Is there still an indication for operative treatment of femoral neck fractures with a ceramic hemiprosthesis?
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This report is a prospective clinical evaluation of total hip replacement using the Charnley prosthesis. The purpose of this study was to determine the expected end results and complications using the Charnley prosthesis in our participating hospitals. It is a summary of interim results (one year or more follow-up) on total hip replacements done prior to December 1971. Although the review is small, it is instructive and has resulted in several major changes in our total hip replacement program.
Interim
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Objective:To observe and approach the relation between the region of femoral head necrosis and femoral neck fracture after the total hip resurfacing by biomechanics. Methods:Twenty-five normal adult proximal femur were harvested. They were divided into five groups at random the different regions of femoral head necrosis were and simulated : normal, 10%,20% both in human femoral head's weight bearing region and 10%?20% in non-weight bearing region ,both of them were tested in vitro by simulating single-leg stance phase. Rigidity of the whole proximal femur and the strain value at the juncture of femoral head and neck under 0,500N,1000N load ... were evaluated , until the femoral neck fracture. Results:The intensity and the bearing capacity of femoral neck were found to be smaller in the necrosis of the femoral head's weight bearing region than in the non-weight bearing region. The groups of 10% and 20% all have this tendency. The difference between the two is 17%, and there is a remarkable statistical difference(P0.001). Conclusions: The region of femoral head necrosis influences the bearing capacity and the intensity of femoral neck. If the femoral head necrosis of femoral head's weight bearing region is up to 20%. The hip resurfacing shonld be choosen cautiously, because the femoral neck fracture is easy to occur.
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The old people often incur a fracture of femoral neck, which is related to poor quality of bone. With the coming of an aging society, the incidence of femoral neck fracture will increase so that the life quality of the aged can be affected. After the fracture of femoral neck, there will be a risk of avascular necrosis of the femoral head. The operative management should vary according to the state of blood supply. This article reviews the applications of SPECT (single photon emission computed tomography) for early diagnosis of avascular necrosis of femoral head for the benefit of clinical orthopedists.
Avascular Necrosis
Blood supply
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Abstract Introduction: Pathological fractures of the femoral neck caused by necrosis of the femoral head are extremely rare. Here, we report a rare case of bilateral femoral head osteonecrosis extending to the femoral neck, with bilateral pathological fractures of the femoral neck occurring within a short period of time. Case report: A 65-year-old male with a 25-year history of daily consumption of 750 ml of liquor, presented with right hip pain after labor for 1 month. He subsequently sustained a right femoral neck fracture without trauma and underwent a right total hip arthroplasty. Two months later, he suffered a non-traumatic left femoral neck fracture and underwent a left total hip arthroplasty. Histopathological examination revealed osteonecrosis of the femoral head and neck, along with the presence of osteoclasts and granulomatous inflammation. Bone mineral density testing also showed osteoporosis. The bilateral femoral neck fractures were ruled out to be caused by any other pathological factors. Discussion: This is the first report of pathological fractures of the bilateral femoral neck caused by femoral head necrosis. During the literature review process, we found that this case conforms to the histological characteristics of rapidly destructive hip disease and analyzed the etiology of femoral head necrosis and the pathogenesis of femoral neck fractures.
Avascular Necrosis
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To investigate the therapeutic efficacy of Fracture Hip Support Joint (FHSJ) implantation on the fresh femoral neck fracture(FNF)to rescue the avascular necrosis of the femoral head(ANFH),36 skeletal mature hybrid dogs were equally divided into experimental group and control group at random. The animal model of femoral neck fracture was adopted by dislocating the hip joint and cutting the femoral neck. FHSJ was planted into the hips of the experimental group. On the contrary, dislocations were repositted and two screws were fixed on the fracture of the contral group.At 12 weeks, all of the animals both in the experimental group and the control group caught the ANFH. At 24 weeks, the ANFH in the experimental group was partly restored. The ANFH bacame worse in the control group. At 48 weeks, the ANFH in the experimental group was healed. At the same time, dogs in the contol group had the cave-in of the femoral head. The plantation of FHSJ, is an available method to prevent the avascular necrosis of the femoral head with the femoral neck fracture
Avascular Necrosis
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Hip Fracture
Stress Fractures
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Deep infection, the most serious local complication of total hip replacement, prompted a study of the records of 135 patients (137 hips) thus afflicted in a nationwide survey of Canada. Particular attention has been paid to the natural history of the infection, and the problems of diagnosis are described. Twenty-one patients died after the insertion, or removal, of the prosthesis, and of the survivors of the original 135 patients only eighteen have been able to retain the prosthesis without further problems with the wound. The remaining patients had the prosthesis removed, and most dry wounds. Certain suggestions are made on management. The advice that a second total hip prosthesis should be inserted after a deep infection of the first implant is not supported.
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Objective To discuss the possibility of total hip replacement for hip tuberculosis patients.Methods 30 patients with hip tuberculosis were admitted during 1986 to 1997 and 26 underwent total hip replacement and 4 underwent hemi-hip prosthesis replacement. All the patients were with long term follow-up. Results For the 26 total hip replacements, there were 2 early infection and one cured by intravenous antibiotics and one by debridment. There were no recurrence of tuberculosis. The other four semi-hip prosthesis replacement were with good results. Conclusions Hip tuberculosis could be successfully treated by prosthesis replacement when the surgery delivered at suitable time.
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The various problems posed by total hip prosthesis are first described. The authors then analyse the various parameters which should guide the choice of this technique which must be used only when all other solution have failed. The recent development of prostheses without cement has made it possible to widen the application of this surgery to younger patients. Two special cases are finally reported: the role of total prostheses in the treatment of sequelae of fractures of the acetabulum, and in disarthrodesis of the hip with insertion of a total prosthesis.
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Objective To investigate the long term effect of the displacement of the greater trochanter with blood vessel inside fomur to treat avascular necrosis of youngsters′ femoral head.Methods Thirty seven cases were subjected to a serial follow up(average 6 years).Results The long term effects of the displacement of the greater trochanter to treat the patients with femoral neck fracture(Ⅲ and Ⅳ types) and the avascular necrosis of the femoral head were satisfactory.The postoperative effective rate was 100.0% and the satisfactory rate was 94.6% respectively.Conclusion It is an effective means that the displacement of the greater trochanter with vessel pedicle inside femour treats the patients with femoral neck fracture (Ⅲ and Ⅳ types) and the avascular necrosis of the femoral head.
Avascular Necrosis
Greater trochanter
Trochanter
Lesser Trochanter
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