BACKGROUND Spontaneous bilateral femur neck fracture is a rare entity in the general population.CASE SUMMARY A 17-year-old immobile,developmentally delayed male with the sequelae of cerebral palsy fractured both femor...BACKGROUND Spontaneous bilateral femur neck fracture is a rare entity in the general population.CASE SUMMARY A 17-year-old immobile,developmentally delayed male with the sequelae of cerebral palsy fractured both femoral necks during a grand mal epileptic seizure.He had been treated with valproic acid as an antiseizure medication for about 10years;otherwise,he had no history of drug use.The laboratory analysis was normal except a marked vitamin D deficiency.Closed reduction and osteosynthesis with percutaneous cannulated screws were performed.Solid union was observed at 6 mo,and rapid postoperative rehabilitation was started.CONCLUSION A femoral neck fracture may occur in a person with epilepsy presenting with hip pain in the emergency department.展开更多
Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The ...Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.展开更多
BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of...BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.展开更多
Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip f...Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.展开更多
Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynt...Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynthesis method has not been elucidated yet. This study investigated the displacement direction of the femoral head fragment and its effect on the bone using finite element method. A finite element model for CSFF was developed from CT image data of a patient with osteoporosis using Mechanical Finder (ver. 11). Subsequently, finite element analyses were performed on six osteosynthesis models under maximum load applied during walking. The compressive stresses, tensile stresses, and compressive strains of each model were examined. The results suggested that the compressive and tensile stress distributions were concentrated on the anterior side of the femoral neck. Compressive strain distribution in the femoral head and neck was concentrated in four areas: at the tip of the blade or lag screw, the anteroinferior side of the blade or lag screw near the fracture site, and the upper right and lower left near the junction of the blade or lag screw and nail. Thus, the distribution of both these stresses revealed that the femoral head fragment was prone to anterior and inferior displacement. Distribution of compressive strains revealed the direction of the stress exerted by the osteosynthetic implant on the bone. The same results were observed in all osteosynthetic implants;thus, the findings could lay the foundation for developing methods for placing osteosynthetic implants less prone to displacement and the osteosynthetic implants themselves. In particular, the study provides insight into the optimal treatment of CSFF.展开更多
目的:通过分析基于QCT数据计算机辅助检测系统(CAD)与双能X线吸收仪(DXA)在股骨颈骨密度(BMD)测量上的相关性,探讨基于QCT数据CAD在BMD检测的准确性、有效性。方法:本研究通过中国医科大学盛京医院伦理委员会同意招募50例健康志愿者,平...目的:通过分析基于QCT数据计算机辅助检测系统(CAD)与双能X线吸收仪(DXA)在股骨颈骨密度(BMD)测量上的相关性,探讨基于QCT数据CAD在BMD检测的准确性、有效性。方法:本研究通过中国医科大学盛京医院伦理委员会同意招募50例健康志愿者,平均年龄57岁,男9例,女41例。本研究对象均行Philips Brilliance型64排螺旋CT扫描和Nor-land XR-36型DXA测量股骨颈BMD,螺旋CT扫描时垫有CT设备通用性体模的双股骨上段。应用OsteoCAD1.1软件分析同侧股骨颈CT数据,测得BMD。应用SPSS11.0统计、对比OsteoCAD软件分析测量股骨颈BMD和DXA测量股骨颈骨密度的各组数据。结果:①OsteoCAD软件分析测量股骨颈BMD结果:松质骨BMD:均值(216.05±60.80)mg/cm3;整体骨BMD:均值(344.61±66.93)mg/cm3;皮质骨BMD:均值(538.54±60.95)mg/cm3。DXA测量股骨颈BMD结果:均值(0.8029±0.1265)g/cm2。②SPSS Linear Regression法显示上述两组数据均呈直线相关,相关系数分别为r松质骨=0.873、r整体骨=0.817、r皮质骨=0.735,经t检验,相关系数均具有高度的统计学意义(P<0.001)。结论:OsteoCAD软件能够自动划分并测量皮质骨、小梁骨,和测量股骨颈长度及最小截面积,可以准确、有效地反映骨强度信息。展开更多
文摘BACKGROUND Spontaneous bilateral femur neck fracture is a rare entity in the general population.CASE SUMMARY A 17-year-old immobile,developmentally delayed male with the sequelae of cerebral palsy fractured both femoral necks during a grand mal epileptic seizure.He had been treated with valproic acid as an antiseizure medication for about 10years;otherwise,he had no history of drug use.The laboratory analysis was normal except a marked vitamin D deficiency.Closed reduction and osteosynthesis with percutaneous cannulated screws were performed.Solid union was observed at 6 mo,and rapid postoperative rehabilitation was started.CONCLUSION A femoral neck fracture may occur in a person with epilepsy presenting with hip pain in the emergency department.
文摘Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
文摘BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.
文摘Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.
文摘Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynthesis method has not been elucidated yet. This study investigated the displacement direction of the femoral head fragment and its effect on the bone using finite element method. A finite element model for CSFF was developed from CT image data of a patient with osteoporosis using Mechanical Finder (ver. 11). Subsequently, finite element analyses were performed on six osteosynthesis models under maximum load applied during walking. The compressive stresses, tensile stresses, and compressive strains of each model were examined. The results suggested that the compressive and tensile stress distributions were concentrated on the anterior side of the femoral neck. Compressive strain distribution in the femoral head and neck was concentrated in four areas: at the tip of the blade or lag screw, the anteroinferior side of the blade or lag screw near the fracture site, and the upper right and lower left near the junction of the blade or lag screw and nail. Thus, the distribution of both these stresses revealed that the femoral head fragment was prone to anterior and inferior displacement. Distribution of compressive strains revealed the direction of the stress exerted by the osteosynthetic implant on the bone. The same results were observed in all osteosynthetic implants;thus, the findings could lay the foundation for developing methods for placing osteosynthetic implants less prone to displacement and the osteosynthetic implants themselves. In particular, the study provides insight into the optimal treatment of CSFF.
文摘目的:通过分析基于QCT数据计算机辅助检测系统(CAD)与双能X线吸收仪(DXA)在股骨颈骨密度(BMD)测量上的相关性,探讨基于QCT数据CAD在BMD检测的准确性、有效性。方法:本研究通过中国医科大学盛京医院伦理委员会同意招募50例健康志愿者,平均年龄57岁,男9例,女41例。本研究对象均行Philips Brilliance型64排螺旋CT扫描和Nor-land XR-36型DXA测量股骨颈BMD,螺旋CT扫描时垫有CT设备通用性体模的双股骨上段。应用OsteoCAD1.1软件分析同侧股骨颈CT数据,测得BMD。应用SPSS11.0统计、对比OsteoCAD软件分析测量股骨颈BMD和DXA测量股骨颈骨密度的各组数据。结果:①OsteoCAD软件分析测量股骨颈BMD结果:松质骨BMD:均值(216.05±60.80)mg/cm3;整体骨BMD:均值(344.61±66.93)mg/cm3;皮质骨BMD:均值(538.54±60.95)mg/cm3。DXA测量股骨颈BMD结果:均值(0.8029±0.1265)g/cm2。②SPSS Linear Regression法显示上述两组数据均呈直线相关,相关系数分别为r松质骨=0.873、r整体骨=0.817、r皮质骨=0.735,经t检验,相关系数均具有高度的统计学意义(P<0.001)。结论:OsteoCAD软件能够自动划分并测量皮质骨、小梁骨,和测量股骨颈长度及最小截面积,可以准确、有效地反映骨强度信息。
