Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report

BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.

Current concepts in the management of radial head fractures

Fracture of the radial head is a common injury. Over the last decades, the radial head is increasingly recognized as an important stabilizer of the elbow. In order to maintain stability of the injured elbow, goals of treatment of radial head fractures have become more and more towards restoring function and stability of the elbow. As treatment strategies have changed over the years, with an increasing amount of literature on this subject, the purpose of this article was to provide an overview of current concepts of the management of radial head fractures.

Incidence and analysis of radial head and neck fractures

AIM: To investigate several complications like persistent radial head dislocation, forearm deformity, elbow stiffness and nerve palsies, associated with radial head fractures. METHODS: This study reviewed the clinical records and trauma database of this level Ⅰ Trauma Center and identified all patients with fractures of the radial head and neck who where admitted between 2000 and 2010. An analysis of clinical records revealed 1047 patients suffering from fractures of the radial head or neck classified according to Mason. For clinical examination, range of motion, local pain and overall outcome were assessed. RESULTS: The incidence of one-sided fractures was 99.2% and for simultaneous bilateral fractures 0.8%. Non-operative treatment was performed in 90.4%(n = 947) of the cases, surgery in 9.6%(n = 100). Bony union was achieved in 99.8%(n = 1045) patients. Full satisfaction was achieved in 59%(n = 615) of the patients. A gender related significant difference(P = 0.035) in Mason type distribution-type Ⅲ fractures were more prominent in male patients vs type Ⅳ fractures in female patients-was observed in our study population. CONCLUSION: Mason typeⅠfractures can be treated safe conservatively with good results. In type Ⅱ to Ⅳ surgical intervention is usually considered to be indicated.

Therapeutic Effect of Artificial Femoral Head Replacement and Proximal Femoral Nail Antirotation on Elderly Unstable Intertrochanteric Fractures

Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.

Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis

BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized with controversial results;surgical hip dislocation(SHD)is among these approaches,with the reputation of being demanding and leading to higher complication rates.AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODS Major databases including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs.We extracted basic studies data,surgery-related data,functional outcomes,radiological outcomes,and postoperative complications.We calculated the mean differences for continuous data with 95%confidence intervals for each outcome and the odds ratio with 95%confidence intervals for binary outcomes.P<0.05 was considered significant.RESULTS Our search retrieved nine studies meeting our inclusion criteria,with a total of 129 FHFs.The results of our analysis revealed that the average operation time was 123.74 min,while the average blood loss was 491.89 mL.After an average followup of 38.4 mo,a satisfactory clinical outcome was achieved in 85%of patients,ranged from 30%to 86%,with avascular necrosis,heterotopic ossification,and osteoarthritis being the most common complications occurring at an incidence of 12%,25%,and 16%,respectively.Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4%and 3.8%,respectively.CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis,the formation of heterotopic ossification,and the development of posttraumatic osteoarthritis;however,it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.

Solute Removal Analysis of a Large-Scale Fracture Plane Considering Different Flow Paths and Different Hydraulic Head Differences

An experimental and numerical study was carried out to investigate the solute removal process through a large-scale fracture plane considering different flow paths and hydraulic head differences.The visualization techniques were utilized in the experiment to capture the removal process images,which were then transferred to binary images.The variations in dimensionless concentration,which is defined as saturation of solute phase,were analyzed.With increasing hydraulic head difference,the speed of solute removal increases and the dimensionless concentration decreases.The flow paths result in different solute distribution patterns and different mechanisms for solute removal such as advection and diffusion,thus the curves of dimensionless concentration versus time are different.The dimensionless concentration over time decreases from approximately 1,which is smaller than 1 due to the existence of bubbles,to approximately 0,which is larger than 0 because the folds of the background are dealt as“solute”.A significant longer time is needed to achieve a certain fixed dimensionless concentration for a smaller hydraulic head difference.With the finite element software COMSOL multiphysics,the solute removal process,flow velocity fields,flow streamlines,as well as the hydraulic pressure fields were analyzed,which shows a good consistency with the experimental results.In practical engineering,when the solute pollutes the underground environment,the removal ability can be more significantly enforced by immediately applying a larger hydraulic head difference along a longer distance between the inlet and outlet boundaries.

The Early Outcomes with Titanium Radial Head Implants in the Treatment of Radial Head Comminuted Fractures

The study assessed the early functional outcomes with cemented titanium implants of radius in the treatment of comminuted fractures of radial heads. The functional outcomes of arthro- plasty with cemented titanium implants of radius in the treatment of radial head fractures （Mason Type Ⅲ： 6; Mason Type Ⅳ： 4） in l0 consecutive patients （mean age, 38 years） were evaluated over a mean time of 23.7 months （18-31 months）. The patients were assessed on the basis of physical examination, functional rating （Mayo） and radiographic findings. The parameters evaluated included motion, stability, pain, and grip strength. Five patients were considered to have excellent results, 4 patients had good results and l patient had fairly good results. There were no cases of infection, prosthetic failure, heterotopic ossification or dislocation. When medial collateral ligament was injured, radial head became the main stabilizing structure of the elbow. Titanium radial head implant may provide the stability similar to that of native radial head. We believe that titanium radial head im- plants may be indicated for the Mason Type Ⅲ and Mason Type IV radial head fractures.

Open reduction and Herbert screw fixation of Pipkin type IV femoral head fracture in an adolescent:A case report

BACKGROUND Femoral head fracture is extremely rare in children.This may be the youngest patient with femoral head fracture ever reported in the literature.There are few pediatric studies that focus on cases treated with open reduction via the modified Hardinge approach.CASE SUMMARY A 14-year-old female adolescent suffered a serious traffic accident when she was sitting on the back seat of a motorcycle.A pelvic radiograph and computed tomography revealed a proximal femoral fracture and slight acetabular rim fracture.This was diagnosed as a Pipkin type IV femoral head fracture.An open reduction and Herbert screw fixation was performed via a modified Hardinge approach.After 1-year follow-up,the patient could walk without aid and participate in physical activities.The X-ray results showed that the fractures healed well with no evidence of complications.CONCLUSION Open reduction and Herbert screw fixation is an available therapy to treat Pipkin type IV femoral head fractures in children.

Treatment of Fracture Dislocation of the Femoral Head in a Resource Limited Country (Burundi)

Introduction: Fractures of the femoral head are rare injuries which generally follow a traumatic dislocation of the hip or in a poly-trauma scenario. A fracture dislocation of the femoral head is an orthopedic emergency. The most frequent complications after a fracture of the femoral head are osteonecrosis, post traumatic arthritis and heterotopic ossification. Objective: To focus on the therapeutic aspect of fracture-dislocations of femoral head and their short- and long-term prognoses. Materials and Methods: This is a prospective study conducted at Kamenge teaching hospital and Rohero Christian medical and surgical clinic from January 2013 to August 2020. All patients diagnosed with fracture-dislocations of the femoral head were included in this study. Results: Five patients were admitted for fracture dislocation of the femoral head. The mean age was 40.4 years and varied between 25 and 55 years. The dashboard injury was the most common mechanism and was found in four patients (80%). A standard x-ray was performed for the five patients as well as CT scans in two cases. All patients had posterior iliac dislocations with fractures of the femoral head classified as Pipkin I in three patients and Pipkin III in two patients. Closed reduction under general anesthesia within six hours was possible in one among the five patients and within 12 hours in two patients. These three cases were managed with open reduction and internal fixation (ORIF) via anterior approach with screw fixation of the femoral head fragment. In the two remaining patients reduction was not possible and for one of them there was a femoral neck fracture following closed manipulation, making the fracture Pipkin III. The two patients with Pipkin III injuries were managed with total hip replacement. With an average follow up of five years, standard x-rays of the three patients who had ORIF showed fracture union without avascular necrosis, posttraumatic arthritis or heterotopic ossification. The functional results for the five patients with an average follow up of four years were very good (3/5) and good (2/5). Conclusion: The diagnosis of fracture dislocations of the femoral head was based on clinical, radiographic and computed tomography criteria. Early reduction and internal fixation can restore the natural anatomy of the hip joint, especially in young adults with a good long-term prognosis. Sometimes total hip replacement is necessary for management of fracture dislocations of the femoral head.

Rare shear-type fracture of the talar head in a thirteen-year-old child—Is this a transitional fracture:A case report and review of the literature

BACKGROUND Talar fractures are exceedingly rare in childhood.There are very few studies on the clinical aspects,the long-term outcomes and the appropriate treatment of these fractures in pediatric patients.The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot.Traumatic mechanism,symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia:the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close.CASE SUMMARY A thirteen-year-old girl reported a high-energy trauma to her right foot,due to falling from her horse.X-rays at the Emergency Department were negative.Because of persistent pain,the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head.Hence,surgical open reduction and fixation with two headless screws was performed.The girl was assessed regularly,and plain films at follow-up revealed complete healing of the fracture.Within six months after surgery,the patient returned to pre-injury sport activities reporting no complications.CONCLUSION Injuries of the talar head in childhood should be considered as transitional fractures.Open reduction with internal fixation aims to reduce malalignment and osteoarthritis.Computed tomography scans are recommended in these cases.

Experimental and numerical investigation of groundwater head losses on and nearby short intersections between disc-shaped fractures

Discrete fracture models are used for investigating precise processes of groundwater flow in fractured rocks,while a disc-shaped parallel-plates model for a single fracture is more reasonable and efficient for computational treatments.The flow velocity has a large spatial differentiation which is more likely to produce non-linear flow and additional head losses on and nearby intersections in such shaped fractures,therefore it is necessary to understand and quantify them.In this study,both laboratory experiments and numerical simulations were performed to investigate the total head loss on and nearby the intersections as well as the local head loss exactly on the intersections,which were not usually paid sufficient attention or even ignored.The investigation results show that these two losses account for 29.17%-84.97%and 0-73.57%of the entire total head loss in a fracture,respectively.As a result,they should be necessarily considered for groundwater modeling in fractured rocks.Furthermore,both head losses become larger when aperture and flow rate increase and intersection length decreases.Particularly,the ratios of these two head losses to the entire total head loss in a fracture could be well statistically explained by power regression equations with variables of aperture,intersection length,and flow rates,both of which achieved high coefficients of determination.It could be feasible through this type of study to provide a way on how to adjust the groundwater head from those obtained by numerical simulations based on the traditional linear flow model.Finally,it is practicable and effective to implement the investigation approach combining laboratory experiments with numerical simulations for quantifying the head losses on and nearby the intersections between disc-shaped fractures.

Subchondral fatigue fracture of the femoral head in young military recruits:Potential risk factors

BACKGROUND Subchondral fatigue fracture of the femoral head(SFFFH)mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head.However,less research focuses on the risk factor for SFFFH.AIM To evaluate the intrinsic risk factors for SFFFH in young military recruits.METHODS X-ray and magnetic resonance imaging data were used for analysis.Acetabular anteversion of the superior acetabulum,acetabular anteversion of the center of the acetabulum(AVcen),anterior acetabular sector angle(AASA),posterior acetabular sector angle,superior acetabular sector angle,neck-shaft angle(NSA),inferior iliac angle(IIA),and ischiopubic angle were calculated.Then,logistic regression,receiver operating characteristic curve analysis,and independent samples t-test were performed to identify the risk factors for SFFFH.RESULTS Based on the results of logistic regression,age[odds ratio(OR):1.33;95%confidence interval(95%CI):1.12-1.65;P=0.0031]and treatment timing(OR:0.86;95%CI:0.75-0.96;P=0.015)could be considered as the indicators for SFFFH.AVcen(P=0.0334),AASA(P=0.0002),NSA(P=0.0007),and IIA(P=0.0316)were considered to have statistical significance.Further,AVcen(OR:1.41;95%CI:1.04-1.95)and AASA(OR:1.44;95%CI:1.21-1.77),especially AASA(area under curve:66.6%),should be paid much more attention due to the higher OR than other indicators.CONCLUSION We have for the first time unveiled that AASA and age could be key risk factors for SFFFH,which further verifies that deficient anterior coverage of the acetabulum might be the main cause of SFFFH.

Radial Head Dislocation Associated with an Ipsilateral Open Type II Gustilo-Anderson Fracture of the Radial Shaft

Radial head dislocation associated with an ipsilateral radial shaft fracture is a rare lesion, even more so for open lesions. Few cases have been found in the literature. We report this case due to its exceptional nature and discuss the mechanism of onset. A twenty-five-year-old patient presented with a dislocation of the radial head associated with a GUSTILO ANDERSON type II open fracture of the radial shaft following an occupational accident. He was managed twenty-four hours after the trauma. The mechanism was a direct blow. The dislocation was reduced by external manoeuvre following open reduction of the radial shaft. The fracture was stabilized by two Kirschner wires following reduction. The result at 12 months was satisfactory from a clinical and radiological standpoint.

Treatment of hip joint dislocation combined with femoral head fracture

Objective To discuss the treatment of the hip joint dislocation combined with femoral head fracture and its clinical therapeutic effects.Methods From July 2001 to July 2008,19 patients with hip joint dislocation combined with femoral head fracture underwent conservative therapy or surgical treatment.Classification was based on Pipkin's criteria,type Ⅰ four,type Ⅱ six,type Ⅲ six,type Ⅳ three.Various procedures were taken according to the different types of the fracture,the time of the fracture,and the age of the patients.The clinical therapeutic effects were analyzed.Results In type Ⅰ,four were rated as excellent by Harris Hip Score's criteria.In type Ⅱ,two rated as excellent,three as good and one as fair.In type Ⅲ,three rated as good,two as fair and one as poor.In type Ⅳ,one rated as excellent,one as good and one as fair,overall rate of excellent and good was 73.7%.Conclusion The treatment of Pipkin fracture should be based on multiple factors such as the type of fracture,the time of fracture,the age of patients and so on.The prognosis is directly related with those factors and the way of the treatment.

Fracture of proximal radius combined with dislocation of the radial head:a case report

Forearm fractures are prevalent which include radius fractures,ulna fractures,or both radius and ulna fractures.Proximal radius fractures combined with dislocations of the radial heads are rare and easily misdiagnosed.The authors present and discuss a case of proximal radius fractures associated with radial head dislocations.A 36 years old male was admitted to the hospital due to pain and activity limitation in his left elbow for 7 hours due to a car accident.An X-ray of the left elbow joint revealed a“left radius fracture with surrounding soft tissue edema”.During the procedure,the radial head was found to be dislocated forward.A 3.0 mm anchor was used to fix the annular ligament.Radius fractures combined dislocations of the radial heads are rare and may be missing the diagnosis.Before undergoing surgery,the possibility of elbow dislocation should be evaluated.Wire anchors can provide reliable fixation.

Preoperative traction is a risk factor for osteonecrosis of femoral head in patients with stable femoral neck fractures

To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution with Garden II femoral neck fracture operated from January 2012 to December 2013 were extracted.Seven-year retrospective comparative study in the first affiliated hospital of Soochow University.Patients were divided into two groups by preoperative treatment:a preoperative traction group(group I)and a T-shaped shoe fixation group(group II).There were 14 patients lost to follow-up.101 patients with Garden II femoral neck fracture followed until July 2016 were available for complete analysis.Intervention:patients received skeletal traction or T-shaped shoe fixation preoperatively.All patients accepted internal fixation with multiple annulated screws.Main outcome measurements:the incidence of osteonecrosis of femoral head was analyzed based on preoperative traction,gender and implant removal.The average follow-up of these patients was 35 months(range,24-48 months).There was no implant failure or nonunion in our study.Nine patients(8.91%)had avascular necrosis.8(15.38%)patients in group I had osteonecrosis of femoral head,whereas only onepatient(2.04%)in group II had osteonecrosis of femoral head.Patients with preoperative traction had significantly higher incidence of osteonecrosis of femoral head compared with T shaped shoe fixation(P=0.032).No significant difference was found between the incidence of osteonecrosis of femoral head based on gender,age,injury-to-surgery interval time,implant removal or weight-bearing time.In patients with femoral neck fracture,preoperative traction may increase the incidence of osteonecrosis.Preoperative traction may not benefit patients with Garden II femoral neck fracture.The weight of traction may be a risk factor to osteonecrosis of femoral head.

Humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus

Objective To investigate the clinical outcome of humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus,to provide clinical guideline of treating complicated fractures of

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients