Objective To explore the way and therapeutic effect of one stage total hi p replacement (THR) intreating ischemic necrosis of femoral head combined with intertrochanteric fracture. Methods From July 1997 to September 2005, one stage THR was performed in 18 cases (11 left and 7 right) of ischemic necrosis of femoral head combined with fresh intertrochanteric fracture, including 13 males and 5 females, with an age range of 32-60 years. There were 11 primary cases, 2 cases of ankylosing spondyl itis, 2 cases of rheumatic arthritis, 2 cases of congenital acetabular dysplasia and 1 case of femoral neck fracture fixed using cannulated cancellous screws postoperatively in all cases of ischemic necrosis of femoral head. They suffered from ischemic necrosis of femoral head for 8 years (4-23 years). According to Evan’s intertrochanteric fracture classification, there were 4 cases of type II, 6 cases of type III, 5 cases of type IV and 3 cases of type V. According to the Ficat ischemic necrosis of femoral head classification, there were 5 cases of type III, and 13 cases of type IV. The disease course was 2-12 hours. The average value of Harris evaluation was 35.2 preoperatively. The prosthesis of biology was used. Results All wounds healed by first intention. One case suffered deep venous thrombosis 3 days postoperatively and recovered completely after treatment. No infection of urinary system and lung as well as no bedsore occurred postoperatively. The X-ray films showed that the fracture ends healed and that prosthesis had good form attitude and position after 4 months of operation. All cases were followed up for 2 years. They could walk and take care of themselves after 6 months. The average value of Harris evaluation was 94.7 points postoperatively (P lt; 0.05). The results were excellent in 15 cases, good in 2 cases, fair in 1 case according to Harris evaluation standard of THR; the excellent and good rate was 94.4%. Conclusion One stage THR for treating ischemic necrosis of femoral head combined with intertrochanteric fracture can avoid secondary operation. It could resume the ideal function of the hip joint.
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.
ObjectiveTo summarize the patterns and research progress of the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter, and to provide a common language among orthopedic surgeons for scientific exchange.MethodsAccording to related literature and authors own experiences concerning the anatomic border between femoral neck and trochanter region, the intertrochanteric line (or intertrochanteric belt) and its capsularligament attachment footprint, fracture patterns, and treatment strategies were reviewed and analyzed.ResultsWith the rapid growing of geriatric hip fractures, an increased incidence was noted in recent years regarding the proximal femoral comminuted fractures that involving ipsilateral intracapsular neck and extracapsular trochanter regions simultaneously. But the concept of femoral neck combined with trochanter fractures was ambiguous. Based on the anatomic type of femoral neck fracture, the location of fracture center, and the ability to achieve direct inferior calcar or anteromedial cortex-to-cortex apposition and buttress, we classified these complex fractures into 3 sub-types: ① Segmental femoral neck fractures (two separate fracture centers at subcapital and trochanteric region respectively); ② Femoral neck fracture (trans-cervical) with extension to the supero-lateral trochanteric region (fracture center in femoral neck); ③ Trochanteric fracture with extension to the medio-inferior femoral neck region (fracture center in trochanter, comminuted basicervical fracture, or variant type of comminuted trochanter fracture). For treatment strategy, surgeons should consider the unique characteristics of femoral neck and trochanter, usually with combined fixation techniques, or arthroplasty supplemented with fixation.ConclusionCurrently there is no consensus on diagnosis and terminology regarding the concomitant ipsilateral fractures of femoral neck and trochanter. Further studies are needed.
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 results of the treatmenton femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail . Methods From Jun. 1999 to Sep. 2003, 74 patients with femoralfractures were treated by intramedullary interlocking nail (inverse limited marrow cavity rasping) .There were 62 males and 12 females. Among them, 5 caseswere type 32A1, 7 cases were type 32A2, 12 cases were type 32A3, 35 cases were type 32B2, and 15 cases were type 32C2. Results Seventyfour patients were followed up for 13 to 29 months(15.4 months in average). Thetime for fracture union ranged from 3 to 5 months(3.8 months in average). The overall rate of excellence was 98.7% by Wuyuesong grading. There was 1 case of non-union, 1 case of delayed infection, and 2 cases of bent screw. Conclusion The treatment on femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail is easy to operate and has minimum impairment to local circulation. It also promotes the healing and early function.
ObjectiveTo investigate the feasibility and effectiveness of a personalized distal femoral valgus resection angle for improving postoperative coronal alignment of lower limb in total knee arthroplasty (TKA). MethodsA retrospective analysis was made on the clinical data of 50 patients who received primary TKA between January 2013 and February 2013. There were 11 male and 39 female patients with degenerative knee osteoarthritis. The patients were divided into 2 groups. In test group (n=25), the resection angle was adjusted to the femoral mechanical anatomical angle (FMA); in control group (n=25), a fixed distal valgus resection angle of 5° was used. There was no significant difference in gender, age, body mass index, disease duration, sides, grade, preoperative FMA, mechanical femorotibial angle (MFT), and preoperative Knee Society Score (KSS) between 2 groups (P>0.05). Whole long X-ray film was taken to measure FMA and MFT at 3 days after operation, postoperative KSS was used to evaluate the knee function after 6 and 15 months. ResultsMFT was (-0.20±1.87)° in test group and was (1.71±3.67)° in control group, showing significant difference between 2 groups (t=2.32, P=0.02). The ideal MFT angle (0±3)° was achieved in 22 patients (88%) of test group and in 16 patients (64%) of control group, showing significant difference between 2 groups (χ2=2.32, P=0.02). Primary healing of incision was obtained in all patients of 2 groups. No deep venous thrombosis occurred. The patients of 2 groups were followed up 15 months after operation. There was significant difference in KSS between test and control groups at 6 months (88.23±2.57 vs. 82.92±2.59) (t=7.26, P=0.00) and at 15 months (90.76±2.77 vs. 88.65±1.77) (t=3.20, P=0.02). No sign of prosthesis loosening was observed by X-ray examination. ConclusionCompared with using of a fixed distal femoral resection angle, an individual FMA can significantly improve the postoperative MFT and promote early recovery of the knee function.
There were several methods, such as free single and folded fibulae autograft, composed tissue autograft, however, it is still very difficult to repair long segment bone defect. In December 1995, we used free juxtaposed bilateral fibulae autograft to repair an 8 cm of femoral bone defect in a 4 years old child in success. The key procedure is to strip a portion of the neighboring periosteal sleeve of juxtaposed fibulae to make bare of the opposite sides of the bone shafts, suture the opposite periosteal sleeves, keep the nutrient arteries, and reconstruct the blood circulation of both fibular by anastomosis of the distal ends of one fibular artery and vein to the proximal ends of the other fibular artery and vein, and anastomosis of the proximal ends of the fibular artery and vein to lateral circumflex artery and vein. After 22 months follow up, the two shafts of juxtaposed fibulae fused into one new bone shaft. The diameter of the new bone shaft was nearly the same as the diameter of the femur. There was only one medullary cavity, and it connected to the medullary cavity of femur. This method also cold be used to repair other long segment bone defect.