FEMORAL NECK FRACTURES AND CLASSIFICATIONS RELIABILITY: ARE WE USING REPRODUCIBLE SYSTEMS?

2021 ◽  
pp. 2150015
Author(s):  
Emilio Enrietti ◽  
Marco Bechis ◽  
Giulia Nicolaci ◽  
Domenico Messina ◽  
Michele Reboli ◽  
...  
Keyword(s):  
Femoral Neck ◽  
High Reliability ◽  
Femoral Neck Fractures ◽  
Classification Systems ◽  
Observer Agreement ◽  
Type I ◽  
X Rays ◽  
Correct Treatment ◽  
Femur Fractures ◽  
Pauwels Classification

Introduction: Classification systems for femoral neck fractures are very helpful for surgeons in order to choose the correct treatment. The purpose of this study was to verify the reliability and reproducibility in the most used classifications for proximal medial femoral fracture: Garden and Pauwels classifications. Materials and methods: Five surgeons independently classified 82 intra-capsular femur fractures treated with 3 cannulated screws using Pauwels and Garden classifications measured on pre- and post-operatively X-Rays. Inter-observer agreement was calculated for both classifications using the multi-rater Fleiss’ kappa; intra-observer agreement from pre-operative to post-operative XRs for Pauwels classification was also calculated with the same method. Results: Only six cases of AVN were registered. The inter-observers agreement based on pre-operative X-rays was moderate for Pauwels classification ([Formula: see text] 0.528) and slightly lower for Garden classification ([Formula: see text] 0.448); but in the simplified Garden classification (type I and II not displaced vs type III and IV displaced) the agreement measured was almost perfect ([Formula: see text] 0.908). The intra-observer agreement for Pauwels classification was moderate ([Formula: see text] 0.456). All the results were statistically significant. Conclusions: This is the first study evaluating the Pauwels angle on both preoperative and postoperative X-rays to assess their reproducibility. Garden classification has a really high reliability and reproducibility in evaluating displaced and not displaced fractures and consequently can be helpful in choosing the correct treatment. Pauwels classification has a lower inter and intra-observer agreement.

216 Fix or Replace: Is Internal Fixation Still A Viable Option in The Elderly with Un-Displaced Intracapsular Femoral Neck Fractures?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Morris ◽  
A Krishna ◽  
H Hamid ◽  
M Chawda ◽  
H Mumtaz
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Revision Surgery ◽  
Retrospective Review ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Cannulated Screws ◽  
Viable Option ◽  
Displaced Femoral Neck Fractures

Abstract Aim The treatment of impacted or un-displaced femoral neck fractures in the elderly osteoporotic patient is still largely debated, with arthroplasty versus internal fixation two surgical options1. Our aim was to retrospectively review patients over the age of 80 with un-displaced intracapsular hip fractures who had undergone internal fixation and assess their rate of mortality and revision surgery. Method We conducted a retrospective review of all patients with femoral neck fractures over a 4-year period between January 2015 to December 2018. We refined this to only patients over the age of 80 with un-displaced intracapsular femoral neck fractures fixed with cannulated screws. We noted their mental and mobility status, their follow-up attendance over 3 years, their mortality and rate of revision surgery. Results There were a total of 1232 femoral neck fractures in a 4-year period. Of these, 37 were >80 with un-displaced intracapsular femoral neck fractures, with 23 fixed with cannulated screws and 14 with a Dynamic Hip Screw. Mean age – 85, M:F (1:4.75). All patients were either Garden Classification Type I or II. 4% had cognitive impairment. All patients were independently mobile. 83% were followed up for 3 years, with 1 patient (4%) undergoing revision surgery 3 years following cannulated screw fixation. The 30-day mortality rate was 5%. Conclusions The treatment choice for un-displaced intracapsular femoral neck fractures in the elderly remains debateable. Our retrospective review shows that the rate of re-operation is low in patients who have undergone fixation with cannulated screws and so this remains a viable option.

Recent Methods of Neck Femur Fixation A Systematic review and meta-analysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Salem Eid ◽  
Ahmed Mohamed Mohasseb ◽  
Ramy Mohamed Mohamed El-Bahnasy
Keyword(s):  
Systematic Review ◽  
Femoral Head ◽  
Femoral Neck ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Final Outcome ◽  
Cannulated Screws ◽  
Fixed Angle ◽  
Femur Fractures ◽  
Femoral Head Osteonecrosis

Abstract Background Femoral neck fractures in adults younger than age 50 years are uncommon and often the result of high energy trauma. They account for only 2-3% of all femoral neck fractures. Femoral neck fractures are associated with aging and osteoporosis and can occur after relatively trivial trauma in elderly patients. femoral neck fractures are associated with higher incidences of femoral head osteonecrosis and nonunion. Fixation options include cannulated screws, non parallel cannulated screws, medial augmentation plate, and fixed angle femoral neck fixation implants. A systematic review of literature done to evaluate which technique is better. Methods After literature search thirteen articles were found and were reviewed to evaluate final outcome of fixation of neck femur fractures by cannulated screws, non parallel cannulated screws, medial augmentation plate, and fixed angle femoral neck fixation implants. Results After evaluation of all studies the incidence of nonunion, osteonecrosis of femoral head, implant failure & revesion surgery is lower in comparing Targon plate with multiple cannulated screws while we need further studies for application of non parallel screws and medial plate. Conclusion Targon plate recorded low incidence of complications in the final outcome in comparison with multiple cannulated screw while we need further studies for application of Non parallel screws and medial plate.

scholarly journals Treatment of Proximal Femur Fractures on the Background of Osteoporosis

2004 ◽  
Vol 11 (1) ◽  
pp. 27-31 ◽  
Author(s):  
A F Lazarev ◽  
E I Solod ◽  
A O Ragozin ◽  
M G Kakabadze ◽  
A F Lazarev ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
Femoral Neck Fractures ◽  
Mineral Density ◽  
Stable Fixation ◽  
Fracture Characteristics ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Choice Of Treatment ◽  
Density Evaluation

Analysis of treatment of 526 patients with proximal femur fractures (362 patients with femoral neck fractures and 164 patients with trochanteric zone fractures) was performed. Patients' age ranged from 34 to 92 (mean 67). Algorithm of differentiated choice of operative tactics depending on fracture characteristics and injury term was presented. Low invasive osteosynthesis of femoral neck with bundle of stressed V-shaped pins was suggested. Theoretical and practical ground of that technique was given. Stress within fixative-bone system created after osteosynthesis by V-shaped pins, provided stable fixation even in marked osteoporosis. The importance of bone mineral density evaluation for the choice of treatment tactics as well as the necessity of medicamental correction of the disturbed bone remodeling after surgical treatment was noted.

scholarly journals Current Management of Femoral Neck Fractures (Literature Review)

2021 ◽  
pp. 68-75
Author(s):  
I.M. Zazirnyi ◽  
O.O. Kostrub
Keyword(s):  
Femoral Neck ◽  
Patient Characteristics ◽  
Femoral Neck Fractures ◽  
Classification Systems ◽  
Fracture Characterization ◽  
Orthopedic Surgeons ◽  
Appropriate Treatment ◽  
Neck Fracture ◽  
In Situ Fixation

Summary. Femoral neck fractures are a commonly encountered injury in orthopedic practice and result in significant morbidity and mortality. It is essential that surgeons are able to recognize specific fracture patterns and patient characteristics that indicate the use of particular implants and methods to effectively manage these injuries. The use of the Garden and Pauwels classification systems has remained the practical mainstay of femoral neck fracture characterization that help choosing appropriate treatment. Operative options include in situ fixation, closed or open reduction and internal fixation, hemiarthroplasty, and total hip arthroplasty. Recent reports demonstrate diversity among orthopedic surgeons in regard to the optimal treatment of femoral neck fractures and changing trends in their management.

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

2018 ◽  
Vol 29 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Wayne Hoskins ◽  
Johnny Rayner ◽  
Rohan Sheehy ◽  
Harry Claireaux ◽  
Roger Bingham ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Outcome Measures ◽  
Surgical Procedures ◽  
Young Patients ◽  
Significant Risk ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Secondary Outcome ◽  
Femur Fractures

Introduction: High-energy femoral neck fractures in young patients can be devastating, with the risk of osteonecrosis, nonunion, malunion and lifelong morbidity. The aim of this study is to define the effects of patient, fracture and surgical factors on the outcome of high-energy femoral neck fractures in patients aged from 15 to 50 years. Methods: A retrospective review was conducted of high-energy femoral neck fractures in patients aged 15–50 managed surgically at a Level 1 Trauma Centre, using a prospectively recorded trauma database. Low energy trauma (including falls from <1 m), medical conditions adversely affecting bone density, and pathological fractures were excluded. A clinical and radiological review was performed. The primary outcome measures were the development of osteonecrosis or nonunion leading to total hip arthroplasty (THA). Secondary outcome measures included osteotomy or other surgical procedures, quality of reduction and malunion. Results: 32 patients meeting the inclusion criteria were identified between January 2008 and July 2015. The mean follow-up was 58.5 months (range 980–3,048 days). 3 patients (9.4%) required THA. No other surgical procedures were performed. None of the 29 other patients developed radiologically apparent osteonecrosis. Fracture type, displacement, anatomical reduction and fixation type were not statistically significant risk factors affecting these outcomes. For all patients, an average of 8% loss of femoral neck height and 10% femoral neck offset were seen. Conclusions: At a mean 4.9-year follow-up, the incidence of high-energy femoral neck fractures leading to THA was 9.4%, as a consequence of osteonecrosis or nonunion. Malunion was common.

scholarly journals Efficacy and complications after delayed fixation of femoral neck fractures in children

2019 ◽  
Vol 28 (1) ◽  
pp. 230949901988968 ◽  
Author(s):  
Chunxing Wu ◽  
Bo Ning ◽  
Ping Xu ◽  
Jun Song ◽  
Dahui Wang
Keyword(s):  
Femoral Neck ◽  
Closed Reduction ◽  
Open Reduction ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Fractures In Children ◽  
Reduction Group ◽  
Time From Injury

Objective: This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. Methods: The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet’s classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27–240 h). According to Garden’s classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed ( n = 9) or open ( n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. Results: The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet’s type II, 12.5%) and in three in the open reduction group (one Delbet’s type I, 50%; two Delbet’s type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. Conclusions: The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

Evaluation of Occult Femoral Neck Fractures – Computed Tomography or Magnetic Resonance Imaging?

2019 ◽  
Vol 1 ◽  
pp. 82-87
Author(s):  
Moomal Haris ◽  
Philip Robinson ◽  
Harun Gupta
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Femoral Neck ◽  
Plain Radiograph ◽  
Femoral Neck Fractures ◽  
Second Line ◽  
Resonance Imaging ◽  
Femur Fractures ◽  
Diagnostic Certainty

Aim: There is an increasing incidence of hip fracture with associated morbidity and mortality making accurate and timely diagnosis essential. The aim of this study was to compare computed tomography (CT) and magnetic resonance imaging (MRI) to ascertain the optimum second-line investigation in cases where plain radiograph is not diagnostic. Material and Methods: Using the radiology information system, a total of 168 patients were identified with the suspected occult neck of femur fractures over 24 months who had undergone CT or MRI as second-line investigation. All relevant imaging was reviewed and diagnosis, any third-line or follow-up imaging was documented. Results: About 16% of patients undergoing CT as second-line test had proven originally occult femoral neck fractures on plain radiograph compared with 13% of those having MRI. About 13% of patients underwent MRI following CT and in 1/13 case MRI detected an occult fracture that had not been detected on CT. The remaining 11 patients were either negative or MRI proved CT suspicions of fracture when extra diagnostic certainty was requested by the surgeons. CT detected more non femoral pelvic fractures 47% versus 37%. Conclusion: CT and MRI are comparable at detecting occult femoral neck fractures. Given the increased availability, improved patient tolerance and speed of CT imaging, we advocate its use as the main second-line imaging modality. MRI remains a valuable problem-solving tool in a select few cases following review with a musculoskeletal radiologist.

scholarly journals Does the Use of Magnetic Resonance Imaging Scan in Occult and Suspected Metastatic Pathological Neck of Femur Fractures Affect the Choice of Surgical Intervention?

2019 ◽  
Vol 10 ◽  
pp. 117956031984328
Author(s):  
Basil Budair ◽  
Mohammad Al-Tibi ◽  
Tarek Boutefnouchet
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Resonance Imaging ◽  
Occult Fracture ◽  
Mri Scan ◽  
Pathological Fractures ◽  
Neck Of Femur ◽  
Femur Fractures

Background: Magnetic resonance imaging (MRI) is often employed as the diagnostic modality of choice in occult and suspected pathological femoral neck fractures. We evaluated the clinical utility of MRI scan in this patient population. Method: Retrospective observational analysis of cases with a radiologically occult or suspected metastatic pathological neck of femur fracture. Results: From a total of 894 femoral neck fractures treated in our institution, 100 patients had and MRI scan pre-operatively for either occult fracture or suspected fracture secondary metastatic disease. Magnetic resonance imaging confirmed the presence of 13 simple fractures. A total of 14 patients had pathological features suggestive of metastasis, of which 12 were clearly visible on plain radiographs. Surgical plan did not change after MRI for any of these pathological fractures. Conclusion: Results of this study demonstrate that an MRI scan had an impact on treatment selection only when a simple but radiographically occult fracture is suspected and but not in the context of suspected metastatic pathological fractures.

Garden type I fractures myth or reality? A prospective study comparing CT scans with X-ray findings in Garden type I femoral neck fractures

Bone ◽  
2012 ◽  
Vol 51 (5) ◽  
pp. 929-932 ◽  
Author(s):  
Wei Chen ◽  
Zhiyong Li ◽  
Yanling Su ◽  
Zhiyong Hou ◽  
Qi Zhang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Prospective Study ◽  
Femoral Neck Fractures ◽  
Ct Scans ◽  
Type I ◽  
X Ray ◽  
A Prospective Study

scholarly journals Four-Year Prospective Evaluation of Femoral Neck Fractures: Types and Complications

2020 ◽  
Vol 7 (3) ◽  
pp. 129-134
Author(s):  
Ali Yeganeh ◽  
◽  
Mehdi Moghtadaei ◽  
Amir Sobhani ◽  
Mehdi Abbasi ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Avascular Necrosis ◽  
Cross Sectional Study ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Cross Sectional ◽  
Non Union ◽  
Type Iv ◽  
The Mean ◽  
Type Of Fracture

Background: Despite the advances in the methods of treating femoral neck fractures, treating some types of these fractures is still challenging. Therefore, understanding these fractures, their treatments, and the ways to control their complications are necessary for the orthopedists.  Objectives: In this study, we evaluate patients with acute femoral neck fractures with respect to the type of fractures and complications. Methods: In a 4-year cross-sectional study, the patients with acute femoral neck fractures who were admitted to Rasoul Akram Hospital were selected. Anatomical features and the type of fracture were determined by using plain radiography and CT scan. Fractures were classified according to the Garden classification. The patients were also evaluated for any postoperative complications for at least 6 months. Results: A total of 124 patients were enrolled. The Mean±SD age of the patients was 64.9±12.7 years and 87 (74.4%) were male. Based on the Garden classification, 7 fractures (5.9%) belonged to type I, 10 fractures (8.5%) to type II, 48 fractures (41%) to type III, and 52 fractures (44.4%) to type IV. Avascular necrosis in 28 cases (23.9%), non-union in 14 cases (12%), and claudication and pain in 35 cases (29.9%) were noted. The mean age of patients was different between fracture groups (P=0.01).  Conclusion: Our results showed that most of the patients with femoral neck fractures admitted to Rasoul Akram Hospital were associated with displacement. In this study, the most common complications were pain and claudication, avascular necrosis of the femoral head, and nonunion. In sum, further displacement of the fracture will result in more complications.

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