Sixty two patients with displaced femoral neck fractures treated by percutaneous pinning are reviewed. There were 37 females and 25 males with an average age of 63.7 years. There were 36 Garden grade III and 26 grade IV fractures. Twenty three patients had other medical conditions. Fourteen patients were operated under local anaesthesia. Superficial wound infection was found in three cases with no deep infection. Union occurred in 41 patients by eight months. Of the 21 non-unions 15 remained painless. The pins migrated outwards in seven cases but caused no clinical problem. Avascular necrosis was seen in 11 patients by 18 months. Avascular necrosis and non-union occurred together in six patients. Secondary hemiarthroplasty was performed in only ten patients. Routine hemiarthroplasty for femoral neck fractures is not always indicated. Femoral head preservation should be attempted before prosthetic replacement. The pinning surgery is simple, fast and can be performed under local anaesthesia. Hemiarthroplasty should be reserved for failed cases only.
The treatment of fractures in osteopetrosis can be complicated and difficult. We describe the use of an industrial grade tungsten carbide drill bit in the treatment of one of these complex fractures. An industrial grade tungsten carbide drill bit was used to fashion a medullary canal in the surgical treatment of a left peri-implant fracture of the neck of femur in a patient with osteopetrosis. The patient was successfully treated with a hemiarthroplasty with good functional outcomes. A tungsten carbide drill bit serves as an effective and safe option in the treatment of osteopetrotic femoral neck fractures.
Femoral neck fracture non-unions often present with significant difficult treatment decision as regards to surgical options and the risk of complication. We present three cases of femoral neck non-union treated with double screw stabilization technique using sliding compression hip screw and anti-rotational screw. The rationale for opting to these simple implants in our setting is discussed.
Fracture neck of the femur is rare in children and occurs following severe trauma. Several recommendations have been made for the treatment of displaced transcervical fracture type 11 (Delbet classification). However there are no recommendations when such a fracture occurs after recent acute osteomyelits of the neck of the femur. The management of a case is described with the outcome after 36 months.
Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.
This retrospective study was undertaken to analyze perioperative parameters, functional outcomes and complications of cemented versus uncemented bipolar hemiarthroplasty in elderly patients presenting with displaced intracapsular femoral neck fracture. The authors reviewed 17 patients that underwent cemented bipolar hemiarthroplasty and 21 patients that underwent uncemented bipolar hemiarthroplasty. The mean follow-up duration in the cemented and uncemented group was 29.9 and 30.5 months respectively. Intraoperative and postoperative blood loss was higher in the cemented group. On the last follow-up the mean HHS was 74.7 in the cemented group and 84.2 in the uncemented group. No statistically significant difference was evident in the pain score. In summary, bipolar hemiarthroplasty was found to be a good option for displaced intracapsular femoral neck fractures, and overall outcome was marginally better in the uncemented group in terms of postoperative of blood loss and functional outcome at last follow up.
PURPOSE: To evaluate the short-term clinical and functional outcomes of total hip arthroplasty performed for physiologically active elderly patients with Garden type-3 or -4 femoral neck fracture.
METHODS: Records of 47 consecutive patients (40 female, 7 male) with type-3 or -4 femoral neck fracture (Garden classification) who underwent cemented total hip arthroplasty at our hospital during January 1999 to December 2002 were reviewed. Radiological and clinical (Harris functional hip score and Oxford hip score) assessments of 38 patients were measured with a mean follow-up period of 21 months (range, 4-48 months).
RESULTS: The mean age of the 47 patients was 75 years (range, 62-89 years). Records of 9 patients were excluded because of death, lost to follow-up, and development of deep infection that necessitated implant removal and excision arthroplasty. The mean Harris hip score of the 38 patients was 83 (range, 59-97), whereas the mean Oxford hip score was 25.2 (range, 14-33). Pain in the hips was absent in 30 patients, 6 had slight pain occasionally, and 2 patients had mild-to-moderate hip discomfort. No signs of aseptic loosening or change in implant position were noted on radiographic assessment. Two cases of dislocation were reduced by closed reduction. Two patients had deep wound infection and were treated with debridement, implant removal, and conversion to girdle stone.
CONCLUSION: This short-term study showed that total hip arthroplasty for femoral neck fracture had good postoperative results in functional hip and pain scores. More attention should be paid to coexisting medical illness (e.g. diabetes mellitus, hypertension, and ischaemic heart disease) and prevention of infection.
Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.
A 47-year-old gentleman, with underlying seborrhoeic dermatitis that was treated with steroid therapy, and hepatitis B, presented with pain in his right hip. He was diagnosed with stage 2 osteonecrosis of the right hip (Ficat and Arlet classification). Core decompression and bone grafting was performed but recovery was complicated by a surgical site infection. Wound debridement, removal of bone graft and clearance of the bone tunnel were carried out. The patient was allowed to bear weight after surgery. Twelve days later, he developed right hip pain and radiographs showed fractured femur neck; the patient then underwent a two-stage total hip replacement (THR).
We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 - 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck's traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.
Salvage total hip arthroplasty (THA) may be required to manage femoral neck fracture implant failures, avascular necrosis and secondary hip arthritis. Cannulated cancellous screws can become stripped or incarcerated during the initial implantation and pose hardware removal issues. We present a novel technique for safe screw removal in a 62-year-old female patient with a painful right hip. She had undergone cancellous screw fixation for a fracture of the neck of femur ten years ago. There was avascular necrosis with screw cut out leading to secondary hip arthritis necessitating THA. Intra-operatively cannulated cancellous screw along the inferior femoral neck region was incarcerated. After posterior dislocation of the head, the neck was osteotomised, and the screw threads were exposed for possible extraction. However, the thickened femoral neck region with solid cortical bone prevented the screw disengagement in either direction. The screw along the femoral trochanter region was cut with a Harrington cutter and the remaining screw disengaged with careful removal of bony spicules and controlled anticlockwise rotations, to remove the screw in around fifteen minutes. Arthroplasty could be completed uneventfully thereafter. We could remove the screw while avoiding an iatrogenic fracture along the calcar region and excessive bone loss along the screw track. The femoral canal remained uncompromised. The anticipation of a difficult implant removal with a thorough understanding of the devices and techniques, is an invaluable asset to the operating surgeon. With a simple tool and novel technique in a difficult situation, we can save on operating time and minimise complications.
Femoral neck stress fractures are rare in children. To the best of our knowledge, the tension type stress fracture has been reported only twice in the English language literature. We report on a five years follow-up of a 10-year-old boy with this injury which was initially missed. The fracture healed after screw fixation. We highlight the importance of considering stress fracture as a differential diagnosis in a child with chronic hip pain. A careful physical examination and the appropriate imaging will avoid missing the diagnosis.
Fracture of the femoral neck is one of the most common types of osteoporotic fractures. Hemiarthroplasty continues to be a good option despite current calls for total hip arthroplasty in this subset of patients. The hemiarthroplasty is less expensive and easier to perform, and can be adequately carried out in smaller hospitals with basic orthopaedic facilities staffed by general orthopaedists. Functional demands of the elderly among Asians are often less compared to similar subsets of Western population on which most comparative hip studies are based. This study was undertaken to investigate the outcome for femoral neck fractures treated with conventional hemiarthroplasty. The authors hope to provide information based on local data as a reference for our doctors and patients.