Multicenter study on atypical femoral fractures in patients with bone metastases taking bone- modifying agents.

Bone-modifying agents (BMAs), with bone-resorptive inhibitory effects, such as zoledronic acid and denosumab, are widely used at higher doses for bone-related events caused by bone metastasis of malignant tumors. These drugs have been suggested to be associated with atypical femoral fractures (AFFs), and the relationship between BMAs and AFFs has attracted attention. To investigate the clinical features including bone union time of AFFs in patients administered BMA for bone metastasis, we conducted a retrospective multicenter study. Thirty AFFs from 19 patients were enrolled in this study. Thirteen patients had bilateral AFFs, and nineteen AFFs had prodromal symptoms. Eighteen AFFs underwent surgery after complete fracture, three failed to achieve bone union and required nonunion surgery, and 11 AFFs that achieved bone union had an average period until bone union of 16.2 months, which was much longer than that previously reported for ordinary AFFs. Seven patients discontinued the BMAs, but not due to AFFs. Stopping BMAs in patients with bone metastasis would make it difficult to secure their performance of activities of daily living, and AFF with BMA administration might require a longer time for union. Therefore, it would be important to prevent incomplete AFF from becoming complete AFF via prophylactic internal fixation.

Higher stability and more predictive fixation with the Femoral Neck System versus Hansson Pins in femoral neck fractures Pauwels II.

OBJECTIVES: To evaluate the biomechanical performance of the Femoral Neck System (FNS) versus the Hansson Pin System (Hansson Pins) with two parallel pins in a Pauwels II femoral neck fracture model with posterior comminution. METHODS: Forty-degree Pauwels II femoral neck fractures AO 31-B2.1 with 15° posterior wedge were simulated in fourteen paired fresh-frozen human femora, followed by instrumentation with either FNS or Hansson Pins in pair-matched fashion. Implant positioning was quantified by measuring shortest implant distances to inferior cortex (DI) and posterior cortex (DP) on anteroposterior and axial X-rays, respectively. Biomechanical testing was performed in 20° adduction and 10° flexion with simulated iliopsoas muscle tension. Progressively increasing cyclic loading was applied until construct failure. Interfragmentary femoral head-to-shaft movements were measured with optical motion tracking. RESULTS: Cycles to 10° varus deformation were significantly higher for FNS (23007 â€‹± â€‹5496) versus Hansson Pins (17289 â€‹± â€‹4686), P â€‹= â€‹0.027. Cycles to 10° femoral head dorsal tilting (FNS: 12765 â€‹± â€‹3425; Hansson Pins: 13357 â€‹± â€‹6104) and cycles to 10° rotation around the femoral neck axis (FNS: 24453 â€‹± â€‹5073; Hansson Pins: 20185 â€‹± â€‹11065) were comparable between the implants, P â€‹≥ â€‹0.314. For Hansson Pins, the outcomes for varus deformation and dorsal tilting correlated significantly with DI and DP, respectively (P â€‹≤ â€‹0.047), whereas these correlations were not significant for FNS (P â€‹≥ â€‹0.310). CONCLUSIONS: From a biomechanical perspective, by providing superior resistance against varus deformation and performing in a less sensitive way to variations in implant placement, the angular stable Femoral Neck System can be considered as a valid alternative to the Hansson Pin System for the treatment of Pauwels II femoral neck fractures. LEVEL OF EVIDENCE: therapeutic, Level V. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: The translational potential of this article is to compare the performance of the FNS with Hansson Pins in a AO 31-B2.1 fracture model featuring a 15 posterior wedge to show the implants behavior concerning the dorsal tilting tendency.

Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification.

PURPOSE: Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. METHODS: Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. RESULTS: In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. CONCLUSIONS: It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

[Hip Fracture--Epidemiology, Management and Liaison Service. Surgical treatment of femoral proximal fracture].

Fragility fracture is increasing with increasing in population of elderly. Especially hip fracture is increasing rapidly and has many problems such as deterioration of QOL and growing medical expenses. In hip fracture, it is necessary to leave the bed in early period after injury and begin the rehabilitation for start to walk again. So surgical treatment is usually advocated as soon as possible after injury. Hip fracture is mainly classified to femoral neck fracture which is intra-articular fracture of hip joint and trochanteric fracture which is extra-articular fracture. Surgical treatment is different in these fractures. In this article, diagnosis and treatment of these femoral neck fracture and trochanteric fracture, especially surgical methods are mentioned.

Clinical and radiological results of locking plate fixation for periprosthetic femoral fractures around hip arthroplasties: a retrospective multi-center study.

BACKGROUND: Osteosynthesis of periprosthetic femoral fractures around hip arthroplasties is challenging, and locking plate fixation has been found to be a reasonable treatment. However, there is a paucity of evidence of the extent to which patients recover their activities of daily living (ADL). The purpose of this study was to study the clinical results, particularly recovery of ADL, radiological results, and potential complications arising from the use of locking plate fixation for periprosthetic femoral fractures around hip arthroplasties. METHODS: We conducted a retrospective, multi-center study. Patients with periprosthetic femoral fractures around hip arthroplasties who were treated by osteosynthesis with use of locking plates and who underwent follow-up for at least 6 months postoperatively were enrolled in the study. For each patient, recovery of ADL, in terms of social and ambulatory recovery and Parker mobility score, were compared before fracture and at last follow-up. Postoperative complications were investigated. Bony union, loss of reduction, and malunion were assessed radiologically. RESULTS: Thirty-two patients were enrolled in this study. Mean follow-up was 25.1 months. For 84.4, 68.8, and 53.1% of patients, respectively, social status, ambulation, and Parker mobility score at last follow-up were determined to be equal to that before the fracture. Bony union was observed for 30 patients within the follow-up period. Four patients had not achieved bony union 6 months postoperatively. There was no loss of reduction, malunion, or implant breakage, and no infection. For one patient each, partial pullout of the locking screws and a supracondylar fracture at the plate end were observed, and additional surgery was required. CONCLUSIONS: Our results reveal that locking plate fixation provided sufficient stability for satisfactory recovery of ADL for most elderly patients with periprosthetic femoral fractures around hip arthroplasties.

Cross-sectional area of a bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction.

The cross-sectional area of the 10-mm wide patellar tendon graft was measured in 50 consecutive patients (31 males and 19 females) who underwent isolated anterior cruciate ligament (ACL) reconstruction and the relationship between the graft size and various factors such as physical characteristics was assessed. The effect of cross-sectional area of the implanted graft on postoperative stability of the reconstructed knee also was examined. Mean patient age at surgery was 22.3 years (range: 14-40 years). The cross-sectional area was measured using an instrumented area micrometer intraoperatively, and correlations between the measured value and various factors such as age, gender, height, body weight, and bony geometry were examined. Follow-up was performed 24 months postoperatively. The average cross-sectional graft area was 33.4 mm2. The measured cross-sectional area was larger in male patients and correlated with physical characteristics such as height, body weight, and femoral condyle width. No significant correlation between the size of the graft and postoperative stability was observed.