骨缺损评估以优化手术方案决策

<正>股骨颈骨折如何选择手术方案一般是以患者的年龄为主导——青壮年患者多首选内固定手术,而老年患者则首选关节置换^[1]。但临床实践中却难以划定一个明确的年龄界线,对这些灰色年龄段的患者是选择内固定还是关节置换,是临床医师十分关注的问题^[2]。评估内固定失败的风险是影响手术方案的重要因素。近期的一项大型多中心研究显示,     

Stability of femoral neck osteosynthesis: Comparison of fixation methods in cadavers

Fixation of vertical femoral neck osteotomies in 50 cadavers was performed with either von Bahr screws or a sliding hip compression screw. One specimen from each pair of femora was used for the osteotomy, the other serving as an intact control. At 0.05 r of torsion the load-deformation test showed that three von Bahr screws provided the strongest fixation, and this was confirmed by the the ultimate torsional moment test. Regardless of positioning, even two von Bahr screws were stronger than the sliding compression screw with or without an additional lag screw. The results indicate that the best torsional stability in femoral neck fractures can be obtained with three 5.5-mm screws.     

A stretcher that facilitates the radiographic evaluation and closed reduction of spinal fractures

A rigid and exceptionally radiolucent stretcher with an attachment for cervical traction has been constructed. A patient is able to remain on this stretcher in the same position during the entire radiographic examination of a spinal fracture, including plain x-ray and computed tomographic and myelographic studies. Two advantages are obtained if this stretcher is used: 1) A patient's spine is well supported and does not need to be moved at any time during these radiographic studies, and 2) the application of traction during the myelography or closed reduction of a cervical fracture is facilitated.     

Stability of fixation in femoral neck fractures. Comparison of four fixation devices in vivo and in cadavers

On human cadaveric femora, internal fixation of cervical osteotomies was performed with four different devices. With the use of a lever, a static force was applied through the acetabulum to the osteotomy site. Motion at the osteotomy site was measured by two strain gauges. The compression force necessary to inhibit motion at the osteotomy site during the fixation procedure was measured. This force was lower with a hook pin than with the other devices. During surgery in 12 patients with displaced femoral neck fractures, the forces holding the fracture surfaces together were measured with a dynamometer. The force at which widening of the fracture gap was observed by fluoroscopy was recorded. In seven fractures, the mean compression force was 110 (60-170) N. The remaining five fractures did not open up when pressures of up to 200 N were applied. These forces were always greater than the hook pin forces measured in the cadaver experiments, but often less than the forces obtained with the other devices.     

Undisplaced femoral neck fractures need a closed reduction before internal fixation

European Journal of Orthopaedic Surgery & Traumatology - Undisplaced femoral neck fractures (UFNF) are generally treated with in situ internal fixation, and few studies have addressed the...