Femoral neck stress fractures （FNSFs） are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic di...Femoral neck stress fractures （FNSFs） are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers with- out underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and sub- trochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on oneside and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular ne- crosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in pa- tients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation.展开更多
Objective： To validate the hypothesis that there exists an optimal axial compression stress range to enhance tibial fracture healing.Methods： Rabbits with a surgically induced V-shaped tibial fracture were separated...Objective： To validate the hypothesis that there exists an optimal axial compression stress range to enhance tibial fracture healing.Methods： Rabbits with a surgically induced V-shaped tibial fracture were separated into 2 main groups： the control group （C Group, n=6） without application of any axial compression stress stimulation postoperatively and the stimulation group （ S Group, n=90）. The S Group was further divided into 20 subgroups （S11 to S54） in terms of 5 axial compression stress stimulation levels （112.8 kPa, 289.8kPa, 396.5 kPa, 472.7 kPa, and 602.3 kPa） and 4 experimental endpoints （1, 3, 5 and 8 weeks after operation）. A custom made circular external fixator was used to provide the axial compression stress of the fracture sites. Based on X-ray observation, a fracture healing scoring system was created to evaluate the fracture healing process.Results： At 8 weeks after operation, there existed a ＂⌒-shape＂ relationship between healing score and axial compression stress stimulation level of fracture site. The optimal axial compression stress stimulation ranged from 289.8 kPa to 472.7 kPa, accompanying the best fracture healing, i.e. the fracture line became indistinct or almost disappeared, and a lot of callus jointed the two fracture ends. Meanwhile, at 5 weeks after operation, corresponding to the relatively low healing scores, there was a fracture healing performance similar to that at 8 weeks. Besides, at 1 or 3 weeks after operation, for all the axial compression stress levels （0-602.3 kPa）, no obvious healing effect was found.Conclusions： It is implied from the stated X-ray observation results in this study that the potential optimal axial compression stress stimulation and optimal fracture healing time are available. The axial compression stress level of 289.8-472.7 kPa and fracture healing time of more than 8 weeks jointly comprise the optimal axial compression stress stimulation conditions to enhance tibial fracture healing.展开更多
文摘Femoral neck stress fractures （FNSFs） are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers with- out underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and sub- trochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on oneside and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular ne- crosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in pa- tients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation.
基金This work was supported by grants from the Chongqing Academician Foundation （No. 1998-93）, the National Natural Science Foundation of China （No. 30122202 and No. 30928005） and the Third Military Medical University Research Foundation （No. 2009 XHG16）,
文摘Objective： To validate the hypothesis that there exists an optimal axial compression stress range to enhance tibial fracture healing.Methods： Rabbits with a surgically induced V-shaped tibial fracture were separated into 2 main groups： the control group （C Group, n=6） without application of any axial compression stress stimulation postoperatively and the stimulation group （ S Group, n=90）. The S Group was further divided into 20 subgroups （S11 to S54） in terms of 5 axial compression stress stimulation levels （112.8 kPa, 289.8kPa, 396.5 kPa, 472.7 kPa, and 602.3 kPa） and 4 experimental endpoints （1, 3, 5 and 8 weeks after operation）. A custom made circular external fixator was used to provide the axial compression stress of the fracture sites. Based on X-ray observation, a fracture healing scoring system was created to evaluate the fracture healing process.Results： At 8 weeks after operation, there existed a ＂⌒-shape＂ relationship between healing score and axial compression stress stimulation level of fracture site. The optimal axial compression stress stimulation ranged from 289.8 kPa to 472.7 kPa, accompanying the best fracture healing, i.e. the fracture line became indistinct or almost disappeared, and a lot of callus jointed the two fracture ends. Meanwhile, at 5 weeks after operation, corresponding to the relatively low healing scores, there was a fracture healing performance similar to that at 8 weeks. Besides, at 1 or 3 weeks after operation, for all the axial compression stress levels （0-602.3 kPa）, no obvious healing effect was found.Conclusions： It is implied from the stated X-ray observation results in this study that the potential optimal axial compression stress stimulation and optimal fracture healing time are available. The axial compression stress level of 289.8-472.7 kPa and fracture healing time of more than 8 weeks jointly comprise the optimal axial compression stress stimulation conditions to enhance tibial fracture healing.
