Total hip arthroplasty for failed internal fixation of femoral neck fracture: a retrospective study with 2-14 years' follow-up of 345 patients.

OBJECTIVES: The purpose of this study was to analyze mid- to long-term outcomes of total hip arthroplasty (THA) following failed internal fixation of femoral neck fracture. METHODS: This study retrospectively analyzed 345 patients with femoral neck fracture who underwent THA after failure of internal fixation at our hospital between January, 2003 and December, 2019. Patients older than 55 years (n = 175) and patients no older than 55 years (n = 170) were compared in terms of complications and survival rates during follow-up, which lasted a mean of 6 years. RESULTS: The two age groups showed similarly low incidence of complications and similarly long periods of survival without revision surgery. Only three younger patients and two older patients underwent revision surgery during follow-up. The two groups showed similarly high survival rates at the end of follow-up (> 93%). Younger patients showed significantly bettter Harris hip score at last follow-up (90.2 vs. 88.1 points, p < 0.001) without clinically significant difference, but they required THA significantly earlier after internal fixation (4.4 vs. 6.8 years, p < 0.001). CONCLUSIONS: THA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients.

Mechanical study of the application of compression screw nails in the cross-inverted triangular pattern for internal fixation of femoral neck fractures.

OBJECTIVE: To design a cross-inverted triangular pattern to insert compression screw nails for the treatment of femoral neck fractures and to compare the biomechanics of inserting compression screw nails in cross-inverted triangular patterns and inverted triangular patterns. I am very sorry that a corresponding author needs to be added to the article. I do not know how to insert it, so I make a note here. Please check the attachment I uploaded. METHODS: The reasonableness of the model is first analyzed using finite elements. A total of 6 adult human specimens were selected, of which 3 males and 3 females were divided into the A1, B1, and C1 groups and the A2, B2, and C2 groups by the random number table method. The A1 and A2 groups were made into subhead femoral neck fracture models, the B1 and B2 groups were made into trans-neck femoral neck fracture models, and the C1 and C2 groups were made into basal femoral neck fracture models. The right femur of each group had a compression screw nail inserted in the crossed-inverted triangular pattern, and the left femur of each group had a compression screw nail inserted in the inverted triangular pattern. The static compression test was performed by an electronic universal testing machine. The maximum load of the femoral neck and the load of 3.00 mm axial displacement of the femoral head were read according to the pressure-displacement curve drawn in the experiment. RESULTS: The finite element analysis showed that the cross-inverted triangular hollow threaded nail has better conductivity and more stable fixation than the inverted triangular hollow threaded nail. The maximum load of the femoral neck and the load of 3.00 mm axial displacement of the femoral head of the left femur were greater than those of the right femur in the A1, A2, B1, B2 and C2 groups, while the maximum load of the femoral neck and the load of 3.00 mm axial displacement of the femoral head of the left femur were smaller than those of the right femur in the C1 group. There was no statistically significant difference in the maximum load of the femoral neck or the load of 3.00 mm axial displacement of the femoral head between the A1 and A2 groups, the B1 and B2 groups, or the C1 and C2 groups (P > 0.05). After the K-S test, the maximum load of the femoral neck and the load of 3.00 mm axial displacement of the femoral head were normally distributed (P = 0.20), and the LSD-t test was conducted for the two load data; the difference was not statistically significant (P = 0.235). CONCLUSION: The effect of compression screw nails in the cross-inverted triangular pattern was the same in males and females, and stability was better in the fixation of subhead and trans-neck femoral neck fractures. However, its stability in fixation of basal femoral neck fracture is worse than that of the inverted triangular pattern. The cross-inverted triangular hollow threaded nail has better conductivity and more stable fixation than the inverted triangular hollow threaded nail.

Application of 3-dimensional printing technology in the treatment of postoperative nonunion of femoral neck fracture: A case report.

Nonunion of the femoral neck represents the main complication following fractures at this location. Few studies have documented the application of 3-dimensional printing technology for the surgical treatment of postoperative nonunion of femoral neck fractures. The present manuscript describes a case of a particular 3-dimensional printing technology method for designing a custom-made guide plate for revision surgery. A 46-year-old man suffered a nonunion of the femoral neck following an internal fracture fixation. Using 3-dimensional printing technology, we preoperatively printed a femur model and a custom-made guide plate. Using the model, we performed a simulated operation before the surgery, and the guide plate was used for accurate osteotomy during the operation. With this method, we achieved the desired results: the fracture healed, the operation time was shortened, and there was no femoral head necrosis. Our case suggests that 3-dimensional printing technology provides an effective aid in the treatment of patients with nonunion following a femoral neck fracture and recommends 3-dimensional printing technology for such cases.

Iron-induced Hypophosphatemic Osteomalacia-An Atypical Case of Bilateral Femoral Stress Fractures.

We present a case of a 61-year-old healthy man who had bilateral femoral neck insufficiency fractures attributed to repeated iron transfusions, causing iron-induced hypophosphatemic rickets, requiring surgical intervention. Atraumatic insufficiency fractures present a diagnostic dilemma in orthopaedics. Chronic fractures with no acute precipitating trigger can often go unrecognized until complete fracturing or displacement occurs. Early identification of the risk factors in conjunction with a comprehensive history, clinical examination, and imaging can potentially avoid these serious complications. Atraumatic femoral neck insufficiency fractures have been sporadically reported in the literature, often unilateral and attributed to the use of long-term bisphosphonates. Through this case, we elaborate on the relatively unknown link between iron transfusions and insufficiency fractures. This case highlights the importance of early detection and imaging of such fractures from an orthopaedic perspective.

The effect of pre-fracture proximal femur geometry on hip fracture type in elderly patients.

This study aimed to analyze the relationship between fracture type by determining data on the geometry of the proximal femur in the pre-fracture period in patients over 65 years of age who had hip fractures as a result of low-energy trauma. A total of 127 patients who were admitted to the hospital for reasons other than hip pathology within 1 year before the occurrence of hip fracture and who had an anterior-posterior pelvic X-ray were included in the study. Measurements were made to evaluate the proximal femur geometry, neck shaft angle, central edge angle, femoral head diameter, femoral neck diameter, femoral neck length, femoral offset length, femoral neck axial length, hip axis length, and femoral shaft diameter. As a result of these measurements, analyses were performed to determine the relationship between the control group and fracture types. The mean Neck shaft angle scores were significantly higher in both fracture types than in the control group (P = .034, P = .002). The mean Femoral offset length values of both fracture types were lower than those of the control group (P = .002, P = .011, respectively). Multiple logistic regression analysis revealed that the risk of collum femoris fracture increased as the Femoral head diameter value increased. (OD = 0.21, P = .002). The geometric parameters of the proximal femur play an important role in the formation of hip fracture types. Therefore, differences in proximal femur geometry in hip fracture types should be considered, and patient-focused choices should be made regarding the surgical procedures and implants to be used during fracture fixation.

Predictors of mortality for patients with hip fracture: a study of the nationwide 1-year records of 24,950 fractures in Romania.

We conducted a study evaluating incidence rates and influencing factors in Romanian hip fracture patients. Our results showed that the type of fracture and its respective surgical procedure as well as hospital characteristics correlate with mortality. Updated incidences can result in updated treatment guidelines. PURPOSE: The aim of our study was to assess incidence rates for a revision-calibration of the Romanian FRAX tool and to evaluate particularities of hip fracture cases to determine patient- and hospital-related variables affecting mortality. METHODS: We conducted a retrospective study using hospital reports of hip fracture codes to the National School of Statistics (NSS) from January 1, 2019, until December 31, 2019. The study population included 24,950 patients presenting to Romanian public hospitals in all 41 counties: ≥ the age of 40 with diagnostic ICD 10 codes: S72.0 femoral neck fracture, S72.1 pertrochanteric femoral fracture, and S72.2 subtrochanteric femoral fracture and procedure codes: O11104 (trochanteric/sub capital internal fixation), O12101 (hemiarthroplasty), O11808 (closed femoral reduction with internal fixation), O12103 (partial arthroplasty), O12104 (total arthroplasty). Hospital length of stay (LoS) was classified as follows: < 6, 6-9, 10-14, and ≥ 15 days. RESULTS: Incidence of hip fractures was 248/100,000 among those aged 50 + and 184/100,000 within the 40 + age category. Average age of the patients was 77 years (80 for females, 71 for males); 83.7% of the patients were 65 + with equivalent urban-rural distributions. Males had a 1.7 times higher mortality risk. Each year increase in age added a mortality risk of 6.9%. In-hospital mortality was 1.34 times higher among patients living in urban areas. Hemiarthroplasty and partial/total unilateral/bilateral arthroplasty had a lower risk of mortality than trochanteric/sub capital internal fixation (p < 0.02, p < 0.033). CONCLUSION: Gender, age, residence, and procedure type had significant impact on mortality. Updated incidence rates will allow the revision of Romania's FRAX model.

A lower canal fill rate and unreestablished vertical femoral offset may increase the risk of the postoperative periprosthetic fractures after cementless bipolar hemiarthroplasty for femoral neck fractures in elderly patients.

BACKGROUND: Periprosthetic fractures (PPFs) is one of the major causes of failure of hip arthroplasty with cementless stem; however, studies on the incidence and risk factors of PPFs after cementless hemiarthroplasty for femoral neck fractures (FNFs) are lacking. METHODS: This retrospective study included patients who underwent cementless bipolar hemiarthroplasty for displaced intracapsular FNFs. The demographic data were reviewed, Dorr classification was used to describe morphology of the femur, radiological parameters were measured including stem-shaft angle, canal fill ratio (CFR), canal flare index (CFI), morphologic cortical index (MCI), canal calcar ratio (CCR), and vertical and horizontal femoral offset. RESULTS: The sample comprised 10 men and 46 women (affected hip: left, 38; right, 18). The mean patient age was 82.82±10.61 (range, 69-93) years, and the mean hemiarthroplasty to PPFs time was 26.28±14.04 (range, 6.54-47.77) months. Seven (12.28%) patients had PPFs. A significant relationship was found between the incidence of PPF and CFR (p = 0.012), patients had a significantly smaller femoral stem CFR (0.76%±0.11%) than controls (0.85%±0.09%). The PPFs group had a significant shorter and unreestablished vertical femoral offset (p = 0.048). CONCLUSIONS: A smaller femoral stem CFR associated with a potentially unacceptably high PPFs risk in uncemented hemiarthroplasty for displaced FNFs may result from mismatched prosthesis and bone dimensions in the elderly population, especially when accompanied by a poorly reestablished vertical femoral offset. With increasing evidence of the benefits of cemented fixation, a cemented stem for the treatment of displaced intracapsular FNFs is recommended for such a elderly frail population.

High-Degree Valgus Osteotomy for Severe Femoral Head Osteonecrosis After Femoral Neck Fracture with Nonunion: A Case Report.

CASE: A 15-year-old adolescent boy had severe groin pain because of extensive osteonecrosis of the femoral head with collapse, joint space narrowing, and nonunion after a failed internal fixation for femoral neck fracture. We performed a 60° valgus osteotomy that moved the posteromedial small viable portion of the femoral head to the weight-bearing acetabular area. The femoral neck nonunion and the necrosis healed completely, and the spherical contour of the femoral head was regained after postoperative hip joint remodeling. CONCLUSIONS: Good remodeling and congruency were achieved by performing high-degree valgus osteotomy to obtain sufficient viable area below the acetabular roof.

Factores de riesgo asociados a infección periprotésica en el paciente con fractura del cuello femoral: estudio de casos y controles / Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case-control study

Antecedentes y objetivo: La infección es una de las complicaciones locales más importantes en el paciente con fractura del cuello femoral tratada con una artroplastia. El objetivo del presente estudio es describir y analizar posibles factores de riesgo que podrían estar implicados en la infección periprotésica del paciente con fractura del cuello femoral. Material y métodos: Se realizó un estudio de casos y controles retrospectivo que incluye a pacientes con fractura del cuello femoral tratada con una artroplastia en el periodo comprendido entre enero de 2015 y diciembre de 2017. Se definieron como casos a los pacientes con fractura del cuello femoral que tras someterse a una artroplastia (hemiartroplastia o artroplastia total de cadera) tuvieron como desenlace una infección periprotésica, cuyo diagnóstico se llevó a cabo atendiendo a los criterios mayores y menores descritos en el Consenso Internacional de Infecciones Musculoesqueléticas (Philadelphia 2018). Con la intención de atenuar la influencia de variables que podrían considerarse confusoras, se realizó un análisis multivariante. Resultados: Se apreció una asociación estadísticamente significativa entre infección periprotésica y determinadas variables presentes en el momento del ingreso, entre las que se encuentran la presencia de anemia moderada o severa (OR: 10,91; IC95%: 1,07-111,50; p=0,007), trombocitopenia (OR: 27,72; IC95%: 3,48-221,01; p=0,002), el antecedente tromboembólico (OR: 8,80; IC95%: 1,31-59,38; p=0,026), el trastorno ansioso-depresivo en tratamiento con 2 o 3 fármacos (OR: 21,36; IC95%: 3,65-125,12; p=0,001) y la hepatopatía (OR: 32,04; IC95%: 2,59-396,29; p=0,007). Conclusiones: La infección periprotésica en el paciente con fractura del cuello femoral tratado con una artroplastia podría relacionarse con la presencia de determinadas variables en el momento del ingreso hospitalario, entre las que se encuentran la anemia moderada o severa...(AU)

Background: Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture. Methods: A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out. Outcomes: A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95%CI: 1.07-111.50; P=.007), thrombocytopenia (OR: 27.72; 95%CI: 3.48-221.01; P=.002), history of thromboembolism event (OR: 8.80; 95%CI: 1.31-59.38; P=.026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95%CI: 3.65-125.12; P=.001) and liver disease (OR: 32.04; 95%CI: 2.59-396.29; P=.007). Conclusions: Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.(AU)

[Translated article] Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case–control study / Factores de riesgo asociados a infección periprotésica en el paciente con fractura del cuello femoral: estudio de casos y controles

Antecedentes y objetivo: La infección es una de las complicaciones locales más importantes en el paciente con fractura del cuello femoral tratada con una artroplastia. El objetivo del presente estudio es describir y analizar posibles factores de riesgo que podrían estar implicados en la infección periprotésica del paciente con fractura del cuello femoral. Material y métodos: Se realizó un estudio de casos y controles retrospectivo que incluye a pacientes con fractura del cuello femoral tratada con una artroplastia en el periodo comprendido entre enero de 2015 y diciembre de 2017. Se definieron como casos a los pacientes con fractura del cuello femoral que tras someterse a una artroplastia (hemiartroplastia o artroplastia total de cadera) tuvieron como desenlace una infección periprotésica, cuyo diagnóstico se llevó a cabo atendiendo a los criterios mayores y menores descritos en el Consenso Internacional de Infecciones Musculoesqueléticas (Philadelphia 2018). Con la intención de atenuar la influencia de variables que podrían considerarse confusoras, se realizó un análisis multivariante. Resultados: Se apreció una asociación estadísticamente significativa entre infección periprotésica y determinadas variables presentes en el momento del ingreso, entre las que se encuentran la presencia de anemia moderada o severa (OR: 10,91; IC95%: 1,07-111,50; p=0,007), trombocitopenia (OR: 27,72; IC95%: 3,48-221,01; p=0,002), el antecedente tromboembólico (OR: 8,80; IC95%: 1,31-59,38; p=0,026), el trastorno ansioso-depresivo en tratamiento con 2 o 3 fármacos (OR: 21,36; IC95%: 3,65-125,12; p=0,001) y la hepatopatía (OR: 32,04; IC95%: 2,59-396,29; p=0,007). Conclusiones: La infección periprotésica en el paciente con fractura del cuello femoral tratado con una artroplastia podría relacionarse con la presencia de determinadas variables en el momento del ingreso hospitalario, entre las que se encuentran la anemia moderada o severa...(AU)

Background: Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture. Methods: A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out. Outcomes: A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95%CI: 1.07-111.50; P=.007), thrombocytopenia (OR: 27.72; 95%CI: 3.48-221.01; P=.002), history of thromboembolism event (OR: 8.80; 95%CI: 1.31-59.38; P=.026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95%CI: 3.65-125.12; P=.001) and liver disease (OR: 32.04; 95%CI: 2.59-396.29; P=.007). Conclusions: Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.(AU)

Biomechanical effects of internal fixation with self-lock compression anti-rotation blade for Pauwels type III femoral neck fractures: a comparative finite element analysis.

BACKGROUND: Self-lock compression anti-rotation blade (SCAB) is a novel internal fixation implant for femoral neck fractures (FNF). We conducted this finite element analysis study to evaluate the biomechanical performances of SCAB combined with a cannulated screw for fixation of Pauwels type III FNF. METHODS: Three finite element models of Pauwels type III FNF treated with various internal fixations were established: a: the inverted triangular parallel cannulated screw (3CS) model, b: the biplane double-supported screw fixation (BDSF) model, c: the SCAB combined with a cannulated screw model. Displacement and Von Mises stress of femurs and internal fixations under increasing loads as well as the average stress on fracture surfaces and maximum displacements on the X and Z axis of proximal fracture fragments at maximum load were measured and compared. RESULT: The SCAB-based internal fixation exhibited superior biomechanical performances compared with 3CS and BDSF configurations, as the former resulted in lower parameters including displacement of the femur, Von Mises stress of internal fixation, stress on fracture surfaces as well as X and Z axis displacement of fracture fragments. CONCLUSION: Internal fixation using SCAB combined with a cannulated screw for Pauwels type III FNFs shows enough stability, with satisfied resistance to varus and shearing forces, which may provide a new option for the treatment of FNFs.

Heroin-induced osteoporosis presented with bilateral femoral neck insufficiency fractures in a male adult: a case report.

BACKGROUND: Osteoporosis has been associated with several disorders; however, there have been only a limited number of reports on heroin-induced osteoporosis. We report a rare case presented with bilateral femoral neck insufficiency fractures without trauma history, caused by heroin-induced osteoporosis. We collect sufficient clinical data and further shed light on the potential mechanism of how heroin affects bone formation and decreases bone density. CASE PRESENTATION: A 55-year-old male patient with normal body mass index (BMI) suffered from bilateral hips pain gradually without trauma history. He had intravenous heroin addiction for more than 30 years. Radiography revealed bilateral femoral neck insufficiency fractures. Laboratory tests showed elevated alkaline phosphatase levels (365 U/L) and decreased inorganic phosphate (1.7 mg/dL), calcium (8.3 mg/dL), 25-(OH)D3 (20.3 ng/ml) and testosterone levels (2.12 ng/ml). Magnetic resonance imaging (MRI) revealed increased signals on STIR images over the sacral ala and bilateral proximal femur, and multiple band-like lesions at the vertebrae of the thoracic and lumbar spine. Bone densitometry revealed osteoporosis with a T score of minus 4.0. The screen for urine morphine was positive (> 1000 ng/ml). Through assessment of the patient, the diagnosis was insufficiency fractures of bilateral femoral neck caused by opioid-induced osteoporosis. After hemiarthroplasty, regular medication with vitamin D3 and calcium, and detoxification treatment, and the patient recovered well after 6 months of follow-up. CONCLUSION: The aim of this report is to highlight the laboratory and radiology findings in a case of osteoporosis caused by opioid addiction and discuss the potential pathway by which osteoporosis is induced by opioids. When an unusual osteoporosis presents with insufficiency fractures, heroin-induced osteoporosis should be considered.

Reducing complications of femoral neck fracture management: a retrospective study on the application of multidisciplinary team.

BACKGROUND: Femoral neck fractures are associated with substantial morbidity and mortality for older adults. Multi-system medical diseases and complications can lead to long-term care needs, functional decline and death, so patients sustaining hip fractures usually have comorbid conditions that may benefit from application of multidisciplinary team(MDT). METHODS: This is a retrospective cohort study that incorporates medical record review with an outcomes management database. 199 patients were included who had surgery for a new unilateral femoral neck fracture from January 2018 to December 2021 (96 patients in usual care (UC) model and 103 patients in MDT model. High-energy, pathological, old and periprosthetic femoral neck fracture were excluded. Age, gender, comorbidity status, time to surgery, and postoperative complication, length of stay, in-hospital mortality, 30-day readmission rate, 90-day mortality data were collected and analyzed. RESULTS: Preoperative general data of sex, age, community dwelling and charlson comorbidity score of MDT group (n = 103) have no statistically significant difference with that of usual care (UC) group. Patients treated in the MDT model had significantly shorter times to surgery (38.5 vs. 73.4 h;P = 0.028) and lower lengths of stay (11.5 vs. 15.2 days;P = 0.031). There were no significant differences between two models in In-hospital mortality (1.0% vs. 2.1%; P = 0.273), 30-day readmission rate (7.8% vs. 11.5%; P = 0.352) and 90-day mortality (2.9% vs. 3.1%; P = 0.782). The MDT model had fewer complications overall (16.5% vs. 31.3%; P = 0.039), with significantly lower risks of delirium, postoperative infection, bleeding, cardiac complication, hypoxia, and thromboembolism. CONCLUSION: Application of MDT can provide standardized protocols and a total quality management approach, leading to fewer complications for elderly patients with femoral neck fracture. TRIAL REGISTRATION: No.

Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system.

OBJECTIVE: To investigate the effects of postoperative femoral neck shortening in patients with femoral neck fractures fixed with femoral neck system screws (FNS) and to explore the factors influencing femoral neck shortening. METHOD: To retrospectively analyze the data of 113 patients with femoral neck fractures admitted to the Second Hospital of Fuzhou City, affiliated with Xiamen University, between December 2019 and January 2022. Of these, 87 patients were followed up for more than 12 months, 49 men and 38 women: 36 cases of Garden I and II fractures and 51 cases of Garden III and IV fractures, to record the patient's hip Harris score at 12 months postoperatively. Patients were divided into femoral neck shortening group and femoral neck no shortening group according to their regular postoperative follow-up radiographic measurements. To count the incidence of femoral neck shortening, a comparison of postoperative complication rates and hip Harris scores between the two groups was made. Statistical comparison of the two groups and a multifactorial logistic regression analysis were also performed to analyze the factors affecting femoral neck shortening. RESULTS: All 87 patients were followed up for more than 12 months after surgery. In 34 of these cases, neck shortening occurred, and the incidence rate was 39.1%. 15 cases of severe shortening, incidence of 17.2%; fracture healing 84 cases, fracture healing rate of 96.5%. The hip Harris score was 83.99 (81.95, 89.20) in the neck shortening group at 12 months postoperatively, 90.87 (87.95, 94.80) for the group without neck shortening; the difference between the two groups was statistically significant (P < 0.01). 32 cases of fracture healing in the neck shortening group at 12 months after surgery, fracture healing rate of 94.1%; 52 cases healed without neck shortening group, fracture healing rate of 98.1%. The difference between the two groups was not statistically significant (P = 0.337). High incidence of neck shortening after FNS fixation of femoral neck fractures, cortical comminution of the severed end, fracture fractionation and quality of reduction were significantly correlated with neck shortening. CONCLUSION: High incidence of postoperative neck shortening after internal fixation of femoral neck fractures with the femoral neck system, the cortical comminution, the type of fracture, and the quality of fracture reduction are the influencing factors; femoral neck shortening can affect postoperative hip function, but does not affect fracture healing.

Validation of direct CT measurement of malrotation in femoral neck fractures: A bone model study.

BACKGROUND: While postoperative malrotation in the subtrochanteric region is a well-known problem, malrotation after osteosynthesis in proximal femoral fractures has not been extensively studied. In this context, many methods for perioperatively assessment of femoral torsion have been described, but none of them is applicable in the basicervical region of the proximal femur. As an important difference in femoral neck fractures, the discontinuous neck fails to serve as a significant "pointer" for measurements and malfunctions to be placed in relation to the condylar plane. Considering postoperative maltorsion at any location as a substantial negative effect on patients' outcome and functional expectations, precise and patient-friendly rotation measurement standards in femoral neck fractures are desired in clinical practice. Recently, a novel computed tomography (CT) based geometric technique was described named "direct measurement" with promising results covering this diagnostic disparity, but still requires validation. Thus, we aimed to validate the previously described technique using a controlled range of displacement in a femoral neck fracture Sawbone® model. METHODS AND FINDINGS: A goniometer was designed to set retro- and anteversion of the proximal femur in a reproducible manner. Prospectively, all femurs underwent a CT scan and were measured 3D for displacement. The interclass correlation between the CT measurements and the goniometer measurements was calculated and was found to be very high (1.00, 95% confidence interval: 0.99-1.00; p < 0.001). For the mean of all measurements, the Pearson's correlation was 1.00 (p < 0.001). No significant differences in the measurements of both investigators were observed, with 20° of retroversion not significant (-1.20 ± 1.71; 95% confidence interval: -2.43-0.03; p = 0.054). CONCLUSION: This CT-based 3D measurement technique may allow for perioperative malrotation assessment in basicervical femoral neck fractures and appears to be feasible in femoral neck fractures when it comes to rare cases of osteosynthesis. Further investigations are still needed to define the thresholds of malrotation provoking functional impairment after osteosynthesis in basicervical femoral neck fractures.

Comparison of femoral neck system versus cannulated screws for treatment of femoral neck fractures: a systematic review and meta-analysis.

BACKGROUND: Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs. METHOD: The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants. RESULTS: A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P < 0.001; I2 = 0%), fracture healing time (WMD = -1.54; 95% CI, -2.38 to -0.70; P < 0.001; I2 = 92%), length of femoral neck shortening (WMD = -2.01; 95% CI, -3.11 to -0.91; P < 0.001; I2 = 0%), femoral head necrosis (OR = 0.27; 95% CI, 0.08 to 0.83; P = 0.02; I2 = 0%), implant failure/cutout (OR = 0.28; 95% CI, 0.10 to 0.82; P = 0.02; I2 = 0%), and Visual Analog Scale Score (WMD = -1.27; 95% CI, -2.51 to -0.04; P = 0.04; I2 = 91%). And the Harris Score was significantly higher in the FNS group than in the CS group (WMD = 4.15; 95% CI, 1.00 to 7.30; P = 0.01; I2 = 89%). CONCLUSIONS: Based on this meta-analysis, FNS shows better clinical efficacy and safety in treating FNFs compared to CS. However, due to the limited quality and number of included studies and the high heterogeneity of the meta-analysis; large samples and multicenter RCTs are needed to confirm this conclusion in the future. LEVEL OF EVIDENCE: II, Systematic review and Meta-analysis. TRIAL REGISTRATION: PROSPERO CRD42021283646.

Effect of subanesthetic dose of esketamine on postoperative rehabilitation in elderly patients undergoing hip arthroplasty.

OBJECTIVE: The majority of individuals with femoral neck fractures opt for total hip replacement to enhance their quality of life. However, this group frequently exhibits perioperative symptoms of pain, anxiety, and sadness, which extends recovery time to some extent. Esketamine, the right-handed monomer of ketamine, is more popular these days due to its sedative, analgesic, and antidepressant properties. There are currently few domestic and international research on the use of esketamine in elderly individuals who have undergone surgery for a femoral neck fracture. In order to further cut the length of the hospital stay and hasten postoperative recovery, this study investigates whether esketamine postoperative analgesia can lessen postoperative pain, anxiety, and depression in older patients having hip replacement. METHODS: 150 patients, ASA physical status I-II, aged ≥ 60 years, no limitation in gender, BMI 18-25 kg/cm2, who underwent selective total hip arthroplasty, according to random number table method, esketamine group (group A) and sufentanil group (group B) were randomized, 75 patients in each group. The two groups received general anesthesia method. At the end of the operation, PCIA was connected for analgesia. In group A, esketamine 2.5 mg/kg was mixed with normal saline to 100 ml. In group B, sufentanil 2.5 ug/kg was mixed with normal saline to 100 ml. Record the VAS scores after operation. Record the first ambulation time, ambulation distance and Patient-controlled Analgesia compression times after operation. The incidence of postoperative adverse reactions such as drowsiness, dizziness, nausea and vomiting, multilingual were recorded. ELISA was used to detect IL-6 and CRP in the morning, 24 h and 72 h after operation. The Hospital Anxiety and Depression Scale (HAD) score and Harris score at 3 days, 1 week and 1 month after operation were followed up. RESULTS: There was no significant difference in VAS score and PCA compression times (P > 0.05), but the incidence of nausea, vomiting and dizziness in group B was higher than that in group A (P < 0.05). Compared with group B, the levels of IL-6 and CRP in group A at 24 h and 72 h after operation were significantly decreased (P < 0.05). Postoperative ambulation time and ambulation distance in group A were better than those in group B (P < 0.05). The HAD score of group A was lower than that of group B at 3 days and 1 week after operation (P < 0.05). However, there was no significant difference between the two groups at 1 month after operation (P > 0.05). The Harris score of group A was higher than that of group B at 3 days, 1 week and 1 month after operation (P < 0.05). CONCLUSIONS: Esketamine can reduce short-term postoperative anxiety and depression, relieve postoperative pain and stress response, shorten bed rest time after total hip replacement, and accelerate postoperative recovery.

Is There a "Black Friday" for Geriatric Hip Fracture Surgery?

OBJECTIVES: Reports show an increase in the short-term mortality rates of hip fracture patients admitted on weekends. However, there are few studies on whether there is a similar effect in Friday admissions of geriatric hip fracture patients. The aim of this study was to evaluate the effects of Friday admission on mortality and clinical outcomes in elderly patients with hip fractures. METHODS: A retrospective cohort study was performed at a single orthopaedic trauma centre and included all patients who underwent hip fracture surgery between January 2018 and December 2021. Patient characteristics, including age, sex, BMI, fracture type, time of admission, ASA grade, comorbidities, and laboratory examinations, were collected. Data pertaining to surgery and hospitalization were extracted from the electronic medical record system and tabulated. The corresponding follow-up was performed. The Shapiro-Wilk test was applied to evaluate the distributions of all continuous variables for normality. The overall data were analyzed by Student's t test or the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables, as appropriate. Univariate and multivariate analyses were used to further test for the independent influencing factors of prolonged time to surgery. RESULTS: A total of 596 patients were included, and 83 patients (13.9%) were admitted on Friday. There was no evidence supporting that Friday admission had an effect on mortality and outcomes, including length of stay, total hospital costs and postoperative complications. However, the patients admitted on Friday had delayed surgery. Then, patients were regrouped into two groups according to whether surgery was delayed, and 317 patients (53.2%) underwent delayed surgery. The multivariate analysis showed that younger age (p = 0.014), Friday admission (p < 0.001), ASA classification III-IV (p = 0.019), femoral neck fracture (p = 0.002), time from injury to admission more than 24 h (p = 0.025), and diabetes (p = 0.023) were risk factors for delayed surgery. CONCLUSIONS: Mortality and adverse outcome rates for elderly hip fracture patients admitted on Friday were similar to those admitted at other time periods. However, Friday admission was identified as one of the risk factors for delayed surgery.

[Disastrous triad of femoral head:femoral neck fracture meeting fracture-dislocation of femoral head].

Femoral head and ipsilateral femoral neck fractures are serious and complicated injuries, which usually yield unsatisfactory results using conventional hip-preserving surgery. The key point of the management and prognosis mainly lies in femoral neck fractures. An apparent and consecutive relationship exists between femoral neck fractures and femoral head fracture-hip dislocation in such injuries. It is believed that disastrous triad of femoral head (DTFH) could summarize these specific injuries, and reflect the injury mechanism and prognostic characteristics. Based on our clinical observation and literature review, DTFH could be divided into three subgroups:TypeⅠ, common DTFH, in which femoral neck fractures occur following femoral head fractures-hip dislocation due to the same trauma; TypeⅡ, iatrogenic DTFH, in which femoral neck fractures come out in the caring process of femoral head fractures-hip dislocation; Type Ⅲ, stressed DTFH, in which femoral neck fractures occur after the management of femoral head fractures-hip dislocation. In the scenario, the line of femoral neck fractures locates distally to the femoral head fractures. Herein, we will discuss clinical characteristics of these types of DTFH.