scholarly journals Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review

2019 ◽  
Vol 6 (1) ◽  
pp. 25-30
Author(s):  
Rajendra Sanjel Chhetri ◽  
Kishor Prashad Khatri ◽  
Krishna Kharel
Keyword(s):  
Avascular Necrosis ◽  
Delayed Union ◽  
Harris Hip Score ◽  
Outcome Analysis ◽  
Fracture Union ◽  
Neck Of Femur ◽  
Strut Graft ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Fibular Strut

Introductions: Avascular necrosis and non-union are common but when the neck of femur fracture in adult is neglected, the chances of complications rises. Among various treatment options, we report the outcome of free fibular strut graft along with two cannulated hip screws in neglected fracture neck of femur. Methods: The outcome analysis of ‘fibular strut graft and two cannulated hip screws’ was conducted in patients with fracture neck of femur who presented at least three weeks after the time of injury, during August 2008 to December 2017, at Lumbini Zonal Hospital and Lumbini Hospital Technical College, Butwal, Nepal. All adult patients aged 18 to 60 years were included. Outcome variables were healing of fracture (union, delayed union, non-union), avascular necrosis and Harris Hip Score (HHS). Results: Out of 20 fractures, 17 (85%) united uneventfully, 2 (10%) had delayed union and 1 (5%) nonunion. We had 3 (15%) avascular necrosis of femoral head. The HHS was excellent in 8 (40%), good in 4 (20%), fair in 6 (30%) and poor in 2 (10%). Conclusions: Fibular Strut graft with two hip screws resulted in fracture union and improved hip functions in patients with neglected fracture of neck of femur.

scholarly journals Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

2020 ◽  
Vol 6 (5) ◽  
pp. 920
Author(s):  
Venugopal S. M. ◽  
Naveen Babu ◽  
Naresh Odnala ◽  
Gudaru Jagadesh
Keyword(s):  
Femoral Neck ◽  
Young Patients ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Osteotomy Site ◽  
Valgus Osteotomy ◽  
Neck Of Femur ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients &gt;60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.</p><p class="abstract"><strong>Conclusions:</strong> Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.</p>

scholarly journals Surgical management of basicervical fracture neck of femur with dynamic hip screw and derotation screw: a prospective study

2019 ◽  
Vol 5 (4) ◽  
pp. 712
Author(s):  
Vijaykumar S. Kulambi ◽  
Ajay Shringeri Satish ◽  
Prathik Rangaraja
Keyword(s):  
Functional Outcome ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Care Hospital ◽  
Fracture Union ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
Hip Screw ◽  
One Year ◽  
Modified Harris Hip Score

<p class="abstract"><strong>Background:</strong> Basicervical region of femur is that part of femur which is intermediate between neck and intertrochanteric region. Fracture in this region carry substantially higher chances of failure due to greater fracture angle and are rotationally unstable. If treated inadequately they carry very high chances of fracture non-union and theoretically risk of osteonecrosis. The objective of the study was to analyse functional outcome of basicervical fracture neck of femur fixation with dynamic hip screw and de-rotation screw in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> 35 cases of basicervical fracture neck of femur admitted in Chigatteri General Hospital and Bapuji Hospital affiliated to JJM Medical College Davangere, in the period of October 2015 to October 2018. Functional outcome was assessed according to Modified Harris Hip Score after one year of follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> The fracture union was found in 100% cases, average time period for fracture union was 12.28±3.71 weeks (11-15 weeks range). The results according to Modified Harris hip score were excellent in 70%, good in 11.4%. good in 5.7% and poor in 2.8% at the end of one year. The correlation analysis with Pearson’s correlation coefficient (r) was 0.74 which show a highly positive correlation between the union of basicervical fracture neck of femur with dynamic hip screw and derotation screw.</p><p><strong>Conclusions:</strong> With the study of 35 cases of basicervical fracture neck femur we conclude that these are a unique type of fractures mid-way between neck and intertrochanteric fractures with rotational and axial instability, and also risk of osteonecrosis. DHS allows for controlled collapse of the fracture for uneventful healing, and de-rotation screw gives rotational stability. </p>

Cannulated cancellous screws fixation in intracapsular fracture neck femur: a study with an emphasis on result of osteosynthesis

2016 ◽  
Vol 2 (3) ◽  
pp. 180
Author(s):  
Varun Vijay ◽  
Naveen Srivastava
Keyword(s):  
Scoring System ◽  
Screw Fixation ◽  
Fracture Site ◽  
Cancellous Screw ◽  
Intracapsular Fracture ◽  
Neck Of Femur ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Post Surgery ◽  
Fracture Neck Femur

<p class="abstract"><strong>Background:</strong> Fracture neck of femur has always presented a great challenge to the orthopaedic surgeons. It is rightly called as “unsolved fracture” as far as treatment and results are concerned. Results generally depend upon time period elapsed from fracture to surgery, adequacy of reduction and fixation. Fixation with cannulated cancellous screw is usually adequate for femoral neck fractures. The aim of the study was to analyse the results of treatment of fracture neck of femur with cannulated cancellous screw fixation and to compare the results with others in the literature using the same modality.  </p><p class="abstract"><strong>Methods:</strong> 25 patients with intra capsular neck of femur fracture were followed for a period of two years post-surgery and their functional outcome was assessed based upon harris hip scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> According to harris hip scoring system, we had excellent results in 72% cases, good in 16% cases, fair in 8% and poor in 4%. One patient went into non-union and two developed avascular necrosis of femoral head.</p><p><strong>Conclusions:</strong> Management of intracapsular fracture neck of femur with cannulated cancellous screw fixation is a very good method of treatment being a surgically easy procedure. Use of multiple cannulated cancellous screw have a compression effect at the fracture site. It also avoids re displacement and rotation.</p>

WITH REGARDS TO THE CLINICO-FUNCTIONAL OUTCOMES, IN BETWEEN FQPP OR BDSF TECHNIQUE, WHICH IS SUPERIOR, AS A CANCELLOUS SCREW FIXATION OPTION, FOR FRACTURE NECK OF FEMUR.

2021 ◽  
pp. 53-56
Author(s):  
Vijayaselvan S ◽  
Venkatachalam K
Keyword(s):  
Femoral Head ◽  
Screw Fixation ◽  
Harris Hip Score ◽  
Cancellous Screw ◽  
Neck Of Femur ◽  
Double Support ◽  
Fracture Neck Of Femur ◽  
Classi Cation ◽  
Poor Outcomes ◽  
Four Quadrant

Fracture Neck of Femur are common and one among the most challenging Orthopaedic trauma cases. Many a factors like age, time elapsed after occurrence of injury, presence of other musculo-skeletal trauma and presence of other co-morbid conditions, are all to be taken into account, before embarking on any surgical intervention. Given the precarious blood supply of the femoral head, AVN of the femoral head is a signicant complication in the displaced fractures. Among the various classication systems available, the Garden classication is still in vogue, as highlighted by Guyton J.L et al; (1). The purpose of this prospective study, is to establish the superiority or otherwise of the 'Four Quadrant Peripheral Parallel (FQPP) Screw Fixation” technique, over the “Biplanar Double Support Screw Fixation (BDSF)” technique, when opting for multiple percutaneous cancellous screw xation, for fracture neck of femur. The age group in our study included patients from 26 years to 55 years and had a total of 18 patients, who were recruited in between March 2018 to February 2020. Of these 18 patients, 9 patients were treated by the FQPP technique and another 9 patients by the BDSF technique. All cases were followed-up for at least 1 year (range: 12 to 35 months, mean 18 months). Evaluation was done by Harris Hip Score (HHS) (2). In the FQPP group, 55.56% (n=5) patients had good to excellent results, 22.22% (n=2) patients had fair and 22.22% (n=2) patients had poor outcomes. In the BDSF group 66.67% (n=6) patients had good to excellent results, 22.22% (n=2) patients had fair and 11.11% (n=1) patient had poor outcome. Thus, the results were only just marginally better for the BDSF group, in comparison to the FQPP group and hence, no substantial deductions could be made favoring the superiority of one xation type over the other.

scholarly journals A Convenient Way to do Valgus Osteotomy for Neglected Fracture Neck of Femur

2015 ◽  
Vol 11 (2) ◽  
pp. 147-151
Author(s):  
P Bansal ◽  
V Singhal ◽  
H Lal ◽  
D Mittal ◽  
RK Arya
Keyword(s):  
Young Adults ◽  
Successful Outcome ◽  
Harris Hip Score ◽  
Wedge Osteotomy ◽  
Valgus Osteotomy ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
Hip Screw ◽  
Prospective Longitudinal

Background Neglected fracture of neck of femur in young adults is a major problem in developing countries. Existing treatment options varies from osteotomy to various graft techniques (muscle pedicle, vascularized and nonvascularized fibula etc.). There is paucity of literature regarding the use of double angle barrel plate and hip screw in such cases. We conducted a prospective longitudinal observational study with displaced, neglected fracture neck of femur in young adults and compared the results with literature. Objectives The aim of this study was to determine feasibility and effectiveness of 120° double angle barrel plate and hip screw fixation in neglected fracture neck of femur. Effectiveness of fixed 30 degree closed wedge osteotomy in neglected fracture neck of femur. Methods Thirty cases of neglected (more than three weeks) femoral neck fracture (Pauwel II and III) of age 20-60 years were included in the study conducted at Postgraduate Institute Of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India in year 2004-06. Average age of the patient was 35.4 years (range, 22yrs-55yrs). In all cases internal fixation was done by 120° double angle barrel plate and hip Screw. At the end of follow-up, results were evaluated according to Askin Bryan Criteria and Harris-hip score. Results Union was achieved in 28 of 30 patients. Two patients that went into nonunion were later treated with hemireplacement arthroplasty. According to Askin Bryan Criteria at the end of study, 35% patients had excellent results, 50% patients had good results. Minimum follow-up in our study was 12 months and maximum was five years. Conclusion This study validates the use of double angled screw plate configuration for successful outcome in patients with neglected fracture neck of femur. Valgus osteotomy is also technically easy operation in hands of average trauma surgeon with the use of a fixed angle plate and hip screw.DOI: http://dx.doi.org/10.3126/kumj.v11i2.12491 Kathmandu University Medical Journal Vol.11(2) 2013: 147-151

scholarly journals PAUWEL'S OSTEOTOMY AND OSEOSYNTHESIS

2007 ◽  
Vol 14 (01) ◽  
pp. 89-96
Author(s):  
MUHAMMAD ASGHAR ◽  
MUKHTAR AHMED TARIQ ◽  
MUHAMMAD SHAFEE
Keyword(s):  
High Energy ◽  
Fracture Site ◽  
Greater Trochanter ◽  
Neck Of Femur ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Younger Age ◽  
Serious Injuries ◽  
Trauma In Elderly

Introduction:- Fracture neck of femur is one of serious injuries encountered in orthopaedic trauma management. It can result from trivial trauma in elderly but are usually the result of high-energy trauma in the younger age group. Objective- To evaluate the results of Pauwel's osteotomy and oseosynthesis in patients with non union of femoral neck fractures. Setting Orthopaedic Unit, Nishtar Hospital, Multan. Duration 1989-1998. Material and methods Sample size 30 patients. Results: 30 cases of neglected fracture neck of femur treated. 5 patients were treated first with traction where greater trochanter migrated a way up to bring it down to the proper level. Then osteotomy was done. In 25 cases Pauwels' osteotomy was primarily done and fixed with 120 degree osteotomy plate. Follow up period ranged from 7 months to 2 and half years. Patients were assessed for reduction of the fracture site in according to alignment index by Garden for union of the fracture and range of mobility and pain relief in follow up period. Conclusion:- This is a reliable method of dealing with nonunion of the fracture neck of the femur in young adults.

scholarly journals Shaft of humerus non-union: operated with fibular strut graft and long PHILOS

2021 ◽  
Vol 7 (4) ◽  
pp. 112-113
Author(s):  
Dr. Vishal Haldar ◽  
Dr. Aditya Kumar Mishra ◽  
Dr. Mohd. Bilal Kaleem ◽  
Dr. Navneet Badoni ◽  
Dr. Anshul Sethi ◽  
...  
Keyword(s):  
Strut Graft ◽  
Non Union ◽  
Fibular Strut

scholarly journals A Systematic Review On The Outcomes Of Fibular Strut Graft For Femoral Neck Fractures In Adults

2021 ◽  
Vol 4 (1) ◽  
pp. 66
Author(s):  
Bintang Soetjahjo ◽  
Udi Heru Nefihancoro ◽  
Rieva Ermawan ◽  
Gilang Teguh Pratama
Keyword(s):  
Systematic Review ◽  
Femoral Neck ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Cochrane Library ◽  
Bony Union ◽  
Scientific Publications ◽  
Strut Graft ◽  
Non Union ◽  
Fibular Strut

Introduction: Femoral neck fractures are a type of intracapsular hip fracture which also be found in younger patients who suffered from high-energy trauma such as vehicle accidents. Non-union and avascular necrosis are the most frequent complications following femoral neck fractures. In this study, we reviewed the outcomes of fibular grafting techniques for femoral neck fractures in adults.Method: Online libraries PubMed, Cochrane Library and Scopus were searched for relevant papers. We searched for scientific publications published between 2009 and 2020. Inclusion and exclusion criteria were used, and prespecified characteristic were extracted from each study.Result: We found 172 papers relevant to the topic. At last, we included 6 papers in this systematic review with a total of 198 patients. Fibular strut graft for femoral neck fractures have shown excellent outcomes, uniting 177 (89,39%) of 198 fractures reviewed. Overall, 15 patients (7,57%) experiencing non-union and 12 patients (6,06%) having avascular necrosis.Conclusion: The outcomes of the intervention turned out to be excellent, assessed by both functional outcome criteria and radiographic bony union. It is important to established a consensus on surgical intervention for femoral neck fractures, specifically including fibular strut grafting.

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