Rating of internal fixation and clinical outcome in displaced femoral neck fractures: A prospective multicenter study
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Clinical Orthopaedics and Related Research
(Impact Factor: 2.77).
02/2007; 454(454):207-13. DOI: 10.1097/01.blo.0000238867.15228.8d
The influence of precise surgical technique on the clinical outcome of internal fixation for displaced femoral neck fractures is an under-reported and potential confounding factor in randomized studies involving internal fixation as a treatment modality. Two experienced surgeons blindly rated internal fixation techniques on the perioperative radiographs of 102 patients selected for internal fixation in a prospective multicenter 2-year followup study. Overall technical, fracture reduction, and implant positioning ratings were given according to instruction. One or both raters assigned an inadequate overall rating in 25% of patients. There was a correlation with 2-year clinical internal fixation failure for overall technique and fracture reduction rating. Implant positioning did not correlate with 2-year internal fixation failure. Correlation increased if both raters agreed on inadequate technique. One inadequate rating indicated a problem could arise, whereas two inadequate ratings strengthened this problem likelihood. Adjudication of technique by independent rater(s) is useful, may have clinical implications, and should be performed routinely in future studies involving internal fixation in patients with displaced femoral neck fractures.
Available from: Lars Nordsletten
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ABSTRACT: We wanted to assess a new technique for augmentation of parallel screws in internal fixation of displaced femoral neck fractures with a bis-GMA-based composite delivered around the screw head. Twenty-one consecutive patients admitted with displaced femoral neck fractures were operated with internal fixation with two parallel Olmed screws augmented with the composite, and followed for 24 months. The composite was introduced through the lumen of the cannulated screws and deposited in the femoral head around the threaded part of the screws. The procedure of augmenting was technically feasible and operation time was on average 33 min. Eleven patients were re-operated due to healing complications within 24 months. There were five redisplacements, four non-unions and two cases of avascular necrosis. Histological examination of four extracted femoral heads showed fragmentation of the composite into small particles with foreign-body response with giant cells and macrophages along with granulation tissue formation and low grade inflammation. The method of augmentation was technically easy, but the failure rate was high and the fragmentation of the composite with inflammatory response found on histology is noteworthy.
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ABSTRACT: Femoral neck fractures in young patients need to be recognized as a unique injury different from the common geriatric hip fracture. These are high energy injuries, often the result of motor vehicle accidents or falls from heights as opposed to falls from standing in the older population. These fractures can be difficult to treat and outcomes have been shown to be related to the quality of the reduction. An open technique may help improve outcomes in the young patient with a femoral neck fracture by enabling anatomic reduction and fixation.
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