The treatment of an unstable slipped capital femoral epiphysis by either intracapsular cuneiform osteotomy or pinning in situ: a comparative study.

PubMed

Walton, R D M; Martin, E; Wright, D; Garg, N K; Perry, D; Bass, A; Bruce, C

2015-03-01

We undertook a retrospective comparative study of all patients with an unstable slipped capital femoral epiphysis presenting to a single centre between 1998 and 2011. There were 45 patients (46 hips; mean age 12.6 years; 9 to 14); 16 hips underwent intracapsular cuneiform osteotomy and 30 underwent pinning in situ, with varying degrees of serendipitous reduction. No patient in the osteotomy group was lost to follow-up, which was undertaken at a mean of 28 months (11 to 48); four patients in the pinning in situ group were lost to follow-up, which occurred at a mean of 30 months (10 to 50). Avascular necrosis (AVN) occurred in four hips (25%) following osteotomy and in 11 (42%) following pinning in situ. AVN was not seen in five hips for which osteotomy was undertaken > 13 days after presentation. AVN occurred in four of ten (40%) hips undergoing emergency pinning in situ, compared with four of 15 (47%) undergoing non-emergency pinning. The rate of AVN was 67% (four of six) in those undergoing pinning on the second or third day after presentation. Pinning in situ following complete reduction led to AVN in four out of five cases (80%). In comparison, pinning in situ following incomplete reduction led to AVN in 7 of 21 cases (33%). The rate of development of AVN was significantly higher following pinning in situ with complete reduction than following intracapsular osteotomy (p = 0.048). Complete reduction was more frequent in those treated by emergency pinning and was strongly associated with AVN (p = 0.005). Non-emergency intracapsular osteotomy may have a protective effect on the epiphyseal vasculature and should be undertaken with a delay of at least two weeks. The place of emergency pinning in situ in these patients needs to be re-evaluated, possibly in favour of an emergency open procedure or delayed intracapsular osteotomy. Non-emergency pinning in situ should be undertaken after a delay of at least five days, with the greatest risk at two and three days after

Bilateral simultaneous femoral neck and shafts fractures - a case report.

PubMed

Sadeghifar, Amirreza; Saied, Alireza

2014-10-01

Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection.

Reduced head-neck offset in nontraumatic osteonecrosis of the femoral head.

PubMed

Fraitzl, Christian R; Kappe, Thomas; Brugger, Annina; Billich, Christian; Reichel, Heiko

2013-08-01

Risk factors for nontraumatic osteonecrosis of the femoral head have in common that they trigger intravascular coagulation and thus lead to devascularization of the femoral head. In part of the patients, however, no risk factors seem to be evident. Mechanical reasons contributing to nontraumatic osteonecrosis have not been discussed so far. We hypothesized that recurrent traumatization of the vessels supplying the femoral head by a cam-type mechanism as in femoroacetabular impingement could add to intravascular coagulation. We, therefore, asked whether structural abnormalities at the femoral head-neck junction indicative of such a mechanism could be observed in radiographs of patients with osteonecrosis of the femoral head. The preoperative anteroposterior and lateral radiographs of 77 patients who underwent surgery because of osteonecrosis of the femoral head were retrospectively screened for a reduced head-neck offset by measuring the α-angle. For comparison, the α-angle was measured on anteroposterior and lateral radiographs of 339 control subjects without evident underlying hip pathology. The mean α-angle was 62.8° (SD 18.7°) for anteroposterior and 67.6° (SD 13.2°) for lateral radiographs in patients with nontraumatic osteonecrosis of the femoral head, whereas in control subjects, the mean α-angle was 47.2° (SD 9.6°) (p < 0.0001) and 47.6° (SD 10.3°) (p < 0.0001), respectively. A reduced head-neck offset in patients with nontraumatic osteonecrosis of the femoral head may act as a mechanical (co-)factor in developing osteonecrosis of the femoral head.

Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation.

PubMed

Zacherl, Max; Gruber, Gerald; Glehr, Mathias; Ofner-Kopeinig, Petra; Radl, Roman; Greitbauer, Manfred; Vecsei, Vilmos; Windhager, Reinhard

2011-10-01

Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

[Treatment of beginning juvenile detachment of the femoral head, taking growth of the femoral neck into account (author's transl)].

PubMed

Engelhardt, P

1979-10-01

Prevention of further detachment is the primary aim in the immediate treatment of beginning juvenile detachment of the femoral head. Screwing of the epiphysis of the head, first introduced by M. E. Mueller (1965), has proved successful. Besides providing immediate mechanical stability, this method, however, results in premature ossification of the joint of the femoral neck. Epiphysiodesis has a particularly unfavourable effect in early childhood, because it inhibits proper growth of the leg and development of the mechanism of the hip joint on account of the shortened femoral neck. Spiking of the epiphysis with Krischner screw wires guarantees safe fixation of the epiphyseal head on the one hand, and sufficient freedom of femoral neck growth on the other. Surgical treatment requires knowledge of the changed hip joint anatomy of the child. Preoperative planning via drawing to determine the length and position of the implantate on the basis of standardised x-ray films, will help to prevent operative failures.

[Treatment of avascular necrosis of femoral head after femoral neck fracture with pedicled iliac bone graft].

PubMed

Wang, Benjie; Zhao, Dewei; Guo, Lin; Yang, Lei; Li, Zhigang; Cui, Daping; Tian, Fengde; Liu, Baoyi

2011-05-01

To explore the effectiveness of pedicled iliac bone graft transposition for treatment of avascular necrosis of femoral head (ANFH) after femoral neck fracture. Between June 2002 and December 2006, 22 cases (22 hips, 16 left hips and 6 right hips) of ANFH after femoral neck fracture were treated with iliac bone graft pedicled with ascending branch of the lateral femoral circumflex vessels. There were 18 males and 4 females with an age range from 28 to 48 years (mean, 37.5 years). The time from injury to internal fixation was 2-31 days, and all fractures healed within 12 months after internal fixation. The ANFH was diagnosed at 15-40 months (mean, 22 months) after internal fixation. The ANFH duration was 3-11 months (mean, 8 months). According to Association Research Circulation Osseous (ARCO) staging system, 2 hips were classified as stage IIa, 3 hips as stage IIb, 3 hips as stage IIc, 3 hips as stage IIIa, 7 hips as stage IIIb, and 4 hips as stage IIIc. The preoperative Harris hip score (HHS) was 64.10 +/- 5.95. All incisions healed by first intention and the patients had no complication of lung embolism, sciatic nerve injury, lower limb deep venous thrombosis, and numbness and pain of donor site. All patients were followed up 2.5 to 6.3 years (mean, 4.8 years). The fracture healing time was 8-12 months, and no femoral neck fracture recurred. The HHS was 90.20 +/- 5.35 at last follow-up, showing significant difference when compared with the preoperative value (t = -18.447, P = 0.000). The hip function were excellent in 11 hips, good in 10 hips, fair in 1 hip, and the excellent and good rate was 95.5%. Four hips were radiographically progressed in ARCO staging, 18 hips remained stable with a stable rate of 81.8%. Pedicled iliac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization, sufficient cancellous bone supply, and relatively simple procedure.

Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation?

PubMed

Lichstein, Paul M; Kleimeyer, John P; Githens, Michael; Vorhies, John S; Gardner, Michael J; Bellino, Michael; Bishop, Julius

2018-07-01

A well-reduced femoral neck fracture is more likely to heal than a poorly reduced one, and increasing the quality of the surgical exposure makes it easier to achieve anatomic fracture reduction. Two open approaches are in common use for femoral neck fractures, the modified Smith-Petersen and Watson-Jones; however, to our knowledge, the quality of exposure of the femoral neck exposure provided by each approach has not been investigated. (1) What is the respective area of exposed femoral neck afforded by the Watson-Jones and modified Smith-Petersen approaches? (2) Is there a difference in the ability to visualize and/or palpate important anatomic landmarks provided by the Watson-Jones and modified Smith-Petersen approaches? Ten fresh-frozen human pelvi underwent both modified Smith-Petersen (utilizing the caudal extent of the standard Smith-Petersen interval distal to the anterosuperior iliac spine and parallel to the palpable interval between the tensor fascia lata and the sartorius) and Watson-Jones approaches. Dissections were performed by three fellowship-trained orthopaedic traumatologists with extensive experience in both approaches. Exposure (in cm) was quantified with calibrated digital photographs and specialized software. Modified Smith-Petersen approaches were analyzed before and after rectus femoris tenotomy. The ability to visualize and palpate seven clinically relevant anatomic structures (the labrum, femoral head, subcapital femoral neck, basicervical femoral neck, greater trochanter, lesser trochanter, and medial femoral neck) was also recorded. The quantified area of the exposed proximal femur was utilized to compare which approach afforded the largest field of view of the femoral neck and articular surface for assessment of femoral neck fracture and associated femoral head injury. The ability to visualize and palpate surrounding structures was assessed so that we could better understand which approach afforded the ability to assess structures that

New QCT analysis approach shows the importance of fall orientation on femoral neck strength.

PubMed

Carpenter, R Dana; Beaupré, Gary S; Lang, Thomas F; Orwoll, Eric S; Carter, Dennis R

2005-09-01

The influence of fall orientation on femur strength has important implications for understanding hip fracture risk. A new image analysis technique showed that the strength of the femoral neck in 37 males varied significantly along the neck axis and that bending strength varied by a factor of up to 2.8 for different loading directions. Osteoporosis is associated with decreased BMD and increased hip fracture risk, but it is unclear whether specific osteoporotic changes in the proximal femur lead to a more vulnerable overall structure. Nonhomogeneous beam theory, which is used to determine the mechanical response of composite structures to applied loads, can be used along with QCT to estimate the resistance of the femoral neck to axial forces and bending moments. The bending moment [My(theta)] sufficient to induce yielding within femoral neck sections was estimated for a range of bending orientations (theta) using in vivo QCT images of 37 male (mean age, 73 years; range, 65-87 years) femora. Volumetric BMD, axial stiffness, average moment at yield (M(y,avg)), maximum and minimum moment at yield (M(y,max) and M(y,min)), bone strength index (BSI), stress-strain index (SSI), and density-weighted moments of resistance (Rx and Ry) were also computed. Differences among the proximal, mid-, and distal neck regions were detected using ANOVA. My(theta) was found to vary by as much as a factor of 2.8 for different bending directions. Axial stiffness, M(y,avg), M(y,max), M(y,min), BSI, and Rx differed significantly between all femoral neck regions, with an overall trend of increasing axial stiffness and bending strength when moving from the proximal neck to the distal neck. Mean axial stiffness increased 62% between the proximal and distal neck, and mean M(y,avg) increased 53% between the proximal and distal neck. The results of this study show that femoral neck strength strongly depends on both fall orientation and location along the neck axis. Compressive yielding in the

Femoroacetabular impingement: bone marrow oedema associated with fibrocystic change of the femoral head and neck junction.

PubMed

James, S L J; Connell, D A; O'Donnell, P; Saifuddin, A

2007-05-01

To describe the association of bone marrow oedema adjacent to areas of fibrocystic change at the femoral head and neck junction in patients with femoroacetabular impingement. The clinical and imaging findings in six patients with bone marrow oedema adjacent to an area of fibrocystic change at the femoral head and neck junction are presented. There were five males and one female (age range 19-42 years, mean age 34.5 years). Three patients were referred with a clinical suspicion of femoroacetabular impingement, two with suspected osteoid osteoma and one with a clinical diagnosis of sciatica. The volume of bone marrow oedema (grade 1: 0-25%, grade 2: 26-50%, grade 3: 51-75% and grade 4: 76-100% of the femoral neck width), presence of labral and articular cartilage abnormality, joint effusion, and femoral head and neck morphology were recorded. Magnetic resonance imaging (MRI) identified fibrocystic change in the anterolateral aspect of the femoral head and neck junction in all cases (mean size 9 mm, range 5-14 mm, three multilocular and three unilocular cysts). The volume of oedema was variable (one grade 1, two grade 2, one grade 3 and two grade 4). All patients had abnormality of the anterosuperior labrum with five patients demonstrating chondral loss. An abnormal femoral head and neck junction was identified in five patients. The radiological finding of fibrocystic change at the anterosuperior femoral neck with or without bone marrow oedema should prompt the search for femoroacetabular impingement. Bone marrow oedema may rarely be identified adjacent to these areas of cystic change and should be considered in the differential diagnosis of bone marrow oedema in the femoral neck.

[Actual relevance of Pauwels' classification of femoral neck fractures--a critical review].

PubMed

Schwarz, N

2010-03-01

The aim of this study was to evaluate the validity of Pauwels' classification of femoral neck fractures. A study of literature was performed. It has never been proven that the inclination of the fracture plane has a prognostic relevance. A number of papers prove the contrary, there are no publications where Pauwels' classification has been used successfully in selecting treatment modalities. Pauwels' theory of fracture inclination angle has not been transferred into clinical practice. This discrepancy probably goes back to the fact that the angle cannot be determined preoperatively, that in the majority of femoral neck fractures the angle is within the range of 40 to 60 degrees, that the theoretical angle variations do practically not exist, and that the shearing forces are reduced to an unknown amount by friction resistance due to the uneven fracture plane. The mechanical laws of the pseudarthrosis of the femoral neck cannot be extrapolated to acute fractures. The theory of Pauwels has apparently no clinical relevance for the majority of acute fractures, except for the rare transcervical fractures, and should not be considered any longer as a classification of acute femoral neck fractures due to the lack of prognostic and therapeutic relevance.

THE TREATMENT OF IRRADIATION FRACTURE OF THE FEMORAL NECK

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leabhart, J.W.; Bonfiglio, M.

1961-10-01

Treatment of 44 patients with 56 postirradiation fractures of the femoral neck is reported. Of 2612 patients who received pelvic irradiation for carcinoma of the uterine cervix, 40 developed fractures of the femoral neck, an incidence of 1.5%. Sixteen of the 40 patients had bilateral fractures. The average age of the patients was 58.5 yr at the time of irradiation. The average irradiation dose was approximates 3600 r (parametrial dose), the largest dose being 4235 r. The average interval from irradiation to the onset of pain in the hip was 36.6 months (3 to 240 months) and from the onsetmore » of pain to diagnosis, 3 months. Forty-six surgical procedures were performed: 36 as primary treatment and 9 because of failure or complications of the first procedure. The average follow-up time of these patients was 6.9 yr. The presenting complaint was usually spontaneous onset of pain in the groin and medial portion of the thigh. Initially the physical examination often revealed only restriction of internal rotation of the affected hip, and the roentgenograms appeared normal in some instances. Subsequently, a change in bone density was noted at the inferior aspect of the femoral neck, denoting an adduction type of fracture. The displaced fractures resembled the traumatic adduction fractures of the femoral neck seen in patients who had not received irradiation. Acetabular changes were also noted, characterized by marked osteoporosis and occasionally fracture of the acetabulum. Seven methods of primary therapy were used to treat these patients: no treatment, nonsurgical measures (crutches or bedrest), internal fixation, bone- grafting (with and without additional fixation), osteotomy, arthroplasty, and the insertion of a prosthesis. Early in situ internal fixation or internal fixation with bone grafts was the procedure of choice in fractures of the femorai neck secondary to irradiation. Reconstructive procedures, such as cup arthroplasty or insertion of a prosthesis, were

The impact of high total cholesterol and high low-density lipoprotein on avascular necrosis of the femoral head in low-energy femoral neck fractures.

PubMed

Zeng, Xianshang; Zhan, Ke; Zhang, Lili; Zeng, Dan; Yu, Weiguang; Zhang, Xinchao; Zhao, Mingdong; Lai, Zhicheng; Chen, Runzhen

2017-02-17

Avascular necrosis of the femoral head (AVNFH) typically constitutes 5 to 15% of all complications of low-energy femoral neck fractures, and due to an increasingly ageing population and a rising prevalence of femoral neck fractures, the number of patients who develop AVNFH is increasing. However, there is no consensus regarding the relationship between blood lipid abnormalities and postoperative AVNFH. The purpose of this retrospective study was to investigate the relationship between blood lipid abnormalities and AVNFH following the femoral neck fracture operation among an elderly population. A retrospective, comparative study was performed at our institution. Between June 2005 and November 2009, 653 elderly patients (653 hips) with low-energy femoral neck fractures underwent closed reduction and internal fixation with cancellous screws (Smith and Nephew, Memphis, Tennessee). Follow-up occurred at 1, 6, 12, 18, 24, 30, and 36 months after surgery. Logistic multi-factor regression analysis was used to assess the risk factors of AVNFH and to determine the effect of blood lipid levels on AVNFH development. Inclusion and exclusion criteria were predetermined to focus on isolated freshly closed femoral neck fractures in the elderly population. The primary outcome was the blood lipid levels. The secondary outcome was the logistic multi-factor regression analysis. A total of 325 elderly patients with low-energy femoral neck fractures (AVNFH, n = 160; control, n = 165) were assessed. In the AVNFH group, the average TC, TG, LDL, and Apo-B values were 7.11 ± 3.16 mmol/L, 2.15 ± 0.89 mmol/L, 4.49 ± 1.38 mmol/L, and 79.69 ± 17.29 mg/dL, respectively; all of which were significantly higher than the values in the control group. Logistic multi-factor regression analysis showed that both TC and LDL were the independent factors influencing the postoperative AVNFH within femoral neck fractures. This evidence indicates that AVNFH was significantly

Is Disuse Osteopenia a Favorable Prognostic Sign After Femoral Neck Fracture?

PubMed

Ting, Beverlie L; Heng, Marilyn; Vrahas, Mark S; Rodriguez, Edward K; Harris, Mitchel B; Weaver, Michael J

2016-09-01

Avascular necrosis (AVN) of the femoral head is a devastating complication following fixation of femoral neck fractures in younger adults. In this study, we investigate the prognostic utility of disuse osteopenia. Retrospective study. Three academic Level 1 trauma centers. One hundred twenty patients younger than 60 years treated for a femoral neck fracture. N/A. The presence of sclerosis or osteopenia, compared to the contralateral femoral head, was measured 6 weeks from injury both subjectively and using a novel radiographic measure, the relative density ratio (RDR). The outcome measure was radiographic development of AVN. The presence of relative sclerosis was associated with AVN and overall treatment failure. Patients with subjective relative sclerosis had a 12.6 (95% confidence interval, 2.9-61.3; P < 0.001) times higher odds of developing AVN. Multiple logistic regression showed that for every 0.10 increase in the RDR, there was a 5.2 increase in the odds (95% confidence interval, 2.1-26.9; P = 0.009) of developing AVN. Patients with an RDR of ≥1.2 have an 80% probability of AVN, whereas those with an RDR ≤0.8 have a <1% probability of developing AVN. Disuse osteopenia detected on 6-week radiographs is a favorable prognostic sign following fixation of femoral neck fractures. Patients who have relative sclerosis of the femoral head at 6-week follow-up are at a higher risk of developing AVN. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Femoral head wedge resection for the treatment of avascular necrosis of the femoral head after pediatric femoral neck fracture: a case report.

PubMed

Kim, Ha Yong; Cha, Yong Han; Choy, Won Sik; Jeung, Sang Wook; Min, Yeon Seung

2018-05-01

This research focuses on femoral head wedge resection for the treatment of avascular necrosis (AVN) of the femoral head. A 9-year-old girl presented to the emergency room complaining of right hip pain that occurred after a pedestrian car accident. After 8 months of internal fixation using cannulated screws for Delbet-type 2 fracture of the femoral neck, AVN of the femoral head developed in the patient. Even though valgus-derotation-extension intertrochanteric osteotomy was performed for the treatment of AVN, it progressed further and femoral head wedge resection was performed to recover the femoral head sphericity. After 3 years of follow-up, radiograph results showed appropriate and satisfactory congruency and containment. This research shows that the treatment of AVN of the femoral head using femoral head wedge resection is an effective method that can yield excellent results.

Femoral neck shaft angles: A radiological anthropometry study.

PubMed

Adekoya-Cole, Thomas Oduntan; Akinmokun, Olasode Israel; Soyebi, Kofoworola O; Oguche, Omachoko Emmanuel

2016-01-01

Most of the available orthopaedic implants were designed and manufactured based on data from Western population whose skeletal dimensions are different from those of Africans. This study was conducted to determine the value of the neck-shaft angle (NSA) of Nigerians living in Lagos for the purpose of adequate planning, preparation, and pre-operative selection of orthopaedic implants for surgeries involving the femoral neck and stocking of orthopaedic implants in hospitals located in resource poor countries like Nigeria. This was a retrospective study which involved measuring the NSAs of anterior-posterior views of pelvic radiographs of adult patients reported "normal study" by the radiologist. A total of 264 femoral necks were analysed from 132 patients' radiographs comprising of 68 males and 64 females. The average NSA for an adult Nigerian living in Lagos is 130.77° ± 6.03° with mean NSA value of 131.28° ± 6.56° for the right and 130.22° ± 5.18° for the left. The mean value of NSA for an adult male is 131.57° ± 5.66° whereas the mean value for an adult female is 129.97° ± 6.33°. The value of NSA obtained from this study should be considered during the surgical fixation of the neck of femur fractures or osteotomies around the neck of the femur of adult Nigerians. It should also be noted during designing and bioengineering construction of orthopaedic implants and hip prosthesis for Nigerians.

Femoral neck-shaft angle in extra-capsular proximal femoral fracture fixation; does it make a TAD of difference?

PubMed

Walton, N P; Wynn-Jones, H; Ward, M S; Wimhurst, J A

2005-11-01

The effect of femoral neck-shaft angle and implant type on the accuracy of lag screw placement in extra-capsular proximal femoral fracture fixation was investigated. Radiographs of all extra-capsular proximal femoral fractures seen in one unit over 18 months were reviewed. Of 399 cases, 307 (237 female, 70 male) were included in the study as they had no contra-lateral proximal femoral metal work. Femoral neck-shaft angle (NSA) of the uninjured hip and magnification adjusted tip-apex distance (TAD) of femoral head lag screw were measured. Type of fixation implant was 135 degrees classic hip screw (CHS) (n=144) or 130 degrees intra-medullary hip screw (IMHS) (n=163). Mean contra-lateral NSA was 130.2 degrees (112.9--148 degrees ) and 64 patients (58 female, 6 male) had a NSA <125 degrees . Mean adjusted TAD was 18.7 mm (5.8--43.8mm) and 88.9% of cases had a TAD of less than 25 mm. TAD values were significantly greater using an IMHS if NSA was <125 degrees than if NSA was >125 degrees (p=0.028). This was not the case with the CHS. The use of the 130 degrees -IMHS in patients with a NSA <125 degrees leads to poorer lag screw placement than if NSA >125 degrees and caution is advocated when using this device in such cases.

Bilateral femoral neck fractures resulting from pregnancy-associated osteoporosis showed bone marrow edema on magnetic resonance imaging.

PubMed

Kasahara, Kyoko; Kita, Nobuyuki; Kawasaki, Taku; Morisaki, Shinsuke; Yomo, Hiroko; Murakami, Takashi

2017-06-01

Femoral neck fractures resulting from pregnancy-associated osteoporosis is a rare condition. Herein, we report an undoubted case of pregnancy-associated osteoporosis in a 38-year-old primiparous patient with pre-existing anorexia nervosa who suffered bilateral femoral neck fractures in the third trimester and early post-partum period. Magnetic resonance imaging revealed femoral neck fractures as well as diffuse marrow edema involving both femoral heads, which are considered under ordinary circumstances as characteristic imaging findings of transient osteoporosis of the hip. Based on our experience, we propose that pregnancy-associated osteoporosis might be present in femoral neck fractures attributed to transient osteoporosis of the hip in pregnancy. Conversely, bone status should be carefully and accurately estimated in cases of potential transient osteoporosis of the hip in pregnancy to reduce future fracture risk. © 2017 The Authors Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.

Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT.

PubMed

Han, Sangwon; Oh, Minyoung; Yoon, Seokho; Kim, Jinsoo; Kim, Ji-Wan; Chang, Jae-Suk; Ryu, Jin-Sook

2017-03-01

Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2-10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

Nonspherical femoral head shape (pistol grip deformity), neck shaft angle, and risk of hip osteoarthritis: a case-control study.

PubMed

Doherty, Michael; Courtney, Philip; Doherty, Sally; Jenkins, Wendy; Maciewicz, Rose A; Muir, Kenneth; Zhang, Weiya

2008-10-01

To determine whether 2-dimensional measures of femoral head shape and angle are associated with hip osteoarthritis (OA). We compared cases with symptomatic radiographic hip OA with asymptomatic controls with no radiographic hip OA. On anteroposterior pelvis radiographs, we measured "pistol grip deformity" for each hip (visually categorized as nonspherical, indeterminate, or spherical), the femoral head-to-femoral neck ratio as an interval measure of femoral head shape, and the femoral neck shaft angle. The relative risk of hip OA associated with each feature was estimated using odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for possible confounders using a logistic regression model. Of 1,007 cases, 965 had definite radiographic hip OA; of 1,123 controls, 1,111 had no radiographic OA. The prevalence of pistol grip deformity in at least 1 hip was 3.61% in controls and 17.71% in cases (OR 6.95 [95% CI 4.64-10.41]), and the prevalence of abnormal femoral head-to-femoral neck ratio in at least 1 hip was 3.70% in controls and 24.27% in cases (OR 12.08 [95% CI 8.05-18.15]). The risk of hip OA increased as the femoral head-to-femoral neck ratio decreased (P for trend<0.001) and with each extreme of neck shaft angle (P<0.05). In cases with unilateral hip OA, the prevalence of abnormal femoral head-to-femoral neck ratio in the unaffected hip was 2 times greater than that in controls (OR 1.82 [95% CI 1.07-3.07]); in contrast, an abnormally low, but not abnormally high, neck shaft angle was more common in unaffected hips than in controls (OR 1.79 [95% CI 1.03-3.14]). Our findings indicate that pistol grip deformity is associated with hip OA. The increased prevalence of pistol grip deformity and an abnormally low neck shaft angle in unaffected hips of cases with unilateral OA suggests that they are risk factors for development of hip OA. However, both a nonspherical head shape and an increase in neck shaft angle may occur as a consequence of OA.

Bilateral spontaneous fracturing of the femoral neck in a patient with renal osteodystrophy☆☆☆

PubMed Central

Garcia, Flavio Luís; Dalio, Renato Bellini; Sugo, Arthur Tomotaka; Picado, Celso Hermínio Ferraz

2014-01-01

We report a case of bilateral fracturing of the femoral neck in a patient with renal osteodystrophy who was treated by means of osteosynthesis. In this type of patient, there is a need to remain watchful for the possibility of occurrences of spontaneous fracturing of the femoral neck, even if the initial radiographic examination is normal. PMID:26229859

Screw-blade fixation systems in Pauwels three femoral neck fractures: a biomechanical evaluation.

PubMed

Knobe, Matthias; Altgassen, Simon; Maier, Klaus-Jürgen; Gradl-Dietsch, Gertraud; Kaczmarek, Chris; Nebelung, Sven; Klos, Kajetan; Kim, Bong-Sung; Gueorguiev, Boyko; Horst, Klemens; Buecking, Benjamin

2018-02-01

To reduce mechanical complications after osteosynthesis of femoral neck fractures, improved fixation techniques have been developed including blade or screw-anchor devices. This biomechanical study compares different fixation systems used for treatment of unstable femoral neck fractures with evaluation of failure mode, load to failure, stiffness, femoral head rotation, femoral neck shortening and femoral head migration. Standardized Pauwels type 3 fractures (AO/OTA 31-B2) with comminution were created in 18 biomechanical sawbones using a custom-made sawguide. Fractures were stabilized using either SHS-Screw, SHS-Blade or Rotationally Stable Screw-Anchor (RoSA). Femurs were positioned in 25 degrees adduction and ten degrees posterior flexion and were cyclically loaded with an axial sinusoidal loading pattern of 0.5 Hz, starting with 300 N, with an increase by 300 N every 2000 cycles until bone-implant failure occurred. Mean failure load for the Screw-Anchor fixation (RoSA) was 5100 N (IQR 750 N), 3900 N (IQR 75 N) for SHS-Blade and 3000 N (IQR 675 N; p = 0.002) for SHS-Screw. For SHS-Screw and SHS-Blade we observed fracture displacement with consecutive fracture collapse as the main reason for failure, whereas RoSA mainly showed a cut-out under high loadings. Mean stiffness at 1800 N was 826 (IQR 431) N/mm for SHS-Screw, 1328 (IQR 441) N/mm for SHS-Blade and 1953 (IQR 617) N/mm for RoSA (p = 0.003). With a load of 1800 N (SHS-Screw 12° vs. SHS-Blade 7° vs. RoSA 2°; p = 0.003) and with 2700 N (24° vs. 15° vs. 3°; p = 0.002) the RoSA implants demonstrated a higher rotational stability and had the lowest femoral neck shortening (p = 0.002), compared with the SHS groups. At the 2700 N load point, RoSA systems showed a lower axial (p = 0.019) and cranial (p = 0.031) femoral head migration compared to the SHS-Screw. In our study, the new Screw-Anchor fixation (RoSA) was superior to the comparable SHS implants regarding rotational

Cortical Bone Morphological and Trabecular Bone Microarchitectural Changes in the Mandible and Femoral Neck of Ovariectomized Rats

PubMed Central

Hsu, Pei-Yu; Tsai, Ming-Tzu; Wang, Shun-Ping; Chen, Ying-Ju; Wu, Jay; Hsu, Jui-Ting

2016-01-01

Objective This study used microcomputed tomography (micro-CT) to evaluate the effects of ovariectomy on the trabecular bone microarchitecture and cortical bone morphology in the femoral neck and mandible of female rats. Materials and Methods Twelve female Wister rats were divided into two groups: the control and ovariectomized groups. The rats in the ovariectomized group received ovariectomy at 8 weeks of age; all the rats were sacrificed at 20 weeks of age, and their mandibles and femurs were removed and scanned using micro-CT. Four microstructural trabecular bone parameters were measured for the region below the first mandibular molar and the femoral neck region: bone volume fraction (BV/TV), trabecular thickness (TbTh), trabecular separation (TbSp), and trabecular number (TbN). In addition, four cortical bone parameters were measured for the femoral neck region: total cross-sectional area (TtAr), cortical area (CtAr), cortical bone area fraction (CtAr/TtAr), and cortical thickness (CtTh). The CtTh at the masseteric ridge was used to assess the cortical bone morphology in the mandible. The trabecular bone microarchitecture and cortical bone morphology in the femoral necks and mandibles of the control group were compared with those of the ovariectomized group. Furthermore, Spearman’s correlation (rs) was conducted to analyze the correlation between the osteoporosis conditions of the mandible and femoral neck. Results Regarding the trabecular bone microarchitectural parameters, the BV/TV of the trabecular bone microarchitecture in the femoral necks of the control group (61.199±11.288%, median ± interquartile range) was significantly greater than that of the ovariectomized group (40.329±5.153%). Similarly, the BV/TV of the trabecular bone microarchitecture in the mandibles of the control group (51.704±6.253%) was significantly greater than that of the ovariectomized group (38.486±9.111%). Furthermore, the TbSp of the femoral necks in the ovariectomized group

Bilateral avascular necrosis of the femoral head following asynchronous postictal femoral neck fractures: a case report and review of the literature.

PubMed

Venkatadass, K; Avinash, M; Rajasekaran, S

2018-05-01

Bilateral avascular necrosis (AVN) following postictal bilateral fracture neck of the femur is a rare occurrence. Here, we report a case of bilateral AVN of the femoral head following an asynchronous bilateral postictal fracture neck of the femur. A 16-year-old autistic boy presented with left hip pain following an episode of seizures and radiographs showed Delbet type II fracture neck of the left femur. This was treated by closed reduction and cancellous screw fixation and skeletal traction for 6 weeks. At 3 months, follow-up radiograph showed union of the fracture, but he had developed segmental AVN with collapse of the head. At 8 months, the patient presented with pain in the right hip following another episode of seizures and radiograph of the pelvis showed a fresh Delbet type II fracture neck of the right femur with established AVN of the left femoral head. He underwent closed reduction and cancellous screw fixation of the right hip and implant exit of the left hip. At the 6-month follow-up after this surgery, his radiograph of the pelvis showed AVN with collapse and extrusion of the femoral head on the right side as well. Literature review shows an increased risk of fracture neck of the femur among epileptics. The incidence of AVN is maximum in Delbet type I, followed by Delbet type II and type III in that order. Although there are no clear guidelines on the management of post-traumatic AVN of the femoral head, the majority have reported that most of them will eventually develop arthritis and will require total hip replacement at a later date. Upon extensive literature search, no case report of bilateral fracture neck of the femur with bilateral AVN was found and hence this case was reported.

Periacetabular osteotomy and combined femoral head-neck junction osteochondroplasty: a minimum two-year follow-up cohort study.

PubMed

Nassif, Nader A; Schoenecker, Perry L; Thorsness, Robert; Clohisy, John C

2012-11-07

Proximal femoral deformities and overcorrection of the acetabulum both can result in secondary femoroacetabular impingement and suboptimal clinical results after periacetabular osteotomy. The purpose of the present study was to determine the rate of complications, the need for reoperations, radiographic correction, and hip function among patients who underwent periacetabular osteotomy and combined femoral head-neck osteochondroplasty as compared with those who underwent periacetabular osteotomy alone. Patients who underwent periacetabular osteotomy with or without osteochondroplasty of the femoral head-neck junction were evaluated retrospectively after a minimum duration of follow-up of two years. We compared the two groups with regard to the modified Harris hip score, radiographic correction, complications, and reoperations. Forty patients (forty hips) who underwent periacetabular osteotomy in conjunction with a femoral head-neck osteochondroplasty were compared with forty-eight patients (forty-eight hips) who underwent an isolated periacetabular osteotomy. Patients were evaluated after a mean duration of follow-up of 3.4 years (range, 2.0 to 9.7 years). Preoperatively, the modified Harris hip score (and standard deviation) was 64.3 ± 13.2 for the study group and 63.2 ± 13.4 for the comparison group. At the time of the latest follow-up, the modified Harris hip score was not significantly different between the study group and the comparison group (p = 0.17). Patients demonstrated equivalent preoperative deformities and postoperative acetabular radiographic parameters. There was a significant decrease in the alpha angle and improvement in head-neck offset in the study group. There was one reoperation for secondary impingement and/or labral pathology in the study group, compared with four reoperations in the comparison group. There were no adhesions requiring surgery, femoral neck fractures, instances of osteonecrosis, or increases in heterotopic ossification in

New type of hip arthroplasty failure related to modular femoral components: breakage at the neck-stem junction.

PubMed

Wodecki, P; Sabbah, D; Kermarrec, G; Semaan, I

2013-10-01

Total hip replacements (THR) with modular femoral components (stem-neck interface) make it possible to adapt to extramedullary femoral parameters (anteversion, offset, and length) theoretically improving muscle function and stability. Nevertheless, adding a new interface has its disadvantages: reduced mechanical resistance, fretting corrosion and material fatigue fracture. We report the case of a femoral stem fracture of the female part of the component where the modular morse taper of the neck is inserted. An extended trochanteric osteotomy was necessary during revision surgery because the femoral stump could not be grasped for extraction, so that a long stem had to be used. In this case, the patient had the usual risk factors for modular neck failure: he was an active overweight male patient with a long varus neck. This report shows that the female part of the stem of a small femoral component may also be at increased failure risk and should be added to the list of risk factors. To our knowledge, this is the first reported case of this type of failure. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Bone mineral density of the femoral neck in resurfacing hip arthroplasty

PubMed Central

Ovesen, Ole; Brixen, Kim; Varmarken, Jens-Erik; Overgaard, SØren

2010-01-01

Background and purpose Resurfacing total hip arthroplasty (RTHA) may preserve the femoral neck bone stock postoperatively. Bone mineral density (BMD) may be affected by the hip position, which might bias longitudinal studies. We investigated the dependency of BMD precision on type of ROI and hip position. Method We DXA-scanned the femoral neck of 15 resurfacing patients twice with the hip in 3 different rotations: 15° internal, neutral, and 15° external. For each position, BMD was analyzed with 3 surface area models. One model measured BMD in the total femoral neck, the second model divided the neck in two, and the third model had 6 divisions. Results When all hip positions were pooled, average coefficients of variation (CVs) of 3.1%, 3.6%, and 4.6% were found in the 1-, 2-, and 6-region models, respectively. The externally rotated hip position was less reproducible. When rotating in increments of 15° or 30°, the average CVs rose to 7.2%, 7.3%, and 12% in the 3 models. Rotation affected the precision most in the model that divided the neck in 6 subregions, predominantly in the lateral and distal regions. For larger-region models, some rotation could be allowed without compromising the precision. Interpretation If hip rotation is strictly controlled, DXA can reliably provide detailed topographical information about the BMD changes around an RTHA. As rotation strongly affects the precision of the BMD measurements in small regions, we suggest that a less detailed model should be used for analysis in studies where the leg position has not been firmly controlled. PMID:20367420

Assessment of risk of femoral neck fracture with radiographic texture parameters: a retrospective study.

PubMed

Thevenot, Jérôme; Hirvasniemi, Jukka; Pulkkinen, Pasi; Määttä, Mikko; Korpelainen, Raija; Saarakkala, Simo; Jämsä, Timo

2014-07-01

To investigate whether femoral neck fracture can be predicted retrospectively on the basis of clinical radiographs by using the combined analysis of bone geometry, textural analysis of trabecular bone, and bone mineral density (BMD). Formal ethics committee approval was obtained for the study, and all participants gave informed written consent. Pelvic radiographs and proximal femur BMD measurements were obtained in 53 women aged 79-82 years in 2006. By 2012, 10 of these patients had experienced a low-impact femoral neck fracture. A Laplacian-based semiautomatic custom algorithm was applied to the radiographs to calculate the texture parameters along the trabecular fibers in the lower neck area for all subjects. Intra- and interobserver reproducibility was calculated by using the root mean square average coefficient of variation to evaluate the robustness of the method. The best predictors of hip fracture were entropy (P = .007; reproducibility coefficient of variation < 1%), the neck-shaft angle (NSA) (P = .017), and the BMD (P = .13). For prediction of fracture, the area under the receiver operating characteristic curve was 0.753 for entropy, 0.608 for femoral neck BMD, and 0.698 for NSA. The area increased to 0.816 when entropy and NSA were combined and to 0.902 when entropy, NSA, and BMD were combined. Textural analysis of pelvic radiographs enables discrimination of patients at risk for femoral neck fracture, and our results show the potential of this conventional imaging method to yield better prediction than that achieved with dual-energy x-ray absorptiometry-based BMD. The combination of the entropy parameter with NSA and BMD can further enhance predictive accuracy. © RSNA, 2014.

Genomic expression analysis of rat chromosome 4 for skeletal traits at femoral neck.

PubMed

Alam, Imranul; Sun, Qiwei; Liu, Lixiang; Koller, Daniel L; Liu, Yunlong; Edenberg, Howard J; Econs, Michael J; Foroud, Tatiana; Turner, Charles H

2008-10-08

Hip fracture is the most devastating osteoporotic fracture type with significant morbidity and mortality. Several studies in humans and animal models identified chromosomal regions linked to hip size and bone mass. Previously, we identified that the region of 4q21-q41 on rat chromosome (Chr) 4 harbors multiple femoral neck quantitative trait loci (QTLs) in inbred Fischer 344 (F344) and Lewis (LEW) rats. The purpose of this study is to identify the candidate genes for femoral neck structure and density by correlating gene expression in the proximal femur with the femoral neck phenotypes linked to the QTLs on Chr 4. RNA was extracted from proximal femora of 4-wk-old rats from F344 and LEW strains, and two other strains, Copenhagen 2331 and Dark Agouti, were used as a negative control. Microarray analysis was performed using Affymetrix Rat Genome 230 2.0 arrays. A total of 99 genes in the 4q21-q41 region were differentially expressed (P < 0.05) among all strains of rats with a false discovery rate <10%. These 99 genes were then ranked based on the strength of correlation between femoral neck phenotypes measured in F2 animals, homozygous for a particular strain's allele at the Chr 4 QTL and the expression level of the gene in that strain. A total of 18 candidate genes were strongly correlated (r(2) > 0.50) with femoral neck width and prioritized for further analysis. Quantitative PCR analysis confirmed 14 of 18 of the candidate genes. Ingenuity pathway analysis revealed several direct or indirect relationships among the candidate genes related to angiogenesis (VEGF), bone growth (FGF2), bone formation (IGF2 and IGF2BP3), and resorption (TNF). This study provides a shortened list of genetic determinants of skeletal traits at the hip and may lead to novel approaches for prevention and treatment of hip fracture.

Genomic expression analysis of rat chromosome 4 for skeletal traits at femoral neck

PubMed Central

Alam, Imranul; Sun, Qiwei; Liu, Lixiang; Koller, Daniel L.; Liu, Yunlong; Edenberg, Howard J.; Econs, Michael J.; Foroud, Tatiana; Turner, Charles H.

2008-01-01

Hip fracture is the most devastating osteoporotic fracture type with significant morbidity and mortality. Several studies in humans and animal models identified chromosomal regions linked to hip size and bone mass. Previously, we identified that the region of 4q21-q41 on rat chromosome (Chr) 4 harbors multiple femoral neck quantitative trait loci (QTLs) in inbred Fischer 344 (F344) and Lewis (LEW) rats. The purpose of this study is to identify the candidate genes for femoral neck structure and density by correlating gene expression in the proximal femur with the femoral neck phenotypes linked to the QTLs on Chr 4. RNA was extracted from proximal femora of 4-wk-old rats from F344 and LEW strains, and two other strains, Copenhagen 2331 and Dark Agouti, were used as a negative control. Microarray analysis was performed using Affymetrix Rat Genome 230 2.0 arrays. A total of 99 genes in the 4q21-q41 region were differentially expressed (P < 0.05) among all strains of rats with a false discovery rate <10%. These 99 genes were then ranked based on the strength of correlation between femoral neck phenotypes measured in F2 animals, homozygous for a particular strain's allele at the Chr 4 QTL and the expression level of the gene in that strain. A total of 18 candidate genes were strongly correlated (r2 > 0.50) with femoral neck width and prioritized for further analysis. Quantitative PCR analysis confirmed 14 of 18 of the candidate genes. Ingenuity pathway analysis revealed several direct or indirect relationships among the candidate genes related to angiogenesis (VEGF), bone growth (FGF2), bone formation (IGF2 and IGF2BP3), and resorption (TNF). This study provides a shortened list of genetic determinants of skeletal traits at the hip and may lead to novel approaches for prevention and treatment of hip fracture. PMID:18728226

MANAGEMENT OF BILATERAL FEMORAL NECK FRACTURE IN A NONAGENARIAN PATIENT--CASE REPORT.

PubMed

Popescu, D; Trandabaţ, C; Puha, B; Veliceasa, B; Alexa, O

2016-01-01

Simultaneous bilateral femoral neck fracture is rare injury. Cases with this type of fracture have been reported in the literature since the 1950s, following the introduction of electroconvulsive therapy which generates violent hip muscle contractions. In young patients' simultaneous bilateral femoral neck fracture results from high energy trauma (car accident or fall from height) in a normal bone. Pathological changes in bone structure occurring in chronic kidney disease, vitamin D deficiency, osteomalacia, osteoporosis, metabolic imbalances and administration of corticosteroids explain the occurrence of this particular type of fracture following low-energy trauma. We present the case of a 90-year-old female patient who suffered a simple fall from her own height resulting in a Garden IV bilateral femoral neck fracture. Our therapeutic option in this patient was bilateral uncemented bipolar hemiarthroplasty in a single session using a single tray of sterile surgical instruments and two sterile drapes. Postoperative outcome was very good, allowing the initiation of functional recovery on the first postoperative day. Uncemented hemiarthroplasty proved to be a good choice in such a patient in the associated diseases may trigger the risk of cardiovascular disturbances specific to bone cement implantation syndrome.

Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures.

PubMed

Mathew, G; Kowalczuk, M; Hetaimish, B; Bedi, A; Philippon, M J; Bhandari, M; Simunovic, N; Crouch, S; Ayeni, O R

2014-04-01

The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (≥ 50 years) who have undergone internal fixation for femoral neck fracture. A total of 187 frog-leg lateral radiographs of elderly patients who underwent internal fixation for a femoral neck fracture were reviewed by two independent reviewers. The alpha angle, beta angle, and femoral head-neck offset ratio were calculated. The presence of two abnormal radiographic parameters was deemed to be diagnostic of radiographic CAM-type impingement. Radiographic CAM-type FAI was identified in 157 out of 187 (84 %) patients who underwent internal fixation for fractures of the femoral neck. Moderate-to-good inter-observer reliability was achieved in the measurement of radiographic parameters. With reference to fracture subtypes and prevalence of radiographic features of CAM-type morphology, 97 (72 %) out of 134 patients were positive for CAM in Garden subtypes I and II, whereas 49 (85.9 %) out of 57 patients had radiographic CAM in Garden III and IV subtypes. There was a high prevalence of CAM-type FAI in patients that underwent surgical fixation of femoral neck fractures. This is significantly higher than the reported prevalence in non-fracture patient populations. The high prevalence of CAM morphology could be related to several factors, including age, fracture morphology, quality of reduction, type of fixation, and fracture healing.

Nonhuman anthropoid primate femoral neck trabecular architecture and its relationship to locomotor mode.

PubMed

Fajardo, Roberto J; Müller, Ralph; Ketcham, Rich A; Colbert, Matthew

2007-04-01

Functional analyses of human and nonhuman anthropoid primate femoral neck structure have largely ignored the trabecular bone. We tested hypotheses regarding differences in the relative distribution and structural anisotropy of trabecular bone in the femoral neck of quadrupedal and climbing/suspensory anthropoids. We used high-resolution X-ray computed tomography to analyze quantitatively the femoral neck trabecular structure of Ateles geoffroyi, Symphalangus syndactylus, Alouatta seniculus, Colobus guereza, Macaca fascicularis, and Papio cynocephalus (n = 46). We analyzed a size-scaled superior and inferior volume of interest (VOI) in the femoral neck. The ratio of the superior to inferior VOI bone volume fraction indicated that the distribution of trabecular bone was inferiorly skewed in most (but not all) quadrupeds and evenly distributed the climbing/suspensory species, but interspecific comparisons indicated that all taxa overlapped in these measurements. Degree of anisotropy values were generally higher in the inferior VOI of all species and the results for the two climbing/suspensory taxa, A. geoffroyi (1.71 +/- 0.30) and S. syndactylus (1.55 +/- 0.04), were similar to the results for the quadrupedal anthropoids, C. guereza (male = 1.64 +/- 0.13; female = 1.68 +/- 0.07) and P. cynocephalus (1.47 +/- 0.13). These results suggest strong trabecular architecture similarity across body sizes, anthropoid phylogenetic backgrounds, and locomotor mode. This structural similarity might be explained by greater similarity in anthropoid hip joint loading mechanics than previously considered. It is likely that our current models of anthropoid hip joint mechanics are overly simplistic.

Operative Mortality After Arthroplasty for Femoral Neck Fracture and Hospital Volume.

PubMed

Maceroli, Michael A; Nikkel, Lucas E; Mahmood, Bilal; Elfar, John C

2015-12-01

The purpose of the present study is to use a statewide, population-based data set to identify mortality rates at 30-day and 1-year postoperatively following total hip arthroplasty (THA) and hemiarthroplasty (HA) for displaced femoral neck fractures. The secondary aim of the study is to determine whether arthroplasty volume confers a protective effect on the mortality rate following femoral neck fracture treatment. New York's Statewide Planning and Research Cooperative System was used to identify 45 749 patients older than 60 years of age with a discharge diagnosis of femoral neck fracture undergoing THA or HA from 2000 through 2010. Comorbidities were identified using the Charlson comorbidity index. Mortality risk was modeled using Cox proportional hazards models while controlling for demographic and comorbid characteristics. High-volume THA centers were defined as those in the top quartile of arthroplasty volume, while low-volume centers were defined as the bottom quartile. Patients undergoing THA for femoral neck fracture rather than HA were younger (79 vs 83 years, P < .001), more likely to have rheumatoid disease, and less likely to have heart disease, dementia, cancer, or diabetes (all P < .05). Thirty-day mortality after HA was higher (8.4% vs 5.7%; P < .001) as was 1-year mortality (25.9% vs 17.8%; P < .001). After controlling for age, gender, ethnicity, and comorbidities, risk of mortality following THA was 21% lower (hazard ratio [HR] 0.79; P = .003) at 30 days and 22% lower (HR 0.78; P < .001) at 1 year than HA. Patients undergoing THA at high-volume arthroplasty centers had improved 1-year mortality when compared to those undergoing THA at low-volume hospitals (HR 0.55; P = .008). Based on this large, population-based study, there is no basis to assume THA carries a greater mortality risk after hip fracture than does standard HA, even when accounting for institutional volume of hip arthroplasty.

The variation of cancellous bones at lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep.

PubMed

Zhang, Yongqiang; Li, Yongfeng; Gao, Qi; Shao, Bo; Xiao, Jianrui; Zhou, Hong; Niu, Qiang; Shen, Mingming; Liu, Baolin; Hu, Kaijin; Kong, Liang

2014-07-01

This study aimed to compare the variation of cancellous bones at four skeletal sites: lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep. Sixteen adult sheep were randomly divided into two groups: eight sheep were ovariectomized served as experimental group; the other eight untreated sheep were served as control group. Bone mineral density was assessed by dual-energy X-ray absorptiometry on lumbar vertebrae at baseline and twelve months after ovariectomy. After 12 months, lumbar vertebrae L3 and L4, femoral necks, mandibular angles and the fourth ribs were harvested for micro-CT scanning, histological analysis and biomechanical test. The results showed that bone mineral density of lumbar vertebra decreased significantly in twelfth month (p<0.05). The results of micro-CT showed that the bone volume/total volume decreased by 45.6%, 36.1% 21.3% and 18.7% in lumbar vertebrae, femoral necks, mandibular angles and ribs in experimental group (p<0.05) respectively. The trabecular number showed the same downtrend (p<0.05). Histological analysis showed trabecular area/tissue area decreased by 32.1%, 23.2% and 20.7% in lumbar vertebrae, femoral necks and mandibular angles respectively (p<0.05), but no significant difference in ribs. Specimens elastic modulus from lumbar vertebra, femoral neck and mandibular angle were 952±76MPa (628±70MPa), 961±173MPa (610±72MPa) and 595±60MPa (444±31MPa) in control group (experimental group) respectively. These datum indicated that the sensibility of cancellous bones to oestrogen deficiency in ovariectomized sheep was site-specific on a pattern as follows: lumbar vertebra, femoral neck, mandibular angle and rib. Copyright © 2014 Elsevier Ltd. All rights reserved.

Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients.

PubMed

Ai, Zi-Sheng; Gao, You-Shui; Sun, Yuan; Liu, Yue; Zhang, Chang-Qing; Jiang, Cheng-Hua

2013-03-01

Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.

Genetic predisposition for femoral neck stress fractures in military conscripts.

PubMed

Korvala, Johanna; Hartikka, Heini; Pihlajamäki, Harri; Solovieva, Svetlana; Ruohola, Juha-Petri; Sahi, Timo; Barral, Sandra; Ott, Jürg; Ala-Kokko, Leena; Männikkö, Minna

2010-10-21

Stress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures. Eight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5, IL-6) were examined in 72 military conscripts with a femoral neck stress fracture and 120 controls. The risk of femoral neck stress fracture was significantly higher in subjects with low weight and body mass index (BMI). An interaction between the CTR (rs1801197) minor allele C and the VDR C-A haplotype was observed, and subjects lacking the C allele in CTR and/or the C-A haplotype in VDR had a 3-fold higher risk of stress fracture than subjects carrying both (OR = 3.22, 95% CI 1.38-7.49, p = 0.007). In addition, the LRP5 haplotype A-G-G-C alone and in combination with the VDR haplotype C-A was associated with stress fractures through reduced body weight and BMI. Our findings suggest that genetic factors play a role in the development of stress fractures in individuals subjected to heavy exercise and mechanical loading. The present results can be applied to the design of future studies that will further elucidate the genetics of stress fractures.

Genetic predisposition for femoral neck stress fractures in military conscripts

PubMed Central

2010-01-01

Background Stress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures. Results Eight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5, IL-6) were examined in 72 military conscripts with a femoral neck stress fracture and 120 controls. The risk of femoral neck stress fracture was significantly higher in subjects with low weight and body mass index (BMI). An interaction between the CTR (rs1801197) minor allele C and the VDR C-A haplotype was observed, and subjects lacking the C allele in CTR and/or the C-A haplotype in VDR had a 3-fold higher risk of stress fracture than subjects carrying both (OR = 3.22, 95% CI 1.38-7.49, p = 0.007). In addition, the LRP5 haplotype A-G-G-C alone and in combination with the VDR haplotype C-A was associated with stress fractures through reduced body weight and BMI. Conclusions Our findings suggest that genetic factors play a role in the development of stress fractures in individuals subjected to heavy exercise and mechanical loading. The present results can be applied to the design of future studies that will further elucidate the genetics of stress fractures. PMID:20961463

Current and past menstrual status is an important determinant of femoral neck geometry in exercising women.

PubMed

Mallinson, Rebecca J; Williams, Nancy I; Gibbs, Jenna C; Koehler, Karsten; Allaway, Heather C M; Southmayd, Emily; De Souza, Mary Jane

2016-07-01

Menstrual status, both past and current, has been established as an important determinant of bone mineral density (BMD) in young exercising women. However, little is known regarding the association between the cumulative effect of menstrual status and indices of bone health beyond BMD, such as bone geometry and estimated bone strength. This study explores the association between cumulative menstrual status and indices of bone health assessed using dual-energy x-ray absorptiometry (DXA), including femoral neck geometry and strength and areal BMD (aBMD), in exercising women. 101 exercising women (22.0±0.4years, BMI 21.0±0.2kg/m(2), 520±40min/week of self-reported exercise) participated in this cross-sectional study. Women were divided into three groups as follows based on their self-reported current and past menstrual status: 1) current and past regular menstrual cycles (C+P-R) (n=23), 2) current and past irregular menstrual cycles (C+P-IR) (n=56), 3) and current or past irregular cycles (C/P-RIR) (n=22). Current menstrual status was confirmed using daily urinary metabolites of reproductive hormones. DXA was used to assess estimates of femoral neck geometry and strength from hip strength analysis (HSA), aBMD, and body composition. Cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), strength index (SI), diameter, and section modulus (Z) were calculated at the femoral neck. Low CSMI, CSA, SI, diameter, and Z were operationally defined as values below the median. Areal BMD (g/cm(2)) and Z-scores were determined at the lumbar spine, femoral neck, and total hip. Low BMD was defined as a Z-score<-1.0. Chi-square tests and multivariable logistic regression were performed to compare the prevalence and determine the odds, respectively, of low bone geometry, strength, and aBMD among groups. Cumulative menstrual status was identified as a significant predictor of low femoral neck CSMI (p=0.005), CSA (p≤0.024), and diameter (p=0.042) after controlling for

Pertrochanteric osteotomy and distraction femoral neck lengthening for treatment of proximal hip ischemic deformities in children.

PubMed

Teplenky, Mikhail; Mekki, Waleed

2016-02-01

Proximal femoral ischemic deformities in the pediatric population is a challenging pathological situation. Many surgical techniques have been proposed to treat this problem, with variable reported results. We believe that a C-shaped pertrochanteric osteotomy plus neck lengthening utilizing distraction osteogenesis principles would restore the femoral anatomical ratios between neck, shaft, and the head, and redress the biomechanics of the proximal femur with resultant sufficient containment of the femoral head within the acetabulum. We reviewed the results of 19 patients divided into two groups with proximal femoral ischemic deformities. Between 2002 and 2009, preoperative and postoperative clinical examination and radiographs were assessed measuring the neck-shaft angle (NSA), neck-epiphyseal angle (NEA), articulo-trochanteric distance (ATD), lateralization of the greater trochanter (LT), the angle of Wiberg (CEA), index of lateral head displacement by Reimers (IM), and lateral angle of displacement (LDA). All patients were followed prospectively. Clinical outcome was assessed using Colton's criteria, which showed average good improvement in function (58.9 %). Radiological indicators were assessed using Kruczynski's criteria. For group I, the postoperative NSA, NEA, and CEA showed significant change (p < 0.01, p < 0.001, and p < 0.001, respectively). For group II, the postoperative NSA, NEA, and CEA showed significant change (p < 0.001, p < 0.001, and p < 0.001, respectively). The midterm functional results are favorable for the implementation of pertrochanteric osteotomy and distraction osteogenesis to treat proximal femoral ischemic deformities in the pediatric population.

Femoral Neck Fractures in Adults Treated With Internal Fixation: A Prospective Multicenter Chinese Cohort.

PubMed

Slobogean, Gerard P; Stockton, David J; Zeng, Bingfang; Wang, Dong; Ma, Bao-Tong; Pollak, Andrew N

2017-04-01

Although femoral neck fractures in young patients are rare and their complications are well-documented, there is a paucity of data on patient-reported outcomes for this population. The purpose of this study was to describe the quality of life and the effect of clinical complications on the outcomes of young patients with femoral neck fractures in a Chinese cohort. In this prospective observational cohort study, patients aged 18 to 55 years admitted to one of three participating trauma hospitals in China for treatment of a femoral neck fracture were recruited. The primary outcome was the patient's health-related quality of life using the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey at 1 year after injury. Associations between the primary outcome and potential predictors were explored with univariate and multivariate regression analysis. One hundred seven patients (mean age, 44 years) completed 1-year follow-up. Nearly all patients were treated with closed reduction and screw fixation. Nine cases of nonunion, 7 cases of malunion, and 11 cases of osteonecrosis were identified. The mean SF-36 Physical Component Score was 48.6 ± 8.5, and the mean Mental Component Score was 51.0 ± 7.4. Fracture displacement, quality of reduction, and nonunion were associated with a poor Physical Component Score outcome. Our results demonstrate that the quality of life for patients after closed reduction and screw fixation of femoral neck fractures is similar to that of the general population, particularly when complications of nonunion and malunion are avoided. Level I.

Successful treatment of solitary intraosseous haemangioma of the femoral neck.

PubMed

Xia, Zhan; Sittampalam, Kesavan; Howe, Tet Sen; Lo, Ngai Nung

2015-04-01

Intraosseous haemangiomas (IOHs) are benign vascular bone tumours that account for 1% of all primary bone tumours. They are most frequently seen in the vertebrae and skull, and are rarely found in long bones. Herein, we present an uncommon case of a 25-year-old woman with a solitary IOH that occupied the left femoral neck. We describe the clinical, radiological and histological details of the case, as well as the three-year outcome of the surgical treatment, which successfully preserved the femoral head. We also conducted a review of the literature on this uncommon entity.

Revision rates and cumulative financial burden in patients treated with hemiarthroplasty compared to cannulated screws after femoral neck fractures.

PubMed

Shields, Edward; Kates, Stephen L

2014-12-01

This study compares re-operation rates and financial burden following the treatment of femoral neck fractures treated with hemiarthroplasty compared to non-displaced femoral neck fractures treated with cannulated screws. Data was retrospectively analyzed from a prospective database at a university hospital setting on patients undergoing hemiarthroplasty after femoral neck fractures and those with non-displaced femoral neck fractures treated with cannulated screws over a 7-year period. Re-operation rates were determined and financial data was analyzed. Charges refer to amounts billed by the hospital to insurance carriers, while costs refer to financial burden carried by the hospital during treatment. There were 491 femoral neck fractures (475 patients) that underwent hemiarthroplasty (HA) and 120 non-displaced fractures (119 patients) treated with cannulated screw (CannS) fixation. Both groups had similar age, sex, Charlson co-morbidity scores, pre-operative Parker mobility scores, and 12-month mortality. There were 29 (5.9 %) reoperations in the HA group and 16 (13.3 %) in the CannS group (P = 0.007). The majority of re-operations occurred within 12 months for both groups [21/29 (72 %) HA group; 15/16 (94 %) CannS group; P = 0.13]. Average hospital charges per patient for the index procedure were higher in the HA group ($17,880 ± 745) compared to the CannS group ($14,104 ± 5,047; P < 0.001). After accounting for additional procedures related to their initial surgical fixation, average hospital charges and costs remained higher in the HA group. Patients treated with hemiarthroplasty for femoral neck fractures have lower re-operation rates than patients treated with cannulated screws for non-displaced femoral neck fractures, with 80 % of re-operations occurring in the first 12 months. Hospital charges and costs to the hospital for treating patients undergoing hemiarthroplasty were higher than patients treated with cannulated screws for the index procedure alone

Modular femoral neck fracture after primary total hip arthroplasty.

PubMed

Sotereanos, Nicholas G; Sauber, Timothy J; Tupis, Todd T

2013-01-01

The use of modular femoral stems in primary total hip arthroplasty has increased considerably in recent years. These modular components offer the surgeon the ability to independently alter version, offset, and length of the femoral component of a hip arthroplasty. This increases the surgeon's ability to accurately recreate the relevant anatomy but increases the possibilities of corrosion and fracture. Multiple case reports have highlighted fractures of these modular components. We present a case of a fracture of a modular design that has had no previously reported modular neck fractures. The patient was informed that data concerning the case would be submitted, and he consented. Copyright © 2013 Elsevier Inc. All rights reserved.

Factors affecting the aluminium content of human femoral head and neck.

PubMed

Zioła-Frankowska, Anetta; Dąbrowski, Mikołaj; Kubaszewski, Łukasz; Rogala, Piotr; Frankowski, Marcin

2015-11-01

Tissues for the study were obtained intraoperatively during hip replacement procedures from 96 patients. In all the cases, the indication for this treatment was primary or secondary degenerative changes in the hip joint. The subject of the study was the head and neck of the femur, resected in situ. Aluminium concentrations measured in femoral head and neck samples from patients aged between 25 and 91 were varied. Statistical methods were applied to determine the variations in relation to the parameters from the background survey. Significant differences in the aluminium content of femoral head samples were observed between patients under and over 60 years of age. Based on the results, it was confirmed that the aluminium accumulates in bones over a lifetime. The study showed that the content of aluminium in the head and neck of the femur depends on the factors such as: type of medicines taken, contact with chemicals at work, differences in body anatomy and sex. The study on the levels of aluminium in bones and the factors affecting its concentration is a valuable source of information for further research on the role of aluminium in bone diseases. Based on the investigations, it was found that the GF-AAS technique is the best analytical tool for routine analysis of aluminium in complex matrix samples. The use of femoral heads in the investigations was approved by the Bioethics Committee of the University of Medical Sciences in Poznań (Poland). Copyright © 2015 Elsevier Inc. All rights reserved.

Comparison of effects of different screw materials in the triangle fixation of femoral neck fractures.

PubMed

Gok, Kadir; Inal, Sermet; Gok, Arif; Gulbandilar, Eyyup

2017-05-01

In this study, biomechanical behaviors of three different screw materials (stainless steel, titanium and cobalt-chromium) have analyzed to fix with triangle fixation under axial loading in femoral neck fracture and which material is best has been investigated. Point cloud obtained after scanning the human femoral model with the three dimensional (3D) scanner and this point cloud has been converted to 3D femoral model by Geomagic Studio software. Femoral neck fracture was modeled by SolidWorks software for only triangle configuration and computer-aided numerical analyses of three different materials have been carried out by AnsysWorkbench finite element analysis (FEA) software. The loading, boundary conditions and material properties have prepared for FEA and Von-Misses stress values on upper and lower proximity of the femur and screws have been calculated. At the end of numerical analyses, the best advantageous screw material has calculated as titanium because it creates minimum stress at the upper and lower proximity of the fracture line.

Calcium Sulphate/Hydroxyapatite Carrier for Bone Formation in the Femoral Neck of Osteoporotic Rats.

PubMed

Sirka, Aurimas; Raina, Deepak Bushan; Isaksson, Hanna; Tanner, K Elizabeth; Smailys, Alfredas; Kumar, Ashok; Tarasevicius, Sarunas; Tägil, Magnus; Lidgren, Lars

2018-06-01

We investigated bone regeneration in the femoral neck canal of osteoporotic rats using a novel animal model. We used a calcium sulphate (CS)/ Hydroxyapatite (HA) carrier to locally deliver a bisphosphonate, zoledronic acid (ZA), with or without added recombinant human bone morphogenic protein-2 (rhBMP-2). Ovariectomized Sprague-Dawley rats of 28 weeks age were used. A 1 mm diameter and 8 mm long defect was created in the femoral neck by drilling from the lateral cortex in the axis of the femoral neck leaving the surrounding cortex intact. Three treatment groups and one control group were used 1) CS/HA alone, 2) CS/HA+ ZA (10 μg) 3) CS/HA+ZA (10 μg)+rhBMP-2 (4 μg) and 4) Empty defect. The bone formation was assessed at 4 weeks post-surgery using in vivo micro computed tomography (micro-CT). At 8 weeks post-surgery, the animals were sacrificed and both defect and contralateral femurs were subjected to micro-CT, mechanical testing and histology. Micro-CT results showed that the combination of CS/HA with ZA or ZA+rhBMP-2 increased the bone formation in the defect when compared to the other groups and to the contralateral hips. Evidence of new dense bone formation in CS/HA+ZA and CS/HA+ZA+rhBMP-2 groups was seen histologically. Mechanical testing results showed no differences in the load to fracture between the treatments in either of the treated or contralateral legs. The CS/HA biomaterial can be used as a carrier for ZA and rhBMP-2 to regenerate bone in the femoral neck canal of osteoporotic rats.

Neck fracture of a cementless forged titanium alloy femoral stem following total hip arthroplasty: a case report and review of the literature

PubMed Central

Grivas, Theodoros B; Savvidou, Olga D; Psarakis, Spyridon A; Bernard, Pierre-Francois; Triantafyllopoulos, George; Kovanis, Ioannis; Alexandropoulos, Panagiotis

2007-01-01

Introduction Fractures of the neck of the femoral component have been reported in uncemented total hip replacements, however, to our knowledge, no fractures of the neck of a cementless forged titanium alloy femoral stem coated in the proximal third with hydroxy-apatite have been reported in the medical literature. Case presentation This case report describes a fracture of the neck of a cementless forged titanium alloy stem coated in the proximal third with hydroxy-apatite. Conclusion The neck of the femoral stem failed from fatigue probably because of a combination of factors described analytically below. PMID:18062807

Sub-Trochanteric Hip Fracture Following Core Decompression for Osteonecrosis in a Patient with a Pre-Existing Contralateral Occult Femoral Neck Fracture.

PubMed

Berger, Ryan J; Sultan, Assem A; Cole, Connor; Sodhi, Nipun; Khlopas, Anton; Mont, Michael A

2018-06-01

We present a unique case of a 62-year-old patient with bilateral osteonecrosis of the femoral heads secondary to corticosteroid use. She presented with an occult right femoral neck fracture and was treated with percutaneous pinning of the right femoral neck and a left-sided percutaneous drilling. Despite apparent appropriate technique, the patient sustained a left sub-trochanteric hip fracture while shifting in bed in the postoperative care unit and was taken back for cephalo-medullary nail fixation. Femoral head osteonecrosis may be an under-reported risk factor for development of pathological neck fractures. We present an overview of this topic along with suggestions for joint preservation treatment of similar patients at higher risk for perioperative fracture.

Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

PubMed

Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

2008-03-01

Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

Percutaneously drilling through femoral head and neck fenestration combining with compacted autograft for early femoral head necrosis: A retrospective study.

PubMed

Li, Donghai; Xie, Xiaowei; Kang, Pengde; Shen, Bin; Pei, Fuxing; Wang, Changde

2017-11-01

The purpose of this study was to evaluate the clinical results, survivorship and quick rehabilitation effects of modified surgery of percutaneously drilling and decompression through femoral head and neck fenestration combined with compacted autograft for early femoral head necrosis. We conducted a retrospective cohort study with 83 hips performed percutaneous decompression through femoral head and neck fenestration (Modified group) combined with autogenous bone grafting for early ONFH. For comparison, another 90 hips treated with conventional core decompression with bone grafting (Control group). Median follow-up was 36 months (32-44 months). The length of incision, blood loss in operation, incision drainage, operation time and hospital stays in Modified group had better results than those in control group (P < 0.001). There were four cases in Modified group and five cases in control group had complications (P = 0.9). The VAS score and range of hip motion were better in Modified group during hospital stays summarily (P < 0.05). The average Harris score in modified group was higher than the control group at the first month (P = 0.005), while at other time of follow-up the two groups were with similar Harris scores (P > 0.05). There were 22 hips progressed to stage III in Modified group, while 23 hips progressed to stage III in control group (P = 0.89). The clinical success rate in Modified group were 86.7%, compared with that in control group (87.8%) ( P= 0.84). Percutaneous drilling and decompression through femoral head and neck fenestration combined with compacted autograft we reported showed an good surgical effect with a quick rehabilitation and had similar short-term effects compared with the conventional core decompression in treatment of early ONFH. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Combined with Bone Marrow-Derived Cells and rhBMP-2 for Osteonecrosis after Femoral Neck Fractures in Children and Adolescents: A case series

PubMed Central

Gao, Fuqiang; Sun, Wei; Guo, Wanshou; Wang, Bailiang; Cheng, Liming; Li, Zirong

2016-01-01

Osteonecrosis of the femoral head (ONFH) following femoral neck fractures is a rare, yet severe, disorder in children and adolescents. This study evaluated the effectiveness of core decompression (CD) combined with implantation of bone marrow–derived cells (BMDC) and rhBMP-2 for osteonecrosis of femoral head (ONFH) after femoral neck fractures in children and adolescents. This study included 51 patients, aged 11.4–18.1 years, with ARCO stages I–III ONFH after femoral neck fractures between 2004 and 2010. The hips were divided into two groups based on whether the lateral pillar of the femoral head (LPFH) was preserved: LPFH and non-LPFH groups. All patients were followed up clinically and radiographically for a minimum of 5 years. 44 patients (86.3%) had improved clinical outcome. Radiologically, 9 of the 51 hips (17.6%) exhibited collapse onset or progression of the femoral head or narrowing of the hip joint space, and one patient in the non-LPFH group required hip arthroplasty due to the worsened syndrome. The technique provided an effective therapeutic option for children and adolescents with ONFH following femoral neck fractures. It relieves hip pain and prevents the progression of osteonecrosis in young patients lasting more than 5 years after surgery. PMID:27477836

Bilateral insufficiency fracture of the femoral head and neck in a case of oncogenic osteomalacia.

PubMed

Chouhan, V; Agrawal, K; Vinothkumar, T K; Mathesul, A

2010-07-01

We describe a case of oncogenic osteomalacia in an adult male who presented with low back pain and bilateral hip pain. Extensive investigations had failed to find a cause. A plain pelvic radiograph showed Looser's zones in both femoral necks. MRI confirmed the presence of insufficiency fractures bilaterally in the femoral head and neck. Biochemical investigations confirmed osteomalacia which was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphataemic osteomalacia. The level of fibroblast growth factor-23 was highly raised, indicating the cause as oncogenic osteomalacia. This was confirmed on positron-emission tomography, MRI and excision of a benign fibrous histiocytoma following a rapid recovery. The diagnosis of oncogenic osteomalacia may be delayed due to the non-specific presenting symptoms. Subchondral insufficiency fractures of the femoral head may be missed unless specifically looked for.

[Evaluation of visual functions in elderly patients with femoral neck fracture].

PubMed

Oner, Mithat; Oner, Ayşe; Güney, Ahmet; Halici, Mehmet; Arda, Hatice; Bilal, Okkeş

2009-01-01

We aimed at assessing the visual functions in elderly patients with femoral neck fracture and to compare the results with age-matched controls in this three-year prospective study. Seventy-one patients with a history of fall related hip fracture (39 females, 32 males; mean age 76.3+/-9.7 years; range 64 to 90 years) and who were diagnosed with femoral neck fracture after direct graphy were treated by means of bipolar partial prosthesis and they were contacted postoperatively or prior to discharge to participate in the study. Visual acuity, depth perception, the presence of cataract in the red reflex were evaluated. A dilated fundus and slit-lamp examination were performed if possible. On completion of the examination, the ophthalmologist documented the causes of any visual impairment found. Control group was comprised of age-matched 40 subjects (22 females, 18 males; mean age 73.2+/-7.6 years; range 62 to 90 years) who applied to ophtalmology clinic for routine examination. The visual acuity was significantly decreased in the patient group as was stereopsis (p<0.05). We found no difference between the study group and the controls when we evaluate the distribution of self reported eye disease and eye disease found on ocular examination. The rate of cases who reported not usually wearing glasses was 35% while it was 5% in the control group. When we evaluate the time since last examination, 38% of cases had not had an eye examination for over four years, as compared with 22.5% of controls. This study shows that elderly people should have their eyes tested at least once every two years, refractive errors should be corrected and eye diseases should be treated to decrease the risk of fall-related femoral neck fractures.

DXA and pQCT predict pertrochanteric and not femoral neck fracture load in a human side-impact fracture model.

PubMed

Gebauer, Matthias; Stark, Olaf; Vettorazzi, Eik; Grifka, Joachim; Püschel, Klaus; Amling, Michael; Beckmann, Johannes

2014-01-01

The validity of dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) measurements as predictors of pertrochanteric and femoral neck fracture loads was compared in an experimental simulation of a fall on the greater trochanter. 65 proximal femora were harvested from patients at autopsy. All specimens were scanned with use of DXA for areal bone mineral density and pQCT for volumetric densities at selected sites of the proximal femur. A three-point bending test simulating a side-impact was performed to determine fracture load and resulted in 16 femoral neck and 49 pertrochanteric fractures. Regression analysis revealed that DXA BMD trochanter was the best variable at predicting fracture load of pertrochanteric fractures with an adjusted R(2) of 0.824 (p < 0.0001). There was no correlation between densitometric parameters and the fracture load of femoral neck fractures. A significant correlation further was found between body weight, height, femoral head diameter, and neck length on the one side and fracture load on the other side, irrespective of the fracture type. Clinically, the DXA BMD trochanter should be favored and integrated routinely as well as biometric and geometric parameters, particularly in elderly people with known osteoporosis at risk for falls. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

PubMed Central

Baksi, D D; Pal, A K; Baksi, D P

2016-01-01

Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG) were excluded. Thus, out of 244 patients, 208 (85.3%) untreated nonunion and 36 (14.7%) following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN) femoral head was found histologically in 135 (54.3%) and radiologically in 48 (19.7%) patients. The patients were operated by open reduction of fracture, cannulated hip

Adverse Local Tissue Reaction Arising from Corrosion at the Femoral Neck-Body Junction in a Dual-Taper Stem with a Cobalt-Chromium Modular Neck

PubMed Central

Cooper, H. John; Urban, Robert M.; Wixson, Richard L.; Meneghini, R. Michael; Jacobs, Joshua J.

2013-01-01

Background: Femoral stems with dual-taper modularity were introduced to allow additional options for hip-center restoration independent of femoral fixation in total hip arthroplasty. Despite the increasing availability and use of these femoral stems, concerns exist about potential complications arising from the modular neck-body junction. Methods: This was a multicenter retrospective case series of twelve hips (eleven patients) with adverse local tissue reactions secondary to corrosion at the modular neck-body junction. The cohort included eight women and three men who together had an average age of 60.1 years (range, forty-three to seventy-seven years); all hips were implanted with a titanium-alloy stem and cobalt-chromium-alloy neck. Patients presented with new-onset and increasing pain at a mean of 7.9 months (range, five to thirteen months) following total hip arthroplasty. After serum metal-ion studies and metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) revealed abnormal results, the patients underwent hip revision at a mean of 15.2 months (range, ten to twenty-three months). Tissue specimens were examined by a single histopathologist, and the retrieved implants were studied with use of light and scanning electron microscopy. Results: Serum metal levels demonstrated greater elevation of cobalt (mean, 6.0 ng/mL) than chromium (mean, 0.6 ng/mL) or titanium (mean, 3.4 ng/mL). MRI with use of MARS demonstrated adverse tissue reactions in eight of nine patients in which it was performed. All hips showed large soft-tissue masses and surrounding tissue damage with visible corrosion at the modular femoral neck-body junction. Available histology demonstrated large areas of tissue necrosis in seven of ten cases, while remaining viable capsular tissue showed a dense lymphocytic infiltrate. Microscopic analysis was consistent with fretting and crevice corrosion at the modular neck-body interface. Conclusions: Corrosion at the modular neck

Outcomes following surgical management of femoral neck fractures in elderly dialysis-dependent patients.

PubMed

Puvanesarajah, Varun; Amin, Raj; Qureshi, Rabia; Shafiq, Babar; Stein, Ben; Hassanzadeh, Hamid; Yarboro, Seth

2018-06-01

Proximal femur fractures are one of the most common fractures observed in dialysis-dependent patients. Given the large comorbidity burden present in this patient population, more information is needed regarding post-operative outcomes. The goal of this study was to assess morbidity and mortality following operative fixation of femoral neck fractures in the dialysis-dependent elderly. The full set of medicare data from 2005 to 2014 was retrospectively analyzed. Elderly patients with femoral neck fractures were selected. Patients were stratified based on dialysis dependence. Post-operative morbidity and mortality outcomes were compared between the two populations. Adjusted odds were calculated to determine the effect of dialysis dependence on outcomes. A total of 320,629 patients met the inclusion criteria. Of dialysis-dependent patients, 1504 patients underwent internal fixation and 2662 underwent arthroplasty. For both surgical cohorts, dialysis dependence was found to be associated with at least 1.9 times greater odds of mortality within 1 and 2 years post-operatively. Blood transfusions within 90 days and infections within 2 years were significantly increased in the dialysis-dependent study cohort. Dialysis dependence alone did not contribute to increased mechanical failure or major medical complications. Regardless of the surgery performed, dialysis dependence is a significant risk factor for major post-surgical morbidity and mortality after operative treatment of femoral neck fractures in this population. Increased mechanical failure in the internal fixation group was not observed. The increased risk associated with caring for this population should be understood when considering surgical intervention and counseling patients.

Modified Pauwels' intertrochanteric osteotomy in neglected femoral neck fractures in children: a report of 10 cases followed for a minimum of 5 years.

PubMed

Magu, Narender Kumar; Singh, Roop; Sharma, Ashwini Kumar; Ummat, Vikas

2007-04-01

To evaluate the role of a modified Pauwels' intertrochanteric osteotomy (MPIO) in neglected femoral neck fractures in children. Prospective study with retrospective analysis. Tertiary care Postgraduate Institute of Medical Sciences. Ten children (8 males, 2 females) with an average age of 10.2 years with neglected femoral neck fractures were seen from 1990 to 1998. A femoral neck fracture was considered neglected when no proper medical treatment was instituted for at least 1 month following the fracture. Nonunion was accompanied by coxa vara and resorption of the femoral neck in 9 patients; a 10th patient had a neglected femoral neck fracture for 1 month without coxa vara. Three patients at time of presentation with Delbet Type II displaced fractures with associated nonunion and coxa vara (2 with Ratliff Type III and 1 with Type I) also had avascular necrosis using plain radiographic criteria of increased density. Modified Pauwels' intertrochanteric osteotomy. The children were immobilized in a hip spica for 6-10 weeks postoperatively and weightbearing was started after hip spica removal. Fracture healing, neck-shaft angle, avascular necrosis, and functional outcome. Patients were followed for an average of 8.2 years (range 5-12 years). All patients had union of their fracture within an average of 16.6 weeks (12-20 weeks) and of the osteotomy site within 8.2 weeks (7-9 weeks). Radiologic signs of avascular necrosis disappeared completely in the 3 patients who presented with avascular necrosis. In 1 patient with a preoperatively viable femoral head, radiologic signs of Ratliff Type I avascular necrosis appeared between 60 and 98 weeks. This radiologic finding became normal again, indicating viability of the femoral head somewhere between 98 to 205 weeks of follow-up. Postoperatively, an average of 135-degree neck-shaft angle was achieved (range 125-160 degrees). The average preoperative neck-shaft angle was 104.4 degrees (range 92-120 degrees) and on the normal hip

An orthopedic surgeon survey on the treatment of displaced femoral neck fracture: opposing views

PubMed Central

Chua, David; Jaglal, Susan B.; Schatzker, Joseph

1997-01-01

Objective To examine the reasons for practice variation in the treatment of displaced femoral neck fractures. Design A survey, asking surgeons to choose either hemiarthroplasty or internal fixation for 2 different female patients with a displaced femoral neck fracture. Setting The Canadian Orthopaedic Association Meeting, Halifax, May 1995. Patients The scenario in the first patient was of an independent 70-year-old woman with no pre-existing medical conditions. The scenario in the second patient was of a housebound 84-year-old woman with co-morbidity. Main outcome measures Proportion of surgeons choosing either hemiarthroplasty or internal fixation for each case scenario. Distribution of reasons to explain the treatment decision. Results Ninety-nine surgeons responded. For the case of the 70-year-old woman, 47% chose hemiarthroplasty and 53% chose internal fixation (p = 0.60), and for the 84-year-old woman, 96% chose hemiarthroplasty. These findings were consistent within the subgroups of teaching surgeons and community practice surgeons. Surgeons with 10 years or less of practice tended to favour hemiarthroplasty whereas those with more than 15 years’ practice favoured internal fixation. Important reasons for treatment choice were avoidance of reoperation in the hemiarthroplasty group (85%) and better hip function in the fixation group (83%), durability (83%) and ease of revision (77%). Conclusion The surgeon’s interpretation of the importance of reoperation and function underlies the differences in treatment decision regarding the management of femoral neck fractures in elderly patients. PMID:9267295

Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck.

PubMed

Jenkins, Thomas; Coutts, Louise V; D'Angelo, Stefania; Dunlop, Douglas G; Oreffo, Richard O C; Cooper, Cyrus; Harvey, Nicholas C; Thurner, Phillipp J

2016-01-01

In contrast to traditional approaches to fracture risk assessment using clinical risk factors and bone mineral density (BMD), a new technique, reference point microindentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery after low-trauma hip fracture (n = 46; 17 male; aged 83 [interquartile range 77-87] years) and compared, using RPI (Biodent Hfc), with 16 cadaveric control samples, free from bone disease (7 male; aged 65 [IQR 61-74] years). A subset of fracture patients returned for dual-energy X-ray absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p < 0.001), which persisted with adjustment for age, sex, body mass index (BMI), and height (p < 0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using receiver-operating characteristic (ROC) analyses (area under the curve [AUC] = 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC = 0.88 to 0.99). In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck. © 2015 American Society for Bone and Mineral

Sex-Specific Genetic Loci for Femoral Neck Bone Mass and Strength Identified in Inbred COP and DA Rats

PubMed Central

Alam, Imranul; Sun, Qiwei; Liu, Lixiang; Koller, Daniel L; Carr, Lucinda G; Econs, Michael J; Foroud, Tatiana; Turner, Charles H

2008-01-01

Introduction Hip fracture is the most devastating osteoporotic fracture type with significant morbidity and mortality. Several studies in humans identified chromosomal regions linked to hip size and bone mass. Animal models, particularly the inbred rat, serve as complementary approaches for studying the genetic influence on hip fragility. The purpose of this study is to identify sex-independent and sex-specific quantitative trait loci (QTLs) for femoral neck density, structure, and strength in inbred Copenhagen 2331 (COP) and Dark Agouti (DA) rats. Materials and Methods A total of 828 (405 males and 423 females) F2 progeny derived from the inbred COP and DA strains of rats were phenotyped for femoral neck volumetric BMD (vBMD), cross-sectional area, polar moment of inertia (Ip), neck width, ultimate force, and energy to break. A whole genome screen was performed using 93 microsatellite markers with an average intermarker distance of 20 cM. Recombination-based marker maps were generated using MAPMAKER/EXP from the COP × DA F2 data and compared with published Rat Genome Database (RGD) maps. These maps were used for genome-wide linkage analyses to detect sex-independent and sex-specific QTLs. Results Significant evidence of linkage (p < 0.01) for sex-independent QTLs were detected for (1) femoral neck vBMD on chromosomes (Chrs) 1, 6, 10, and 12, (2) femoral neck structure on Chrs 5, 7, 10, and 18, and (3) biomechanical properties on Chrs 1 and 4. Male-specific QTLs were discovered on Chrs 2, 9, and 18 for total vBMD, on Chr 17 for trabecular vBMD, on Chr 9 for total bone area, and on Chr 15 for ultimate force. A female-specific QTL was discovered on Chr 2 for ultimate force. The effect size of the individual QTL varied between 1% and 4%. Conclusions We detected evidence that sex-independent and sex-specific QTLs contribute to hip fragility in the inbred rat. Several QTLs regions identified in this study are homologous to human chromosomal regions previously linked to

Effect of rivaroxaban on preventing deep vein thrombosis in aged diabetics with femoral neck fractures after hip replacement

PubMed Central

Jiang, Xin; Sun, Yan-Shan

2017-01-01

The present study estimates the effect of rivaroxaban on preventing deep vein thrombosis (DVT) in aged diabetics with femoral neck fractures after hip replacement. Our study consisted of 236 aged diabetics with femoral neck fractures, which were divided into the rivaroxaban and control groups. Reaction time (R time), clot formation time (K time), α angle (α), maximum amplitude (MA), clot elasticity (G) and coagulation index (CI), prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured. DVT was diagnosed by color duplex Doppler ultrasound (CDDU). The risk factors of DVT were analysed by logistic regression analysis. Compared with the control group, in the rivaroxaban group, R time and K time were extended and α, MA and G decreased 1 day before operation. One day after operation, the rivaroxaban group had less PT and APPT and lower incidence of DVT than the control group. In the two groups, preoperative and postoperative PT and APPT significantly differed. Body mass index (BMI) ≥25, abnormal coagulation indicators, use of cemented femoral hip prosthesis, high haemoglobin content and non-ankle pump exercise after operation were the risk factors for DVT. Rivaroxaban could prevent DVT in aged diabetics with femoral neck fractures after hip replacement. PMID:28442600

Analysis of mechanical strength to fixing the femoral neck fracture in synthetic bone type Asnis

PubMed Central

Freitas, Anderson; Lula, Welder Fernandes; de Oliveira, Jonathan Sampaio; Maciel, Rafael Almeida; Souto, Diogo Ranier de Macedo; Godinho, Patrick Fernandes

2014-01-01

OBJECTIVE: To analyze the results of biomechanical assays of fixation of Pauwels type III femoral neck fracture in synthetic bone, using 7.5mm cannulated screws in inverted triangle formation, in relation to the control group. METHODS: Ten synthetic bones were used, from a domestic brand, divided into two groups: test and control. In the test group, a 70° tilt osteotomy of the femoral neck was fixated using three cannulated screws in inverted triangle formation. The resistance of this fixation and its rotational deviation were analyzed at 5mm displacement (phase 1) and 10mm displacement (phase 2). The control group was tested in its integrity until the fracture of the femoral neck occurred. The Mann-Whitney test was used for group analysis and comparison. RESULTS: The values in the test group in phase 1, in samples 1-5, showed a mean of 579N and SD =77N. Rotational deviations showed a mean of 3.33°, SD = 2.63°. In phase 2, the mean was 696N and SD =106N. The values of the maximum load in the control group had a mean of 1329N and SD=177N. CONCLUSION: The analysis of mechanical strength between the groups determined a statistically significant lower value in the test group. Level of Evidence III, Control Case. PMID:25246851

The effects of femoral neck cut, cable tension, and muscles forces on the greater trochanter fixation.

PubMed

Petit, Yvan; Cloutier, Luc P; Duke, Kajsa; Laflamme, G Yves

2012-04-01

Greater trochanter (GT) stabilization techniques following a fracture or an osteotomy are still showing high levels of postoperative complications. Understanding the effect of femoral neck cut placement, cable tension and muscles forces on GT fragment displacements could help surgeons optimize their techniques. A 3D finite element model has been developed to evaluate, through a statistical experimental design, the impact of the above variables on the GT fragment gap and sliding displacements. Muscles forces were simulating typical daily activities. Stresses were also investigated. The femoral neck cut placement had the most significant effect on the fragment displacement. Lowering it by 5 mm increased the gap and sliding fragment displacements by 288 and 128 %, respectively. Excessive cable tightening provided no significant reduction in fragment displacement. Muscle activities increased the gap and the sliding displacements for all muscle configurations. The maximum total displacement of 0.41 mm was present with a 10 mm femoral neck cut, a cable tension of 178 N, and stair climbing. Caution must be used not to over tighten the cables as the potential damage caused by the increased stress is more significant than any reduction in fragment displacement. Furthermore, preservation of the contact area is important for GT stabilization.

Lateral X-ray for proximal femoral fractures - Is it really necessary?

PubMed

Riaz, Osman; Nisar, Sohail; Arshad, Rizwan; Vanker, Raees

2016-10-01

Historically routine work up of a patient with a proximal femoral fracture always included anterior-posterior (AP) and a lateral film of the hip. The aim was to define the role of the lateral X-ray in the assessment and surgical planning of proximal femur fractures. Radiographs of 320 consecutive patients with proximal femoral fractures who were admitted over a 12 months period were divided into lateral and AP views. Two blinded reviewers independently assessed the AP view alone and then the AP plus the lateral view. Fracture classification was noted for each X-ray and then compared with intraoperative diagnosis which was our study's gold standard. A 2 × 2 contingency square table and Pearson's x(2) test were used for statistical analysis. The rate of correct classification by the reviewers enhanced by the assessment of the lateral X-ray in addition to the AP view for intracapsular fractures (p = 0.018) but not for extracapsular fractures (p = 0.29). Operative management did not change for intracapsular fractures which appeared displaced on initial AP view after reviewing the lateral X-ray. The only advantage of obtaining a lateral view in intracapsular fracture was the detection of displacement were the fracture appeared to be undisplaced on initial AP view. This study provides statistical evidence that one view is adequate and safe for majority of proximal femoral fractures. The lateral radiograph should not be performed on a routine basis thus making considerable saving in time and money, and avoiding unnecessary radiation exposure and discomfort to the patient. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

[Pathological fractures of the femoral neck in hemodialyzed patients. Apropos of 26 cases].

PubMed

Hardy, P; Benoit, J; Donneaud, B; Jehanno, P; Lortat-Jacob, A

1994-01-01

This study is based on a retrospective analysis of 26 pathological fractures of the femoral neck in 19 chronic haemodialysis patients. The purpose of this study is to analyze the epidemiological and etiological factors of these fractures in relation to osteo-arthropathy of the dialyzed patient, as well as the results of various treatments, both curative and preventive. 26 pathological fractures of the femoral neck appeared in 19 chronic haemodialysis patients, 11 men and 8 women, 6 patients presented bilateral fractures. The patient's average age at the time of the fracture was 61 years (27 to 82). The average duration of dialysis was 11 years with a minimum of 2 years and a maximum of 21 years. Hyper parathyroidism was found in 14 patients, aluminic intoxication in 6 and amyloidosis at the level of the coxo-femoral joint 18 times. Surgical treatment consisted of 6 osteosynthesis, 2 cephalic arthroplasties, 13 modular arthroplasties and 5 total hip arthroplasties. For each case, we studied the presence of necrosis of the femoral neck due to aluminic intoxication, osteoporosis due to hyperparathyroidism and also the presence of amyloidosis without aluminic intoxication. Cortisonic necrosis and porosis was found 4 times out of 26 cases, hyperparathyroidism once, aluminic osteomalacy 3 times and beta-2-microglobulin amyloid 18 times. Amyloidosis remains the most frequent etiological factor. All patients had been operated for median nerve compression in the carpal tunnel, usually 2.5 years before appearance of the pathological fracture. Non surgical treatment was used 5 times in undisplaced fractures without any sign of amyloidosis and was successful 3 times and unsuccessful twice necessitating a new operation by osteosynthesis. Out of 6 osteosynthesis performed for fractures either with little or no displacement we observed 4 failures, all of them in the cases with intra-osseous amyloidosis. Best results were obtained by arthroplasties. Modular arthroplasty has given

Early mortality and morbidity after total hip arthroplasty in patients with femoral neck fracture

PubMed Central

Hailer, Nils P; Garland, Anne; Rogmark, Cecilia; Garellick, Göran; Kärrholm, Johan

2016-01-01

Background and purpose — Early postoperative mortality is relatively high after total hip arthroplasty (THA) that has been performed due to femoral neck fracture. However, this has rarely been investigated after adjustment for medical comorbidity and comparison with the mortality in an age-matched population. We therefore assessed early mortality in hip fracture patients treated with a THA, in the setting of a nationwide matched cohort study. Patients and methods — 24,699 patients who underwent THA due to a femoral neck fracture between 1992 and 2012 were matched with 118,518 controls. Kaplan-Meier survival analysis was used to calculate cumulative unadjusted survival, and Cox regression models were fitted to compute hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for age, sex, comorbidity, and socioeconomic background. Results — 90-day survival was 96.3% (95% CI: 96.0–96.5) for THA cases and 98.7% (95% CI: 98.6–98.8) for control individuals, giving an adjusted HR of 2.2 (95% CI: 2.0–2.4) for THA cases compared to control individuals. Comorbidity burden increased in THA cases over time, but the adjusted risk of death within 90 days did not differ statistically significantly between the time periods investigated (1992–1998, 1999–2005, and 2006–2012). A Charlson comorbidity index of 3 or more, an American Society of Anesthesiologists (ASA) grade of 3 and above, male sex, an age of 80 years and above, an income below the first quartile, and a lower level of education were all associated with an increased risk of 90-day mortality. Interpretation — The adjusted early mortality in femoral neck fracture patients who underwent THA was about double that in a matched control population. Patients with femoral neck fracture but with no substantial comorbidity and an age of less than 80 years appear to have a low risk of early death. Patients older than 80 years and those with a Charlson comorbidity index of more than 2 have a high

Study of bone mineral density in lumbar spine and femoral neck in a Spanish population. Multicentre Research Project on Osteoporosis.

PubMed

Diaz Curiel, M; Carrasco de la Peña, J L; Honorato Perez, J; Perez Cano, R; Rapado, A; Ruiz Martinez, I

1997-01-01

The aim of this study was to generate standard curves for bone mineral density (BMD) in a Spanish population using dual-energy X-ray absorptiometry (DXA), at both lumbar spine and femoral neck sites. The total sample size was 2442 subjects of both sexes aged 20-80 years, stratified according to survival rates, demographic distribution by local regions and sex ratio in the Spanish population. Subjects with suspected conditions affecting bone metabolism or receiving any treatment affecting bone mineralization were excluded. The study was carried out in 14 hospitals and bone density measurements were performed, using a QDR/ 1000 Hologic device. In the female population, the highest value for lumbar spine BMD was found within the 30-39 years age group, being significantly lower after the age of 49 years. In the male population, the highest values for lumbar spine BMD are found one decade earlier than in the female population and become significantly lower after the age of 69 years. The highest values for femoral neck BMD in men and women was found in the 20-29 year age group. Values for femoral neck BMD in the female population become statistically lower after the age of 49 years, while in the male population this effect was seen after the age of 69 years. Values for femoral neck BMD were higher in men than women at all ages.

Simultaneous Bilateral Femur Neck Fracture in A Young Adult with Chronic Renal Failure- A Case Report and Review of Literature.

PubMed

V, Sathyanarayana; Patel, Maulik Tulsibhai; S, Raghavan; D, Naresh

2015-01-01

Pathological bilateral femoral neck fracture due to renal osteodystrophy is rare. This is a report of a chronic renal failure patient who had sustained bilateral intra-capsular displaced fracture neck of femur following an episode of convulsion and the difficulties encountered in early diagnosis and treatment. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure are also discussed. A 23 years old male patient admitted with h/o dysuria, pyuria and loss of appetite since 3 months. He was a known case of chronic renal failure and reflux nephropathy. On investigating, patient's renal parameters were high and he was started with haemodialysis. The next day patient had c/o bilateral hip pain and inability to move bilateral lower limbs following an episode of seizure. Radiograph of pelvis showed vertical sub capital fractures of bilateral neck of femur. In this patient, considering his age, general condition & prognosis, an elective surgery in the form of bilateral uncemented modular bipolar hemiarthroplasty was done. Overall risk of hip fracture among patients with chronic renal failure is considerably higher than in the general population, independent of age and gender. Simultaneous spontaneous bilateral fractures of the femoral neck are rare and a delayed diagnosis is usual. The study of etiological factors of these fractures is essential to guide us in choosing the treatment of choice. Obviously patient's age, life expectancy as well as renal co morbidity has an influence over deciding treatment and outcome.

HEMIARTHROPLASTY IN THE TREATMENT FRACTURES OF THE FEMORAL NECK

PubMed Central

Ono, Nelson Keiske; de Andrade Lima, Guilherme Didier; Honda, Emerson Kiyoshi; Polesello, Giancarlo Cavalli; Guimarães, Rodrigo Pereira; Júnior, Walter Ricioli; de Queiroz, Marcelo Cavalheiro

2015-01-01

Objective: To epidemiologically and clinically evaluate patients with displaced femoral neck fractures that were surgically treatment with cemented hip hemiarthroplasty. Methods: All patients with displaced femoral neck fractures (Garden III and IV) who underwent cemented hip hemiarthroplasty using a unipolar prosthesis (Thompson), by means of a posterolateral access between June 2005 and September 2008 were retrospectively evaluated. Results: Seventy patients were initially evaluated. Their mean age was 83.1 years. The patients were predominantly female (84.3%). Thirty-six patients were monitored as outpatients for periods ranging from 10 to 48 months (mean of 26.5 months). Fifteen patients were lost to follow-up. Nineteen patients died, and the mortality rate within the first year was 25.4%. Patients classified as ASA III had a mortality rate of 25.7% and ASA II patients, a rate of 12.1%. Two patients had symptomatic deep vein thrombosis; one patient had an operative wound infection; and none of the patients presented hip dislocation. Most of the patients did not experience pain. Twelve patients (33%) showed deterioration of their walking ability. Conclusion: There were no cases of hip dislocation. Patients classified as ASA III had a higher mortality rate than did patients with ASA I or II. There was a worsening of walking ability in 33% of the patients. No revision due to loosening or pain was needed for any patient. Thirty patients did not present any pain (83.3%), four presented moderate pain (11.1%) and two presented intense pain (5.5%). PMID:27022567

Postoperative stroke after hemiarthroplasty for femoral neck fracture: a report of 2 cases and review of literature.

PubMed

Ding, David Yi; Christoforou, Dimitrios; Turner, Garth; Tejwani, Nirmal C

2014-06-01

Femoral neck fractures in the elderly comprise a significant number of orthopedic surgical cases at a major trauma center. These patients are immediately incapacitated, and surgical fixation can help increase mobility, restore independence, and reduce morbidity and mortality. However, operative treatment carries its own inherent risks including infections, deep vein thromboses, and intraoperative cardiovascular collapse. Cerebrovascular stroke is a relatively uncommon occurrence after hip fractures. We present 2 cases with unusual postoperative medical complication after cemented hip hemiarthroplasty for femoral neck fracture that will serve to illustrate an infrequent but very serious complication. Case 1 was a 73-year-old man with a Garden IV femoral neck fracture who underwent a right hip unipolar cemented hemiarthroplasty under general anesthesia. After uneventful surgery, he developed neurological deficits, and a postoperative noncontrast head computed tomography showed a right medial thalamic infarct. Case 2 was an 82-year-old man with a Garden IV femoral neck fracture who underwent a right hip unipolar cemented hemiarthroplasty under general anesthesia. After uneventful surgery, the patient became hemodynamically unstable. A postoperative noncontrast head computed tomography showed a large evolving left middle cerebral artery stroke. General anesthesia in the setting of decreased cardiac function (decreased ejection fraction and output) carries the risk for ischemic injury to the brain from decreased cerebral perfusion. Risk factors including advanced age, history of coronary artery disease, atherosclerotic disease, and atrial fibrillation increase the risk for perioperative stroke. Furthermore, it is known that during the cementing of implants, microemboli can be released, which must be considered in patients with preoperative heart disease. As a result, consideration of using a noncemented implant or cementing without pressurizing in this clinical scenario

The application of PRP combined with TCP in repairing avascular necrosis of the femoral head after femoral neck fracture in rabbit.

PubMed

Zhang, X-L; Wang, Y-M; Chu, K; Wang, Z-H; Liu, Y-H; Jiang, L-H; Chen, X; Zhou, Z-Y; Yin, G

2018-02-01

In view of the high occurrence of avascular necrosis of the femoral head (ANFH) after femoral neck fracture and the difficulties in the treatment, our work aimed to explore the effects of platelet-rich plasma (PRP) combined with tri-calcium phosphate (TCP) on the repair of ANFH after femoral neck fracture and to provide reference for clinical treatment. Thirty New Zealand white rabbits were randomly divided into control group, TCP group, and PRP+TCP group. The rabbit ANFH model was established and femoral head tissues were collected. HE staining was used for histological observation. Image analysis and statistical analysis were used to calculate the New Bone Area fraction (NBA %). The levels of bone morphogenetic protein (BMP)-7, transforming growth factor (TGF)-β1, basic fibroblast growth factor (bFGF), interleukin (IL)-6 and tumor necrosis factor (TNF)-a in serum were detected by Enzyme-Linked ImmunoSorbent Assay (ELISA). The new bone area of TCP group was significantly lower than that of PRP+TCP group (p<0.05). Compared with the control group, the levels of BMP-7, TGF-β1 and bFGF were significantly increased in both TCP and PRP+TCP groups (p<0.05), and the increase in PRP+TCP group was higher than that in TCP group. TCP and PRP+TCP can both significantly reduce the content of IL-6 and TNF-a (p<0.05); however, higher decrease was found in PRP+TCP group compared with the TCP group at 8 weeks after injection. PRP combined with TCP, which can promote new bone formation and inhibit inflammatory response, showed higher efficiency in repairing ANFH than internal fixation alone.

Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture.

PubMed Central

Goode, H. F.; Burns, E.; Walker, B. E.

1992-01-01

OBJECTIVE--To evaluate the contribution of specific nutritional deficiencies (as indicated by zinc; vitamin A, C, and E; albumin; and haemoglobin concentrations) to the risk of pressure sores. DESIGN--Observational cohort study. SETTING--St James's University Hospital, Leeds. SUBJECTS--21 elderly patients presenting consecutively to the orthopaedic unit with femoral neck fracture. MAIN OUTCOME MEASURE--Full thickness epidermal break over a pressure bearing surface. RESULTS--10 patients (48%) developed a pressure sore during their hospital stay. Indices of zinc status and concentrations of albumin, haemoglobin, and vitamins A and E were similar in patients who developed a pressure sore and those who did not. Mean leucocyte vitamin C concentration, however, was 6.3 (SD 2.2) micrograms/10(8) cells in patients who developed a pressure sore as compared with 12.8 (4.6) micrograms/10(8) cells in patients who did not. CONCLUSIONS--Low concentrations of leucocyte vitamin C appear to be associated with subsequent development of pressure sores in elderly patients with femoral neck fractures. PMID:1458073

Panoramic images of white and black post-menopausal females evidencing carotid calcifications are at high risk of comorbid osteopenia of the femoral neck

PubMed Central

Friedlander, AH; Chang, TI; Aghazadehsanai, N; Berenji, GR; Harada, ND; Garrett, NR

2013-01-01

Objectives: Femoral neck fractures in older females resulting from decreased bone mineral density (BMD; osteopenia) are associated with increased morbidity and mortality. Bone mineralization inhibition is probably controlled by proteins which also foster vascular calcification. Therefore, we evaluated the relationship between calcified carotid artery plaque (CCAP) on panoramic images and BMD on dual energy X-ray absorptiometry (DXA) bone scans. Methods: Images and hospital records identified by dentists defined two study groups (20 white females and 24 black females) having CCAP and an incidentally obtained bone scan. Ethnically matched (age±7 years, body mass index ±3 units) control groups with panoramic images devoid of CCAP and accompanying DXA scan were likewise constituted. A physician determined the BMD on the DXA. Results: Females with CCAP had significantly (p = 0.03) poorer BMD at the femoral neck than those without CCAP. Although mean femoral neck BMD was significantly lower (p = 0.009) for white than for black females, there was no significant interaction between race and CCAP (p = 0.80). Conclusion: We observed a significant inverse association between the CCAP on panoramic images and femoral neck BMD in post-menopausal white females. PMID:23571481

Panoramic images of white and black post-menopausal females evidencing carotid calcifications are at high risk of comorbid osteopenia of the femoral neck.

PubMed

Friedlander, A H; Chang, T I; Aghazadehsanai, N; Berenji, G R; Harada, N D; Garrett, N R

2013-01-01

Femoral neck fractures in older females resulting from decreased bone mineral density (BMD; osteopenia) are associated with increased morbidity and mortality. Bone mineralization inhibition is probably controlled by proteins which also foster vascular calcification. Therefore, we evaluated the relationship between calcified carotid artery plaque (CCAP) on panoramic images and BMD on dual energy X-ray absorptiometry (DXA) bone scans. Images and hospital records identified by dentists defined two study groups (20 white females and 24 black females) having CCAP and an incidentally obtained bone scan. Ethnically matched (age±7 years, body mass index ±3 units) control groups with panoramic images devoid of CCAP and accompanying DXA scan were likewise constituted. A physician determined the BMD on the DXA. Females with CCAP had significantly (p = 0.03) poorer BMD at the femoral neck than those without CCAP. Although mean femoral neck BMD was significantly lower (p = 0.009) for white than for black females, there was no significant interaction between race and CCAP (p = 0.80). We observed a significant inverse association between the CCAP on panoramic images and femoral neck BMD in post-menopausal white females.

Bilateral Femoral Neck Fatigue Fracture due to Osteomalacia Secondary to Celiac Disease: Report of Three Cases.

PubMed

Selek, Ozgur; Memisoglu, Kaya; Selek, Alev

2015-08-01

Bilateral non traumatic femoral neck fatigue fracture is a rare condition usually occurring secondary to medical conditions such as pregnancy, pelvic irradiation, corticosteroid exposure, chronic renal failure and osteomalacia. In this report, we present three young female patients with bilateral femoral neck fracture secondary to osteomalacia. The underlying cause of osteomalacia was Celiac disease in all patients. The patients were treated with closed reduction and internal fixation with cannulated lag screws. They were free of pain and full weight bearing was achieved at three months. There were no complications, avascular necrosis and nonunion during the follow up period. In patients with bone pain, non traumatic fractures and muscle weakness, osteomalacia should be kept in mind and proper diagnostic work-up should be performed to identify the underlying cause of osteomalacia such as celiac disease.

Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures: A retrospective study.

PubMed

Chen, Chao; Yu, Li; Tang, Xin; Liu, Mo-Zhen; Sun, Li-Zhong; Liu, Changjian; Zhang, Zhen; Li, Chang-Zhou

2017-10-01

The aim of this study was to compare clinical outcomes of patients with femoral neck fractures treated with the dynamic hip system blade (DHS-BLADE) or cannulated compression screws. Eighty-six patients with femoral neck fractures were treated by closed reduction internal fixation with a DHS-BLADE (n = 42; 18 males and 24 females; mean age: 56.3 years (37-87)) or cannulated compression screws (n = 44; 20 males and 24 females; mean age: 53.8 years (26-83)) between March 2011 and August 2013. The groups were compared with Harris hip score, operation time, surgical blood loss, incision size, hospital stay, and related complications. The average follow-up time was 27 months (range, 24-36 months). There was no significant difference for the operation time, incision size, hospital stay, and Harris hip score between the groups. Also, no statistically significant differences in the rates of nonunion (4.5% vs. 0) and avascular necrosis of the femoral head (9.1% vs. 7.1%) were observed. However, the screw group experienced significantly less surgical blood loss (32.4 ± 24.7 ml) than the blade group (87.2 ± 46.6 ml; P = 0.041). The incidence of femoral neck shortening above 10 mm in the screw group was significantly higher than that in the blade group (15.9% vs. 2.4%, P = 0.031). The blade group had a significantly lower incidence of screw migration than the screw group (4.8% vs. 22.7%, P = 0.016). The DHS-BLADE and cannulated compression screws might be equally effective in terms of postoperative fracture union. However, the DHS-BLADE has advantages over cannulated compression screws for preventing femoral neck shortening, screw migration, and cut-out. Level III, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Prospective evaluation of femoral head viability following femoral neck fracture

DOE Office of Scientific and Technical Information (OSTI.GOV)

Binkert, B.; Kroop, S.A.; Nepola, I.V.

1984-01-01

The bone scans of 33 patients (pts) with recent subcapital fractures (fx) of the femur were evaluated prospectively to determine their value in predicting femoral head visability. Each of the 33 pts (ll men, 22 women, age range 30-92) had a pre-operative bone scan within 72 hrs of the fx (23 pts within 24 hrs). Anterior and posterior planar views of both hips and pinhole views (50% of pts) were obtained 2 hrs after administration of Tc-99m HDP. The femoral head was classified as perfused if it showed the same activity as the opposite normal side or if it showedmore » only slightly decreased activity. Femoral heads showing absent activity were classified as nonperfused. Overall, 20 of the 33 pts showed a photopenic femoral head on the side of the fx. Only 2 pts showed increased activity at hte site of the fx. Internal fixation of the fx was performed in 23 pts, 12 of whom had one or more follow-up scans. Five of these 12 pts showed absent femoral head activity on their initial scan, but 2 showed later reperfusion. The other 7 pts showed good perfusion initially, with only 1 later showing decreased femoral head activity. The other 10 pts (7 of whom had absent femoral head activity) had immediate resection of the femoral head and insertion of a Cathcart prosthesis. The results suggest that femoral head activity seen on a bone scan in the immediate post-fx period is not always a reliable indicator of femoral head viability. Decreased femoral head activity may reflect, in part, compromised perfusion secondary to post-traumatic edema, with or without anatomic disruption of the blood supply.« less

Femoral head asymmetry and coxa magna: anatomic study.

PubMed

Young, Ernest Y; Gebhart, Jeremy J; Bajwa, Navkirat; Cooperman, Daniel R; Ahn, Nicholas U

2014-06-01

Coxa magna, the asymmetrical circumferential enlargement of the femoral head, is an important sequela of pediatric disorders such as Legg-Calvé-Perthes disease. Definitions vary because of lack of controls and a scarcity of research on the distribution of the femoral head asymmetry. This study aims at defining the normal distribution of asymmetry between the left and the right femoral head and neck in the population and how demographics affect these properties. The study also looked at the distribution of side dominance (left or right). This study measured 230 paired femurs from individuals (20 to 40 y old) distributed for sex and ethnicity. The height and weight of the individuals were also recorded. The femoral head diameter and minimal femoral neck diameter in the anteroposterior view were measured on each paired femurs. The absolute and percent differences were determined to define asymmetry. Most of the population fell within 3% of asymmetry for the femoral head and 4% for the femoral neck. The maximum head percent asymmetry was 7.4%. Absolute difference in millimeters to percent asymmetry showed a ratio of 2:1 for the femoral head and 3:1 for the femoral neck. African Americans showed greater femoral head symmetry and a bias toward left-sided femoral head and neck enlargement when compared with their white counterparts. There was a high degree of symmetry between the left and right femoral heads and necks, which supports definitions found in the literature that define coxa magna above 10%. This study defines asymmetry in the femoral head in the normal population, which will help to define a quantitative definition of coxa magna.

Femoral head and neck excision arthroplasty in a leopard tortoise (Stigmochelys pardalis).

PubMed

Naylor, Adam D

2013-12-01

Cases of femoral head and neck excision arthroplasty are infrequently reported in reptiles, and details of surgical technique and clinical outcome in chelonia are lacking. An adult female leopard tortoise (Stigmochelys pardalis) was presented with chronic non-weight-bearing lameness of the left hind limb. Examination and radiography were consistent with coxofemoral luxation, and as a result of the chronic presentation, surgical intervention was recommended. A cranial approach to the joint via the prefemoral fossa afforded good surgical exposure. A depressed lytic acetabular lesion was noted during the procedure, postulated to be a result of abnormal wear from the luxated femoral head. A fiberglass prop was used during recovery to allow extension of the limb without full weight-bearing. Lameness persisted postoperatively, but limb usage significantly improved.

Rheumatoid pseudocyst (geode) of the femoral neck without apparent joint involvement.

PubMed

Morrey, B F

1987-05-01

Typically, rheumatoid cysts are associated with obvious joint involvement and are located in the subchondral portion of the adjacent joint. Giant pseudocysts (geodes) are uncommon and are characteristically associated with extensive joint destruction. The patient described in this report had a giant pseudocyst of the femoral neck but no joint involvement. To the best of my knowledge, this is the first report of such a manifestation of a giant pseudocyst. As such, it posed a somewhat difficult diagnostic problem.

Preoperative Use of Clopidogrel Does Not Affect Outcomes for Femoral Neck Fractures Treated With Hemiarthroplasty.

PubMed

Ghanem, Elie S; Richard, Raveesh D; Wingert, Nathaniel C H; Gotoff, James R; Graham, Jove H; Bowen, Thomas R

2017-07-01

The antiplatelet effect of clopidogrel on blood loss and perioperative complications after surgical intervention remains ambiguous. The purpose of this study was to determine if patients on clopidogrel before hemiarthroplasty for femoral neck fracture are predisposed to greater surgical bleeding and perioperative complications compared with those not taking clopidogrel before surgery. We conducted a review of our electronic medical record from 2006-2013 and identified 602 patients who underwent 623 hemiarthroplasty procedures for displaced femoral neck fracture, of which 54 cases (9%) were taking clopidogrel before hospital admission. Patient demographics and comorbidities, operative and surgical variables, and perioperative complications at 90 days were compared between the clopidogrel and nonclopidogrel user groups. The 2 groups of patients had similar baseline characteristics, but patients taking clopidogrel preoperatively were sicker with higher American Society of Anesthesiologists scores (P = .049) and age-adjusted Charlson index (P = .001). They also had a greater incidence of cerebrovascular disease (P = .01), chronic obstructive pulmonary disease (P = .03), diabetes (0.03), and malignancy (P < .001). There was no significant difference between the 2 patient groups with respect to 90-day postoperative medical readmissions (P = .85), surgical readmissions (P = .26), infection (P = .99), and mortality (P = .89). Patients taking clopidogrel who present with a displaced femoral neck fracture can safely undergo a hemiarthroplasty while actively on clopidogrel without an increase in medical or surgical complications and mortality. We do not recommend delaying surgical intervention until the antiplatelet effects of clopidogrel subside. Copyright © 2017 Elsevier Inc. All rights reserved.

The femoral neck-shaft angle on plain radiographs: a systematic review.

PubMed

Boese, Christoph Kolja; Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Scheyerer, Max Joseph; Bredow, Jan; Lechler, Philipp

2016-01-01

The femoral neck-shaft angle (NSA) is an important measure for the assessment of the anatomy of the hip and planning of operations. Despite its common use, there remains disagreement concerning the method of measurement and the correction of hip rotation and femoral version of the projected NSA on conventional radiographs. We addressed the following questions: (1) What are the reported values for NSA in normal adult subjects and in osteoarthritis? (2) Is there a difference between non-corrected and rotation-corrected measurements? (3) Which methods are used for measuring the NSA on plain radiographs? (4) What could be learned from an analysis of the intra- and interobserver reliability? A systematic literature search was performed including 26 publications reporting the measurement of the NSA on conventional radiographs. The mean NSA of healthy adults (5,089 hips) was 128.8° (98-180°) and 131.5° (115-155°) in patients with osteoarthritis (1230 hips). The mean NSA was 128.5° (127-130.5°) for the rotation-corrected and 129.5° (119.6-151°) for the non-corrected measurements. Our data showed a high variance of the reported neck-shaft angles. Notably, we identified the inconsistency of the published methods of measurement as a central issue. The reported effect of rotation-correction cannot be reliably verified.

[Comparing different treatments for femoral neck fracture of displacement type in the elderly:a meta analysis].

PubMed

Zhao, Wenbo; Tu, Chongqi; Zhang, Hui; Fang, Yue; Wang, Guanglin; Liu, Lei

2014-04-01

To compare the effects and security between internal fixation and total hip arthroplasty for the patients in elderly with femoral neck fracture of displacement type through a meta analysis. Studies on comparison between internal fixation and total hip arthroplasty for the patients in the elderly with femoral neck fracture of displacement type were identified from PubMed database,EMBase database, COCHRANE library, CMB database, CNKI database and MEDLINE database. Data analysis were performed using Revman 5.2.6(the Cochrane Collaboration). Six published randomized controlled trials including 627 patients were suitable for the review, 286 cases in internal fixation group and 341 cases in total hip arthroplasty group. The results of meta analysis indicated that statistically significant difference were observed between the two groups in the quality of life which was reflected by the Harris scale (RR = 0.82, 95%CI:0.72-0.93, P < 0.05) , the reoperation rate (RR = 5.81, 95%CI:3.09-10.95, P < 0.05) and the major complications rate (RR = 3.60, 95%CI:2.29-5.67, P < 0.05) postoperatively. There were no difference in the mortality at 1 year and 5 years postoperatively(P > 0.05). For the patients with femoral neck fracture of displacement type in the elderly, there is no statistical difference between two groups in the mortality postoperatively. The quality of life and the security of operation in internal fixation group is worse than the total hip arthroplasty group.

Pathologic Femoral Neck Fracture Due to Fanconi Syndrome Induced by Adefovir Dipivoxil Therapy for Hepatitis B

PubMed Central

Lee, Yoon-Suk; Kim, Byung-Kook; Lee, Ho-Jae

2016-01-01

In Fanconi syndrome, hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids, glucose, urate, and phosphate. We present a rare case of a 43-year-old Korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to Fanconi syndrome. He had been receiving low-dose adefovir dipivoxil (ADV, 10 mg/day) for the treatment of chronic hepatitis B virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction. The incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture. After cessation of ADV and correction of hypophosphatemia with oral phosphorus supplementation, the patient's clinical symptoms, such as bone pain, muscle weakness, and laboratory findings improved. PMID:27247753

Femoral head-neck junction deformity is related to osteoarthritis of the hip.

PubMed

Barros, Hilton José Melo; Camanho, Gilberto Luis; Bernabé, Antônio Carlos; Rodrigues, Marcelo Bordalo; Leme, Luiz Eugênio Garcez

2010-07-01

Primary or idiopathic osteoarthritis (OA) of the hip has increasingly been attributed to the presence of presumably minor femoral or acetabular deformities that are not routinely identified. The alpha angle reflects one such deformity of the femoral neck and reflects a risk for femoroacetabular impingement, which in turn reportedly is associated with OA. If impingement is in fact associated with OA, then one might expect the mean alpha angle to be greater in patients with presumed idiopathic hip OA. We therefore compared the alpha angle among a group of elderly patients with idiopathic OA with that in a control group of elderly individuals without OA. We measured the alpha angles in 50 individuals (72 hips) with a mean age of 70 years (range, 60-84 years) with apparently idiopathic OA and compared their angles with those from a control group of 56 individuals without OA. The alpha angle was measured by means of radiographs of their hips using the Dunn view at 45 degrees flexion. The patients with OA had a greater percentage with abnormal alpha angles than did the normal subjects: 82% versus 30%, respectively. The mean alpha angle in the group with OA was larger than in the control subjects: 66.4 masculine (range, 28 degrees -108 degrees ) versus 48.1 masculine (range, 34 degrees -68 degrees ). Hips with presumably idiopathic OA had more abnormalities at the femoral head-neck junction than did the control hips without OA and may relate to the risk of OA developing. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Implant Removal After Internal Fixation of a Femoral Neck Fracture: Effects on Physical Functioning.

PubMed

Zielinski, Stephanie M; Heetveld, Martin J; Bhandari, Mohit; Patka, Peter; Van Lieshout, Esther M M

2015-09-01

The effect of implant removal after internal fixation of a femoral neck fracture on physical functioning was analyzed. Characteristics of patients who had their implant removed were studied, as it is currently unknown from which type of patients implants are removed and what effect removal has on function. Secondary cohort study alongside a randomized controlled trial. Multicenter study in 14 hospitals. Patients who had their implant removed after internal fixation of a femoral neck fracture are compared with patients who did not. Patient characteristics and quality of life (Short Form 12, Western Ontario McMaster Osteoarthritis Index) were compared. Matched pairs were selected based on patient/fracture characteristics and prefracture physical functioning. Of 162 patients, 37 (23%) had their implant removed. These patients were younger (median age: 67 vs. 72 years, P = 0.024) and more often independently ambulatory prefracture (100% vs. 84%, P = 0.008) than patients who did not. They more often had evident implant back-out on x-rays (54% vs. 34%, P = 0.035), possibly related to a higher rate of Pauwels 3 fractures (41% vs. 22%, P = 0.032). In time, quality of life improved more in implant removal patients [+2 vs. -4 points, Short Form 12 (physical component), P = 0.024; +9 vs. 0 points, Western Ontario McMaster Osteoarthritis Index, P = 0.019]. Implant removal after internal fixation of a femoral neck fracture positively influenced quality of life. Implant removal patients were younger and more often independently ambulatory prefracture, more often had a Pauwels 3 fracture, and an evident implant back-out. Implant removal should be considered liberally for these patients if pain persists or functional recovery is unsatisfactory. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Frank Stinchfield Award : Total Hip Arthroplasty for Femoral Neck Fracture Is Not a Typical DRG 470: A Propensity-matched Cohort Study.

PubMed

Schairer, William W; Lane, Joseph M; Halsey, David A; Iorio, Richard; Padgett, Douglas E; McLawhorn, Alexander S

2017-02-01

Hip fractures are a major public health concern. For displaced femoral neck fractures, the needs for medical services during hospitalization and extending beyond hospital discharge after total hip arthroplasty (THA) may be different than the needs after THA performed for osteoarthritis (OA), yet these differences are largely uncharacterized, and the Medicare Severity Diagnosis-Related Groups system does not distinguish between THA performed for fracture and OA. (1) What are the differences in in-hospital and 30-day postoperative clinical outcomes for THA performed for femoral neck fracture versus OA? (2) Is a patient's fracture status, that is whether or not a patient has a femoral neck fracture, associated with differences in in-hospital and 30-day postoperative clinical outcomes after THA? The National Surgical Quality Improvement Program (NSQIP) database, which contains outcomes for surgical patients up to 30 days after discharge, was used to identify patients undergoing THA for OA and femoral neck fracture. OA and fracture cohorts were matched one-to-one using propensity scores based on age, gender, American Society of Anesthesiologists grade, and medical comorbidities. Propensity scores represented the conditional probabilities for each patient having a femoral neck fracture based on their individual characteristics, excluding their actual fracture status. Outcomes of interest included operative time, length of stay (LOS), complications, transfusion, discharge destination, and readmission. There were 42,692 patients identified (41,739 OA; 953 femoral neck fractures) with 953 patients in each group for the matched analysis. For patients with fracture, operative times were slightly longer (98 versus 92 minutes, p = 0.015), they experienced longer LOS (6 versus 4 days, p < 0.001), and the overall frequency of complications was greater compared with patients with OA (16% versus 6%, p < 0.001). Although the frequency of preoperative transfusions was higher

Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures.

PubMed

Tidermark, Jan; Ponzer, Sari; Carlsson, Pronoti; Söderqvist, Anita; Brismar, Kerstin; Tengstrand, Birgitta; Cederholm, Tommy

2004-08-01

To evaluate the effects of a protein-rich liquid supplementation, alone or in combination with the anabolic steroid nandrolone decanoate, on body composition, activities of daily living (ADL) status and the health-related quality of life (HRQoL) after a femoral neck fracture. Sixty women, aged 83 +/- 5 years (mean +/- SD), BMI < 24 kg/m2 (20.4 +/- 2 kg/m2 ) and capable of co-operating, with a femoral neck fracture treated with internal fixation, were randomised to open treatment during 6 months with a protein-rich liquid formula alone (PR, Fortimel, 200 ml/day, 20 g protein/day) or in combination with nandrolone decanoate (PR/N, Deca-Durabol 25 mg i.m./3 weeks) or to a control group (C). The patients were re-examined after 6 and 12 months regarding body weight (BW), lean body mass (LBM, DXA), ADL status according to Katz, HRQoL according to EQ 5-D and fracture healing. LBM decreased in the C (-1.2 +/- 2 kg) and PR groups (-1.2 +/- 1 kg) but remained the same in the PR/N group (0.3 +/- 1 kg) (P < 0.05 between groups). ADL remained at a high level in the two intervention groups but declined significantly in the C group (P < 0.005 between groups). The decline in HRQoL was least pronounced in the PR/N group at 6 months (P < 0.05 between groups). Patients with fracture healing complications lost more BW (P < 0.05) and LBM (P < 0.01) than patients with uneventful fracture healing. Protein-rich liquid supplementation in combination with nandrolone given for 6 months to lean elderly women after a femoral neck fracture may positively affect LBM, ADL and HRQoL. Copyright 2003 Elsevier Ltd.

Effect of dynamic hip screw on the treatment of femoral neck fracture in the elderly.

PubMed

Zhao, Wernbo; Liu, Lei; Zhang, Hui; Fang, Yue; Pei, Fuxing; Yang, Tianfu

2014-04-01

To discuss the indications, surgical procedures, and curative effect of dynamic hip screw (DHS) in the treatment of femoral neck fracture in the elderly. A retrospective study was conducted to analyse the clinical data of 42 elderly patients who had been treated for femoral neck fracture with DHS in our department between June 2009 and November 2011. There were 21 males and 21 females with a mean age of 68.5 years (range 60-75 years). According to the Garden Classification, there were 19 cases of type II, 21 cases of type III and 2 cases of type IV fractures. By the Singh Index Classification, there were 3 cases of level 2, 19 cases of level 3 and 20 cases of level 4 fractures. The Harris criterion, complications and function recovery after opera- tion were analysed. The average hospitalization time in 42 patients was 11.2 days (range 7-21 days). All patients were followed up for 12-26 months (mean 18 months). No lung infection, deep venous thrombosis or other complications occurred. Partial backing-out of the screws was found in 2 cases. The internal fixation device was withdrawn after fracture healing. Internal fixation cutting was found in 1 case, and he had a good recovery after total hip arthroplasty. The time for fracture healing ranged from 3-6 months (average 4.5 months). According to Harris criterion, 15 cases were rated as excellent, 24 good, 2 fair and 1 poor. The Harris scale was significantly improved from 30.52±2.71 preoperatively to 86.61±2.53 at 6 months postoperatively (P<0.05). DHS, being minimal invasive, allowing early activity and weight-bearing, is advisable for treatment of elderly patients with femoral neck fracture. In addition, it can avoid complications seen in artificial joint replacement. It is especially suitable for patients with mild osteoporosis.

Cement augmentation of implants--no general cure in osteoporotic fracture treatment. A biomechanical study on non-displaced femoral neck fractures.

PubMed

Hofmann-Fliri, Ladina; Nicolino, Tomas I; Barla, Jorge; Gueorguiev, Boyko; Richards, R Geoff; Blauth, Michael; Windolf, Markus

2016-02-01

Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non-displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut-out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non-augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load-cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non-augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non-displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Prediction of incident hip fracture by femoral neck bone mineral density and neck-shaft angle: a 5-year longitudinal study in post-menopausal females.

PubMed

Gnudi, S; Sitta, E; Pignotti, E

2012-08-01

To compare hip fracture incidence in post-menopausal females who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry. In a 5 year follow-up study, the hip fracture incidence in 729 post-menopausal females (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck-shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating females with and without a hip fracture. The hip fracture incidence of the whole cohort was significantly higher in females with a wide NSA (8.52%) than in those with a narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD, respectively, gave a significantly higher fracture incidence in older than in younger women, whereas women with a combined wide NSA and low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%). Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of a wide NSA together with a low FNBMD should identify females at high probability of incident hip fracture.

Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture.

PubMed

Zielinski, Stephanie M; Keijsers, Noël L; Praet, Stephan F E; Heetveld, Martin J; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M M

2014-12-01

To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Secondary cohort study to a randomized controlled trial. Multicenter trial in the Netherlands, including 14 academic and nonacademic hospitals. Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. None (observatory study). Patient characteristics, SF-12, and Western Ontario McMaster osteoarthritis index scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis. Of 248 internal fixation patients (median age, 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower Western Ontario McMaster osteoarthritis index score (median, 73 vs. 90; P = 0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio, -8.9 vs. 0.4, P = 0.013) and a significant greater loss of abduction strength (median, -25.4 vs. -20.4 N, P = 0.025). Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture. Therapeutic level III.

New approach to probability estimate of femoral neck fracture by fall (Slovak regression model).

PubMed

Wendlova, J

2009-01-01

3,216 Slovak women with primary or secondary osteoporosis or osteopenia, aged 20-89 years, were examined with the bone densitometer DXA (dual energy X-ray absorptiometry, GE, Prodigy - Primo), x = 58.9, 95% C.I. (58.42; 59.38). The values of the following variables for each patient were measured: FSI (femur strength index), T-score total hip left, alpha angle - left, theta angle - left, HAL (hip axis length) left, BMI (body mass index) was calculated from the height and weight of the patients. Regression model determined the following order of independent variables according to the intensity of their influence upon the occurrence of values of dependent FSI variable: 1. BMI, 2. theta angle, 3. T-score total hip, 4. alpha angle, 5. HAL. The regression model equation, calculated from the variables monitored in the study, enables a doctor in praxis to determine the probability magnitude (absolute risk) for the occurrence of pathological value of FSI (FSI < 1) in the femoral neck area, i. e., allows for probability estimate of a femoral neck fracture by fall for Slovak women. 1. The Slovak regression model differs from regression models, published until now, in chosen independent variables and a dependent variable, belonging to biomechanical variables, characterising the bone quality. 2. The Slovak regression model excludes the inaccuracies of other models, which are not able to define precisely the current and past clinical condition of tested patients (e.g., to define the length and dose of exposure to risk factors). 3. The Slovak regression model opens the way to a new method of estimating the probability (absolute risk) or the odds for a femoral neck fracture by fall, based upon the bone quality determination. 4. It is assumed that the development will proceed by improving the methods enabling to measure the bone quality, determining the probability of fracture by fall (Tab. 6, Fig. 3, Ref. 22). Full Text (Free, PDF) www.bmj.sk.

Association analyses of RANKL/RANK/OPG gene polymorphisms with femoral neck compression strength index variation in Caucasians.

PubMed

Dong, Shan-Shan; Liu, Xiao-Gang; Chen, Yuan; Guo, Yan; Wang, Liang; Zhao, Jian; Xiong, Dong-Hai; Xu, Xiang-Hong; Recker, Robert R; Deng, Hong-Wen

2009-08-01

Femoral neck compression strength index (fCSI), a novel phenotypic parameter that integrates bone density, bone size, and body size, has significant potential to improve hip fracture risk assessment. The genetic factors underlying variations in fCSI, however, remain largely unknown. Given the important roles of the receptor activator of the nuclear factor-kappaB ligand/receptor activator of the nuclear factor-kappaB/osteoprotegerin (RANKL/RANK/OPG) pathway in the regulation of bone remodeling, we tested the associations between RANKL/RANK/OPG polymorphisms and variations in fCSI as well as its components (femoral neck bone mineral density [fBMD], femoral neck width [FNW], and weight). This was accomplished with a sample comprising 1873 subjects from 405 Caucasian nuclear families. Of the 37 total SNPs studied in these three genes, 3 SNPs, namely, rs12585014, rs7988338, and rs2148073, of RANKL were significantly associated with fCSI (P = 0.0007, 0.0007, and 0.0005, respectively) after conservative Bonferroni correction. Moreover, the three SNPs were approximately in complete linkage disequilibrium. Haplotype-based association tests corroborated the single-SNP results since haplotype 1 of block 1 of the RANKL gene achieved an even more significant association with fCSI (P = 0.0003) than any of the individual SNPs. However, we did not detect any significant associations of these genes with fBMD, FNW, or weight. In summary, our findings suggest that the RANKL gene may play an important role in variation in fCSI, independent of fBMD and non-fBMD components.

Association Analyses of RANKL/RANK/OPG Gene Polymorphisms with Femoral Neck Compression Strength Index Variation in Caucasians

PubMed Central

Dong, Shan-Shan; Liu, Xiao-Gang; Chen, Yuan; Guo, Yan; Wang, Liang; Zhao, Jian; Xiong, Dong-Hai; Xu, Xiang-Hong; Recker, Robert R.

2010-01-01

Femoral neck compression strength index (fCSI), a novel phenotypic parameter that integrates bone density, bone size, and body size, has significant potential to improve hip fracture risk assessment. The genetic factors underlying variations in fCSI, however, remain largely unknown. Given the important roles of the receptor activator of the nuclear factor-κB ligand/receptor activator of the nuclear factor-κB/osteoprotegerin (RANKL/RANK/OPG) pathway in the regulation of bone remodeling, we tested the associations between RANKL/RANK/OPG polymorphisms and variations in fCSI as well as its components (femoral neck bone mineral density [fBMD], femoral neck width [FNW], and weight). This was accomplished with a sample comprising 1873 subjects from 405 Caucasian nuclear families. Of the 37 total SNPs studied in these three genes, 3 SNPs, namely, rs12585014, rs7988338, and rs2148073, of RANKL were significantly associated with fCSI (P = 0.0007, 0.0007, and 0.0005, respectively) after conservative Bonferroni correction. Moreover, the three SNPs were approximately in complete linkage disequilibrium. Haplotype-based association tests corroborated the single-SNP results since haplotype 1 of block 1 of the RANKL gene achieved an even more significant association with fCSI (P = 0.0003) than any of the individual SNPs. However, we did not detect any significant associations of these genes with fBMD, FNW, or weight. In summary, our findings suggest that the RANKL gene may play an important role in variation in fCSI, independent of fBMD and non-fBMD components. PMID:19458885

Corrosion at the head-neck interface of current designs of modular femoral components: essential questions and answers relating to corrosion in modular head-neck junctions.

PubMed

Osman, K; Panagiotidou, A P; Khan, M; Blunn, G; Haddad, F S

2016-05-01

There is increasing global awareness of adverse reactions to metal debris and elevated serum metal ion concentrations following the use of second generation metal-on-metal total hip arthroplasties. The high incidence of these complications can be largely attributed to corrosion at the head-neck interface. Severe corrosion of the taper is identified most commonly in association with larger diameter femoral heads. However, there is emerging evidence of varying levels of corrosion observed in retrieved components with smaller diameter femoral heads. This same mechanism of galvanic and mechanically-assisted crevice corrosion has been observed in metal-on-polyethylene and ceramic components, suggesting an inherent biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers clinicians and researchers must understand regarding corrosion of the taper, and its relevance to current orthopaedic practice. Cite this article: Bone Joint J 2016;98-B:579-84. ©2016 The British Editorial Society of Bone & Joint Surgery.

A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis.

PubMed

Xu, Dan-Feng; Bi, Fang-Gang; Ma, Chi-Yuan; Wen, Zheng-Fa; Cai, Xun-Zi

2017-02-10

It remains unclear whether conservative treatment should be used to treat the common undisplaced femoral neck fractures that develop in the elderly. Herein, we systematically review the rates of union and avascular necrosis after conservative and surgical treatment of undisplaced femoral neck fractures. We searched the EMBASE, PubMed, OVID, Cochrane Library, Web of Science, and Scopus databases for randomized controlled trials or observational studies that assessed the outcomes of conservative or surgical treatments of undisplaced femoral neck fractures. No language or publication year limitation was imposed. Statistical analyses were performed with the aid of the chi-squared test. We evaluated the quality of each publication and the risk of bias. Twenty-nine studies involving 5071 patients were ultimately included; 1120 patients were treated conservatively and 3951 surgically. The union rates were 68.8% (642/933) and 92.6% (635/686) in the former and latter groups, respectively (p < 0.001). The avascular necrosis rate in the conservatively treated group was 10.3% (39/380), while it was 7.7% (159/2074) in the surgically treated group (p = 0.09). Surgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment.

Improving the preoperative care of patients with femoral neck fractures through the development and implementation of a checklist.

PubMed

Agha, Riaz; Edison, Eric; Fowler, Alexander

2014-01-01

The incidence of femoral neck fractures (FNFs) is expected to rise with life expectancy. It is important to improve the safety of these patients whilst under the care of orthopaedic teams. This study aimed to increase the performance of vital preoperative tasks in patients admitted for femoral neck fracture operations by producing and implementing a checklist as an aide memoir. The checklist was designed primarily for use by senior house officers (SHOs) admitting patients from the emergency department. A list of 12 preoperative tasks was identified. A baseline audit of 10 random patients showed that the mean proportion of the 12 tasks completed was 53% (range 25% - 83%). A survey of 14 nurses and surgeons found that the majority of respondents agreed that there was a problem with the performance of most of the tasks. The tasks were incorporated into a checklist which was refined in three plan-do-study-act cycles and introduced into the femoral neck fracture pathway. In the week following the introduction of the checklist, 77% of the checklist tasks were completed, 24% more than at the baseline audit (53%). In week 3, the completion of checklist tasks rose to 88% and to 95% in week 4. In conclusion, a simple checklist can markedly improve the performance and recording of preoperative tasks by SHOs. We recommend the wider adoption of the new checklist to be produced as a sticker for patients' medical records. Further study is required to ascertain the effect of the checklist on clinical outcomes.

Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages.

PubMed

Souza, A D; Ankolekar, V H; Padmashali, S; Das, A; Souza, Asd; Hosapatna, M

2015-07-01

Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. The present study was undertaken on 48 fetal femurs to calculate the NSA and FNA in fetuses digitally. End on images of upper end of the femurs were taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t test showed the FNA and NSA of femur did not vary significantly during the third trimester.

Intracapsular tonsillectomy for keratosis pharyngeous: A pilot study of postoperative recovery and surgical efficacy.

PubMed

Gaudreau, Philip A; Gessler, Eric M

2017-09-01

Our objective was to perform a pilot study comparing intracapsular radiofrequency ablation tonsillectomy with subcapsular tonsillectomy in adult patients with keratosis pharyngeous. Patients diagnosed with keratosis pharyngeous between December 2010 and February 2013 were randomized to undergo either intracapsular or subcapsular tonsillectomy using radiofrequency ablation. Postoperative pain scores and amount of pain medication taken were recorded for 2 weeks. A 6-month follow-up questionnaire was used to assess efficacy of the procedure. Twenty-two patients completed the initial 2-week questionnaire. Eighteen completed the 6-month follow-up questionnaire. The amount of pain medication consumed on postoperative days 8 (p = 0.0293), 9 (p = 0.0146), and 10 (p = 0.035) was significantly less in the intracapsular group. Risk of recurrence of tonsilloliths was significantly greater at the 6-month follow-up in the intracapsular cohort (p = 0.0291). Based on these findings, in patients undergoing tonsillectomy for keratosis pharyngeous, intracapsular radiofrequency ablation tonsillectomy may result in decreased pain medication consumption compared with subcapsular tonsillectomy. Intracapsular tonsillectomy, however, resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication may be offset by the greater likelihood for symptoms to recur. Larger studies are needed to confirm these findings.

The effect of hip positioning on the projected femoral neck-shaft angle: a modeling study.

PubMed

Bhashyam, Abhiram R; Rodriguez, Edward K; Appleton, Paul; Wixted, John J

2018-04-03

The femoral neck-shaft angle (NSA) is used to restore normal hip geometry during hip fracture repair. Femoral rotation is known to affect NSA measurement, but the effect of hip flexion-extension is unknown. The goals of this study were to determine and test mathematical models of the relationship between hip flexion-extension, femoral rotation and NSA. We hypothesized that hip flexion-extension and femoral rotation would result in NSA measurement error. Two mathematical models were developed to predict NSA in varying degrees of hip flexion-extension and femoral rotation. The predictions of the equations were tested in vitro using a model that varied hip flexion-extension while keeping rotation constant, and vice versa. The NSA was measured from an AP radiograph obtained with a C-arm. Attributable measurement error based on hip positioning was calculated from the models. The predictions of the model correlated well with the experimental data (correlation coefficient = 0.82 - 0.90). A wide range of patient positioning was found to result in less than 5-10 degree error in the measurement of NSA. Hip flexion-extension and femoral rotation had a synergistic effect in measurement error of the NSA. Measurement error was minimized when hip flexion-extension was within 10 degrees of neutral. This study demonstrates that hip flexion-extension and femoral rotation significantly affect the measurement of the NSA. To avoid inadvertently fixing the proximal femur in varus or valgus, the hip should be positioned within 10 degrees of neutral flexion-extension with respect to the C-arm to minimize positional measurement error. N/A, basic science study.

Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years.

PubMed

Song, Hyung Keun; Choi, Ho June; Yang, Kyu Hyun

2016-12-01

The aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. We conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50-97 years), with a mean follow-up of 21.4 months (range, 12-64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. FIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p<0.001). The odds of FIT were 17-fold higher in patients with initial valgus and posterior tilts>15° (B1.1.2) compared to patients with <15° of tilt in both planes (B1.2.1). The severity of initial deformity predicts AVN and FF in patients with valgus angulated femoral neck fractures. Patients with an initial valgus and posterior tilt>15° are reasonable candidates for primary arthroplasty due to high risk of FIT. Copyright © 2016 Elsevier Ltd. All rights reserved.

[A method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck].

PubMed

Chen, Tao; Shang, Xifu; He, Rui; Hu, Fei; Ge, Chang

2012-03-01

To investigate the method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck. The clinical data were analyzed retrospectively from 38 patients undergoing unilateral total hip arthroplasty between April 2005 and December 2010. There were 26 males and 12 females, aged 45-78 years (mean, 62.3 years). Among these cases, there were 11 cases of avascular necrosis of the femoral head, 17 cases of hip osteoarthritis, and 10 cases of femoral neck fracture. Before operation, 29 cases had leg length discrepancy; and the shortened length of the legs was 10-24 mm with an average of 14.5 mm by clinical measurement, and was 11-25 mm with an average of 14.7 mm by X-ray film measurement. The Harris score before operation was 44.0 +/- 3.6. At 1 day after operation, 3 cases had legs lengthening by clinical and X-ray film measurement; limb length difference less than 10 mm was regarded as equal limb length in the other 35 patients (92.1%). All incisions healed by first intention, and no complication of infection or lower limb deep venous thrombosis occurred. In 3 patients who had legs lengthening, 1 patient had abnormal gait and slight limping after increasing heel pad because the lower limb was lengthened by 16 mm, and 2 patients had slight limping. The other patients could walk normally and achieved pain relief of hip. Thirty-six patients were followed up 12-68 months (mean, 43.8 months). The Harris score was 86.7 +/- 2.3 after 6 months, showing significant difference (t = 3.260, P = 0.031) when compared with that before operation. The X-ray films showed no prosthetic loosening or subsidence. For patients with congenital short femoral neck during total hip arthroplasty, the surgeons should pay attention to osteotomy plane determination, limb length measurement, and use of the prosthesis with collar to avoid the lengthening lower limbs.

Do physical examination and CT-scan measures of femoral neck anteversion and tibial torsion relate to each other?

PubMed

Sangeux, Morgan; Mahy, Jessica; Graham, H Kerr

2014-01-01

Informed clinical decision making for femoral and/or tibial de-rotation osteotomies requires accurate measurement of patient function through gait analysis and anatomy through physical examination of bony torsions. Validity of gait analysis has been extensively studied; however, controversy remains regarding the accuracy of physical examination measurements of femoral and tibial torsion. Comparison between CT-scans and physical examination measurements of femoral neck anteversion (FNA) and external tibial torsion (ETT) were retrospectively obtained for 98 (FNA) and 64 (ETT) patients who attended a tertiary hospital for instrumented gait analysis between 2007 and 2010. The physical examination methods studied for femoral neck anteversion were the trochanteric prominence angle test (TPAT) and the maximum hip rotation arc midpoint (Arc midpoint) and for external tibial torsion the transmalleolar axis (TMA). Results showed that all physical examination measurements statistically differed to the CT-scans (bias(standard deviation): -2(14) for TPAT, -10(12) for Arc midpoint and -16(9) for TMA). Bland and Altman plots showed that method disagreements increased with increasing bony torsions in all cases but notably for TPAT. Regression analysis showed that only TMA and CT-scan measurement of external tibial torsion demonstrated good (R(2)=57%) correlation. Correlations for both TPAT (R(2)=14%) and Arc midpoint (R(2)=39%) with CT-scan measurements of FNA were limited. We conclude that physical examination should be considered as screening techniques rather than definitive measurement methods for FNA and ETT. Further research is required to develop more accurate measurement methods to accompany instrumented gait analysis. Copyright © 2013. Published by Elsevier B.V.

High-Density Association Study of 383 Candidate Genes for Volumetric BMD at the Femoral Neck and Lumbar Spine Among Older Men

PubMed Central

Yerges, Laura M.; Klei, Lambertus; Cauley, Jane A.; Roeder, Kathryn; Kammerer, Candace M.; Moffett, Susan P.; Ensrud, Kristine E.; Nestlerode, Cara S.; Marshall, Lynn M.; Hoffman, Andrew R.; Lewis, Cora; Lang, Thomas F.; Barrett-Connor, Elizabeth; Ferrell, Robert E.; Orwoll, Eric S.

2009-01-01

Genetics is a well-established but poorly understood determinant of BMD. Whereas some genetic variants may influence BMD throughout the body, others may be skeletal site specific. We initially screened for associations between 4608 tagging and potentially functional single nucleotide polymorphisms (SNPs) in 383 candidate genes and femoral neck and lumbar spine volumetric BMD (vBMD) measured from QCT scans among 862 community-dwelling white men ≥65 yr of age in the Osteoporotic Fractures in Men Study (MrOS). The most promising SNP associations (p < 0.01) were validated by genotyping an additional 1156 white men from MrOS. This analysis identified 8 SNPs in 6 genes (APC, DMP1, FGFR2, FLT1, HOXA, and PTN) that were associated with femoral neck vBMD and 13 SNPs in 7 genes (APC, BMPR1B, FOXC2, HOXA, IGFBP2, NFATC1, and SOST) that were associated with lumbar spine vBMD in both genotyping samples (p < 0.05). Although most associations were specific to one skeletal site, SNPs in the APC and HOXA gene regions were associated with both femoral neck and lumbar spine BMD. This analysis identifies several novel and robust genetic associations for volumetric BMD, and these findings in combination with other data suggest the presence of genetic loci for volumetric BMD that are at least to some extent skeletal-site specific. PMID:19453261

Dislocation and spontaneous reduction of the femoral implant against the femoral neck in an infected metal on metal hip resurfacing with complex collection.

PubMed

Tins, Bernhard

2011-07-01

Metal on metal resurfacing hip implants are known to have complications unique to this type of implant. The case presented adds a further previously not described complication, the dislocation and spontaneous reduction of the pin of the femoral component against the femoral neck. The radiographic and CT findings are demonstrated. The dislocation was aided by bone loss due to an infection with a large periarticular collection. Periarticular collections in hip resurfacings are often due to a hypersensitivity type reaction to metal debris. However in the case presented it was due to infection. MRI was not able to discern the infection from a sterile collection. CT demonstrated bone loss and periosteal reaction suggestive of infection. In addition calcification of the pseudocapsule was seen, this is not a recognized feature of sterile collections. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Surgical site infection after surgery to repair femoral neck fracture: a French multicenter retrospective study.

PubMed

Merrer, Jacques; Girou, Emmanuelle; Lortat-Jacob, Alain; Montravers, Philippe; Lucet, Jean-Christophe

2007-10-01

Femoral neck fracture is the most frequent orthopedic emergency among elderly persons. Despite a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in this population, no multicenter study of antibiotic prophylaxis practices and the rate and microbiological characteristics of surgical site infection (SSI) has been performed in France. Retrospective, multicenter cohort study. Twenty-two university and community hospitals in France. Each center provided data on 25 consecutive patients who underwent surgery for femoral neck fracture during the first quarter of 2005. Demographic, clinical, and follow-up characteristics were recorded, and most patients had a follow-up office visit or were involved in a telephone survey 1 year after surgery. These 22 centers provided data on 541 patients, 396 (73%) of whom were followed up 1 year after surgery. Of 504 (93%) patients for whom antibiotic prophylaxis was recorded, 433 (86%) received a cephalosporin. Twenty-two patients had an SSI, for a rate of 5.6% (95% confidence interval, 3.7-8.0). SSI was reported for 15 (6.9%) of patients who had a prosthesis placed and for 7 (3.9%) who underwent osteosynthesis (P=.27). SSI was diagnosed a median of 30 days after surgery (interquartile range, 21-41 days); 7 (32%) of these SSIs were superficial infections, and 15 (68%) were deep or organ-space infections. MRSA caused 7 SSIs (32%), Pseudomonas aeruginosa caused 5 (23%), other staphylococci caused 4 (18%), and other bacteria caused 2 (9%); the etiologic pathogen was unknown in 4 cases (18%). Reoperation was performed for 14 patients with deep or organ-space SSI, including 6 of 7 patients with MRSA SSI. The mortality rate 1 year after surgery was 20% overall but 50% among patients with SSI. In univariate analysis, only the National Nosocomial Infections Surveillance System risk index score was significantly associated with SSI (P=.006). SSI after surgery for femoral neck fracture is severe, and MRSA is the most

The recent prevalence of Osteoporosis and low bone mass in the United States based on bone mineral density at the Femoral Neck or Lumbar Spine

USDA-ARS?s Scientific Manuscript database

The goal of our study was to estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). We applied prevalence estimates of osteoporosis or low bone mass at the femoral ...

The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis

PubMed Central

Jostmeier, Janine; Haneder, Stefan; Dargel, Jens; Eysel, Peer; Lechler, Philipp

2016-01-01

Background. The femoral neck-shaft angle (NSA) is of high importance for the diagnostics and treatment of various conditions of the hip. However, rotational effects limit its precision and applicability using plain radiographs. This study introduces a novel method to measure the femoral NSA: the modified NSA (mNSA), possibly being less susceptible against rotational effects compared to the conventional NSA. Patients and Methods. The method of measurement is described and its applicability was tested in 400 pelvis computed tomography scans (800 hips). Age- and gender-dependent reference values are given and intra- and interrater reliability are analyzed. Results. The mean age of all 400 patients (800 hips) was 54.32 years (18–100, SD 22.05 years). The mean mNSA was 147.0° and the 95% confidence interval was 146.7°–147.4°. Differences of the mNSA between sexes, age groups, and sides were nonsignificant. The absolute difference between NSA and mNSA was 16.3° (range 3–31°; SD 4.4°); the correlation was high (0.738; p < 0.001). Overall, the intra- and interrater reliability were excellent for the mNSA. Interpretation. We introduced a novel concept for the analysis of the neck-shaft angle. The high reliability of the measurement has been proven and its robustness to hip rotation was demonstrated. PMID:28070521

The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis.

PubMed

Boese, Christoph Kolja; Frink, Michael; Jostmeier, Janine; Haneder, Stefan; Dargel, Jens; Eysel, Peer; Lechler, Philipp

2016-01-01

Background . The femoral neck-shaft angle (NSA) is of high importance for the diagnostics and treatment of various conditions of the hip. However, rotational effects limit its precision and applicability using plain radiographs. This study introduces a novel method to measure the femoral NSA: the modified NSA (mNSA), possibly being less susceptible against rotational effects compared to the conventional NSA. Patients and Methods . The method of measurement is described and its applicability was tested in 400 pelvis computed tomography scans (800 hips). Age- and gender-dependent reference values are given and intra- and interrater reliability are analyzed. Results . The mean age of all 400 patients (800 hips) was 54.32 years (18-100, SD 22.05 years). The mean mNSA was 147.0° and the 95% confidence interval was 146.7°-147.4°. Differences of the mNSA between sexes, age groups, and sides were nonsignificant. The absolute difference between NSA and mNSA was 16.3° (range 3-31°; SD 4.4°); the correlation was high (0.738; p < 0.001). Overall, the intra- and interrater reliability were excellent for the mNSA. Interpretation . We introduced a novel concept for the analysis of the neck-shaft angle. The high reliability of the measurement has been proven and its robustness to hip rotation was demonstrated.

Bilateral subcapital femoral neck fractures secondary to transient osteoporosis during pregnancy: a case report.

PubMed

Emami, Mohammad Jafar; Abdollahpour, Hamid Reza; Kazemi, Ali Reza; Vosoughi, Amir Reza

2012-08-01

Transient osteoporosis during pregnancy is a rare, self-limiting disease. We report on a 36-year-old woman who had bilateral subcapital femoral neck fractures during the 6th month of pregnancy. The diagnosis was made 4 days after delivery, because radiography was declined by the patient for fear of radiation. Fixation was not feasible owing to bone resorption, and 2-stage bipolar hemiarthroplasty was therefore performed. Magnetic resonance imaging is the best non-invasive investigative tool for pregnant women with hip pain. Early detection can prevent complications and resorting to major surgeries.

Modular Neck vs Nonmodular Femoral Stems in Total Hip Arthroplasty-Clinical Outcome, Metal Ion Levels, and Radiologic Findings.

PubMed

Mikkelsen, Rasmus T; Fløjstrup, Marianne; Lund, Christian; Kjærsgaard-Andersen, Per; Skjødt, Thomas; Varnum, Claus

2017-09-01

Modular neck femoral stem (MNFS) for total hip arthroplasty (THA) was introduced to optimize the outcome, but created concerns about pain, elevated blood metal ion levels, and adverse reaction to metal debris such as pseudotumors (PTs), related to corrosion between femoral neck and stem. We compared these outcomes in patients with MNFS or nonmodular femoral stem (NFS) THA. Thirty-three patients with unilateral MNFS THA were compared with 30 patients with unilateral NFS THA. Levels of pain, serum cobalt, serum chromium were determined. Magnetic resonance imaging was performed to describe PT and fatty atrophy of muscles. The MNFS and NFS group had a mean follow-up of 2.3 and 3.1 years, respectively. Four and 13 patients in the MNFS and NFS group had pain, respectively (P = .005). The MNFS group had higher levels of serum cobalt (P < .0001) and chromium (P = .006). PTs were present in both the MNFS (n = 15) and NFS (n = 7) groups (P = .066). PTs were related to serum cobalt (P = .04) but not to pain or serum chromium. Fatty atrophy prevalence in the piriformis and gluteal muscles were higher in patients with MNFS (P = .009 and P = .032, respectively). More patients in the NFS group had pain. Serum cobalt and chromium levels were higher in the MNFS group. Prevalence of PTs was twice as high in the MNFS group, but the difference was insignificant. Copyright © 2017 Elsevier Inc. All rights reserved.

Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135º single-angled barrel plate for un-united and neglected femoral neck fractures.

PubMed

Gupta, Sameer; Kukreja, Sunil; Singh, Vivek

2014-04-01

To review the outcome of 60 patients who underwent valgus subtrochanteric osteotomy and its repositioning for un-united and neglected femoral neck fractures. 60 patients (mean age, 35 years) underwent valgus subtrochanteric osteotomy and repositioning of the osteotomy and fixation with a dynamic hip screw and a 135° single-angled barrel plate for closed un-united femoral neck fractures after failed internal fixation (n=27) or neglected (>3 weeks) fractures (n=33). The most common fracture type was transcervical (n=48), followed by subcapital (n=6) and basal (n=6). All patients had displaced femoral neck fractures (Garden types 3 and 4). According to the Pauwel angle, 45 fractures were type 2 (30º-70º) and 15 were type 3 (>70º). Patients were followed up for a mean of 3.5 (range, 2-7.5) years. The mean Pauwel angle of the fracture was corrected from 65° (range, 50°-89°) to 26° (range, 25°-28°). Bone union was achieved in 56 patients after a mean of 3.9 (range, 3-5.5) months. The mean Harris hip score improved from 65 to 87.5. Outcome was excellent in 30 patients, good in 24, and poor in 6. Four of the patients developed avascular necrosis; 2 of whom nonetheless achieved a good outcome. Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135° single-angled barrel plate was effective treatment for un-united and neglected femoral neck fractures.

Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block.

PubMed

Yun, M J; Kim, Y H; Han, M K; Kim, J H; Hwang, J W; Do, S H

2009-11-01

In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture. The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 microg/kg, followed by a continuous infusion of alfentanil 0.25 microg/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual analogue pain scale (VAS) scores, time to achieve spinal anaesthesia, quality of patient positioning, and patient acceptance were compared. VAS scores during positioning (mean and range) were lower in the FIC group than in the IVA group [2.0 (1-4) vs. 3.5 (2-6), P=0.001], and the mean (+/- SD) time to achieve spinal anaesthesia was shorter in the FIC group (6.9 +/- 2.7 min vs. 10.8 +/- 5.6 min; P=0.009). Patient acceptance (yes/no) was also better in the FIC group (19/1) than in the IVA group (12/8)(P=0.008). An FIC block is more efficacious than i.v. alfentanil in terms of facilitating the lateral position for spinal anaesthesia in elderly patients undergoing surgery for femoral neck fractures.

Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study.

PubMed

Burgers, P T P W; Hoogendoorn, M; Van Woensel, E A C; Poolman, R W; Bhandari, M; Patka, P; Van Lieshout, E M M

2016-06-01

The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness. The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi- or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data. Data of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %. The main cost determinants for hemi- or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.

Does increased femoral antetorsion predispose to cartilage lesions of the patellofemoral joint?

PubMed

Oppermann, Johannes; Bredow, Jan; Wissusek, Boris; Spies, Christian Karl; Boese, Christoph Kolja; Chang, Shi-Min; Eysel, Peer; Dargel, Jens

2017-09-01

The purpose of this study was to investigate whether there was a relationship between femoral neck antetorsion and the presence and pattern of osteoarthritis of the patellofemoral joint. It was hypothesized that an increased femoral neck antetorsion (1) correlates with osteoarthritic changes of the lateral facet of the patellofemoral joint and (2) correlates with an increased lateral trochlear height and a decreased sulcus angle. Seventy-eight formalin-embedded cadaveric lower extremities from thirty-nine subjects with a median age of 74 years (range 60-88) were used. Surrounding soft tissues of the lower limb were removed. The femoral neck antetorsion was measured and referenced to the transepicondylar axis and the posterior condylar line. The height of the medial and lateral facet of the trochlea and the sulcus angle was measured. The location and the degree of patellofemoral cartilage degeneration were recorded. A Pearson's correlation analysis was performed to correlate the femoral neck antetorsion with the measured knee parameters. No significant correlation could be found between the femoral antetorsion and cartilage degeneration of the lateral patellofemoral joint (n.s.), the height of the lateral trochlea (n.s.) and the sulcus angle (n.s.). This study could not document that the femoral neck antetorsion and subsequent internal rotation of the distal femur correlated with the degree of degeneration of the lateral facet of the patellofemoral joint. Clinically, femoral internal rotation may play a minor role in the development of lateral patellofemoral joint degeneration.

Tiptoeing through the rest of his life: A functional adaptation to a leg shortened by femoral neck fracture.

PubMed

Lovell, Nancy C

2016-06-01

Salvage excavation of a Roman cemetery (1st-2nd century CE) at the site of ancient Erculam (region of Campania), Italy, yielded the skeleton of an older male with a healed fracture of the femoral neck that reduced the femoral neck angle and resulted in leg shortening. The right foot shows bony alterations that appear to have developed as a consequence. The distal joint surfaces of the first and second metatarsals extend dorsally for articulation of the proximal phalanges in hyper-dorsiflexion. I argue that, in order to compensate for the shortened leg, the man lengthened it functionally by bearing weight primarily on his toes when he walked, rather than striking the heel first and then pushing off from the toe. The severity of degenerative joint disease in the right knee and in the metatarsophalangeal joints suggests that the injury occurred years before the man's death. This case adds to the bioarchaeological record of individuals who adapted to impaired mobility in the past, and it may be of interest to scholars who study the bioarchaeology of impairment and disability. Copyright © 2016 Elsevier Inc. All rights reserved.

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density.

PubMed

Ripamonti, C; Lisi, L; Avella, M

2014-05-01

To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures.

Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density

PubMed Central

Lisi, L; Avella, M

2014-01-01

Objective: To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. Methods: We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. Results: Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. Conclusion: NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. Advances in knowledge: The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures. PMID:24678889

Brief communication: Paleobiological inferences on the locomotor repertoire of extinct hominoids based on femoral neck cortical thickness: The fossil great ape hispanopithecus laietanus as a test-case study.

PubMed

Pina, Marta; Alba, David M; Almécija, Sergio; Fortuny, Josep; Moyà-Solà, Salvador

2012-09-01

The relationship between femoral neck superior and inferior cortical thickness in primates is related to locomotor behavior. This relationship has been employed to infer bipedalism in fossil hominins, although bipeds share the same pattern of generalized quadrupeds, where the superior cortex is thinner than the inferior one. In contrast, knuckle-walkers and specialized suspensory taxa display a more homogeneous distribution of cortical bone. These different patterns, probably related to the range of movement at the hip joint and concomitant differences in the load stresses at the femoral neck, are very promising for making locomotor inferences in extinct primates. To evaluate the utility of this feature in the fossil record, we relied on computed tomography applied to the femur of the Late Miocene hominoid Hispanopithecus laietanus as a test-case study. Both an orthograde body plan and orang-like suspensory adaptations had been previously documented for this taxon on different anatomical grounds, leading to the hypothesis that this fossil ape should display a modern ape-like distribution of femoral neck cortical thickness. This is confirmed by the results of this study, leading to the conclusion that Hispanopithecus represents the oldest evidence of a homogeneous cortical bone distribution in the hominoid fossil record. Our results therefore strengthen the utility of femoral neck cortical thickness for making paleobiological inferences on the locomotor repertoire of fossil primates. This feature would be particularly useful for assessing the degree of orthograde arboreal locomotor behaviors vs. terrestrial bipedalism in putative early hominins. Copyright © 2012 Wiley Periodicals, Inc.

Bilateral Femoral Neck Fractures in Cerebrotendinous Xanthomatosis Treated by Hip Arthroplasties: The First Case Report and Literature Review.

PubMed

Wejjakul, Witchuree; Chatmaitri, Swist; Wattanarojanaporn, Thongek; Pongkunakorn, Anuwat; Ittiwut, Chupong; Shotelersuk, Vorasuk

2017-01-01

Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disease caused by mutations of the CYP27A1 gene and deficiency of the sterol-27-hydroxylase enzyme in bile acid biosynthesis. It is characterized by the accumulation of cholestanol and bile alcohols in plasma, the formation of xanthomatous lesions in various tissues, and organ degeneration. This disorder is also associated with osteoporosis and increased risk of fracture. To date, only two CTX patients with femoral neck fractures have been reported. Neither was treated by arthroplasties, and the operative outcomes are lacking. We report the case of a 46-year-old Thai female who presented with consecutive bilateral femoral neck fractures following minor trauma within a 3-year period and received cementless bipolar hemiarthroplasties. Her phenotypic expression included Achilles tendon masses, childhood-onset cataracts, intellectual disability, and cerebellar ataxia. A brain computed tomography showed non-enhancing hypodense lesions in the bilateral cerebellar hemispheres with mild brain atrophy. Histopathology from an Achilles tendon biopsy revealed tendinous xanthoma and molecular analysis confirmed a homozygous nonsense mutation, c.1072C>T (p.Gln358Ter), in exon 6 of the CYP27A1 gene. The intra-operative crack of a calcar femorale was a major complication during both prosthetic insertion surgeries and warranted cerclage wiring. At the 7-month follow-up of the right hip and the 41-month follow-up of the left hip, postoperative radiographs showed well-fixed and well-aligned prostheses. Independent household ambulation could be resumed with Harris hip scores of 81 points equally. CTX is associated with osteoporosis, and middle-aged patients could present with femoral neck fracture following minor trauma. Cementless bipolar hemiarthroplasty for a totally displaced fracture is justified for a patient who has cognitive impairment. Intra-operative fracture is a major complication during

Burnei's technique of femoral neck variation and valgisation by using the intramedullary rod in Osteogenesis imperfecta.

PubMed

Georgescu, I; Gavriliu, Șt; Nepaliuc, I; Munteanu, L; Țiripa, I; Ghiță, R; Japie, E; Hamei, S; Dughilă, C; Macadon, M

2014-01-01

Varus or valgus deviations of the femoral neck in osteogenesis imperfecta have been an ignored chapter because the classic correction procedures were applied in medical practice with unsatisfying results. Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially corrected, which required an extensive use of the wheel chair or bed immobilization of the patient. The concomitant correction of the complex deformities, coxa vara/valga and femoral integrated configuration, have been a progress which allowed the patients to walk with or without support. The purpose of this study is to present the Burnei's technique, a therapeutic alternative in deformity corrections of the varus or valgus hip in children with osteogenesis imperfecta. The paper is about a retrospective study done in a single center, which analyses Burnei technique and other procedures described in literature. The content of the article is based on a 12 years experience on a batch of 51 patients with osteogenesis imperfecta from which 10 patients (13 hips) presented frontal plane deviations of the femoral neck. All the patients with osteogenesis imperfecta who presented coxa vara or valga were submitted to investigations with the purpose of measuring blood loss, the possibility of extending the surgical intervention to the leg, the association of severe deformities of the proximal extremity of the femur and the necessity of postoperative intensive care. Burnei's technique: The operation was first performed in 2002. A subtrochanteric osteotomy was made in an oblique cut, from the internal side to the external side and from proximal to distal for coxa vara, or by using a cuneiform resection associated with muscular disinsertions. Only telescopic rods were used for osteosynthesis. There are a few articles in literature, which approach corrections of vara or valgus deviations in osteogenesis imperfecta

A comparison of DXA and CT based methods for estimating the strength of the femoral neck in post-menopausal women

PubMed Central

Danielson, Michelle E.; Beck, Thomas J.; Karlamangla, Arun S.; Greendale, Gail A.; Atkinson, Elizabeth J.; Lian, Yinjuan; Khaled, Alia S.; Keaveny, Tony M.; Kopperdahl, David; Ruppert, Kristine; Greenspan, Susan; Vuga, Marike; Cauley, Jane A.

2013-01-01

Purpose Simple 2-dimensional (2D) analyses of bone strength can be done with dual energy x-ray absorptiometry (DXA) data and applied to large data sets. We compared 2D analyses to 3-dimensional (3D) finite element analyses (FEA) based on quantitative computed tomography (QCT) data. Methods 213 women participating in the Study of Women’s Health across the Nation (SWAN) received hip DXA and QCT scans. DXA BMD and femoral neck diameter and axis length were used to estimate geometry for composite bending (BSI) and compressive strength (CSI) indices. These and comparable indices computed by Hip Structure Analysis (HSA) on the same DXA data were compared to indices using QCT geometry. Simple 2D engineering simulations of a fall impacting on the greater trochanter were generated using HSA and QCT femoral neck geometry; these estimates were benchmarked to a 3D FEA of fall impact. Results DXA-derived CSI and BSI computed from BMD and by HSA correlated well with each other (R= 0.92 and 0.70) and with QCT-derived indices (R= 0.83–0.85 and 0.65–0.72). The 2D strength estimate using HSA geometry correlated well with that from QCT (R=0.76) and with the 3D FEA estimate (R=0.56). Conclusions Femoral neck geometry computed by HSA from DXA data corresponds well enough to that from QCT for an analysis of load stress in the larger SWAN data set. Geometry derived from BMD data performed nearly as well. Proximal femur breaking strength estimated from 2D DXA data is not as well correlated with that derived by a 3D FEA using QCT data. PMID:22810918

More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly

PubMed Central

Chammout, Ghazi; Muren, Olle; Laurencikas, Evaldas; Bodén, Henrik; Kelly-Pettersson, Paula; Sjöö, Helene; Stark, André; Sköldenberg, Olof

2017-01-01

Background and purpose Total hip replacement (THR) is the preferred method for the active and lucid elderly patient with a displaced femoral neck fracture (FNF). Controversy still exists regarding the use of cemented or uncemented stems in these patients. We compared the effectiveness and safety between a modern cemented, and a modern uncemented hydroxyapatite-coated femoral stem in patients 65–79 years of age who were treated with THR for displaced FNF. Patients and methods In a single-center, single-blinded randomized controlled trial, we included 69 patients, mean age 75 (65–79) and with a displaced FNF (Garden III–IV). 35 patients were randomized to a cemented THR and 34 to a reverse-hybrid THR with an uncemented stem. Primary endpoints were: prevalence of all hip-related complications and health-related quality of life, evaluated with EuroQol-5D (EQ-5D) index up to 2 years after surgery. Secondary outcomes included: overall mortality, general medical complications, and hip function. The patients were followed up at 3, 12, and 24 months. Results According to the calculation of sample size, 140 patients would be required for the primary endpoints, but the study was stopped when only half of the sample size was included (n = 69). An interim analysis at that time showed that the total number of early hip-related complications was substantially higher in the uncemented group, 9 (among them, 3 dislocations and 4 periprosthetic fractures) as compared to 1 in the cemented group. The mortality and functional outcome scores were similar in the 2 groups. Interpretation We do not recommend uncemented femoral stems for the treatment of elderly patients with displaced FNFs. PMID:27967333

Minimally invasive positioning robot system of femoral neck hollow screw implants based on x-ray error correction

NASA Astrophysics Data System (ADS)

Zou, Yunpeng; Xu, Ying; Hu, Lei; Guo, Na; Wang, Lifeng

2017-01-01

Aiming the high failure rate, the high radiation quantity and the poor positioning accuracy of femoral neck traditional surgery, this article develops a set of new positioning robot system of femoral neck hollow screw implants based on X-rays error correction, which bases on the study of x-rays perspective principle and the Motion Principle of 6 DOF(degree of freedom) series robot UR(Universal Robots). Compared with Computer Assisted Navigation System, this system owns better positioning accuracy and more simple operation. In addition, without extra Equipment of Visual Tracking, this system can reduce a lot of cost. During the surgery, Doctor can plan the operation path and the pose of mark needle according to the positive and lateral X-rays images of patients. Then they can calculate the pixel ratio according to the ratio of the actual length of mark line and the length on image. After that, they can calculate the amount of exercise of UR Robot according to the relative position between operation path and guide pin and the fixed relationship between guide pin and UR robot. Then, they can control UR to drive the positioning guide pin to the operation path. At this point, check the positioning guide pin and the planning path is coincident, if not, repeat the previous steps, until the positioning guide pin and the planning path coincide which will eventually complete the positioning operation. Moreover, to verify the positioning accuracy, this paper make an errors analysis aiming to thirty cases of the experimental model of bone. The result shows that the motion accuracy of the UR Robot is 0.15mm and the Integral error precision is within 0.8mm. To verify the clinical feasibility of this system, this article analysis on three cases of the clinical experiment. In the whole process of positioning, the X-rays irradiation time is 2-3s, the number of perspective is 3-5 and the whole positioning time is 7-10min. The result shows that this system can complete accurately

Effects of serum 25-hydroxyvitaminD level on decreased bone mineral density at femoral neck and total hip in Chinese type 2 diabetes.

PubMed

Guo, Liting; Gao, Zhihong; Ge, Huanqi

2017-01-01

The aims of this study is to observe the levels of serum 25-hydroxyvitaminD (25OHD), parathyroid hormone and bone mineral density (BMD) in type 2 diabetes as well as to analyze the correlationship between 25OHD level and BMD. The subjects included 368 type 2 diabetic patients, ages ranged 40-79 years and 300 non-diabetic control subjects matched for age, gender and body mass index. The serum 25OHD concentration, parathyroid hormone level and BMDs value at lumbar spine (L1-L4), femoral neck, total hip and total body were measured. The BMDs (g/cm2) was measured by LUNAR's DEXA dual-energy X-ray absorptiometry. ①Compared with control subjects, the serum 25OHD level, BMDs at the femoral neck and total hip declined in type 2 diabetes[(45±17 vs. 36±12 nmol/L), (0.93±0.17 vs. 0.85±0.14 g/cm2), (0.93±0.14 vs. 0.87±0.15g/cm2) (all P<0.05)]; The parathyroid hormone level in type 2 diabetes was higher in type 2 diabetes than that in control subjects (8.5±4.2 vs. 5.6±3.9 pmol/L) (P<0.05). ②Compared with diabetes duration ≤10 years group, BMDs at the femoral neck and total hip decreased in diabetes duration >10years group [(0.88±0.11 vs. 0.81±0.15 g/cm2), (0.91±0.14 vs. 0.84±0.16 g/cm2)(All P<0.05)]; The parathyroid hormone level increased in diabetes duration >10years group than diabetes duration ≤10 years group (10.6±9.1 vs. 7.1±3.7 pmol/L) (P<0.05). ③ Compared with hemoglobin A1c (HbA1c) ≤8% group, 25OHD and BMDs at the femoral neck and total hip in HbA1c>8% group decreased [(40±15 vs. 32±13 nmol/l), (0.89±0.13 vs. 0.83±0.13 g/cm2), (0.95±0.13 vs. 0.83±0.16 g/cm2) (All P<0.05)] and the parathyroid hormone level increased (7.2±4.0 vs. 10.0±8.8 pmol/L) (P<0.05). ④The morbidity of diabetic osteoporosis and osteopenia (41.0%, 47.8%) were higher than those in control subjects (27.0%,33.3%) (X2 = 4.37 and 4.70, P = 0.04 and 0.03); Diabetes duration, HbA1c and parathyroid hormone levels were longer or higher in Diabetic osteoporosis group than

The societal costs of femoral neck fracture patients treated with internal fixation.

PubMed

Zielinski, S M; Bouwmans, C A M; Heetveld, M J; Bhandari, M; Patka, P; Van Lieshout, E M M

2014-03-01

The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are comparable to internationally published costs. The aim of this study was to provide a detailed overview of the cost and healthcare consumption of patients treated for a hip fracture with internal fixation. A secondary aim was to compare costs of patients who underwent a revision surgery with patients who did not. The study was performed alongside the Dutch sample of an international randomized controlled trial, concerning femoral neck fracture patients treated with internal fixation. Patient characteristics and healthcare consumption were collected. Total follow-up was 2 years. A societal perspective was adopted. Costs included hospital costs during primary stay and follow-up, and costs related to rehabilitation and changes in living situation. Costs were compared between non-revision surgery patients, implant removal patients, and revision arthroplasty patients. A total of 248 patients were included (mean age 71 years). Mean total costs per patient at 2-years follow-up were 19,425. In the non-revision surgery patients total costs were 17,405 (N = 137), in the implant removal patients 10,066 (N = 38), and in the revision arthroplasty patients 26,733 (N = 67). The main contributing costs were related to the primary surgery, admission days, physical therapy, and revision surgeries. The main determinant was the costs of admission to a rehabilitation center/nursing home. Costs were specifically high in elderly with comorbidity, who were less independent pre-fracture, and have a longer admission to the hospital and/or a nursing home. Costs were also higher in revision surgery patients. The 2-years follow-up costs in our study were comparable to published costs

Improving consent in patients undergoing surgery for fractured neck of femur.

PubMed

Thiruchandran, Gajendiran; McKean, Andrew R; Rudran, Branavan; Imam, Mohamed A; Yeong, Keefai; Hassan, Abdel

2018-05-02

Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of

Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures.

PubMed

Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

2016-01-01

When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years) and mean followup period was 52.1 months (range 27-72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study.

PubMed

Yuenyongviwat, Varah; Tuntarattanapong, Pakjai; Tangtrakulwanich, Boonsin

2016-01-11

Internal fixation is one treatment for femoral neck fracture. Some devices and techniques reported improved accuracy and decreased fluoroscopic time. However, these are not widely used nowadays due to the lack of available special instruments and techniques. To improve the surgical procedure, the authors designed a new adjustable drill guide and tested the efficacy of the device. The authors developed a new adjustable drill guide for cannulated screw guide wire insertion for multiple screw fixation. Eight orthopaedic surgeons performed the experimental study to evaluate the efficacy of this device. Each surgeon performed guide wire insertion for multiple screw fixation in six synthetic femurs: three times with the new device and three times with the conventional technique. The fluoroscopic time, operative time and surgeon satisfaction were evaluated. In the operations with the new adjustable drill guide, the fluoroscopic and operative times were significantly lower than the operations with the conventional technique (p < 0.05). The mean score for the level of satisfaction of this device was also statistically significantly better (p = 0.02) than the conventional technique. The fluoroscopic and operative times with the new adjustable drill guide were reduced for multiple screw fixation of femoral neck fracture and the satisfaction of the surgeons was good.

Another fractured neck of femur: do we need a lateral X-ray?

PubMed

Almazedi, B; Smith, C D; Morgan, D; Thomas, G; Pereira, G

2011-05-01

This study aimed to define the role of the lateral X-ray in the assessment and treatment planning of proximal femoral fractures. Occult fractures were not included. Radiographs from 359 consecutive patients with proximal femoral fractures admitted to our emergency department over a 12 month period were divided into anteroposterior (AP) views and lateral views. Three blinded reviewers independently assessed the radiographs, first AP views alone then AP plus lateral views, noting the fracture classification for each radiograph. These assessments were then compared with the intra-operative diagnosis, which was used as the gold standard. A 2 × 2 contingency square table was created and Pearson's χ(2) test was used for statistical analysis. The rate of correct classification by the reviewers was improved by the assessment of the lateral X-ray in addition to the AP view for intracapsular fractures (p<0.013) but not for extracapsular fractures (p=0.27). However, the only advantage obtained by assessing the lateral view in intracapsular fractures was the detection of displacement where the fracture appeared undisplaced on the initial AP view. This study provides statistical evidence that one view is adequate and safe for the majority of hip fractures. The lateral radiograph should not be performed routinely in order to make considerable savings in money and time and to avoid unnecessary patient discomfort.

Femoral Head Avascular Necrosis Is Not Caused by Arthroscopic Posterolateral Femoroplasty.

PubMed

Rupp, Robert E; Rupp, Sasha N

2016-05-01

This study was conducted to identify the risk of avascular necrosis of the femoral head after arthroscopic femoroplasty extending to the posterolateral femoral neck, the source of the primary blood supply to the femoral head. Cam lesions of femoroacetabular impingement are typically anterior along the junction of the femoral head and neck. However, anatomic variations can involve the posterolateral vascular region of the femoral head and neck. Femoroplasty involving this vascular region can lead to injury to the blood supply to the femoral head, with subsequent avascular necrosis. If the posterolateral portion of the cam lesion is preserved, persistent femoroacetabular impingement may occur. A retrospective review identified 112 patients who underwent arthroscopic femoroplasty for femoroacetabular impingement over a 2-year period. Of these patients, 14 had femoroplasty that extended to the posterolateral femoral head. Of this group, 5 had undergone magnetic resonance imaging (MRI) after femoroplasty and the other 9 were contacted to undergo MRI of the hip to evaluate for avascular necrosis. A radiologist and the senior author evaluated all MRI scans specifically for avascular necrosis of the femoral head. All procedures were performed by the senior author. Mean age of the 14 patients (8 women and 6 men) with femoroplasty that extended into the posterolateral vascular region of the femoral head was 44 years (range, 23-69 years). All 14 patients underwent MRI evaluation of the affected hip a mean of 25 months (range, 7-44 months) after femoroplasty. No MRI scans showed evidence of avascular necrosis of the femoral head. Femoroplasty of the posterolateral vascular region of the femoral head is not associated with avascular necrosis. Patients with femoroacetabular impingement and a cam lesion extending to the posterolateral femoral head can undergo femoroplasty of this region without the development of avascular necrosis. [Orthopedics. 2016; 39(3):177-180.]. Copyright

Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes: Analysis of the prospective multi-center study of hip fracture outcomes in China (SHOC).

PubMed

Slobogean, Gerard P; Stockton, David J; Zeng, Bing-Fang; Wang, Dong; Ma, Baotong; Pollak, Andrew N

2017-08-01

Young femoral neck fracture patients require surgical fixation to preserve the native hip joint and accommodate increased functional demands. Recent reports have identified a high incidence of fracture shortening and this may have negative functional consequences. We sought to determine if fracture shortening is associated with poor functional outcome in young femoral neck fracture patients. One hundred and forty-two patients with femoral neck fractures age 18-55 were recruited in this prospective cohort study across three Level 1 trauma hospitals in Mainland China. Patient-reported and objective functional outcomes were measured with the Harris Hip Score (HHS), Timed Up and Go (TUG), and SF-36 Physical Component Summary (SF-36 PCS) at 12 months. Radiographic fracture shortening was measured along the long axis of the femoral neck and corrected for magnification. Severe shortening was defined as ≥10mm. The primary analysis measured associations between severe radiographic shortening and HHS at one-year post-fixation. One hundred and two patients had complete radiographic and functional outcomes available for analysis at one year. The mean age of participants was 43.7±10.8years and 53% were male. Fifty-five percent of fractures were displaced and 37% were vertically orientated (Pauwels Type 3). The mean functional outcome scores were: HHS 90.0±10.8, TUG 12.0±5.1s, and PCS 48.5±8.6. Severe shortening occurred in 13% of patients and was associated with worse functional outcome scores: HHS mean difference 9.9 (p=0.025), TUG mean difference 3.2s (p=0.082), and PCS mean difference 5.4 (p=0.055). Severe shortening is associated with clinically important decreases in functional outcome as measured by HHS following fixation of young femoral neck fractures, occurring in 13% of patients in this population. The principle of fracture site compression utilized by modern constructs may promote healing; however, excessive shortening is associated with worse patient

Impact of frailty on outcomes in geriatric femoral neck fracture management: An analysis of national surgical quality improvement program dataset.

PubMed

Dayama, Anand; Olorunfemi, Odunayo; Greenbaum, Simon; Stone, Melvin E; McNelis, John

2016-04-01

Frailty is a clinical state of increased vulnerability resulting from aging-associated decline in physiologic reserve. Hip fractures are serious fall injuries that affect our aging population. We retrospectively sought to study the effect of frailty on postoperative outcomes after Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) for femoral neck fracture in a national data set. National Surgical Quality Improvement Project dataset (NSQIP) was queried to identify THA and HA for a primary diagnosis femoral neck fracture using ICD-9 codes. Frailty was assessed using the modified frailty index (mFI) derived from the Canadian Study of Health and Aging. The primary outcome was 30-day mortality and secondary outcomes were 30-day morbidity and failure to rescue (FTR). We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for confounders. Of 3121 patients, mean age of patients was 77.34 ± 9.8 years. The overall 30-day mortality was 6.4% (3.2%-THA and 7.2%-HA). One or more severe complications (Clavien-Dindo class-IV) occurred in 7.1% patients (6.7%-THA vs.7.2%-HA). Adjusted odds ratios (ORs) for mortality in the group with the higher than median frailty score were 2 (95%CI, 1.4-3.7) after HA and 3.9 (95%CI, 1.3-11.1) after THA. Similarly, in separate multivariate analysis for Clavien-Dindo Class-IV complications and failure to rescue 1.6 times (CI95% 1.15-2.25) and 2.1 times (CI95% 1.12-3.93) higher odds were noted in above median frailty group. mFI is an independent predictor of mortality among patients undergoing HA and THA for femoral neck fracture beyond traditional risk factors such as age, ASA class, and other comorbidities. Level II. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

The Direct Anterior Approach Does Not Increase Return to Function Following Hemiarthroplasty for Femoral Neck Fracture.

PubMed

Carlson, Victor R; Ong, Alvin C; Orozco, Fabio R; Lutz, Rex W; Duque, Andres F; Post, Zachary D

2017-11-01

The purpose of this study was to evaluate functional outcomes for hemiarthroplasty using a direct anterior approach or a direct lateral approach for femoral neck fracture. This retrospective review used data collected from a single institution between 2006 and 2016. Eighty-five and 75 consecutive patients who underwent hemiarthroplasty via a direct anterior approach and a direct lateral approach, respectively, met inclusion criteria. All patients with femoral neck fractures were treated by 1 of 2 fellowship-trained orthopedic surgeons using the direct anterior approach or the direct lateral approach to hemiarthroplasty. Disposition, ambulation, and other perioperative surgical outcomes were compared between the cohorts. Compared with the direct lateral cohort, the direct anterior cohort had a shorter mean operative time (2.4 minutes, P<.01), a shorter mean length of hospital stay (2.7 days, P<.01), and a smaller mean decrease in hemoglobin postoperatively (0.7 g/dL, P<.01). No significant difference was observed between the cohorts for postoperative disposition, the number of feet ambulated on the second postoperative day, or the prevalence of ambulatory decline at 4- to 6-week and 4- to 6-month follow-up visits. Compared with the direct lateral approach, the direct anterior approach may benefit patients by small, but statistically significant, improvements in blood loss, surgical time, and length of hospital stay after hemiarthroplasty. However, the direct anterior approach does not appear to decrease the likelihood of transfer to a skilled nursing facility postoperatively or accelerate return to preoperative function. [Orthopedics. 2017; 40(6):e1055-e1061.]. Copyright 2017, SLACK Incorporated.

Radiology of adolescent slipped capital femoral epiphysis: measurement of epiphyseal angles and diagnosis.

PubMed

Gekeler, Jörg

2007-10-01

AIMS OF DIAGNOSTIC RADIOGRAPHY: Visualization of the proximal femur in two clearly defined projections. Radiologic and morphological diagnosis of slipped capital femoral epiphysis. Evaluation of the stability of the femoral epiphysis: chronic slippage or acute interruption of continuity between the femoral epiphysis and the femoral neck metaphysis. Radiometric measurement of the spatial deformity of the femoral epiphysis. Measurement of the projected epiphyseal angle on the radiograph as the basis for possible conversion into anatomically correct angles at the proximal femur. Preoperative planning of therapeutic surgical procedures. Idiopathic hip pain in the growing child or adolescent. Referred pain to the knee or thigh. Unusual gait pattern with external rotation deformity of the leg, limping that favors one leg or limping due to leg length discrepancy. Abnormal sonography, CT or MRI findings. Eventful history including minor injury or genuine trauma. Symptoms and uncommon physical constitution: obesity, exceptional longitudinal growth of the extremities, and absence of secondary sex characteristics. Indications for Radiographic Imaging of the Hip Joint in Two Planes None. Standard positioning of the patient or the affected extremity. First standard radiograph: proximal femur in anteroposterior projection. Position of the leg with the patella directed anteriorly. Contraction of the external rotators at the hip joint is compensated by elevation of the hip until the leg is in the neutral position. Second standard radiograph: axial view of the proximal femur in anteroposterior projection. Leg flexed to 90 degrees at the hip and in 45 degrees abduction. Thigh position parallel to the longitudinal axis of the table (zero rotation). Early signs of incipient or imminent femoral epiphyseolysis: --Disintegration, widening and blurred margins of the epiphyseal plate. --Increasing loss of height of the femoral epiphysis due to incipient dislocation. --The tangent to the

Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture.

PubMed

Kang, Jeong Hoon; Lee, Sang Hong; Jung, Sung

2015-12-01

The current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry. Seventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis. At the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C. Bipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture.

Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems.

PubMed

Barlow, Brian T; Assini, Joseph; Boles, John; Lee, Yuo-Yu; Westrich, Geoffrey H

2015-07-01

Elevated serum metal ions have been well documented with the Rejuvenate modular neck femoral stem (Stryker, Mahwah, NJ); however, the rate at which ion levels decline following revision is less clear. This study included fifty-nine consecutive revisions of Rejuvenate stems for symptomatic ALTR. Blood tests prior to revision and postoperatively at 6weeks, 3months, 6months, and 1year measured serum cobalt and chromium concentrations, ESR, and CRP. At six weeks following revision of a unilateral Rejuvenate, cobalt and chromium levels dropped from preoperative levels by 67% and 42%, respectively. At three months, cobalt levels declined to 19% of preoperative values, but chromium levels remained stable. With this information, surgeons can set realistic expectations for serum metal ion levels following Rejuvenate stem revision. Published by Elsevier Inc.

Anatomic compatibility of femoral intramedullary implants: a cadaveric study.

PubMed

Biçer, Ömer Sunkar; Huri, Gazi; Tekin, Mustafa; Mirioğlu, Akif; Aydın, Ahmet; Tan, İsmet

2016-01-01

The purpose of this study was to describe the morphology of the proximal and diaphysis of femur, distribution of neck version, neck-shaft angles, and radius of anterior curvature in a Turkish population to compare with that of femoral intramedullary implants. Using 84 cadaveric femora, three-dimensional (3D) modeling was performed with a light scanner, data were transferred to Solidworks 2013 software (Solidworks, Waltham, MA, USA) to determine the variability in the femoral length (FL), neck version, neck-shaft angle (NSA), and anterior bow. Three independent observers' measurements were tested with a reliability analysis and then evaluated using Cronbach's alpha value, after which they were compared with the neck-shaft angles, and the radii of curvature (RAC) of intramedullary femoral nails, as stated on the official manufacturer websites. Mean FL, femoral neck anteversion (FNA), and NSA had ranges of 346.1-454.1 mm, -11.3-40.4°, and 105.9-149.0°, respectively, and RAC was between 1.0 and 1.2 m. The correlation coefficient and 95% confidence intervals (CI) were 0.89 (CI 0.849-0.928), 0.86 (CI 0.799-0.904), and 0.85 (95% CI 0.785-0.898) for FL, FNA, and NSA, respectively. FNA was <10° in 32 femora (37.6%) and >14° 38 (44.7%). NSA was between 130° and 135° in 40 femora (47.1%), and RAC ranged from 0.5 to 1.5 m in 76 femora (91.6%), <1 m in 38 (45.8%), and >1.5 m in 7 (8.4%). FNA and NSA show a wide distribution, mostly out of the range of intramedullary implants. There is a need for implants that are compatible with a range of NSAs and versions, so that they are suitable for use with a variety of morphologies.

Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures.

PubMed

Bhandari, Mohit; Tornetta, Paul; Ellis, Thomas; Audige, Laurent; Sprague, Sheila; Kuo, Jonathann C; Swiontkowski, Marc F

2004-01-01

There have been a number of non-randomized studies comparing arthroplasty with internal fixation in patients with femoral neck fractures. However, there remains considerable debate about whether the results of non-randomized studies are consistent with the results of randomized, controlled trials. Given the economic burden of hip fractures, it remains essential to identify therapies to improve outcomes; however, whether data from non-randomized studies of an intervention should be used to guide patient care remains unclear. We aimed to determine whether the pooled results of mortality and revision surgery among non-randomized studies were similar to those of randomized trials in studies comparing arthroplasty with internal fixation in patients with femoral neck fractures. We conducted a Medline search from 1969 to June 2002, identifying both randomized and non-randomized studies comparing internal fixation with arthroplasty in patients with femoral neck fractures. Additional strategies to identify relevant articles included Cochrane database, SCISEARCH, textbooks, annual meeting programs, and content experts. We abstracted information on mortality and revision rates in each study and compared the pooled results between non-randomized and randomized studies. In addition, we explored potential reasons for dissimilar results between the two study designs. We identified 140 citations that addressed the general topic of comparison of arthroplasty and internal fixation for hip fracture. Of these, 27 studies met the eligibility criteria, 13 of which were non-randomized studies and 14 of which were randomized trials. Mortality data was available in all 13 non-randomized studies ( n=3108 patients) and in 12 randomized studies ( n=1767 patients). Non-randomized studies overestimated the risk of mortality by 40% when compared with the results of randomized trials (relative risk 1.44 vs 1.04, respectively). Information on revision risk was available in 9 non-randomized studies

Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008–2013) in Kyoto prefecture, Japan

PubMed Central

Horii, Motoyuki; Fujiwara, Hiroyoshi; Mikami, Yasuo; Ikeda, Takumi; Ueshima, Keiichiro; Ikoma, Kazuya; Shirai, Toshiharu; Nagae, Masateru; Oka, Yoshinobu; Sawada, Koshiro; Kuriyama, Nagato; Kubo, Toshikazu

2016-01-01

Summary Background The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period. Methods Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain. Results There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had “uncertain” as the cause of injury than trochanteric fracture in all age groups. Conclusions Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures. PMID:27252738

An unusual complication of combined gonioscopy-assisted transluminal trabeculotomy and phacoemulsification: vision loss due to intracapsular hematoma.

PubMed

Yalinbas, Duygu; Aktas, Zeynep; Hepsen, İbrahim; Dilekmen, Nilay

2017-09-23

To report two cases with an acute vision loss due to intracapsular hemorrhage (hematoma) after an uncomplicated gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification surgery. Case report. Seventy-six-year-old male and 75-year-old female patients with cataract and pseudoexfoliative glaucoma (XFG) uncontrolled with maximum medical therapy both underwent GATT combined with phacoemulsification. Shortly after the surgery, intracapsular hematoma behind the intraocular lens (IOL) were noted in both patients. Hematoma cleared in both of them via IOL extraction-anterior vitrectomy and YAG-laser capsulotomy, respectively. Hematoma cleared in both patients without any surgical complications. Vision loss due to unclearing intracapsular hematoma might be an early complication of combined GATT and phacoemulsification surgery.

The natural alpha angle of the femoral head-neck junction.

PubMed

Gollwitzer, H; Suren, C; Strüwind, C; Gottschling, H; Schröder, M; Gerdesmeyer, L; Prodinger, P M; Burgkart, R

2018-05-01

Aims Asphericity of the femoral head-neck junction is common in cam-type femoroacetabular impingement (FAI) and usually quantified using the alpha angle on radiographs or MRI. The aim of this study was to determine the natural alpha angle in a large cohort of patients by continuous circumferential analysis with CT. Methods CT scans of 1312 femurs of 656 patients were analyzed in this cross-sectional study. There were 362 men and 294 women. Their mean age was 61.2 years (18 to 93). All scans had been performed for reasons other than hip disease. Digital circumferential analysis allowed continuous determination of the alpha angle around the entire head-neck junction. All statistical tests were conducted two-sided; a p-value < 0.05 was considered statistically significant. Results The mean maximum alpha angle for the cohort was 59.0° (sd 9.4). The maximum was located anterosuperiorly at 01:36 on the clock face, with two additional maxima of asphericity at the posterior and inferior head-neck junction. The mean alpha angle was significantly larger in men (59.4°, sd 8.0) compared with women (53.5°, sd 7.4°; p = 0.0005), and in Caucasians (60.7°, sd 9.0°) compared with Africans (56.3°, sd 8.0; p = 0.007) and Asians (50.8°, sd 7.2; p = 0.0005). The alpha angle showed a weak positive correlation with age (p < 0.05). If measured at commonly used planes of the radially reconstructed CT or MRI, the alpha angle was largely underestimated; measurement at the 01:30 and 02:00 positions showed a mean underestimation of 4° and 6°, respectively. Conclusion This study provides important data on the normal alpha angle dependent on age, gender, and ethnic origin. The normal alpha angle in men is > 55°, and this should be borne in mind when making a diagnosis of cam-type morphology. Cite this article: Bone Joint J 2018;100-B:570-8.

Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for elderly patients with a femoral neck fracture.

PubMed

Burgers, Paul T P W; Poolman, Rudolf W; Van Bakel, Theodorus M J; Tuinebreijer, Wim E; Zielinski, Stephanie M; Bhandari, Mohit; Patka, Peter; Van Lieshout, Esther M M

2015-05-06

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older. The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%). The WOMAC showed good

Corail uncemented hemiarthroplasty with a Cathcart head for intracapsular hip fractures.

PubMed

Kendrick, B J L; Wilson, H A; Lippett, J E; McAndrew, A R; Andrade, A J M D

2013-11-01

The National Institute for Health and Clinical Excellence (NICE) guidelines from 2011 recommend the use of cemented hemi-arthroplasty for appropriate patients with an intracapsular hip fracture. In our institution all patients who were admitted with an intracapsular hip fracture and were suitable for a hemi-arthroplasty between April 2010 and July 2012 received an uncemented prosthesis according to our established departmental routine practice. A retrospective analysis of outcome was performed to establish whether the continued use of an uncemented stem was justified. Patient, surgical and outcome data were collected on the National Hip Fracture database. A total of 306 patients received a Cathcart modular head on a Corail uncemented stem as a hemi-arthroplasty. The mean age of the patients was 83.3 years (SD 7.56; 46.6 to 94) and 216 (70.6%) were women. The mortality rate at 30 days was 5.8%. A total of 46.5% of patients returned to their own home by 30 days, which increased to 73.2% by 120 days. The implant used as a hemi-arthroplasty for intracapsular hip fracture provided satisfactory results, with a good rate of return to pre-injury place of residence and an acceptable mortality rate. Surgery should be performed by those who are familiar with the design of the stem and understand what is required for successful implantation.

Diffusion tensor imaging and magnetic resonance spectroscopy assessment of cancellous bone quality in femoral neck of healthy, osteopenic and osteoporotic subjects at 3T: Preliminary experience.

PubMed

Manenti, Guglielmo; Capuani, Silvia; Fanucci, Ezio; Assako, Elie Parfait; Masala, Salvatore; Sorge, Roberto; Iundusi, Riccardo; Tarantino, Umberto; Simonetti, Giovanni

2013-07-01

We assessed the potential of diffusion tensor imaging (DTI) in combination with proton magnetic resonance spectroscopy (1H-MRS), in cancellous bone quality evaluation of the femoral neck in postmenopausal women. DTI allows for non-invasive microarchitectural characterization of heterogeneous tissue. In this work we hypothesized that DTI parameters mean diffusivity (MD) and fractional anisotropy (FA) of bone marrow water, can provide information about microstructural changes that occur with the development of osteoporosis disease. Because osteoporosis is associated with increased bone marrow fat content, which in principal can alter DTI parameters, the goal of this study was to examine the potential of MD and FA, in combination with bone marrow fat fraction (FF), to discriminate between healthy, osteopenic and osteoporotic subjects, classified according to DXA criteria. Forty postmenopausal women (mean age, 68.7 years; range 52-81 years), underwent a Dual-energy X-ray absorptiometry (DXA) examination in femoral neck, to be classified as healthy (n=12), osteopenic (n=14) and osteoporotic (n=14) subjects. 1H-MRS and DTI (with b value=2500 s/mm2) of femoral neck were obtained in each subject at 3T. The study protocol was approved by local Ethics Committee. MD, FA, FF and MD/FF, FA/FF were obtained and compared among the three bone-density groups. One-way ANOVA with multiple comparisons Bonferroni test and Pearson correlation analysis were applied. Receiver operating characteristic (ROC) curve analysis was also performed. Reproducibility of DTI measures was satisfactory. CV was approximately 2%-3% for MD and 4%-5% for FA measurements. Moreover, no significant difference was found in both MD and FA measurements between two separate sessions (median 34 days apart) comprised of six healthy volunteers. FF was able to discriminate between healthy and osteoporotic subjects only. Conversely MD and FA were able to discriminate healthy from osteopenic and healthy from

Nurse egg consumption and intracapsular development in the common whelk Buccinum undatum (Linnaeus 1758)

NASA Astrophysics Data System (ADS)

Smith, Kathryn E.; Thatje, Sven

2013-03-01

Intracapsular development is common in marine gastropods. In many species, embryos develop alongside nurse eggs, which provide nutrition during ontogeny. The common whelk Buccinum undatum is a commercially important North Atlantic shallow-water gastropod. Development is intracapsular in this species, with individuals hatching as crawling juveniles. While its reproductive cycle has been well documented, further work is necessary to provide a complete description of encapsulated development. Here, using B. undatum egg masses from the south coast of England intracapsular development at 6 °C is described. Number of eggs, veligers and juveniles per capsule are compared, and nurse egg partitioning, timing of nurse egg consumption and intracapsular size differences through development are discussed. Total development took between 133 and 140 days, over which 7 ontogenetic stages were identified. The number of both eggs and veligers were significantly related to capsule volume, with approximately 1 % of eggs developing per capsule. Each early veliger consumed nurse eggs rapidly over just 3-7 days. Within each capsule, initial development was asynchronous, but it became synchronous during the veliger stage. No evidence for cannibalism was found during development, but large size differences between embryos developing within each capsule were observed, and occasionally `empty' veligers were seen, which had not successfully consumed any nurse eggs. These results indicate a high level of competition for nurse eggs within each capsule during development in the common whelk. The initial differences observed in nurse egg uptake may affect individual predisposition in later life.

Postoperative fever after hemiarthroplasty in elderly patients over 70 years of age with displaced femoral neck fracture: Necessity of routine workup?

PubMed

Yoo, Je-Hyun; Kim, Ki-Tae; Kim, Tae-Young; Hwang, Ji-Hyo; Chang, Jun-Dong

2017-02-01

Displaced femoral neck fracture in elderly patients has been treated with hemiarthroplasty as the treatment of choice. Fever following HA is common in these elderly patients. The aim of this study was to determine which post-HA fever workup could be beneficial in this group of patients. A total of 272 consecutive patients aged ≥70 years undergoing HA for displaced femoral neck fracture were retrospectively investigated. Postoperative fever (POF) was defined as any recorded body temperature ≥38°C in the early postoperative period. POF in each patient was characterized by the maximum temperature, the day of the first fever, and frequency of fever, stratified as either single or multiple fever spikes. Medical records were reviewed to identify positive fever workups and febrile complications. Of 272 patients, 135 (49.6%) developed POF. A total of 428 routine diagnostic tests were performed in all patients with POF, of which only 57 tests (13.3%) were positive. Urinalysis showed the highest positive rate (21.9%), followed by urine culture (14.3%), chest x-ray (12.6%), and blood culture (1.1%). The most common febrile complication was pneumonia (12.6%), followed by urinary tract infection (8.1%). On multivariate logistic regression for positive workups, only fever after postoperative day (POD) 2 was a risk factor for positive chest x-ray (OR 3.86, p=0.016) and urine culture (OR 5.04, p=0.019). Moreover, fever after POD 2 (OR 6.93, p<0.0001) and multiple fever spikes (OR 2.92, p=0.026) were independent predictors of infectious febrile complications. Routine workup for POF following hemiarthroplasty in elderly patients with displaced femoral neck fracture is not warranted. However, for fever after POD 2 and multiple fever spikes, chest x-ray and urinalysis would be necessary to rule out the two most common febrile complications such as pneumonia and urinary tract infection. Copyright © 2016 Elsevier Ltd. All rights reserved.

The relationship between body composition and femoral neck osteoporosis or osteopenia in adults with previous poliomyelitis.

PubMed

Chang, Kwang-Hwa; Tseng, Sung-Hui; Lin, Yu-Ching; Lai, Chien-Hung; Hsiao, Wen-Tien; Chen, Shih-Ching

2015-04-01

Articles in the literature describing the association between body composition and osteoporosis in subjects with poliomyelitis are scarce. To assess the relationship between body composition and femoral neck osteoporosis or osteopenia in adults with previous polio. After excluding postmenopausal women, 44 polio (mean age ± standard deviation, 46.1 ± 3.3 years) and 44 able-bodied control volunteers (47.0 ± 4.0 years) participated in the study. Each participant's femoral neck bone mineral density (FNBMD) and whole body composition were measured using dual-energy X-ray absorptiometry. With local reference BMD values of normal young adults installed in the instrument, we obtained T-score values that depended on each FNBMD value. A T-score value of ≤-1.0 indicated decreased T-score, including osteoporosis (T-score ≤ -2.5) and osteopenia (-1.0 to -2.5). This study conducted logistic regression analyses to find factors associated with osteoporosis and osteopenia. Based on the FNBMD T-score values, 60.0% of middle-aged men with polio had osteoporosis. In adjusted logistic regression analyses, total lean tissue mass (Adjusted odds ratio [95% confidence interval], 0.74 [0.56-0.99], P < 0.05) and male gender (947.16 [6.02-148,926.16], P < 0.01) were important factors associated with decreased T-score in polio group. Osteoporosis or osteopenia is a common medical problem for middle-aged men with polio. Reduced total lean tissue mass seems to be one of the important factors associated with osteoporosis or osteopenia among subjects with polio. Further research for a clinical tool to assess lean tissue mass for subjects with polio is needed. Copyright © 2015 Elsevier Inc. All rights reserved.

The tridimensional geometry of the proximal femur should determine the design of cementless femoral stem in total hip arthroplasty.

PubMed

Wegrzyn, Julien; Roux, Jean-Paul; Loriau, Charlotte; Bonin, Nicolas; Pibarot, Vincent

2018-02-22

Using a cementless femoral stem in total hip arthroplasty (THA), optimal filling of the proximal femoral metaphyseal volume (PFMV) and restoration of the extramedullary proximal femoral (PF) parameters (i.e., femoral offset (FO), neck length (FNL), and head height (FHH)) constitute key goals for optimal hip biomechanics, functional outcome, and THA survivorship. However, almost 30% of mismatch between the PF anatomy and implant geometry of the most widely implanted non-modular cementless femoral stem has been demonstrated in a computed tomography scan (CT scan) study. Therefore, this anatomic study aimed to evaluate the relationship between the intra- and extramedullary PF parameters using tridimensional CT scan reconstructions. One hundred fifty-one CT scans of adult healthy hips were obtained from 151 male Caucasian patients (mean age = 66 ± 11 years) undergoing lower limb CT scan arteriography. Tridimensional PF reconstructions and parameter measurements were performed using a corrected PF coronal plane-defined by the femoral neck and diaphyseal canal longitudinal axes-to avoid influence of PF helitorsion and femoral neck version on extramedullary PF parameters. Independently of the femoral neck-shaft angle, the PFMV was significantly and positively correlated with the FO, FNL, and FHH (r = 0.407 to 0.420; p < 0.0001). This study emphasized that the tridimensional PF geometry measurement in the corrected coronal plane of the femoral neck can be useful to determine and optimize the design of a non-modular cementless femoral stem. Particularly, continuous homothetic size progression of the intra- and extramedullary PF parameters should be achieved to assure stem fixation and restore anatomic hip biomechanics.

Clinical accuracy of a patient-specific femoral osteotomy guide in minimally-invasive posterior hip arthroplasty.

PubMed

Schneider, Adrian K; Pierrepont, Jim W; Hawdon, Gabrielle; McMahon, Stephen

2018-04-01

Patient specific guides can be a valuable tool in improving the precision of planned femoral neck osteotomies, especially in minimally invasive hip surgery, where bony landmarks are often inaccessible. The aim of our study was to validate the accuracy of a novel patient specific femoral osteotomy guide for THR through a minimally invasive posterior approach, the direct superior approach (DSA). As part of our routine preoperative planning 30 patients underwent low dose CT scans of their arthritic hip. 3D printed patient specific femoral neck osteotomy guides were then produced. Intraoperatively, having cleared all soft tissue from the postero-lateral neck of the enlocated hip, the guide was placed and pinned onto the posterolateral femoral neck. The osteotomy was performed using an oscillating saw and the uncemented hip components were implanted as per routine. Postoperatively, the achieved level of the osteotomy at the medial calcar was compared with the planned level of resection using a 3D/2D matching analysis (Mimics X-ray module, Materialise, Belgium). A total of 30 patients undergoing uncemented Trinity™ acetabular and TriFit TS™ femoral component arthroplasty (Corin, UK) were included in our analysis. All but one of our analysed osteotomies were found to be within 3 mm from the planned height of osteotomy. In one patient the level of osteotomy deviated 5 mm below the planned level of resection. Preoperative planning and the use of patient specific osteotomy guides provides an accurate method of performing femoral neck osteotomies in minimally invasive hip arthroplasty using the direct superior approach. IV (Case series).

Femoral neck stress fracture in a female athlete: a case report

PubMed Central

Avrahami, Daniel; Pajaczkowski, Jason A.

2012-01-01

Objective The purpose of this case report is to describe chiropractic rehabilitation of a master's-level athlete with proximal femoral stress fracture and provide a brief discussion of stress fracture pathology. Clinical Features A 41-year-old female master's-level endurance athlete presented with chronic groin pain later diagnosed and confirmed by magnetic resonance imaging as a stress fracture of the femoral neck. After diagnosis, the patient was referred to a doctor of chiropractic at week 1 of the non–weight-bearing physical rehabilitation process. At that time, the patient presented with sharp and constant groin pain rated 6/10 on a numeric rating scale. Intervention and Outcome This patient avoided weight-bearing activity for 8 weeks while cross-training and was able to return to her sport after this period. The patient was progressed through a series of non–weight-bearing strengthening exercises for the lower extremity. Myofascial release therapy was performed on the gluteal, hip flexor, and groin muscle groups to improve range of motion. Motion palpation testing the lumbar and sacroiliac joints was performed during each session, and manipulative therapy was performed when necessary. The patient was seen once a week for 8 weeks. Reevaluation was performed at week 8; at that time, the patient reported no groin pain (0/10). The patient was discharged from care and referred back to the supervising physician for clearance to return to sporting activities. One month after discharge, she reported that she was pain free and had fully returned to sport activities. Conclusion This case report demonstrates the importance of a through clinical history, physical examination, and magnetic resonance imaging in the accurate diagnosis of a patient with chronic groin pain and that chiropractic care can contribute to rehabilitation programs for these injuries. PMID:23843760

An analysis of factors affecting the mercury content in the human femoral bone.

PubMed

Zioła-Frankowska, A; Dąbrowski, M; Kubaszewski, Ł; Rogala, P; Kowalski, A; Frankowski, M

2017-01-01

The study was carried out to determine the content of mercury in bone tissue of the proximal femur (head and neck bone) of 95 patients undergoing total hip replacement due to osteoarthritis, using CF-AFS analytical technique. Furthermore, the investigations were aimed at assessing the impact of selected factors, such as age, gender, tobacco smoking, alcohol consumption, exposure to chemical substance at work, type of degenerative changes, clinical evaluation and radiological parameters, type of medications, on the concentration of mercury in the head and neck of the femur, resected in situ. Mercury was obtained in all samples of the head and neck of the femur (n = 190) in patients aged 25-91 years. The mean content of mercury for the whole group of patients was as follows: 37.1 ± 35.0 ng/g for the femoral neck and 24.2 ± 19.5 ng/g for the femoral head. The highest Hg contents were found in femoral neck samples, both in women and men, and they amounted to 169.6 and 176.5 ng/g, respectively. The research showed that the mercury content of bones can be associated with body mass index, differences in body anatomy, and gender. The uses of statistical analysis gave the possibility to define the influence of factors on mercury content in human femoral bones.

Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique.

PubMed

Nousiainen, Markku T; Omoto, Daniel M; Zingg, Patrick O; Weil, Yoram A; Mardam-Bey, Sami W; Eward, William C

2013-02-01

: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement. Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other. The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful

Traumatic Extra-capsular and Intra-capsular Floating Fat: Fat-fluid Levels of the Knee Revisited

PubMed Central

Davis, Derik L; Vachhani, Prasann

2015-01-01

Floating fat is a sign of acute bone injury at the knee following trauma. The goal of this article is to review the etiology, patterns, and mimickers of extra-capsular and intra-capsular floating fat, with the major emphasis on knee trauma in the acute setting. We will discuss the spectrum of multimodal imaging findings for rare presentations of extra-capsular floating fat, and contrast these with common and atypical forms of intra-capsular lipohemarthrosis, as an aid to the assessment of acute bone trauma at the knee. PMID:26713176

Effect of once-yearly zoledronic acid five milligrams on fracture risk and change in femoral neck bone mineral density.

PubMed

Eastell, Richard; Black, Dennis M; Boonen, Steven; Adami, Silvano; Felsenberg, Dieter; Lippuner, Kurt; Cummings, Steven R; Delmas, Pierre D; Palermo, Lisa; Mesenbrink, Peter; Cauley, Jane A

2009-09-01

In the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly - Pivotal Fracture Trial (HORIZON-PFT), zoledronic acid (ZOL) 5 mg significantly reduced fracture risk. The aim of the study was to identify factors associated with greater efficacy during ZOL 5 mg treatment. We conducted a subgroup analysis (preplanned and post hoc) of a multicenter, double-blind, placebo-controlled, 36-month trial in 7765 women with postmenopausal osteoporosis. A single infusion of ZOL 5 mg or placebo was administered at baseline, 12, and 24 months. Primary endpoints were new vertebral fracture and hip fracture. Secondary endpoints were nonvertebral fracture and change in femoral neck bone mineral density (BMD). Baseline risk factor subgroups were age, BMD T-score and vertebral fracture status, total hip BMD, race, weight, geographical region, smoking, height loss, history of falls, physical activity, prior bisphosphonates, creatinine clearance, body mass index, and concomitant osteoporosis medications. Greater ZOL induced effects on vertebral fracture risk were seen with younger age (treatment-by-subgroup interaction, P = 0.05), normal creatinine clearance (P = 0.04), and body mass index >or= 25 kg/m(2) (P = 0.02). There were no significant treatment-factor interactions for hip or nonvertebral fracture or for change in BMD. ZOL appeared more effective in preventing vertebral fracture in younger women, overweight/obese women, and women with normal renal function. ZOL had similar effects irrespective of fracture risk factors or femoral neck BMD.

Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up.

PubMed

Berggren, M; Stenvall, M; Olofsson, B; Gustafson, Y

2008-06-01

A randomized, controlled fall-prevention study including 199 patients operated on for femoral neck fracture reduced inpatient falls and injuries. No statistically significant effects of the intervention program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone old people. This study evaluates whether a postoperative multidisciplinary, multifactorial fall-prevention program performed by a geriatric team that reduced inpatient falls and injuries had any continuing effect after discharge. The intervention consisted of staff education, systematic assessment and treatment of fall risk factors and vitamin D and calcium supplementation. The randomized, controlled trial with a one-year follow-up at Umeå University Hospital, Sweden, included 199 patients operated on for femoral neck fracture, aged > or = 70 years. After one year 44 participants had fallen 138 times in the intervention group compared with 55 participants and 191 falls in the control group. The crude postoperative fall incidence was 4.16/1,000 days in the intervention group vs. 6.43/1,000 days in the control group. The incidence rate ratio was 0.64 (95% CI: 0.40-1.02, p = 0.063). Seven new fractures occurred in the intervention group and 11 in the control group. A team applying comprehensive geriatric assessment and rehabilitation, including prevention and treatment of fall-risk factors, reduced inpatient falls and injuries, but no statistically significant effects of the program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone elderly.

FGF2 and FAM201A affect the development of osteonecrosis of the femoral head after femoral neck fracture.

PubMed

Huang, Gangyong; Zhao, Guanglei; Xia, Jun; Wei, Yibing; Chen, Feiyan; Chen, Jie; Shi, Jingsheng

2018-04-30

Osteonecrosis of the femoral head (ONFH) is a common orthopedic disease associated with high disability, and femoral neck fracture (FNF) is one of the most common reasons for traumatic ONFH. This study was designed to reveal the mechanisms underlying ONFH. Using fastx_toolkit and prinseq-lite tools, quality control was conducted for the sequencing data. The differentially expressed genes (DEGs, including both mRNAs and lncRNAs) between ONFH and FNF samples were identified using the edgeR package in R, and were then subjected to enrichment analysis using the BioCloud platform. Subsequently, protein-protein interaction (PPI) networks were constructed using Cytoscape software. After the target genes of DE-lncRNAs were predicted based on Spearman's rank correlation coefficient, lncRNA-gene coexpression network was visualized using the Cytoscape software. Furthermore, functional enrichment analysis was carried out for the target genes using the clusterprofiler package in R. Additionally, the key genes were detected by quantitative real-time polymerase chain reaction (qRT-PCR). A total of 2965 DEGs were identified from the ONFH samples, including 602 DE-lncRNAs (such as downregulated FAM201A). In the PPI networks, eight upregulated genes (including FGF2, IGF1, SOX9, and COL2A1) and 11 downregulated genes were among the top 20 genes according to all of the scores, such as degree centrality, closeness centrality, and betweenness centrality scores. Functional enrichment analysis showed that IGF1, SOX9, and COL2A1 were significantly enriched during skeletal system development. Moreover, qRT-PCR experiments detected the upregulation of FGF2 and downregulation of FAM201A in ONFH samples. FGF2 and FAM201A were correlated with the development of ONFH. Besides, IGF1, SOX9, and COL2A1 might also affect the pathogenesis of ONFH. Copyright © 2018. Published by Elsevier B.V.

Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head.

PubMed

Urish, Kenneth L; Hamlin, Brian R; Plakseychuk, Anton Y; Levison, Timothy J; Higgs, Genymphas B; Kurtz, Steven M; DiGioia, Anthony M

2017-09-01

Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty (THA) reported across a range of manufacturers. Specific lots of the Stryker low friction ion treatment (LFIT) anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF. We report on 28 patients (30 implants) with either GTF (n = 18) or head-neck taper corrosion (n = 12) of the LFIT CoCr femoral head and the Accolade titanium-molybdenum-zirconium-iron alloy femoral stems. All these cases were associated with adverse local tissue reactions requiring revision of the THA. In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0 ± 1.4 years from the index procedure. Failures were associated with a high-offset 127° femoral stem neck angle and increased neck lengths; 43.3% (13 of 30) of the observed failures included implant sizes outside the voluntary recall (27.8% [5 of 18] of the GTF and 75.0% [8 of 12] of the taper corrosion cases). Serum cobalt and chromium levels were elevated (cobalt: 8.4 ± 7.0 μg/mL; chromium: 3.4 ± 3.3 μ/L; cobalt/chromium ratio: 3.7). The metal artifact reduction sequence magnetic resonance imaging demonstrated large cystic fluid collections typical with adverse local tissue reactions. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared with the neck taper on radiographs. In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful LFIT femoral head and Accolade titanium-molybdenum-zirconium-iron alloy THA with unknown etiology. Almost half of the failures we observed included sizes outside of the

Fourier transform infrared imaging of femoral neck bone: reduced heterogeneity of mineral-to-matrix and carbonate-to-phosphate and more variable crystallinity in treatment-naive fracture cases compared with fracture-free controls.

PubMed

Gourion-Arsiquaud, Samuel; Lukashova, Lyudmilla; Power, Jon; Loveridge, Nigel; Reeve, Jonathan; Boskey, Adele L

2013-01-01

After the age of 60 years, hip fracture risk strongly increases, but only a fifth of this increase is attributable to reduced bone mineral density (BMD, measured clinically). Changes in bone quality, specifically bone composition as measured by Fourier transform infrared spectroscopic imaging (FTIRI), also contribute to fracture risk. Here, FTIRI was applied to study the femoral neck and provide spatially derived information on its mineral and matrix properties in age-matched fractured and nonfractured bones. Whole femoral neck cross sections, divided into quadrants along the neck's axis, from 10 women with hip fracture and 10 cadaveric controls were studied using FTIRI and micro-computed tomography. Although 3-dimensional micro-CT bone mineral densities were similar, the mineral-to-matrix ratio was reduced in the cases of hip fracture, confirming previous reports. New findings were that the FTIRI microscopic variation (heterogeneity) of the mineral-to-matrix ratio was substantially reduced in the fracture group as was the heterogeneity of the carbonate-to-phosphate ratio. Conversely, the heterogeneity of crystallinity was increased. Increased variation of crystallinity was statistically associated with reduced variation of the carbonate-to-phosphate ratio. Anatomical variation in these properties between the different femoral neck quadrants was reduced in the fracture group compared with controls. Although our treatment-naive patients had reduced rather than increased bending resistance, these changes in heterogeneity associated with hip fracture are in another way comparable to the effects of experimental bisphosphonate therapy, which decreases heterogeneity and other indicators of bone's toughness as a material. Copyright © 2013 American Society for Bone and Mineral Research.

Comparison of routine prophylaxis with vancomycin or cefazolin for femoral neck fracture surgery: microbiological and clinical outcomes.

PubMed

Merrer, Jacques; Desbouchages, Laetitia; Serazin, Valérie; Razafimamonjy, Jimmy; Pauthier, François; Leneveu, Michel

2006-12-01

To assess the impact of antibiotic prophylaxis on the emergence of vancomycin-resistant strains of Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus and the incidence of surgical site infection (SSI) after vancomycin or cefazolin prophylaxis for femoral neck fracture surgery. Prospective cohort study. A hospital with a high prevalence of methicillin-resistant S. aureus (MRSA) carriage. All patients admitted with a femoral neck fracture from March 1, 2004 through February 28, 2005 were prospectively identified and screened for MRSA and vancomycin-resistant (VRE) carriage at admission and at day 7. Deep incisional and organ/space SSIs were also recorded. Of 263 patients included in the study, 152 (58%) received cefazolin and 106 (40%) received vancomycin. At admission, the prevalence of MRSA carriage was 6.8%; it was 12% among patients with risk factors and 2.2% among patients with no risk factors (P=.002). At day 7 after surgery, there were 6 patients (2%) who had hospital-acquired MRSA, corresponding to 0.7% in the cefazolin group and 5% in the vancomycin group (P=.04); none of the MRSA isolates were resistant to glycopeptides. The rate of VRE carriage at admission was 0.4%. Three patients (1%) had acquired carriage of VRE (1 had E. faecium and 2 had E. faecalis); all 3 were in the cefazolin group (2% of patients) and none in the vancomycin group (P=.27). Eight SSIs (3%) occurred, 4% in the cefazolin group and 2% in the vancomycin group (P=.47). This preliminary study demonstrates that cefazolin and vancomycin prophylaxis have similar impacts on the emergence of glycopeptide-resistant pathogens. Neither MRSA infection nor increased rates of SSI with other bacteria were observed in the vancomycin group, suggesting that a larger multicenter study should be initiated.

A method for the measurement of dispersion curves of circumferential guided waves radiating from curved shells: experimental validation and application to a femoral neck mimicking phantom

NASA Astrophysics Data System (ADS)

Nauleau, Pierre; Minonzio, Jean-Gabriel; Chekroun, Mathieu; Cassereau, Didier; Laugier, Pascal; Prada, Claire; Grimal, Quentin

2016-07-01

Our long-term goal is to develop an ultrasonic method to characterize the thickness, stiffness and porosity of the cortical shell of the femoral neck, which could enhance hip fracture risk prediction. To this purpose, we proposed to adapt a technique based on the measurement of guided waves. We previously evidenced the feasibility of measuring circumferential guided waves in a bone-mimicking phantom of a circular cross-section of even thickness. The goal of this study is to investigate the impact of the complex geometry of the femoral neck on the measurement of guided waves. Two phantoms of an elliptical cross-section and one phantom of a realistic cross-section were investigated. A 128-element array was used to record the inter-element response matrix of these waveguides. This experiment was simulated using a custom-made hybrid code. The response matrices were analyzed using a technique based on the physics of wave propagation. This method yields portions of dispersion curves of the waveguides which were compared to reference dispersion curves. For the elliptical phantoms, three portions of dispersion curves were determined with a good agreement between experiment, simulation and theory. The method was thus validated. The characteristic dimensions of the shell were found to influence the identification of the circumferential wave signals. The method was then applied to the signals backscattered by the superior half of constant thickness of the realistic phantom. A cut-off frequency and some portions of modes were measured, with a good agreement with the theoretical curves of a plate waveguide. We also observed that the method cannot be applied directly to the signals backscattered by the lower half of varying thicknesses of the phantom. The proposed approach could then be considered to evaluate the properties of the superior part of the femoral neck, which is known to be a clinically relevant site.

Progression of a fracture site impaction as a prognostic indicator of impacted femoral neck fracture treated with multiple pinning.

PubMed

Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

2012-03-01

We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.

Effect of Once-Yearly Zoledronic Acid Five Milligrams on Fracture Risk and Change in Femoral Neck Bone Mineral Density

PubMed Central

Eastell, Richard; Black, Dennis M.; Boonen, Steven; Adami, Silvano; Felsenberg, Dieter; Lippuner, Kurt; Cummings, Steven R.; Delmas, Pierre D.; Palermo, Lisa; Mesenbrink, Peter; Cauley, Jane A.

2016-01-01

Context In the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly – Pivotal Fracture Trial (HORIZON-PFT), zoledronic acid (ZOL) 5 mg significantly reduced fracture risk. Objective The aim of the study was to identify factors associated with greater efficacy during ZOL 5 mg treatment. Design, Setting, and Patients We conducted a subgroup analysis (preplanned and post hoc) of a multicenter, double-blind, placebo-controlled, 36-month trial in 7765 women with postmenopausal osteoporosis. Intervention A single infusion of ZOL 5 mg or placebo was administered at baseline, 12, and 24 months. Main Outcome Measures Primary endpoints were new vertebral fracture and hip fracture. Secondary endpoints were nonvertebral fracture and change in femoral neck bone mineral density (BMD). Baseline risk factor subgroups were age, BMD T-score and vertebral fracture status, total hip BMD, race, weight, geographical region, smoking, height loss, history of falls, physical activity, prior bisphosphonates, creatinine clearance, body mass index, and concomitant osteoporosis medications. Results Greater ZOL induced effects on vertebral fracture risk were seen with younger age (treatment-by-subgroup interaction, P =0.05), normal creatinine clearance (P =0.04), and body mass index ≥ 25 kg/m2 (P = 0.02). There were no significant treatment–factor interactions for hip or nonvertebral fracture or for change in BMD. Conclusions ZOL appeared more effective in preventing vertebral fracture in younger women, overweight/obese women, and women with normal renal function. ZOL had similar effects irrespective of fracture risk factors or femoral neck BMD. PMID:19567517

Objective sound wave amplitude measurement generated by a tuning fork. An analysis of its use as a diagnostic tool in suspected femoral neck fractures.

PubMed

Jawad, Z; Odumala, A; Jones, M

2012-06-01

Hip injuries are becoming a more common problem as the elderly population increases and their management represents a significant proportion of health care costs. Diagnosis of a fracture based on clinical assessment and plain films is not always conclusive and further investigations for such occult fractures, such as magnetic resonance imaging (MRI), are sometimes required which are expensive and may be difficult to access. Disruption to the conduction of a sound wave travelling through a fractured bone is a concept that has been used to diagnose fractures. In our study we used a tuning fork with frequency of 128 Hz to objectively measure the reduction in sound amplitude in fractured and non-fractured hips. We looked at the feasibility of using this test as a diagnostic tool for neck of femur fractures. A total of 20 patients was included in the study, using MRI scan as the standard for comparison of diagnostic findings. Informed consent was obtained from the patients. There was a significant difference in the amplitude reduction of the sound waves when comparing normal to fractured hips. This was 0.9 in normal hips, compared to 0.31 and 0.18 in intra-capsular and extra-capsular fractures, respectively. Our test was 80% accurate at diagnosing neck of femur fractures. In conclusion this test may be used as a diagnostic test or screening tool in the assessment of occult hip fractures. Copyright © 2011 Elsevier Ltd. All rights reserved.

Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures.

PubMed

Dolatowski, Filip C; Adampour, Mina; Frihagen, Frede; Stavem, Knut; Erik Utvåg, Stein; Hoelsbrekken, Sigurd Erik

2016-06-01

Background and purpose - It has been suggested that preoperative posterior tilt of the femoral head may increase the risk of fixation failure in Garden-I and -II femoral neck fractures. To investigate this association, we studied a cohort of 322 such patients. Patients and methods - Patients treated with internal fixation between 2005 and 2012 were retrospectively identified using hospital records and the digital image bank. 2 raters measured the preoperative posterior tilt angle and categorized it into 3 groups: < 10°, 10-20°, and ≥ 20°. The inter-rater reliability (IRR) was determined. Patients were observed until September 2013 (with a minimum follow-up of 18 months) or until failure of fixation necessitating salvage arthroplasty. The risk of fixation failure was assessed using competing-risk regression analysis, adjusting for time to surgery. Results - Patients with a posterior tilt of ≥ 20° had a higher risk of fixation failure: 19% (8/43) as compared to 11% (14/127) in the 10-20° category and 6% (9/152) in the < 10° category (p = 0.03). Posterior tilt of ≥ 20° increased the risk of fixation failure, with an adjusted hazard ratio of 3.4 (95% CI: 1.3-8.9; p = 0.01). The interclass correlation coefficient for angular measurements of posterior tilt was 0.90 (95% CI: 0.87-0.92), and the IRR for the categorization of posterior tilt into 3 groups was 0.76 (95% CI: 0.69-0.81). Interpretation - Preoperative posterior tilt of ≥ 20° in Garden-I and -II femoral neck fractures increased the risk of fixation failure necessitating salvage arthroplasty. The reliability of the methods that we used to measure posterior tilt ranged from good to excellent.

Femoral neck-shaft angle and climate-induced body proportions.

PubMed

Child, Stephanie L; Cowgill, Libby W

2017-12-01

Declination in femoral neck-shaft angle (NSA) is commonly linked to an increased level of physical activity during life. More recently, however, research suggests that lower NSA might also be explained, in part, as the mechanical consequence of differences in ecogeographic body proportions. This study tests the proposed link between NSA and climatic-induced body proportions, using relative body mass (RBM), throughout the course of development. NSA and RBM were collected for 445 immature remains from five geographic locations. NSA and RBM were standardized for age-effects. ANOVA was used to examine when population differences emerged in both NSA and RBM. Regression analyses were used to examine the pattern of relationship between NSA and RBM. Populations differ significantly in NSA and RBM before skeletal maturity, and these differences occur early in life. While both NSA and RBM change over the course of development, no significant relationship was found between NSA and RBM for any sample, or any age category (p = .244). Individuals who have relatively greater relative body mass do not necessarily have lower NSA. Population differences in NSA were found to be variable, while differences in RBM remained consistent across the developmental span. Taken together, these results suggest that regardless of body proportions, the degree of declination of NSA is presumed to be similar among individuals with similar gait and ambulatory behaviors. Conversely, populations differ in RBM from birth, and these differences are consistent throughout development. These two measures likely are responsive to diffing stimuli, and any potential relationship is likely complex and multifactorial. © 2017 Wiley Periodicals, Inc.

Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment

PubMed Central

Lee, Jong-Sung; Jeon, Eun-Gyu; Seol, Guk-Jin; Choi, So-Young; Kim, Jin-Wook; Kwon, Tae-Geon; Paeng, Jun-Young

2014-01-01

Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases. PMID:27489844

Increased torsional stability by a novel femoral neck locking plate. The role of plate design and pin configuration in a synthetic bone block model.

PubMed

Brattgjerd, Jan Egil; Loferer, Martin; Niratisairak, Sanyalak; Steen, Harald; Strømsøe, Knut

2018-06-01

In undisplaced femoral neck fractures, internal fixation remains the main treatment, with mechanical failure as a frequent complication. As torsional stable fixation promotes femoral neck fracture healing, the Hansson Pinloc® System with a plate interlocking pins, was developed from the original hook pins. Since its effect on torsional stability is undocumented, the novel implant was compared with the original configurations. Forty-two proximal femur models custom made of two blocks of polyurethane foam were tested. The medial block simulated the cancellous head, while the lateral was laminated with a glass fiber filled epoxy sheet simulating trochanteric cortical bone. Two hollow metal cylinders with a circumferential ball bearing in between mimicked the neck, with a perpendicular fracture in the middle. Fractures were fixated by two or three independent pins or by five configurations involving the interlocking plate (two pins with an optional peg in a small plate, or three pins in a small, medium or large plate). Six torsional tests were performed on each configuration to calculate torsional stiffness, torque at failure and failure energy. The novel configurations improved parameters up to an average of 12.0 (stiffness), 19.3 (torque) and 19.9 (energy) times higher than the original two pins (P < 0.001). The plate, its size and its triangular configuration improved all parameters (P = 0.03), the plate being most effective, also preventing permanent failure (P < 0.001). The novel plate design with its pin configuration enhanced torsional stability. To reveal clinical relevance a clinical study is planned. Copyright © 2018 Elsevier Ltd. All rights reserved.

Progression of a Fracture Site Impaction as a Prognostic Indicator of Impacted Femoral Neck Fracture Treated with Multiple Pinning

PubMed Central

Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup

2012-01-01

Background We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. Methods There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. Results There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). Conclusions Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant. PMID:22379557

Computer-assisted virtual technology in intracapsular condylar fracture with two resorbable long-screws.

PubMed

Wang, W H; Deng, J Y; Zhu, J; Li, M; Xia, B; Xu, B

2013-03-01

Our aim was to fix intracapsular condylar fractures (ICF) with two resorbable long screws using preoperative computer-assisted virtual technology. From February 2008 to July 2011, 19 patients with ICF were treated with two resorbable long screws. Preoperatively we took panoramic radiographs and spiral computed tomography (CT). Depending on their digital imaging and communications in medicine (DICOM) data, the dislocated condylar segments were restored using the SimPlant Pro™ software, version 11.04. The mean (SD) widths of the condylar head and neck from lateral to medial were 19.01 (1.28)mm and 13.84 (1.13)mm, respectively. In all patients, the mandibles and the ICF seen intraoperatively corresponded with the preoperative three-dimensional and virtual reposition. All patients were followed up for 6-46 months (mean 21). Occlusion and mouth opening had been restored completely in all but one patient, and absolute anatomical reduction was also achieved in most cases. Computer-assisted virtual technology plays an important part in the diagnosis of ICF, as well as in its preoperative design. Fixation with only two resorbable long screws is an effective and reliable method for fixing ICF. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Increased anteversion of press-fit femoral stems compared with anatomic femur.

PubMed

Emerson, Roger H

2012-02-01

With contemporary canal-filling press-fit stems, there is no adjustability of stem position in the canal and therefore the canal anatomy determines stem version. Stem version will affect head/neck impingement, polyethylene wear from edge loading, and hip stability, but despite this, the postoperative version of a canal-filling press-fit stem is unclear. Is there a difference between the version of the nonoperated femur and the final version of a canal-filling press-fit femoral component? Could a difference create an alignment problem for the hip replacement? Sixty-four hips were studied with fluoroscopy and 46 nonarthritic and 41 arthritic hips were studied with MRI. A standardized fluoroscopic technique for determining preoperative and postoperative femoral version was developed with the patient supine on a fracture table undergoing supine total hip arthroplasty. To validate the methods, the results were compared with two selected series of axial MRI views of the hip comparing the version of the head with the version of the canal at the base of the neck. For the operated hips, the mean anatomic hip version was less than the stem version: 18.9° versus 27.0°. The difference on average was 8.1° of increased anteversion (SD, 7.4°). Both MRI series showed the femoral neck was more anteverted on average than the femoral head, thereby explaining the operative findings. With a canal-filling press-fit femoral component there is wide variation of postoperative component anteversion with most stems placed in increased anteversion compared with the anatomic head. The surgical technique may need to adjust for this if causing intraoperative impingement or instability.

Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties.

PubMed

Nawaz, S Z; Keightley, A J; Desai, A; Granville-Chapman, J; Elliott, D; Newman, K; Khaleel, A

2017-04-01

A Cochrane review influenced new NICE guidelines, which recommended surgeons: Offer cemented implants to patients undergoing surgery with arthroplasty. However our trust routinely uses HAC uncemented stem (Taperloc ® , Biomet) hemiarthroplasties. A review of a consecutive series of uncemented HAC stem hemiarthroplasties including measures such as intro-operative complications, mortality and revision surgery. Prospectively collected data between January 2008 and June 2014 was used, with medical record and radiographic reviews performed. 810 consecutive Taperloc uncemented hemiarthroplasty with monopolar heads were performed in 763 patients, with a minimum 12 month follow-up (12-90) follow-up. Mean age 83yrs; 71% female. Meantime to operation was 28.5h. 30day mortality: 4.4% (33/763). One year mortality was 11.2% (89/763). 2.5% (20/810) were admitted on a separate admission with the periprosthetic fracture. 0.6% (5/810) were revised to total hip replacement for subsidence and associated pain. Only 1% (8/810) had intraoperative calcar fractures, all of which were treated with intraoperative cabling with no evidence of clinically relevant subsidence or medium term complications requiring revision surgery within a year. To the author's knowledge this is largest outcome series for modern design uncemented hemiarthroplasty. Our study shows comparable data to cemented hemiarthroplasty but no deaths in the first 2days post-op. Our series also demonstrates a well below average mortality figures which are clearly multifactorial but believe uncemented prosthesis play a role. We believe that uncemented proven stem design hemiarthroplasty remains a safe and good surgical option for displaced intracapsular fractures. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study.

PubMed

Konya, Mehmet Nuri; Verim, Özgür

2017-09-29

Proximal femoral fracture rates are increasing due to osteoporosis and traffic accidents. Proximal femoral nails are routinely used in the treatment of these fractures in the proximal femur. To compare various combinations and to determine the ideal proximal lag screw position in pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31-A1) of the femur by using optimized finite element analysis. Biomechanical study. Computed tomography images of patients' right femurs were processed with Mimics. Afterwards a solid femur model was created with SolidWorks 2015 and transferred to ANSYS Workbench 16.0 for response surface optimization analysis which was carried out according to anterior-posterior (-10°femoral nail hole, the small diameter portion of stem joints with a large diameter and lag screw mounts to the stem. The most suitable position of the proximal lag screw was found at the middle position of the tip-apex distance (20 mm) and femoral neck (anterior-posterior, inferior-superior=0°), according to von Mises compression stress values occurring on the fracture line. In our study, we couldn't find any correlation between proximal lag screw movement and tip-apex distance on stresses of the fracture surfaces, but the proximal lag screw

Adherence to oral bisphosphonates and the risk of subtrochanteric and femoral shaft fractures among female medicare beneficiaries

PubMed Central

Wang, Z.; Ward, M. M.; Chan, L.

2014-01-01

Summary Previous studies have shown an association between duration of bisphosphonate use and atypical femur fractures. This cohort study showed an increasingly higher risk of subtrochanteric and femoral shaft fractures among those who were more adherent to oral bisphosphonates. Introduction Long-term use of oral bisphosphonates has been implicated in an increased risk of atypical femur fractures located in subtrochanteric and femoral shaft regions. Another measure of drug exposure, medication adherence, however, has not been investigated. Methods Among all Medicare fee-for-service female beneficiaries from 2006–2010, we followed 522,287 new bisphosphonate users from their index prescription until being censored or having a primary diagnosis of closed subtrochanteric/ femoral shaft or intertrochanteric/femoral neck fractures. Data about radiographs of fracture site and features were not available. Adherence was classified according to the medication possession ratio (MPR) as the following: MPR<1/3 as less compliant, MPR≥1/3–<2/3 as compliant, and MPR≥2/3 as highly compliant. Alternative cutoff points at 50 and 80 % were also used. Survival analysis was used to determine the cumulative incidence and hazard of subtrochanteric/femoral shaft or intertrochanteric/femoral neck fractures. Results There was a graded increase in incidence of subtrochanteric/femoral shaft fractures as the level of adherence increased (Gray’s test, P<0.001). The adjusted hazard ratio (HR) for the highly compliant vs. the less compliant was 1.23 (95 % Confidence Interval [CI] 1.06–1.43) overall, became significant after 2 years of follow-up (HR=1.51, 95 % CI 1.06–2.15) and reached the highest risk in the fifth year (HR=4.06, 95 % CI 1.47–11.19). However, age-adjusted incidence rates of intertrochanteric/femoral neck fractures were significantly lower among highly compliant beneficiaries, compared to less compliant users (HR=0.69, 95 % CI 0.66–0.73). Similar results were

Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis.

PubMed

Dagnino, Augusto; Ursino, Nicola; Ripamonti, Carlo A M; Fiorentini, Carlo E; Scelsi, Michele; D'Ambrosi, Riccardo; Portinaro, Nicola M

2017-12-01

Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year.

Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis

PubMed Central

Dagnino, Augusto; Ursino, Nicola; Ripamonti, Carlo A. M.; Fiorentini, Carlo E.; Scelsi, Michele; D'Ambrosi, Riccardo; Portinaro, Nicola M.

2017-01-01

Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year. PMID:29270564

Parathyroid hormone response to severe vitamin D deficiency is associated with femoral neck bone mineral density: an observational study of 405 women with hip-fracture.

PubMed

Di Monaco, Marco; Castiglioni, Carlotta; Tappero, Rosa

2016-10-01

Hip-fracture patients with vitamin D deficiency can have either secondary hyperparathyroidism or normal levels of parathyroid hormone (PTH). We hypothesized that bone mineral density (BMD) could be lower in patients with high PTH levels than in those with normal levels of PTH, irrespectively of the severity of vitamin D depletion. In this cross-sectional study, we examined 405 women who had serum 25-hydroxyvitamin D below 12ng/ml 20.0 ± 5.9 (mean ± SD) days after a hip-fracture. PTH was assessed by a chemiluminescent immunometric assay and BMD by dual-energy x-ray absorptiometry at the unfractured femoral neck. BMD was significantly lower in the 148 women with secondary hyperparathyroidism than in the 257 with normal PTH levels: the mean T-score (SD) was -2.88 (0.93) and -2.65 (0.83), respectively, in the two groups (mean difference 0.23; 95% CI 0.05 - 0.41; P = 0.010). The association between PTH status and BMD persisted after adjustment for age, body mass index, phosphate, albumin-adjusted total calcium, 25-hydroxyvitamin D, estimated glomerular filtration rate, and magnesium (P=0.01). The presence of secondary hyperparathyroidism was significantly associated with a femoral neck T-score lower than -2.5. The adjusted odds ratio was 1.81 (95% CI 1.11 - 2.95; P=0.017). Our results show that PTH levels in the presence of severe vitamin D deficiency were significantly associated with femoral BMD in women with hip-fracture. Prevention and treatment of vitamin D deficiency may be particularly relevant in women who develop secondary hyperparathyroidism.

Does a novel school-based physical activity model benefit femoral neck bone strength in pre- and early pubertal children?

PubMed

Macdonald, H M; Kontulainen, S A; Petit, M A; Beck, T J; Khan, K M; McKay, H A

2008-10-01

The effects of physical activity on bone strength acquisition during growth are not well understood. In our cluster randomized trial, we found that participation in a novel school-based physical activity program enhanced bone strength acquisition and bone mass accrual by 2-5% at the femoral neck in girls; however, these benefits depended on teacher compliance with intervention delivery. Our intervention also enhanced bone mass accrual by 2-4% at the lumbar spine and total body in boys. We investigated the effects of a novel school-based physical activity program on femoral neck (FN) bone strength and mass in children aged 9-11 yrs. We used hip structure analysis to compare 16-month changes in FN bone strength, geometry and bone mineral content (BMC) between 293 children who participated in Action Schools! BC (AS! BC) and 117 controls. We assessed proximal femur (PF), lumbar spine (LS) and total body (TB) BMC using DXA. We compared change in bone outcomes between groups using linear regression accounting for the random school effect and select covariates. Change in FN strength (section modulus, Z), cross-sectional area (CSA), subperiosteal width and BMC was similar between control and intervention boys, but intervention boys had greater gains in BMC at the LS (+2.7%, p = 0.05) and TB (+1.7%, p = 0.03) than controls. For girls, change in FN-Z tended to be greater (+3.5%, p = 0.1) for intervention girls than controls. The difference in change increased to 5.4% (p = 0.05) in a per-protocol analysis that included girls whose teachers reported 80% compliance. AS! BC benefits bone strength and mass in school-aged children; however, our findings highlight the importance of accounting for teacher compliance in classroom-based physical activity interventions.

Treatment of mandibular symphyseal fracture combined with dislocated intracapsular condylar fractures.

PubMed

Xu, Xiaofeng; Shi, Jun; Xu, Bing; Dai, Jiewen; Zhang, Shilei

2015-03-01

To evaluate the treatment methods of mandibular symphyseal fracture combined with dislocated intracapsular condylar fractures (MSF&DICF) and to compare the effect of different treatment methods of condylar fractures. Twenty-eight patients with MSF&DICF were included in this study. Twenty-two sites were treated by open reduction, and all the medial condylar fragments were fixed with titanium screws; whereas the other 22 sites underwent close treatment. The surgical effect between these 2 groups was compared based on clinical examination and radiographic examination results. Seventeen of 22 condyle fractures were repositioned in the surgery group, whereas 4 of 22 condyle fractures were repositioned in the close treatment group. Statistical difference was observed between these 2 groups (P < 0.01). Functional outcomes of the patients treated in the surgical treatment group also were better than those in the close treatment group. The dislocated intracapsular condyle fractures should be treated by surgical reduction with the maintenance of the attachment of lateral pterygoid muscle, which is beneficial to repositioning the dislocated condyle to its original physiological position, to closure of the mandibular lingual gap, to restore the mandibular width.

[Osteoarthritic changes in hip joint in patients with fractures of femoral neck].

PubMed

Kravtsov, Vladimir; Saranga, Dan; Kidron, Debora

2013-06-01

Fractures of proximal femur are common among elderly people. They are associated with considerable morbidity and mortality. Identification of etiopathogenetic factors associated with fractures might facilitate prevention. Osteoporosis is commonly present in the heads of femurs. The prevalence of osteoarthritic changes in hip joints is controversial. Some authorities report low prevalence and even speculate on the protective effect of osteoarthritis against fractures. The goal of the study was to examine the association between osteoarthritic changes (radiologic and histologic) and fractures of the neck of the femur. The patient population included 41 patients undergoing replacement of femoral head for subcapital fracture; their ages ranged from 61 - 93 years of age. Radiologic criteria for osteoarthritis included: (a)narrowing of joint space (b) subchondral sclerosis (c) deformation of head of femur (d) subchondra cysts and (e] osteophytes. Osteoarthritic changes, usually mild, were present in 22 (54%) patients, regardless of age and gender The frequency of radioLogical changes was similar to the general population. HistoLogic findings included subchondral fibrosis and subchondral cysts. Mild subchondral fibrosis was present in 78% of cases. The findings support lack of association between osteoarthritic changes in hip joint and fracture of proximal femur, without a protective effect.

Prediction of incident hip fracture by femoral neck bone mineral density and neck–shaft angle: a 5-year longitudinal study in post-menopausal females

PubMed Central

Gnudi, S; Sitta, E; Pignotti, E

2012-01-01

Objective To compare hip fracture incidence in post-menopausal females who were differently stratified for the fracture risk according to bone mineral density and proximal femur geometry. Methods In a 5 year follow-up study, the hip fracture incidence in 729 post-menopausal females (45 of whom suffered from incident hip fracture) was assessed and compared. Forward logistic regression was used to select independent predictors of hip fracture risk, including age, age at menopause, height, weight, femoral neck bone mineral density (FNBMD), neck–shaft angle (NSA), hip axis length, femoral neck diameter and femoral shaft diameter as covariates. Fracture incidence was then calculated for the categories of young/old age, high/low FNBMD and wide/narrow NSA, which were obtained by dichotomising each hip fracture independent predictor at the value best separating females with and without a hip fracture. Results The hip fracture incidence of the whole cohort was significantly higher in females with a wide NSA (8.52%) than in those with a narrow NSA (3.51%). The combination of wide NSA and low FNBMD had the highest hip fracture incidence in the whole cohort (17.61%) and each age category. The combinations of narrow/wide NSA with low/high FNBMD, respectively, gave a significantly higher fracture incidence in older than in younger women, whereas women with a combined wide NSA and low FNBMD had no significantly different fracture incidence in young (14.60%) or old age (21.62%). Conclusion Our study showed that NSA is effective at predicting the hip fracture risk and that the detection in early post-menopause of a wide NSA together with a low FNBMD should identify females at high probability of incident hip fracture. PMID:22096224

Development and application of computer assisted optimal method for treatment of femoral neck fracture.

PubMed

Wang, Monan; Zhang, Kai; Yang, Ning

2018-04-09

To help doctors decide their treatment from the aspect of mechanical analysis, the work built a computer assisted optimal system for treatment of femoral neck fracture oriented to clinical application. The whole system encompassed the following three parts: Preprocessing module, finite element mechanical analysis module, post processing module. Preprocessing module included parametric modeling of bone, parametric modeling of fracture face, parametric modeling of fixed screw and fixed position and input and transmission of model parameters. Finite element mechanical analysis module included grid division, element type setting, material property setting, contact setting, constraint and load setting, analysis method setting and batch processing operation. Post processing module included extraction and display of batch processing operation results, image generation of batch processing operation, optimal program operation and optimal result display. The system implemented the whole operations from input of fracture parameters to output of the optimal fixed plan according to specific patient real fracture parameter and optimal rules, which demonstrated the effectiveness of the system. Meanwhile, the system had a friendly interface, simple operation and could improve the system function quickly through modifying single module.

The Incidence of Atypical Femoral Fractures in Patients with Rheumatic Disease: Yamagata Prefectural Committee of Atypical Femoral Fractures (YamaCAFe) Study.

PubMed

Takakubo, Yuya; Ohta, Daichi; Ishi, Masaji; Ito, Juji; Oki, Hiroharu; Naganuma, Yasushi; Uno, Tomohiro; Sasaki, Akiko; Akabane, Takeru; Dairaku, Katsuyuki; Goto, Shinichi; Goto, Yasuo; Kanauchi, Yumiko; Kobayashi, Shinji; Nakajima, Taku; Masuda, Keiji; Matsuda, Michiharu; Mura, Nariyuki; Takenouchi, Kenji; Tsuchida, Hiroyuki; Onuma, Yasushi; Shibuya, Junichirou; Seino, Mitsuyoshi; Yamaguchi, Osamu; Hiragami, Ken; Urayama, Yasuhiro; Furukawa, Takashi; Okuda, Shouta; Ogura, Ken; Nakamura, Takeshi; Sasaki, Kan; Konta, Tsuneo; Takagi, Michiaki

2017-08-01

Atypical femoral fractures (AFFs) have been reported to occur with minimal or spontaneous subtrochanteric and femoral shaft fractures with a characteristic transverse pattern, compared with typical femoral fractures in young patients with high-energy trauma. AFFs are related to long-term use of bisphosphonates (BPs), glucocorticoids and rheumatic diseases. We have estimated a blind analysis of AFFs in rheumatic patients receiving BPs and glucocorticoids ordinary over a long time in all Yamagata prefectural area through radiographic examination. The 123 AFFs including suspected cases over six years were collected and reviewed by two independent orthopedic surgeons. We found 86 patients with a total of 99 AFFs between 2009 and 2014 (1.43 cases/100,000 person/year). Of these 99 AFFs, 11 were in 8 rheumatic patients including three patients with bilateral AFFs. The incidence of AFFs in rheumatic patients had trend to increase from 2012. The mean age of all 8 patients was 54.9 years. All 8 patients received BPs and 7/8 received prednisolone (PSL). The mean dose of PSL was 14 mg/day. Compared to patients with unilateral AFFs, those with bilateral AFFs in rheumatic patients were on a higher dose of PSL (20 mg/day vs. 7 mg/day) and had less femoral neck-shaft angle (129° vs. 136°, p < 0.05). In conclusion, the incidence of AFFs in rheumatic patients showed a trend to increase from 2012 to 2014 in Yamagata prefecture. Careful management of AFFs is of particular importance in rheumatic patients who have taken high doses of PSL and have small femoral neck-shaft angle.

Complications of hip fractures: A review

PubMed Central

Carpintero, Pedro; Caeiro, Jose Ramón; Carpintero, Rocío; Morales, Angela; Silva, Samuel; Mesa, Manuel

2014-01-01

Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections (alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum -a major contributor to fracture healing- in the femoral neck. In extracapsular fractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients. PMID:25232517

Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review.

PubMed

Hopley, Colin; Stengel, Dirk; Ekkernkamp, Axel; Wich, Michael

2010-06-11

To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Systematic review and meta-analysis of randomised trials, quasirandomised trials, and cohort studies. Medline, Embase, Cochrane register of controlled trials, publishers' databases, and manual search of bibliographies. Randomised controlled trials, quasirandomised trials, and cohort studies (retrospective and prospective) comparing hemiarthroplasty with total hip arthroplasty for treating displaced femoral neck fractures in patients aged more than 60 years. Relative risks, risk differences, and mean differences from each trial, aggregated using random effects models. Analyses were stratified for experimental and non-experimental designs, and two way sensitivity analyses and tests for interaction were done to assess the influence of various criteria of methodological quality on pooled estimates. 3821 references were identified. Of the 202 full papers inspected, 15 were included (four randomised controlled trials, three quasirandomised trials, and eight retrospective cohort studies, totalling 1890 patients). Meta-analysis of 14 studies showed a lower risk of reoperation after total hip arthroplasty compared with hemiarthroplasty (relative risk 0.57, 95% confidence interval 0.34 to 0.96, risk difference 4.4%, 95% confidence interval 0.2% to 8.5%), although this effect was mainly driven by investigations without concealed treatment allocation. Total hip arthroplasty consistently showed better ratings in the Harris hip score (three studies, 246 patients, weighted mean difference 5.4, 95% confidence interval 2.7 to 8.2) after follow-up periods of 12 to 48 months. The standardised mean difference of different scores from five studies was 0.42 (95% confidence interval 0.24 to 0.61), indicating a medium functional advantage of total

Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures.

PubMed

2014-06-26

Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813).

Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures

PubMed Central

2014-01-01

Background Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. Methods/Design FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. Discussion This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. Trial registration The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813). PMID:24965132

Dose--effect relationships for femoral fractures after multimodality limb-sparing therapy of soft-tissue sarcomas of the proximal lower extremity.

PubMed

Pak, Daniel; Vineberg, Karen A; Griffith, Kent A; Sabolch, Aaron; Chugh, Rashmi; Ben-Josef, Edgar; Biermann, Janet Sybil; Feng, Mary

2012-07-15

We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). We examined 131 patients with proximal lower extremity STS who received limb-sparing surgery and external-beam radiation therapy between 1985 and 2006. Five (4%) patients sustained pathologic femoral fractures. Dosimetric analysis was limited to 4 fracture patients with full three-dimensional dose information, who were compared with 59 nonfracture patients. The mean doses and volumes of bone (V(d)) receiving specified doses (≥30 Gy, 45 Gy, 60 Gy) at the femoral body, femoral neck, intertrochanteric region, and subtrochanteric region were compared. Clinical predictive factors were also evaluated. Of 4 fracture patients in our dosimetric series, there were three femoral neck fractures with a mean dose of 57.6 ± 8.9 Gy, V30 of 14.5 ± 2.3 cc, V45 of 11.8 ± 1.1 cc, and V60 of 7.2 ± 2.2 cc at the femoral neck compared with 22.9 ± 20.8 Gy, 4.8 ± 5.6 cc, 2.5 ± 3.9 cc, and 0.8 ± 2.7 cc, respectively, for nonfracture patients (p < 0.03 for all). The femoral neck fracture rate was higher than at the subtrochanteric region despite lower mean doses at these subregions. All fracture sites received mean doses greater than 40 Gy. Also, with our policy of prophylactic femoral intramedullary nailing for high-risk patients, there was no significant difference in fracture rates between patients with and without periosteal excision. There were no significant differences in age, sex, tumor size, timing of radiation therapy, and use of chemotherapy between fracture and nonfracture patients. These dose-volume toxicity relationships provide RT optimization goals to guide future efforts for reducing pathologic fracture rates. Prophylactic femoral intramedullary nailing may also reduce fracture risk for susceptible patients. Copyright © 2012 Elsevier Inc. All rights reserved.

Melatonin improves bone mineral density at the femoral neck in postmenopausal women with osteopenia: a randomized controlled trial.

PubMed

Amstrup, Anne Kristine; Sikjaer, Tanja; Heickendorff, Lene; Mosekilde, Leif; Rejnmark, Lars

2015-09-01

Melatonin is known for its regulation of circadian rhythm. Recently, studies have shown that melatonin may have a positive effect on the skeleton. By increasing age, the melatonin levels decrease, which may lead to a further imbalanced bone remodeling. We aimed to investigate whether treatment with melatonin could improve bone mass and integrity in humans. In a double-blind RCT, we randomized 81 postmenopausal osteopenic women to 1-yr nightly treatment with melatonin 1 mg (N = 20), 3 mg (N = 20), or placebo (N = 41). At baseline and after 1-yr treatment, we measured bone mineral density (BMD) by dual X-ray absorptiometry, quantitative computed tomography (QCT), and high-resolution peripheral QCT (HR-pQCT) and determined calciotropic hormones and bone markers. Mean age of the study subjects was 63 (range 56-73) yr. Compared to placebo, femoral neck BMD increased by 1.4% in response to melatonin (P < 0.05) in a dose-dependent manner (P < 0.01), as BMD increased by 0.5% in the 1 mg/day group (P = 0.55) and by 2.3% (P < 0.01) in the 3 mg/day group. In the melatonin group, trabecular thickness in tibia increased by 2.2% (P = 0.04), and volumetric bone mineral density (vBMD) in the spine, by 3.6% (P = 0.04) in the 3 mg/day. Treatment did not significantly affect BMD at other sites or levels of bone turnover markers; however, 24-hr urinary calcium was decreased in response to melatonin by 12.2% (P = 0.02). In conclusion, 1-yr treatment with melatonin increased BMD at femoral neck in a dose-dependent manner, while high-dose melatonin increased vBMD in the spine. Further studies are needed to assess the mechanisms of action and whether the positive effect of nighttime melatonin will protect against fractures. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Complex radial folds versus subtle signs of intracapsular rupture of breast implants: MR findings with surgical correlation.

PubMed

Soo, M S; Kornguth, P J; Walsh, R; Elenberger, C D; Georgiade, G S

1996-06-01

Detection of intracapsular rupture of silicone breast prostheses using MR imaging is often performed by identifying the "linguine sign" [1]. The linguine sign is easily differentiated from simple radial folds that are seen in intact implants. However, more subtle signs of intracapsular rupture, including undulating subcapsular lines and the "teardrop sign," are less often recognized [2-5] and may prove difficult for the less experienced radiologist to differentiate from complex radial folds of intact implants. In this essay, we illustrate the MR imaging findings of complex radial folds in intact implants and compare them with findings of incomplete shell collapse in ruptured implants in a surgically confirmed series of explanted silicone breast prostheses.

Closed bone graft epiphysiodesis for avascular necrosis of the capital femoral epiphysis.

PubMed

Thompson, George H; Lea, Ethan S; Chin, Kenneth; Liu, Raymond W; Son-Hing, Jochen P; Gilmore, Allison

2013-07-01

Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression. We investigated whether early MRI screening and CBGE prevented the development of advanced AVN changes in the CFE and the rates of complications with this approach. We prospectively followed all 13 patients (seven boys, six girls) with unstable SCFEs (six patients), femoral neck fractures (five patients), and traumatic hip dislocations (two patients) and evidence of early AVN treated between 1984 and 2012. Mean age at initial injury was 12 years (range, 10-16 years). Nine of the 13 patients had followup of at least 2 years or until conversion to THA (mean, 4.5 years; range, 0.8-8.5 years), including two with unstable SCFEs, the five with femoral neck fractures, and the two with traumatic hip dislocations. All patients had technetium scans and/or MRI within 1 to 2 months of their initial injury (before CBGE) and all had evidence of early (Ficat 0) AVN. Patients were followed clinically and radiographically for AVN progression. Six of the nine hips did not develop typical clinical or radiographic evidence of AVN. These six patients have been followed 6.3 years (range, 4.3-9.1 years) from initial injury and 5.9 years (range, 3.8-8.5 years) from CBGE. The remaining three patients were diagnosed with AVN at periods ranging from 3 to 6 months after CBGE. Early recognition and treatment of AVN with a CBGE may alter the natural history of this complication. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures.

PubMed

Sprague, S; Bhandari, M; Heetveld, M J; Liew, S; Scott, T; Bzovsky, S; Heels-Ansdell, D; Zhou, Q; Swiontkowski, M; Schemitsch, E H

2018-03-01

Aims The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility. Patients and Methods Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL. Results The following were associated with lower physical HRQL: older age (-1.42 for every ten-year increase, 95% confidence interval (CI) -2.17 to -0.67, p < 0.001); female gender (-1.52, 95% CI -3.00 to -0.05, p = 0.04); higher body mass index (-0.69 for every five-point increase, 95% CI -1.36 to -0.02, p = 0.04); American Society of Anesthesiologists class III ( versus class I) (-3.19, 95% CI -5.73 to -0.66, p = 0.01); and sustaining a displaced fracture (-2.18, 95% CI -3.88 to -0.49, p = 0.01). Additional factors were associated with mental HRQL, hip function, and health utility. Conclusion We identified several baseline factors associated with lower HRQL, hip function, and utility after a femoral neck fracture. These findings may be used by clinicians to inform treatment and outcomes. Cite this article: Bone Joint J 2018;100-B:361-9.

Quantification of Femoral Neck Exposure Through a Minimally Invasive Smith-Petersen Approach

DTIC Science & Technology

2010-06-01

Gautier E, et al. Surgical dislocation of the adult hip: A technique with full access to femoral head and acetabulum without the risk of avascular ... necrosis . J Bone Joint Surg (Br). 2001;83:1119 1124. 24. Gautier E, Ganz K, Krugel N, et al. Anatomy of the medial femoral circumflex artery and its

Femoral stem size mismatch in women undergoing total hip arthroplasty.

PubMed

Dundon, John M; Felberbaum, Dvorah Leah; Long, William J

2018-06-01

Total hip arthroplasty (THA) is a highly successful surgery with a high prevalence in women. Women have been noted to have smaller proximal femoral anatomy and decreased bone strength compared to males. The goal of our study was to define the size discrepancy in femoral stem implants between men and women using a metaphyseal fitting single taper stem. We retrospectively reviewed the THA's performed by a single surgeon over the previous two years. Data was extracted from operative reports regarding stem size, neck length and offset, and conversion to a different type of stem. This data was reviewed with confidence intervals and a t -test was performed for independent samples with a p < 0.05 being determined significant. We analyzed the data from 276 THA's performed (129 in men, and 147 in women). Women were noted to be associated with smaller stem sizes compared to men (37.67% in women, 6.11% in men), with 7.48% of women requiring conversion to a different type of implant. There was a significant difference in mean stem size (9.21 in men, 6.70 in women, p < 0.0001). Women also required reduced neck options significantly more often than men (38.97% in women, 9.29% in men, p < 0.0001). Review of femoral stem sizes reveals that current femoral stem sizing may not appropriately account for women and alternative stem options should be available if using a metaphyseal fitting single tapered stems. Future consideration should be given to more anatomic female sized femoral stems or alternative options should be available.

The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip.

PubMed

Grose, A W; Gardner, M J; Sussmann, P S; Helfet, D L; Lorich, D G

2008-10-01

The inferior gluteal artery is described in standard anatomy textbooks as contributing to the blood supply of the hip through an anastomosis with the medial femoral circumflex artery. The site(s) of the anastomosis has not been described previously. We undertook an injection study to define the anastomotic connections between these two arteries and to determine whether the inferior gluteal artery could supply the lateral epiphyseal arteries alone. From eight fresh-frozen cadaver pelvic specimens we were able to inject the vessels in 14 hips with latex moulding compound through either the medial femoral circumflex artery or the inferior gluteal artery. Injected vessels around the hip were then carefully exposed and documented photographically. In seven of the eight specimens a clear anastomosis was shown between the two arteries adjacent to the tendon of obturator externus. The terminal vessel arising from this anastomosis was noted to pass directly beneath the posterior capsule of the hip before ascending the superior aspect of the femoral neck and terminating in the lateral epiphyseal vessels. At no point was the terminal vessel found between the capsule and the conjoined tendon. The medial femoral circumflex artery receives a direct supply from the inferior gluteal artery immediately before passing beneath the capsule of the hip. Detailed knowledge of this anatomy may help to explain the development of avascular necrosis after hip trauma, as well as to allow additional safe surgical exposure of the femoral neck and head.

Analysis on the mechanical resistance of fixation of femoral neck fractures in synthetic bone, using the dynamic hip system and an anti-rotation screw☆☆☆

PubMed Central

Freitas, Anderson; Torres, Gustavo Melo; Souza, André Cezar de Andrade de Mello e; Maciel, Rafael Almeida; Souto, Diogo Ranier de Macedo; Ferreira, George Neri de Barros

2014-01-01

Objective To statistically analyze the results obtained from biomechanical tests on fixation of femoral neck fractures of Pauwels III type, in synthetic bone, using the dynamic hip system with an anti-rotation screw, versus a control group. Methods Ten synthetic bones from a Brazilian manufacturer (model C1010) were used and divided into two groups: test and control. In the test group, fixation of an osteotomy was performed with 70° of inclination at the level of the femoral neck, using DHS with an anti-rotation screw. The resistance of this fixation was evaluated, along with its rotational deviation at 5 mm of displacement (phase 1) and at 10 mm of displacement (phase 2), which was considered to be failure of synthesis. In the control group, the models were tested in their entirety until femoral neck fracturing occurred. Results The test values in the test group (samples 1–5) in phase 1 were: 1512 N, 1439 N, 1205 N, 1251 N and 1273 N, respectively (mean = 1336 N; standard deviation [SD] = 132 N). The rotational deviations were: 4.90°, 3.27°, 2.62°, 0.66° and 0.66°, respectively (mean = 2.42°; SD = 1.81°). In phase 2, we obtained: 2064 N, 1895 N, 1682 N, 1713 N and 1354 N, respectively (mean = 1742 N; SD = 265 N). The failure loading values in the control group were: 1544 N, 1110 N, 1359 N, 1194 N and 1437 N, respectively (mean = 1329 N; SD = 177 N). The statistical analysis using the Mann–Whitney test showed that the test group presented maximum loading at a displacement of 10 mm, i.e. significantly greater than the failure loading of the control group (p = 0.047). Conclusion The mechanical resistance of the test group was significantly greater than that of the control group. PMID:26229866

The effect of patient, fracture and surgery on outcomes of high energy neck of femur fractures in patients aged 15-50.

PubMed

Hoskins, Wayne; Rayner, Johnny; Sheehy, Rohan; Claireaux, Harry; Bingham, Roger; Santos, Roselyn; Bucknill, Andrew; Griffin, Xavier L

2018-05-01

High-energy femoral neck fractures in young patients can be devastating, with the risk of osteonecrosis, nonunion, malunion and lifelong morbidity. The aim of this study is to define the effects of patient, fracture and surgical factors on the outcome of high-energy femoral neck fractures in patients aged from 15 to 50 years. A retrospective review was conducted of high-energy femoral neck fractures in patients aged 15-50 managed surgically at a Level 1 Trauma Centre, using a prospectively recorded trauma database. Low energy trauma (including falls from <1 m), medical conditions adversely affecting bone density, and pathological fractures were excluded. A clinical and radiological review was performed. The primary outcome measures were the development of osteonecrosis or nonunion leading to total hip arthroplasty (THA). Secondary outcome measures included osteotomy or other surgical procedures, quality of reduction and malunion. Thirty-two patients meeting the inclusion criteria were identified between January 2008 and July 2015. The mean follow-up was 58.5 months (range 980-3,048 days). Three patients (9.4%) required THA. No other surgical procedures were performed. None of the 29 other patients developed radiologically apparent osteonecrosis. Fracture type, displacement, anatomical reduction and fixation type were not statistically significant risk factors affecting these outcomes. For all patients, an average of 8% loss of femoral neck height and 10% femoral neck offset were seen. At a mean 4.9-year follow-up, the incidence of high-energy femoral neck fractures leading to THA was 9.4%, as a consequence of osteonecrosis or nonunion. Malunion was common.

Use of clinical and computed tomography findings to assess long-term unsatisfactory outcome after femoral head and neck ostectomy in four large breed dogs.

PubMed

Ober, Ciprian; Pestean, Cosmin; Bel, Lucia; Taulescu, Marian; Milgram, Joshua; Todor, Adrian; Ungur, Rodica; Leșu, Mirela; Oana, Liviu

2018-05-10

Femoral head and neck ostectomy (FHNO) is a salvage surgical procedure intended to eliminate hip joint laxity associated pain in the immature dog, or pain due to secondary osteoarthritis in the mature dog. The outcome of the procedure is associated with the size of the dog but the cause of a generally poorer outcome in larger breeds has not been determined. The objective of this study was to assess the long-term results of FHNO associated with unsatisfactory functional outcome by means of clinical examination and computed tomography (CT) scanning. Four large mixed breed dogs underwent FHNO in different veterinary clinics. Clinical and CT scanning evaluations were carried out long time after the procedures had been done. Hip pain, muscle atrophy, decreased range of motion and chronic lameness were observed at clinical examination. Extensive remodelling, unacceptable bone-on-bone contact with bony proliferation involving the femoral neck and acetabulum, but also excessive removal with bone lysis were observed by CT scanning. Revision osteotomy was performed in one dog. Deep gluteal muscle interposition was used, but no improvements were observed postoperatively. This is the first report on the evaluation of three-dimensional CT reconstructions of the late bone remodelling associated with poor clinical outcome in large dogs. The study shows that FHNO could lead to severe functional deficits in large breed dogs. An extensive follow-study is necessary to more accurately determine the frequency of such complications.

[Ex vivo microCT analysis of possible microfractures of the femoral head during implantation of a cementless hip resurfacing femoral component].

PubMed

Lerch, M; Olender, G; von der Höh, N; Thorey, F; von Lewinski, G; Meyer-Lindenberg, A; Windhagen, H; Hurschler, C

2009-01-01

Microfractures of the femoral head during implantation of the femoral components are suspected to be a cause of fractures at the implant/neck junction which represent a common failure mode in hip resurfacing arthroplasty. Callus formation observed in femoral head retrievals suggests the occurrence of microfractures inside the femoral head, which might be inadvertently caused by the surgeon during implantation. The aim of this biomechanical study was to analyse whether or not the implantation of a cementless femoral component hip resurfacing system causes microfractures in the femoral head. After the preparation of 20 paired human cadaveric femoral heads, the cementless femoral component ESKA Typ BS (ESKA Implants GmbH & Co., Lübeck) was implanted on 9 specimens with an impaction device that generates 4.5 kN impaction force. On 9 specimens the femoral component was implanted by hand. One head was used as a fracture model, 1 specimen served as control without manipulation. The femoral component used for impaction was equipped with hinges to enable its removal without further interfering with the bone stock. Specimens were scanned with a microCT device before and after impaction and the microCT datasets before and after impaction were compared to identify possible microfractures. Twenty strikes per hand or with the impaction device provided sufficient implant seating. Neither the macroscopic examination nor the 2-dimensional microCT analysis revealed any fractures of the femoral heads after impaction. At least macroscopically and in the 2-dimensional microCT analysis, implantation of the cementless hip resurfacing femoral component ESKA Typ BS with 4.5 kN or by hand does not seem to cause fractures of the femoral head. Georg Thieme Verlag KG Stuttgart, New York.

Fourier Transformed Infra-Red Imaging of Femoral Neck Bone: Reduced Heterogeneity of Mineral-to-Matrix and Carbonate-to-Phosphate and more Variable Crystallinity in Treatment-Naïve Fracture Cases compared to Fracture-Free Controls

PubMed Central

Gourion-Arsiquaud, Samuel; Lukashova, Lyudmilla; Power, Jon; Loveridge, Nigel; Reeve, Jonathan; Boskey, Adele L.

2012-01-01

After age 60 hip fracture risk strongly increases, but only a fifth of this increase is attributable to reduced mineral density (BMD, measured clinically). Changes in bone quality, specifically bone composition as measured by Fourier Transform Infrared spectroscopic imaging (FTIRI), also contribute to fracture risk. Here, FTIRI was applied to study the femoral neck and provide spatially derived information on its mineral and matrix properties in age-matched fractured and non-fractured bones. Whole femoral neck cross sections, divided into quadrants along the neck’s axis, from 10 women with hip fracture and 10 cadaveric controls were studied using FTIRI and micro-computed Tomography. Although 3-dimensional micro-CT bone mineral densities were similar, the mineral-to-matrix ratio was reduced in the cases of hip fracture, confirming previous reports. New findings were that the FTIRI microscopic variation (heterogeneity) of the mineral-to-matrix ratio was substantially reduced in the fracture group as was the heterogeneity of the carbonate-to-phosphate ratio. Conversely, the heterogeneity of crystallinity was increased. Increased variation of crystallinity was statistically associated with reduced variation of the carbonate-to-phosphate ratio. Anatomical variation in these properties between the different femoral neck quadrants was reduced in the fracture group compared to controls. While our treatment-naïve patients had reduced rather than increased bending resistance, these changes in heterogeneity associated with hip fracture are in another way comparable to the effects of experimental bisphosphonate therapy, which decreases heterogeneity and other indicators of bone’s toughness as a material. PMID:22865771

Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study

PubMed Central

Dong, Chenhui; Wang, Yunjiao; Wang, Ziming; Wang, Yu; Wu, Siyu; Du, Quanyin; Wang, Aimin

2016-01-01

Background Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients. Methods In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained. Results Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3–10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups. Conclusion In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events. PMID:27149117

Designing an Optimized Novel Femoral Stem

PubMed Central

Babaniamansour, Parto; Ebrahimian-Hosseinabadi, Mehdi; Zargar-Kharazi, Anousheh

2017-01-01

Background: After total hip arthroplasty, there would be some problems for the patients. Implant loosening is one of the significant problems which results in thigh pain and even revision surgery. Difference between Young's modulus of bone-metal is the cause of stress shielding, atrophy, and subsequent implant loosening. Materials and Methods: In this paper, femoral stem stiffness is reduced by novel biomechanical and biomaterial design which includes using proper design parameters, coating it with porous surface, and modeling the sketch by the software. Parametric design of femoral stem is done on the basis of clinical reports. Results: Optimized model for femoral stem is proposed. Curved tapered stem with trapezoidal cross-section and particular neck and offset is designed. Fully porous surface is suggested. Moreover, Designed femoral stem analysis showed the Ti6Al4V stem which is covered with layer of 1.5 mm in thickness and 50% of porosity is as stiff as 77 GPa that is 30% less than the stem without any porosity. Porous surface of designed stem makes it fix biologically; thus, prosthesis loosening probability decreases. Conclusion: By optimizing femoral stem geometry (size and shape) and also making a porous surface, which had an intermediate stiffness of bone and implant, a more efficient hip joint prosthesis with more durability fixation was achieved due to better stress transmission from implant to the bone. PMID:28840118

Femoral nerve block Intervention in Neck of Femur fracture (FINOF): study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background Hip fractures are very painful leading to lengthy hospital stays. Conventional methods of treating pain are limited. Non-steroidal anti-inflammatories are relatively contraindicated and opioids have significant side effects.Regional anaesthesia holds promise but results from these techniques are inconsistent. Trials to date have been inconclusive with regard to which blocks to use and for how long. Interpatient variability remains a problem. Methods/Design This is a single centre study conducted at Queen’s Medical Centre, Nottingham; a large regional trauma centre in England. It is a pragmatic, parallel arm, randomized controlled trial. Sample size will be 150 participants (75 in each group). Randomization will be web-based, using computer generated concealed tables (service provided by Nottingham University Clinical Trials Unit). There is no blinding. Intervention will be a femoral nerve block (0.5 mls/kg 0.25% levo-bupivacaine) followed by ropivacaine (0.2% 5 ml/hr−1) infused via a femoral nerve catheter until 48 hours post-surgery. The control group will receive standard care. Participants will be aged over 70 years, cognitively intact (abbreviated mental score of seven or more), able to provide informed consent, and admitted directly through the Emergency Department from their place of residence. Primary outcomes will be cumulative ambulation score (from day 1 to 3 postoperatively) and cumulative dynamic pain scores (day 1 to 3 postoperatively). Secondary outcomes will be cumulative dynamic pain score preoperatively, cumulative side effects, cumulative calorific and protein intake, EUROQOL EQ-5D score, length of stay, and rehabilitation outcome (measured by mobility score). Discussion Many studies have shown the effectiveness of regional blockade in neck of femur fractures, but the techniques used have varied. This study aims to identify whether early and continuous femoral nerve block can be effective in relieving pain and enhancing mobilization

Patient survival and surgical re-intervention predictors for intracapsular hip fractures.

PubMed

González Quevedo, David; Mariño, Iskandar Tamimi; Sánchez Siles, Juan Manuel; Escribano, Esther Romero; Granero Molina, Esther Judith; Enrique, David Bautista; Smoljanović, Tomislav; Pareja, Francisco Villanueva

2017-08-01

Choosing between total hip replacement (THR) and partial hip replacement (PHR) for patients with intracapsular hip fractures is often based on subjective factors. Predicting the survival of these patients and risk of surgical re-intervention is essential to select the most adequate implant. We conducted a retrospective cohort study on mortality of patients over 70 years with intracapsular hip fractures who were treated between January 2010 and December 2013, with either PHR or THR. Patients' information was withdrawn from our local computerized database. The age-adjusted Charlson comorbidity index (ACCI) and American Society of Anesthesiologists (ASA) score were calculated for all patients. The patients were followed for 2 years after surgery. Survival and surgical re-intervention rates were compared between the two groups using a Multivariate Cox proportional hazard model. A total of 356 individuals were included in this study. At 2 years of follow-up, 221 (74.4%) of the patients with ACCI score≤7 were still alive, in contrast to only 20 (29.0%) of those with ACCI score>7. In addition, 201 (76.2%) of the patients with ASA score≤3 were still alive after 2 years, compared to 30 (32.6%) of individuals with ASA >3. Patients with the ACCI score>7, and ASA score>3 had a significant increase in all-cause 2-year mortality (adjusted hazard ratio of 3.2, 95% CI 2.2-4.6; and 3.12, 95% CI 2.2-4.5, respectively). Patients with an ASA score>3 had a quasi-significant increase in the re-intervention risk (adjusted hazard ratio 2.2, 95% CI 1.0-5.1). The sensitivity, specificity, positive predictive value and negative predictive values of ACCI in predicting 2-year mortality were 39.2%, 91.1%, 71%, and 74.4%, respectively. On the other hand, the sensitivity, specificity, positive predictive value and negative predictive values of ASA score in predicting 2-year mortality were 49.6%, 79.1%, 67.4%, and 76.1%, respectively. Both ACCI and ASA scales were able to predict the 2-year

Magnetic Resonance Imaging Predicts Adverse Local Tissue Reaction Histologic Severity in Modular Neck Total Hip Arthroplasty.

PubMed

Barlow, Brian T; Ortiz, Philippe A; Fields, Kara G; Burge, Alissa J; Potter, Hollis G; Westrich, Geoffrey H

2016-10-01

The association between advanced imaging, serum metal ion levels, and histologic adverse local tissue reaction (ALTR) severity has not been previously reported for Rejuvenate modular neck femoral stems. A cohort of 90 patients with 98 Rejuvenate modular neck femoral stems was revised by a single surgeon from July 2011 to December 2014. Before revision, patients underwent multiacquisition variable resonance image combination sequence magnetic resonance imaging (MRI), and serum cobalt and chromium ion levels were measured. Histologic samples from the revision surgery were scored for synovial lining, inflammatory infiltrate, and tissue organization as proposed by Campbell. Regression based on the generalized estimating equations approach was used to assess the univariate association between each MRI, demographic, and metal ion measure and ALTR severity while accounting for the correlation between bilateral hips. Random forest analysis was then used to determine the relative importance of MRI characteristics, demographics, and metal ion levels in predicting ALTR severity. Synovial thickness as measured on MRI was found to be the strongest predictor of ALTR histologic severity in a recalled modular neck femoral stem. MRI can accurately describe ALTR in modular femoral neck total hip arthroplasty. MRI characteristics, particularly maximal synovial thickness and synovitis volume, predicted histologic severity. Serum metal ion levels do not correlate with histologic severity in Rejuvenate modular neck total hip arthroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

Proximal femoral fractures: Principles of management and review of literature.

PubMed

Mittal, Ravi; Banerjee, Sumit

2012-06-01

The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems.

Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty.

PubMed

Lecerf, G; Fessy, M H; Philippot, R; Massin, P; Giraud, F; Flecher, X; Girard, J; Mertl, P; Marchetti, E; Stindel, E

2009-05-01

BACKGROUND OBJECTIVE: Femoral offset is supposed to influence the results of hip replacement but little is known about the accurate method of measure and the true effect of offset modifications. This article is a collection of independent anatomic, radiological and clinical works, which purpose is to assess knowledge of the implications of femoral offset for preoperative templating and total hip arthroplasty. There is a strong correlation between femoral offset, abductors lever arm and hip abductor strength. Hip lateralization is independent of the femoral endomedullary characteristics. The abductors lever arm is highly correlated to the gluteus medius activation angle. There were correlations between femoral offset and endomedullary shape. The hip center was high and medial for stovepipe metaphysis while it was lower and lateralized for champagne - flute upper femur. A study was performed to compare the femoral offset measured by X-ray and CT-scan in 50 patients, demonstrated that plain radiography underestimates offset measurement. The 2D templating cannot appreciate the rotation of the lower limb. Taking into account the horizontal plane is essential to obtain proper 3D planning of the femoral offset. A randomized study was designed to compare femoral offset measurements after hip resurfacing and total hip arthroplasty. This study underlined hip resurfacing reduced the femoral offset, while hip replacement increased offset. However, the reduction of femoral offset after hip resurfacing does not affect the function. A pilot study was designed to assess the results of 120 hip arthroplasties with a modular femoral neck. This study showed that the use of a modular collar ensures an easier restoration of the femoral offset. A cohort of high offset stems (Lubinus 117 degrees) was retrospectively assessed. The survival rate was slightly lower that the standard design reported in the Swedish register. Finally, the measurement of offset and leg length was assessed with

Dissociation of modular total hip arthroplasty at the neck-stem interface without dislocation.

PubMed

Kouzelis, A; Georgiou, C S; Megas, P

2012-12-01

Modular femoral and acetabular components are now widely used, but only a few complications related to the modularity itself have been reported. We describe a case of dissociation of the modular total hip arthroplasty (THA) at the femoral neck-stem interface during walking. The possible causes of this dissociation are discussed. Successful treatment was provided with surgical revision and replacement of the modular neck components. Surgeons who use modular components in hip arthroplasties should be aware of possible early complications in which the modularity of the prostheses is the major factor of failure.

A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures.

PubMed

Jenkins, Paul J; Ramaesh, Rishikesan; Pankaj, Pankaj; Patton, James T; Howie, Colin R; Goffin, Jérôme M; Merwe, Andrew van der; Wallace, Robert J; Porter, Daniel E; Simpson, A Hamish

2013-10-01

The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head. 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head. The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head. The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

Proximal femoral fractures: Principles of management and review of literature

PubMed Central

Mittal, Ravi; Banerjee, Sumit

2012-01-01

Purpose The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. Methods: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. Results and conclusions: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems. PMID:25983451

High femoral bone mineral content and density in male football (soccer) players.

PubMed

Calbet, J A; Dorado, C; Díaz-Herrera, P; Rodríguez-Rodríguez, L P

2001-10-01

This investigation examined the effect that long-term football (soccer) participation may have on areal bone mineral density (BMD) and bone mineral content (BMC) in male football players. Dual energy x-ray absorptiometry (DXA) scans were obtained in 33 recreational male football players active in football for the last 12 yr and 19 nonactive subjects from the same population. Both groups had comparable age (23 +/- 4 yr vs 24 +/- 3 yr), body mass (73 +/- 7 kg vs 72 +/- 11 kg), height (176 +/- 5 cm vs 176 +/- 8 cm), and calcium intake (23 +/- 10 mg.kg(-1).d(-1) vs 20 +/- 11 mg.kg(-1).d(-1) (mean +/- SD). The football players showed 8% greater total lean mass (P < 0.001), 13% greater whole-body BMC (P < 0.001), and 5 units lower percentage body fat (P < 0.001) than control subjects. Lumbar spine (L2-L4) BMC and BMD were 13% and 10% higher, respectively, in the football players than in the control subjects (P < 0.05). Furthermore, football players displayed higher femoral neck BMC (24%, 18%, 23%, and 24% for the femoral neck, intertrochanteric, greater trochanter, and Ward's triangle subregions, respectively, P < 0.05) and BMD (21%, 19%, 21%, and 27%, respectively, P < 0.05) than controls. BMC in the whole leg was 16-17% greater in the football players, mainly because of enhanced BMD (9-10%) but also because of bone hypertrophy, since the area occupied by the osseous pixels was 7% higher (867 +/- 63 cm2 vs 814 +/- 26 cm2, P < 0.05). Leg muscle mass was 11% higher in the football players than in the control subjects (20,635 +/- 2,073 g vs 18,331 +/- 2,301 g, P < 0.001). No differences were found between the legs in either groups for BMC, BMD, and muscle mass. Left leg muscle mass was correlated with femoral neck BMC and BMD (P < 0.001), as well as with lumbar spine (L2-L4) BMC and BMD (P < 0.001). Long-term football participation, starting at prepubertal age, is associated with markedly increased BMC and BMD at the femoral neck and lumbar spine regions.

Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging.

PubMed

Duan, Yunbo; Beck, Thomas J; Wang, Xiao-Fang; Seeman, Ego

2003-10-01

The structural basis for sex differences in femoral neck (FN) fragility was studied in 1196 subjects and 307 patients with hip fracture. The absolute and relative patterns of modeling and remodeling on the periosteal and endocortical envelopes during growth and aging produce changes in FN geometry and structure that results in FN fragility in both sexes and sexual dimorphism in hip fracture risk in old age. Femoral neck (FN) fragility in old age is usually attributed to age-related bone loss, while the sex differences in hip fracture rate are attributed to less bone loss in men than in women. The purpose of this study was to define the structural and biomechanical basis underlying the increase in FN fragility in elderly men and women and the structural basis of sex differences in hip fracture incidence in old age. We measured FN dimensions and areal bone mineral density in 1196 healthy subjects (801 females) 18-92 years of age and 307 patients (180 females) with hip fracture using DXA. We then used the DXA-derived FN areal bone mineral density (BMD) and measured periosteal diameter to estimate endocortical diameter, cortical thickness, section modulus (a measure of bending strength), and buckling ratio (indices for structural stability). Neither FN cortical thickness nor volumetric density differed in young adult women and men after height and weight adjustment. The sex differences in geometry were confined to the further displacement of the cortex from the FN neutral axis in young men, which produced 13.4% greater bending strength than in young women. Aging amplified this geometric difference; widening of the periosteal and endocortical diameters continued in both sexes but was greater in men, shifting the cortex even further from the neutral axis maintaining bending strength in men, not in women. In both sexes, less age-related periosteal than endocortical widening produced cortical thinning increasing the risk for structural failure by local buckling of the

Location of Femoral Fractures in Patients with Different Weight Classes in Fall and Motorcycle Accidents: A Retrospective Cross-Sectional Analysis.

PubMed

Chang, Meng-Wei; Liu, Hang-Tsung; Huang, Chun-Ying; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

2018-05-27

This study aimed to determine the incidence of femoral fracture location in trauma patients with different weight classes in fall and motorcycle accidents. A total of 2647 hospitalized adult patients with 2760 femoral fractures from 1 January 2009 to 31 December 2014 were included in this study. Femoral fracture sites were categorized based on their location: proximal femur (type A, trochanteric; type B, neck; and type C, head), femoral shaft, and distal femur. The patients were further classified as obese (body mass index [BMI] of ≥30 kg/m²), overweight (BMI of.

Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

PubMed Central

2012-01-01

We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249 PMID:22906214

Nano-structural, compositional and micro-architectural signs of cortical bone fragility at the superolateral femoral neck in elderly hip fracture patients vs. healthy aged controls.

PubMed

Milovanovic, Petar; Rakocevic, Zlatko; Djonic, Danijela; Zivkovic, Vladimir; Hahn, Michael; Nikolic, Slobodan; Amling, Michael; Busse, Bjoern; Djuric, Marija

2014-07-01

To unravel the origins of decreased bone strength in the superolateral femoral neck, we assessed bone structural features across multiple length scales at this cortical fracture initiating region in postmenopausal women with hip fracture and in aged-matched controls. Our combined methodological approach encompassed atomic force microscopy (AFM) characterization of cortical bone nano-structure, assessment of mineral content/distribution via quantitative backscattered electron imaging (qBEI), measurement of bone material properties by reference point indentation, as well as evaluation of cortical micro-architecture and osteocyte lacunar density. Our findings revealed a wide range of differences between the fracture group and the controls, suggesting a number of detrimental changes at various levels of cortical bone hierarchical organization that may render bone fragile. Namely, mineral crystals at external cortical bone surfaces of the fracture group were larger (65.22nm±41.21nm vs. 36.75nm±18.49nm, p<0.001), and a shift to a higher mineral content and more homogenous mineralization profile as revealed via qBEI were found in the bone matrix of the fracture group. Fracture cases showed nearly 35% higher cortical porosity and showed significantly reduced osteocyte lacunar density compared to controls (226±27 vs. 247±32#/mm(2), p=0.05). Along with increased crystal size, a shift towards higher mineralization and a tendency to increased cortical porosity and reduced osteocyte lacunar number delineate that cortical bone of the superolateral femoral neck bears distinct signs of fragility at various levels of its structural organization. These results contribute to the understanding of hierarchical bone structure changes in age-related fragility. Copyright © 2014 Elsevier Inc. All rights reserved.

Autologous Platelet Concentrates as Treatment for Avascular Necrosis of Femoral Head in a Dog.

PubMed

Parra, Estefanía; Vergara, Andrea; Silva, Raúl F

2017-03-01

Avascular necrosis of the femoral head is a developmental disturbance that generally affects young dogs of small breeds and produces ischemic necrosis of the femoral head resulting in an incongruous and malformed joint. The most common treatment is the excisional arthroplasty of the head and femoral neck. The aim of this study is to describe the treatment of avascular necrosis in a Yorkshire dog using intra-articular injections of autologous platelet concentrate. Evaluations were made at 0, 15, 30, 60, and 120 days of treatment, describing the following parameters: clinical gait analysis, perimetry, goniometry, and radiographic evaluations. The results obtained in this case suggest that the autologous platelet concentrate may be an alternative for the treatment of avascular necrosis of the femoral head in dogs. Copyright © 2017 Elsevier Inc. All rights reserved.

The Assessment of Blood Loss During Total Knee Arthroplasty When Comparing Intravenous vs Intracapsular Administration of Tranexamic Acid.

PubMed

May, Jedediah H; Rieser, Geoffrey R; Williams, Chad G; Markert, Ronald J; Bauman, Ryan D; Lawless, Matthew W

2016-11-01

Administration of tranexamic acid topically and intravenously has demonstrated effectiveness in decreasing blood loss and transfusion rates. We randomized 131 patients undergoing primary total knee arthroplasty to receive either intracapsular (69) or intravenous tranexamic acid (62). Postoperative blood loss was calculated using the formula derived by Nadler et al. The number of units transfused was recorded, as well as length of hospital stay. We found no statistically significant difference on calculated blood loss (postoperative day [POD] 1: 624 ± 326 vs 644 ± 292; P = .71, POD 2: 806 ± 368 vs 835 ± 319; P = .64, and POD 3: 1076 ± 419 vs 978 ± 343; P = .55). There was no difference in number of blood transfusions, length of stay, or complications. Intracapsular tranexamic acid is not inferior to intravenous tranexamic acid in decreasing blood loss and blood transfusion rate in primary total knee arthroplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

The subtle intracapsular survival of the fittest: maternal investment, sibling conflict, or environmental effects?

PubMed

Smith, Kathryn E; Thatje, Sven

2013-10-01

Developmental resource partitioning and the consequent offspring size variations are of fundamental importance for marine invertebrates, in both an ecological and evolutionary context. Typically, differences are attributed to maternal investment and the environmental factors determining this; additional variables, such as environmental factors affecting development, are rarely discussed. During intracapsular development, for example, sibling conflict has the potential to affect resource partitioning. Here, we investigate encapsulated development in the marine gastropod Buccinum undatum. We examine the effects of maternal investment and temperature on intracapsular resource partitioning in this species. Reproductive output was positively influenced by maternal investment, but additionally, temperature and sibling conflict significantly affected offspring size, number, and quality during development. Increased temperature led to reduced offspring number, and a combination of high sibling competition and asynchronous early development resulted in a common occurrence of "empty" embryos, which received no nutrition at all. The proportion of empty embryos increased with both temperature and capsule size. Additionally, a novel example ofa risk in sibling conflict was observed; embryos cannibalized by others during early development ingested nurse eggs from inside the consumer, killing it in a "Trojan horse" scenario. Our results highlight the complexity surrounding offspring fitness. Encapsulation should be considered as significant in determining maternal output. Considering predicted increases in ocean temperatures, this may impact offspring quality and consequently species distribution and abundance.

Intracapsular lens extraction for the treatment of pupillary block glaucoma associated with anterior subluxation of the crystalline lens.

PubMed

Kim, Yong Joon; Ha, Seung Joo

2013-01-01

To report a case of pupillary block glaucoma associated with spontaneous crystalline lens subluxation into the anterior chamber in a 34-year-old man. Dry vitrectomy was performed for securing enough retrolental space, and an intracapsular lens extraction was then performed via a corneolimbal incision. Additional endothelial cell damage was avoided with an injection of viscoelastics and gentle extraction of the crystalline lens. After deepening of the anterior chamber, scleral fixation of the intraocular lens was performed with an ab externo technique. Two months after the operation, a well-fixated intraocular lens was observed and intraocular pressure was stable. The postoperative corneal astigmatism was -3.5 dpt, and the patient had a best-corrected visual acuity of 20/25. Postoperative complications included decreased endothelial cell count and sector iris paralysis near the incision site. An anteriorly subluxated crystalline lens can cause pupillary block glaucoma in healthy young adults. To prevent intraoperative complications, intracapsular lens extraction with dry vitrectomy can be a good surgical option. The endothelial cell density should be closely monitored after surgery.

Short-stem hip arthroplasty in osteonecrosis of the femoral head.

PubMed

Floerkemeier, Thilo; Budde, Stefan; Gronewold, Jens; Radtke, Kerstin; Ettinger, Max; Windhagen, Henning; von Lewinski, Gabriela

2015-05-01

Osteonecrosis of the femoral head (ONFH) is a locally destructive and complex disorder. Without treatment, infraction of the femoral head is likely. There is also a lack of consensus in the literature about the most appropriate arthroplasty method in patients with progressive ONFH. During the last decade, the number of short-stem prostheses has increased. Some short-stem designs have a metaphyseal anchorage. It is questionable whether ONFH represents a risk factor for failure after implantation of short stems. The aim of this study was to review existing literature regarding the outcome of short-stem arthroplasty in ONFH and to present the pros and cons of short-stem hip arthroplasty in osteonecrosis of the femoral head. This review summarises existing studies on short-stem hip arthroplasty in osteonecrosis of the femoral head. Few studies have analysed the clinical and radiological outcome of short-stem THA in patients with ONFH. Only a handful of studies present clinical and radiological outcome after implantation of a short-stem arthroplasty in patients with the underlying diagnosis of osteonecrosis of the femoral head. The short- to medium-term results show predominantly good outcomes. However, due to differences in the design of short stems and their fixation, it is hard to draw a general conclusion. Short stems with primary diaphyseal fixation do not reveal a high increased risk of failed osseointegration or loosening. For designs with a primary metaphyseal anchorage, an MRI should be conducted to exclude that the ostenecrosis exceeds the femoral neck.

Prediction of femoral neck and spine bone mineral content from the BMC of the radius or ulna and the relationship between bone strength and BMC

NASA Technical Reports Server (NTRS)

Wilson, C. R.

1974-01-01

The bone mineral content (BMC) is extensively used to provide information about the status of an entire skeleton. Changes in BMC are employed to evaluate the effect of various drugs, disease states, weightlessness, exercise, renal dialysis and others on the skeleton. Clinical and functional information is discussed that may be derived from the BMC of a limited region of the skeleton. In particular there is a fairly high degree of correlation between the BMC of the radius or ulna and that of the femoral neck, r about 0.85 and a somewhat lower relationship between the BMC of the radius or ulna and the thoracic vertebrae, r about 0.65. Also the BMC is highly related to the strength of bone at that scan site.

Evaluation of the Painful Dual Taper Modular Neck Stem Total Hip Arthroplasty: Do They All Require Revision?

PubMed

Kwon, Young-Min

2016-07-01

Although dual taper modular-neck total hip arthroplasty (THA) design with additional neck-stem modularity has the potential to optimize hip biomechanical parameters by facilitating adjustments of leg length, femoral neck version and offset, there is increasing concern regarding this stem design as a result of the growing numbers of adverse local tissue reactions due to fretting and corrosion at the neck-stem taper junction. Implant factors such as taper cone angle, taper surface roughness, taper contact area, modular neck taper metallurgy, and femoral head size play important roles in influencing extent of taper corrosion. There should be a low threshold to conduct a systematic clinical evaluation of patients with dual-taper modular-neck stem THA using systematic risk stratification algorithms as early recognition and diagnosis will ensure prompt and appropriate treatment. Although specialized tests such as metal ion analysis and cross-sectional imaging modalities such as metal artifact reduction sequence magnetic resonance imaging (MARS MRI) are useful in optimizing clinical decision-making, overreliance on any single investigative tool in the clinical decision-making process for revision surgery should be avoided. Copyright © 2016 Elsevier Inc. All rights reserved.

Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial.

PubMed

Waaler Bjørnelv, G M; Frihagen, F; Madsen, J E; Nordsletten, L; Aas, E

2012-06-01

We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2 years, patients treated with hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective. Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly. A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82 years were randomized to either internal fixation (n = 86) or hemiarthroplasty (n = 80). Patients were followed up at 4, 12, and 24 months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients' quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios. Over the 2-year period, patients treated with hemiarthroplasty gained 0.15-0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (p = 0.81), €2,474 (p = 0.80), and €14,160 (p = 0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings. Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.

The remodeling of the neck-shaft angle after proximal femoral varus osteotomy for the treatment of Legg-Calve-Perthes syndrome.

PubMed

Chiarapattanakom, Pariyut; Thanacharoenpanich, Songkiat; Pakpianpairoj, Charoenchai; Liupolvanish, Prasert

2012-10-01

To study the corrections of the neck-shaft angle (NSA) and the related clinical symptoms after proximal femoral varus osteotomy (PFVO) for the treatment of Legg-Calve-Perthes syndrome (LCPS). Retrospective cohort study. Consecutive cases of LCPS treated at Lerdsin General Hospital during 1999 to 2010 were reviewed. The patients were excluded if they had less than 3 years of follow-up, there was incomplete data, and bilateral involvement. Demographic data and clinical symptoms were collected. The NSA were measured before and after PFVO. Twenty-two patients were treated by PFVO. The mean pre-operative NSA was 140 degrees. The mean varus angle created by PFVO was 20 degrees. The mean post-operative NSA at 6 weeks, 6 months, 1 year, 2 years and 3 years were 119, 119, 118, 120 and 120 degrees respectively. No statistical difference between the mean NSA at 6 weeks and 3 years (p = 0.65). There were 9 patients whose NSA increased more than 5 degrees at 3 years after operation. This group of patients had a more varus angulation at the early post-operative period. No physeal arrest was detected in any cases at 3 years after PFVO. No correlation between the NSA and pain or limitation of the hip abduction were observed. There were 3 patients, who had NSA less than 110 degrees after PFVO, had limping gait. It is difficult to predict the degree of remodeling of an individual hip after proximal femoral varus osteotomy. Special attention should be paid to avoid excessive varus of the proximal femur less than 110 degrees whenever PFVO is performed.

Assessment of the equivalence of a generic to a branded femoral stem

PubMed Central

Hothi, H.; Henckel, J.; Shearing, P.; Holme, T.; Cerquiglini, A.; Laura, A. Di; Atrey, A.; Skinner, J.; Hart, A.

2017-01-01

Aims The aim of this study was to compare the design of the generic OptiStem XTR femoral stem with the established Exeter femoral stem. Materials and Methods We obtained five boxed, as manufactured, implants of both designs at random (ten in total). Two examiners were blinded to the implant design and independently measured the mass, volume, trunnion surface topography, trunnion roughness, trunnion cone angle, Caput-Collum-Diaphyseal (CCD) angle, femoral offset, stem length, neck length, and the width and roughness of the polished stem shaft using peer-reviewed methods. We then compared the stems using these parameters. Results We found that the OptiStems were lighter (p < 0.001), had a rougher trunnion surface (p < 0.001) with a greater spacing and depth of the machined threads (p < 0.001), had greater trunnion cone angles (p = 0.007), and a smaller radius at the top of the trunnion (p = 0.007). There was no difference in stem volume (p = 0.643), CCD angle (p = 0.788), offset (p = 0.993), neck length (p = 0.344), stem length (p = 0.808), shaft width (p = 0.058 to 0.720) or roughness of the polished surface (p = 0.536). Conclusion This preliminary investigation found that whilst there were similarities between the two designs, the generic OptiStem is different to the branded Exeter design. Cite this article: Bone Joint J 2017;99-B:310–16. PMID:28249969

Cam type femoro-acetabular impingement: quantifying the diagnosis using three dimensional head-neck ratios.

PubMed

Masjedi, Milad; Marquardt, Charles S; Drummond, Isabella M H; Harris, Simon J; Cobb, Justin P

2013-03-01

Cam hips are commonly quantified using the two-dimensional α angle. The accuracy of this measurement may be affected by patient position and the technician's experience. In this paper, we describe a method of measurement that provides a quantitative definition of cam hips based upon three-dimensional computed tomography (CT) images. CT scans of 47 (24 cam, 23 normal) femurs were segmented. A sphere was fitted to the articulating surface of the femoral head, the radius (r) recorded, and the femoral neck axis obtained. The cross sectional area at four locations spanning the head neck junction (r/4, r/2, 3r/4 and r), perpendicular to the neck axis, was measured. The ratios (Neck/Head) between the areas at each cut relative to the surface area at the head centre were calculated and aggregated. Normal and cam hips were significantly different: the sum of the head-neck ratios (HNRs) of the cam hips were always smaller than normal hips (p < 0.01). A cut off point of 2.55 with no overlap was found between the two groups, with HNRs larger than this being cam hips, and smaller being normal ones. Owing to its sensitivity and repeatability, the method could be used to confirm or refute the clinical diagnosis of a cam hip. Furthermore it can be used as a tool to measure the outcome of cam surgery.

Characterization of proximal femoral anatomy in the skeletally-immature patient.

PubMed

Beutel, B G; Girdler, S J; Collins, J A; Otsuka, N Y; Chu, A

2018-04-01

The morphology of the proximal femur has been extensively studied in the adult population. However, no literature providing a comprehensive evaluation of the anatomy in paediatric patients exists. The current study aims to characterize such anatomy in skeletally-immature patients, examine potential differences between genders, and analyze how these anatomical parameters change with age. Cadaveric femurs from the Hamann-Todd Osteological Collection were examined. Specimens with open physes and no skeletal disease or deformity were included for analysis. Age and gender were recorded for each specimen. Each femur was photographed in standardized modified axial and anteroposterior views. In all, 14 proximal femoral anatomical parameters were measured from these photographs. Comparisons between genders and age were calculated. A total of 43 femurs from ages four to 17 years met inclusion criteria. The majority were female (56%); no difference existed in age between genders (p = 0.62). The specimens had a neutral mean neck-shaft angle (130.7º) and anteversion (12.8º), and the sphericity of the ossified femoral heads was symmetrical. Male specimens had significantly higher alpha angles (p = 0.01), posterior offset (p = 0.02), neck width (p = 0.04) and head-neck length ratio (p = 0.02) values than female specimens. Strong positive correlations exist between length/size parameters and age, while negligible correlations were noted for angular measurements. This study establishes reference values for a comprehensive list of anatomical parameters for the skeletally-immature ossified proximal femur. It highlights gender differences in morphology and demonstrates that angular characteristics remain relatively stable while length parameters generally increase with age. Level III Diagnostic.

Association between calcium ingested from drinking water and femoral bone density in elderly women: evidence from the EPIDOS cohort.

PubMed

Aptel, I; Cance-Rouzaud, A; Grandjean, H

1999-05-01

Although the main source of dietary calcium is dairy products, the calcium contained in mineral water, which is as available as that of milk, could provide a valuable source of calcium. We analyzed the data from the EPIDOS multicenter study to evaluate the relationship between both dietary calcium and that supplied by drinking water and bone density measured at the femoral neck by dual-energy X-ray absorptiometry. The study included 4434 women over 75 years of age who had not received any treatment likely to interfere with calcium metabolism. A significant correlation was found between total calcium intake and bone density at the femoral neck (r = 0.10, p < 0. 001). After adjustment for the main variables influencing bone density, an increase of 100 mg/day in calcium from drinking water was associated to a 0.5% increase in femoral bone density, while a similar increase in dietary calcium from other sources only led to a 0.2% increase; however, this difference was not significant. The consumption of calcium-rich mineral water may be of interest, especially in older women who consume little calcium from dairy products.

Mortality Following Periprosthetic Proximal Femoral Fractures Versus Native Hip Fractures.

PubMed

Boylan, Matthew R; Riesgo, Aldo M; Paulino, Carl B; Slover, James D; Zuckerman, Joseph D; Egol, Kenneth A

2018-04-04

The number of periprosthetic proximal femoral fractures is expected to increase with the increasing prevalence of hip arthroplasties. While native hip fractures have a well-known association with mortality, there are currently limited data on this outcome among the subset of patients with periprosthetic proximal femoral fractures. Using the New York Statewide Planning and Research Cooperative System, we identified patients from 60 to 99 years old who were admitted to a hospital in the state with a periprosthetic proximal femoral fracture (n = 1,655) or a native hip (femoral neck or intertrochanteric) fracture (n = 97,231) between 2006 and 2014. Within the periprosthetic fracture cohort, the indication for the existing implant was not available in the data set. We used mixed-effects regression models to compare mortality at 1 and 6 months and 1 year for periprosthetic compared with native hip fractures. The risk of mortality for patients who sustained a periprosthetic proximal femoral fracture was no different from that for patients who sustained a native hip fracture at 1 month after injury (3.2% versus 4.6%; odds ratio [OR], 0.90; 95% confidence interval [CI], 0.68 to 1.19; p = 0.446), but was lower at 6 months (3.8% versus 6.5%; OR, 0.74; 95% CI, 0.57 to 0.95; p = 0.020) and 1 year (9.7% versus 15.9%; OR, 0.71; 95% CI, 0.60 to 0.85; p < 0.001). Among periprosthetic proximal femoral fractures, factors associated with a significantly increased risk of mortality at 1 year included advanced age, male sex, and higher Deyo comorbidity scores. In the acute phase, any type of hip fracture appears to confer a similar risk of death. Over the long term, however, periprosthetic proximal femoral fractures are associated with lower mortality rates than native hip fractures, even after accounting for age and comorbidities. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Transcervical access via direct neck exposure for neurointerventional procedures in the hybrid angiosuite.

PubMed

Lee, Jong Young; Park, Jong-Hwa; Jeon, Hong Jun; Yoon, Dae Young; Park, Seoung Woo; Cho, Byung Moon

2018-05-01

A complicated course of the femoral route for neurointervention can prevent approaching the target. Thus, we determined whether transcervical access in the hybrid angiosuite is applicable and beneficial in real practice. From January 2014 to March 2017, this approach was used in 17 of 453 (3.75%) cases: 11 cerebral aneurysms (4 ruptured, 7 unruptured), 4 acute occlusions of the large cerebral artery, 1 proximal internal carotid artery (ICA) stenosis, and 1 direct carotid cavernous fistula (CCF). All patients were elderly (mean age, 78.1 years). The main cause was severe tortuosity of the supra-aortic course or the supra-aortic and infra-aortic courses (eight and five cases, respectively), orifice disturbance (three cases), and femoral occlusion (one case). Through neck dissection, 6-8Fr guiding catheters were placed via subcutaneous tunneling to enhance device stability and support. All cerebral aneurysms were embolized (eight complete and three neck remnants) using the combination of several additional devices. Mechanical stent retrieval with an 8Fr balloon guiding catheter was successfully achieved in a few runs (mean, 2 times; range, 1-3) within the proper time window (mean skin to puncture, 17 ± 4 min; puncture to recanalization, 25 ± 4 min). Each stent was satisfactorily deployed in the proximal ICA and direct CCF without catheter kick-back. All puncture sites were closed through direct suturing without complications. In the hybrid angiosuite, transcervical access via direct neck exposure is feasible in terms of device profile and support when the femoral route has an unfavorable anatomy.

Anti-platelet drugs in patients with femoral neck fractures undergoing cemented hip hemiarthroplasty surgery. A study of complications and mortality.

PubMed

Agudo Quiles, M; Sanz-Reig, J; Alcalá-Santaella Oria de Rueca, R

2015-01-01

To assess complications and factors predicting one-year mortality in patients on antiplatelet agents presenting with femoral neck fractures undergoing hip hemiarthroplasty surgery. A review was made on 50 patients on preoperative antiplatelet agents and 83 patients without preoperative antiplatelet agents. Patients in both groups were treated with cemented hip hemiarthroplasty. A statistical comparison was performed using epidemiological data, comorbidities, mental state, complications and mortality. There was no lost to follow-up. The one-year mortality was 20.3%. In patients without preoperative antiplatelet agents it was 14.4% and in patients with preoperative antiplatelet agents was 30%. Age, ASA grade, number of comorbidities and antiplatelet agent therapy were predictors of one-year mortality. The one-year mortality of patients on clopidogrel was 46.1%, versus 24.3% in patients on acetylsalicylic acid. Patients with preoperative antiplatelet therapy were older and had greater number of comorbidities, ASA grade, delayed surgery, and a longer length of stay than patients without antiplatelet therapy. The one-year mortality was higher in patients with preoperative antiplatelet therapy. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Migration of cemented femoral components after THR. Roentgen stereophotogrammetric analysis.

PubMed

Kiss, J; Murray, D W; Turner-Smith, A R; Bithell, J; Bulstrode, C J

1996-09-01

We studied the migration of 58 cemented Hinek femoral components for total hip replacement, using roentgen stereophotogrammetric analysis over four years. The implants migrated faster during the first year than subsequently, and the pattern of migration in the second period was very different. During the first year they subsided, tilted into varus and internally rotated. After this there was slow distal migration with no change in orientation. None of the prostheses has yet failed. The early migration is probably caused by resorption of bone damaged by surgical trauma or the heat generated by the polymerisation of bone cement. Later migration may be due to creep in the bone cement or the surrounding fibrous membrane. The prosthesis which we studied allows the preservation of some of the femoral neck, and comparison with published migration studies of the Charnley stem suggests that this decreases rotation and may help to prevent loosening.

Increased Dickkopf-1 expression accelerates bone cell apoptosis in femoral head osteonecrosis.

PubMed

Ko, Jih-Yang; Wang, Feng-Sheng; Wang, Ching-Jen; Wong, To; Chou, Wen-Yi; Tseng, Shin-Ling

2010-03-01

Intensive bone cell apoptosis contributes to osteonecrosis of femoral head (ONFH). Dickkopf-1 (DKK1) reportedly mediates various types of skeletal disorders. This study investigated whether DKK1 was linked to the occurrence of ONFH. Thirty-nine patients with various stages of ONFH were recruited. Bone specimens were harvested from 34 ONFH patients underwent hip arthroplasty, and from 10 femoral neck fracture patients. Bad, Bcl2 TNFalpha, DKK1, Wnt3a, LRP5, and Axin1 expressions were analyzed by quantitative RT-PCR and ELISA. Apoptotic cells were assayed using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labelling (TUNEL). Primary bone-marrow mesenchymal cells were treated with DKK1 RNA interference and recombinant DKK1 protein. ONFH patients with the histories of being administrated corticosteroids and excessive alcohol consumption had significantly higher Bad and DKK1 mRNA expressions in bone tissue and DKK1 abundances in serum than femoral neck fracture patients. Bone cells adjacent to osteonecrotic bone displayed strong DKK1 immunoreactivity and TUNEL staining. Increased DKK1 expression in bone tissue and serum correlated with Bad expression and TUNEL staining. Serum DKK1 abundance correlated with the severity of ONFH. The DKK1 RNA interference and recombinant DKK1 protein regulated Bad expression and apoptosis of primary bone-marrow mesenchymal cells. Knock down of DKK1 reduced dexamethasone-induced apoptosis of mesenchymal cells. Taken together, promoted DKK1 expression was associated with bone cell apoptosis in the occurrence of ONFH patients with the histories of corticosteroid and alcohol intake and progression of ONFH. DKK1 expression in injured tissue provides new insight into ONFH pathogenesis.

Streptozocin-induced type-1 diabetes mellitus results in decreased density of CGRP sensory and TH sympathetic nerve fibers that are positively correlated with bone loss at the mouse femoral neck.

PubMed

Enríquez-Pérez, Iris A; Galindo-Ordoñez, Karla E; Pantoja-Ortíz, Christian E; Martínez-Martínez, Arisaí; Acosta-González, Rosa I; Muñoz-Islas, Enriqueta; Jiménez-Andrade, Juan M

2017-08-10

Type-1 diabetes mellitus (T1DM) results in loss of innervation in some tissues including epidermis and retina; however, the effect on bone innervation is unknown. Likewise, T1DM results in pathological bone loss and increased risk of fracture. Thus, we quantified the density of calcitonin gene-related peptide (CGRP + ) sensory and tyrosine hydroxylase (TH + ) sympathetic nerve fibers and determined the association between the innervation density and microarchitecture of trabecular bone at the mouse femoral neck. Ten weeks-old female mice received 5 daily administrations of streptozocin (i.p. 50mg/kg) or citrate (control group). Twenty weeks later, femurs were analyzed by microCT and processed for immunohistochemistry. Confocal microscopy analysis revealed that mice with T1DM had a significant loss of both CGRP + and TH + nerve fibers in the bone marrow at the femoral neck. Likewise, microCT analysis revealed a significant decrease in the trabecular bone mineral density (tBMD), bone volume/total volume ratio (BV/TB), trabecular thickness (Tb.Th), trabecular number (Tb.N) and trabecular separation (Tb.Sp) in mice with T1DM as compared to control mice. Analysis of correlation revealed a positive and significant association between density of CGRP + or TH + nerve fibers with tBMD, BV/TV, Tb.Th and Tb.Sp, but not with trabecular number (there was a positive association only for CGRP + ) and degree of anisotropy (DA). This study suggests an interaction between sensory and sympathetic nervous system and T1DM-induced bone loss. Identification of the factors involved in the loss of CGRP + sensory and TH + sympathetic fibers and how they regulate bone loss may result in new avenues to treat T1DM-related osteoporosis. Copyright © 2017 Elsevier B.V. All rights reserved.

An Unexpected Complication of Residual Fibular Strut Graft While Performing A Press fit Hemiarthroplasty for A Secondary Nonunion Fracture Neck of the Femur.

PubMed

Huda, Najmul; Julfiqar; Pant, Ajay; Aslam, M

2015-01-01

Perioperative complications are well known during partial and total hip arthroplasty. One of the common categories of these complications is an intraoperative fractures of the proximal femur. Here we discuss a case of perforation of posteromedial cortex of the proximal femur, while doing a press fit modular bipolar hemiarthroplasty, in a young adult with secondary nonunion of the femoral neck fracture. The cause of this proximal femur perforation was residual fibular strut graft that, redirected the femoral stem into undesirable direction. This complication of residual fibular strut graft has not been disscussed much in the orthopedic literature previously. A press fit modular bipolar hiparthroplasty was performed in a young adult male with nonunion fracture neck of the femur secondary to initial fixation using 6.5mm cannulated hip screws and nonvascularized free fibular strut grafting. Failure to completely remove the fibular strut from the proximal femur lead to difficult negotiation of the femoral stem into the femoral canal and ultimately a perforation in the proximal femur at the level of the lesser trochanter. A revision procedure was done to completely remove the residual fibular graft, and then a fresh press fit modular bipolar hemiarthroplasty was done. Complete removal of fibular strut graft should be done, while performing hip arthroplasty in patients with failed fibular grafting for fracture neck of the femur.

Femoral curvature variability in modern humans using three-dimensional quadric surface fitting.

PubMed

Chapman, Tara; Sholukha, Victor; Semal, Patrick; Louryan, Stéphane; Rooze, Marcel; Van Sint Jan, Serge

2015-12-01

This study analysed femoral curvature in a population from Belgium in conjunction with other morphological characteristics by the use of three-dimensional (3D) quadric surfaces (QS) modelled from the bone surface. 3D models were created from computed tomography data of 75 femoral modern human bones. Anatomical landmarks (ALs) were palpated in specific bony areas of the femur (shaft, condyles, neck and head). QS were then created from the surface vertices which enclose these ALs. The diaphyseal shaft was divided into five QS shapes to analyse curvature in different parts of the shaft. Femoral bending differs in different parts of the diaphyseal shaft. The greatest degree of curvature was found in the distal shaft (mean 4.5° range 0.2°-10°) followed by the proximal (mean 4.4° range 1.5°-10.2°), proximal intermediate (mean 3.7° range 0.9°-7.9°) and distal intermediate (mean 1.8° range 0.2°-5.6°) shaft sections. The proximal and distal angles were significantly more bowed than the intermediate proximal and the intermediate distal angle. There was no significant difference between the proximal and distal angle. No significant correlations were found between morphological characteristics and femoral curvature. An extremely large variability of femoral curvature with several bones displaying very high or low degrees of femoral curvature was also found. 3D QS fitting enables the creation of accurate models which can discriminate between different patterns in similar curvatures and demonstrates there is a clear difference between curvature in different parts of the shaft.

Multiple Small Diameter Drillings Increase Femoral Neck Stability Compared with Single Large Diameter Femoral Head Core Decompression Technique for Avascular Necrosis of the Femoral Head.

PubMed

Brown, Philip J; Mannava, Sandeep; Seyler, Thorsten M; Plate, Johannes F; Van Sikes, Charles; Stitzel, Joel D; Lang, Jason E

2016-10-26

Femoral head core decompression is an efficacious joint-preserving procedure for treatment of early stage avascular necrosis. However, postoperative fractures have been described which may be related to the decompression technique used. Femoral head decompressions were performed on 12 matched human cadaveric femora comparing large 8mm single bore versus multiple 3mm small drilling techniques. Ultimate failure strength of the femora was tested using a servo-hydraulic material testing system. Ultimate load to failure was compared between the different decompression techniques using two paired ANCOVA linear regression models. Prior to biomechanical testing and after the intervention, volumetric bone mineral density was determined using quantitative computed tomography to account for variation between cadaveric samples and to assess the amount of bone disruption by the core decompression. Core decompression, using the small diameter bore and multiple drilling technique, withstood significantly greater load prior to failure compared with the single large bore technique after adjustment for bone mineral density (p< 0.05). The 8mm single bore technique removed a significantly larger volume of bone compared to the 3mm multiple drilling technique (p< 0.001). However, total fracture energy was similar between the two core decompression techniques. When considering core decompression for the treatment of early stage avascular necrosis, the multiple small bore technique removed less bone volume, thereby potentially leading to higher load to failure.

Computation of Femoral Canine Morphometric Parameters in Three-Dimensional Geometrical Models.

PubMed

Savio, Gianpaolo; Baroni, Teresa; Concheri, Gianmaria; Baroni, Ermenegildo; Meneghello, Roberto; Longo, Federico; Isola, Maurizio

2016-11-01

To define and validate a method for the measurement of 3-dimensional (3D) morphometric parameters in polygonal mesh models of canine femora. Ex vivo/computerized model. Sixteen femora from 8 medium to large-breed canine cadavers (mean body weight 28.3 kg, mean age 5.3 years). Femora were measured with a 3D scanner, obtaining 3D meshes. A computer-aided design-based (CAD) software tool was purposely developed, which allowed automatic calculation of morphometric parameters on a mesh model. Anatomic and mechanical lateral proximal femoral angles (aLPFA and mLPFA), anatomic and mechanical lateral distal femoral angles (aLDFA and mLDFA), femoral neck angle (FNA), femoral torsion angle (FTA), and femoral varus angle (FVA) were measured in 3D space. Angles were also measured onto projected planes and radiographic images. Mean (SD) femoral angles (degrees) measured in 3D space were: aLPFA 115.2 (3.9), mLPFA 105.5 (4.2), aLDFA 88.6 (4.5), mLDFA 93.4 (3.9), FNA 129.6 (4.3), FTA 45 (4.5), and FVA -1.4 (4.5). Onto projection planes, aLPFA was 103.7 (5.9), mLPFA 98.4 (5.3), aLDFA 88.3 (5.5), mLDFA 93.6 (4.2), FNA 132.1 (3.5), FTA 19.1 (5.7), and FVA -1.7 (5.5). With radiographic imaging, aLPFA was 109.6 (5.9), mLPFA 105.3 (5.2), aLDFA 92.6 (3.8), mLDFA 96.9 (2.9), FNA 120.2 (8.0), FTA 30.2 (5.7), and FVA 2.6 (3.8). The proposed method gives reliable and consistent information about 3D bone conformation. Results are obtained automatically and depend only on femur morphology, avoiding any operator-related bias. Angles in 3D space are different from those measured with standard radiographic methods, mainly due to the different definition of femoral axes. © Copyright 2016 by The American College of Veterinary Surgeons.

Automated computation of femoral angles in dogs from three-dimensional computed tomography reconstructions: Comparison with manual techniques.

PubMed

Longo, F; Nicetto, T; Banzato, T; Savio, G; Drigo, M; Meneghello, R; Concheri, G; Isola, M

2018-02-01

The aim of this ex vivo study was to test a novel three-dimensional (3D) automated computer-aided design (CAD) method (aCAD) for the computation of femoral angles in dogs from 3D reconstructions of computed tomography (CT) images. The repeatability and reproducibility of three manual radiography, manual CT reconstructions and the aCAD method for the measurement of three femoral angles were evaluated: (1) anatomical lateral distal femoral angle (aLDFA); (2) femoral neck angle (FNA); and (3) femoral torsion angle (FTA). Femoral angles of 22 femurs obtained from 16 cadavers were measured by three blinded observers. Measurements were repeated three times by each observer for each diagnostic technique. Femoral angle measurements were analysed using a mixed effects linear model for repeated measures to determine the levels of intra-observer agreement (repeatability) and inter-observer agreement (reproducibility). Repeatability and reproducibility of measurements using the aCAD method were excellent (intra-class coefficients, ICCs≥0.98) for all three angles assessed. Manual radiography and CT exhibited excellent agreement for the aLDFA measurement (ICCs≥0.90). However, FNA repeatability and reproducibility were poor (ICCs<0.8), whereas FTA measurement showed slightly higher ICCs values, except for the radiographic reproducibility, which was poor (ICCs<0.8). The computation of the 3D aCAD method provided the highest repeatability and reproducibility among the tested methodologies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Automated 3D quantitative assessment and measurement of alpha angles from the femoral head-neck junction using MR imaging

NASA Astrophysics Data System (ADS)

Xia, Ying; Fripp, Jurgen; Chandra, Shekhar S.; Walker, Duncan; Crozier, Stuart; Engstrom, Craig

2015-10-01

To develop an automated approach for 3D quantitative assessment and measurement of alpha angles from the femoral head-neck (FHN) junction using bone models derived from magnetic resonance (MR) images of the hip joint. Bilateral MR images of the hip joints were acquired from 30 male volunteers (healthy active individuals and high-performance athletes, aged 18-49 years) using a water-excited 3D dual echo steady state (DESS) sequence. In a subset of these subjects (18 water-polo players), additional True Fast Imaging with Steady-state Precession (TrueFISP) images were acquired from the right hip joint. For both MR image sets, an active shape model based algorithm was used to generate automated 3D bone reconstructions of the proximal femur. Subsequently, a local coordinate system of the femur was constructed to compute a 2D shape map to project femoral head sphericity for calculation of alpha angles around the FHN junction. To evaluate automated alpha angle measures, manual analyses were performed on anterosuperior and anterior radial MR slices from the FHN junction that were automatically reformatted using the constructed coordinate system. High intra- and inter-rater reliability (intra-class correlation coefficients  >  0.95) was found for manual alpha angle measurements from the auto-extracted anterosuperior and anterior radial slices. Strong correlations were observed between manual and automatic measures of alpha angles for anterosuperior (r  =  0.84) and anterior (r  =  0.92) FHN positions. For matched DESS and TrueFISP images, there were no significant differences between automated alpha angle measures obtained from the upper anterior quadrant of the FHN junction (two-way repeated measures ANOVA, F  <  0.01, p  =  0.98). Our automatic 3D method analysed MR images of the hip joints to generate alpha angle measures around the FHN junction circumference with very good reliability and reproducibility. This work has the

Large Diameter Femoral Heads Impose Significant Alterations on the Strains Developed on Femoral Component and Bone: A Finite Element Analysis

PubMed Central

Theodorou, E.G; Provatidis, C.G; Babis, G.C; Georgiou, C.S; Megas, P.D

2011-01-01

Total Hip Arthroplasty aims at fully recreating a functional hip joint. Over the past years modular implant systems have become common practice and are widely used, due to the surgical options they provide. In addition Big Femoral Heads have also been implemented in the process, providing more flexibility for the surgeon. The current study aims at investigating the effects that femoral heads of bigger diameter may impose on the mechanical behavior of the bone-implant assembly. Using data acquired by Computed Tomographies and a Coordinate Measurement Machine, a cadaveric femur and a Profemur-E modular stem were fully digitized, leading to a three dimensional finite element model in ANSYS Workbench. Strains and stresses were then calculated, focusing on areas of clinical interest, based on Gruen zones: the calcar and the corresponding below the greater trochanter area in the proximal femur, the stem tip region and a profile line along linea aspera. The performed finite elements analysis revealed that the use of large diameter heads produces significant changes in strain development within the bone volume, especially in the lateral side. The application of Frost’s law in bone remodeling, validated the hypothesis that for all diameters normal bone growth occurs. However, in the calcar area lower strain values were recorded, when comparing with the reference model featuring a 28mm femoral head. Along line aspera and for the stem tip area, higher values were recorded. Finally, stresses calculated on the modular neck revealed increased values, but without reaching the yield strength of the titanium alloy used. PMID:21792381

Large diameter femoral heads impose significant alterations on the strains developed on femoral component and bone: a finite element analysis.

PubMed

Theodorou, E G; Provatidis, C G; Babis, G C; Georgiou, C S; Megas, P D

2011-01-01

Total Hip Arthroplasty aims at fully recreating a functional hip joint. Over the past years modular implant systems have become common practice and are widely used, due to the surgical options they provide. In addition Big Femoral Heads have also been implemented in the process, providing more flexibility for the surgeon. The current study aims at investigating the effects that femoral heads of bigger diameter may impose on the mechanical behavior of the bone-implant assembly. Using data acquired by Computed Tomographies and a Coordinate Measurement Machine, a cadaveric femur and a Profemur-E modular stem were fully digitized, leading to a three dimensional finite element model in ANSYS Workbench. Strains and stresses were then calculated, focusing on areas of clinical interest, based on Gruen zones: the calcar and the corresponding below the greater trochanter area in the proximal femur, the stem tip region and a profile line along linea aspera. The performed finite elements analysis revealed that the use of large diameter heads produces significant changes in strain development within the bone volume, especially in the lateral side. The application of Frost's law in bone remodeling, validated the hypothesis that for all diameters normal bone growth occurs. However, in the calcar area lower strain values were recorded, when comparing with the reference model featuring a 28mm femoral head. Along line aspera and for the stem tip area, higher values were recorded. Finally, stresses calculated on the modular neck revealed increased values, but without reaching the yield strength of the titanium alloy used.

Patello-femoral and tibio-femoral contact forces during kicking type of activity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Engin, A.E.; Tumer, S.T.

1996-12-31

In this paper patello-femoral and tibia-femoral contact forces during kicking type of activity is presented by means of a dynamic model of the knee joint which includes tibio-femoral and patello-femoral articulations, and the major ligaments of the joint. The model shows that the patella can be subjected to very large transient patello-femoral contact forces during a strenuous lower limb activity such as kicking even under conditions of small knee-flexion angles.

The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction

PubMed Central

Byun, Ha Young; Shin, Heesuk; Lee, Eun Shin; Kong, Min Sik; Lee, Seung Hun

2016-01-01

Objective To assess the intra-rater and inter-rater reliability for measuring femoral anteversion angle (FAA) by a radiographic method using three-dimensional computed tomography reconstruction (3D-CT). Methods The study included 82 children who presented with intoeing gait. 3D-CT data taken between 2006 and 2014 were retrospectively reviewed. FAA was measured by 3D-CT. FAA is defined as the angle between the long axis of the femur neck and condylar axis of the distal femur. FAA measurement was performed twice at both lower extremities by each rater. The intra-rater and inter-rater reliability were calculated by intraclass correlation coefficient (ICC). Results One hundred and sixty-four lower limbs of 82 children (31 boys and 51 girls, 6.3±3.2 years old) were included. The ICCs of intra-rater measurement for the angle of femoral neck axis (NA) were 0.89 for rater A and 0.96 for rater B, and those of condylar axis (CA) were 0.99 for rater A and 0.99 for rater B, respectively. The ICC of inter-rater measurement for the angle of NA was 0.89 and that of CA was 0.92. By each rater, the ICCs of the intrarater measurement for FAA were 0.97 for rater A and 0.95 for rater B, respectively and the ICC of the inter-rater measurement for FAA was 0.89. Conclusion The 3D-CT measures for FAA are reliable within individual raters and between different raters. The 3D-CT measures of FAA can be a useful method for accurate diagnosis and follow-up of femoral anteversion. PMID:27152273

Femur Neck Fracture in a Young Marfan Syndrome Patient.

PubMed

Kwon, Yong-Uk; Kong, Gyu-Min; Park, Jun-Ho

2016-12-01

Marfan syndrome is an autosomal dominant and could decrease bone mineral density. So patients with Marfan syndrome could vulnerable to trauma in old ages. We present the first report, to the best of our knowledge, of a rare fracture of the femoral neck with a minor traumatic history in a juvenile Marfan syndrome patient whose physis is still open. Although the patient is young, her bone mineral density was low and the geometry of femur is changed like old ages. The femur neck fracture in children is very rare and only caused by high energy trauma, we concluded that the Marfan syndrome makes the bone weaker in young age and preventative medications to avoid fractures in younger Marfan syndrome patients are necessary in early ages.

The "Swiss-cheese Doppler-guided laser tonsillectomy": a new safe cribriform approach to intracapsular tonsillectomy.

PubMed

Palmieri, B; Iannitti, T; Fistetto, G; Rottigni, V

2013-05-01

Outpatient laser ablation of palatine tonsils is a very interesting procedure that has been recently introduced as a routine in head and neck surgery departments. The aim of this study was to describe a new strategy using a Doppler-guided fibre optic neodymium-yttrium-aluminium-garnet (YAG) laser to remove up to 80 % of tonsillar tissue, as assessed in the long-term postoperative clinical evaluation of the volume of the tonsils at the follow-up, and leaving the capsule in place, thus avoiding any haemorrhagic complication and minimize pain. A total of 20 patients (men, n=13; women, n=7), aged between 6 and 63, were recruited for the procedure. They were affected by chronic hypertrophic tonsillitis with a recurrent fever and other symptoms that were related to oral inflammation. Among the 20 patients, no serious adverse events, including haemorrhage-related complications, were observed. Treatment was well tolerated, even in patients displaying an overall low pain threshold. No dropout or uncompleted procedure occurred in the present study. Minor complications included sore throat, moderate oedema, mild acute pharynx inflammation, slight peritonsillar exudate and local burning. The postoperative pain, measured by Scott-Huskisson visual analogue scale, was between 5 and 40 mm and was easily counteracted by means of external ice packages and nonsteroidal anti-inflammatory drugs, according to the individual patient's need. During the 12-36-month follow-up patients showed improved symptoms (n=7) and complete recovery (n=13). A relapse episode was observed in two patients. This study supports fibre optic laser neodymium-YAG tonsil surgery, named "cribriform intracapsular tonsillectomy" or "Swiss-cheese laser tonsillectomy", as an effective alternative to the traditional cold knife approach or electrosurgery. This approach could become the gold standard for tonsil surgery in the third millennium for safety reasons, acceptable cost-benefit ratio, the precise targeting of

Femoral neck-shaft angle in humans: variation relating to climate, clothing, lifestyle, sex, age and side.

PubMed

Gilligan, Ian; Chandraphak, Supichya; Mahakkanukrauh, Pasuk

2013-08-01

The femoral neck-shaft angle (NSA) varies among modern humans but measurement problems and sampling limitations have precluded the identification of factors contributing to its variation at the population level. Potential sources of variation include sex, age, side (left or right), regional differences in body shape due to climatic adaptation, and the effects of habitual activity patterns (e.g. mobile and sedentary lifestyles and foraging, agricultural, and urban economies). In this study we addressed these issues, using consistent methods to assemble a global NSA database comprising over 8000 femora representing 100 human groups. Results from the analyses show an average NSA for modern humans of 127° (markedly lower than the accepted value of 135°); there is no sex difference, no age-related change in adults, but possibly a small lateral difference which could be due to right leg dominance. Climatic trends consistent with principles based on Bergmann's rule are evident at the global and continental levels, with the NSA varying in relation to other body shape indices: median NSA, for instance, is higher in warmer regions, notably in the Pacific (130°), whereas lower values (associated with a more stocky body build) are found in regions where ancestral populations were exposed to colder conditions, in Europe (126°) and the Americas (125°). There is a modest trend towards increasing NSA with the economic transitions from forager to agricultural and urban lifestyles and, to a lesser extent, from a mobile to a sedentary existence. However, the main trend associated with these transitions is a progressive narrowing in the range of variation in the NSA, which may be attributable to thermal insulation provided by improved cultural buffering from climate, particularly clothing. © 2013 Anatomical Society.

Femoral neck-shaft angle in humans: variation relating to climate, clothing, lifestyle, sex, age and side

PubMed Central

Gilligan, Ian; Chandraphak, Supichya; Mahakkanukrauh, Pasuk

2013-01-01

The femoral neck-shaft angle (NSA) varies among modern humans but measurement problems and sampling limitations have precluded the identification of factors contributing to its variation at the population level. Potential sources of variation include sex, age, side (left or right), regional differences in body shape due to climatic adaptation, and the effects of habitual activity patterns (e.g. mobile and sedentary lifestyles and foraging, agricultural, and urban economies). In this study we addressed these issues, using consistent methods to assemble a global NSA database comprising over 8000 femora representing 100 human groups. Results from the analyses show an average NSA for modern humans of 127° (markedly lower than the accepted value of 135°); there is no sex difference, no age-related change in adults, but possibly a small lateral difference which could be due to right leg dominance. Climatic trends consistent with principles based on Bergmann's rule are evident at the global and continental levels, with the NSA varying in relation to other body shape indices: median NSA, for instance, is higher in warmer regions, notably in the Pacific (130°), whereas lower values (associated with a more stocky body build) are found in regions where ancestral populations were exposed to colder conditions, in Europe (126°) and the Americas (125°). There is a modest trend towards increasing NSA with the economic transitions from forager to agricultural and urban lifestyles and, to a lesser extent, from a mobile to a sedentary existence. However, the main trend associated with these transitions is a progressive narrowing in the range of variation in the NSA, which may be attributable to thermal insulation provided by improved cultural buffering from climate, particularly clothing. PMID:23781912

Does Choice of Head Size and Neck Geometry Affect Stem Migration in Modular Large-Diameter Metal-on-Metal Total Hip Arthroplasty? A Preliminary Analysis

PubMed Central

Georgiou, CS; Evangelou, KG; Theodorou, EG; Provatidis, CG; Megas, PD

2012-01-01

Due to their theoretical advantages, hip systems combining modular necks and large diameter femoral heads have gradually gained popularity. However, among others, concerns regarding changes in the load transfer patterns were raised. Recent stress analyses have indeed shown that the use of modular necks and big femoral heads causes significant changes in the strain distribution along the femur. Our original hypothesis was that these changes may affect early distal migration of a modular stem. We examined the effect of head diameter and neck geometry on migration at two years of follow-up in a case series of 116 patients (125 hips), who have undergone primary Metal-on-Metal total hip arthroplasty with the modular grit-blasted Profemur®E stem combined with large-diameter heads (>36 mm). We found that choice of neck geometry and head diameter has no effect on stem migration. A multivariate regression analysis including the potential confounding variables of the body mass index, bone quality, canal fill and stem positioning revealed only a negative correlation between subsidence and canal fill in midstem area. Statistical analysis, despite its limitations, did not confirm our hypothesis that choice of neck geometry and/or head diameter affects early distal migration of a modular stem. However, the importance of correct stem sizing was revealed. PMID:23284597

Does Choice of Head Size and Neck Geometry Affect Stem Migration in Modular Large-Diameter Metal-on-Metal Total Hip Arthroplasty? A Preliminary Analysis.

PubMed

Georgiou, Cs; Evangelou, Kg; Theodorou, Eg; Provatidis, Cg; Megas, Pd

2012-01-01

Due to their theoretical advantages, hip systems combining modular necks and large diameter femoral heads have gradually gained popularity. However, among others, concerns regarding changes in the load transfer patterns were raised. Recent stress analyses have indeed shown that the use of modular necks and big femoral heads causes significant changes in the strain distribution along the femur. Our original hypothesis was that these changes may affect early distal migration of a modular stem. We examined the effect of head diameter and neck geometry on migration at two years of follow-up in a case series of 116 patients (125 hips), who have undergone primary Metal-on-Metal total hip arthroplasty with the modular grit-blasted Profemur®E stem combined with large-diameter heads (>36 mm). We found that choice of neck geometry and head diameter has no effect on stem migration. A multivariate regression analysis including the potential confounding variables of the body mass index, bone quality, canal fill and stem positioning revealed only a negative correlation between subsidence and canal fill in midstem area. Statistical analysis, despite its limitations, did not confirm our hypothesis that choice of neck geometry and/or head diameter affects early distal migration of a modular stem. However, the importance of correct stem sizing was revealed.

A new classification and treatment protocol for combined fractures of the femoral shaft with the proximal or distal femur with closed locked intramedullary nailing: clinical experience of 63 fractures.

PubMed

Lambiris, Elias; Giannikas, Dimitrios; Galanopoulos, George; Tyllianakis, Minos; Megas, Panagiotis

2003-03-01

The medical records and radiographs of 63 patients, who were admitted between 1989-1997, with a combined femur fracture, were reviewed. Associated injuries were present in 38 (60%) patients. The combined fractures were classified into four major types depending on their anatomical position: type I, femoral shaft fracture combined with hip neck fracture; type II, femoral shaft fracture combined with a trochanteric fracture; type III, femoral shaft fracture combined with a distal femur fracture; and type IV, femoral shaft fracture combined with a proximal or distal femur fracture. The fractures were treated with locked intramedullary nailing and additional free cancellous 6.5-mm screws as needed. Fifty-six fractures healed without further operations. Of the remaining 6 fractures, 2 were material failures, 1 malunion with 3-cm shortening and external rotation of the femoral diaphysis, 2 early infections of the surgical wound, and 1 pseudarthrosis of the femoral shaft. All fractures were healed between 16 and 32 weeks (average: 20 weeks).

Influence of Femoral Component Design on Retrograde Femoral Nail Starting Point.

PubMed

Service, Benjamin C; Kang, William; Turnbull, Nathan; Langford, Joshua; Haidukewych, George; Koval, Kenneth J

2015-10-01

Our experience with retrograde femoral nailing after periprosthetic distal femur fractures was that femoral components with deep trochlear grooves posteriorly displace the nail entry point resulting in recurvatum deformity. This study evaluated the influence of distal femoral prosthetic design on the starting point. One hundred lateral knee images were examined. The distal edge of Blumensaat's line was used to create a ratio of its location compared with the maximum anteroposterior condylar width called the starting point ratio (SPR). Femoral trials from 6 manufacturers were analyzed to determine the location of simulated nail position in the sagittal plane compared with the maximum anteroposterior prosthetic width. These measurements were used to create a ratio, the femoral component ratio (FCR). The FCR was compared with the SPR to determine if a femoral component would be at risk for retrograde nail starting point posterior to the Blumensaat's line. The mean SPR was 0.392 ± 0.03, and the mean FCR was 0.416 ± 0.05, which was significantly greater (P = 0.003). The mean FCR was 0.444 ± 0.06 for the cruciate retaining (CR) trials and was 0.393 ± 0.04 for the posterior stabilized trials; this difference was significant (P < 0.001). The FCR for the femoral trials studied was significantly greater than the SPR for native knees and was significantly greater for CR femoral components compared with posterior stabilized components. These findings demonstrate that many total knee prostheses, particularly CR designs, are at risk for a starting point posterior to Blumensaat's line.

Mechanism of chlorogenic acid treatment on femoral head necrosis and its protection of osteoblasts.

PubMed

Zhang, Mingjuan; Hu, Xianda

2016-07-01

The aim of the present study was to investigate the therapeutic effect of chlorogenic acid on hormonal femoral head necrosis and its protection of osteoblasts. The study established a femoral head necrosis model in Wistar rats using Escherichia coli endotoxin and prednisolone acetate. The rats were divided into five groups and were treated with different concentrations of chlorogenic acid (1, 10 and 20 mg/kg). The main detected indicators were the blood rheology, bone mineral density, and the hydroxyproline and hexosamine (HOM) contents. At a cellular level, osteoblasts were cultured and treated by drug-containing serum. Subsequently, cell proliferation and the osteoblast cycle were measured using flow cytometry, and the protein expression levels of Bax and B-cell lymphoma 2 (Bcl-2) were detected using western blotting. Chlorogenic acid at a concentration of 20 mg/kg (high-dose) enhanced the bone mineral density of the femoral head and femoral neck following ischemia. Simultaneously, blood flow following the injection of prednisolone acetate was significantly improved, and the HOM contents of the high-dose chlorogenic acid group were significantly different. The results from the flow cytometry analysis indicated that chlorogenic acid can efficiently ameliorate hormone-induced necrosis. The osteoblasts were isolated and cultured. The MTT colorimetric assay showed that chlorogenic acid at different densities can increase the proliferation capabilities of osteoblasts and accelerate the transition process of G 0 /G 1 phase to S phase, as well as enhance mitosis and the regeneration of osteoblasts. Western blotting detection indicated that chlorogenic acid may prohibit the decrease of Bcl-2 and the increase of Bax during apoptosis, thereby inhibiting osteoblast apoptosis and preventing the deterioration of femoral head necrosis. In conclusion, chlorogenic acid at the density of 20 mg/kg is effective in the treatment of hormonal femoral head necrosis, which may be

Long-Duration Spaceflight During the Bion-M1 Spaceflight Experiment Resulted in Significant Bone Loss in the Femoral Head and Alterations in Stem Cell Differentiation Potential in Male Mice

NASA Astrophysics Data System (ADS)

Blaber, Elizabeth; Almeida, Eduardo; Grigoryan, Eleonora; Globus, Ruth

Scientific understanding of the effects of microgravity on mammalian physiology has been limited to short duration spaceflight experiments (10-15 days). As long duration and inter-planetary missions are being initiated, there is a great need to understand the long-term effects of spaceflight on various physiological processes, including stem cell-based tissue regeneration. Bion-M1, for the first time, enabled the possibility of studying the effects of 30-days of microgravity exposure on a mouse model with sufficient sample size to enable statistical analysis. In this experiment, we hypothesized that microgravity negatively impacts stem cell based tissue regeneration, such as bone remodeling and regeneration from hematopoietic and mesenchymal precursors, thereby resulting in tissue degeneration in mice exposed to spaceflight. To test this hypothesis we collected the pelvis and proximal femur from space-flown mice and asynchronous ground controls and analyzed bone and bone marrow using techniques including Microcomputed Tomography (MicroCT), and in-vitro differentiation and differentiating cell motility assays. To determine the effects of 30-days spaceflight on bone tissue mass, we used MicroCT to analyze the trabecular bone of the femoral head and the cortical bone of the femoral neck and mid-shaft. We found that spaceflight caused a 45% decrease in bone volume ratio, a 17% decrease in trabecular thickness, a 25% decrease in trabecular number, and a 17% increase in trabecular spacing of trabecular bone. Furthermore, structural model index and trabecular pattern factor were increased by 32% and 82% respectively indicating that 30-days spaceflight resulted not only in a large loss of trabecular bone but also in a decrease of bone strength indicators. Analysis of the femoral neck cortical bone showed an increase in marrow area and cortical porosity indicating an overall widening of the femoral neck. Interestingly, no significant alterations were found in the cortical

Lateral Cortical Thickening and Bone Heterogeneity of the Subtrochanteric Femur Measured With Quantitative CT as Indicators for Early Detection of Atypical Femoral Fractures in Long-Term Bisphosphonate Users.

PubMed

Lee, Seung Hyun; Lee, Young Han; Suh, Jin-Suck

2017-10-01

The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-naïve patients with no history of femoral fracture using quantitative CT (QCT). Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naïve patients. The lateral cortical thickness index (CTI) and the mean BMD (BMD mean ) and SD of the BMD (BMD SD ) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test. Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naïve group (median, 0.21) (p = 0.009). The lateral cortex BMD SD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm 3 ) than the BP users without a femoral fracture (median, 39.27 mg/cm 3 ; p = 0.049) and the BP-naïve group (median, 31.02 mg/cm 3 ; p = 0.037). There was no significant difference among groups in lateral cortex BMD mean , BMD mean and BMD SD of the entire cross-sectional area, and femoral neck-shaft angle. Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMD SD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naïve patients.

Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations.

PubMed

Schwaiger, Benedikt J; Kopperdahl, David L; Nardo, Lorenzo; Facchetti, Luca; Gersing, Alexandra S; Neumann, Jan; Lee, Kwang J; Keaveny, Tony M; Link, Thomas M

2017-08-01

Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans-as validated in previous studies-as a reference standard. Men with prostate cancer (n=82, 71.6±8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤80mg/cm 3 , femoral neck or total hip T-score ≤-2.5, vertebral strength ≤6500N and femoral strength ≤3500N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. All measurements from PET/CT versus MDCT were strongly correlated (R 2 =0.93-0.97; P<0.0001 for all). Mean differences for total hip areal BMD (0.001g/cm 2 , 1.1%), femoral strength (-60N, 1.3%), vertebral trabecular BMD (2mg/cm 3 , 2.6%) and vertebral strength (150N; 1.7%) measurements were not statistically significant (P>0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (-0.018g/cm 2 ; -2

Femoral nerve damage (image)

MedlinePlus

The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

Specificity of the femoral slump test for the assessment of experimentally induced anterior knee pain.

PubMed

Lai, Weng-Hang; Shih, Yi-Fen; Lin, Pei-Ling; Chen, Wen-Yin; Ma, Hsiao-Li

2012-12-01

To assess the specificity of the femoral slump test (FST) when assessing experimentally induced anterior knee pain. Cross-sectional, exploratory study. Research laboratory. Asymptomatic subjects (N=12; 6 men; 6 women) for the study. An experimental pain model was used to simulate anterior knee pain by injecting .25 mL of hypertonic saline solution (5% NaCl) into the medial infrapatellar fat pad. Not applicable. The changes in pain intensity and diameter after applying the structure differential maneuver (neck flexion/extension) during the FST were recorded and analyzed. Results revealed that the structure differential maneuver of the FST did not alter the pain intensity or diameter in 9 (neck extension) and 10 (neck flexion) out of 12 subjects, which meant that the FST provided appropriate testing responses in 75% to 83% cases when the anterior knee pain did not originate in neural tissues. The FST had a specificity of more than .75 when detecting nerve mechanosensitivity problems of anterior knee pain. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Objectively measured physical activity and bone strength in 9-year-old boys and girls.

PubMed

Sardinha, Luís B; Baptista, Fátima; Ekelund, Ulf

2008-09-01

The purpose of this work was to analyze the relationship between intensity and duration of physical activity and composite indices of femoral neck strength and bone-mineral content of the femoral neck, lumbar spine, and total body. Physical activity was assessed by accelerometry in 143 girls and 150 boys (mean age: 9.7 years). Measurement of bone-mineral content, femoral neck bone-mineral density, femoral neck width, hip axis length, and total body fat-free mass was performed with dual-energy radiograph absorptiometry. Compressive [(bone-mineral density x femoral neck width/weight)] and bending strength [(bone-mineral density x femoral neck width(2))/(hip axis length x weight)] express the forces that the femoral neck has to withstand in weight bearing, whereas impact strength [(bone-mineral density x femoral neck width x hip axis length)/(height x weight)] expresses the energy that the femoral neck has to absorb in an impact from standing height. Analysis of covariance (fat-free mass and age adjusted) showed differences between boys and girls of approximately 9% for compressive, 10% for bending, and 9% for impact strength. Stepwise regression analysis using time spent at sedentary, light, moderate, and vigorous physical activity as predictors revealed that vigorous physical activity explained 5% to 9% of femoral neck strength variable variance in both genders, except for bending strength in boys, and approximately 1% to 3% of total body and femoral neck bone-mineral content variance. Vigorous physical activity was then used to categorize boys and girls into quartiles. Pairwise comparison indicated that boys in the third and fourth quartiles (accumulation of >26 minutes/day) demonstrated higher compressive (11%-12%), bending (10%), and impact (14%) strength than boys in the first quartile. In girls, comparison revealed a difference between the fourth (accumulation of >25 minutes/day) and first quartiles for bending strength (11%). We did not observe any

Actis Total Hip System 2 Year Follow-up

ClinicalTrials.gov

2017-08-14

Osteoarthritis; Traumatic Arthritis; Rheumatoid Arthritis; Congenital Hip Dysplasia; Avascular Necrosis of the Femoral Head; Acute Traumatic Fracture of the Femoral Head or Neck; Certain Cases of Ankylosis; Non-union of Femoral Neck Fractures; Certain High Sub-Capital & Femoral Neck Fractures in Elderly

Head salvage of an infected neck of femur fracture in an adult: a case report.

PubMed

Joseph, Christina Marie; Jepegnanam, Thilak Samuel

2018-05-23

Head preservation of an infected neck of femur fracture appears to be extremely rare with no described cases in literature till date. We present the outcome of head salvage in a young adult with an infected neck of femur nonunion who in addition had chronic osteomyelitic sequelae of his entire femur with reactivation of latent infection in the distal femoral diaphysis. Osteosynthesis was performed by means of cancellous screw fixation augmented with bone substitute following a failed attempt at salvage with a valgus intertrochanteric osteotomy. The patient had an excellent functional outcome with near normal hip range of movements at a follow-up of 5 years after union.

A multiple intervention strategy for reducing femoral neck stress injuries and other serious overuse injuries in U.S. Army Basic Combat Training.

PubMed

Scott, Shawn J; Feltwell, David N; Knapik, Joseph J; Barkley, Colleen B; Hauret, Keith G; Bullock, Steven H; Evans, Rachel K

2012-09-01

We hypothesized that the use of evidence based injury prevention strategies would lead to a reduction in the incidence of femoral neck stress injuries (FNSIs) and other serious overuse injuries in U.S. Army Basic Combat Training (BCT). An injury prevention strategy began in late 2008 that included: (1) leadership education, (2) leadership enforcement of proven methods, and (3) injury surveillance and reporting. Data on FNSI and removal from training for injury were analyzed based on the fiscal year 2006 through 2010 (n = 210,002). For men, FNSI were reduced from 13 to 20 cases/10,000 recruits per year (2006-2008) to 8 cases/10,000 recruits in 2010 (p < 0.01); for women, FNSI were reduced from 35 to 41 cases/10,000 recruits per year (2006-2008) to 18 cases/10,000 recruits per year in 2010 (p < 0.01). For men, removals from training for injury were reduced from 0.8 to 1.1 cases/100 recruits per year (2006-2008) to 0.5 cases/100 recruits in 2010 (p < 0.01); for women removal from training for injury was reduced from 2.3 to 2.4 cases/100 recruits (2006-2008) to 1.0 case/100 recruits per years in 2010 (p < 0.01). The time course of the changes suggests that following specific injury prevention methods was effective in reducing injuries.

Three-dimensional MRI Analysis of Femoral Head Remodeling After Reduction in Patients With Developmental Dysplasia of the Hip.

PubMed

Tsukagoshi, Yuta; Kamada, Hiroshi; Kamegaya, Makoto; Takeuchi, Ryoko; Nakagawa, Shogo; Tomaru, Yohei; Tanaka, Kenta; Onishi, Mio; Nishino, Tomofumi; Yamazaki, Masashi

2018-05-02

Previous reports on patients with developmental dysplasia of the hip (DDH) showed that the prereduced femoral head was notably smaller and more nonspherical than the intact head, with growth failure observed at the proximal posteromedial area. We evaluated the shape of the femoral head cartilage in patients with DDH before and after reduction, with size and sphericity assessed using 3-dimensional (3D) magnetic resonance imaging (MRI). We studied 10 patients with unilateral DDH (all female) who underwent closed reduction. Patients with avascular necrosis of the femoral head on the plain radiograph 1 year after reduction were excluded. 3D MRI was performed before reduction and after reduction, at 2 years of age. 3D-image analysis software was used to reconstruct the multiplanes. After setting the axial, coronal, and sagittal planes in the software (based on the femoral shaft and neck axes), the smallest sphere that included the femoral head cartilage was drawn, the diameter was measured, and the center of the sphere was defined as the femoral head center. We measured the distance between the center and cartilage surface every 30 degrees on the 3 reconstructed planes. Sphericity of the femoral head was calculated using a ratio (the distance divided by each radius) and compared between prereduction and postreduction. The mean patient age was 7±3 and 26±3 months at the first and second MRI, respectively. The mean duration between the reduction and second MRI was 18±3 months. The femoral head diameter was 26.7±1.5 and 26.0±1.6 mm on the diseased and intact sides, respectively (P=0.069). The ratios of the posteromedial area on the axial plane and the proximoposterior area on the sagittal plane after reduction were significantly larger than before reduction (P<0.01). We demonstrated that the size of the reduced femoral head was nearly equal to that of the intact femoral head and that the growth failure area of the head before reduction, in the proximal posteromedial

Mediolateral femoral component position in TKA significantly alters patella shift and femoral roll-back.

PubMed

Steinbrück, Arnd; Schröder, Christian; Woiczinski, Matthias; Schmidutz, Florian; Müller, Peter E; Jansson, Volkmar; Fottner, Andreas

2017-11-01

Increased retropatellar pressure and altered kinematics are associated with anterior knee pain and unsatisfied patients after total knee arthroplasty (TKA). Since malposition of the implant is believed to contribute to postoperative pain, we performed this in vitro study to evaluate the influence of mediolateral femoral component position on retropatellar pressure as well as tibio-femoral and patella kinematics. For the test, a fixed-bearing TKA was implanted in eight fresh frozen cadaver specimens. To determine the impact of mediolateral (ML) position, three variants of femoral components (3-mm medialization, neutral position and 3-mm lateralization) were produced using rapid prototyping replicas. In a knee rig, a loaded squat from 20° to 120° of flexion was applied. Retropatellar pressure distribution was measured with a pressure-sensitive film. Additionally, an ultrasonic-based three-dimensional motion analysis system was used to register patello- and tibio-femoral kinematics. ML translation of the femoral component by 3 mm did not lead to a significant alteration in retropatellar peak pressure (medial 6.5 ± 2.5 MPa vs. lateral 6.0 ± 2.4 MPa). Following the ML translation of the femoral component, the patella was significantly shifted and tilted in the same directions. Varying the ML femoral component position also led to a significant alteration in femoral roll-back. In day-by-day use, ML position should be chosen with care since there is a significant influence on patella shift and femoral roll-back. Retropatellar pressure is not significantly altered, so there is no clear evidence of an impact on anterior knee pain.

Fat embolism: special situations bilateral femoral fractures and pathologic femoral fractures.

PubMed

Kontakis, George M; Tossounidis, Theodoros; Weiss, Kurt; Pape, Hans-Christoph; Giannoudis, Peter V

2006-10-01

Few data are available in the literature regarding fat embolism in cases of bilateral femoral and pathological femoral fractures. The incidence of bilateral femoral fractures ranges from 2-9.5% of the total number of patients with femoral fractures, and they usually occur in high energy trauma and multi-trauma patients. Although injury severity scores tend to underestimate the severity of these injuries, fat embolism seems to occur in increased frequency ranging from 4.8-7.5%. Intramedullary nailing, which is the preferred surgical treatment, triggers a systemic inflammatory response that poses an additional burden to pulmonary function. In addition, the femur is a common site of metastatic bone disease. The treatment of impending and actual pathological fractures is complicated by increased rates of lung damage due to various factors. Fat embolism during treatment--mainly with intramedullary nails--generally seems to range from 0-10%.

Correlation of ultrasound appearance, gross anatomy, and histology of the femoral nerve at the femoral triangle.

PubMed

Lonchena, Tiffany K; McFadden, Kathryn; Orebaugh, Steven L

2016-01-01

Correlation between ultrasound appearance, gross anatomic characteristics, and histologic structure of the femoral nerve (FN) is lacking. Utilizing cadavers, we sought to characterize the anatomy of the FN, and provide a quantitative measure of its branching. We hypothesize that at the femoral crease, the FN exists as a group of nerve branches, rather than a single nerve structure, and secondarily, that this transition into many branches is apparent on ultrasonography. Nineteen preserved cadavers were investigated. Ultrasonography was sufficient to evaluate the femoral nerve in nine specimens; gross dissection was utilized in all 19. Anatomic characteristics were recorded, including distances from the inguinal ligament to femoral crease, first nerve branch, and complete arborization of the nerve. The nerves from nine specimens were excised for histologic analysis. On ultrasound, the nerve became more flattened, widened, and less discrete as it coursed distally. Branching of the nerve was apparent in 12 of 18 images, with mean distance from inguinal ligament of 3.9 (1.0) cm. However, upon dissection, major branching of the femoral nerve occurred at 3.1 (1.0) cm distal to the inguinal ligament, well proximal to the femoral crease. Histologic analysis was consistent with findings at dissection. The femoral nerve arborizes into multiple branches between the inguinal ligament and the femoral crease. Initial branching is often high in the femoral triangle. As hypothesized, the FN exists as a closely associated group of nerve branches at the level of the femoral crease; however, the termination of the nerve into multiple branches is not consistently apparent on ultrasonography.

Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

PubMed

Bonin, Nicolas; Gedouin, Jean-Emmanuel; Pibarot, Vincent; Bejui-Hughues, Jacques; Bothorel, Hugo; Saffarini, Mo; Batailler, Cécile

2017-10-03

Even if the benefits of collars are unclear, they remain widely used, in several femoral stem designs. This study aimed to determine whether collar size should be proportional to hip dimensions and morphology. The hypothesis was that the collar should be larger for greater stem sizes and for varus femoral necks. Computed Tomography scans of 204 healthy hips were digitally analysed and manually templated to determine principle dimensions, appropriate stem size and model, as well as cortical distance at the femoral calcar (ideal collar size). Univariable analysis revealed that cortical distance was moderately correlated with mediolateral offset (r = 0.572; p < 0.0001) and stem model (r = 0.520; p < 0.0001). Cortical distance was weakly correlated with head diameter (r = 0.399; p < 0.0001), stem size (r = 0.200; p = 0.017), and patient gender (r = 0.361; p < 0.0001). Multivariable analysis confirmed that stem model (p < 0.0001) and head diameter (p = 0.0162) are directly correlated to cortical distance. We found that cortical distance along the femoral calcar is directly correlated with the model of the stem implanted ('standard' or 'varus') and with the head diameter. This cortical distance indicates optimal collar size, which would grant maximum calcar coverage without prosthetic overhang. Collar size should be proportional to the size of the operated hip, and should be larger for 'varus' stem models than for 'standard' stem models.

Femoral Neck X-Ray Absorptiometry Parameters and Peripheral Quantitative Computer Tomography Tibial Cortical Density Predict Survival in Dialysis Patients.

PubMed

Yap, Natalie; Wong, Phillip; McGinn, Stella; Nery, Maria-Liza; Doyle, Jean; Wells, Lynda; Clifton-Bligh, Phillip; Clifton-Bligh, Roderick J

2017-01-01

Low bone mineral density (BMD) is a known independent predictor of mortality in the general elderly population. However, studies in patients with end-stage renal disease (ESRD) are limited. The present study evaluated mortality during long-term follow-up in a population of patients having dialysis for ESRD, in whom BMD was also measured. Fifty-eight patients with ESRD were recruited consecutively from a dialysis clinic and followed prospectively for 6 years. Baseline BMD of the lumbar spine and femoral neck (FN) were measured by X-ray absorptiometry and by peripheral quantitative CT at the radius and tibia. Serum calcium, phosphate, parathyroid hormone (PTH), and albumin were measured at baseline. During follow-up, 25 patients died. Univariate analysis showed that mortality was significantly associated with FN-BMD: hazards ratio (HR) per 0.1 g/cm2 decrease 1.50 (95% CI 1.07-2.10), p = 0.019; FN-T score: HR per 1-SD decrease 1.84 (95% CI 1.16-2.92), p = 0.009; and tibial cortical density: HR per 10 mg/cm3 decrease 1.08 (95% CI 1.02-1.14), p = 0.010. In multivariate analysis with stepwise adjustment for age, sex, transplant status, albumin, PTH, phosphate, dialysis duration, diabetes, and smoking, FN-T score remained significantly associated with mortality: HR per 1-SD decrease 1.82 (95% CI 1.02-3.24), p = 0.044, whereas the HR for FN-BMD and tibial cortical density were no longer significant. When 4 patients who had peritoneal dialysis were excluded, the HR relating FN-BMD, FN-T score, and tibial cortical density to mortality remained significant but became insignificant when albumin was included in the multivariate analysis. Reduced FN-BMD, FN-T score, and tibial cortical density were significantly associated with an increased risk of death in patients with ESRD. © 2017 S. Karger AG, Basel.

Hip Fractures and the Bundle: A Cost Analysis of Patients Undergoing Hip Arthroplasty for Femoral Neck Fracture vs Degenerative Joint Disease.

PubMed

Grace, Trevor R; Patterson, Joseph T; Tangtiphaiboontana, Jennifer; Krogue, Justin D; Vail, Thomas P; Ward, Derek T

2018-06-01

The purpose of this study is to determine whether episode Target Prices in the Bundled Payment for Care Improvement (BPCI) initiative sufficiently match the complexities and expenses expected for patients undergoing hip arthroplasty for femoral neck fracture (FNF) as compared to hip degenerative joint disease (DJD). Claims data under BPCI Model 2 were collected for patients undergoing hip arthroplasty at a single institution over a 2-year period. Payments from the index hospitalization to 90 days postoperatively were aggregated by Medicare Severity Diagnosis-Related Group (469 or 470), indication (DJD vs FNF), and categorized as index procedure, postacute services, and related hospital readmissions. Actual episode costs and Target Prices were compared in both the FNF and DJD cohorts undergoing hip arthroplasty to gauge the cost discrepancy in each group. A total of 183 patients were analyzed (31 with FNFs, 152 with DJD). In total, the FNF cohort incurred a $415,950 loss under the current episode Target Prices, whereas the DJD cohort incurred a $172,448 gain. Episode Target Prices were significantly higher than actual episode prices for the DJD cohort ($32,573 vs $24,776, P < .001). However, Target Prices were significantly lower than actual episode prices for the FNF cohort ($32,672 vs $49,755, P = .021). Episode Target Prices in the current BPCI model fall dramatically short of the actual expenses incurred by FNF patients undergoing hip arthroplasty. Better risk-adjusting Target Prices for this fragile population should be considered to avoid disincentives and delays in care. Copyright © 2018 Elsevier Inc. All rights reserved.

Use of a statistical model of the whole femur in a large scale, multi-model study of femoral neck fracture risk.

PubMed

Bryan, Rebecca; Nair, Prasanth B; Taylor, Mark

2009-09-18

Interpatient variability is often overlooked in orthopaedic computational studies due to the substantial challenges involved in sourcing and generating large numbers of bone models. A statistical model of the whole femur incorporating both geometric and material property variation was developed as a potential solution to this problem. The statistical model was constructed using principal component analysis, applied to 21 individual computer tomography scans. To test the ability of the statistical model to generate realistic, unique, finite element (FE) femur models it was used as a source of 1000 femurs to drive a study on femoral neck fracture risk. The study simulated the impact of an oblique fall to the side, a scenario known to account for a large proportion of hip fractures in the elderly and have a lower fracture load than alternative loading approaches. FE model generation, application of subject specific loading and boundary conditions, FE processing and post processing of the solutions were completed automatically. The generated models were within the bounds of the training data used to create the statistical model with a high mesh quality, able to be used directly by the FE solver without remeshing. The results indicated that 28 of the 1000 femurs were at highest risk of fracture. Closer analysis revealed the percentage of cortical bone in the proximal femur to be a crucial differentiator between the failed and non-failed groups. The likely fracture location was indicated to be intertrochantic. Comparison to previous computational, clinical and experimental work revealed support for these findings.

Experimentally gained insight - based proposal apropos the treatment of osteonecrosis of the femoral head.

PubMed

Boss, J H; Misselevich, I; Bejar, J; Norman, D; Zinman, C; Reis, D N

2004-01-01

An impeded blood flow through the femoral head is incriminated in the etiopathogenesis of osteonecrosis of the femoral head. The disorder is either primary (idiopathic avascular osteonecrosis) or secondary to one condition or another, say, corticosteroid medication, fracture of the neck, coagulation defects, physical or thermal damage, storage disorders, alcoholism, and infectious, autoimmune as also marrow infiltrating diseases. In the wake of the necrosis, several mediators are released in increased amounts, prime among which is the vascular endothelial growth factor. The intermediates recruit endothelial progenitor cells, macrophages, osteoclasts, fibroblasts, and osteoblasts, which, pervading throughout the necrotic areas, initiate the reparative processes. The dead, soft and hard tissular debris is substituted by fibrous - later on by hematopoietic-fatty tissue - and bone. The newly formed, appositional and intramembranous bone is deficient in its mechanical properties. The ordinary load-carrying functions suffice to deform these weakened femoral heads so that osteoarthritic changes develop. Considering contemporary assumptions of the causes of osteonecrosis, oxygenation, revascularization, and core decompression are the realistic therapeutic interventions. Necrosis of rats' femoral heads is studied as a model of osteonecrosis in both adults and children. In view of rodents' lifelong persisting physeal cartilage, vascular deprivation-induced osteonecrosis in rats mimics children's Perthes disease. The experimental model, which is well suited to test treatment modalities, has been used to investigate the effects of exposure to hyperbaric oxygen with and without non-weight bearing, medication of enoxaparin, and creation of an intraosseous conduit on the remodeling of the avascular necrotic femoral head. Intriguingly, the shape of treated rats' femoral heads is disfigured to a greater degree than that of untreated animals. This is most likely due to the reduced

The impact of proximal femoral morphology on failure strength with a mid-head resection short-stem hip arthroplasty.

PubMed

Olsen, Michael; Al Saied, Mohamed; Morison, Zachary; Sellan, Michael; Waddell, James P; Schemitsch, Emil H

2014-12-01

Mid-head resection short-stem hip arthroplasty is a conservative alternative to conventional total hip replacement and addresses proximal fixation challenges in patients not suitable for hip resurfacing. It is unclear whether proximal femoral morphology impacts the ultimate failure load of mid-head resection implanted femurs, thus the aim of this study was to investigate the effect of native neck-shaft angle (NSA) and coronal implant alignment on proximal femoral strength. In total, 36 synthetic femurs with two different proximal femoral morphologies were utilized in this study. Of them, 18 femurs with a varus NSA of 120° and 18 femurs with a valgus NSA of 135° were each implanted with a mid-head resection prosthesis. Femurs within the two different femoral morphology groups were divided into three equal coronal implant alignment groups: 10° valgus, 10° varus or neutral alignment. Prepared femurs were tested for stiffness and to failure in axial compression. There was no significant difference in stiffness nor failure load between femurs implanted with valgus-, varus- or neutrally aligned implants in femurs with a NSA of 120° (p = 0.396, p = 0.111, respectively). Femurs implanted in valgus orientation were significantly stiffer and failed at significantly higher loads than those implanted in varus alignment in femurs with a NSA of 135° (p = 0.001, p = 0.007, respectively). A mid-head resection short-stem hip arthroplasty seems less sensitive to clinically relevant variations of coronal implant alignment and may be more forgiving upon implantation in some femoral morphologies, however, a relative valgus component alignment is recommended. © IMechE 2014.

[Poldi-Čech cemented femoral stem in total hip arthroplasty after 25 years].

PubMed

Rozkydal, Z; Janíček, P

2010-08-01

-Čech stem with its anatomical shape and a highly polished surface meets the principles of successful composite beam stems. Its disadvantage is a valgus neck- shaft angle of 140° giving lower femoral offset and the risk of development of valgus deformity of the ipsilateral knee. In most cases osteolysis, radiolucent lines and bone rarefaction of the femur resulted from polyethylene wear of the acetabular component. This study demonstrates a long-term survivorship of the Poldi-Čech femoral component in patients undergoing total hip arthroplasty 25 to 35 years ago.

Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calvé-Perthes disease.

PubMed

Terjesen, Terje; Wiig, Ola; Svenningsen, Svein

2012-09-01

In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%. We asked whether (1) femoral osteotomy improves femoral head sphericity at followup in all patients with more than 50% femoral head necrosis or in selected groups only and (2) there is a critical age between 6.0 and 10.0 years over which femoral osteotomy does not improve the prognosis. We treated 70 patients with unilateral LCPD, age at diagnosis of more than 6.0 years, and femoral head necrosis of more than 50% with varus femoral osteotomy between 1996 and 2000. We classified necrosis using the Catterall classification. We established a control group of 51 similar children who received physiotherapy. At the 5-year followup visit, the hips were graded according to femoral head shape: spherical, ovoid, or flat. At 5-year followup, there was no difference between the treatment groups in radiographic outcome in Catterall Group 3 hips. In Catterall Group 4 hips, femoral head sphericity was better in the osteotomy group, with flat femoral heads in 14% compared to 75% after physiotherapy. The same trend toward better head sphericity occurred when the lateral pillar classification was used. In children aged 6.0 to 10.0 years, in whom the whole femoral head is affected, femoral head sphericity 5 years after femoral osteotomy was better than that after physiotherapy.

Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins.

PubMed

Christie, J; Howie, C R; Armour, P C

1988-03-01

One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.

Preferential reduction of bone mineral density at the femur reflects impairment of physical activity in patients with low-activity rheumatoid arthritis.

PubMed

Sugiguchi, Shigeru; Goto, Hitoshi; Inaba, Masaaki; Nishizawa, Yoshiki

2010-02-01

Bone mineral density (BMD) and factors influencing BMD in rheumatoid arthritis (RA) under good or moderate control were examined to assess management of osteoporosis in RA. BMD of the lumbar spine, femur, and distal radius was measured in 105 female patients with well-controlled RA. Laboratory and clinical variables associated with disease activity were measured in the same subjects, and correlations between these variables and BMD were evaluated. The RA patients showed a greater decrease in BMD of the femoral neck than of the lumbar spine. Age, Health Assessment Questionnaire (HAQ) score, and Larsen damage score had negative correlations with BMD of the femoral neck. In multiple regression analysis of the parameters associated with BMD of the femoral neck in simple regression analysis, an increase in HAQ score showed a negative correlation with BMD of the femoral neck. After initiation of treatment with alendronate (ALN), BMD of the femoral neck increased and correlated with improvement in HAQ score. A decrease in BMD of the femoral neck is a characteristic of RA. This suggests that muscle tonus has more effect than weight-bearing activity on BMD in patients with RA. BMD of the femoral neck is a useful index for general evaluation of RA patients.

Numerical simulation of blood flow in femoral perfusion: comparison between side-armed femoral artery perfusion and direct femoral artery perfusion.

PubMed

Kitamura, Shingo; Shirota, Minori; Fukuda, Wakako; Inamura, Takao; Fukuda, Ikuo

2016-12-01

Computational numerical analysis was performed to elucidate the flow dynamics of femoral artery perfusion. Numerical simulation of blood flow was performed from the right femoral artery in an aortic model. An incompressible Navier-Stokes equation and continuity equation were solved using computed flow dynamics software. Three different perfusion models were analyzed: a 4.0-mm cannula (outer diameter 15 French size), a 5.2-mm cannula (18 French size) and an 8-mm prosthetic graft. The cannula was inserted parallel to the femoral artery, while the graft was anastomosed perpendicular to the femoral artery. Shear stress was highest with the 4-mm cannula (172 Pa) followed by the graft (127 Pa) and the 5.2-mm cannula (99 Pa). The cannula exit velocity was high, even when the 5.2-mm cannula was used. Although side-armed perfusion with an 8-mm graft generated a high shear stress area near the point of anastomosis, flow velocity at the external iliac artery was decreased. The jet speed decreased due to the Coanda effect caused by the recirculation behind sudden expansion of diameter, and the flow velocity maintains a constant speed after the reattachment length of the flow. This study showed that iliac artery shear stress was lower with the 5.2-mm cannula than with the 4-mm cannula when used for femoral perfusion. Side-armed graft perfusion generates a high shear stress area around the anastomotic site, but flow velocity in the iliac artery is slower in the graft model than in the 5.2-mm cannula model.

Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study.

PubMed

Rivadeneira, Fernando; Zillikens, M Carola; De Laet, Chris Edh; Hofman, Albert; Uitterlinden, André G; Beck, Thomas J; Pols, Huibert Ap

2007-11-01

We studied HSA measurements in relation to hip fracture risk in 4,806 individuals (2,740 women). Hip fractures (n = 147) occurred at the same absolute levels of bone instability in both sexes. Cortical instability (propensity of thinner cortices in wide diameters to buckle) explains why hip fracture risk at different BMD levels is the same across sexes. Despite the sexual dimorphism of bone, hip fracture risk is very similar in men and women at the same absolute BMD. We aimed to elucidate the main structural properties of bone that underlie the measured BMD and that ultimately determines the risk of hip fracture in elderly men and women. This study is part of the Rotterdam Study (a large prospective population-based cohort) and included 147 incident hip fracture cases in 4,806 participants with DXA-derived hip structural analysis (mean follow-up, 8.6 yr). Indices compared in relation to fracture included neck width, cortical thickness, section modulus (an index of bending strength), and buckling ratio (an index of cortical bone instability). We used a mathematical model to calculate the hip fracture distribution by femoral neck BMD, BMC, bone area, and hip structure analysis (HSA) parameters (cortical thickness, section modulus narrow neck width, and buckling ratio) and compared it with prospective data from the Rotterdam Study. In the prospective data, hip fracture cases in both sexes had lower BMD, thinner cortices, greater bone width, lower strength, and higher instability at baseline. In fractured individuals, men had an average BMD that was 0.09 g/cm(2) higher than women (p < 0.00001), whereas no significant difference in buckling ratios was seen. Modeled fracture distribution by BMD and buckling ratio levels were in concordance to the prospective data and showed that hip fractures seem to occur at the same absolute levels of bone instability (buckling ratio) in both men and women. No significant differences were observed between the areas under the ROC curves

Low stiffness floors can attenuate fall-related femoral impact forces by up to 50% without substantially impairing balance in older women.

PubMed

Laing, Andrew C; Robinovitch, Stephen N

2009-05-01

Low stiffness floors such as carpet appear to decrease hip fracture risk by providing a modest degree of force attenuation during falls without impairing balance. It is unknown whether other compliant floors can more effectively reduce impact loads without coincident increases in fall risk. We used a hip impact simulator to assess femoral neck force for four energy-absorbing floors (SmartCell, SofTile, Firm Foam, Soft Foam) compared to a rigid floor. We also assessed the influence of these floors on balance/mobility in 15 elderly women. We observed differences in the mean attenuation in peak femoral neck force provided by the SmartCell (24.5%), SofTile (47.2%), Firm Foam (76.6%), and Soft Foam (52.4%) floors. As impact velocity increased from 2 to 4m/s, force attenuation increased for SmartCell (from 17.3% to 33.7%) and SofTile (from 44.9% to 51.2%), but decreased for the Firm Foam (from 87.0% to 64.5%) and Soft Foam (from 66.1% to 37.9%) conditions. Regarding balance, there were no significant differences between the rigid, SmartCell, and SofTile floors in proportion of successful trials, Get Up and Go time, balance confidence or utility ratings. SofTile, Firm Foam, and Soft Foam caused significant increases (when compared to the rigid floor) in postural sway in the anterior-posterior and medial-lateral directions during standing. However, SmartCell increased sway only in the anterior-posterior direction. This study demonstrates that two commercially available compliant floors can attenuate femoral impact force by up to 50% while having only limited influence on balance in older women, and supports development of clinical trials to test their effectiveness in high-risk settings.

Functional and radiologic outcome of open reduction and internal fixation of condylar head and neck fractures using miniplate or microplate system.

PubMed

Xie, Si-Tian; Singhal, Dhruv; Chen, Chien-Tzung; Chen, Yu-Ray

2013-12-01

Although the appropriate management of condylar process fractures after miniplate or microplate fixation has been described, there has been no comparative analysis of these plating systems. A retrospective review of patients who underwent open reduction and internal fixation (ORIF) of condylar head or neck fractures at our institution from January 2000 through August 2010 identified 70 patients. Of these, 38 were treated with microplates and 32 with miniplates. The primary functional and radiographic results were the maximal mouth opening and condylar bone resorption, respectively. The rates of complications, including malocclusion, chin deviation, temporomandibular joint complaints, and facial nerve palsy, were recorded. The maximal mouth opening was larger in the microplate group than in the miniplate group throughout the follow-up period; this difference was statistically significant 12 (P = 0.020), 18 (P = 0.026), and 24 (P = 0.032) months after ORIF. Similarly, the radiographic scores for bone resorption and condyle morphology were significantly better in the microplate group than in the miniplate group throughout the follow-up period [6 (P = 0.011), 12 (P = 0.035), 24 (P = 0.026), and 48 (P = 0.040) months after ORIF]. Moreover, patients who underwent miniplate fixation experienced a significantly higher incidence of temporomandibular joint click than those who underwent microplate fixation (P = 0.014). Microplates limit dissection, providing excellent fixation for intracapsular condylar head fractures, and also provide adequate rigidity for fixation of condylar neck fractures. Microplate fixation of condylar head and neck fractures yielded excellent functional and radiographic results. The rates of complications after microplate fixation were equal to or less than those in the miniplate group. Prospective studies are needed to confirm these findings.

Pre-operative digital templating in cemented hip hemiarthroplasty for neck of femur fractures.

PubMed

Kwok, Iris H Y; Pallett, Scott J C; Massa, Edward; Cundall-Curry, Duncan; Loeffler, Mark D

2016-03-01

Pre-operative digital templating allows the surgeon to foresee any anatomical anomalies which may lead to intra-operative problems, and anticipate appropriate instruments and implants required during surgery. Although its role is well-established in successful elective total hip arthroplasty, little work has been done on its use in hip hemiarthroplasty in neck of femur fractures. We describe our initial experience of digital templating in 40 consecutive patients who have undergone cemented hip hemiarthroplasty, assessing templating accuracy between templated implant sizes to actual implant sizes. 81% of implanted heads were templated to within two head sizes, and 89% of implanted stems were templated to within two sizes. Although there was a moderately strong correlation of 0.52 between templated and actual head sizes, this correlation was not demonstrated in femoral stem sizes. Mean leg length discrepancy was -2.5mm (S.D. 8.5), and the mean difference in femoral offset between the operated and non-operated hip was -1mm (S.D. 4.4). Digital templating is a useful adjunct to the surgeon in pre-operative planning of hip hemiarthroplasty in the restoration of leg length and femoral offset. However, its accuracy is inferior to that of elective total hip arthroplasty. Copyright © 2016 Elsevier Ltd. All rights reserved.

Ultrasound-guided placement of a permanent percutaneous femoral nerve stimulator leads for the treatment of intractable femoral neuropathy.

PubMed

Narouze, Samer N; Zakari, Adel; Vydyanathan, Amaresh

2009-01-01

Femoral nerve injury is a rare complication of cardiac catheterization and is usually caused by direct trauma during femoral artery access, compression from a hematoma, or prolonged digital pressure for post-procedural hemostasis. Peripheral nerve stimulation has been used to treat different pain syndromes in the upper and lower extremities with variable success and it typically requires direct vision with open surgical approach. Since the femoral nerve can be readily seen with ultrasonography, an ultrasound-guided lead placement seemed practical. A 61-year-old morbidly obese male who sustained femoral nerve injury during cardiac catheterization continued to complain of intractable femoral neuropathy 18 months afterwords. He failed multiple treatment modalities and continued to complain of severe neuropathic pains that markedly interfere with his daily activities. Two percutaneous leads were placed under real-time ultrasonography and the placement was confirmed with fluoroscopy. One lead was placed along the longitudinal axis of the nerve and the patient had good coverage over the anterior thigh but not below the knee. So another lead was placed horizontally across the femoral nerve in order to stimulate all the branches and the patient reported good coverage along the saphenous nerve distribution down to the foot. The patient continues to be pain free 20 months after the implant. Here we described a novel non-invasive percutaneous approach for femoral nerve stimulation with ultrasound guidance which allowed precise placement of the stimulating lead very close to the femoral nerve without the need for surgical exploration.

Relationship between neck circumference, insulin resistance and arterial stiffness in overweight and obese subjects.

PubMed

Fantin, Francesco; Comellato, Gabriele; Rossi, Andrea P; Grison, Elisa; Zoico, Elena; Mazzali, Gloria; Zamboni, Mauro

2017-09-01

Background Only a few studies have investigated the relationship between neck circumference and cardiometabolic risk. The aim of this study was to assess the relationships between neck circumference, waist circumference, metabolic variables and arterial stiffness in a group of overweight and obese subjects evaluating a possible independent role of neck circumference in determining arterial stiffness. Methods and results We studied 95 subjects (53 women) with an age range of 20-77 years and body mass index range from 25.69 to 47.04 kg/m 2 . In each subject we evaluated body mass index, waist, hip and neck circumference, systolic and diastolic blood pressure, insulin, fasting glucose, cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWVcf) and carotid-radial pulse wave velocity (PWVcr). Both PWVcf and PWVcr were higher in subjects with high values of neck circumference compared with subjects with normal values of neck circumference. Subjects with high values of neck circumference and abdominal obesity presented higher values of mean arterial pressure, PWVcr and homeostasis model assessment (HOMA) index and lower values of high-density lipoprotein than subjects with only abdominal obesity. Two models of stepwise multiple regression were performed in order to evaluate the combined effect of independent variables on arterial stiffness. In the first model PWVcf was considered a dependent variable, and age, gender, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, waist circumference, neck circumference, HOMA index and the use of anti-hypertensive medications were considered independent variables. Age, systolic blood pressure, triglycerides and waist circumference were significant predictors of PWVcf, explaining 65% of its variance. In the second model, in which PWVcr was considered a dependent variable, neck circumference

In situ femoral dual-energy X-ray absorptiometry related to ash weight, bone size and density, and its relationship with mechanical failure loads of the proximal femur.

PubMed

Lochmüller, E M; Miller, P; Bürklein, D; Wehr, U; Rambeck, W; Eckstein, F

2000-01-01

The objective of this study was to directly compare in situ femoral dual-energy X-ray absorptiometry (DXA) and in vitro chemical analysis (ash weight and calcium) with mechanical failure loads of the proximal femur, and to determine the influence of bone size (volume) and density on mechanical failure and DXA-derived areal bone mineral density (BMD, in g/cm2). We performed femoral DXA in 52 fixed cadavers (age 82.1 +/- 9.7 years; 30 male, 22 female) with intact skin and soft tissues. The femora were then excised, mechanically loaded to failure in a stance phase configuration, their volume measured with a water displacement method (proximal neck to lesser trochanter), and the ash weight and calcium content of this region determined by chemical analysis. The correlation coefficient between the bone mineral content (measured in situ with DXA) and the ash weight was r = 0.87 (standard error of the estimate = 16%), the ash weight allowing for a better prediction of femoral failure loads (r = 0.78; p < 0.01) than DXA (r = 0.67; p < 0.01). The femoral volume (r = 0.61; p < 0.01), but not the volumetric bone density (r = 0.26), was significantly associated with the failure load. The femoral bone volume had a significant impact (r = 0.35; p < 0.01) on the areal BMD (DXA), and only 63% of the variability of bone volume could be predicted (based on the basis of body height, weight and femoral projectional bone area. The results suggest that accuracy errors of femoral DXA limit the prediction of mechanical failure loads, and that the influence of bone size on areal BMD cannot be fully corrected by accounting for body height, weight and projected femoral area.

Accuracy of femoral templating in reproducing anatomical femoral offset in total hip replacement.

PubMed

Davies, H; Foote, J; Spencer, R F

2007-01-01

Restoration of hip biomechanics is a crucial component of successful total hip replacement. Preoperative templating is recommended to ensure that the size and orientation of implants is optimised. We studied how closely natural femoral offset could be reproduced using the manufacturers' templates for 10 femoral stems in common use in the UK. A series of 23 consecutive preoperative radiographs from patients who had undergone unilateral total hip replacement for unilateral osteoarthritis of the hip was employed. The change in offset between the templated position of the best-fitting template and the anatomical centre of the hip was measured. The templates were then ranked according to their ability to reproduce the normal anatomical offset. The most accurate was the CPS-Plus (Root Mean Square Error 2.0 mm) followed in rank order by: C stem (2.16), CPT (2.40), Exeter (3.23), Stanmore (3.28), Charnley (3.65), Corail (3.72), ABG II (4.30), Furlong HAC (5.08) and Furlong modular (7.14). A similar pattern of results was achieved when the standard error of variability of offset was analysed. We observed a wide variation in the ability of the femoral prosthesis templates to reproduce normal femoral offset. This variation was independent of the seniority of the observer. The templates of modern polished tapered stems with high modularity were best able to reproduce femoral offset. The current move towards digitisation of X-rays may offer manufacturers an opportunity to improve template designs in certain instances, and to develop appropriate computer software.

[Isolated true aneurysm of the deep femoral artery].

PubMed

Salomon du Mont, L; Holzer, T; Kazandjian, C; Saucy, F; Corpataux, J M; Rinckenbach, S; Déglise, S

2016-07-01

Aneurysms of the deep femoral artery, accounting for 5% of all femoral aneurysms, are uncommon. There is a serious risk of rupture. We report the case of an 83-year-old patient with a painless pulsatile mass in the right groin due to an aneurysm of the deep femoral artery. History taking revealed no cardiovascular risk factors and no other aneurysms at other localizations. The etiology remained unclear because no recent history of local trauma or puncture was found. ACT angiography was performed, revealing a true isolated aneurysm of the deep femoral artery with a diameter of 90mm, beginning 1cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient underwent open surgery, with exclusion of the aneurysm and interposition of an 8-mm Dacron graft to preserve deep femoral artery flow. Due to their localization, the diagnosis and the management of aneurysms of the deep femoral artery can be difficult. Options are surgical exclusion or an endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, aneurysms of the deep femoral artery should be treated without any delay. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Comparison of femoral strength and fracture risk index derived from DXA-based finite element analysis for stratifying hip fracture risk: A cross-sectional study.

PubMed

Yang, Shuman; Luo, Yunhua; Yang, Lang; Dall'Ara, Enrico; Eastell, Richard; Goertzen, Andrew L; McCloskey, Eugene V; Leslie, William D; Lix, Lisa M

2018-05-01

Dual-energy X-ray absorptiometry (DXA)-based finite element analysis (FEA) has been studied for assessment of hip fracture risk. Femoral strength (FS) is the maximum force that the femur can sustain before its weakest region reaches the yielding limit. Fracture risk index (FRI), which also considers subject-specific impact force, is defined as the ratio of von Mises stress induced by a sideways fall to the bone yield stress over the proximal femur. We compared risk stratification for prior hip fracture using FS and FRI derived from DXA-based FEA. The study cohort included women aged ≥65years undergoing baseline hip DXA, with femoral neck T-scores <-1 and no osteoporosis treatment; 324 cases had prior hip fracture and 655 controls had no prior fracture. Using anonymized DXA hip scans, we measured FS and FRI. Separate multivariable logistic regression models were used to estimate odds ratios (ORs), c-statistics and their 95% confidence intervals (95% CIs) for the association of hip fracture with FS and FRI. Increased hip fracture risk was associated with lower FS (OR per SD 1.36, 95% CI: 1.15, 1.62) and higher FRI (OR per SD 1.99, 95% CI: 1.63, 2.43) after adjusting for Fracture Risk Assessment Tool (FRAX) hip fracture probability computed with bone mineral density (BMD). The c-statistic for the model containing FS (0.69; 95% CI: 0.65, 0.72) was lower than the c-statistic for the model with FRI (0.77; 95% CI: 0.74, 0.80) or femoral neck BMD (0.74; 95% CI: 0.71, 0.77; all P<0.05). FS and FRI were independently associated with hip fracture, but there were differences in performance characteristics. Copyright © 2018 Elsevier Inc. All rights reserved.

Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

PubMed Central

Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

2016-01-01

Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women: A meta-analysis of international cohorts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johansson, H.; Kanis, J. A.; Oden, A.

There are occasional marked discordances in BMD T-scores at the lumbar spine (LS) and femoral neck (FN). We investigated whether such discordances could contribute independently to fracture prediction using FRAX. In this paper, we studied 21,158 women, average age 63 years, from 10 prospective cohorts with baseline FRAX variables as well as FN and LS BMD. Incident fractures were collected by self-report and/or radiographic reports. Extended Poisson regression examined the relationship between differences in LS and FN T-scores (ΔLS–FN) and fracture risk, adjusted for age, time since baseline and other factors including FRAX 10-year probability for major osteoporotic fracture calculatedmore » using FN BMD. To examine the effect of an adjustment for ΔLS–FN on reclassification, women were separated into risk categories by their FRAX major fracture probability. High risk was classified using two approaches: being above the National Osteoporosis Guideline Group intervention threshold or, separately, being in the highest third of each cohort. The absolute ΔLS–FN was greater than 2 SD for 2.5 % of women and between 1 and 2 SD for 21 %. ΔLS–FN was associated with a significant risk of fracture adjusted for baseline FRAX (HR per SD change = 1.09; 95 % CI = 1.04–1.15). In reclassification analyses, only 2.3–3.2 % of the women moved to a higher or lower risk category when using FRAX with ΔLS–FN compared with FN-derived FRAX alone. Adjustment of estimated fracture risk for a large LS/FN discrepancy (>2SD) impacts to a large extent on only a relatively small number of individuals. More moderate (1–2SD) discordances in FN and LS T-scores have a small impact on FRAX probabilities. Finally, this might still improve clinical decision-making, particularly in women with probabilities close to an intervention threshold.« less

Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women: A meta-analysis of international cohorts

DOE PAGES

Johansson, H.; Kanis, J. A.; Oden, A.; ...

2014-09-04

There are occasional marked discordances in BMD T-scores at the lumbar spine (LS) and femoral neck (FN). We investigated whether such discordances could contribute independently to fracture prediction using FRAX. In this paper, we studied 21,158 women, average age 63 years, from 10 prospective cohorts with baseline FRAX variables as well as FN and LS BMD. Incident fractures were collected by self-report and/or radiographic reports. Extended Poisson regression examined the relationship between differences in LS and FN T-scores (ΔLS–FN) and fracture risk, adjusted for age, time since baseline and other factors including FRAX 10-year probability for major osteoporotic fracture calculatedmore » using FN BMD. To examine the effect of an adjustment for ΔLS–FN on reclassification, women were separated into risk categories by their FRAX major fracture probability. High risk was classified using two approaches: being above the National Osteoporosis Guideline Group intervention threshold or, separately, being in the highest third of each cohort. The absolute ΔLS–FN was greater than 2 SD for 2.5 % of women and between 1 and 2 SD for 21 %. ΔLS–FN was associated with a significant risk of fracture adjusted for baseline FRAX (HR per SD change = 1.09; 95 % CI = 1.04–1.15). In reclassification analyses, only 2.3–3.2 % of the women moved to a higher or lower risk category when using FRAX with ΔLS–FN compared with FN-derived FRAX alone. Adjustment of estimated fracture risk for a large LS/FN discrepancy (>2SD) impacts to a large extent on only a relatively small number of individuals. More moderate (1–2SD) discordances in FN and LS T-scores have a small impact on FRAX probabilities. Finally, this might still improve clinical decision-making, particularly in women with probabilities close to an intervention threshold.« less

Intracapsular development and dispersal polymorphism in the predatory gastropod Ocenebra erinaceus (Linnaeus 1758)

NASA Astrophysics Data System (ADS)

Smith, Kathryn E.; Reed, Adam J.; Thatje, Sven

2015-09-01

Intraspecific polymorphism during development, such as poecilogony or dispersal polymorphism, has rarely been observed in the marine environment. The ecological advantages of this bet-hedging strategy, whereby the offspring from one species exhibit multiple developmental modes, include the potential for rapid colonization of new habitats while simultaneously achieving a degree of gene flow between populations. The muricid gastropod, Ocenebra erinaceus, is a common, shallow-water marine predator found across England and France. Historically, O. erinaceus caused significant damage to shellfisheries, but more recently it has been impacted by TBT-induced imposex. Despite the previous attention given to this species, little is known about its encapsulated development. Studying O. erinaceus egg capsules from the Solent, UK, we describe intracapsular development at 15 °C, the in situ temperature at time of oviposition. Within each capsule, all embryos developed; no nurse eggs were present. Development was categorized into eight ontogenetic stages, although not all individuals displayed every stage; embryos hatched as either swimming late-pediveliger larvae or crawling juveniles after 59-69 days, indicating dispersal polymorphism to occur in this species. Swimming late-pediveliger larvae completed metamorphosis within 72 h of hatching. As O. erinaceus continues to recover from TBT pollution, dispersal polymorphism may facilitate a rapid expansion in both population size and range. If this occurs, O. erinaceus has the potential to, once again, become a serious problem for shellfisheries around Europe.

Effects of postoperative administration of ketoprofen or carprofen on short- and long-term results of femoral head and neck excision in dogs.

PubMed

Grisneaux, Emmanuelle; Dupuis, Jacques; Pibarot, Philippe; Bonneau, Norbert H; Charette, Benoît; Blais, Diane

2003-10-01

To determine whether postoperative administration of ketoprofen or carprofen had any effects on short- or long-term results of femoral head and neck excision (FHNE) in dogs. Prospective randomized controlled trial. 40 client-owned, large-breed dogs undergoing FHNE and 15 healthy large-breed dogs used as controls for hip joint angle measurements and force plate analyses. Dogs undergoing FHNE were treated with ketoprofen, carprofen, or a placebo for 21 days after surgery. Hip joint abduction and extension angles were measured at the end of surgery and 120 days later. Lameness scores were assigned, and force plate analyses were performed on days 3, 15, and 120. There were no significant differences among treatment groups in regard to hip joint angles or lameness scores. Force plate analysis revealed that dogs in all 3 treatment groups bore consistently less weight on the operated limb than did control dogs for the duration of the study. Dogs receiving ketoprofen had greater peak propulsive force at a walk on day 3 and greater peak vertical force at a walk on day 15 than did dogs receiving the placebo. Treatment of an acute condition and preservation of the lesser trochanter, but not postoperative analgesic administration, were positively associated with ground reaction forces on day 120. Owners of 12 of 31 dogs indicated that the dog's gait worsened for a few days after discontinuation of analgesic administration. Administration of ketoprofen or carprofen after surgery was not associated with long-term results of FHNE, probably because of the impact of other factors. Because some owners noticed worsening of the lameness following cessation of analgesic administration in the present study, it is possible that longer administration would have improved long-term results.

Proximal femoral bone loss and increased rate of fracture with a proximally hydroxyapatite-coated femoral component.

PubMed

Radl, R; Aigner, C; Hungerford, M; Pascher, A; Windhager, R

2000-11-01

We performed a retrospective analysis of the clinical and radiological outcomes of total hip replacement using an uncemented femoral component proximally coated with hydroxyapatite. Of 136 patients, 118 who had undergone 124 primary total hip replacements were available for study. Their mean age was 66.5 years (19 to 90) and the mean follow-up was 5.6 years (4.25 to 7.25). At the final follow-up the mean Harris hip score was 92 (47.7 to 100). Periprosthetic femoral fractures, which occurred in seven patients (5.6%), were treated by osteosynthesis in six and conservatively in one. We had to revise five femoral components, one because of aseptic loosening, one because of septic loosening and three because of periprosthetic fracture. At the final follow-up there were definite signs of aseptic loosening in two patients. Radiologically, proximal femoral bone loss in Gruen zones I and VI was evident in 96.8% of hips, while bone hypertrophy in zones III and V was seen in 64.7%. In 24 hips (20.2%) the mean subsidence of the stem was 3.7 mm which occurred within the first 12 postoperative weeks. This indicated poor initial stability, which might have been aggravated by early weight-bearing. The high rate of failure in our study suggests that proximal femoral bone loss affects the long-term survival of the replacement.

Femoral component rotation in patellofemoral joint replacement.

PubMed

van Jonbergen, Hans-Peter W; Westerbeek, Robin E

2018-06-01

Clinical outcomes in patellofemoral joint replacement may be related to femoral component rotation. Assessment of rotational alignment is however difficult as patients with isolated patellofemoral osteoarthritis often have trochlear dysplasia. The use of the medial malleolus as a landmark to guide rotation has been suggested. The purpose of our study was to evaluate this technique with regard to femoral component rotation, and to correlate rotation with clinical outcomes at one-year follow-up. Forty-one knees in 39 patients had patellofemoral joint replacement using the Zimmer Gender-Solutions patellofemoral prosthesis. Intraoperatively, we determined femoral component rotational alignment using an extramedullary rod aimed at the inferior tip of the medial malleolus. Postoperatively, we measured the angle between the femoral component and the anatomical transepicondylar axis using CT. The amount of rotation was correlated with clinical outcomes at one-year follow-up. Forty knees in 38 patients were available for one-year follow-up. Mean femoral component rotation relative to the anatomical transepicondylar axis was 1.4° external rotation (range, -3.8 to 5.7°). We found no statistically significant correlation between femoral component rotation and change from baseline KOOS subscales at one-year follow-up. Our findings show that when using the medial malleolus as a landmark to guide rotation, the femoral component of the patellofemoral prosthesis was oriented in external rotation relative to the anatomical transepicondylar axis in 80% of knees. Our study did not show a relation between the amount of external rotation and clinical outcomes. Level III. Copyright © 2018 Elsevier B.V. All rights reserved.

Femoral lipectomy increases postprandial lipemia in women

PubMed Central

Hernandez, Teri L.; Bessesen, Daniel H.; Cox-York, Kimberly A.; Erickson, Christopher B.; Law, Christopher K.; Anderson, Molly K.; Wang, Hong; Jackman, Matthew R.

2015-01-01

Femoral subcutaneous adipose tissue (SAT) appears to be cardioprotective compared with abdominal SAT, possibly through better triglyceride (TG) sequestration. We hypothesized that removal of femoral SAT would increase postprandial TG through a reduction in dietary fatty acid (FA) storage. Normal-weight (means ± SD; BMI 23.9 ± 2.6 kg/m2) women (n = 29; age 45 ± 6 yr) were randomized to femoral lipectomy (LIPO) or control (CON) and followed for 1 yr. Regional adiposity was measured by DEXA and CT. A liquid meal labeled with [14C]oleic acid was used to trace the appearance of dietary FA in plasma (6-h postprandial TG), breath (24-h oxidation), and SAT (24-h [14C]TG storage). Fasting LPL activity was measured in abdominal and femoral SAT. DEXA leg fat mass was reduced after LIPO vs. CON (Δ−1.4 ± 0.7 vs. 0.1 ± 0.5 kg, P < 0.001) and remained reduced at 1 yr (−1.1 ± 1.4 vs. −0.2 ± 0.5 kg, P < 0.05), as did CT thigh subcutaneous fat area (−39.6 ± 36.6 vs. 4.7 ± 14.6 cm2, P < 0.05); DEXA trunk fat mass and CT visceral fat area were unchanged. Postprandial TG increased (5.9 ± 7.7 vs. −0.6 ± 5.3 × 103 mg/dl, P < 0.05) and femoral SAT LPL activity decreased (−21.9 ± 22.3 vs. 10.5 ± 26.5 nmol·min−1·g−1, P < 0.05) 1 yr following LIPO vs. CON. There were no group differences in 14C-labeled TG appearing in abdominal and femoral SAT or elsewhere. In conclusion, femoral fat remained reduced 1 yr following lipectomy and was accompanied by increased postprandial TG and reduced femoral SAT LPL activity. There were no changes in storage of meal-derived FA or visceral fat. Our data support a protective role for femoral adiposity on circulating TG independent of dietary FA storage and visceral adiposity. PMID:25968576

Femoral lipectomy increases postprandial lipemia in women.

PubMed

Hernandez, Teri L; Bessesen, Daniel H; Cox-York, Kimberly A; Erickson, Christopher B; Law, Christopher K; Anderson, Molly K; Wang, Hong; Jackman, Matthew R; Van Pelt, Rachael E

2015-07-01

Femoral subcutaneous adipose tissue (SAT) appears to be cardioprotective compared with abdominal SAT, possibly through better triglyceride (TG) sequestration. We hypothesized that removal of femoral SAT would increase postprandial TG through a reduction in dietary fatty acid (FA) storage. Normal-weight (means ± SD; BMI 23.9 ± 2.6 kg/m(2)) women (n = 29; age 45 ± 6 yr) were randomized to femoral lipectomy (LIPO) or control (CON) and followed for 1 yr. Regional adiposity was measured by DEXA and CT. A liquid meal labeled with [(14)C]oleic acid was used to trace the appearance of dietary FA in plasma (6-h postprandial TG), breath (24-h oxidation), and SAT (24-h [(14)C]TG storage). Fasting LPL activity was measured in abdominal and femoral SAT. DEXA leg fat mass was reduced after LIPO vs. CON (Δ-1.4 ± 0.7 vs. 0.1 ± 0.5 kg, P < 0.001) and remained reduced at 1 yr (-1.1 ± 1.4 vs. -0.2 ± 0.5 kg, P < 0.05), as did CT thigh subcutaneous fat area (-39.6 ± 36.6 vs. 4.7 ± 14.6 cm(2), P < 0.05); DEXA trunk fat mass and CT visceral fat area were unchanged. Postprandial TG increased (5.9 ± 7.7 vs. -0.6 ± 5.3 × 10(3) mg/dl, P < 0.05) and femoral SAT LPL activity decreased (-21.9 ± 22.3 vs. 10.5 ± 26.5 nmol·min(-1)·g(-1), P < 0.05) 1 yr following LIPO vs. CON. There were no group differences in (14)C-labeled TG appearing in abdominal and femoral SAT or elsewhere. In conclusion, femoral fat remained reduced 1 yr following lipectomy and was accompanied by increased postprandial TG and reduced femoral SAT LPL activity. There were no changes in storage of meal-derived FA or visceral fat. Our data support a protective role for femoral adiposity on circulating TG independent of dietary FA storage and visceral adiposity. Copyright © 2015 the American Physiological Society.

Neck Pain

MedlinePlus

Neck pain Overview Neck pain is a common complaint. Neck muscles can be strained from poor posture — whether it's leaning over your computer or ... workbench. Osteoarthritis also is a common cause of neck pain. Rarely, neck pain can be a symptom of ...

Neck curve polynomials in neck rupture model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kurniadi, Rizal; Perkasa, Yudha S.; Waris, Abdul

2012-06-06

The Neck Rupture Model is a model that explains the scission process which has smallest radius in liquid drop at certain position. Old fashion of rupture position is determined randomly so that has been called as Random Neck Rupture Model (RNRM). The neck curve polynomials have been employed in the Neck Rupture Model for calculation the fission yield of neutron induced fission reaction of {sup 280}X{sub 90} with changing of order of polynomials as well as temperature. The neck curve polynomials approximation shows the important effects in shaping of fission yield curve.

The influence of patient factors on femoral rotation after total hip arthroplasty.

PubMed

Tezuka, Taro; Inaba, Yutaka; Kobayashi, Naomi; Choe, Hyonmin; Higashihira, Syota; Saito, Tomoyuki

2018-06-09

A postoperative change in femoral rotation following total hip arthroplasty (THA) might be the cause of dislocation due to the change in combined anteversion. However, very few studies have evaluated the femoral rotation angle following THA, or the factors that influence femoral rotation. We aimed to evaluate changes in femoral rotation after THA, and to investigate preoperative patient factors that influence femoral rotation after THA. This study involved 211 hips treated with primary THA. We used computed tomography to measure the femoral rotation angle before and one week after THA. In addition, multiple regression analysis was performed to evaluate preoperative patient factors that could influence femoral rotation after THA. The femoral rotation angle was 0.2 ± 14° externally before surgery and 4.4 ± 12° internally after surgery (p < 0.001). Multiple regression analysis revealed that sex (β = 0.19; p = 0.003), age (β = 0.15; p = 0.017), preoperative anatomical femoral anteversion (β = - 0.25; p = 0.002), and preoperative femoral rotation angle (β = 0.36; p < 0.001) were significantly associated with the postoperative femoral rotation angle. The final model of the regression formula was described by the following equation: [postoperative femoral rotation angle = 5.41 × sex (female: 0, male: 1) + 0.15 × age - 0.22 × preoperative anatomical femoral anteversion + 0.33 × preoperative femoral rotation angle - 10.1]. The current study showed the mean internal change of 4.6° in the femoral rotation angle one week after THA. Sex, age, preoperative anatomical femoral anteversion and preoperative femoral rotation were associated with postoperative femoral rotation. The patients who were male, older, and who exhibited lesser preoperative anatomical femoral anteversion or greater preoperative femoral rotation angles, tended to demonstrate an externally rotated femur after THA. Conversely

Femoral Reconstruction Using External Fixation

PubMed Central

Palatnik, Yevgeniy; Rozbruch, S. Robert

2011-01-01

Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur. Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD), limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups. Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA) for the entire group as well as the subgroups. Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction. PMID:21991425

Normal neurodynamic responses of the femoral slump test.

PubMed

Lai, Weng-Hang; Shih, Yi-Fen; Lin, Pei-Ling; Chen, Wen-Yin; Ma, Hsiao-Li

2012-04-01

Femoral slump test is a neurodynamic testing, which could be used to assess the mechanosensitivity of the femoral component of the nervous system. Although Trainor and Pinnington reported the diagnosis accuracy of the femoral slump test, the neurodynamic responses of the femoral slump test have never been studied. The purposes of this study were to evaluate whether maneuvers that changed the nerve tension altered the responses of the femoral slump test and if these responses were influenced by gender and leg dominance; and to identify the correlations between flexibility and measured hip extension angle. Thirty-two asymptomatic subjects (16 males, 16 females) were recruited. The femoral slump test was performed in trunk slump and neutral positions, and cervical extension was used as the structure differential technique. Hip extension angle and visual analog scale (VAS) of thigh pain was measured during the test. Our results showed the decrease of nerve tension significantly increased hip extension ROM (P < 0.001) and lowered pain intensity (P < 0.001). The hip extension ROM was similar between genders but smaller for the dominant leg, as compared to the non-dominant side (P < 0.05); and the hip ROM did not correlate with any of the flexibility indices (P > 0.05). These findings indicated that femoral slump test resulted in normal neurodynamic responses in individuals free of lower extremity problems, and these responses were independent of the influence of muscle flexibility or gender. Future research should emphasize the use of femoral slump test in patient groups such as low back and anterior knee pain. Copyright © 2011 Elsevier Ltd. All rights reserved.

Poor relation between biomechanical and clinical studies for the proximal femoral locking compression plate

PubMed Central

Viberg, Bjarke; Rasmussen, Katrine M V; Overgaard, Søren; Rogmark, Cecilia

2017-01-01

Background and purpose The proximal femur locking compression plate (PF-LCP) is a new concept in the treatment of hip fractures. When releasing new implants onto the market, biomechanical studies are conducted to evaluate performance of the implant. We investigated the relation between biomechanical and clinical studies on PF-LCP. Methods A systematic literature search of relevant biomechanical and clinical studies was conducted in PubMed on December 1, 2015. 7 biomechanical studies and 15 clinical studies were included. Results Even though the biomechanical studies showed equivalent or higher failure loads for femoral neck fracture, the clinical results were far worse, with a 37% complication rate. There were no biomechanical studies on pertrochanteric fractures. Biomechanical studies on subtrochanteric fractures showed that PF-LCP had a lower failure load than with proximal femoral nail, but higher than with angled blade plate. 4 clinical studies had complication rates less than 8% and 9 studies had complication rates between 15% and 53%. Interpretation There was no clear relation between biomechanical and clinical studies. Biomechanical studies are generally inherently different from clinical studies, as they examine the best possible theoretical use of the implant without considering the long-term outcome in a clinical setting. Properly designed clinical studies are mandatory when introducing new implants, and they cannot be replaced by biomechanical studies. PMID:28287002

Comparison of the diagnostic value of ultrasonography and standing radiography for pelvic-femoral disorders in horses.

PubMed

Geburek, Florian; Rötting, Anna K; Stadler, Peter M

2009-04-01

To assess agreement between ultrasonography (transcutaneous and transrectal) and standing radiography in horses with fractures in the pelvic region and disorders of the coxofemoral joint. Case series. Warmblood horses (n=23) and 2 ponies. Medical records (1999-2008) of equids with pelvic or coxofemoral disorders that had pelvic radiography and ultrasonography were retrieved and results of both techniques compared. Radiography and ultrasonography each identified equal numbers of fractures of the tuber coxa (n=4), ilial shaft (2), ischium (3), femoral neck (2), and osteoarthritis/osis of the coxofemoral joint (6). Fractures of the ilial wing (4) were only identified by ultrasonography not by standing radiography. Of 9 acetabular fractures, 3 were identified on radiographs only, 5 were identified with both modalities. One pubic fracture was identified using ultrasonography and radiography. One acetabular and 1 pubic fracture were only diagnosed on necropsy. We found reasonable agreement (73%; 24/33) between ultrasonography and standing radiography for diagnosis of pelvic-femoral disorders. Ultrasonography was more useful for ilial wing fractures and radiography for acetabular fractures. Ultrasonography is a rapid, safe imaging technique for detecting disorders of the pelvic region with a high diagnostic yield and is a preferred initial approach in horses with severe hindlimb lameness.

Morphometric analysis of the femur in cerebral palsy: 3-dimensional CT study.

PubMed

Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

2010-09-01

The cause of hip disorder in cerebral palsy (CP) has been thought to involve muscle imbalance, flexion, and adduction contracture of the hip joint, acetabular dysplasia, and femoral growth abnormalities. The aim of this study was to quantitatively evaluate the 3-dimensional femoral geometry and subluxation/dislocation of the hip in spastic CP using 3D-CT reconstructed images of the pelvis and the femur, focusing on the femoral growth abnormalities in CP. Between June 2006 and September 2009, 186 hips in 93 bilateral spastic CP patients, including spastic diplegia (SD) in 73 patients and spastic quadriplegia (SQ) in 20 patients, who had not received any surgical treatment, were investigated using 3D-CT at our hospital. There were 59 boys and 34 girls with an average age of 5.3 years (range: 2.6 to 6.8 y). As an index for the femoral geometry, the neck-shaft angle, the femoral anteversion, and the femoral offset were 3-dimensionally measured. The center of the acetabulum and the femoral head were determined to calculate the CT migration percentage as the distance between these centers divided by the femoral head diameter. To elucidate the factors related to hip subluxation/dislocation, the relationships between the neck-shaft angle, the femoral anteversion, the femoral offset, and the CT migration percentage were investigated. The mean neck-shaft angle was 150.4+/-9.4 degrees (range: 129.4 to 173.2 degrees). The mean femoral anteversion was 44.4+/-13.6 degrees (range: 5.8 to 84.0 degrees). The mean CT migration percentage was 22.4+/-22.7% (range: 3 to 129%). There was positive correlation between the CT migration percentage and the neck-shaft angle (r=0.49). Hips with large CT migration percentage tended to show coxa valga. There was an inverse correlation between the neck-shaft angle and the femoral offset (r=-0.90), but no correlation between the CT migration percentage and the femoral anteversion (r=0.26), between the femoral offset and the femoral anteversion (r

Use of the lateral circumflex femoral artery perforator flap in the reconstruction of gunshot wounds to the face.

PubMed

Fernandes, Rui; Lee, Jason

2007-10-01

The reconstruction of large avulsive tissue loss in the head and neck region is one of the most difficult tasks faced by reconstructive surgeons. The advent of free tissue transfer has improved our ability to predictably reconstruct these patients. One of the most recent advances in the field of microvascular surgery is the use of perforator flaps. We have used the lateral circumflex femoral artery perforator (LCFAP) flap for reconstructions in patients who have suffered severe gunshot wounds (GSWs) to the maxillofacial area. A retrospective chart review was conducted of patients treated with a LCFAP flap in our division for large defects of the face resulting from GSWs between July 2005 and July 2006. The patient's age and gender, site and size of defect, and degree of bone and soft tissue loss were recorded. Flap survival and donor site morbidity were noted as outcomes of the reconstruction. Four patients who met the inclusion criteria were identified. The success rate for the flaps was 100%. There was no partial necrosis of the flaps. The size of the defect ranged from 20 x 10 cm to 10 x 10 cm. None of the patients had donor site complications, and all donor sites were closed primarily. Use of the LCFAP flap for the reconstruction of large defects secondary to GSWs to the face is a reliable option for the immediate reconstruction of this patient population. The lateral circumflex femoral artery perforator (LCFAP) flap is at a site not involved in the immediate resuscitation of trauma patients, thus ensuring an intact vascular system. This fact makes the LCFAP flap a reliable source for small to large soft tissues for reconstructing avulsive soft tissue losses in the head and neck.

Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: a cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament.

PubMed

Rue, John-Paul H; Ghodadra, Neil; Bach, Bernard R

2008-01-01

There is controversy regarding the necessity of reconstructing both the posterolateral and anteromedial bundles of the anterior cruciate ligament. A laterally oriented transtibial drilled femoral tunnel replaces portions of the femoral footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Descriptive laboratory study. Footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament were preserved on 7 matched pairs (5 female, 2 male) of fresh-frozen human cadaveric femurs (14 femurs total). Each femur was anatomically oriented and secured in a custom size-appropriate, side-matched replica tibia model to simulate transtibial retrograde drilling of a 10-mm femoral tunnel in each specimen. The relationship of the tunnel relative to footprints of both bundles of the anterior cruciate ligament was recorded using a Microscribe MX digitizer. The angle of the femoral tunnel relative to the vertical 12-o'clock position was recorded for all 14 specimens; only 10 specimens were used for footprint measurements. On average, the 10-mm femoral tunnel overlapped 50% of the anteromedial bundle (range, 2%-83%) and 51% of the posterolateral bundle (range, 16%-97%). The footprint of the anteromedial bundle occupied 32% (range, 3%-49%) of the area of the tunnel; the footprint of the posterolateral bundle contributed 26% (range, 7%-41%). The remainder of the area of the 10-mm tunnel did not overlap with the anterior cruciate ligament footprint. The mean absolute angle of the femoral tunnel as measured directly on the specimen was 48 degrees (range, 42 degrees-53 degrees) from vertical, corresponding to approximately a 10:30 clock face position on a right knee. Anterior cruciate ligament reconstruction using a laterally oriented transtibial drilled femoral tunnel incorporates portions of the anteromedial and posterolateral bundle origins of the native anterior cruciate ligament. A laterally oriented transtibial drilled

3D geometrical assessment of femoral curvature: a reverse engineering technique.

PubMed

Chantarapanich, Nattapon; Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Wongcumchang, Marut; Siribodhi, Pongwit

2008-09-01

Investigate the 2D/3D geometry of femoral curvature and femoral length using the advanced technique of computerized tomography combined with reverse engineering techniques. The present study was performed using reverse engineering technique based on CT data of 99 cadaveric femora. The femur was divided into three segments, proximal, mid-shaft, and distal regions by defining 35% and 65% of the femoral total length as a boundary of each region. The intramedullary canal in the mid-shaft region was mainly extracted to determine the set of circular center, which could consequence to approximate the 3D femoral radius of curvature using the 3D least square best fit. The 3D femoral curvature was then projected into A-P and M-L directions to investigate the correlation of 2D/3D femoral curvature as normal radiographic images. It was found that the average 3D Thai femoral curvature was 895.46-mm (SD = 238.06) and the average femoral total length is 421.96-mm (SD = 27.61). In addition, the 2D femoral curvature derived from sagittal radiographic image can be used to determine the 3D femoral curvature with this equation: R3D = RSagittal + 3.67 with r = 0.987. This described technique is a non-destructive method that can effectively assess the internal/ external 3D geometric data of the femur The obtained data is useful to develop a proper design of prosthesis that required inserting into the intramedullary canal. From the present study, it can be concluded that the 2DSagittal femoral curvature derived from standard radiographic image can be represented for the 3D femoral curvature.

An Ex Vivo Model in Human Femoral Heads for Histopathological Study and Resonance Frequency Analysis of Dental Implant Primary Stability

PubMed Central

Hernández-Cortés, Pedro; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David

2014-01-01

Objective. This study was designed to explore relationships of resonance frequency analysis (RFA)—assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. Material and Methods. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. Results. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Conclusion. Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies. PMID:24995307

An ex vivo model in human femoral heads for histopathological study and resonance frequency analysis of dental implant primary stability.

PubMed

Hernández-Cortés, Pedro; Monje, Alberto; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Mesa, Francisco; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David; O'Valle, Francisco

2014-01-01

This study was designed to explore relationships of resonance frequency analysis (RFA)-assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies.

Percutaneous triplanar femoral osteotomy correction for developmental coxa vara: a new technique.

PubMed

Sabharwal, Sanjeev; Mittal, Rahul; Cox, Garrick

2005-01-01

Developmental coxa vara (DCV) is a well-known pediatric hip disorder that is associated with triplanar deformity of the proximal femur. Several techniques of proximal femur osteotomies have being cited in the literature, with variable outcomes. Recently, the authors have used a percutaneous technique with application of a low-profile Ilizarov external fixator for acute opening wedge correction of the femoral deformity associated with DCV. Five children (six affected hips) underwent the above procedure at an average age of 8 + 4 years. The average improvement in Hilgenreiner's epiphyseal angle was from 74 degrees before surgery to 33 degrees after surgery, the neck-shaft angle improved from 86 degrees to 137 degrees, and the articulo-trochanteric distance improved from -6 mm to +11 mm. Latest follow-up at a mean of 2.1 years after surgery showed satisfactory healing with no significant loss of correction in any case. This percutaneous technique offers several advantages over currently available methods for surgical correction of DCV.

[Femoral artery pseudoaneurysms encountered in orthopedics and traumatology].

PubMed

Raherinantenaina, F; Rajaonanahary, T M A; Rakoto Ratsimba, H N

2015-12-01

Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial.

PubMed

Seto, Arnold H; Tyler, Jeffrey; Suh, William M; Harrison, Alexander T; Vera, Jesus A; Zacharias, Soni J; Daly, Timothy S; Sparling, Jeffrey M; Patel, Pranav M; Kern, Morton J; Abu-Fadel, Mazen

2017-06-01

We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. The CFA bifurcation occurs below the middle 1/3 rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. Operators should attempt to access the CFA at the level of the middle 1/3 rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

A new rule for femoral nerve blocks.

PubMed

Schulz-Stübner, Sebastian; Henszel, Angela; Hata, J Steven

2005-01-01

Acupuncture points are described by use of a proportional system that is based on the width of the thumb at the level of the distal interphalangeal joint, defined as 1 CUN. Our study tested first the correlation between the CUN and weight and height in 500 Americans and second the hypothesis that the CUN system is superior to the conventional landmarks to localize the femoral nerve 1 or 2 cm lateral to the artery in a prospective, double-blinded, randomized study. Sixty-two patients were randomized to receive a femoral nerve block by a needle entry point either 1 CUN lateral, 1 cm lateral, or 2 cm lateral to the femoral artery at the level of the inguinal crease. The time from needle entry to injection of local anesthetic was measured by an investigator blind to the technique, who also counted the frequency of needle repositioning, graded the ease of the block and its success, and registered complications. Good correlation occurred between weight and CUN (r = 0.79) and height and CUN (r = 0.83), which indicates that the CUN of a normal person (predefined as 175 cm tall and 70 kg weight) is 18.7 +/- 1 mm. In the CUN group, the femoral block was achieved significantly faster (P < .01) with fewer attempts (P < .003). The success rate was the same and complications did not differ significantly between the groups. A needle insertion point 1 CUN lateral to the midpoint of the palpated femoral artery at the level of the inguinal crease makes femoral nerve blocks faster and easier compared with conventional landmark 1 cm to 2 cm lateral to the artery.

[Midterm follow-up results on Asian femoral intramedullary nail for the treatment of segmental and comminuted femoral fractures].

PubMed

Li, Lang; Gao, Feng; Huang, Qi; Li, Qiang; Xie, Lin; Zhang, Bin

2016-06-01

To investigate midterm follow-up results on Asian femoral intramedullary nail in treating segmental and comminuted femoral fractures. Between June 2011 and October 2012,16 patients with segmental and comminuted femoral fractures were treated with minimally invasive reset and Asian femoral intramedullary nail under extension table. Among them, there were 10 males and 6 females aged from 21 to 49 years old with an average of 34.5 years old; the time from injury to operation ranged from 3 to 24 d with an average of 9.1 d. There were 6 cases were type C1,2 cases were type C2 and 8 cases were type C3 according to AO classification. X-ray of femoral segment at 3,6 and 12 months after operation were applied for evaluating fracture healing. Harris score of hip joint and HSS score of knee joint were used to evaluate postoperative function. All patients were followed up from 24 to 36 months with an average of 28.4 months. Operative time was from 88 to 112 min with an average of 90.7 min; blood loss ranged from 150 to 200 ml with an average of 188.75 ml; the time of fracture healing was from 5 to 9 months with an average of 5.4 months. All incision were healed at stage I. No loosening, breakage of internal fixation and displacement of fracture were occurred. There were no significant differences in Harris score of hip joint at 3, 6 and 12 months after operation (F = 0.07, P = 0.893 > 0.05), 10 cases obtained excellent results, 5 good and 1 moderate. There was no obvious meaning in HSS score of knee joint (F = 0.08,P = 0.876 > 0.05), 9 cases obtained excellent results, 6 good and 1 poor. Asian femoral intramedullary nail could treat segmental and comminuted femoral fractures by using variety of less invasive ways,which has advantages of less trauma, quick recovery of function and satisfied midterm following-up results. But long term following-up effects remains to be seen.

Endocrine Dysfunction and Slipped Capital Femoral Epiphysis 1

PubMed Central

Ogden, John A.; Southwick, Wayne O.

1977-01-01

Five patients with concomitant endocrinopathy and slipped capital femoral epiphysis were studied in detail. One had diabetes and hypothyroidism, one had hypothyroidism, one had hypergonadotropic hypogonadism and two had a craniopharyngioma (one of whom had severe panhypopituitarism post-operatively). An additional seven patients with cranio-pharyngioma revealed marked delay in closure of epiphyses and an additional undiagnosed case of slipped capital femoral epiphysis. Of the six patients with slipped capital femoral epiphysis, three had bilateral and three unilateral involvement. Of the five patients undergoing surgical stabilization, there was significant delay of epiphyseodesis, prompting us to recommend concomitant bone grafting. Histological examination of the femoral head from a three year old child with panhypopituitarism showed marked irregularity of the growth plate and loss of columnar integrity, which may be a predisposing factor to slipping in older children with endocrinopathies. The effects of various hormones on the physis are specifically discussed, especially as they relate to the possible etiology of slipped capital femoral epiphysis. ImagesFIG. 1A and 1BFIG. 2FIG. 3A and 3BFIG. 4A and 4BFIG. 5 PMID:191998

Neck dissection

MedlinePlus

... cancer - neck dissection; Throat cancer - neck dissection; Squamous cell cancer - neck dissection ... blood cells around the body to fight infection. Cancer cells in the mouth or throat can travel in ...

Using Ultrasound to Enhance Medical Students' Femoral Vascular Physical Examination Skills.

PubMed

Ahn, Justin S; French, Andrew J; Thiessen, Molly E W; Browne, Vaughn; Deutchman, Mark; Guiton, Gretchen; Madigosky, Wendy; Kendall, John L

2015-10-01

To determine whether the addition of ultrasound to traditional physical examination instruction improves junior medical students' abilities to locate the femoral pulse. Initially, 150 second-year medical students were taught the femoral pulse examination using traditional bedside teaching on standardized patients and online didactic videos. Students were then randomized into 2 groups: group 1 received ultrasound training first and then completed the standardized examination; and group 2 performed the standardized examination first and then received ultrasound training. On the standardized patients, the femoral artery was marked with invisible ink before the sessions using ultrasound. Compared to these markers, students were then evaluated on the accuracy of femoral artery pulse palpation and the estimated location of the femoral vein. All students completed a self-assessment survey after the ultrasound sessions. Ultrasound training improved the students' ability to palpate the femoral pulse (P= .02). However, ultrasound did not facilitate correct estimation of the femoral vein's anatomic location (P = .09). Confidence levels in localizing the femoral artery and vein were equal between groups at baseline, and both increased after the ultrasound sessions. The addition of ultrasound teaching to traditional physical examination instruction enhanced medical student competency and confidence with the femoral vascular examination. However, understanding of anatomy may require emphasis on precourse didactic material, but further study is required. © 2015 by the American Institute of Ultrasound in Medicine.

Effects of Multiple Drilling on the Ischemic Capital Femoral Epiphysis of Immature Piglets

PubMed Central

Gong, Sun Young; Kim, Hyun Woo; Park, Hui-Wan; Lee, Seung Yup

2011-01-01

Purpose This study investigated the effects of multiple drilling on the immature capital femoral epiphysis following ischemic injury in a piglet model. Materials and Methods Ischemic necrosis of capital femoral epiphysis was induced bilaterally in 12 piglets using a cervical ligation method. Three weeks later, medial, central, and lateral 3 drill holes were made on the left femoral head using 0.062" K-wire. At 3, 6, 9, and 12 weeks following the multiple drilling, femoral heads were harvested from each three piglets. On histologic examination, percent of revascularization, percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height were evaluated. Untreated right femoral heads served as control. Results While percent of revascularization of left capital femoral epiphysis with multiple drilling was significantly higher than untreated control side (p<0.001), percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height showed no significant difference. Conclusion This study indicates that multiple drilling could promote revascularization of ischemic capital femoral epiphysis, and multiple drilling does not appear to produce bony physeal bars at short-term, if using small diameter drill. However, multiple drilling alone does not seem to prevent femoral head deformity or to promote new bone formation. PMID:21786447

Short-term femoral nerve complications following percutaneous transfemoral procedures.

PubMed

Jarosz, J M; McKeown, B; Reidy, J F

1995-01-01

To determine the prevalence of transient femoral nerve anesthesia following transfemoral angiographic procedures. Fifty-eight patients undergoing a variety of routine transfemoral procedures underwent a neurologic assessment within an hour of the procedure. Nine patients (16%) were found to have complete or partial deficits in the ipsilateral femoral nerve territory. All deficits were transient. Transient femoral nerve deficits are not uncommon following transfemoral procedures. With the advent of true outpatient vascular procedures (where the patient may walk away after only a 30-minutes recovery period following a transvenous intervention or after 60 minutes following arteriography), transient neurologic problems related to the infiltration of local anesthetic around the femoral artery assume real clinical importance.

Sonographic correlation of foetal neck circumference and area with gestational age among pregnant women in Port Harcourt, Nigeria.

PubMed

Abonyi, Obinna Everistus; Eze, Charles Ugwoke; Onwuzu, Sobechukwu W I

2017-11-01

The purpose of this study was to create a reference range nomogram of foetal neck circumference (FNC) and foetal neck area (FNA) in a Nigerian population using polynomial regression models. This cross-sectional study involved 723 pregnant women between 14 and 40 weeks of gestation. Axial measurements of the FNC and FNA were obtained in three measurements and the mean taken as the final value and the 5th, 50th and 95th percentiles for each foetal gestational age (FGA) were calculated. FNC and FNA correlated strongly with FGA, biparietal diameter, abdominal circumference, head circumference, and femoral length. Cubic models fitted the FNC vs FGA, and FNA vs. FGA values, and the mathematical relationships are given as: [Formula: see text] [Formula: see text] [Formula: see text]. Nomograms of FNC and FNA are thus generated. Impact statement The foetal neck circumference (FNC) and foetal neck area (FNA) can serve as predictors of foetal gestational age (FGA) since they correlate strongly and positively with FGA and known biometric parameters. The measurements obtained vary with the population studied. This study provides a nomogram of the FNA and FNC for an African population. The values correlate with that of the Caucasian population up to 32 weeks FGA. Interestingly, FNA and FNC measurements demonstrate high correlation but poor agreement in measurements between sonographers. Even though FNA and FNC could be used as predictors of foetal gestational age, the measurements vary significantly between sonographers. This is attributable to the difficulty in obtaining a satisfactory axial view of foetal neck, which is dependent on foetal presentation.

Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose.

PubMed

Bellomo, Rinaldo; Mårtensson, Johan; Lo, Serigne; Kaukonen, Kirsi-Maija; Cass, Alan; Gallagher, Martin

2016-01-01

The study aims to describe the use of dialysis catheters in critically ill patients treated with continuous renal replacement therapy (CRRT) and to study the impact of femoral versus non-femoral access on CRRT dose. Statistical analysis and predictive modelling of data from the Randomized Evaluation of Normal vs. Augmented Level renal replacement therapy trial. The femoral vein was the first access site in 937 (67%) of 1,399 patients. These patients had higher Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores (p = 0.009) and lower pH (p < 0.001) but similar mortality to patients with non-femoral access (44 vs. 45%; p = 0.63). Lower body weight was independently associated with femoral access placement (OR 0.97, 95% CI 0.96-0.98). Femoral access was associated with a 1.03% lower CRRT dose (p = 0.05), but a 4.20% higher dose was achieved with 13.5 Fr catheters (p = 0.03). Femoral access was preferred in lighter and sicker patients. Catheter gauge had greater impact than catheter site in CRRT dose delivery. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=439581. © 2015 S. Karger AG, Basel.

Trombo flutuante em veia femoral

PubMed Central

Bertanha, Matheus; Pimenta, Rafael Elias Farres; Brandão, Gustavo Muçouçah Sampaio; Sobreira, Marcone Lima; Moura, Regina; Jaldin, Rodrigo Gibin; de Camargo, Paula Angeleli Bueno; Yoshida, Winston Bonetti

2017-01-01

Resumo O trombo venoso flutuante em veia femoral é um tipo de trombo com alto potencial de embolização pulmonar. Entretanto, ainda é controversa a conduta mais apropriada nesses casos. Tratamentos clínicos com anticoagulantes ou fibrinolíticos e trombectomias abertas ou por meio de dispositivos endovasculares vêm sendo empregados ainda sem um critério de indicação bem definido. Apresentamos três casos clínicos de trombos flutuantes em veia femoral, de etiologias distintas, cujos tratamentos e respectivas evoluções serão discutidos. PMID:29930666

Femoral head necrosis: A finite element analysis of common and novel surgical techniques.

PubMed

Cilla, Myriam; Checa, Sara; Preininger, Bernd; Winkler, Tobias; Perka, Carsten; Duda, Georg N; Pumberger, Matthias

2017-10-01

Femoral head necrosis is a common cause of secondary osteoarthritis. At the early stages, treatment strategies are normally based on core decompression techniques, where the number, location and diameter of the drilling holes varies depending on the selected approach. The purpose of this study was to investigate the risk of femoral head, neck and subtrochanteric fracture following six different core decompression techniques. Five common and a newly proposed techniques were analyzed in respect to their biomechanical consequences using finite element analysis. The geometry of a femur was reconstructed from computed-tomography images. Thereafter, the drilling configurations were simulated. The strains in the intact and drilled femurs were determined under physiological, patient-specific, muscle and joint contact forces. The following results were observed: i) - an increase in collapse and fracture risk of the femur head by disease progression ii) - for a single hole approach at the subtrochanteric region, the fracture risk increases with the diameter iii) - the highest fracture risks occur for an 8mm single hole drilling at the subtrochanteric region and approaches with multiple drilling at various entry points iv) - the proposed novel approach resulted in the most physiological strains (closer to the experienced by the healthy bone). Our results suggest that all common core decompression methods have a significant impact on the biomechanical competence of the proximal femur and impact its mechanical potential. Fracture risk increases with drilling diameter and multiple drilling with smaller diameter. We recommend the anterior approach due to its reduced soft tissue trauma and its biomechanical performance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Trochanteric entry femoral nails yield better femoral version and lower revision rates-A large cohort multivariate regression analysis.

PubMed

Yoon, Richard S; Gage, Mark J; Galos, David K; Donegan, Derek J; Liporace, Frank A

2017-06-01

Intramedullary nailing (IMN) has become the standard of care for the treatment of most femoral shaft fractures. Different IMN options include trochanteric and piriformis entry as well as retrograde nails, which may result in varying degrees of femoral rotation. The objective of this study was to analyze postoperative femoral version between three types of nails and to delineate any significant differences in femoral version (DFV) and revision rates. Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (AO/OTA 32A-C). Of these patients, 316 met inclusion criteria and obtained postoperative computed tomography (CT) scanograms to calculate femoral version and were thus included in the study. In this study, our main outcome measure was the difference in femoral version (DFV) between the uninjured limb and the injured limb. The effect of the following variables on DFV and revision rates were determined via univariate, multivariate, and ordinal regression analyses: gender, age, BMI, ethnicity, mechanism of injury, operative side, open fracture, and table type/position. Statistical significance was set at p<0.05. A total of 316 patients were included. Piriformis entry nails made up the majority (n=141), followed by retrograde (n=108), then trochanteric entry nails (n=67). Univariate regression analysis revealed that a lower BMI was significantly associated with a lower DFV (p=0.006). Controlling for possible covariables, multivariate analysis yielded a significantly lower DFV for trochanteric entry nails than piriformis or retrograde nails (7.9±6.10 vs. 9.5±7.4 vs. 9.4±7.8°, p<0.05). Using revision as an endpoint, trochanteric entry nails also had a significantly lower revision rate, even when controlling for all other variables (p<0.05). Comparative, objective comparisons between DFV between different nails based on entry point revealed that trochanteric nails had a significantly lower DFV and a lower revision rate, even after regression

Text neck and neck pain in 18-21-year-old young adults.

PubMed

Damasceno, Gerson Moreira; Ferreira, Arthur Sá; Nogueira, Leandro Alberto Calazans; Reis, Felipe José Jandre; Andrade, Igor Caio Santana; Meziat-Filho, Ney

2018-06-01

The aim of this study was to investigate whether there is an association between text neck and neck pain in young adults. Observational cross-sectional study with 150 18-21-year-old young adults from a public high school in the state of Rio de Janeiro was performed. In the self-report questionnaire, the participants answered questions on sociodemographic factors, anthropometric factors, time spent texting or playing on a mobile phone, visual impairments, and concern with the body posture. The neck posture was assessed by participants' self-perception and physiotherapists' judgment during a mobile phone texting message task. The Young Spine Questionnaire was used to evaluate the neck pain. Four multivariate logistic regression models were fitted to investigate the association between neck posture during mobile phone texting and neck pain, considering potential confounding factors. There is no association between neck posture, assessed by self-perception, and neck pain (OR = 1.66, p = 0.29), nor between neck posture, assessed by physiotherapists' judgment, and neck pain (OR = 1.23, p = 0.61). There was also no association between neck posture, assessed by self-perception, and frequency of neck pain (OR = 2.19, p = 0.09), nor between neck posture, assessed by physiotherapists' judgment, and frequency of neck pain (OR = 1.17, p = 0.68). This study did not show an association between text neck and neck pain in 18-21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.

Titanium-titanium modular neck for primary THA. Result of a prospective series of 170 cemented THA with a minimum follow-up of 5 years.

PubMed

Ollivier, M; Parratte, S; Galland, A; Lunebourg, A; Flecher, X; Argenson, J-N

2015-04-01

Although they have been in use since the end of the 1980s, modular titanium neck components are associated with a risk of wear or fracture, and their safety has recently become a subject of debate and has never been evaluated in a consecutive series of patients. The goal of this study was to evaluate: revision-free survival of these implants after a minimum follow-up of 5 years; clinical and radiographic results; and the potential complications associated with the use of modular titanium neck components. The use of titanium modular neck on cemented titanium THA is safe at a minimum follow-up of 5 years. Between January 2006 and December 2008, we prospectively followed 170 patients (170 hips) who underwent primary anatomical THA with a modular cemented titanium stem design implant. The indications were unilateral THA for primary (n=160) or secondary (n=10) hip osteoarthritis (aseptic osteonecrosis of the femoral head or hip dysplasia). Mean age of patients was 75.4±5.8 years old (52-85), and mean BMI was 26.1±4.5 kg/m(2) (16.6-42.1). Patients were operated on by a modified Watson-Jones anterolateral approach based on preoperative 2D planning. All patients underwent annual clinical and radiological follow-up by an independent observer. At a mean follow-up of 71±8 months (60-84), 5 patients died and 7 were lost to follow-up. There was no revision of THA after a maximum follow-up of 84 months. The Harris score improved significantly from 50.4±11.3 (0-76) preoperatively to 84.5±15.2 (14-100) at the final follow-up. There was no difference in postoperative femoral offset or the position of the center of rotation compared to the opposite side. On the other hand, the neck-shaft angle (NSA) and limb length were corrected (2±5° [-11 to +14°] and 2.16±3.6 mm [-7.4 to +12.7 mm]) respectively. Fifteen patients (9%) had limb length discrepancies of more than 5 mm and 4 patients (2%) of more than 10 mm. There were no complications due to the modular implant design. Our

Evaluation of the stability of reference genes in bone mesenchymal stem cells from patients with avascular necrosis of the femoral head.

PubMed

Wang, X N; Yang, Q W; Du, Z W; Yu, T; Qin, Y G; Song, Y; Xu, M; Wang, J C

2016-05-25

This study aimed to evaluate 12 genes (18S, GAPDH, B2M, ACTB, ALAS1, GUSB, HPRT1, PBGD, PPIA, PUM1, RPL29, and TBP) for their reliability and stability as reference sequences for real-time quantitative PCR (RT-qPCR) in bone marrow-derived mesenchymal stem cells (BMSCs) isolated from patients with avascular necrosis of the femoral head (ANFH). BMSCs were isolated from 20 ANFH patients divided into four groups according to etiology, and four donors with femoral neck fractures. Total RNA was isolated from BMSCs and reverse transcribed into complementary DNA, which served as a template for RT-qPCR. Three commonly used programs were then used to analyze the results. Reference gene expression varied within each group, between specific groups, and among all five groups. Based on comparisons of all five groups, two of the programs used suggested that HPRT1 was the most stable reference gene, while 18S and ACTB were the most variable. Among the 12 candidate reference genes, HPRT1 exhibited the greatest reliability, followed by PPIA. Thus, these sequences could be used as references for the normalization of RT-qPCR results.

Neck muscle function in violinists/violists with and without neck pain.

PubMed

Steinmetz, Anke; Claus, Andrew; Hodges, Paul W; Jull, Gwendolen A

2016-04-01

Neck pain is associated with changes in neuromuscular control of cervical muscles. Violin and viola playing requires good function of the flexor muscles to stabilize the instrument. This study investigated the flexor muscle behaviour in violin/viola players with and without neck pain using the craniocervical flexion test (CCFT). In total, 12 violin/viola players with neck pain, 21 violin/viola players without neck pain in the preceding 12 weeks and 21 pain-free non-musicians were included. Activity of the sternocleidomastoid muscles (SCM) was measured with surface electromyography (EMG) during the CCFT. Violin/viola players with neck pain displayed greater normalised SCM EMG amplitudes during CCFT than the pain-free musicians and non-musicians (P < 0.05). Playing-related neck pain in violinists/violists is associated with altered behaviour of the superficial neck flexor muscles consistent with neck pain, despite the specific use of the deep and superficial neck flexors during violin playing.

Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: derivation and validation of a hybrid system.

PubMed

Leslie, William D; Lix, Lisa M

2011-03-01

The World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) computes 10-year probability of major osteoporotic fracture from multiple risk factors, including femoral neck (FN) T-scores. Lumbar spine (LS) measurements are not currently part of the FRAX formulation but are used widely in clinical practice, and this creates confusion when there is spine-hip discordance. Our objective was to develop a hybrid 10-year absolute fracture risk assessment system in which nonvertebral (NV) fracture risk was assessed from the FN and clinical vertebral (V) fracture risk was assessed from the LS. We identified 37,032 women age 45 years and older undergoing baseline FN and LS dual-energy X-ray absorptiometry (DXA; 1990-2005) from a population database that contains all clinical DXA results for the Province of Manitoba, Canada. Results were linked to longitudinal health service records for physician billings and hospitalizations to identify nontrauma vertebral and nonvertebral fracture codes after bone mineral density (BMD) testing. The population was randomly divided into equal-sized derivation and validation cohorts. Using the derivation cohort, three fracture risk prediction systems were created from Cox proportional hazards models (adjusted for age and multiple FRAX risk factors): FN to predict combined all fractures, FN to predict nonvertebral fractures, and LS to predict vertebral (without nonvertebral) fractures. The hybrid system was the sum of nonvertebral risk from the FN model and vertebral risk from the LS model. The FN and hybrid systems were both strongly predictive of overall fracture risk (p < .001). In the validation cohort, ROC analysis showed marginally better performance of the hybrid system versus the FN system for overall fracture prediction (p = .24) and significantly better performance for vertebral fracture prediction (p < .001). In a discordance subgroup with FN and LS T-score differences greater than 1 SD, there was a significant

[Femoral arteriovenous fistula: a late uncommon complication of central venous catheterization].

PubMed

Conz, P A; Malagoli, A; Normanno, M; Munaro, D

2007-01-01

A 77-year-old woman was admitted due to AV graft thrombosis; given the technical impossibility of performing other native AV fistulas, we chose to insert a tunnelled central venous catheter. Considering the vascular history of the patient, the central venous catheter could not be placed into the internal jugular vein; it was therefore put into the left femoral vein. Following a 3-month-period of the catheter working properly, the patient was hospitalized due to sudden acute pain in the left thigh. In a few days the patient developed an important haematoma with serious anemization in the left lower limb. Ultrasonography showed the presence of a fistula between the left common femoral artery and the femoral vein, leading to the subsequent successful positioning of a stent into the common femoral artery through right trans-femoral access. Angiography examination showed the femoral vein patency along the proximal stretch with respect to the function of the tunnelled venous catheter.

Performance assessment of femoral knee components made from cobalt-chromium alloy and oxidized zirconium.

PubMed

Brandt, J-M; Guenther, L; O'Brien, S; Vecherya, A; Turgeon, T R; Bohm, E R

2013-12-01

The surface characteristics of the femoral component affect polyethylene wear in modular total knee replacements. In the present retrieval study, the surface characteristics of cobalt-chromium (CoCr) alloy and oxidized zirconium (OxZr) femoral components were assessed and compared. Twenty-six retrieved CoCr alloy femoral components were matched with twenty-six retrieved OxZr femoral components for implantation period, body-mass index, patient gender, implant type, and polyethylene insert thickness. The surface damage on the retrieved femoral components was evaluated using a semi-quantitative assessment method, scanning electron microscopy, and contact profilometry. The retrieved CoCr alloy femoral components showed less posterior surface gouging than OxZr femoral components; however, at a higher magnification, the grooving damage features on the retrieved CoCr alloy femoral components confirmed an abrasive wear mechanism. The surface roughness values Rp, Rpm, and Rpk for the retrieved CoCr alloy femoral components were found to be significantly higher than those of the retrieved OxZr femoral components (p≤0.031). The surface roughness values were higher on the medial condyles than on the lateral condyles of the retrieved CoCr alloy femoral components; such a difference was not observed on the retrieved OxZr femoral components. The surface roughness of CoCr alloy femoral components increased while the surface roughness of the OxZr femoral components remained unchanged after in vivo service. Therefore, the OxZr femoral components' resistance to abrasive wear may enable lower polyethylene wear and ensure long-term durability in vivo. Level IV. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

An integrated CAD/CAM/robotic milling method for custom cementless femoral prostheses.

PubMed

Wen-ming, Xi; Ai-min, Wang; Qi, Wu; Chang-hua, Liu; Jian-fei, Zhu; Fang-fang, Xia

2015-09-01

Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Atypical Femoral Shaft Fractures in Female Bisphosphonate Users Were Associated with an Increased Anterolateral Femoral Bow and a Thicker Lateral Cortex: A Case-Control Study.

PubMed

Jang, Seung Pil; Yeo, Ingwon; So, Sang-Yeon; Kim, Keunbyuel; Moon, Young-Wan; Park, Youn-Soo; Lim, Seung-Jae

2017-01-01

The purpose of our study was to investigate the radiographic characteristics of atypical femoral shaft fractures (AFSFs) in females with a particular focus on femoral bow and cortical thickness. We performed a fracture location-, age-, gender-, and ethnicity-matched case-control study. Forty-two AFSFs in 29 patients and 22 typical osteoporotic femoral shaft fractures in 22 patients were enrolled in AFSF group and control group, respectively. With comparing demographics between two groups, radiographically measured femoral bow and cortical thicknesses of AFSF group were compared with control group. All AFSF patients were females with a mean age of 74.4 years (range, 58-85 years). All had a history of bisphosphonate (BP) use with a mean duration of 7.3 years (range 1-17 years). Femoral bow of AFSF group was significantly higher than control group on both anteroposterior (AP) and lateral radiographs after age correction. Mean femoral bow on an AP radiograph was 12.39° ± 5.38° in AFSF group and 3.97 ± 3.62° in control group ( P < 0.0001). Mean femoral bow on the lateral radiograph was 15.71° ± 5.62° in AFSF group and 10.72° ± 4.61° in control group (after age correction P = 0.003). And cortical thicknesses of AFSF group demonstrated marked disparity between tensile and compressive side of bowed femurs in this study. An adjusted lateral cortical thickness was 10.5 ± 1.4 mm in AFSF group and 8.1 ± 1.3 mm in control group (after age correction P < 0.0001) while medial cortical thickness of AFSF group was not statistically different from control group. Correlation analysis showed that the lateral femoral bow on the AP radiograph was solely related to lateral CTI ( R = 0.378, P = 0.002). AFSFs in female BP users were associated with an increased anterolateral femoral bow and a thicker lateral cortex of femurs.

3D-Printed Patient-Specific ACL Femoral Tunnel Guide from MRI.

PubMed

Rankin, Iain; Rehman, Haroon; Frame, Mark

2018-01-01

Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Anatomic ACL reconstruction attempts to closely reproduce the patient's individual anatomic characteristics with the aim of restoring knee kinematics, in order to improve patient short and long-term outcomes. We designed an arthroscopic, patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel. The guide design was based on MRI scan of the subject's uninjured contralateral knee, identifying the femoral footprint and its anatomical position relative to the borders of the femoral articular cartilage. Image processing software was used to create a 3D computer aided design which was subsequently exported to a 3D-printing service. Transparent acrylic based photopolymer, PA220 plastic and 316L stainless steel patient-specific ACL femoral tunnel guides were created; the models produced were accurate with no statistical difference in size and positioning of the center of the ACL femoral footprint guide to MRI ( p =0.344, p =0.189, p =0.233 respectively). The guides aim to provide accurate marking of the starting point of the femoral tunnel in arthroscopic ACL reconstruction. This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction.

Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head.

PubMed

Pyda, Michał; Koczy, Bogdan; Widuchowski, Wojciech; Widuchowska, Małgorzata; Stołtny, Tomasz; Mielnik, Michał; Hermanson, Jacek

2015-01-25

Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul's method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score--UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.

Hip Resurfacing Arthroplasty in Treatment of Avascular Necrosis of the Femoral Head

PubMed Central

Pyda, Michał; Koczy, Bogdan; Widuchowski, Wojciech; Widuchowska, Małgorzata; Stołtny, Tomasz; Mielnik, Michał; Hermanson, Jacek

2015-01-01

Background Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Material/Methods Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul’s method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. Results The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score – UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Conclusions Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients. PMID:25618763

Femoral medullary infarction secondary to canine total hip arthroplasty.

PubMed

Sebestyen, P; Marcellin-Little, D J; DeYoung, B A

2000-01-01

To evaluate the prevalence of femoral intramedullary infarction after total hip arthroplasty (THA) and to determine whether any specific femoral morphology predisposes to bone infarction. Retrospective clinical study. All dogs from our hospital population undergoing THA between 1984 and 1997 with radiographic follow-up available at 1 year or more postoperatively. A case control study was conducted within the THA group to determine risk factors predisposing to femoral infarction after THA. Medical records and radiographs were reviewed. Data were collected on clinical parameters, femoral morphology, prosthesis, and bone changes. Radiographic diagnosis was confirmed using histopathology in 11 femora. Radiographs of 50 age-matched control dogs weighing more than 20 kg with coxofemoral degenerative joint disease were randomly chosen to determine the prevalence of bone infarction in nonoperated dogs. Ninety-one dogs with 110 THA were included in the study. Fifteen of the 110 femora with THA had radiographic evidence of infarction (14%). Infarction was not present in any femora in the control group. There was no significant difference in the prevalence of infarction between dogs that received cemented or uncemented prostheses. Clinical signs were not reported in any patient that developed femoral infarction. Young age (P = .03) and a distance between the greater trochanter and nutrient foramen greater than 79 mm (P = .008) predisposed dogs to femoral infarction. Over time, three infarcts decreased in size radiographically, five remained unchanged, and three expanded. An osteosarcoma developed at the site of a bone infarct in one dog. Femoral intramedullary infarction occurred in 15 of 110 THA. Young age at the time of THA and a greater distance between the greater trochanter and the nutrient foramen predisposed to infarction. Intramedullary infarction occurs after canine THA. These bone infarcts do not appear to cause clinical signs; however, they may present a diagnostic

Femoral artery pseudoaneurysm as a complication of angioplasty. How can it be prevented?

PubMed Central

Gupta, Prabha Nini; Salam Basheer, Abdul; Sukumaran, Gireesh Gomaty; Padmajan, Sabin; Praveen, Satheesan; Velappan, Praveen; Nair, Bigesh Unnikrishnan; Nair, Sandeep Govindan; Kunjuraman, Usha Kumari; Madthipat, Unnikrishnan; R, Jayadevan

2013-01-01

Femoral pseudoaneurysm is a common complication of repeated femoral puncture during cardiac catheterisation. We describe here the development of femoral pseudoaneurysms in a patient with Takayasu's arteritis, which healed in response to conservative treatment, and review the literature on the prevention and treatment of femoral pseudoaneurysm. PMID:27326111

Revision total hip arthroplasty: the femoral side using cemented implants.

PubMed

Holt, Graeme; Hook, Samantha; Hubble, Matthew

2011-02-01

Advances in surgical technique and implant technology have improved the ten-year survival after primary total hip arthroplasty (THA). Despite this, the number of revision procedures has been increasing in recent years, a trend which is predicted to continue into the future. Revision THA is a technically demanding procedure often complicated by a loss of host bone stock which may be compounded by the need to remove primary implants. Both cemented and uncemented implant designs are commonly used in the United Kingdom for primary and revision THA and much controversy still exists as to the ideal method of stem fixation. In this article we discuss revision of the femur using cemented components during revision THA. We focus on three clinical scenarios including femoral cement-in-cement revision where the primary femoral cement-bone interface remains well fixed, femoral cement-in-cement revision for peri-prosthetic femoral fractures, and femoral impaction grafting. We discuss the clinical indications, surgical techniques and clinical outcomes for each of these procedures.

Femoral head epiphysis growth and development among Chinese children aged 0-5 years.

PubMed

Luo, Jiayou; Tang, Jin; Zhou, Libo; Zeng, Rong; Mou, Jinsong; Zhang, Lingli

2009-05-01

The aim of this study was to examine the pattern of femoral head epiphysis growth and development among Chinese children. Between January and December, 2007, we randomly sampled 1,450 healthy Chinese children (0-5 years old) from Hunan Provincial Children's Hospital in Changsha, Hunan, China. The diameter of femoral head epiphysis was measured by pelvic X-ray photography and processed by medical image processing software. The growth of femoral head epiphysis in girls was 2-3 months earlier than that in boys. The diameter of femoral head epiphysis increased with advancing age in both girls and boys, but the diameter of femoral head epiphysis in 2, 3, 4, 6, and 10-month-old girls was significantly larger than that in boys. Cubic regression equations between the diameter of femoral head epiphysis and age were created for boys and girls that could be used to predict the diameter of femoral head epiphysis. In conclusion, there was gender difference in femoral head epiphysis growth and development among Chinese children, and our prediction models will provide the guidance for early diagnosis of diseases related to the growth and development of the femoral head epiphysis.

The Most Cut-Resistant Neck Guard for Preventing Lacerations to the Neck

PubMed Central

Loyd, Andre M.; Berglund, Lawrence; Twardowski, Casey P.; Stuart, Michael B.; Smith, Aynsley M.; Gaz, Daniel V.; Krause, David A.; An, Kai-Nan; Stuart, Michael J.

2017-01-01

Objective To evaluate the effectiveness of a variety of neck guard brands when contacted by a sharpened hockey skate blade. Design Analytic experimental. Setting Laboratory. Participants Neck surrogate. Interventions Forty-six samples of 14 different types of neck guards were tested on a custom-made laceration machine using a neck surrogate. Closed-cell polyethylene foam was placed between the neck surrogate and the protective device. Main Outcome Measures The effectiveness of the neck guard was evaluated by observation of the foam after the simulated slicing action of the skate blade. Two sets of tests were performed on each device sample including low and high force. For low-force tests, initial compression loads of 100, 200, and 300 N were applied between the neck surrogate for each of 2 orientations of the blade at 45 and 90 degrees. For high-force tests, representing a more severe simulation, the applied load was increased to 600 N and a blade angle fixed at 45 degrees. All tests were performed at a blade speed of 5 m/s. Results Only 1 product, the Bauer N7 Nectech, failed during the 300-N compression tests. All of the neck guards failed during 600-N test condition except for the Skate Armor device and 1 of the 3 Reebok 11K devices. Conclusions A skate blade angle of 45 degrees increased the likelihood of a neck laceration compared with a skate blade angle of 90 degrees due to decreased contact area. Damage to the neck guard is not an indicator of the cut resistance of a neck guard. Neck protectors with Spectra fibers were the most cut resistant. Clinical Relevance The study provides data for the selection of neck guards and neck guard materials that can reduce lacerations to the neck. PMID:24949830

Neck postures in air traffic controllers with and without neck/shoulder disorders.

PubMed

Arvidsson, Inger; Hansson, Gert-Ake; Mathiassen, Svend Erik; Skerfving, Staffan

2008-03-01

Prolonged computer work with an extended neck is commonly believed to be associated with an increased risk of neck-shoulder disorders. The aim of this study was to compare neck postures during computer work between female cases with neck-shoulder disorders, and healthy referents. Based on physical examinations, 13 cases and 11 referents were selected among 70 female air traffic controllers with the same computer-based work tasks and identical workstations. Postures and movements were measured by inclinometers, placed on the forehead and upper back (C7/Th1) during authentic air traffic control. A recently developed method was applied to assess flexion/extension in the neck, calculated as the difference between head and upper back flexion/extension. cases and referents did not differ significantly in neck posture (median neck flexion/extension: -10 degrees vs. -9 degrees ; p=0.9). Hence, the belief that neck extension posture is associated with neck-shoulder disorders in computer work is not supported by the present data.

Asymmetry of neck motion and activation of the cervical paraspinal muscles during prone neck extension in subjects with unilateral posterior neck pain.

PubMed

Park, Kyue-Nam; Kwon, Oh-Yun; Kim, Su-Jung; Kim, Si-Hyun

2017-01-01

Although unilateral posterior neck pain (UPNP) is more prevalent than central neck pain, little is known about how UPNP affects neck motion and the muscle activation pattern during prone neck extension. To investigate whether deviation in neck motion and asymmetry of activation of the bilateral cervical paraspinal muscles occur during prone neck extension in subjects with UPNP compared to subjects without UPNP. This study recruited 20 subjects with UPNP and 20 age- and sex-matched control subjects without such pain. Neck motion and muscle onset time during prone neck extension were measured using a three-dimensional motion-analysis system and surface electromyography. The deviation during prone neck extension was greater in the UPNP group than in the controls (p < 0.05). Compared with the controls, cervical extensor muscle activation in the UPNP group was significantly delayed on the painful side during prone neck extension (p < 0.05). Subjects with UPNP showed greater asymmetry of neck motion and muscle activation during prone neck extension compared with the controls. This suggests that UPNP has specific effects on neck motion asymmetry and the functions of the cervical extensors, triggering a need for specific evaluation and exercises in the management of patients with UPNP.

The diagnosis of aortoiliac disease. A noninvasive femoral cuff technique.

PubMed Central

Barringer, M; Poole, G V; Shircliffe, A C; Meredith, J W; Hightower, F; Plonk, G W

1983-01-01

An inexpensive femoral "cuff" developed in this noninvasive vascular laboratory allows pulse volume recordings and systolic pressure measurements of the femoral arteries. Using the parameters 1) femoral/brachial systolic pressure ratio, 2) wave amplitude, and 3) status of the dicrotic notch for assessment of results, it was found that the cuff correctly identified 59 of 62 limbs with at least 50% aortoiliac stenosis, with only two false-positive results, for an accuracy of 97%. The high, wide thigh cuff identified 57 of the 62 limbs, but had 45 false-positive results (77% accuracy). Use of the femoral "cuff" has refined the ability to identify the anatomic location of significant arterial stenoses in the lower extremities. Images Fig. 1. Fig. 2. PMID:6824373

How to deal with penile carcinoma inguinal metastases invading femoral vessels.

PubMed

Fodor, Marius; Petrut, Bogdan; Fodor, Lucian

2017-01-01

Penile cancer accounts for 1-10% of men neoplastic diseases and 30-60% of patients have inguinal metastases at the time of diagnosis. Inguinal metastases of penile cancer with femoral vessel involvement could lead to vascular fistula and hemorrhagic shock. We present 3 consecutive patients with inguinal metastases of penile cancer complicated by infection and hemorrhage from femoral vessels invaded by the tumor. Simultaneous extra-anatomical axillo-femoral bypass graft, wide excision of tumor and groin defect reconstruction was used to achieve "tumor-free" oncologic aim and to save the lower limb. We consider the extra-anatomic axillo-femoral bypass associated with wide inguinal tumor excision and defect covering a feasible surgical solution for improving the life quality and extend life expectancy in patients with lymph node metastasis of penile cancer complicated by necrosis, infection and femoral vessel involvement.

Evaluation of a patient specific femoral alignment guide for hip resurfacing.

PubMed

Olsen, Michael; Naudie, Douglas D; Edwards, Max R; Sellan, Michael E; McCalden, Richard W; Schemitsch, Emil H

2014-03-01

A novel alternative to conventional instrumentation for femoral component insertion in hip resurfacing is a patient specific, computed tomography based femoral alignment guide. A benchside study using cadaveric femora was performed comparing a custom alignment guide to conventional instrumentation and computer navigation. A clinical series of twenty-five hip resurfacings utilizing a custom alignment guide was conducted by three surgeons experienced in hip resurfacing. Using cadaveric femora, the custom guide was comparable to conventional instrumentation with computer navigation proving superior to both. Clinical femoral component alignment accuracy was 3.7° and measured within ± 5° of plan in 20 of 24 cases. Patient specific femoral alignment guides provide a satisfactory level of accuracy and may be a better alternative to conventional instrumentation for initial femoral guidewire placement in hip resurfacing. Crown Copyright © 2014. All rights reserved.

Upregulation of microRNA-320 decreases the risk of developing steroid-induced avascular necrosis of femoral head by inhibiting CYP1A2 both in vivo and in vitro.

PubMed

Wei, Ji-Hua; Luo, Qun-Qiang; Tang, Yu-Jin; Chen, Ji-Xia; Huang, Chun-Lan; Lu, Ding-Gui; Tang, Qian-Li

2018-06-20

Steroid-induced avascular necrosis of femoral head (SANFH) occurs frequently in patients receiving high-dose steroid treatment for these underlying diseases. The target of this study is to investigate the effect of microRNA-320 (miR-320) on SANFH by targeting CYP1A2. CYP1A2 expression was detected using immunohistochemistry. Specimens were collected from patients with SANFH and femoral neck fracture. Seventy rats were assigned into seven groups. The targeting relationship between miR-320 and CYP1A2 was verified by bioinformatics website and dual luciferase reporter gene assay. RT-qPCR and Western blot analysis were used to detect miR-320 and CYP1A2 expressions. The enzymatic activity of CYP1A2 was detected by fluorescence spectrophotometry. Hemorheology and microcirculation were measured in rats. MiR-320 expression decreased and CYP1A2 expression and enzymatic activity increased in SANFH patients compared to those with femoral neck fracture. CYP1A2 was the target gene of miR-320. Hemorheology and microcirculation results showed that up-regulated expression of CYP1A2 promoted the development of SANFH while increased expression of miR-320 inhibited the development of SANFH. Compared with the SANFH group, the SANFH + miR-320 mimic group showed increased miRNA-320 expression, and decreased CYP1A2 expression and enzymatic activity. Opposite results were found in the SANFH + miR-320 inhibitor group. The SANFH + miR-320 inhibitor + pCR-CYP1A2_KO group showed decreased miRNA-320 expression and the SANFH + pCR-CYP1A2_KO group showed decreased CYP1A2 expression and enzymatic activity. Our findings provide evidences that miR-320 might inhibit the development of SANFH by targeting CYP1A2. Copyright © 2018 Elsevier B.V. All rights reserved.

Management of male osteoporosis.

PubMed

Cortet, B; Vasseur, J; Grardel, B; Catanzariti, L; Marchandise, X; Delcambre, B

2001-05-01

The objective of this study was to evaluate the efficacy of treatments for male osteoporosis selected based on the cause of the disease. Sixty-three men with osteoporosis (T-score at the lumbar spine and/or femoral neck lower than -2.5) with a mean age of 53+/-11 years were studied. Forty-three (68.3%) had a history of fracturing without trauma (vertebral fractures, 37 patients, 57%). Treatments were as follows: idiopathic osteoporosis: calcium and vitamin D supplements (N = 10) or cyclical etidronate for 2 weeks followed by calcium and vitamin D supplements for 76 days (N = 29); moderate idiopathic phosphate diabetes: calcitriol and phosphate (N = 15); idiopathic hypercalciuria: hydrochlorothiazide (N = 6); and hypogonadism: testosterone (N = 3). Percentage change in bone mineral density (mean +/- standard error of the mean) after 18 months: calcium and vitamin D (lumbar spine: 0.6+/-2; femoral neck: 2.2+/-2.2); etidronate (lumbar spine: 3.6+/-1.4*; femoral neck: 0.5+/-1); calcitriol (lumbar spine: 7.0+/-3.5*; femoral neck: 0.0+/-1.4); thiazide diuretic (lumbar spine: 1+/-3.2; femoral neck: -2.3+/-3.7); and testosterone (lumbar spine: 6.8+/-6.4; femoral neck: 2.5+/-2.7), where *P < 0.05 versus baseline. Gastrointestinal side effects occurred in three patients (4.8%), including two on calcitriol-phosphate therapy and one on etidronate therapy. Of the six (9.5%) patients who experienced incident fractures, four were on etidronate, one on calcitriol-phosphate, and one on calcium-vitamin D. No patients discontinued their treatment because of side effects. Etidronate and the combination of calcitriol-phosphate produce a significant increase in lumbar spine bone mass in men with idiopathic osteoporosis or moderate idiopathic phosphate diabetes.

Survival of cementless femoral components after osteonecrosis of the femoral head with different etiologies.

PubMed

Radl, Roman; Egner, Sigrun; Hungerford, Marc; Rehak, Peter; Windhager, Reinhard

2005-06-01

We reviewed 41 patients with 55 cementless total hip arthroplasty operated for advanced osteonecrosis. Patients were divided into 2 groups according to etiology of the osteonecrosis. The first group included 17 cases with osteonecrosis without a systemic disease and the second group 38 cases with osteonecrosis associated with a systemic disease. The follow-up was on average 6.4 years (range, 2-12.8). Eight (15.4%) stem revisions had to be performed; all of them were in the patients with a systemic disease. Ten-year survival rates with femoral revision as the endpoint were in the first group 100% and in the systemic disease group 68% (P = .03). The data of this retrospective study indicate a correlation between the survival of the femoral component and the etiology of the osteonecrosis.

Osteoarthritis of the patella, lateral femoral condyle and posterior medial femoral condyle correlate with range of motion.

PubMed

Suzuki, Takashi; Motojima, Sayaka; Saito, Shu; Ishii, Takao; Ryu, Keinosuke; Ryu, Junnosuke; Tokuhashi, Yasuaki

2013-11-01

The type of osteoarthritis and the degree of severity which causes restriction of knee range of motion (ROM) is still largely unknown. The objective of this study was to analyse the location and the degree of cartilage degeneration that affect knee range of motion and the connection, if any, between femorotibial angle (FTA) and knee ROM restriction. Four hundreds and fifty-six knees in 230 subjects with knee osteoarthritis undergoing knee arthroplasty were included. Articular surface was divided into eight sections, and cartilage degeneration was evaluated macroscopically during the operation. Cartilage degeneration was classified into four grades based on the degree of exposure of subchondral bone. A Pearson correlation was conducted between FTA and knee flexion angle to determine whether high a degree of FTA caused knee flexion restriction. A logistic regression analysis was also conducted to detect the locations and levels of cartilage degeneration causing knee flexion restriction. No correlation was found between FTA and flexion angle (r = -0.08). Flexion angle was not restricted with increasing FTA. Logistic regression analysis showed significant correlation between restricted knee ROM and levels of knee cartilage degeneration in the patella (odds ratio (OR) = 1.77; P = 0.01), the lateral femoral condyle (OR = 1.62; P = 0.03) and the posterior medial femoral condyle (OR = 1.80; P = 0.03). For clinical relevance, soft tissue release and osteophyte resection around the patella, lateral femoral condyle and posterior medial femoral condyle might be indicated to obtain a higher degree of knee flexion angle.

21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral (hemi-knee...

21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral (hemi-hip...

Structural and functional studies of bioobjects prepared from femoral heads

NASA Astrophysics Data System (ADS)

Kirilova, I. A.; Sharkeev, Yu. P.; Podorozhnaya, V. T.; Popova, K. S.; Uvarkin, P. V.

2015-11-01

Results of examination of physicomechanical characteristics of samples of medial femoral head cuts are presented. The samples of medial femoral head cuts resected in 6 patients with coxarthrosis in primary endoprosthetic replacement of a coxofemoral joint have been tested for micro- and nanohardness. Young's modulus and elemental composition of bone tissue have been investigated. To estimate the architectonics of cancellous tissue of the femoral head, adjacent cuts of the same patient have been analyzed. The porosity of bone tissue was estimated from macroscopic images obtained using macrophotography. The total porosity is calculated as the ratio of the total length of straight line segments overlapping pores to the total length of secants. A three-point bending test of the samples has shown that their strength changed from 0.187 to 1.650 MPa and their elasticity modulus changes from 1.69 to 8.15 MPa. The microhardness of the samples changes in the range 220-265 MPa and the average microhardness of medial femoral head cuts is 240 MPa. The elemental composition of medial femoral head cuts is represented by basic Ca, P, O, Na and Mg elements as well as by Sn, S, Fe, Cr, and C in microamounts. The atomic Ca to P ratio for bone tissue is 1.55. It is revealed that pores of the upper part of the femoral head have a more regular shape and in the lower part they are more elongated along the cut and occupy a larger volume. The lower part of the femoral head has a higher porosity (39 and 33%) than the upper part (34 and 30%). The total porosity of all samples does not exceed 37%.

Management of Post-Traumatic Phlegmasia Cerulea Dolens via Right-to-Left Femoral Vein to Femoral Vein Bypass (Palma Procedure).

PubMed

Dua, Anahita; Heller, Jennifer; Lee, Cheong

2017-11-01

Phlegmasia cerulea dolens (PCD) is a rare condition resulting from venous occlusion that impairs arterial flow. We report a rare case of post-traumatic PCD after ligation of the iliac vein with successful treatment by right-to-left femoral vein to femoral vein bypass using left great saphenous vein (Palma procedure). The clinical presentation, diagnostic process, and approach to management along with a literature review on the operative management of PCD are presented in this case report.

How to deal with penile carcinoma inguinal metastases invading femoral vessels

PubMed Central

FODOR, MARIUS; PETRUT, BOGDAN; FODOR, LUCIAN

2017-01-01

Penile cancer accounts for 1–10% of men neoplastic diseases and 30–60% of patients have inguinal metastases at the time of diagnosis. Inguinal metastases of penile cancer with femoral vessel involvement could lead to vascular fistula and hemorrhagic shock. We present 3 consecutive patients with inguinal metastases of penile cancer complicated by infection and hemorrhage from femoral vessels invaded by the tumor. Simultaneous extra-anatomical axillo-femoral bypass graft, wide excision of tumor and groin defect reconstruction was used to achieve “tumor-free” oncologic aim and to save the lower limb. We consider the extra-anatomic axillo-femoral bypass associated with wide inguinal tumor excision and defect covering a feasible surgical solution for improving the life quality and extend life expectancy in patients with lymph node metastasis of penile cancer complicated by necrosis, infection and femoral vessel involvement. PMID:29151798

Percutaneous ex-vivo femoral arterial bypass: a novel approach for treatment of acute limb ischemia as a complication of femoral arterial catheterization.

PubMed

Merhi, William M; Turi, Zoltan G; Dixon, Simon; Safian, Robert D

2006-09-01

This report describes the use of a percutaneous ex-vivo femoral arterial bypass in three patients with acute lower extremity ischemia that occurred as a complication of femoral artery catheterization. Utilizing standard equipment and techniques, a percutaneous ex-vivo femoral artery bypass can restore antegrade flow to the ischemic limb in patients with impaired aorto-iliac inflow circulation, which may arise from iatrogenic dissection or the need for large in-dwelling sheaths required for hemodynamic support. This technique is considered a temporizing measure when conventional therapies are not possible. Contrast angiography is recommended to localize and define the cause of limb ischemia, and to permit safe placement of vascular sheaths in the "donor and recipient" arteries.

Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report.

PubMed

Won, Yougun; Lee, Gi Soo; Kim, Sang Bum; Kim, Sun Joong; Yang, Kyu Hyun

2016-11-01

As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposures and implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenient and able to lessen surgical time without morbidity of the donor site associated with the harvest.

Intracapsular origin of the long head of the biceps tendon with glenoid avulsion of the glenohumeral ligaments.

PubMed

Parikh, Shital N; Bonnaig, Nicolas; Zbojniewicz, Andrew

2011-11-09

An 18-year-old woman presented with a history of recurrent glenohumeral dislocations involving her right dominant shoulder. Physical examination suggested physiologic hyperlaxity and anterior instability. Magnetic resonance arthrography demonstrated an anomalous intracapsular origin of the long head of the biceps tendon (LHBT), with normal-appearing LHBT in the intertubercular groove. Diagnostic arthroscopy confirmed the absence of the LHBT attachment on the superior labrum. Instead, the LHBT originated from the capsule of the shoulder joint. Diagnostic arthroscopy also revealed glenoid avulsion of the glenohumeral ligaments (GAGL) lesion as a tear in the anterior-inferior capsule near its insertion on the glenoid and labrum. An arthroscopic anterior capsulolabral repair was performed with rotator interval closure by imbrication of superior and middle glenohumeral ligaments. A retrospective review of the magnetic resonance arthrogram identified irregularity and interposition of contrast between the capsule and the anterior-inferior labrum that was reproduced in the abduction-external rotation view corresponding with the GAGL lesion seen at arthroscopy. At 12 months postoperatively, the patient demonstrated full range of motion and no signs of instability. This case report helps to raise awareness about 2 rare shoulder lesions: the anomalous origin of LHBT and the GAGL lesion. Diagnosing such lesions on preoperative magnetic resonance imaging may aid in operative planning and avoid unexpected intraoperative findings. Copyright 2011, SLACK Incorporated.

Treatment of femoral Ewing's sarcoma.

PubMed

Terek, R M; Brien, E W; Marcove, R C; Meyers, P A; Lane, J M; Healey, J H

1996-07-01

The treatment of Ewing's sarcoma consists of chemotherapy for systemic and local disease. However, the role of radiation therapy, and/or surgical resection for definitive local treatment has yet to be determined. A retrospective review of 32 patients (24 males and 8 females) treated for femoral Ewing's sarcoma between 1970 and 1985 was performed. Patients were divided into 3 treatment groups: chemotherapy and radiotherapy (CR) (10); chemotherapy and surgery (CS) (9); and chemotherapy, surgery, and radiotherapy (CSR) (13). Patients in the CR group received a mean of 5320 centigray (cGy) of radiation and patients in the CSR group received a mean of 3590 cGy. Multiagent cyclophosphamide/doxorubicin based chemotherapy was used in all cases. Surgery consisted of wide resection or amputation. Patients in the CR group had a higher risk of local recurrence than patients in the CS and CSR groups (P=0.02, log rank). The combination of local recurrences and treatment complications necessitated surgery for 7 of 10 CR patients, whereas 1 of 9 and 4 of 13 in the CS and CSR groups required additional surgery. The median survival for the entire group was 39 months. Minimum follow-up for surviving patients was 45 months. Five-year survival consisted of 1 of 10 patients in the CR group, 2 of 9 in the CS group, and 7 of 13 in the CSR group. There were no statistically significant differences among the three survival curves. Tumor location within the femur was a significant prognostic variable. Distal femoral location had a survival advantage compared with proximal and mid-femur locations (P = 0.049, log rank). Femoral Ewing's sarcoma remains a disease with a poor prognosis. Radiation alone for local treatment results in a high rate of local recurrence and complications. Our current local treatment strategy for femoral Ewing's sarcoma includes surgery in all and adjuvant radiotherapy in many of the patients.

Neurodynamic responses to the femoral slump test in patients with anterior knee pain syndrome.

PubMed

Lin, Pei-Ling; Shih, Yi-Fen; Chen, Wen-Yin; Ma, Hsiao-Li

2014-05-01

Matched-control, cross-sectional study. The purpose of this study was to compare the responses to the femoral slump test (FST), including the change in hip range of motion and level of discomfort, between subjects with and without anterior knee pain. Anterior knee pain syndrome is a common problem among adults. The FST is the neurodynamic test used to assess the mechanosensitivity of the femoral component of the nervous system. However, as of yet, there is no literature discussing the use of the FST in patients with anterior knee pain. Thirty patients with anterior knee pain and 30 control participants, matched by gender, age, and dominant leg, were recruited. The subjects received the FST, during which the hip extension angle and the location and intensity of pain/discomfort were recorded. Reproduction of symptoms that were alleviated by neck extension was interpreted as a positive test. Differences in hip extension angle and pain intensity between groups were examined using a 2-way, repeated-measures analysis of variance and a Kruskal-Wallis analysis. The level of significance was set at α = .05. Subjects with anterior knee pain had a smaller hip extension angle than that of controls (-3.6° ± 5.3° versus 0.6° ± 6.1°; mean difference, 4.2°; 95% confidence interval [CI]: 1.24°, 7.15°; P = .006). Eight patients with anterior knee pain showed a positive FST, and those with a positive FST had a smaller hip extension angle (-5.7° ± 4.5°) than that of controls (mean difference, 6.3°; 95% CI: 0.8°, 11.8°; P = .007). There was no difference in the hip extension angle between the positive and negative FST groups (mean difference, 2.9°; 95% CI: -8.5°, 2.0°) or between the negative FST and control groups (mean difference, 3.4°; 95% CI: -0.4°, 7.3°). Results of this study suggest that altered mechanosensitivity of the femoral nerve occurred in the patients with anterior knee pain who presented with a positive FST. The role of increased mechanosensitivity

Development of a method for measuring femoral torsion using real-time ultrasound.

PubMed

Hafiz, Eliza; Hiller, Claire E; Nicholson, Leslie L; Nightingale, E Jean; Clarke, Jillian L; Grimaldi, Alison; Eisenhuth, John P; Refshauge, Kathryn M

2014-07-01

Excessive femoral torsion has been associated with various musculoskeletal and neurological problems. To explore this relationship, it is essential to be able to measure femoral torsion in the clinic accurately. Computerized tomography (CT) and magnetic resonance imaging (MRI) are thought to provide the most accurate measurements but CT involves significant radiation exposure and MRI is expensive. The aim of this study was to design a method for measuring femoral torsion in the clinic, and to determine the reliability of this method. Details of design process, including construction of a jig, the protocol developed and the reliability of the method are presented. The protocol developed used ultrasound to image a ridge on the greater trochanter, and a customized jig placed on the femoral condyles as reference points. An inclinometer attached to the customized jig allowed quantification of the degree of femoral torsion. Measurements taken with this protocol had excellent intra- and inter-rater reliability (ICC2,1 = 0.98 and 0.97, respectively). This method of measuring femoral torsion also permitted measurement of femoral torsion with a high degree of accuracy. This method is applicable to the research setting and, with minor adjustments, will be applicable to the clinical setting.

[Recent advances in treatment of aseptic femoral shaft nonunion].

PubMed

Zhang, Wei; Chen, Hua; Tang, Peifu

2018-05-01

To review the recent advances in treatment of aseptic femoral shaft nonunion. The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.

Are differences in leg length predictive of lateral patello-femoral pain?

PubMed

Carlson, Mary; Wilkerson, Jerry

2007-03-01

Lateral patello-femoral pain can shorten an athletic career and generally decrease an individual's physical activity and functional level, such as preventing stair climbing and reducing the ability to rise from a chair. Leg length inequality is associated with patello-femoral pain. A leg length test that best distinguishes the difference between people who have lateral patello-femoral pain and those who do not would have clinical utility. The purpose of the present study was, first, to determine if unilateral, lateral patello-femoral pain was associated with the longer leg when inequality of leg lengths existed and, second, to determine if leg length direct measurement, indirect measurement or quadriceps angle (Q angle) could correctly classify participants according to the presence or absence of patello-femoral pain. The study used an ex post facto, two-group quasi-experimental design. A volunteer sample of 52 participants (14 males, 38 females), ranged in age from 18 to 52 years. Three methods were used to measure leg lengths: palpation meter (PALM) on anterior superior iliac spines (ASIS) while participants maintained centred weight-bearing position on a high resolution pressure mat; tape measurement from ASIS to medial malleolus (supine); tape measurement from ASIS to lateral malleolus (supine). Additionally, Q angle was measured in supine position. Patellar grind test, medial retinacular and lateral patellar palpation screened for patello-femoral pain. Logistic regression analysis determined correctness of membership in painful and non-painful patello-femoral groups. The PALM method of indirect measurement of leg length differences overall correctly classified approximately 83 % of the participants. Tape measure to medial and lateral malleoli as well as Q angle did not yield significant results. The results suggested that the PALM method of measuring leg length differences may have clinical utility in differentiating between patients who are likely to sustain

Structural and functional studies of bioobjects prepared from femoral heads

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kirilova, I. A., E-mail: IKirilova@niito.ru; Podorozhnaya, V. T., E-mail: VPodorognaya@niito.ru; Sharkeev, Yu. P., E-mail: sharkeev@ispms.tsc.ru

2015-11-17

Results of examination of physicomechanical characteristics of samples of medial femoral head cuts are presented. The samples of medial femoral head cuts resected in 6 patients with coxarthrosis in primary endoprosthetic replacement of a coxofemoral joint have been tested for micro- and nanohardness. Young’s modulus and elemental composition of bone tissue have been investigated. To estimate the architectonics of cancellous tissue of the femoral head, adjacent cuts of the same patient have been analyzed. The porosity of bone tissue was estimated from macroscopic images obtained using macrophotography. The total porosity is calculated as the ratio of the total length ofmore » straight line segments overlapping pores to the total length of secants. A three-point bending test of the samples has shown that their strength changed from 0.187 to 1.650 MPa and their elasticity modulus changes from 1.69 to 8.15 MPa. The microhardness of the samples changes in the range 220–265 MPa and the average microhardness of medial femoral head cuts is 240 MPa. The elemental composition of medial femoral head cuts is represented by basic Ca, P, O, Na and Mg elements as well as by Sn, S, Fe, Cr, and C in microamounts. The atomic Ca to P ratio for bone tissue is 1.55. It is revealed that pores of the upper part of the femoral head have a more regular shape and in the lower part they are more elongated along the cut and occupy a larger volume. The lower part of the femoral head has a higher porosity (39 and 33%) than the upper part (34 and 30%). The total porosity of all samples does not exceed 37%.« less

Relationship of homocysteine levels with lumbar spine and femur neck BMD in postmenopausal women.

PubMed

Bahtiri, E; Islami, H; Rexhepi, S; Qorraj-Bytyqi, H; Thaçi, K; Thaçi, S; Karakulak, C; Hoxha, R

2015-01-01

The focus of several studies in recent years has been the association between increased plasma concentrations of homocysteine (Hcy), reduced bone mineral density and increased risk of bone fractures. Nevertheless, inconsistencies persist in the literature. Thus, the objective of this study was to investigate the possible relationship between serum Hcy and vitamin B12 status, and bone mineral density, on a group of post-menopausal women. One hundred thirty-nine postmenopausal women were recruited to enter this cross-sectional study. Bone mineral density (BMD) of total hip, femoral neck and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA) and serum Hcy, vitamin B12, parathyroid hormone (PTH), total calcium and magnesium levels were determined. In addition, we investigated the relationship of Hcy and vitamin B12 and BMD using a meta-analysis approach. Serum Hcy levels were significantly higher in osteoporotic women when compared to other BMD groups, and were inversely related to lumbar spine BMD and femur neck BMD. Body mass index and serum Hcy levels were shown to be significant predictors of BMD at lumbar spine, femur neck and total hip. The performed meta-analysis showed that serum Hcy levels were significantly higher in osteoporotic subjects compared to normal BMD subjects. This study shows that Hcy status, but not vitamin B12 status, is associated with BMD in this cohort of postmenopausal women. We therefore confirm that high Hcy levels are an independent risk factor for osteoporosis. BMD evaluation in women at post menopause with high Hcy levels may be helpful in advising precautionary measures.

Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

PubMed

Novais, Eduardo N; Sink, Ernest L; Kestel, Lauryn A; Carry, Patrick M; Abdo, João C M; Heare, Travis C

2016-08-01

The modified Dunn procedure, which is an open subcapital realignment through a surgical dislocation approach, has gained popularity for the treatment of unstable slipped capital femoral epiphysis (SCFE). Intraoperative monitoring of the femoral head perfusion has been recommended as a method of predicting osteonecrosis; however, the accuracy of this assessment has not been well documented. We asked (1) whether intraoperative assessment of femoral head perfusion would help identify hips at risk of developing osteonecrosis; (2) whether one of the four methods of assessment of femoral head perfusion is more accurate (highest area under the curve) at identifying hips at risk of osteonecrosis; and (3) whether specific clinical features would be associated with osteonecrosis occurrence after a modified Dunn procedure for unstable SCFE. Between 2007 and 2014, we performed 29 modified Dunn procedures for unstable SCFE (16 boys, 11 girls; median age, 13 years; range, 8-17 years); two were lost to followup before 1 year. During this period, six patients with unstable SCFE were treated by other procedures. All patients undergoing modified Dunn underwent assessment of epiphyseal perfusion by the presence of active bleeding and/or by intracranial pressure (ICP) monitoring. In the initial five patients perfusion was recorded once, either before dissection of the retinacular flap or after fixation by one of the two methods. In the remaining 22 patients (81%), perfusion was systematically assessed before dissection of the retinacular flap and after fixation by both methods. Minimum followup was 1 year (median, 2.5 years; range, 1-8 years) because osteonecrosis typically develops within the first year after surgery. Patients were assessed for osteonecrosis by the presence of femoral head collapse at radiographs obtained every 3 months during the first year after surgery. Seven (26%) of the 27 patients developed osteonecrosis. Measures of diagnostic accuracy including sensitivity

Femoral-gluteal subcutaneous and intermuscular adipose tissues have independent and opposing relationships with CVD risk

PubMed Central

Yim, Jung-Eun; Heshka, Stanley; Albu, Jeanine B.; Heymsfield, Steven; Gallagher, Dympna

2009-01-01

—Femoral-gluteal adipose tissue (AT) may be cardioprotective through fatty acids uptake. Femoral-gluteal AT has previously been defined as leg fat measured by dual energy x-ray absorptiometry (DXA); however, subcutaneous adipose tissue (SAT) and intermuscular adipose tissue (IMAT) are inseparable using DXA. This study investigated the independent relationships between femoral-gluteal SAT, femoral-gluteal IMAT, and cardiovascular disease (CVD) risk factors [fasting serum measures of glucose, total cholesterol (TC), high density lipoprotein cholesterol (HDLC), triglycerides (TG) and insulin] and whether race differences exist in femoral-gluteal AT distribution. Adult Caucasians (56 men and 104 women), African-Americans (37 men and 76 women), and Asians (11 men and 35 women) had total AT (TAT) including femoral-gluteal AT (upper leg SAT and IMAT) and visceral AT (VAT) by magnetic resonance imaging (MRI). General linear models identified the independent effects of femoral-gluteal SAT and femoral-gluteal IMAT on each risk factor after covarying for TAT, VAT, age, race, sex, and two-way interactions. Femoral-gluteal IMAT and glucose (P < 0.05) were positively associated independent of VAT. There were also significant inverse associations between femoral-gluteal SAT and insulin (P < 0.01) and TG (P < 0.05), although the addition of VAT rendered these effects nonsignificant, possibly due to collinearity. Asian women had less femoral-gluteal SAT and greater VAT than Caucasians and African-Americans (P < 0.05) and Asian and African-American men had greater femoral-gluteal IMAT than Caucasians, adjusted for age and TAT (P < 0.05 for both). Femoral-gluteal SAT and femoral-gluteal IMAT distribution varies by sex and race, and these two components have independent and opposing relationships with CVD risk factors. PMID:18079271

Prevalence and characteristics of femoral injection among Seattle-area injection drug users.

PubMed

Coffin, Phillip O; Coffin, Lara S; Murphy, Shilo; Jenkins, Lindsay M; Golden, Matthew R

2012-04-01

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5-6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3-5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2-32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.

Modified femoral pressuriser generates a longer lasting high pressure during cement pressurisation

PubMed Central

2011-01-01

Background The strength of the cement-bone interface in hip arthroplasty is strongly related to cement penetration into the bone. A modified femoral pressuriser has been investigated, designed for closer fitting into the femoral opening to generate higher and more constant cement pressure compared to a commercial (conventional) design. Methods Femoral cementation was performed in 10 Sawbones® models, five using the modified pressuriser and five using a current commercial pressuriser as a control. Pressure during the cementation was recorded at the proximal and distal regions of the femoral implant. The peak pressure and the pressure-time curves were analysed by student's t-test and Two way ANOVA. Results The modified pressuriser showed significantly and substantially longer durations at higher cementation pressures and slightly, although not statistically, higher peak pressures compared to the conventional pressuriser. The modified pressuriser also produced more controlled cement leakage. Conclusion The modified pressuriser generates longer higher pressure durations in the femoral model. This design modification may enhance cement penetration into cancellous bone and could improve femoral cementation. PMID:22004662

[Fiddler's neck].

PubMed

Knierim, C; Goertz, W; Reifenberger, J; Homey, B; Meller, S

2013-10-01

The fiddler's neck is an uncommon variant of acne mechanica in violinists and violists. It is a single firm red-brown dermal nodule usually on the left side of neck. This special form of acne mechanica represents a therapeutic challenge since the triggering mechanical factors persist, unless they can be corrected by changes in positioning or modifications of the chin pad. A 72-year-old woman who had played the violin since childhood presented with a red-brown nodule on her neck for 18 months. Cushioning provided no relief. Excision of the affected area with primary closure represented one therapeutic option. Further supportive measures include improved posture to reduce the pressure between skin and instrument and interposing a neck cloth.

EPIDEMIOLOGICAL STUDY OF CHILDREN DIAPHYSEAL FEMORAL FRACTURES

PubMed Central

Hoffmann, Cassiano Ricardo; Traldi, Eduardo Franceschini; Posser, Alexandre

2015-01-01

Objective: To evaluate the personal, fracture, treatment and complication characteristics among patients with pediatric femoral shaft fractures attended at the pediatric orthopedic service of the Joana de Gusmão Children's Hospital. Methods: This was a retrospective cross-sectional study on a population consisting of patients with femoral shaft fractures, aged between birth and 14 years and 11 months, who were divided into four age groups. Information was obtained from medical records and was transferred to a survey questionnaire to present personal, fracture, treatment and complication variables. Results: The study population consisted of 96 patients. Their mean age was 6.8 years. The cases were predominantly among males, comprising closed fractures on the right side, in the middle third with a single line. Regarding fracture etiology, traffic accidents predominated overall in the sample. Most of the patients (74 to 77.1%) presented femoral fractures as their only injury. Conservative treatment predominated in the group younger than six years of age, and surgical treatment in the group aged 6 to 14 years and 11 months. The complications observed until bone union were: discrepancy, infection and movement limitation. The mean time taken for consolidation was 9.6 ± 2.4 weeks, varying with age. Conclusion: The features of these fractures were similar to those described in the literature and the treatment used showed good results. The Joana de Gusmão Children's Hospital has used the treatment proposed in the literature for pediatric femoral shaft fractures. PMID:27042619

Macroscopic and microscopic findings in avascular necrosis of the femoral head.

PubMed

Kamal, Diana; Alexandru, D O; Kamal, C K; Streba, C T; Grecu, D; Mogoantă, L

2012-01-01

The avascular necrosis of the femoral head is an illness induced by the cutoff of blood flow to the femoral head and it affects mostly young adults between the ages of 30 and 50 years, raising therapeutic and diagnostic issues. Many risk factors are incriminated in the development of avascular necrosis of the femoral head like: trauma, chronic alcohol consumption, smoking, administration of corticosteroid drugs, most of the cases are considered to be idiopathic. The main goal of our paper is to describe the macroscopic and microscopic variations of the bone structure, which occur in patients with avascular necrosis of the femoral head. The biological material needed for our study was obtained following hip arthroplasty surgery in 26 patients between the ages of 29 and 59 years, which previously were diagnosed with avascular necrosis of the femoral head and admitted in the Orthopedics Department of the Emergency County Hospital of Craiova (Romania) between 2010 and 2011. From a macroscopic point of view, we found well defined areas of necrosis, most of which were neatly demarcated of the adjacent viable tissue by hyperemic areas, loss of shape and contour of the femoral head and transformations of the articular cartilage above the area of necrosis. When examined under the microscope, we found vast areas of fibrosis, narrow bone trabeculae, obstructed blood vessels or blood vessels with clots inside, hypertrophic fat cells, bone sequestration but also small cells and pyknotic nuclei. The microscopic and macroscopic findings on the femoral head sections varied with the patients and the stage of the disease.

Neck pain: manipulating the upper back helps lessen pain and improve neck motion.

PubMed

2011-09-01

Neck pain is very common. In the United States, between 30% and 50% of people suffer from an aching neck each year. Although neck pain can be caused by injury, most of this pain results from more gradual stresses, such as particular sitting, standing, or work postures, lifting patterns, or sleeping positions. Typical neck pain can also cause headaches, pain between your shoulders, or a feeling of knots in your neck and upper back muscles. Although manual therapy, sometimes called "manipulation," is a common treatment for many types of spine pain, some people are uncomfortable having their necks manipulated. Recently, though, researchers have tested the benefits of a thrust manipulation of the upper back to treat neck pain. A study published in the September 2011 issue of JOSPT provides new insight and an evidence-based summary of the benefits of manipulating the upper back to ease and eliminate neck pain.

Effects of posture on shear rates in human brachial and superficial femoral arteries

PubMed Central

Newcomer, S. C.; Sauder, C. L.; Kuipers, N. T.; Laughlin, M. H.; Ray, C. A.

2012-01-01

Shear rate is significantly lower in the superficial femoral compared with the brachial artery in the supine posture. The relative shear rates in these arteries of subjects in the upright posture (seated and/or standing) are unknown. The purpose of this investigation was to test the hypothesis that upright posture (seated and/or standing) would produce greater shear rates in the superficial femoral compared with the brachial artery. To test this hypothesis, Doppler ultrasound was used to measure mean blood velocity (MBV) and diameter in the brachial and superficial femoral arteries of 21 healthy subjects after being in the supine, seated, and standing postures for 10 min. MBV was significantly higher in the brachial compared with the superficial femoral artery during upright postures. Superficial femoral artery diameter was significantly larger than brachial artery diameter. However, posture had no significant effect on either brachial or superficial femoral artery diameter. The calculated shear rate was significantly greater in the brachial (73 ± 5, 91 ± 11, and 97 ± 13 s−1) compared with the superficial femoral (53 ± 4, 39 ± 77, and 44 ± 5 s−1) artery in the supine, seated, and standing postures, respectively. Contrary to our hypothesis, our current findings indicate that mean shear rate is lower in the superficial femoral compared with the brachial artery in the supine, seated, and standing postures. These findings of lower shear rates in the superficial femoral artery may be one mechanism for the higher propensity for atherosclerosis in the arteries of the leg than of the arm. PMID:18245564

Femoral vessel injuries in modern warfare since Vietnam.

PubMed

Pearl, Jonathan P; McNally, Michael P; Perdue, Philip W

2003-09-01

The incidence of lower extremity injuries is high in modern warfare; however the mortality rate from these injuries is low. Despite the overall low mortality of lower extremity injuries, many deaths in modern conflicts are due to femoral vessel injury. The modern warfare literature was reviewed. In Somalia, 1 of the 14 reported deaths was due to a laceration of the superficial femoral artery. In the Persian Gulf, three deaths were reported in an Army field hospital, one resulted from uncontrolled hemorrhage from a profunda femoris artery wound and two others resulted from traumatic amputations with consequent major arterial injury. Despite the advances in modern body armor, the groin is left unprotected. A strategy to help minimize U.S. casualties in modern warfare may be a method of field hemostasis specifically designed for femoral vessel injury.

Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain.

PubMed

Kim, Su-Rim; Kang, Mi-Hee; Bahng, Sun-Young; An, Jin-Kyoung; Lee, Ji-Young; Park, Sang-Young; Kim, Seong-Gil

2016-05-01

[Purpose] This study aimed to investigate the correlations among scapular asymmetry, neck pain, and neck disability index in women in their 20s with slight neck pain. [Subjects and Methods] A total of 60 female students at U university in Gyeongsangbuk-do, South Korea, participated in this study. The lateral scapular slide test, which measures the distance between the thorax and scapula, was used to analyze the scapular asymmetry. The lateral scapular slide test was performed in three positions. The visual analogue scale and neck disability index were used to measure neck pain. [Results] In the lateral scapular slide test in position 3 (shoulder abduction at 90 degrees), the scapular left-right asymmetry and VAS showed a moderate positive linear relationship, with r=0.344. The VAS and NDI showed a moderate positive linear relationship, with r = 0.632. [Conclusion] Scapular asymmetry indicates imbalance of surrounding muscles of the scapula and is related to neck pain based on the results of measuring the distance from the thorax to the scapula.

Proximal femoral fractures.

PubMed

Webb, Lawrence X

2002-01-01

Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

Modular femoral component for conversion of previous hip surgery in total hip arthroplasty.

PubMed

Goldstein, Wayne M; Branson, Jill J

2005-09-01

The conversion of previous hip surgery to total hip arthroplasty creates a durable construct that is anatomically accurate. Most femoral components with either cemented or cementless design have a fixed tapered proximal shape. The proximal femoral anatomy is changed due to previous hip surgery for fixation of an intertrochanteric hip fracture, proximal femoral osteotomy, or a fibular allograft for avascular necrosis. The modular S-ROM (DePuy Orthopaedics Inc., Warsaw, Ind) hip stem accommodates these issues and independently prepares the proximal and distal portion of the femur. In preparation and implantation, the S-ROM hip stem creates less hoop stresses on potentially fragile stress risers from screws and thin bone. The S-ROM hip stem also prepares a previously distorted anatomy by milling through cortical bone that can occlude the femoral medullar canals and recreate proper femoral anteversion and reduces the risk of intraoperative or postoperative periprosthetic fracture due to the flexible titanium-slotted stem. The S-ROM femoral stem is recommended for challenging total hip reconstructions.

Total knee arthroplasty following prior distal femoral fracture.

PubMed

Papadopoulos, Elias C; Parvizi, Javad; Lai, Choon H; Lewallen, David G

2002-12-01

Femoral fracture may predispose the knee to the development of post-traumatic arthritis by either a direct intra-articular injury or residual limb malalignment. Malunion, intra-articular osseous defects, limb malalignment, retained internal fixation devices, and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) in these patients. The aim of our study was to evaluate the result of TKA in patients with previous distal femoral fracture. The results of 48 cemented condylar total knee arthroplasties, performed between 1980 to 1998, in 47 patients with a previous distal femoral fracture were reviewed. There were 37 females and 10 males with an average age of 65 years (range, 19-84 years). Follow-up averaged 6.2 years (range, 2-16 years). No patients were lost to follow-up. At the time of arthroplasty a femoral fracture non-union was present in three knees, all of which were treated with a long stem cemented femoral component and bone grafting. Malunion, defined as angulation greater than 10 degrees in the coronal plain or greater than 15 degrees in the sagittal plain, was present in 21 knees. Of these, six underwent distal femoral osteotomy during TKA. In the remaining 15 patients, with a malunion, the deformity was addressed by alterations in the orientation and location of bone resection. Other procedures were commonly needed at the time of arthroplasty and included: lateral retinacular release (22 knees), extensor mechanism realignment (eight knees), and collateral ligament reconstruction (two knees). The mean pre-operative Knee Society Scores were 40 (range, 0-80) for pain and 48 (range, 0-100) for function and improved significantly to a mean of 84 (range, 37-99) and 66 (range, 0-100) points, respectively, at the latest follow-up (P<0.001). The knee arc of motion improved from a pre-operative mean of 83-99 degrees at the latest follow-up (P<0.004). Post-operative manipulation under anesthesia for poor motion was

Optimized functional femoral rotation in navigated total knee arthroplasty considering ligament tension.

PubMed

Walde, T A; Bussert, J; Sehmisch, S; Balcarek, P; Stürmer, K M; Walde, H J; Frosch, K H

2010-12-01

Femoral malrotation in total knee arthroplasty is correlated to an increased number of revisions. Anatomic landmarks such as Whiteside line, posterior condyle axis and transepicondylar axis are used for determining femoral component rotation. The femoral rotation achieved with the anatomical landmarks is compared to the femoral rotation achieved by a navigated ligament tension-based tibia-first technique. Ninety-three consecutive patients with gonarthritis were prospectively enrolled. Intraoperatively the anatomical landmarks for femoral rotation and the achieved femoral rotation using a navigated tension-based tibia-first technique were determined and stored for further comparison. A pre- and postoperative functional diagram displaying the extension and flexion and varus or valgus positions was also part of the evaluation. Using anatomical landmarks the rotational errors ranged from 12.2° of internal rotation to 15.5° of external rotation from parallel to the tibial resection surface at 90° flexion. A statistical significant improved femoral rotation was achieved using the ligament tension-based method with a rotational error ranged from 3.0° of internal rotation to 2.4° of external rotation. The functional analyses demonstrated statistical significant lower varus/valgus deviations within the flexion range and an improved maximum varus deviation at 90° flexion using the ligament tension-based method. Compared to the anatomical landmarks a balanced, almost parallel flexion gap was achieved using a navigation technique taking the ligament tension of the knee joint into account. As a result the improved femoral rotation was demonstrated by the functional evaluation. Unilateral overloading of the polyethylene inlay and unilateral instability can thus be avoided. Copyright © 2009 Elsevier B.V. All rights reserved.

In vivo precision of the GE Lunar iDXA densitometer for the measurement of total-body, lumbar spine, and femoral bone mineral density in adults.

PubMed

Hind, Karen; Oldroyd, Brian; Truscott, John G

2010-01-01

Knowledge of precision is integral to the monitoring of bone mineral density (BMD) changes using dual-energy X-ray absorptiometry (DXA). We evaluated the precision for bone measurements acquired using a GE Lunar iDXA (GE Healthcare, Waukesha, WI) in self-selected men and women, with mean age of 34.8 yr (standard deviation [SD]: 8.4; range: 20.1-50.5), heterogeneous in terms of body mass index (mean: 25.8 kg/m(2); SD: 5.1; range: 16.7-42.7 kg/m(2)). Two consecutive iDXA scans (with repositioning) of the total body, lumbar spine, and femur were conducted within 1h, for each subject. The coefficient of variation (CV), the root-mean-square (RMS) averages of SDs of repeated measurements, and the corresponding 95% least significant change were calculated. Linear regression analyses were also undertaken. We found a high level of precision for BMD measurements, particularly for scans of the total body, lumbar spine, and total hip (RMS: 0.007, 0.004, and 0.007 g/cm(2); CV: 0.63%, 0.41%, and 0.53%, respectively). Precision error for the femoral neck was higher but still represented good reproducibility (RMS: 0.014 g/cm(2); CV: 1.36%). There were associations between body size and total-body BMD and total-hip BMD SD precisions (r=0.534-0.806, p<0.05) in male subjects. Regression parameters showed good association between consecutive measurements for all body sites (r(2)=0.98-0.99). The Lunar iDXA provided excellent precision for BMD measurements of the total body, lumbar spine, femoral neck, and total hip. Copyright © 2010 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Histopathology of femoral head donations: a retrospective review of 6161 cases.

PubMed

Mackie, Katherine E; Zhou, Ziqiang; Robbins, Peter; Bulsara, Max; Zheng, Ming H

2011-08-17

Although total hip arthroplasty is one of the most common orthopaedic surgical procedures, it remains unclear whether histopathological examination of the excised femoral head adds to the quality of patient care. We propose that assessment of femoral heads resected during total hip arthroplasty and donated for allograft use may provide a profile of femoral head pathology that benefits total hip arthroplasty patients and bone donors. We retrospectively analyzed the histological findings reported for 6161 femoral heads donated for allograft use between 1993 and 2006. Specimens obtained during total hip arthroplasty and specimens donated at death were reviewed. Follow-up investigations that resulted from abnormal histopathological findings were also reviewed. The Western Australian Cancer Registry was used to determine whether patients with a suspected neoplasm were subsequently diagnosed with such a disease. A retrospective review of the histopathological findings was conducted to evaluate and reclassify all previous observations of abnormalities. One hundred and five femoral heads demonstrated abnormal or reactive histopathological features not reported prior to surgery and were rejected for allograft use. A reactive lymphocytic infiltrate, most likely due to osteoarthritis, was the most commonly identified feature (forty-five cases). Other features observed in twenty-seven cases were also most likely due to the presence of severe osteoarthritis. Ten femoral heads demonstrated plasmacytosis, which may have been related to osteoarthritis. Two patients were diagnosed with Paget's disease, and two, with rheumatoid arthritis. Nineteen patients had a suspected neoplasm. Of these nineteen, eight cases of non-Hodgkin's lymphoma or chronic lymphocytic leukemia and one case of myelodysplastic syndrome were confirmed on further investigation. One subsequently confirmed malignancy was detected per 770 femoral heads examined. Our findings indicate that, even with a detailed

Inter-Vertebral Flexibility of the Ostrich Neck: Implications for Estimating Sauropod Neck Flexibility

PubMed Central

Cobley, Matthew J.; Rayfield, Emily J.; Barrett, Paul M.

2013-01-01

The flexibility and posture of the neck in sauropod dinosaurs has long been contentious. Improved constraints on sauropod neck function will have major implications for what we know of their foraging strategies, ecology and overall biology. Several hypotheses have been proposed, based primarily on osteological data, suggesting different degrees of neck flexibility. This study attempts to assess the effects of reconstructed soft tissues on sauropod neck flexibility through systematic removal of muscle groups and measures of flexibility of the neck in a living analogue, the ostrich (Struthio camelus). The possible effect of cartilage on flexibility is also examined, as this was previously overlooked in osteological estimates of sauropod neck function. These comparisons show that soft tissues are likely to have limited the flexibility of the neck beyond the limits suggested by osteology alone. In addition, the inferred presence of cartilage, and varying the inter-vertebral spacing within the synovial capsule, also affect neck flexibility. One hypothesis proposed that flexibility is constrained by requiring a minimum overlap between successive zygapophyses equivalent to 50% of zygapophyseal articular surface length (ONP50). This assumption is tested by comparing the maximum flexibility of the articulated cervical column in ONP50 and the flexibility of the complete neck with all tissues intact. It is found that this model does not adequately convey the pattern of flexibility in the ostrich neck, suggesting that the ONP50 model may not be useful in determining neck function if considered in isolation from myological and other soft tissue data. PMID:23967284

Delayed appearance of hypaesthesia and paralysis after femoral nerve block

PubMed Central

Landgraeber, Stefan; Albrecht, Thomas; Reischuck, Ulrich; von Knoch, Marius

2012-01-01

We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible. PMID:22577509

[Historical outline on the nomenclature of neck lymph nodes as a basis of neck dissection classification].

PubMed

Werner, J A

2001-07-01

The neck dissection classification is based considerably on the organization of the lymph nodes of the neck. Terminology and anatomical allocation of nearly 300 cervicofacial lymph nodes repeatedly changed since the beginning of the 20th century. Analysis of the literature on neck lymph node organization with reference to the development of the neck dissection classification. The first fundamental nomenclature of the neck lymph nodes is founded on the work of Rouviére (1932). Suárez (1963) described the functional neck dissection on the basis of the fascial compartmentalization of the neck. Lindberg (1972) left the predominantly anatomically correlated grouping of the cervical lymph nodes as described by Rouviére and divided the lymphatic system of the neck on basis of pathophysiological mechanisms. The attention regarding the location of occult metastases led to the description of the selective neck dissection. Since the fundamental work of Shah et al. (1981) there was a multiplicity of more or less slight changes of the neck node regions. These changes were again basis for new neck dissection terminologies. A new classification was introduced in the year 2000 as the revised version of the American Head and Neck Society. The revised version of the neck dissection classification can reduce former controversies, particularly regarding an optimized intraoperative allocation of the lymph nodes and a simplified terminology of the selective neck dissection. With the goal of a standardization of the neck dissection forms it remains to be seen if the proponents of the functional neck dissection after Suárez consider the extent of the neck dissection in patients with N0 neck in favor of the selective neck dissection.

Neck movement and muscle activity characteristics in female office workers with neck pain.

PubMed

Johnston, V; Jull, G; Souvlis, T; Jimmieson, N L

2008-03-01

Cross-sectional study. To explore aspects of cervical musculoskeletal function in female office workers with neck pain. Evidence of physical characteristics that differentiate computer workers with and without neck pain is sparse. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius (UT) muscles during specific tasks. Understanding cervical musculoskeletal function in office workers will better direct intervention and prevention strategies. Measures included neck range of motion; superficial neck flexor muscle activity during a clinical test, the craniocervical flexion test; and a motor task, a unilateral muscle coordination task, to assess the activity of both the anterior and posterior neck muscles. Office workers with and without neck pain were formed into 3 groups based on their scores on the Neck Disability Index. Nonworking women without neck pain formed the control group. Surface electromyographic activity was recorded bilaterally from the sternocleidomastoid, anterior scalene (AS), cervical extensor (CE) and UT muscles. Workers with neck pain had reduced rotation range and increased activity of the superficial cervical flexors during the craniocervical flexion test. During the coordination task, workers with pain demonstrated greater activity in the CE muscles bilaterally. On completion of the task, the UT and dominant CE and AS muscles demonstrated an inability to relax in workers with pain. In general, there was a linear relationship between the workers' self-reported levels of pain and disability and the movement and muscle changes. These results are consistent with those found in other cervical musculoskeletal disorders and may represent an altered muscle recruitment strategy to stabilize the head and neck. An exercise program including motor reeducation may assist in the management of neck pain in office workers.

Lateral Intercondylar Ridge: Is it a reliable landmark for femoral ACL insertion?: An anatomical study.

PubMed

Bhattacharyya, Rahul; Ker, Andrew; Fogg, Quentin; Spencer, Simon J; Joseph, Jibu

2018-02-01

Incorrect femoral tunnel placement is the most common cause of graft failure during Anterior Cruciate Ligament (ACL) Reconstruction. A reliable landmark can minimize errors. To identify whether the Lateral Intercondylar Ridge (LIR) is a consistent anatomical structure and define its relationship with the femoral ACL insertion. Phase 1: we studied 23 femoral dry bone specimens macroscopically. Using a digital microscribe, the medial surface of the lateral femoral condyle was reconstructed (3D) to evaluate whether there was an identifiable bony ridge. Phase 2: 7 cadaveric specimens with intact soft tissues were dissected to identify the femoral ACL insertion. A 3D reconstruction of the femoral ACL insertion and the surface allowed us to define the relationship between the LIR and the ACL insertion. All specimens had a defined LIR on the medial surface of the lateral femoral condyle. The ridge was consistently located just anterior to the femoral ACL insertion. The ACL footprint was present in the depression between the ridge and the Inferior Articular Cartilage Margin (IACM). The mean distance from the midpoint of the IACM to the LIR was 10.1 mm. This is the first study to use the microscribe to digitally reconstruct the medial surface of the lateral femoral condyle. It shows that the LIR is a consistent anatomical structure that defines the anterior margin of the femoral ACL insertion, which guides femoral tunnel placement. Our findings support the ruler technique, which is a commonly used method for anatomic single bundle ACL reconstruction. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Synovial sarcoma of the neck associated with previous head and neck radiation therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mischler, N.E.; Chuprevich, T.; Tormey, D.C.

1978-08-01

Synovial sarcoma is a rare neoplasm that uncommonly arises in the neck. Fourteen years after facial and neck radiation therapy for acne, synovial sarcoma of the neck developed in a young man. Possible radiation-induced benign and malignant neoplasms that arise in the head and neck region, either of thyroid or extrathyroid origin, remain a continuing medical problem.

Parity, Lactation, Bone Strength, and 16-year Fracture Risk in Adult Women: Findings From the Study of Women’s Health Across the Nation (SWAN)

PubMed Central

Mori, Takahiro; Ishii, Shinya; Greendale, Gail A.; Cauley, Jane A.; Ruppert, Kristine; Crandall, Carolyn J.; Karlamangla, Arun S.

2015-01-01

Our objective was to examine the associations of lifetime parity and accumulated length of lactation with bone strength in women prior to the menopause transition and fracture risk during and after the transition. Participants were 2239 pre- or early perimenopausal women from the Study of Women's Health Across the Nation (SWAN), ages 42–53 at baseline, who had no childbirths after age 42. Bone mineral density (BMD) was measured in the femoral neck and the lumbar spine at the baseline SWAN visit using dual-energy x-ray absorptiometry, and composite indices of femoral neck strength relative to load (in three failure modes: compression, bending, and impact) were calculated from femoral neck BMD, femoral neck size, and body size. Data on fractures after age 42 were collected for a median follow-up of 15.7 years (interquartile range, 11.4 –18.5 years). In multiple linear regression adjusted for covariates, lifetime parity was associated positively with femoral neck strength relative to load (0.024 standard deviation (SD) increment in impact strength index per childbirth, p= 0.049), but accumulated length of lactation was associated negatively with lumbar spine BMD (0.018 SD decrement per every additional 6 months of lactation p=0.040). In Cox proportional hazards regression adjusted for covariates, neither parity nor lactation was associated with fracture hazard after age 42. In conclusion, parity and lactation have little impact on peak bone strength prior to menopause, and do not affect fracture risk after age 42 over 16-year follow-up. PMID:25528102

Resection of tumors of the neck of the pancreas with venous invasion: the "Whipple at the Splenic Artery (WATSA)" procedure.

PubMed

Strasberg, Steven M; Sanchez, Luis A; Hawkins, William G; Fields, Ryan C; Linehan, David C

2012-05-01

Tumors of the neck of the pancreas may involve the superior mesenteric and portal veins as well as the termination of the splenic vein. This presents a difficult problem since the pancreas cannot be transected through the neck as is standard in a Whipple procedure. Here, we present our method of resecting such tumors, which we term "Whipple at the Splenic Artery (WATSA)". The superior mesenteric and portal veins are isolated below and above the pancreas, respectively. The pancreas and splenic vein are divided just to the right of the point that the splenic artery contacts the superior border of the pancreas. This plane of transection is approximately 2 cm to the left of the pancreatic neck and away from the tumor. The superior mesenteric artery is cleared from the left side of the patient. With the specimen remaining attached only by the superior mesenteric and portal veins, these structures are clamped and divided. Reconstruction is performed with or without a superficial femoral vein graft. The splenic vein is not reconstructed. Ten cases have been performed to date without mortality. We have previously shown that the pattern of venous collateral development following occlusion of the termination of the splenic vein in the manner described is not similar to that of cases of sinistral (left sided) portal hypertension. Whipple at the splenic artery (WATSA) is a safe method for resection of tumors of the neck of the pancreas with vein involvement. It should be performed in high-volume pancreatic surgery centers.

Ipsilateral femoral shaft and vertical patella fracture: a case report

PubMed Central

Ozkan, Korhan; Eceviz, Engin; Sahin, Adem; Ugutmen, Ender

2009-01-01

Introduction A femoral shaft fracture with an ipsilateral patella fracture has been, to our knowledge, given only cursory attention in English-speaking literature. Case presentation A 15 year old male patient had hitten by a car to his motorcycle came to emergency room and he had been operated for his femoral shaft freacture and vertical patellar fracture which was iniatally missed. Conclusion To us it is vital to obtain CT scan of the patient’s knee if there is an ipsilateral femoral fracture with an ipsilateral knee effusion and a punction which reveals hematoma even in the absence of a fracture line seen in AP and lateral projections. PMID:19829933

Morphometric findings in avascular necrosis of the femoral head.

PubMed

Kamal, Diana; Trăistaru, Rodica; Alexandru, D O; Kamal, C K; Pirici, D; Pop, O T; Mălăescu, D Gh

2012-01-01

Avascular necrosis of the femoral head is an illness with a controversial etiology, the trigger event being the suppression of blood flow to the femoral head. The disease affects mostly young adults within their third and fifth decade, the majority of the patients being men. The main risk factors are trauma, chronic alcohol consumption, smoking, corticotherapy. The main goal of our study is to describe the morphometric changes found in the bone tissue of patients diagnosed with avascular necrosis of the femoral head, with different risk factors, by comparing the area of bone trabeculae inside the area of necrosis with that from the adjacent viable tissue. The morphometric study used biological material from 16 patients with ages between 29 and 57 years, who underwent surgery for avascular necrosis of the femoral head. They were admitted in the Orthopedics Department at the Emergency County Hospital in Craiova between 2010 and 2011 and were split into four groups. Group I presented trauma as the main risk factor, Group II had corticotherapy as the defining risk factor, Group III presented chronic alcohol consumption and Group IV was represented by the patients who smoked and exhibited chronic alcohol consumption. There was not a significant statistical difference between the areas of bone trabeculae of the four groups when we compared viable bone tissue to the necrotized one. Knowing the risk factors of the avascular necrosis of the femoral head is critical to the management of the disease, because diagnosing it in an early stage is a necessity for obtaining a good result for conservative treatment.