Significance of urgent (within 6 h) internal fixation in the management of fractures of the neck of the femur

doi:10.1016/0020-1383(89)90152-6

Injury

Volume 20, Issue 2, March 1989, Pages 101-105

https://doi.org/10.1016/0020-1383(89)90152-6 Get rights and content

Abstract

The value of internal fixation of fractures of the neck of the femur within 6 h was assessed in a review of a 3-year series. Three groups were compared, in which the operation was performed within 6 h, between 6 and 24 h and after 24 h respectively. The time and quality of union and the incidence of collapse of the head of the femur were significantly better in the first group. The difference in the results between the other two groups was not significant. In view of these data the authors recommend the internal fixation of fractures of the neck of the femur within 6 h.

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There are more references available in the full text version of this article.

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Non-operative predictors for subsequent interventions after intracapsular femoral neck fractures in elderly: A comprehensive analysis of the Hungarian nationwide health insurance database
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To investigate the correlation between non-operative prognostic factors and non-prosthetic fracture-related treatments following internal fixation of intracapsular femoral neck fractures in elderly patients.
Retrospective observational cohort study. Comprehensive analysis of the Hungarian nationwide health insurance database.
Data of in-patient records with S7200 ICD-10 codes were collected from the Hungarian National Health Insurance Fund Administration (HNHIFA) and from the health care provider institutes. The patients with femoral neck fractures in the year of 2000, following reduction and internal fixation aged 60 years or older were evaluated. The secondary, non-prosthetic fracture related treatments during the 8 year follow-up period were registered.
Of the prognostic factors, age, gender, type of fracture, season and day of the primary surgery, length of waiting time to the operation and the accompanied diseases were evaluated as risk factors for all type of fracture-related further interventions, with the exception of arthroplasties.
A total of 2895 patients with intracapsular femoral neck fractures met the study criteria. The mean age was 77.96 years (SD: 8.54). The cohort of the patients was observed for a total of 10,077.8 person-years. The non-prosthetic fracture related treatment was performed in 265 patients (9,2%); the median of the time elapsed to the secondary definitive treatment was 3.5 months. With Cox regression analysis, significant correlation was revealed between the incidence of non-prosthetic treatment and younger age (year, HR = 0.977, p = 0.002), surgical delay (12–24 h vs 0–6 h, HR = 1.518, p = 0.023; 24h+ vs 0–6 h, HR = 1.372, p = 0.050), season of primary osteosynthesis (fall vs summer, HR = 0.636, p = 0.012), and type of femoral neck fracture (intracapsular displaced vs intracapsular undisplaced, HR = 1.340, p = 0,047). There was no significant effect of the day of primary surgery, the gender and the presence of co-morbidities on the incidence of further surgical interventions.
The summertime primary surgical intervention, delay of surgery longer than 12 h and type of femoral neck fracture are independent predictors of non-prosthetic further treatment of femoral neck fractures in elderly patients.
Level IV, evidence from cohort studies.
Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate
2019, Chinese Journal of Traumatology - English Edition
Citation Excerpt :
Young and active patients are generally treated by anatomical reduction and internal fixation to preserve one's own hip as much as possible. Maninger et al.2 reported a lower incidence of femoral head collapse when surgery was carried out within 6 h of injury; however patients are often reported after few weeks and some even months of trauma. Despite modern treatment modalities and good understanding of anatomy of femoral neck, nonunion is still reported in one third of cases of femoral neck fracture with displacement.3,4
Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion, requiring additional procedures like valgus osteotomy; but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup.
We reported a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein valgus osteotomy was added to reduction fixation which was secured with a commonly available 135° dynamic hip screw and plate.
Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3.
The 135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results.
Evaluation of a vital staining protocol with 2,3,5-triphenyltetrazolium chloride for cancellous bone in a sheep model
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Decision making on the optimal surgical treatment of fractures often is hampered by the lack of a method for direct assessment of bone vitality. In various contexts, for example to determine the extents of cerebral insults or of myocardial infarctions in experimental studies, tetrazolium based staining procedures of vital cells are widely used. Here, we set out to test the applicability of tetrazolium based staining on bone samples. 8 brains and 26 femoral heads from sheep were used to prepare tissue slices, which were stained with 2,3,5-triphenyltetrazolium chloride (TTC) at various times (1 to 12 h) after explantation. Staining of tissue slices was quantified by densitometric image analysis. Spectrophotometry was used for quantification in cultured cells. TTC-staining of tissue slices indicated detectability of vital cells in slices from both tissues up to 4 h after explantation. Staining intensity at later time-points was indistinguishable from the staining of untreated samples or sodium azide treated (necrotic cells) controls. We provide experimental evidence that the choice of the optimal surgical approach for the treatment of fractures involving cancellous bone could be aided by a simple staining procedure for vital bone. However, the described procedure depends on the availability of bone specimens (slices). Therefore, search for an improved stain directly applicable to the bone surface is needed.
The management of intracapsular hip fractures
2016, Orthopaedics and Trauma
Hip fractures are the most common, serious musculo-skeletal injury to affect the elderly population. Approximately 80 000 hip fractures occur each year in the UK with an estimated annual associated cost of £2 billion. The annual burden of hip fractures is expected to increase over the coming years as a result of demographic changes to the UK population. There is significant mortality and morbidity associated with these injuries. It is therefore essential that a multidisciplinary approach is employed to maximize potential recovery after this injury. The surgical management of hip fractures varies depending upon the anatomical location of the fracture. Approximately one half of all hip fractures are intracapsular in nature. In this article we explore the current controversies in treatment of these fractures and factors which may affect management decisions.
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PaperSignificance of urgent (within 6 h) internal fixation in the management of fractures of the neck of the femur

Abstract

Injury

Subcapital fractures of the femur

J. Bone Joint Surg.

Transcervical femoral fracture

J. Bone Joint Surg.

Stability and union in subcapital fractures of the femur

J. Bone Joint Surg

Treatment and outcome of femoral neck fracture

Clin. Orthop.

La mortalité dans les fractures de l'extrémité superieure de fémur

Chirurgie

Paper
Significance of urgent (within 6 h) internal fixation in the management of fractures of the neck of the femur