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Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures

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World Journal of Clinical Cases 2024年第6期12卷 1076-1083页

作者： Ting-Xin Yan Sheng-Jie Dong Bo Ning Yu-Chi Zhao Department of Joint Surgery Yantaishan HospitalYantai 264003Shandong ProvinceChina Department of Joint Surgery Dongying People's HospitalDongying 257091Shandong ProvinceChina

BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System score

关键词： Conjoined tendon preserving Bipolar hip arthroplasty femoral neck fractures Postoperative dislocation Posterolateral approach

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Direct anterior compared to posterior approach for hip hemiarthroplasty following femoral neck fractures

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World Journal of Orthopedics 2024年第6期15卷 605-607页

作者： Kevin A Wu Alexandra N Krez Albert T Anastasio Department of Orthopaedic Surgery Duke University HospitalDurhamNC 27710United States Department of Orthopaedic Surgery Duke University School of MedicineDurhamNC 27710United States

The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.

关键词： Direct anterior approach Posterior approach Hemiarthroplasty femoral neck fractures Arthroplasty Dislocation Surgical technique

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Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults

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Chinese Journal of Traumatology 2016年第4期19卷 209-212页

作者： Mayank Gupta Rajendra Kumar Arya Satish Kumar Vijay Kumar Jain Skand Sinha Ananta Kumar Naik Department of Orthopedics Post Graduate Institute of Medical Education and Research Dr Ram Manohar Lohia Hospital New Delhi 110001 India

OBJECTIVE:Both cannulated cancellous screw (CCS) and sliding hip screw (SHS) are used in femoral neck fracture fixations, but which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults.;METHODS:Adults (16e60 years) with femoral neck fracture were divided into Group 1 fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed.;RESULTS:Group 1 (n=40) achieved radiological union at mean of 7.6 months, with the union rate of 87.5% (n=35), avascular necrosis (AVN) rate of 7.5% (n=3) and mean Harris Hip Score (HHS) of 86.15 at the end of 4 years. In Group 2 (n=45) these parameters were union at 7.1 months, union rate of 82.22% (n=37), AVN rate of 6.67% (n=3) and HHS of 88.65. Comparative results were statistically insignificant.;CONCLUSIONS:There is no significant difference in clinicoradiological outcome between the two implants.

关键词： femoral neck fractures Bone screws Young adult

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Comparison of DAA and PLA Approaches for Total Hip Replacement in the Treatment of femoral neck fractures

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Surgical Science 2022年第12期13卷 566-576页

作者： Dun Liu Jinpeng Zheng Shuan Liu Mingyong Zhang Bing Hu Department of Orthopedics Tianyou Hospital Affiliated to Wuhan University of Science & Technology Wuhan China

Objectives: femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral approach (PLA) in the treatment of femoral neck fracture. Methods: Retrospective analysis of 100 cases of elderly patients with femoral neck fracture who underwent total hip arthroplasty admitted to Tianyou Hospital affiliated to Wuhan University of Science and Technology from January 2019 to January 2022. 50 patients treated with DAA approach were included in the observation group, and 50 patients treated with PLA approach were included in the control group. The operation indexes, postoperative acetabular abduction angle and anteversion angle, hip joint function, Harris score and complications were compared between the two groups. Result: The length of incision in the observation group was shorter than that in the control group, and the amount of intraoperative bleeding and postoperative hospital stay were shorter than those in the control group (P 0.05);Harris score of hip joint: 6 months after operation, the anterior approach group was significantly higher than the posterolateral approach group (P 0.05);The total incidence of complications in the observation group was lower than that in the control group, with a statistically significant difference (P Conclusion: DAA and PLA approaches for total hip replacement can restore the hip joint structure of patients with femoral neck fractures and achieve good results, but DAA

关键词： Total Hip Replacement femoral neck fractures Direct Anterior Approach Posterolateral Approach Clinical Effect

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

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Life Research 2021年第4期4卷 8-12页

作者： Xin Ju Cheng-Yuan Yang Xin-Lin Su Jun Lin Department of Orthopaedic Surgery The First Affiliated Hospital of Soochow UniversitySuzhouChina.

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.

关键词： femoral neck fractures preoperative traction femoral head necrosis incidence

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Intracapsular fracture of the proximal femur in a bilateral above-knee amputee: A case report with technical tips for intraoperative positioning and literature review

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Chinese Journal of Traumatology 2022年第5期25卷 306-310页

作者： Aditya Jain Hemant Bansal Samarth Mittal Arvind Kumar Vivek Trikha Primus Super Specialy Hospital New DelhiIndia Department of orthopaedics Jay Prakash Narayan Apex Trauma Center All India Institute of Medical SciencesNew DelhiIndia Department of Orthopaedis Hamdard Institute of Medical Sciences&ResearchNew DelhiIndia

Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.

关键词： femoral neck fractures Bilateral amputee Above-knee amputation Intraoperative positioning Surgical management

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Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis

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Chinese Journal of Traumatology 2020年第6期23卷 356-362页

作者： Wei Peng Na Bi Jun Zheng Na Xi Eighth Medical Center of Chinese PLA General Hospital Beijing 100091China

Purpose By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality,dislocation,infection,reoperation rate,and thromboembolic event.Methods The PubMed,EMBASE databases,and Cochrane library were systematically searched from the inception dates to April 1,2020 for relevant randomized controlled trials in English language using the keywords:“total hip arthroplasty”,“hemiarthroplasty”and“femoral neck fracture”to identify systematic reviews and meta-analyses.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’stools,and discussed any disagreements.The third reviewer was consulted for any doubts or uncertainty.We derived risk ratios and 95%confidence intervals.Mortality was defined as the primary outcome.Secondary outcomes were other complications,dislocation,infection,reoperation rate,and thromboembolic event.Results This meta-analysis included 10 studies with 1419 patients,which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation,infection rate,and thromboembolic event.However,there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.Conclusion Based on our results,we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.

关键词： Total hip arthroplasty Hemiarthroplasty femoral neck fractures Meta-analysis

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