Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis
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Background Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation. Questions/purposes We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup. Methods Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science™ were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I2) and publication bias was assessed using forest plots. Results There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06-0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06-0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02-1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, −0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32-14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40-2.01; p = 0.78) between patients treated with arthroplasty and internal fixation. Conclusions Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty.Objective:To discuss the indications, timing of ope ration, choice of optimum internal fixation of subcapital femoral neck fracture. Methods:To summarize and analyse the process of treatment and rehab ilitation of 50 cases of subcapital femoral fracture. Results:All the 50 patients were treated by closed reduction and inter nal fixation with three screws. All the cases were followed for at least nine mo nths. Unions in 38 cases, nonunions 4 cases, avascular necrosis 6 cases, and 2 c ases with both ununion and necrosis. The average scores of the 38 case of united hips were 88 with the Harris evaluation system. Conclusion:In younger patients of subcapital femoral neck fracture, a natomical reduction, early effective internal fixation and correct treatment dur ing and post operation are the key to minimize the complications.
Avascular Necrosis
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Objective To observe the clinical effect of internal fixation with hollow compression screw for old patients with femoral neck fracture.Methods 102 old patients with femoral neck fracture were randomly classified into two groups,which observation group with 57 cases were treated with internal fixation with hollow compression screw and control group with 45 cases were treated with total hip replacement.The clinical effect between the two groups were compared.Results The effective rate in observation group was significantly higher than that in control group(x2=4.33,P＜0.05).There was no significant difference in avascular necrosis between the two groups(x2=1.91,P＞0.05).Conclusion Internal fixation with hollow compression Screw for old patients with femoral neck fracture Was safe and can improve clinical effect,which could be applied in clinic.
Key words:
Femoral neck fractures; Fracture fixation,internal; Aged
Avascular Necrosis
Dynamic compression plate
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Objective:To explore the possible causes and the treatment of the unefficient internal fixation of Galeazzi fracture.Methods:Twenty-three cases of the unefficient internal fixations of Galeazzi fracture were treated with internal fixations of LC-DCP,autologus spongy bone transplantations.Results:Patients were followed up for 6 to 24 months.All cases had bony union,of which and 20 cases(87%) were obtained satisfactory functional rehabilitations.Conclusion:The major causes that may lead to the unefficient internal fixation of Galeazzi fracture are improper internal fixation,security of internal fixation,and improper early movement.Proper internal fixation,autologus spongy bone transplantation are efftective in the treatment of the unefficient internal fixation of fractures and in the functional rehahililalion of the forearms.
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To investigate the short-term effectiveness of femoral neck system (FNS) in the treatment of femoral neck fracture.The clinical data of 34 patients with femoral neck fracture admitted between January 2019 and April 2020 who met the selection criteria were retrospectively analyzed and divided into group A (19 patients were treated with conventional cannulated screw internal fixation) and group B (15 patients were treated with FNS internal fixation) according to the different methods of internal fixation. There was no significant difference between the two groups in general data such as gender, age, affected side, cause of injury, fracture type, and time from injury to operation ( P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency, and fracture healing time were recorded and compared between the two groups. X-ray film and CT examinations were performed postoperatively to evaluate fracture reduction and internal fixation, and the shortening of the femoral neck on the affected side was measured compared with that on the healthy side. The Harris score was used to evaluate hip function.There was 1 unsatisfied reduction case in groups A and B respectively, the rest of the patients in both groups were obtained satisfied reduction. There was no significant difference in the quality of reduction between the two groups ( Z=-0.195, P=0.854). There was no significant difference in operation time between the two groups ( t=0.649, P=0.064). The intraoperative blood loss in group A was significantly less than that in group B, and the fluoroscopy frequency was significantly more than that in group B, with significant differences ( P<0.05). Except for 1 case in group A with screw out at 3 months after operation and no obvious callus formation, all fractures in the two groups reached clinical healing, and there was no significant difference in fracture healing time between the two groups ( t=-0.127, P=0.899). There was no necrosis of femoral head in the two groups. At last follow-up, there were 4 cases of femoral neck shortening in group A and 2 cases in group B. The hip function of both groups recovered well, and there was no significant difference in Harris score at last follow-up ( t=0.956, P=0.346).The treatment of femoral neck fracture using FNS has less trauma. Compared with cannulated screw internal fixation, it can reduce the intraoperative fluoroscopy frequency and obtain satisfactory short-term effectiveness.探讨股骨颈动力交叉钉系统（femoral neck system，FNS）治疗股骨颈骨折的近期临床疗效。.回顾分析 2019 年 1 月—2020 年 4 月收治且符合选择标准的 34 例股骨颈骨折患者临床资料，根据内固定方式不同分为 A 组（19 例，采用传统空心螺钉内固定治疗）和 B 组（15 例，采用 FNS 内固定治疗）。两组患者性别、年龄、患侧侧别、致伤原因、骨折分型及受伤至手术时间等一般资料比较，差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中出血量、透视次数、骨折愈合时间等；术后常规行 X 线片、CT 检查评估骨折复位及内固定情况，并测量患侧较健侧股骨颈短缩情况；采用 Harris 评分评价髋关节功能。.术后 A、B 组分别有 1 例患者骨折复位不满意，其余患者均获满意复位，两组骨折复位质量比较差异无统计学意义（ Z=–0.195， P=0.854）。两组患者手术时间比较差异无统计学意义（ t=0.649， P=0.064）；A 组术中出血量显著少于 B 组，透视次数显著多于 B 组，差异均有统计学意义（ P<0.05）。除 A 组 1 例术后 3 个月退钉，骨折无明显骨痂形成外，两组其余患者骨折均达临床愈合，两组骨折愈合时间比较差异无统计学意义（ t=–0.127， P=0.899）；两组均无股骨头坏死发生。末次随访时，X 线片检测示 A、B 组分别有 4 例和 2 例发生股骨颈短缩。两组髋关节功能均恢复良好，末次随访时 Harris 评分比较差异无统计学意义（ t=0.956， P=0.346）。.FNS 治疗股骨颈骨折创伤小，与空心螺钉内固定相比可减少术中透视次数，可获得满意近期疗效。.
Harris Hip Score
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Objective To investigate the risk factors of the infection after orthopedic internal fixation,provide a reference for prevention of infection after orthopedic internal fixation.Methods 52 case of infection patients after internal fixation in our hospital from January 2004 to December 2010 were retrospectively collected,and at the same time,104 cases of no-infected in our department were collected.Univariate analysis on open or not,polluted or not,internal fixed material and other information were took.Multivariate analysis on significant related factors were took.Results Univariate analysis showed: open or not,wound polluted or not,multiple fractures or not,operation time,using of hormones,diabetes and merger basic disease were significantly associated with infections after orthopedic internal fixation.Multivariate analysis showed: wound polluted or not,multiple fractures or not,operation time,using of hormones,diabetes and merger basic disease were independent risk factor of the after orthopedic internal fixation.Conclusion Treatment of infection after orthopedic internal fixation is difficult.Paying attention to the reference value of these risk factors in infection after the internal fixation may further reduce the occurrence of infection after the internal fixation.
Univariate analysis
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The follow-up results for an average of 7.9 years were analyzed on 86 hips in 82 patients with intracapsular fracture of the femoral neck treated by internal fixation. The functional and X-ray results were not significantly different between the two groups of under and over 60 years of age. The internal fixation was thought to be a method of choice for intracapsular fracture of the femoral neck, even in the aged.
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Femoral neck fractures are not common in young patients, accounting for merely 3% of all these fractures. However, since the young femoral neck fractures are mostly caused by high energy violence, they usually jeopardize local blood supply and mechanical environment, resulting in higher risks of non-union and avascular necrosis. Besides, young patients often make a greater demand for functional recovery. Consequently, young femoral neck fracture is always a clinical challenge. In this article, we introduce in details the latest techniques and standards for reduction of young femoral neck fracture, compare advantages and drawbacks of various internal fixations, illustrate up-to-date progress in treatment methods and concepts for delayed and nonunited femoral neck fractures, and lastly put forward some unsolved issues open to dispute. In treatment of young femoral neck fractures, it is necessary for us to get familiarized with their anatomy and biomechanical characteristics, grasp the principles of treatment on the whole, and choose operational and internal fixation methods based on the clinical evidence before we can improve therapeutic efficacy, accelerate rehabilitation progress and restore function of the hip joint as much as possible.
Key words:
Femoral neck fractures; Fracture fixation, internal; Therapy; Young
Avascular Necrosis
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Objective: To determine the knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic surgical devices used in surgical implants. Methods: A questionnaire was applied to Brazilian Orthopedic Surgeons during the 46th Brazilian Congress on Orthopedics and Traumatology. Results: Two hundred and one Orthopedic Surgeons completely filled out the questionnaire. The difference between the average prices estimated by the surgeons and the average prices provided by the supplier companies was 47.1%. No differences were found between the orthopedic specialists and other subspecialties on the prices indicated for specific orthopedic implants. However, differences were found among orthopedic surgeons who received visits from representatives of implant companies and those who did not receive those visits on prices indicated for shaver and radiofrequency device. Correlation was found between length of orthopedic experience and prices indicated for shaver and interference screw, and higher the experience time the lower the price indicated by Surgeons for these materials. Conclusion: The knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic implants is precarious. Reduction of cost of orthopedics materials depends on a more effective communication and interaction between doctors, hospitals and supplier companies with solid orientation programs and awareness for physicians about their importance in this scenario.Level of Evidence III, Cross-Sectional Study.
Traumatology
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Summary: Femoral neck fractures are frequently treated with open reduction and internal fixation to achieve anatomical reduction. This video demonstrates open reduction internal fixation of a femoral neck fracture in a 59-year-old man, performed through an anterior approach. This approach provides safe and effective access to the femoral neck, including the subcapital and basicervical regions, with excellent direct visualization of the fracture site.
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