31B3 Femoral neck, basicervical fracture

T1 - Assessment of femoral neck fracture risk for a novel proximal epiphyseal hip prosthesis

Femoral neck fractures in young patients are difficult to treat, ..


The authors present this case because THA has rarely been reported as a primary treatment for acute femoral neck fracture in BKA while internal fixation is still relevant for this type of entity [13]. Most orthopedists resort to technical tips using material or specific constructs unlike our report in which we chose to use the normal anatomy of the patient’s hip as a guide in the implants positioning.
Through our limited experience combined with a brief literature review, we would suggest the following guidelines:
– Acute femoral neck fracture in BKA should be managed by THA as a primary treatment, before the onset of post-traumatic osteoarthritis of the hip and avascular necrosis of the femoral head. At these stages, the procedure would be much more intricate since a hip dislocation is required.
– Total hip arthroplasty provides a better rehabilitation with an early full-weight bearing and return to ambulation, unlike internal fixation, in the management of femoral neck fractures, even the non-displaced ones.
– The high risk of sustaining a fracture in osteoporotic residual stump should be included in the health education of amputee patient.

A displaced fracture completely disrupts the blood vessels of the femoral neck and can tear those of the hip capsule.

Hip Bipolar Hemiarthroplasty for Femoral Neck Fracture

Moore and Bohlman, after removal of a giant cell tumor ofthe femoral head, introduced hemiarthroplasty in 1940. Sincethen it has also been used for the treatment of displacedfemoral neck fractures. It had the following features: solidpolished unipolar head with a collared, straight, fenestratedstem designed for non-cemented use.

Femoral Neck Fracture - Fracture of the Ball of Hip

Which type of hemiarthroplasty should we select for theelderly patients with displaced fractures of the femoral neck?Based on the results of our study, there appears to bestatistical difference between the two groups, that is bipolarbeing better in functional aspects. The results of our studyshowed that the incidence of complications were lower afterbipolar hemiarthroplasty.

The Cemented Unipolar Prosthesis for the Management of Displaced Femoral Neck Fractures in the ..


Prosthetic Replacement in Femoral Neck Fractures

AB - Background: This study addresses the risk of femoral neck fracture associated with resurfacing hip prostheses. A novel cemented Proximal Epiphyseal Replacement (PER) featuring a short curved stem was investigated. Methods: Seven pairs of femurs were in vitro tested. One femur of each pair was randomly assigned for PER implantation. The contralateral femur was tested intact. All femurs were loaded to failure in a validated, physiological configuration. High-speed videos (10,000-12,000 frames/s) were acquired to identify the location of fracture initiation. For comparison, data were included from Birmingham Hip Resurfacing previously tested in an identical fashion (N = 3). Findings: Relative to the contralateral intact femurs, the failure load of the PER and Birmingham implants was 15.4% higher and 10.0% lower, respectively. In six of the seven PER implants, fracture initiation (neck or inter-trochanteric) was similar to the contralateral intact femurs, suggesting comparable stress distribution. Conversely, fracture initiation in the Birmingham implants occurred at the lateral prosthesis rim, which differed substantially from the intact femurs. No correlation existed between bone quality and strengthening/weakening effect of the PER (failure load of implant as a percentage of intact: R∧2 = 0.067). Conversely, Birmingham implantation weakened the femurs with lower density (R∧2 = 0.92). Therefore, unlike most resurfacing prostheses, the PER seems suitable also for osteoporotic subjects. Interpretation: This study seems to confirm that resurfacing with a Birmingham Hip tends to reduce the strength of the proximal femur. The opposite seemed to happen with the PER, which slightly reduced the risk of neck fracture, also in low-quality bones.

Prosthetic Replacement in Femoral Neck ..

Background: This study addresses the risk of femoral neck fracture associated with resurfacing hip prostheses. A novel cemented Proximal Epiphyseal Replacement (PER) featuring a short curved stem was investigated. Methods: Seven pairs of femurs were in vitro tested. One femur of each pair was randomly assigned for PER implantation. The contralateral femur was tested intact. All femurs were loaded to failure in a validated, physiological configuration. High-speed videos (10,000-12,000 frames/s) were acquired to identify the location of fracture initiation. For comparison, data were included from Birmingham Hip Resurfacing previously tested in an identical fashion (N = 3). Findings: Relative to the contralateral intact femurs, the failure load of the PER and Birmingham implants was 15.4% higher and 10.0% lower, respectively. In six of the seven PER implants, fracture initiation (neck or inter-trochanteric) was similar to the contralateral intact femurs, suggesting comparable stress distribution. Conversely, fracture initiation in the Birmingham implants occurred at the lateral prosthesis rim, which differed substantially from the intact femurs. No correlation existed between bone quality and strengthening/weakening effect of the PER (failure load of implant as a percentage of intact: R∧2 = 0.067). Conversely, Birmingham implantation weakened the femurs with lower density (R∧2 = 0.92). Therefore, unlike most resurfacing prostheses, the PER seems suitable also for osteoporotic subjects. Interpretation: This study seems to confirm that resurfacing with a Birmingham Hip tends to reduce the strength of the proximal femur. The opposite seemed to happen with the PER, which slightly reduced the risk of neck fracture, also in low-quality bones.

and the attached remaining portion of the femoral prosthesis

Between 2000 and 2004 we performed an excision arthroplasty of the femoral head/neck in 10 consecutive patients (5 M, 5 F) due to bacterial infections of the proximal femur. A total of 11 antibiotic-loaded PMMA hip spacers were implanted (Table ). At the time of surgery, the mean age of the patients was 66 [52-77] years. After infection eradication, a prosthesis has been reimplanted in 8 cases. One patient passed away due to an unclear cause between stages, another patient (bilateral spacer implantation) due to a cardiomyopathy. In both cases, a reinfection could be excluded by magnet resonance imaging (MRI).