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1.
Zhongguo Gu Shang ; 34(10): 934-40, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34726022

RESUMO

OBJECTIVE: To compare the clinical efficacy of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position. METHODS: From February 2017 to January 2019, 67 patients underwent hip arthroplasty due to hip diseases, including 21 patients in the minimally invasive group, 12 males and 9 females;there were 10 cases of femoral neck fracture, 5 cases of aseptic necrosis of femoral head and 6 cases of hip osteoarthritis. In the traditional group, 46 cases were treated by traditional posterolateral approach, including 28 males and 18 females;there were 24 cases of femoral neck fracture, 12 cases of aseptic necrosis of femoral head and 10 cases of hip osteoarthritis. All patientsused biological ceramic artificial joint prosthesis. The operation time, intraoperative bleeding, incision length, preoperative and postoperative creatine kinase (CK-NAC), underground activity time, hospital stay, abduction angle and anteversion angle of prosthesis were observed and compared between two groups. Harris scores before operation and 12 months after operation were compared between two groups. RESULTS: All cases were followed up for 14 to 26(18.4±3.6) months. There was no significant difference in intraoperative bleeding, postoperative anteversion and abduction angle between two groups (P>0.05). There were significant differences in operation time, incision length, postoperative creatine kinase, underground time and hospital stay between two groups (P<0.05). There was no significant difference in Harris function score between two groups before operation and 12 months after operation(P>0.05). CONCLUSION: The two approaches of total hip arthroplasty can obtain satisfactory results.OCM approach has less damage and rapid postoperative recovery. It is a reliable surgical approach and can be popularized and used.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Prótese de Quadril , Feminino , Fraturas do Colo Femoral/cirurgia , Cabeça do Fêmur , Humanos , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Decúbito Dorsal , Resultado do Tratamento
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(11): 1434-1439, 2021 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-34779170

RESUMO

Objective: To evaluate the effectiveness of unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft. Methods: The clinical data of 18 patients with unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft between July 2016 and March 2020 were retrospectively analyzed. The age ranged from 22 to 64 years, with a median age of 43 years. The causes of injury included 11 cases of falling injury, 3 cases of traffic accident injury, and 4 cases of fall from height injury. According to Garden classification, the femoral neck fracture was classified as type Ⅲ in 3 cases, type Ⅳ in 15 cases, and all patients were type Ⅲ according to Pauwels classification. The time from injury to operation was 1-5 days, with an average of 2.3 days. The fracture healing time and complications were recorded. The quality of fracture reduction was evaluated by Garden index immediately after operation; at last follow-up, the degree of femoral neck shortening was determined by Zlowodzki method, Harris score was used to evaluate hip function. Results: The operation time was 62-98 minutes (mean, 75 minutes); intraoperative blood loss was 101-220 mL (mean, 153 mL). Cannulated screws guide wire was inserted 3-5 times (mean, 4 times). Intraoperative fluoroscopy was performed 9-21 times (mean, 15 times). The hospital stay was 5-11 days (mean, 7.2 days). All the patients were followed up 12-40 months with an average of 17.3 months. There was no postoperative complication such as accumulated pneumonia, lower extremity deep venous thrombosis, nail cutting, nail withdrawal, internal fixation fracture, and so on. There was no fracture nonunion and osteonecrosis of the femoral head during the follow-up; the fracture healing time was 7-15 weeks, with an average of 12.1 weeks. The quality of fracture reduction was evaluated immediately after operation, the results were grade Ⅰ in 15 cases and grade Ⅱ in 3 cases. At last follow-up, there were 2 cases with femoral neck shortening less than 5 mm and 1 case with 5-10 mm. The incidence of femoral neck shortening was 16.7%. The Harris score of hip joint was 73-97, with an average of 93.5; among them, 12 cases were rated as excellent, 3 cases as good, and 3 cases as fair, with an excellent and good rate of 83.3%. Conclusion: For the treatment of unstable femoral neck fracture with posteromedial comminutations, cannulated screws and medial bracing plate combined with bone allograft are dramatically effective due to earlier weight bearing, faster fracture healing, and better hip function recovery.


Assuntos
Fraturas do Colo Femoral , Adulto , Aloenxertos , Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Arch Osteoporos ; 16(1): 160, 2021 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-34708275

RESUMO

Secular changes in the incidence rate of hip fractures were estimated to vary by fracture type, i.e., femoral neck or trochanteric fractures, age, and sex, in urban or rural areas in Kyoto Prefecture, Japan from 2008 to 2017. PURPOSE: Our survey in Kyoto Prefecture from 2008 to 2017 showed that the incidence rate of femoral neck fractures is generally increasing. We investigated the differences between urban and rural areas in the changes of the incidence rate over time of femoral neck and trochanteric fractures during the same period. METHODS: Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The ratio of sick beds for acute-term care at the investigated hospitals to total number of beds in the urban area was 16.5% (1863/11,158) and 30.6% (1863/5623) in the rural area. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. RESULTS: There were 3559 and 6474 hip fractures in the urban and rural areas, respectively. Femoral neck fractures were 1936 (54.4%) and 2813 (43.5%) in each area. The increase of the population-adjusted numbers was marked by neck fractures in males, in both areas. In women, there was a significant increase in femoral neck fractures in the urban area in those aged 85 years and over. For trochanteric fractures, a significant increase was only found in women aged 65 to 74 years in the rural area. CONCLUSION: A regional difference in the secular changes in incidence rate of hip fractures was found in women, not in men, mostly because neck fractures in women increased in the over 85 group in the urban area.


Assuntos
Fraturas do Colo Femoral , Fraturas do Quadril , Idoso , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Japão/epidemiologia , Masculino , População Rural
4.
J Pak Med Assoc ; 71(Suppl 5)(8): S59-S63, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34634018

RESUMO

OBJECTIVE: To evaluate the risk factors for postoperative complications in fracture neck femur treated with cannulated screws. Methods: This cross sectional series was performed at the Department of Trauma and Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi from January 2015 to December 2019. A Total of 149 patients with close fracture neck femur of either gender between 20-60 years of age were included in the study. Patients with hip arthritis and pathological fractures such as tumours were excluded. Minimum three cannulated screws were used to fix the fracture with parallel configuration in compression mode. Patients were followed and evaluated for fracture healing and related complications such as nonunion and Avascular necrosis for two years. Descriptive statistics were calculated and stratification was done. Post stratification chi square test was applied taking p-value ? ≤0.05 as statistically significant. RESULTS: There were 113 (75.8%) male and 36 (24.2%)female patients. Mean age was 37.54±10.66 years. Mean operation time was 38.56±4.61 minutes. Out of these, 93 (62.4%) injuries were caused by motor vehicle accident, 34(22.8%) fall and 22(14.8%) by sports injury. Garden type III fracture was observed in 69 (46.3%) patients followed by 41 (27.5%) fractures of grade-IV. Fracture union was observed in 126 (84.6%) patients at a mean time of 4.0±1.1months and non-union in 23 (15.4%) cases whereas rate of avascular necrosis was noted in 28 (18.8%) cases and were significantly associated with age, injury mode, time from injury to surgery and fracture classification. Non-union was significantly associated with open reduction and delayed fixation of fracture for more than 24 hours. CONCLUSIONS: Although cannulated screws are a universally accepted method of fixation for femoral neck fractures, the incidence of complications such as Avascular necrosis and non-union is quite high particularly in young males meeting a motor vehicle accident, undergoing open reduction for displaced fractures even with early diagnosis and treatment.


Assuntos
Fraturas do Colo Femoral , Adulto , Parafusos Ósseos , Estudos Transversais , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fêmur , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
5.
Medicine (Baltimore) ; 100(43): e27588, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34713834

RESUMO

ABSTRACT: The purpose of this study was to analyze the outcomes of titanium elastic nail (TEN) for the children in 6 to 10 years old who sustained a Delbet IV femoral neck fracture.A total of 56 children aged 6 to 10 years old with Delbet IV femoral neck fracture treated with TEN or cannulated screw (SC) were identified at our hospital from January 2009 to December 2019. Of which 24 were treated with TEN, and 32 with SC. All of them were followed up for 1 year after operation, and the differences in operation time, intraoperative blood loss, hospitalization time, hip joint function, and complication between the 2 groups were compared. Harris and Ratliff hip score were used to evaluate the hip function.All 56 fractures united properly. No major complications were noted in both groups. The intraoperative blood loss and operation time in TEN group and SC group were (11.42 ±â€Š3.41) mL, (19.66 ±â€Š4.05) mL (P = .000) and (33.58 ±â€Š7.89) min, (40.22 ±â€Š7.48) min (P = .002), respectively. There was no significant statistical difference between hip regarding range of motion and femoral neck-shaft angle in both groups, as well as Harris and Ratliff hip score between the 2 groups.TEN represent safe and effective methods in the treatment of Delbet IV femoral neck fracture in 6 to 10 years old children. TEN internal fixation is a minimal invasive and simpler technique and suitable for young children of Delbet IV femoral neck fracture.


Assuntos
Pinos Ortopédicos , Fraturas do Colo Femoral/cirurgia , Fixação Intramedular de Fraturas/métodos , Titânio , Perda Sanguínea Cirúrgica , Parafusos Ósseos , Criança , Feminino , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1286-1292, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651482

RESUMO

Objective: To compare the effectiveness of femoral neck system (FNS) and cannulate compression screw (CCS) in the treatment of femoral neck fractures in young and middle-aged patients. Methods: The clinical data of 82 young and middle-aged patients with femoral neck fracture treated between January 2018 and September 2020 were retrospectively analyzed. They were divided into FNS group (24 cases) and CCS group (58 cases) according to different surgical methods. There was no significant difference between the two groups ( P>0.05) in general data such as gender, age, height, body mass, cause of injury, complications, fracture location, and fracture classification (Garden classification and Pauwells classification). The operation time, intraoperative blood loss, complications (nonunion, osteonecrosis of the femoral head, shortening of femoral neck, etc.), visual analogue scale (VAS) score at 2 days after operation, clinical healing time of fracture, and Harris score of hip joint after operation were recorded and compared between the two groups. Results: The operation time and VAS score at 2 days after operation in FNS group were significantly lower than those in CCS group ( P<0.05); there was no significant difference in intraoperative blood loss between the two groups ( t=0.263, P=0.796). The patients in CCS group were followed up 6-18 months, with an average of 13.6 months; and the follow-up time in FNS group was 3-12 months, with an average of 7.3 months. There was no complication of internal fixator loosening in both groups. There were 2 cases of osteonecrosis of the femoral head, 1 case of bone nonunion, and 13 cases of femoral neck shortening in CCS group and only 2 cases of femoral neck shortening in FNS group. The difference in the incidence of complications between the two groups (27.6% vs. 8.3%) was significant ( χ 2=36.670, P=0.015). In CCS group, 3 cases underwent secondary artificial hip arthroplasty due to bone nonunion and osteonecrosis of the femoral head, and the remaining 55 cases achieved clinical healing; in FNS group, 6 patients excluded in the statistics because the follow-up time was less than 6 months, and the remaining 18 fractures healed clinically; there was significant difference in fracture healing time between the two groups ( t=4.481, P=0.000). The difference of Harris score of hip joint between 9 months and 6 months after operation in FNS group was significantly higher than that in CCS group ( P<0.05), and the Harris score at 9 months after operation was significantly higher than that at 6 months after operation in both groups ( P<0.05). Conclusion: FNS can accelerate the healing of femoral neck fractures in young and middle-aged patients, so that patients can start functional exercise as soon as possible, thereby reducing the incidence of related complications.


Assuntos
Fraturas do Colo Femoral , Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Colo do Fêmur , Fixação Interna de Fraturas , Articulação do Quadril , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Comput Methods Programs Biomed ; 211: 106409, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34560605

RESUMO

BACKGROUND: No consensus has been reached for the treatment of vertical femoral neck fractures (vFNFs). Recently, two alternative methods were invented to treat vFNFs, one of which is a new plate with a sliding groove, which was designed as a substitution of the medial buttress locking plate to combine with cannulated compression screws (CCS) for reducing the breakage possibility of the proximal locking screw during the bone healing. Another one is the femoral neck system (FNS), which was believed with biomechanical superiority. This study aims to compare the biomechanics of these two new implants with three previous methods via finite element analysis (FEA) to validate whether they are suitable for the treatment of vFNFs. METHODS: Five 70-degree Pauwels type III transcervical FNFs (vFNFs, AO/OTA 31B2.3r) models were built and fixed by CCS augmented with the newly designed sliding groove buttress plate (CCS+BS) and FNS. For comparison, models fixed by three parallel cannulated compression screws (CCS), biplane double-supported screw fixation (BDSF), CCS augmented with a medial buttress locking plate (CCS+BL) were also built. A 2100N load was applied along with the mechanical axis. Parameters of the maximal stress as well as the maximal displacement of the implants and bone, the maximal relative displacement of interfragments, and the stiffness, were analyzed to compare the biomechanical characteristics of the five models. RESULTS: CCS+BS and CCS+BL showed stronger fixation strength with improved stiffness (1012.05N/mm, 1092.04N/mm), reduced maximal displacement of the implants (1.976mm, 1.838mm) and bone (2.075mm, 1.923mm), when compared with CCS (925.11N/mm, 2.158mm and 2.270mm) and BDSF (842.36N/mm, 2.299mm and 2.493mm). While FNS showed the weakest stiffness (593.22N/mm) and largest maximal displacement of the implants (3.234mm) and bone (3.540mm) among the five models. CONCLUSIONS: CCS+BS has a better biomechanical performance than CCS and BDSF, which offers a new choice to deal with vFNFs. The construction stability of FNS is weaker than CCS, BDSF, and CCS+BL, indicating that this method may not as stable as reported in the previous study.


Assuntos
Fraturas do Colo Femoral , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Análise de Elementos Finitos , Fixação Interna de Fraturas , Humanos
8.
Injury ; 52(11): 3227-3238, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34481668

RESUMO

BACKGROUND: Pauwels classification, which categorizes types of femoral neck fractures, cannot fully reflect the three-dimensional characteristics of this injury. The purpose of our study was to determine the morphological characteristics of Pauwels III fractures through computed tomography image analysis and summarize the relevant biomechanical characteristics of different morphological fractures. METHODS: We retrospectively reviewed a total of 209 patients diagnosed with Pauwels type III femoral neck fractures. Fracture reduction was simulated based on mirror symmetry of the bilateral femur by Mimics. The fracture angle was measured and subtypes were defined. Biomechanical characteristics were compared by finite element analysis and validated using a biomechanical experiment, which was performed on a cadaveric sample. RESULTS: Pauwels III femoral neck fractures can be divided into three subtypes: anterior, posterior, and classical. The proportion of three subtypes was 28.71%, 67.46%, and 3.82%, respectively. The anterior subtype showed the lowest axial stiffness but highest implant and bone stress. High stress distributions was concentrated on the screw-bone interface and screw-plate connections. CONCLUSIONS: Biomechanical differences across the three subtypes of Pauwels III femoral neck fractures could increase our understanding of the biomechanical characteristics that underlie the Pauwels type III femoral neck fractures (such as, three-dimensional morphology and the stress distribution of bone and implant) that have been associated with high failure rates.


Assuntos
Fraturas do Colo Femoral , Fenômenos Biomecânicos , Parafusos Ósseos , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Adulto Jovem
9.
J Pak Med Assoc ; 71(9): 2255-2257, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34580525

RESUMO

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients' charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 (11.1%) patients while none was noted in the early THR group. The difference was statistically significant with a P-value of 0.008. With regards to post-operative complications, significantly higher percentage of patients were noted to have developed electrolyte imbalances (P = 0.003), postoperative psychosis (P = 0.02), and acute kidney injury (AKI) (P = 0.02) in the delayed THR group compared to the early THR group. Delay in surgery for neck of femur fracture is associated with increased 30-day mortality and postoperative complications.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Fraturas do Quadril , Idoso , Artroplastia de Quadril/efeitos adversos , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Morbidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos
11.
J Int Med Res ; 49(9): 3000605211045224, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34590917

RESUMO

OBJECTIVE: The association of chronic non-malignant pain (CNP) with dyslipidemia is unclear. This retrospective study was performed to evaluate the association between CNP and dyslipidemia in elderly patients with femoral neck fractures (FNFs) treated by primary unilateral total hip arthroplasty (THA). METHODS: We retrospectively identified 521 consecutive patients with FNFs (AO/OTA type 31B) who underwent primary unilateral THA from 2009 to 2021. The study population was divided into patients with and without CNP. Serum lipids were measured for each patient. The association between CNP and dyslipidemia was assessed using a multivariate binary logistic regression model. RESULTS: In total, 436 patients (220 with CNP, 216 without CNP) were eligible for analysis. In the quantile regression, the adverse effect of CNP was significantly attenuated by resilience in patients with a high high-density lipoprotein (HDL) concentration and low low-density lipoprotein (LDL) concentration. The multivariate binary logistic regression model showed that the HDL and LDL concentrations were the only variables significantly associated with the development of CNP. CONCLUSION: Both a low HDL and high LDL concentration may result in the occurrence of CNP in elderly patients with FNFs treated by primary unilateral THA.


Assuntos
Artroplastia de Quadril , Dislipidemias , Fraturas do Colo Femoral , Idoso , Artroplastia de Quadril/efeitos adversos , Dislipidemias/complicações , Fraturas do Colo Femoral/cirurgia , Humanos , Dor , Estudos Retrospectivos
12.
BMC Musculoskelet Disord ; 22(1): 810, 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34548069

RESUMO

BACKGROUND: Femoral neck fracture combined with anterior dislocation of the femoral head is very rare. To our knowledge, there is no classification system yet for this rare form of injury, and the injury mechanism of femoral neck fracture combined with obturator head dislocation has not been described in the literature. In this study, we systematically reviewed the literature and the cases treated in our hospital, and identified and classified all injury types according to the injury mechanism of femoral neck fracture combined with anterior dislocation of the femoral head. Further, based on the experience of treating a patient with femoral neck fracture and obturator dislocation of the femoral head, a theoretical hypothesis was proposed for the injury mechanism of this rare type of injury. METHODS: A comprehensive search was conducted on PubMed, WOS, CNKI database. These fractures were classified according to the dislocation site and injury mechanism (one injury or two injuries). RESULTS: 1891 articles were initially identified through PubMed and other databases, and after bibliographic research, study screening, and removing duplicates, 1455 articles were selected. After applying the exclusion criteria, a total of 18 full-text articles describing femoral neck fractures combined with anterior dislocation of the femoral head. Different dislocation sites have different injury mechanisms. Our classification system, to the best of the authors' knowledge, allowed us to include all types of femoral neck fractures combined with anterior dislocation of the femoral head from the literature. According to the proposed classification system, the morphological features of femoral neck fracture combined with anterior dislocation of the femoral head can be accurately conveyed between doctors. CONCLUSIONS: All injury patterns can likely be identified using the proposed classification system. This can help avoid confusion in the nomenclature of femoral neck fractures combined with anterior dislocation of the femoral head and help surgeons to more accurately detect lesions, thereby guiding surgical treatment.


Assuntos
Fraturas do Colo Femoral , Luxação do Quadril , Luxações Articulares , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Luxações Articulares/cirurgia
13.
BMC Musculoskelet Disord ; 22(1): 806, 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34537036

RESUMO

BACKGROUND: Performing postoperative laboratory tests following joint arthroplasty is a regular practice. However, the role of routine postoperative laboratory tests in primary hip arthroplasty is currently in doubt. This study aimed to assess the role of routine postoperative laboratory tests for femoral neck fractures in elderly patients who underwent hip hemiarthroplasty and to evaluate the risk factors for postoperative laboratory testing abnormalities and related interventions. METHODS: This retrospective study reviewed 735 consecutive patients with femoral neck fractures (FNFs) who underwent hip hemiarthroplasty at a single tertiary academic organization. Patient characteristic features and laboratory testing values were recorded. Logistic regression models were calculated to identify risk factors. RESULTS: A total of 321 elderly patients (> 75 years of age) were ultimately enrolled for analysis. Abnormal postoperative laboratory tests were found in 265 patients (82.6%). Only a minority of the included patients (7.5%) needed medical intervention to treat postoperative laboratory testing abnormalities. Multivariate logistic regression analysis reported that a higher Charlson comorbidity index (CCI) (P = 0.03), abnormal preoperative haemoglobin level (P < 0.01), higher intraoperative blood loss (P < 0.01) and less frequent tranexamic acid use (P = 0.05) were risk factors for abnormal postoperative laboratory tests. Furthermore, a higher CCI has been identified as a risk factor for patients needing clinical interventions related to laboratory abnormalities. CONCLUSIONS: Because 92.5% of laboratory tests did not influence postoperative management, the authors suggest that routine laboratory tests after hip hemiarthroplasty for FNFs are less instructive for the majority of elderly patients. Nevertheless, for patients with identified risk factors, postoperative laboratory tests are still required to identify the abnormalities that need to be managed.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Hemiartroplastia , Idoso , Artroplastia de Quadril/efeitos adversos , Fraturas do Colo Femoral/diagnóstico , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Humanos , Laboratórios , Período Pós-Operatório , Estudos Retrospectivos
14.
Int Orthop ; 45(11): 2899-2907, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34549321

RESUMO

INTRODUCTION: Avascular necrosis (AVN) after femoral neck fracture (FNF) is a rare and severe paediatric condition, but only few studies described its prognosis and risk factors. The present study aimed to evaluate the outcomes and independent factors for poor prognosis of AVN after FNF in children and adolescents. METHOD: This retrospective study included children and adolescents with AVN after FNF who received conservative treatment (CT group) or non-vascularized bone grafting (NVBG group) between 2000 and 2018. The primary outcomes were the risk of hip arthritis (Tönnis grade) and hip deformity risk (Stulberg classification). All patients were followed for at least two years to assess AVN progression. RESULTS: Study included 81 patients. In the CT group, 23/43 patients (53.4%) developed hip arthritis, and 24/43 patients (55.8%) showed hip deformity. In the NVBG group, 23/38 patients (60.5%) developed hip arthritis, and 34/38 patients (89.5%) had a hip deformity. The multivariable analysis indicated that NVBG surgery had no significant effect on the outcomes. Post-treatment femoral head collapse (P = 0.05, OR = 3.80, 95% CI = 1.01-14.29) and post-treatment hip subluxation (P = 0.01, OR = 2.85, 95% CI = 2.31-129.56) were independent risk factors for severe hip arthritis. Post-treatment femoral head collapse (P < 0.01, OR = 7.64, 95% CI = 3.23-18.04) and pre-treatment hip subluxation (P = 0.02, OR = 7.33, 95% CI = 1.44-37.41) were independent risk factors for severe hip deformity. CONCLUSION: Neither CT nor NVBG have demonstrated superiority regarding long-term outcomes in patients with AVN after FNF. Upon the disease progression to severe collapse with subluxation and severe arthritis, further hip preservation attempts could be futile.


Assuntos
Fraturas do Colo Femoral , Necrose da Cabeça do Fêmur , Adolescente , Criança , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Cabeça do Fêmur , Necrose da Cabeça do Fêmur/diagnóstico , Necrose da Cabeça do Fêmur/epidemiologia , Necrose da Cabeça do Fêmur/etiologia , Humanos , Estudos Retrospectivos , Fatores de Risco
15.
Int J Med Inform ; 155: 104572, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34547625

RESUMO

PURPOSE: Femoral neck fracture is a frequent cause of hospitalization, and length of stay is an important marker of hospital cost and quality of care provided. As an extension of traditional statistical methods, machine learning provides the possibility of accurately predicting the length of hospital stay. The aim of this paper is to retrospectively identify predictive factors of the length of hospital stay (LOS) and predict the postoperative LOS by using machine learning algorithms. METHOD: Based on the admission and perioperative data of the patients, linear regression was used to analyze the predictive factors of the LOS. Multiple machine learning models were developed, and the performance of different models was compared. RESULT: Stepwise linear regression showed that preoperative calcium level (P = 0.017) and preoperative lymphocyte percentage (P = 0.007), in addition to intraoperative bleeding (p = 0.041), glucose and sodium chloride infusion after surgery (P = 0.019), Charlson Comorbidity Index (p = 0.007) and BMI (P = 0.031), were significant predictors of LOS. The best performing model was the principal component regression (PCR) with an optimal MAE (1.525) and a proportion of prediction error within 3 days of 90.91%. CONCLUSION: Excessive intravenous glucose and sodium chloride infusion after surgery, preoperative hypocalcemia, preoperative high percentages of lymphocytes, excessive intraoperative bleeding, lower BMI and higher CCI scores were related to prolonged LOS by using linear regression. Machine learning could accurately predict the postoperative LOS. This information allows hospital administrators to plan reasonable resource allocation to fulfill demand, leading to direct care quality improvement and more reasonable use of scarce resources.


Assuntos
Fraturas do Colo Femoral , Algoritmos , Fraturas do Colo Femoral/cirurgia , Humanos , Tempo de Internação , Aprendizado de Máquina , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 100(38): e27299, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559143

RESUMO

ABSTRACT: The aim of this study was to estimate the degree of normalization of C-reactive protein (CRP) at 2-weeks and 4-weeks after hip arthroplasty after femoral neck fracture. We also wished to determine whether the degree of CRP normalization differs after total hip arthroplasty (THA) compared to bipolar hemiarthroplasty (BH). We also wanted to analyze the patient factors that may influence CRP normalization.We conducted a retrospective study of 135 patients who had undergone THA (32 cases) or BH (103 cases) for femoral neck fracture by single surgeon from January 2015 to December 2019. We analyzed CRP levels during the preoperative period, the early postoperative period, the 2-week postoperative period, and the 4-week postoperative period.In THA, CRP was normalized in 4 patients (12.5%) and in 15 patients (46.9%) within 2-weeks and 4-weeks after surgery, respectively. In BH, CRP was normalized in 16 patients (15.5%) and in 52 patients (50.5%) within 2-weeks and 4-weeks after surgery, respectively. There were no statistical differences between THA and BH. Compared to women, men were 3.78 (95% confidence interval, 1.05-13.63) times less likely to have normalized CRP at 2-weeks after surgery (P = .042). Compared to women, men were 3.01 (95% confidence interval, 1.44-6.27) times less likely to have normalized CRP at 4-weeks after surgery (P = .003).Only 50% of patient's CRP level was normalized during 4-week postoperative period. In men, CRP levels were significantly higher than women in whole period. In the case of THA, the CRP level was higher only in early postoperative period compared to BH, and there was no difference since then.


Assuntos
Artroplastia de Quadril , Proteína C-Reativa/metabolismo , Fraturas do Colo Femoral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fraturas do Colo Femoral/metabolismo , Hemiartroplastia , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
17.
J Orthop Trauma ; 35(10): 517-522, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34510125

RESUMO

OBJECTIVE: To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches. DESIGN: Retrospective cohort study. SETTING: Twelve Level 1 North American trauma centers. PATIENTS: Eighty adults 18-65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation. INTERVENTION: Thirty-two modified Smith-Petersen anterior approaches versus 48 Watson-Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons. MAIN OUTCOME: Reduction quality as assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs. RESULTS: No difference was observed in the rate of acceptable reduction by modified Smith-Petersen (81%) versus Watson-Jones (81%) approach (risk difference null, 95% confidence interval -17.4% to 17.4%, P = 1.00) with 90.4% panel agreement (Fleiss' weighted κ = 0.63, P < 0.01). Stratified analyses did not identify a significant difference in the rate of acceptable reduction between approaches when stratified by Pauwels angle, basicervical or transcervical fracture location, or posterior comminution. The Smith-Petersen approach afforded a better reduction when preoperative skeletal traction was not applied (RR = 1.67 [95% CI 1.10-2.52] vs. RR = 0.87 [95% CI 0.70-1.08], P = 0.006). CONCLUSIONS: No difference was observed in the quality of open reduction of displaced femoral neck fractures in young adults when a Watson-Jones anterolateral approach versus a modified Smith-Petersen anterior approach was performed by orthopaedic trauma surgeons. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas do Colo Femoral , Fraturas Cominutivas , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Humanos , Redução Aberta , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
PLoS One ; 16(9): e0257955, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34591909

RESUMO

Type 2 diabetes mellitus (T2DM) adversely affects the normal functioning, intrinsic material properties, and structural integrity of many tissues, including bone. It is well known that the clinical utility of areal bone mineral density (aBMD) is limited to assess bone strength in individuals with T2DM. Therefore, there is a need to explore new diagnostic techniques that can better assist and improve the accuracy of assessment of bone tissue quality. The present study investigated the link between bone and fingernail material/compositional properties in type 2 diabetes mellitus (T2DM). For that, femoral head and fingernail samples were obtained from twenty-five adult female patients (with/without T2DM) with fragility femoral neck fractures undergoing hemi/total hip arthroplasty. Cylindrical cores of trabecular bone were subjected to micro-CT, and lower bone volume fraction was observed in the diabetic group than the non-diabetic group due to fewer and thinner trabeculae in individuals with T2DM. The material and compositional properties of bone/fingernail were estimated using nanoindentation and Fourier Transform Infrared Spectroscopy, respectively. Both bone/fingernails in T2DM had lower reduced modulus (Er), hardness (H), lower Amide I and Amide II area ratio (protein content), higher sugar-to-matrix ratio, and relatively high carboxymethyl-lysine (CML) content compared with non-diabetic patients. Sugar-to-matrix ratio and relative CML content were strongly and positively correlated with HbA1c for both bone/fingernail. There was a positive correlation between bone and fingernail glycation content. Our findings provide evidence that the degradation pattern of bone and fingernail properties go hand-in-hand in individuals with T2DM. Hence, the fingernail compositional/material properties might serve as a non-invasive surrogate marker of bone quality in T2DM; however, further large-scale studies need to be undertaken.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Fraturas do Colo Femoral/patologia , Colo do Fêmur/diagnóstico por imagem , Lisina/análogos & derivados , Unhas/diagnóstico por imagem , Osteoporose Pós-Menopausa/diagnóstico por imagem , Idoso , Artroplastia de Quadril , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Fraturas do Colo Femoral/cirurgia , Colo do Fêmur/química , Colo do Fêmur/patologia , Humanos , Lisina/análise , Pessoa de Meia-Idade , Unhas/química , Unhas/patologia , Osteoporose Pós-Menopausa/metabolismo , Osteoporose Pós-Menopausa/patologia , Projetos Piloto , Espectroscopia de Infravermelho com Transformada de Fourier , Microtomografia por Raio-X
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1079-1085, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523270

RESUMO

Objective: To summarize the patterns and research progress of the concomitant ipsilateral fractures of intracapsular femoral neck and extracapsular trochanter, and to provide a common language among orthopedic surgeons for scientific exchange. Methods: According to related literature and authors own experiences concerning the anatomic border between femoral neck and trochanter region, the intertrochanteric line (or intertrochanteric belt) and its capsularligament attachment footprint, fracture patterns, and treatment strategies were reviewed and analyzed. Results: With the rapid growing of geriatric hip fractures, an increased incidence was noted in recent years regarding the proximal femoral comminuted fractures that involving ipsilateral intracapsular neck and extracapsular trochanter regions simultaneously. But the concept of femoral neck combined with trochanter fractures was ambiguous. Based on the anatomic type of femoral neck fracture, the location of fracture center, and the ability to achieve direct inferior calcar or anteromedial cortex-to-cortex apposition and buttress, we classified these complex fractures into 3 sub-types: ① Segmental femoral neck fractures (two separate fracture centers at subcapital and trochanteric region respectively); ② Femoral neck fracture (trans-cervical) with extension to the supero-lateral trochanteric region (fracture center in femoral neck); ③ Trochanteric fracture with extension to the medio-inferior femoral neck region (fracture center in trochanter, comminuted basicervical fracture, or variant type of comminuted trochanter fracture). For treatment strategy, surgeons should consider the unique characteristics of femoral neck and trochanter, usually with combined fixation techniques, or arthroplasty supplemented with fixation. Conclusion: Currently there is no consensus on diagnosis and terminology regarding the concomitant ipsilateral fractures of femoral neck and trochanter. Further studies are needed.


Assuntos
Fraturas do Fêmur , Fraturas do Colo Femoral , Fraturas do Quadril , Idoso , Fraturas do Colo Femoral/cirurgia , Fêmur , Colo do Fêmur/diagnóstico por imagem , Humanos , Estudos Retrospectivos
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1111-1118, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523275

RESUMO

Objective: To compare the effectiveness of the femoral neck system (FNS) and inverted triangle cannulated screws (ITCS) for the treatment of Pauwels type Ⅲ femoral neck fractures. Methods: The clinical data of 59 patients with Pauwels type Ⅲ femoral neck fractures treated between May 2019 and November 2020 were retrospectively analysed. The patients were divided into FNS group (28 cases) and ITCS group (31 cases) according to the different internal fixation. There was no significant difference in gender, age, affected side, body mass index, cause of injury, smoking history, alcohol abuse history, Pauwels angle, Garden classification, AO/Orthopaedic Trauma Association (AO/OTA) classification, and time from injury to operation between the two groups ( P>0.05). The operation time, incision length, intraoperative blood loss, extra assisted reduction procedures (Kirschner wire prying reduction or open reduction), hospitalization stay, and early complications were recorded and compared between the two groups. Garden index and Haidukewych score were used to evaluate fracture reduction. Fracture healing time, lateral thigh irritation, time of partial or total weight-bearing postoperatively, shortening length and degree of femoral neck, change of caput-collum-diaphysis (CCD) angle (the difference of CCD angle between immediate after operation and last follow-up), incidence of osteonecrosis of femoral head and revision surgery were recorded and compared between the two groups. Hip joint function were evaluated by Harris score. Results: The operation time of FNS group was significantly shorter than ITCS group, and the incision length was significantly longer than ITCS group ( P<0.05). There was no significant difference in intraoperative blood loss, assisted reduction, Garden index, Haidukewych score, and hospitalization stay between the two groups ( P>0.05). All the incisions healed by first intention. There were 2 deep vein thrombosis in the FNS group and 1 pulmonary infection and 1 deep vein thrombosis in the ITCS group. No significant difference was found in the incidence of early postoperative complications (7.1% vs. 6.5%) between the two groups ( P=1.000). Patients in both groups were followed up 3-14 months, and there was no significant difference in follow-up time between the two groups ( t=-0.553, P=0.582). The fracture healing time, Harris score, and the partial weight-bearing time after operation of the FNS group were significantly better than those of the ITCS group ( P<0.05). However, there was no significant difference in total weight-bearing time between the two groups ( Z=-1.298, P=0.194). No lateral thigh irritation was found in the FNS group, while 10 patients in the ITCS group had lateral thigh irritation, and the incidence between the two groups (0 vs. 32.3%) was significant ( P=0.001). At last follow-up, the shortening length and degree of femoral neck and the change of CCD angle in FNS group were significantly less than those in ITCS group ( P<0.05). There was no patient with osteonecrosis of femoral head or reoperation in the FNS group, while 4 patients in the ITCS group underwent reoperation (including 2 cases of osteonecrosis of the femoral head). However, the incidences (0 vs. 6.5%; 0 vs.12.9%) between the two groups were not significant ( P=0.493; P=0.114). Conclusion: Using FNS to treat Pauwels type Ⅲ femoral neck fracture is simple as well as able to reduce the shortening of the femoral neck and the change of the CCD angle. Also, FNS is conducive to the recovery of hip joint function, which should be considered as a new choice for the treatment of young femoral neck fracture patients.


Assuntos
Fraturas do Colo Femoral , Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Colo do Fêmur , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Resultado do Tratamento
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