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Mohit Bhandari - One of the best experts on this subject based on the ideXlab platform.
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management of young Femoral Neck fractures is there a consensus
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Sheila Sprague, Gerard P. Slobogean, Taryn Scott, Michael D Mckee, Mohit BhandariAbstract:Abstract Background Femoral Neck fractures in young adults (ages Methods A 17-item survey was developed and tested for validity and reliability prior to administration. The questionnaire characterised surgeon demographics, treatment preferences for displaced and undisplaced fractures, and controversies for future clinical trials. The target population consisted of surgeons from the Canadian Orthopaedic Association, the Orthopaedic Trauma Association, and attendees at an international fracture course. Results 540 surgeons completed the survey, exceeding our sample size requirement. There was a similar proportion of respondents from academic and community hospitals. Most surgeons (61%) treat 1–5 young adult Femoral Neck fractures per year. For undisplaced fractures, 78% of respondents prefer to use multiple cannulated screws. For displaced fractures, equal preference for multiple screws (46%) and the sliding hip screw (SHS, 49%) was reported. The majority of surgeons perform an open reduction in less than 25% of cases, and the time to fixation was typically between 8 and 24 h. Conclusions Multiple cannulated screws remain the preferred treatment for most surgeons treating undisplaced fractures; however, there is an equal divide in preference between multiple screws and the SHS for displaced fractures. This increased preference for the SHS contradicts previous survey and small trial data recommending multiple screws for all fracture patterns. The lack of surgeon consensus and the high rates of fracture complications associated with fixation of young Femoral Neck fractures supports the need for definitive clinical trials to optimise patient important outcomes.
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Complications following young Femoral Neck fractures.
Injury, 2014Co-Authors: Gerard P. Slobogean, Sheila Sprague, Taryn Scott, Mohit BhandariAbstract:Abstract Background Femoral Neck fractures in patients 60 years of age or younger are challenging injuries to treat because of the high-energy trauma mechanisms and the displaced fracture patterns typically found in this patient population. Understanding the burden of disease is an important first step in addressing treatment controversies in this population. The purpose of the current study is to quantitatively pool the incidence of patient important complications following internal fixation of young Femoral Neck fractures. Methods A comprehensive search of the Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Central databases was completed under the direction of a biomedical librarian. Multiple outcomes of interest (complications) were collected and included: reoperation, Femoral head avascular necrosis, fracture non-union, infection, implant failure, and malunion. Results 1558 fractures from 41 studies were included in the meta-analysis. An18.0% pooled reoperation incidence was observed for isolated Femoral Neck fractures. The total pooled incidence of avascular necrosis (AVN) was 14.3%, and the total incidence of nonunion was 9.3%. When stratified for fracture displacement displaced fractures were more likely to undergo reoperation and to result in AVN or non-union. The total incidence of malunion was 7.1%, implant failure was 9.7%, and surgical site infection was 5.1%. Complications associated with a Femoral Neck fracture treated in conjunction with an ipsilateral Femoral shaft fracture were lower overall than the pooled estimates for isolated Neck fractures. Conclusions The results of our analysis demonstrate that the incidence of complications experienced by young Femoral Neck fracture patients is relatively high. Reoperation following internal fixation of isolated Femoral Neck fractures occurred in nearly 20% of cases, and AVN and nonunion were the most common complications that likely contributed to repeat surgeries. These results highlight the importance of further efforts to improve the clinical outcomes in this population.
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Femoral Neck shortening after internal fixation of a Femoral Neck fracture
Orthopedics, 2013Co-Authors: Stephanie M. Zielinski, Mohit Bhandari, Martin J. Heetveld, Peter Patka, Noel L W Keijsers, Stephan F E Praet, Jean Pierre Wilssens, Esther M.m. Van LieshoutAbstract:This study assesses Femoral Neck shortening and its effect on gait pattern and muscle strength in patients with Femoral Neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral Neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median Femoral Neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for Femoral Neck shortening. Femoral Neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of Femoral Neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to Femoral Neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome.
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Femoral Neck shortening after fracture fixation with multiple cancellous screws incidence and effect on function
Journal of Trauma-injury Infection and Critical Care, 2008Co-Authors: Michael Zlowodzki, Olufemi Ayieni, Brad Petrisor, Mohit BhandariAbstract:Background:Shortening of the Femoral Neck after fracture fixation with multiple parallel screws decreases the moment arm for the abductor muscles of the hip. This study aimed to assess the incidence of Femoral Neck shortening quantitatively and qualitatively in patients with Femoral Neck fractures t
Gerard P. Slobogean - One of the best experts on this subject based on the ideXlab platform.
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measuring lateral screw protuberance is a clinically accurate method for quantifying Femoral Neck shortening
Journal of Orthopaedic Trauma, 2020Co-Authors: Aresh Sepehri, James R Martinson, Lucas S Marchand, Matthew D Riedel, Ian P Mcalister, Nathan N Ohara, David J Stockton, Gerard P. SlobogeanAbstract:OBJECTIVES: The purpose of this study is to compare the reliability and accuracy of the screw protuberance method (SPM) and overlay method (OM) for measuring Femoral Neck shortening on AP radiographs. The secondary aim is to investigate the changes in reliability and accuracy with varying Femoral rotation. METHODS: Radio-opaque femur sawbone models were fitted with either three cancellous screws or a sliding hip screw implant. AP radiographs were obtained using C-arm fluoroscopy with Femoral Neck shortening up to 15 mm and with the Femoral shaft in 30 degrees of internal rotation (IR) to 30 degrees of external rotation (ER). Four observers measured Femoral Neck shortening at two time points.Intra-observer and inter-observer reliability were calculated using the intraclass coefficient (ICC). Accuracy was analyzed through a Bland-Altman agreement statistic stratified by Femoral rotation. RESULTS: Both measurement techniques displayed excellent reliability, regardless of Femoral rotation or implant. There was a significant difference in Femoral Neck shortening measurements with rotation for both the OM (p<0.001) and SPM (p<0.001). Both methods are accurate within 1 mm of the actual magnitude of shortening from 30 degrees IR to 15 degrees ER. At 30 degrees ER, shortening was underestimated by -2.10 mm using the OM (95% CI: -2.43, -1.76, p<0.01) and by -1.64 mm using the SPM (95% CI: -1.83, -1.45, p<0.01). CONCLUSION: This study demonstrates that both the OM and SPM are accurate and reliable assessments for Femoral Neck shortening; however, both methods are sensitive to extreme external rotation. Given the simplicity of the SPM technique, it may have increased utility for pragmatic research studies. LEVEL OF EVIDENCE: Not Applicable.
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management of young Femoral Neck fractures is there a consensus
Injury-international Journal of The Care of The Injured, 2015Co-Authors: Sheila Sprague, Gerard P. Slobogean, Taryn Scott, Michael D Mckee, Mohit BhandariAbstract:Abstract Background Femoral Neck fractures in young adults (ages Methods A 17-item survey was developed and tested for validity and reliability prior to administration. The questionnaire characterised surgeon demographics, treatment preferences for displaced and undisplaced fractures, and controversies for future clinical trials. The target population consisted of surgeons from the Canadian Orthopaedic Association, the Orthopaedic Trauma Association, and attendees at an international fracture course. Results 540 surgeons completed the survey, exceeding our sample size requirement. There was a similar proportion of respondents from academic and community hospitals. Most surgeons (61%) treat 1–5 young adult Femoral Neck fractures per year. For undisplaced fractures, 78% of respondents prefer to use multiple cannulated screws. For displaced fractures, equal preference for multiple screws (46%) and the sliding hip screw (SHS, 49%) was reported. The majority of surgeons perform an open reduction in less than 25% of cases, and the time to fixation was typically between 8 and 24 h. Conclusions Multiple cannulated screws remain the preferred treatment for most surgeons treating undisplaced fractures; however, there is an equal divide in preference between multiple screws and the SHS for displaced fractures. This increased preference for the SHS contradicts previous survey and small trial data recommending multiple screws for all fracture patterns. The lack of surgeon consensus and the high rates of fracture complications associated with fixation of young Femoral Neck fractures supports the need for definitive clinical trials to optimise patient important outcomes.
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Complications following young Femoral Neck fractures.
Injury, 2014Co-Authors: Gerard P. Slobogean, Sheila Sprague, Taryn Scott, Mohit BhandariAbstract:Abstract Background Femoral Neck fractures in patients 60 years of age or younger are challenging injuries to treat because of the high-energy trauma mechanisms and the displaced fracture patterns typically found in this patient population. Understanding the burden of disease is an important first step in addressing treatment controversies in this population. The purpose of the current study is to quantitatively pool the incidence of patient important complications following internal fixation of young Femoral Neck fractures. Methods A comprehensive search of the Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Central databases was completed under the direction of a biomedical librarian. Multiple outcomes of interest (complications) were collected and included: reoperation, Femoral head avascular necrosis, fracture non-union, infection, implant failure, and malunion. Results 1558 fractures from 41 studies were included in the meta-analysis. An18.0% pooled reoperation incidence was observed for isolated Femoral Neck fractures. The total pooled incidence of avascular necrosis (AVN) was 14.3%, and the total incidence of nonunion was 9.3%. When stratified for fracture displacement displaced fractures were more likely to undergo reoperation and to result in AVN or non-union. The total incidence of malunion was 7.1%, implant failure was 9.7%, and surgical site infection was 5.1%. Complications associated with a Femoral Neck fracture treated in conjunction with an ipsilateral Femoral shaft fracture were lower overall than the pooled estimates for isolated Neck fractures. Conclusions The results of our analysis demonstrate that the incidence of complications experienced by young Femoral Neck fracture patients is relatively high. Reoperation following internal fixation of isolated Femoral Neck fractures occurred in nearly 20% of cases, and AVN and nonunion were the most common complications that likely contributed to repeat surgeries. These results highlight the importance of further efforts to improve the clinical outcomes in this population.
Scott M Sporer - One of the best experts on this subject based on the ideXlab platform.
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a case of disassociation of a modular Femoral Neck trunion after total hip arthroplasty
Journal of Arthroplasty, 2006Co-Authors: Scott M Sporer, Craig Dellavalle, Joshua J Jacobs, Markus A WimmerAbstract:Modular Femoral heads offer the advantages of increased intraoperative flexibility through the adjustment of leg length and offset, whereas a modular Femoral Neck can also allow independent adjustment of Femoral anteversion. Despite the potential advantages of hip systems using increased modularity, these component designs also offer a greater number of junctions through which problems may occur. This case demonstrates the potential for dissociation of a Morse taper between a modular Femoral Neck and stem.
Yanyan Bian - One of the best experts on this subject based on the ideXlab platform.
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cemented versus uncemented hemiarthroplasty for Femoral Neck fractures in elderly patients a meta analysis
PLOS ONE, 2013Co-Authors: Tao Li, Qianyu Zhuang, Xisheng Weng, Lei Zhou, Yanyan BianAbstract:Objective Controversy still exists regarding using cemented or uncemented hemiarthroplasty for Femoral Neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in Femoral Neck fracture patients over 70 years old.
Markus A Wimmer - One of the best experts on this subject based on the ideXlab platform.
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a case of disassociation of a modular Femoral Neck trunion after total hip arthroplasty
Journal of Arthroplasty, 2006Co-Authors: Scott M Sporer, Craig Dellavalle, Joshua J Jacobs, Markus A WimmerAbstract:Modular Femoral heads offer the advantages of increased intraoperative flexibility through the adjustment of leg length and offset, whereas a modular Femoral Neck can also allow independent adjustment of Femoral anteversion. Despite the potential advantages of hip systems using increased modularity, these component designs also offer a greater number of junctions through which problems may occur. This case demonstrates the potential for dissociation of a Morse taper between a modular Femoral Neck and stem.
