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
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
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
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
BACKGROUND Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates.AIM To model the po...BACKGROUND Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates.AIM To model the potential risk of hip fracture via femur geometric parameters.METHODS Seventy educational cadaveric femurs from people aged 14 to 80 years,10 X-ray images from the records of the Human Anatomy Department and 10 X-ray images from the Department of Traumatology,Orthopedics and Disaster Surgery of Sechenov University,were evaluated.The parameters of the fractured bone were measured using images captured with a Canon d60 camera.The projection values of the proximal epiphysis of the cadaveric femurs and geometric parameters of the bones shown in the X-ray images were measured with Autodesk software(AutoCAD 2018).Analysis of the video frames showing bone rotation reveal that the greater trochanter can be inscribed in a parallelepiped,where one of the faces is parallel to the plane of view in the frontal standard projection and is rectangular.The angle of bone rotation obtained by turning the cube corresponded to the angle measured with the second technique.This reliable method of calculating the rotation of the bone relative to the anterior projection was employed in subsequent calculations.The geometric parameters of the femur were measured using X-ray images according to the proposed method.RESULTS The geometric parameters of 70 femurs were analyzed,and correlation coefficients were calculated.Our measurement results were compared with those reported by other authors.The potential influence of femur geometry on force distribution in the proximal epiphysis of the femur was described,and a 2-dimensional model of the femur epiphysis associated with minimal neck fracture risk was provided.The assessment of the geometric parameters of the femoral epiphysis indicated the greatest risk of a varus fracture of the neck if the angle of the minimal resistance zone(AMRZ)index>24°and the neck-shaft angle(NSA)<127.5°.In contrast,the minimum risk was observed at AMRZ<14°and NSA>128.87°.CONCLUSION The proposed method provides the potential femur neck fracture risk based on geometric parameters.展开更多
BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality.However,limitations of the resources,risk of disease transmission and redirection of medical a...BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality.However,limitations of the resources,risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019(COVID-19)pandemic period have affected the quality of care even in a surgical emergency.AIM To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.METHODS The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times.After careful screening,eight studies were eligible for quantitative and qualitative analysis of data.RESULTS The pooled data of eight studies(n=1586)revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods[9.63%vs 6.33%;odds ratio(OR),0.62;95%CI,0.33,1.17;P=0.14].Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time,and all hip fracture patients treated during the pre-pandemic period(OR,1.03;95%CI,0.61,1.75;P=0.91).A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients(OR,6.99;95%CI,3.45,14.16;P<0.00001).There was no difference in the duration of hospital stay(OR,-1.52,95%CI,-3.85,0.81;P=0.20),overall complications(OR,1.62;P=0.15)and incidence of pulmonary complications(OR,1.46;P=0.38)in these two-time frames.Nevertheless,the preoperative morbidity was more severe,and there was less use of general anesthesia during the pandemic time.CONCLUSION There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods.However,the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients.There was no difference in time to surgery,complications and hospitalization time between these two time periods.展开更多
目的探究对老年股骨颈骨折患者应用人工股骨头置换术与人工全髋关节置换术的效果。方法回顾性选取2017年1月—2022年5月高邮市中医医院收治的238例股骨颈骨折患者的临床资料,依据治疗方案不同分为对照组(n=132)和观察组(n=106)。对照组...目的探究对老年股骨颈骨折患者应用人工股骨头置换术与人工全髋关节置换术的效果。方法回顾性选取2017年1月—2022年5月高邮市中医医院收治的238例股骨颈骨折患者的临床资料,依据治疗方案不同分为对照组(n=132)和观察组(n=106)。对照组实施人工股骨头置换术治疗,观察组实施人工全髋关节置换术治疗,比较两组治疗效果、临床相关指标、髋关节功能评分(Harris Hip Score,HHS)、髋关节疼痛程度评分(Visual Analogue Scale,VAS)、并发症。结果观察组治疗效果(96.23%)高于对照组(89.39%),差异有统计学意义(χ^(2)=3.926,P<0.05)。与对照组相比,观察组手术时间、住院时间较长,术中出血量、术后引流量较多,差异有统计学意义(P<0.05)。术后1年,观察组HHS评分高于对照组,差异有统计学意义(P<0.05)。和对照组比较,观察组各时间点VAS评分以及并发症发生率均较低,差异有统计学意义(P<0.05)。结论采用人工股骨头置换术治疗老年股骨颈骨折患者,有着手术时间短等优点,但其远期效果较差。虽然人工全髋关节置换术的手术时间等较长,但远期效果较好,疼痛感低,并发症少,可依据患者实际情况而选择手术方案。展开更多
Background: Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess...Background: Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods: We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results: Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001), CEA (37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ), FND (35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P 〈 0.001 ). The greater NSA was the risk factor for femoral neck fractures (,odds ratio [OR]: 0.70, P 〈 0.001 ), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P 〈 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P 〈 0.001). Conclusions: We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.展开更多
Purpose:Hip fractures among elderly patients are surgical emergencies.During COVID-19 pandemic time,many such patients could not be operated at early time because of the limitation of the medical resources,the risk of...Purpose:Hip fractures among elderly patients are surgical emergencies.During COVID-19 pandemic time,many such patients could not be operated at early time because of the limitation of the medical resources,the risk of infection and redirection of medical attention to a severe infective health problem.Methods:A search of electronic databases(PubMed,Medline,CINAHL,EMBASE and the Cochrane Central Register of Controlled Trials)with the keywords"COVID","COVID-19","SARS-COV-2","Corona","pandemic","hip fracture","trochanteric fracture"and"neck femur fracture"revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time.The 30-day mortality rate,inpatient mortality rate,critical care/special care need,readmission rate and complications rate in both groups were evaluated.Data were analyzed using Review Manager(RevMan)V.5.3.Results:After screening,7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected(COVID-19+)and non-infected(COVID-19-)patients.There were significantly increased risks of 30-day mortality(32.23%COVID-19+deathvs.8.85%COVID-19-death)and inpatient mortality(29.33%vs.2.62%)among COVID-19+patients with odds ratio(OR)of 4.84(95%CI:3.13-7.47,p<0.001)and 15.12(95%CI:6.12-37.37,p<0.001),respectively.The COVID-19+patients needed more critical care admission(OR=5.08,95%CI:1.49-17.30,p<0.009)and they remain admitted for a longer time in hospital(mean difference=3.6,95% CI:1.74-5.45,p<0.001);but there was no difference in readmission rate between these 2 groups.The risks of overall complications(OR=17.22),development of pneumonia(OR=22.25),and acute respiratory distress syndrome/acute respiratory failure(OR=32.96)were significantly high among COVID-19+patients compared to COVID-19-patients.Conclusions:There are increased risks of the 30-day mortality,inpatient mortality and critical care admission among hip fracture patients who are COVID-19+.The chances of developing pneumonia and acute respiratory failure are more in COVID-19+patients than in COVID-19-patients.展开更多
Background: The safe amount of radiation permissible during fixation of neck of femur fractures has long been studied. Factors including surgeons’ experience have been highlighted. We aimed in this study to compare d...Background: The safe amount of radiation permissible during fixation of neck of femur fractures has long been studied. Factors including surgeons’ experience have been highlighted. We aimed in this study to compare different factors for quality and safety improvement. Methods: It was a retrospective study, including all patients who had undergone a standard DHS fixation between January 2018 and June 2019 for inter-trochanteric neck of femur fractures. Two groups were stratified;(Group A) had the procedure performed by a specialist non-consultant surgeon (NCG) and (Group B) by an established consultant (CG). The Dose Area Product (DAP) and the duration of radiation exposure were recorded. Results: Over a period of 18 months, 91 cases were included with a mean age of 82 years old. The mean weight was 62 kg. 42 patients had complex fractures, and 49 patients had simple fractures. 12% of patients were ASA II, 70% of cases were ASA III and 18% of the patients were ASA IV. The mean DAP for group A was 345.131 CGYCM2 (SD 273.65) and for group B 234.63 CGYCM2 (SD 165.30). The time of exposure was 8.6 sec and 13.16 sec in groups B and A respectively. Conclusion: The data collected from this study were comparable to others. The amount of radiation exposure was of difference related to the decision-making intra-operatively. Other factors were not statistically significant.展开更多
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BACKGROUND Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates.AIM To model the potential risk of hip fracture via femur geometric parameters.METHODS Seventy educational cadaveric femurs from people aged 14 to 80 years,10 X-ray images from the records of the Human Anatomy Department and 10 X-ray images from the Department of Traumatology,Orthopedics and Disaster Surgery of Sechenov University,were evaluated.The parameters of the fractured bone were measured using images captured with a Canon d60 camera.The projection values of the proximal epiphysis of the cadaveric femurs and geometric parameters of the bones shown in the X-ray images were measured with Autodesk software(AutoCAD 2018).Analysis of the video frames showing bone rotation reveal that the greater trochanter can be inscribed in a parallelepiped,where one of the faces is parallel to the plane of view in the frontal standard projection and is rectangular.The angle of bone rotation obtained by turning the cube corresponded to the angle measured with the second technique.This reliable method of calculating the rotation of the bone relative to the anterior projection was employed in subsequent calculations.The geometric parameters of the femur were measured using X-ray images according to the proposed method.RESULTS The geometric parameters of 70 femurs were analyzed,and correlation coefficients were calculated.Our measurement results were compared with those reported by other authors.The potential influence of femur geometry on force distribution in the proximal epiphysis of the femur was described,and a 2-dimensional model of the femur epiphysis associated with minimal neck fracture risk was provided.The assessment of the geometric parameters of the femoral epiphysis indicated the greatest risk of a varus fracture of the neck if the angle of the minimal resistance zone(AMRZ)index>24°and the neck-shaft angle(NSA)<127.5°.In contrast,the minimum risk was observed at AMRZ<14°and NSA>128.87°.CONCLUSION The proposed method provides the potential femur neck fracture risk based on geometric parameters.
文摘BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality.However,limitations of the resources,risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019(COVID-19)pandemic period have affected the quality of care even in a surgical emergency.AIM To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.METHODS The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times.After careful screening,eight studies were eligible for quantitative and qualitative analysis of data.RESULTS The pooled data of eight studies(n=1586)revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods[9.63%vs 6.33%;odds ratio(OR),0.62;95%CI,0.33,1.17;P=0.14].Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time,and all hip fracture patients treated during the pre-pandemic period(OR,1.03;95%CI,0.61,1.75;P=0.91).A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients(OR,6.99;95%CI,3.45,14.16;P<0.00001).There was no difference in the duration of hospital stay(OR,-1.52,95%CI,-3.85,0.81;P=0.20),overall complications(OR,1.62;P=0.15)and incidence of pulmonary complications(OR,1.46;P=0.38)in these two-time frames.Nevertheless,the preoperative morbidity was more severe,and there was less use of general anesthesia during the pandemic time.CONCLUSION There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods.However,the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients.There was no difference in time to surgery,complications and hospitalization time between these two time periods.
文摘目的探究对老年股骨颈骨折患者应用人工股骨头置换术与人工全髋关节置换术的效果。方法回顾性选取2017年1月—2022年5月高邮市中医医院收治的238例股骨颈骨折患者的临床资料,依据治疗方案不同分为对照组(n=132)和观察组(n=106)。对照组实施人工股骨头置换术治疗,观察组实施人工全髋关节置换术治疗,比较两组治疗效果、临床相关指标、髋关节功能评分(Harris Hip Score,HHS)、髋关节疼痛程度评分(Visual Analogue Scale,VAS)、并发症。结果观察组治疗效果(96.23%)高于对照组(89.39%),差异有统计学意义(χ^(2)=3.926,P<0.05)。与对照组相比,观察组手术时间、住院时间较长,术中出血量、术后引流量较多,差异有统计学意义(P<0.05)。术后1年,观察组HHS评分高于对照组,差异有统计学意义(P<0.05)。和对照组比较,观察组各时间点VAS评分以及并发症发生率均较低,差异有统计学意义(P<0.05)。结论采用人工股骨头置换术治疗老年股骨颈骨折患者,有着手术时间短等优点,但其远期效果较差。虽然人工全髋关节置换术的手术时间等较长,但远期效果较好,疼痛感低,并发症少,可依据患者实际情况而选择手术方案。
文摘Background: Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods: We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results: Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001), CEA (37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ), FND (35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P 〈 0.001 ). The greater NSA was the risk factor for femoral neck fractures (,odds ratio [OR]: 0.70, P 〈 0.001 ), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P 〈 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P 〈 0.001). Conclusions: We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.
文摘Purpose:Hip fractures among elderly patients are surgical emergencies.During COVID-19 pandemic time,many such patients could not be operated at early time because of the limitation of the medical resources,the risk of infection and redirection of medical attention to a severe infective health problem.Methods:A search of electronic databases(PubMed,Medline,CINAHL,EMBASE and the Cochrane Central Register of Controlled Trials)with the keywords"COVID","COVID-19","SARS-COV-2","Corona","pandemic","hip fracture","trochanteric fracture"and"neck femur fracture"revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time.The 30-day mortality rate,inpatient mortality rate,critical care/special care need,readmission rate and complications rate in both groups were evaluated.Data were analyzed using Review Manager(RevMan)V.5.3.Results:After screening,7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected(COVID-19+)and non-infected(COVID-19-)patients.There were significantly increased risks of 30-day mortality(32.23%COVID-19+deathvs.8.85%COVID-19-death)and inpatient mortality(29.33%vs.2.62%)among COVID-19+patients with odds ratio(OR)of 4.84(95%CI:3.13-7.47,p<0.001)and 15.12(95%CI:6.12-37.37,p<0.001),respectively.The COVID-19+patients needed more critical care admission(OR=5.08,95%CI:1.49-17.30,p<0.009)and they remain admitted for a longer time in hospital(mean difference=3.6,95% CI:1.74-5.45,p<0.001);but there was no difference in readmission rate between these 2 groups.The risks of overall complications(OR=17.22),development of pneumonia(OR=22.25),and acute respiratory distress syndrome/acute respiratory failure(OR=32.96)were significantly high among COVID-19+patients compared to COVID-19-patients.Conclusions:There are increased risks of the 30-day mortality,inpatient mortality and critical care admission among hip fracture patients who are COVID-19+.The chances of developing pneumonia and acute respiratory failure are more in COVID-19+patients than in COVID-19-patients.
文摘Background: The safe amount of radiation permissible during fixation of neck of femur fractures has long been studied. Factors including surgeons’ experience have been highlighted. We aimed in this study to compare different factors for quality and safety improvement. Methods: It was a retrospective study, including all patients who had undergone a standard DHS fixation between January 2018 and June 2019 for inter-trochanteric neck of femur fractures. Two groups were stratified;(Group A) had the procedure performed by a specialist non-consultant surgeon (NCG) and (Group B) by an established consultant (CG). The Dose Area Product (DAP) and the duration of radiation exposure were recorded. Results: Over a period of 18 months, 91 cases were included with a mean age of 82 years old. The mean weight was 62 kg. 42 patients had complex fractures, and 49 patients had simple fractures. 12% of patients were ASA II, 70% of cases were ASA III and 18% of the patients were ASA IV. The mean DAP for group A was 345.131 CGYCM2 (SD 273.65) and for group B 234.63 CGYCM2 (SD 165.30). The time of exposure was 8.6 sec and 13.16 sec in groups B and A respectively. Conclusion: The data collected from this study were comparable to others. The amount of radiation exposure was of difference related to the decision-making intra-operatively. Other factors were not statistically significant.