Posts

The ‘Unsolved’ Fracture Neck of Femur– A Comprehensive Review

Vol. 9 | Issue 2 | August-September 2021 | Page: 02-11 | Sandeep Vijayan, Nikhil Hegde, Mahesh Suresh Kulkarni, Monappa Naik Aroor, Vishweshwar Bhat, Sharath K Rao

DOI:10.13107/jkoa.2021.v09i02.038


Authors: Sandeep Vijayan [1], Nikhil Hegde [1], Mahesh Suresh Kulkarni [1], Monappa Naik Aroor [1], Vishweshwar Bhat [1], Sharath K Rao [1]

[1] Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, India.

Address of Correspondence
Dr. Mahesh Suresh Kulkarni,
Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, India.
E-mail: maheshskulkarnibmc@gmail.com


Abstract


Introduction: Fractures involving the neck of the femur constitute a small proportion of total fractures in the body. Though these fractures mainly occur in the elderly population, their occurrence in youngsters due to high-velocity trauma is not uncommon. These fractures are commonly termed the ‘unsolved fractures’ as the outcome of these fractures are highly variable. The peculiar anatomy and precarious blood supply to the proximal femur and intracapsular location create an unfavourable biological environment for fracture union. The lack of prospective clinical trials which have evaluated the ideal surgical timing, technique and construct of the implant further adds to the confusion.
Discussion: The aim of this review was to go through the recent relevant literature on the management of femoral neck fractures to find out the answers to the debated questions and to summarize the current diagnostic and management approaches to a patient with a suspected fracture neck of the femur.
Conclusion: Knowing the patient and fracture related factors which influence the outcome are extremely important to achieve the goal of early uncomplicated fracture healing. This would help the surgeon in the thoughtful selection of the operative intervention for each patient on an individual basis and facilitate a thorough discussion between the surgeon and the patient which is vital in decision making.
Keywords: Closed reduction, Hemiarthroplasty, Hip fractures, Intracapsular, Neck of Femur, Pauwel


References


[1] Yin H, Pan Z, Jiang H. Is dynamic locking plate(Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis. International Journal of Surgery 2018; 52: 30–34.
[2] Schwartsmann CR, Lammerhirt HM, Spinelli L de F, et al. Treatment of displaced femoral neck fractures in young patients with DHS and its association to osteonecrosis. Revista Brasileira de Ortopedia (English Edition) 2018; 53: 82–87.
[3] Wang Y, Ma J, Yin T, et al. Correlation Between Reduction Quality of Femoral Neck Fracture and Femoral Head Necrosis Based on Biomechanics. Orthop Surg 2019; 11: 318–324.
[4] Goudie EB, Duckworth AD, White TO. Hip fractures in young adults. Orthopaedics and Trauma 2017; 31: 76–85.
[5] Papakostidis C, Panagiotopoulos A, Piccioli A, et al. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome. Injury 2015; 46: 459–466.
[6] Pauyo T, Drager J, Albers A, et al. Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop 2014; 5: 204–217.
[7] Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am 2008; 90: 2254–2266.
[8] Falk NW L, D K, M H, et al. Trans-Cervical Femoral Fractures in Young Adults: The Prognosis is not only in the Hands of Orthopaedic Surgeons. Emerg Med 2018; 08: 1–8.
[9] Rogmark C, Kristensen MT, Viberg B, et al. Hip fractures in the non-elderly—Who, why and whither? Injury 2018; 49: 1445–1450.
[10] Duckworth AD, Bennet SJ, Aderinto J, et al. Fixation of intracapsular fractures of the femoral neck in young patients: RISK FACTORS FOR FAILURE. The Journal of Bone and Joint Surgery British volume 2011; 93-B: 811–816.
[11] Stacey SC, Renninger CH, Hak D, et al. Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol 2016; 26: 355–363.
[12] Florschutz AV, Langford JR, Haidukewych GJ, et al. Femoral Neck Fractures: Current Management. Journal of Orthopaedic Trauma 2015; 29: 121–129.
[13] Rawall S, Bali K, Upendra B, et al. Displaced femoral neck fractures in the young: significance of posterior comminution and raised intracapsular pressure. Arch Orthop Trauma Surg 2012; 132: 73–79.
[14] Cheung R. Neck of femur fracture: perioperative management. Update in Anaesthesia 2016; 31: 43–47.
[15] Mahajan RH, Kumar S, Mishra B. Technique for gentle accurate reproducible closed reduction of intracapsular fracture of neck of femur. Injury 2017; 48: 789–790.
[16] Flynn M. A new method of reduction of fractures of the neck of the femur based on anatomical studies of the hip joint. Injury 1974; 5: 309–317.
[17] Ye Y, Chen K, Tian K, et al. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results. Injury 2017; 48: 2189–2193.
[18] Su Y, Chen W, Zhang Q, et al. An irreducible variant of femoral neck fracture: a minimally traumatic reduction technique. Injury 2011; 42: 140–145.
[19] Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma 2013; 27: e254-259.
[20] Pal C, Pruthi K, Singh P, et al. Role of proximal femoral nailing in fracture neck of femur. J Orthop Traumatol Rehabil 2014; 7: 59–63.
[21] Maruenda JI, Barrios C, Gomar-Sancho F. Intracapsular hip pressure after femoral neck fracture. Clin Orthop Relat Res 1997; 172–180.
[22] Liu C, Von Keudell A, McTague M, et al. Ideal length of thread forms for screws used in screw fixation of nondisplaced femoral neck fractures. Injury 2019; 50: 727–732.
[23] Augat P, Bliven E, Hackl S. Biomechanics of Femoral Neck Fractures and Implications for Fixation. Journal of Orthopaedic Trauma 2019; 33: S27–S32.
[24] Zhuang L, Wang L, Xu D, et al. Anteromedial femoral neck plate with cannulated screws for the treatment of irreducible displaced femoral neck fracture in young patients: a preliminary study. Eur J Trauma Emerg Surg 2019; 45: 995–1002.
[25] Zhang B, Liu J, Zhu Y, et al. A new configuration of cannulated screw fixation in the treatment of vertical femoral neck fractures. International Orthopaedics (SICOT) 2018; 42: 1949–1955.
[26] Guo J, Dong W, Qin S, et al. Definition of ideal configuration for femoral neck screw fixation in older people. Sci Rep 2019; 9: 12895.
[27] Callaghan JJ, Liu SS, Haidukewych GJ. Subcapital fractures: a changing paradigm. The Journal of Bone and Joint Surgery British volume 2012; 94-B: 19–21.
[28] Giordano V, Paes RP, Alves DD, et al. Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: a comparative mechanical study. Eur J Orthop Surg Traumatol 2018; 28: 1359–1367.
[29] Guimarães JAM, Rocha LR, Noronha Rocha TH, et al. Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw. Injury 2017; 48: S10–S16.
[30] Chiang M-H, Wang C-L, Fu S-H, et al. Does fully-threaded Headless Compression Screw provide a length-stable fixation in undisplaced femoral neck fractures? Asian Journal of Surgery 2019; 42: 320–325.
[31] Filipov O. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Traumatol 2011; 21: 539–543.
[32] Kalia A, Singh J, Ali N. Role of Biplane Double Supported Screw Fixation For Fracture Neck Femur In Elderly Population: A Prospective Study. TOORTHJ 2018; 12: 514–524.
[33] Stoffel K, Zderic I, Gras F, et al. Biomechanical Evaluation of the Femoral Neck System in Unstable Pauwels III Femoral Neck Fractures: A Comparison with the Dynamic Hip Screw and Cannulated Screws. J Orthop Trauma 2017; 31: 131–137.
[34] Zhou X, Li Z, Xu R, et al. Comparison of Early Clinical Results of Femoral Neck System and Cannulated Screws in the Treatment of Unstable Femoral Neck Fractures. Preprint, In Review. Epub ahead of print 18 December 2020. DOI: 10.21203/rs.3.rs-129837/v1.
[35] Samsami S, Saberi S, Sadighi S, et al. Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations. J Med Biol Eng 2015; 35: 566–579.
[36] Guo J, Dong W, Yin B, et al. Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures. J Int Med Res 2019; 47: 557–568.
[37] Giordano V, Alves DD, Paes RP, et al. The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws. J EXP ORTOP 2019; 6: 18.
[38] Dolatowski FC, Frihagen F, Bartels S, et al. Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled Trial. The Journal of Bone and Joint Surgery 2019; 101: 136–144.
[39] Robertson GA, Wood AM. Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence? WJO 2018; 9: 235–244.
[40] Baker RP, Squires B, Gargan MF, et al. Total Hip Arthroplasty and Hemiarthroplasty in Mobile, Independent Patients with a Displaced Intracapsular Fracture of the Femoral Neck: A Randomized, Controlled Trial. JBJS 2006; 88: 2583–2589.
[41] Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. Journal of Clinical Epidemiology 1994; 47: 1245–1251.
[42] Bigoni M, Turati M, Leone G, et al. Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate. Aging Clin Exp Res 2020; 32: 1173–1178.
[43] Schmidt AH, Leighton R, Parvizi J, et al. Optimal Arthroplasty for Femoral Neck Fractures: Is Total Hip Arthroplasty the Answer? Journal of Orthopaedic Trauma 2009; 23: 428–433.
[44] Miller CP, Buerba RA, Leslie MP. Preoperative Factors and Early Complications Associated With Hemiarthroplasty and Total Hip Arthroplasty for Displaced Femoral Neck Fractures. Geriatr Orthop Surg Rehabil 2014; 5: 73–81.
[45] Blomfeldt R, Törnkvist H, Eriksson K, et al. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. JBJS 2007; 89: 160–165.
[46] Hedbeck CJ, Enocson A, Lapidus G, et al. Comparison of Bipolar Hemiarthroplasty with Total Hip Arthroplasty for Displaced Femoral Neck Fractures: A Concise Four-Year Follow-up of a Randomized Trial*. JBJS 2011; 93: 445–450.
[47] Nikitovic M. Total Hip Arthroplasty Versus Hemiarthroplasty for Displaced Femoral Neck Fractures: A Rapid Review. Rapid Review 2013; 1–22.
[48] Maceroli M, Nikkel LE, Mahmood B, et al. Total Hip Arthroplasty for Femoral Neck Fractures: Improved Outcomes With Higher Hospital Volumes. Journal of Orthopaedic Trauma 2016; 30: 597–604.
[49] Ukaj S, Zhuri O, Ukaj F, et al. Dual Mobility Acetabular Cup Versus Hemiarthroplasty in Treatment of Displaced Femoral Neck Fractures in Elderly Patients: Comparative Study and Results at Minimum 3-Year Follow-up. Geriatr Orthop Surg Rehabil 2019; 10: 1–7.
[50] Hedbeck CJ, Blomfeldt R, Lapidus G, et al. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. International Orthopaedics (SICOT) 2011; 35: 1703–1711.
[51] Pace TB, Prather B, Burnikel B, et al. Comparative Outcomes Assessment: Hip Hemiarthroplasty as an Alternative to THA in Patients with Surgically Pristine Acetabulum—Is There Still a Role? ISRN Orthopedics 2013; 2013: 1–6.
[52] Sawadogo M, Kafando H, Ouedraogo S, et al. Is Head and Neck Resection of the Femur (Girdlestone’s Procedure) Still Relevant? Indications and Results About 24 Cases. TOORTHJ 2018; 12: 69–74.


How to Cite this article: Vijayan S, Hegde N, Kulkarni MS, Aroor MN, Bhat V, Rao SK | The ‘Unsolved’ Fracture Neck of Femur– A Comprehensive Review | Journal of Karnataka Orthopaedic Association | August-
September 2021; 9(2): 2-11.

 


                                          (Abstract Text HTML)      (Download PDF)


Functional Outcome of Unipolar (Austin Moore’s) versus Uncemented Bipolar Hemiarthroplasty of Hip at 1-Year Follow-up

Vol. 9 | Issue 1 | January-February 2021 | Page: 36-40 | Prashanth Dhanraj, Eshwar patel, Harish Kodi, Lokesh Gupta, Sunkoj Krishna sai


Authors: Prashanth Dhanraj [1], Eshwar patel [1], Harish Kodi [1], Lokesh Gupta [1], Sunkoj Krishna sai [1]

[1] Department of Orthopaedics, Kamineni Institute of medical sciences, Telangana, India.

Address of Correspondence
Dr. Prashanth Dhanraj
Assistant Professor, Department of Orthopaedics, Kamineni Institute of medical sciences, Telangana, India.
E-mail: plachuriye@yahoo.co.in

 


Abstract


Background: Fracture neck of the femur leads to significant morbidity and mortality in elderly population. Various surgical options are available for the treatment in the elderly, but the gold standard between Austin Moore’s prosthesis and bipolar prosthesis is always debated. Hence, we designed a short-term prospective study to compare the monopolar and bipolar hemiarthroplasty in the elderly having fracture neck of the femur.
Materials and Methods: We conducted a prospective study at a tertiary hospital between 2017 and 2019. In our study, we enrolled 30 patients in each group. Patients in Group A (monopolar) underwent Austin Moore’s hemiarthroplasty and in Group B (Bipolar) underwent uncemented bipolar hemiarthroplasty by standard posterolateral approach. Patients were treated by standard protocols and analyzed at regular intervals with final assessment done at the end of 1 year. Functional outcome was evaluated using Harris Hip Score.
Results: Out of total 60 patients, 51 were evaluated at the end of 1 year. Mean age of population was 66.58 ± 5.96 in monopolar and 64.68 ± 7.48 in bipolar group. Harris Hip Score was 86.58 ± 5.42 in monopolar and 88.52 ± 3.08 in bipolar group. Pain was 38.69 ± 3.58 in monopolar and 40.20 ± 1.50 in bipolar group. Functional status was 39.72 ± 3.00 in monopolar group and 39.58 ±3.45 in bipolar group. Excellent outcome was noted in 13 of monopolar and 15 of bipolar patients seven 7 complications in monopolar and six in bipolar group, respectively.
Conclusion: In our study, we had comparable functional (Harris Hip Score) results in the monopolar and bipolar prosthesis groups, though more excellent outcomes and less complications were encountered in the bipolar group than monopolar which is statistically insignificant at the end of 1 year.
Keywords: Austin Moore, Bipolar, Hemiarthroplasty, Monopolar, Neck of femur fracture, Hemireplacement.

 


References


1. Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 2016;98-B:291-7.
2. Leonardsson O, Garellick G, Kärrholm J, Åkesson K, Rogmark C. Changes in implant choice and surgical technique for hemiarthroplasty: 21, 346 procedures from the Swedish hip arthroplasty register 2005-2009. Acta Orthop 2012;83:7-13.
3. Zhou Z, Yan F, Sha W, Wang L, Zhang X. Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures in elderly patients. Orthopedics 2015;38:697-702.
4. Wang F, Zhang H, Zhang Z, Ma C, Feng X. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis. BMC Musculoskelet Disord 2015;16:229.
5. Liu Y, Tao X, Wang P, Zhang Z, Zhang W, Qi Q. Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures. Int Orthop 2014;38:1691-6.
6. Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am 2003;85:899-904.
7. Sabnis BM, Brenkel IJ. Unipolar versus bipolar uncemented hemiarthroplasty for elderly patients with displaced intracapsular femoral neck fractures. J Orthop Surg (Hong Kong) 2011;19:8-12.
8. Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: A concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 2011;93:445-50.
9. Rodríguez-Merchán EC. Displaced intracapsular hip fractures: Hemiarthroplasty or total arthroplasty? Clin Orthop Relat Res 2002;399:72-7.
10. Alazzawi S, de Rover WB, Brown J, Davis B. The conversion rate of bipolar hemiarthroplasty after a hip fracture to a total hip arthroplasty. Clin Orthop Surg 2012;4:117-20.
11. Sharkey PF, Hozack J, Rothman H. Conversion of hemiarthroplasty to total hip arthroplasty: Can groin pain be eliminated? J Arthroplasty 1998;13:627-30.
12. Inngul C, Hedbeck CJ, Blomfeldt R, Lapidus G, Ponzer S, Enocson A. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: A four-year follow-up of a randomised controlled trial. Int Orthop 2013;37:2457-64.
13. Somashekar, Krishna SV, Murthy JS. Treatment of femoral neck fractures: Unipolar versus bipolar hemiarthroplasty. Malays Orthop J 2013;7:6-11.
14. Enocson A, Hedbeck CJ, Törnkvist H, Tidermark J, Lapidus LJ. Unipolar versus bipolar Exeter hip hemiarthroplasty: A prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop 2012;36:711-7.
15. Jia Z, Ding F, Wu Y, Li W, Li H, Wang D, et al. Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: A systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2015;10:8.
16. Ayhan E, Kesmezacar H, Karaman O, Sahin A, Kir N. Bipolar or unipolar hemiarthroplasty after femoral neck fracture in the geriatric population. Balkam Med J 2013;30:400-5.
17. Jeffcote B, Li MG, Barnet‐Moorcroft A, Wood D, Nivbrant B. Roentgen stereophotogrammetric analysis and clinical assessment of unipolar versus bipolar hemiarthroplasty for subcapital femur fracture: A randomized prospective study. ANZ J Surg 2010;80:242-6.
18. Barnes CL, Berry DJ, Sledge CB. Dislocation after bipolar hemiarthroplasty of the hip. J Arthroplasty 1995;10:667-9.
19. Phillips T. The Bateman bipolar femoral head replacement. A fluoroscopic study of movement over a four-year period. J Bone Joint Surg Br 1987;69:761-4.
20. Varley J, Parker MJ. Stability of hip hemiarthroplasties. Int Orthop 2004;28:274-7.
21. Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ. Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: A randomised prospective study. J Bone Joint Surg Br 1996;78:391-4.
22. Ong BC, Maurer SG, Aharonoff GB, Zuckerman JD, Koval KJ. Unipolar versus bipolar hemiarthroplasty: Functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up. J Orthop Trauma 2002;16:317-22.
23. Leonardsson O, Kärrholm J, Åkesson K, Garellick G, Rogmark C. Higher risk of reoperation for bipolar and uncemented hemiarthroplasty: 23, 509 procedures after femoral neck fractures from the Swedish hip arthroplasty register, 2005-2010. Acta Orthop 2012;83:459-66.
24. Calton TF, Fehring TK, Griffin WL, Mccoy TH. Failure of the polyethylene after bipolar hemiarthroplasty of the hip. A report of five cases. J Bone Joint Surg Am 1998;80:420-3.
25. Gilbert MS, Capozzi J. Unipolar or bipolar prosthesis for the displaced intracapsular hip fracture? An unanswered question. Clin Orthop Relat Res 1998;353:81-5.
26. Raia FJ, Chapman CB, Herrera MF, Schweppe MW, Michelsen CB, Rosenwasser MP. Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res 2003;414:259-65.
27. Bhattacharyya T, Koval KJ. Unipolar versus bipolar hemiarthroplasty for femoral neck fractures: Is there a difference? J Orthop Trauma 2009;23:426-7.


How to Cite this article:  Dhanraj P, Patel E, Kodi H, Gupta L, Sai SK | Functional Outcome of Unipolar (Austin Moore’s) Versus Uncemented Bipolar Hemiarthroplasty of Hip at 1-Year Follow-up | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 36-40.

 


 


                                          (Abstract    Full Text HTML)      (Download PDF)