Abstract To understand the femoral head activity in old fracture of femoral neck, 159 cases from 1982 to 1994 were observed through X-ray film, pathological sections, transparent electronic microscope, tetracycline label technique and ECT examination. The results showed that under a status without stress, the avascular femoral head tended to be repaired in its natural way. The collapse of femoral head was caused by stress to some extent duringthe active repair process. Great attention should be paid in treating fracture of femoral neck that load should never be put on the femoral head during the process of fracture healing.
【摘要】 目的 探讨人工双极股骨头置换术治疗老老年（gt;80岁）股骨颈骨折的临床疗效。 方法 2006年1月－2009年12月采用人工双极股骨头置换术治疗23例老老年股骨颈骨折患者，其中男8例，女15例；年龄81~100岁，平均88岁。左侧10例，右侧13例。致伤原因：走路摔伤20例，交通事故伤3例。骨折按Garden分型：Ⅲ型14例，Ⅳ型9例。均为新鲜骨折，受伤至手术时间3~12 d。术前均合并慢性内科疾病。 结果 术后切口均I期愈合，3例发生肺部感染，1例发生深静脉血栓形成，无切口感染及假体脱位。2例患者分别于术后5个月死于急性心肌梗死及术后1年死于高血压性脑溢血。余21例均获随访，随访时间12~48个月，平均26个月。X线片示假体位置良好。根据Harris髋关节评分标准：优12例，良6例，可2例，差1例，优良率为85.7%。 结论 人工双极股骨头置换术治疗老老年股骨颈骨折手术时间短，可早期髋关节活动，减少了卧床并发症，提高了生存率，改善了患者生活质量，是一种较理想的治疗手段。【Abstract】 Objective To discuss the clinical effects of bipolar hemiarthroplasty for treatment of femoral neck fracture in super-aged patients who were over 80 years old. Methods From January 2006 to December 2009, 23 cases of femoral neck fracture were operated by bipolar hemiarthroplasty. Among the patients, there were 8 males and 15 females, with their age ranged from 81 to 100 years old averaging at 87.5 years. Ten patients had left femoral neck fracture, and 13 had right femoral neck fracture. Twenty patients had the injury because of falling on the ground while walking, and 3 due to car accident. Based on Garden classification, there were 14 cases of type Ⅲ and 9 of type Ⅳ fractures. All fractures were fresh. The interval between the injury and operation was 3 to 12 days. Before operation, all patients had concomitant chronic diseases. Results All incisions healed in the first stage with 3 cases of lung infection and 1 case of deep venous thrombus, and without incision infection or prosthesis dislocation. One patient died of acute myocardial infarction 5 months after operation and the other one died of hypertensive cerebral hemorrhage 1 year after operation. All the remaining 21 patients were followed up for 12 to 48 months averaging at 26 months. X-ray result showed a good location of the prosthesis. According to the Harris scoring system, the results were very good in 12 cases, good in 6 cases, fair in 2 cases and poor in 1 cases, with a total effective rate of 85.7％. Conclusions Bipolar hemiarthroplasty is an ideal method to treat femoral neck fracture in super-aged patients. It can shorten operation time, facilitate early movements of the hip joint, decrease complication rate due to lying in bed, and improve survival rate and quality of life.
Objective To compare the efficacy and safety of dynamic hip screw (DHS) + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults. Methods PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, SinoMed, Wanfang, and Chongqing VIP database were searched for the literature related to the comparison between DHS + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults from the establishment of databases to 2022. RevMan 5.3 software was used for meta-analysis. Results Finally, 25 clinical studies were included, including 8 randomized controlled trials and 17 observational studies, 5 in English and 20 in Chinese. There were a total of 2099 patients, including 989 in the DHS + anti-rotation screw group and 1110 in the cannulated screw group. The meta-analysis results showed that the incidence of bone nonunion [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.17, 0.48)], incidence of femoral head necrosis [OR=0.48, 95% CI (0.27, 0.88)], failure rate of internal fixation [OR=0.28, 95% CI (0.15, 0.51)] in the DHS + anti-rotation screw group were lower than those in the cannulated screw group (P<0.05). The surgical duration [mean difference (MD)=9.91, 95% CI (6.78, 13.05)], incision length [MD=1.25, 95% CI (0.15, 2.35)], and Harris score [MD=6.77, 95% CI (4.66, 8.88)] in the DHS + anti-rotation screw group were higher than those in the cannulated screw group (P<0.05). There was no statistically significant difference in intraoperative bleeding volume, Visual Analogue Scale score, hospital stay, and fracture healing time between the two groups (P>0.05). The incidence of bone nonunion in the DHS + anti-rotation screw group after Pauwels type Ⅲ fracture [OR=0.16, 95% CI (0.05, 0.50)] was lower than that in the cannulated screw group (P<0.05), and there was no statistically significant difference in the incidence of femoral head necrosis between the two groups (P>0.05). Conclusions For femoral neck fracture in adults, DHS + anti-rotation screw can reduce the incidence of bone nonunion, femoral head necrosis, and internal fixation failure compared with cannulated screw alone, and has a higher Harris score, but the surgical duration and incision are longer. Overall, DHS + anti-rotation screw are better at reducing the incidence of complications than cannulated screws alone.
Objective To evaluate the feasibility and short-term effectiveness of polyaxial locking plate for fixation of femoral neck fracture in the middle-aged and elderly patients. Methods A retrospective analysis was made on the clinical data of 13 patients with femoral neck fracture undergoing fixation with polyaxial locking plates between September 2013 and June 2015 (group A) and 13 patients with femoral neck fracture undergoing fixation with three cannulated screws in the same period (group B). There was no significant difference in gender, age, side, cause of injury, Garden type, type of fracture position, type of Pauwels angle, Singh index, time between injury and operation, and preoperative complications between 2 groups (P>0.05). The femoral neck shortening at 1 year postoperatively, and fracture nonunion, femoral head necrosis, and Harris hip score at last follow-up were compared between 2 groups. Results The follow-up time was (19.23±3.98) months in group A and (18.00±3.61) months in group B, showing no significant difference between 2 groups (t=2.063,P=0.417). No femoral head necrosis occurred in group A, but head necrosis occurred in 1 case of group B, and hemiarthroplasty was performed. There was no significant difference in the rate of femoral head necrosis between 2 groups (χ2=0.000,P=1.000). Bone union was obtained in the other patients of 2 groups. The Harris hip score of group A (85.23±2.95) was significantly higher than that of group B (81.92±3.64) at last follow-up (t=2.064,P=0.018). No infection or internal fixation failure occurred in 2 groups. One case had pain at the outer thigh at 1 month after operation in group A, but pain relief was achieved at 3 months after operation. At 1 year after operation, no femoral neck shortening occurred in group A, but degree I, II, and III femoral neck shortening was observed in 3, 2, and 8 cases of group B, respectively, showing significant difference between 2 groups (Z=–4.714,P=0.000). Conclusion Although fixation with polyaxial locking plate for femoral neck fracture in the middle-aged and elderly patients has similar femoral head necrosis rate to fixation with cannulated screws, it has advantages in preventing neck shortening and improving hip joint function after operation.
Thirty-nine cases of fracturc of the femoral neck were treated by transplantation of iliac bone graft pedicled with the deep circumflex iliac vessel. The average period of the follow up was 89.4 months. The results showed that Harris Hip Functional Evaluation was 88.2±15.6. The rate of necrosis of the femoral head was 48.7 percent before being operated and 23.1 percent after being operated. The non-union rate of the fracture was 56.4 in contrast to 17.9 percent. The authors believed that the indications wer...
Objective To investigate whether adding 1 transverse screw (TS) to the triangular parallel cannulated screw (TPCS) fixation has a mechanical stability advantage for Pauwels type Ⅲ femoral neck fractures by conducting finite element analysis on four internal fixation methods. Methods Based on CT data of a healthy adult male volunteer’s femur, three Pauwels type Ⅲ femoral neck fracture models (Pauwels angle 70°, Pauwels angle 80°, and Pauwels angle 70° combined with bone defect) were constructed using Mimics 21.0 software and SolidWorks 2017 software. Four different internal fixation models were built at the same time, including TPCS, TPCS+TS, three cross screws (TCS), and TPCS+medial buttress plate (MBP). The mechanical stability of different models under the same load was compared by finite element analysis. Results The femoral model established in this study exhibited a maximum stress of 28.62 MPa, with relatively higher stress concentrated in the femoral neck. These findings were comparable to previous studies, indicating that the constructed femoral finite element model was correct. The maximum stress of internal fixation in finite element analysis showed that TCS was the lowest and TPCS+MBP was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. The maximum displacement of internal fixation in each fracture model was located at the top of the femoral head, with TCS having the highest maximum displacement of the femur. The maximum stress of fracture surface in finite element analysis showed that TCS was the lowest and TPCS was the highest in the Pauwels angle 70° model, while TPCS+MBP was the lowest and TPCS/TCS were the highest in the Pauwels angle 80° model and the Pauwels angle 70° combined with bone defect model, respectively. The maximum displacement of fracture surfece analysis showed that TPCS+MBP was the lowest and TCS was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. Conclusion For Pauwels type Ⅲ femoral neck fractures, the biomechanical stability of TPCS+TS was superior to that of TPCS alone and TCS, but it has not yet reached the level of TPCS+MBP.
Objective To compare the effectiveness of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients. Methods The clinical data of 55 young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture between June 2021 and December 2022 was retrospectively analyzed. All patients were treated with closed reduction and internal fixation with hollow screws, 25 cases were treated with biplanar vertical fixation (study group), 30 cases with inverted triangle fixation (control group). There was no significant difference in gender, age, affected side, cause of injury, underlying diseases, and time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, guide needle puncture times, starting time of weight bearing, time of full weight bearing, time of fracture healing, and complications were recorded and compared between the two groups. The hip joint function was evaluated by Harris score at 1 day, 6 months, 12 months after operation, and at last follow-up, and the pain relief was evaluated by visual analogue scale (VAS) score. The femoral neck shortening was measured on the X-ray film at last follow-up. Results All patients were followed up 12-31 months (mean, 22.0 months), and there was no significant difference in follow-up time between the two groups (P>0.05). The operation time, intraoperative blood loss, and fluoroscopy times in the study group were higher than those in the control group, but the difference was not significant (P>0.05). The guide needle puncture times in the study group was more than that in the control group, and the time of starting weight bearing and the time of full weight bearing in the study group were shorter than those in the control group, the differences were significant (P<0.05). Bony healing was achieved in both groups, and there was no significant difference in fracture healing time between the two groups (P>0.05). No osteonecrosis of the femoral head and incision-related complication was found in the two groups during follow-up, and the femoral neck shortening length in the study group was significantly shorter than that in the control group at last follow-up (P<0.05). There was no significant difference in Harris score between the two groups at 1 day after operation (P>0.05), and the Harris score of the study group was significantly better than that of the control group at other time points (P<0.05); there was no significant difference in VAS score between the two groups at each time point after operation (P>0.05). Conclusion Compared with the inverted triangle fixation, the treatment of Pauwels type Ⅲ femoral neck fracture with biplanar vertical fixation can effectively reduce femoral neck shortening without affecting fracture healing, and improve hip joint function in early stage.
Objective To summarize the characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. Methods The clinical data of 4 patients with irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations between January 2010 and December 2019 were collected. There were 2 males and 2 females and the age ranged from 24 to 41 years, with an average age of 33.5 years. The cause of injury included traffic accident in 3 cases and falling in 1 case. Pipkin classification was 2 cases of type Ⅰ and 2 cases of type Ⅱ. The time from injury to operation was 1-2 days. The clinical features were that the hip joint of the affected limb was in a locked position, and the passive range of motion was poor. The affected limb was slightly flexed at the hip joint and shortened, in a state of neutral position or slight adduction and internal rotation. The imaging data suggested that the femoral head dislocated backward and upward, and the hard cortex of the posterior edge of the acetabulum was embedded in the cancellous bone of the femoral head, and the two were compressed and incarcerated. Patients of cases 1-3 underwent closed reduction of hip dislocation 1-2 times at 3, 1, and 3 hours after injury respectively, and femoral neck fracture occurred. The injury types changed to Pipkin type Ⅲ, and open reduction and internal fixation were performed. Patient of case 4 did not undergo closed reduction, but underwent open reduction and internal fixation directly. Results Patients of cases 1-3 were followed up 14, 17, and 12 months, respectively. They developed osteonecrosis of the femoral head at 9, 5, and 10 months after operation respectively, and all underwent total hip arthroplasty. Patient of case 4 was followed up 24 months and had no hip pain and limited mobility; the imaging data indicated that the internal fixator position was good and the fracture healed; no collapse or deformation of the femoral head was seen, and no osteonecrosis of the femoral head occurred. Conclusion Clinicians need to improve their understanding of the unique clinical features and imaging findings of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. It is suggested that open reduction and simultaneous fixation of femoral head fracture should be directly used to reduce the incidence of osteonecrosis of the femoral head.