Showing papers on "Femoral neck published in 1975"
TL;DR: A new approach is presented, involving complete capsulectomy without osteotomy of the greater trochanter, which provides wide exposure of the acetabulum and of the femoral neck, which permits total hip replacement to be done without osteotomized with satisfactory exposure in many instances.
Abstract: To be able to perform total hip replacement without osteotomy of the greater trochanter has specific advantages including reduced operating time, reduced blood loss and shorter rehabilitation time. However, the exposure is less wide than when the greater trochanter is osteotomized and likelihood of technical error is increased. A new approach is presented, involving complete capsulectomy without osteotomy of the greater trochanter, which provides wide exposure of the acetabulum and of the femoral neck. It permits total hip replacement to be done without osteotomy of the greater trochanter with satisfactory exposure in many instances. Specific contraindications against the use of this approach are those circumstances which require shortening of the limb, cases with severe distortion of the anatomy, cases of severe protrusio acetabulum and cases with marked scarring from previous surgery.
43 citations
Proceedings Article•
01 Oct 1975
TL;DR: A structural model has been developed, in an attempt to predict the failure load of specimens solely from measurements made from an anteroposterior radiograph of the neck region, and good correlation was obtained between the predicted and experimental values for the range tested.
Abstract: In this study 39 male and female cadaveric femoral necks of ages between 21 and 89 years have been radiographed and subsequently mechanically tested to determine failure load. A structural model has been developed, in an attempt to predict the failure load of specimens solely from measurements made from an anteroposterior radiograph of the neck region. Good correlation was obtained between the predicted and experimental values for the range tested. The influence of average bone porosity is discussed. It is believed that this method, with modifications will provide a basis for the quantitative assessment of femoral neck strength in the clinical situation.
34 citations
TL;DR: Persistence of the external rotation contracture was the main cause of toeing-out gait in this study and Femoral neck retroversion was not present clinically in any of the patients examined, and so appears to be quite rare.
Abstract: External rotation contracture of the extended hip is common in young infants, decreasing progressively with growth so that it appears to be present in less than 5 per cent of the children over age 18 months. Persistence of the external rotation contracture was the main cause of toeing-out gait in this study. Femoral neck anteversion, as a cause of internal rotation posturing of the limb, does not become clinically recognizable until complete resolution of the external rotation contracture of the hip has occurred, that is, usually after 18 months of age. Femoral neck retroversion was not present clinically in any of the patients examined, and so appears to be quite rare. Approximately 80 per cent of children under 18 months of age who toe-in have internal tibiofibular torsion; most of these also have significant talar neck adductus! Approximately 70 per cent of children over age 2 years who toe-in have excess femoral neck anteversion as the cause. Approximately 75 per cent of the children with metatarsus adductus deformity have coexistent internal tibial torsion and talar neck adductus; only 25 per cent of children with internal tibial torsion have coexistent metatarsus adductus deformity. Physiologic genu varum usually occurs prior to 2 years of age and physiologic genus valgum usually occurs after 2 years of age.
32 citations
TL;DR: Clinical cases of pelvic disease in the cat were surveyed over a 5 year period and treatment of proximal femoral epiphyseal separation and femoral neck fracture by excision arthroplasty gave a more rapid return to soundness compared with conservative treatment.
Abstract: Clinical cases of pelvic disease in the cat were surveyed over a 5 year period and were classified into proximal femoral epiphyseal separation and femoral neck fracture (19-6%), anterodorsal hip luxation (19-6%), pelvic fracture (34%), sacroiliac separation (16%), sacral and coccygeal fracture separation (7-2%) and neoplasia (3-1%).
Treatment of proximal femoral epiphyseal separation and femoral neck fracture by excision arthroplasty gave a more rapid return to soundness compared with conservative treatment. The majority of hip luxations responded well to external reduction and restricted exercise for 2-4 days. All cases of pelvic fract. ure were treated conservatively (2-14 days of ‘cage-rest’) and showed marked improvement within 2 weeks. Radiographic and clinical assessment of these revealed that the fractured bones eventually stabilized in their displaced positions. Sacral and coccygeal fracture separations required careful evaluation for bladder function and some cases needed tail amputation. Certain complications associated with conservative treatment of pelvic injuries in cats have been considered although in no case did these prove a serious clinical problem. Two cases of giant cell sarcoma and one of spindle cell sarcoma, of periosteal origin, were included in the survey.
30 citations
TL;DR: Histologic and histochemical examinations suggest that a loss of glycosaminoglycans in the matrix is evidence for conversion of chondrocyte activity to mitosis which occurs, however, within the limit of "the point of irreversibility", analogous to the observations from the biochemical point of view.
Abstract: Autoradiographic studies using thymidine-3H reveal the mitosis of chondrocytes in degenerated joints, i.e. joints having secondary osteoarthritis or aseptic necrosis of the femoral head. The findings obtained provide additional support for the recent investigations regarding chondrocyte mitosis in primary osteoarthritic cartilage. Histologic and histochemical examinations suggest that a loss of glycosaminoglycans in the matrix is evidence for conversion of chondrocyte activity to mitosis which occurs, however, within the limit of "the point of irreversibility", analogous to the observations from the biochemical point of view. Biomechanical and nutritional factors are also discussed in relation to the results obtained from cartilages of the femoral heads in cases of femoral neck fracture and aseptic necrosis of the femoral head.
29 citations
TL;DR: Three cases are described in which a femoral neck fracture developed at least 1 year after a healed intertrochanteric fracture of the femur is felt to be the cause.
Abstract: Three cases are described in which a femoral neck fracture developed at least 1 year after a healed intertrochanteric fracture of the femur. Trauma via osteoporotic bone is felt to be the cause. To prevent this complication, a nail extending just to the articular cartilage of the hip joint is needed. This can be accomplished by the displacement osteotomy technique or by the use of the sliding nail-plate into the more stable posterior inferior quadrant of the head.
26 citations
TL;DR: Early weightbearing had a beneficial effect upon the healing of the fracture and there was no evidence in the case of early weightbearers of any additional complications.
Abstract: This study is a survey of a series of 446 patients, treated in the city of Turku, Finland, between 1964 and 1971, for medial fractures of the femoral neck. Fractures were treated by means of the classical nailing method (nail placed along the central axis of the femoral neck, ad modum Smith-Petersen). An unselected group of patients were treated in such a way that they were already allowed to bear weight on the injured limb 2 weeks post-operatively (120 patients). The remaining patients were not allowed to bear weight on the injured limb until 12-14 weeks after nailing (261 patients). The progress of recovery was studied retrospectively, a comparison being made between the early and late weightbearers. Without reference to the type of fracture (according to the classifications of Garden or Pauwels) or to the method of fixing (Smith-Petersen nail, with or without side-plate) bone union was relatively more frequent and failures were relatively less frequent among early weightbearers than among late weightbearers. Early weightbearing had a beneficial effect upon the healing of the fracture and there was no evidence in the case of early weightbearers of any additional complications. A comparative study of the whole patient group on the basis of the time-lag between the accident and the operation--some were nailed 1-3 days, some 4-7 days and some more than a week after the fracture had taken place--revealed no significant differences.
17 citations
TL;DR: In nine patients with osteoarthritis of the hip who suffered from pain at rest, intraosseous pressure was measured in both the femoral head and neck before and immediately after fenestration in the lateral aspect of the greater trochanter.
Abstract: In nine patients with osteoarthritis of the hip who suffered from pain at rest, intraosseous pressure was measured in both the femoral head and neck before and immediately after fenestration in the lateral aspect of the greater trochanter. A small but significant drop in intraosseous pressure in both the femoral neck and head was registered as a result of the fenestration procedure.
17 citations
15 citations
Journal Article•
TL;DR: In this article, a retrospective analysis was made of fractures in adult patients treated in the University Hospital in Turku and also in the Municipal Hospital in the same city between 1964 and 1971.
Abstract: In order to regularize the classification of medial fractures of the femoral neck a retrospective analysis was made of fractures in adult patients treated in the University Hospital in Turku and also in the Municipal Hospital in the same city between 1964 and 1971. There were 446 cases of medial fracture of the femoral neck, 75 of which occurred in male patients and 368 in female patients. Medial fractures of the femoral neck were classified according to the scheme laid down by Garden (8) and Pauwels (18) and in addition, the situation of the level of the fracture in the femoral neck was determined according the method proposed by Brown and Abrami (3). No correlation could be found between either the division made by Garden and that made by Pauwels or between the situation of the level of the fracture in the femoral neck and the degree of primary dislocation in the fracture. Following Garden's classification, dislocated (stage 3 or stage 4) fractures were more common among women than men. Pauwels' figures showed that there were relatively more unstable fractures (groups 3--4) among men than among women. Among women patients the situation of the level of the fracture was, on the average, more medial than among men. The healing of fractures was evaluated according to the calssifications of Garden and Pauwels. That of Garden proved to be much more logical and from the point of view of prognosis of recovery, more reliable. The present authors recommend the classification made by Garden in cases of medial fracture of the femoral neck.
11 citations
01 Jan 1975
TL;DR: In any population there is going to be considerable overlap between individuals with symptomatic osteoporosis and controls as far as bone mass, bone metabolism and hormonal abnormalities are concerned.
Abstract: An osteoporotic individual is defined symptomatically as one with pain and disability resulting from fractures, generally a femoral neck fracture or one or more fractures of the spine. The disease can be defined by the degree of bone loss using quantitative radiological techniques such as bone cortical thickness or the Singh Index (BARNETT and NORDIN, 1960; SINGH et al., 1972).However, an arbitrary decision must be made as to precisely what level of bone loss constitutes osteoporosis and ultimately the definition remains dependent on the presence or absence of symptoms resulting from fracture. A symptomatic patient with a recent fracture is expressing evidence of a long history of the process of bone loss while a non-symptomatic, and therefore “normal” individual, may have the same degree of bone loss as a diagnosed osteoporotic patient and has only failed to sustain a fracture because no stress has occurred. It is obvious therefore that in any population there is going to be considerable overlap between individuals with symptomatic osteoporosis and controls as far as bone mass, bone metabolism and hormonal abnormalities are concerned. The disease or pain reflects rate of bone loss, duration of bone loss and recent stress. A fracture results from both a decreased amount of bone and stress; if the stress does not occur, there is no fracture.
Journal Article•
TL;DR: Having reviewed 28 cases of fractures of the femoral head complicating traumatic dislocation of the hip the authors point out that the problems to be solved are the reduction of the dislocation (close or surgical) and the fate of the Femoral head fragment.
Abstract: Having reviewed 28 cases of fractures of the femoral head complicating traumatic dislocation of the hip the authors point out that the problems to be solved are the reduction of the dislocation (close or surgical) and the fate of the femoral head fragment. Close reduction succeeded in 12 cases, failed in 12 other cases, was not attempted 4 times. Open reduction was performed 16 times. When the femoral fragment was small, close reduction was attempted and the femoral head fragment neglected (10 cases). In three cases close reduction was attempted despite a big femoral fragment. These cases were complicated by a secondary femoral neck fracture. After open reduction the femoral head fragment should be neglected if small, screwed if important. Eight times a rather big fragment was removed but final results were unsatisfactory.
Journal Article•
TL;DR: The most common complication of femoral neck fractures is avascular necrosis secondary to loss of blood supply; this condition occurs in one of every three patients incurring such an injury as mentioned in this paper.
Abstract: The most common complication of femoral neck fractures is avascular necrosis secondary to loss of blood supply; this condition occurs in one of every three patients incurring such an injury. A simple, accurate procedure for assessing the blood supply prior to definitive surgery would identify those patients in whom this complication could develop, thus avoiding secondary salvage operations. In previous studies, we found positron scintigraphy using radioactive fluorine (/sup 18/F) to be useful in the clinical management of patients with fractures of the femoral neck. /sup 99m/Tc diphosphonate is one of the newer, less-expensive bone scanning agents which have become more readily available, and we undertook a study to determine its usefulness.
TL;DR: Of 102 hips with femoral neck fracture complications, 75 required major secondary procedures such as total hip replacement, femoral prosthesis, cup arthroplasty, tibial bone grafting, and head and neck resection.
Abstract: Of 102 hips with femoral neck fracture complications, 75 required major secondary procedures such as total hip replacement, femoral prosthesis, cup arthroplasty, tibial bone grafting, and head and neck resection The method chosen depended on the specific problem: nonunion, aseptic necrosis, infection, degenerative arthritis, or a failed primary prosthesis Other factors influencing treatment were the patient's chronological and physiological age, his general health, his life pattern, and the familiarity of the surgeon with the technique and the advantages and disadvantages of the various salvage procedures
TL;DR: If comminuted intertrochanteric fractures of the femoral neck are treated in the same way as the simple ones--by reduction, McLaughlin nailing, and early weightbearing--many complications will occur, in most cases failure of the osteosynthesis or infection.
Abstract: If comminuted intertrochanteric fractures of the femoral neck are treated in the same way as the simple ones--by reduction, McLaughlin nailing, and early weightbearing--many complications will occur, in most cases failure of the osteosynthesis or infection. If operation is to be used at all in these fractures, it must take the form of a firmer fixation or primary osteotomy. Moreover, the time of commencement of weight-bearing must be accurately and individually determined.
TL;DR: A review was made of 62 operations in the elderly patients over the age of 65 years from 1972 to 1974, in which 75% of patients were female, and preoperative condition revealed hypertension in 18 patients, in whom cardiac disturbance was 5 and 27 patients had some pathologic ECG.
Abstract: A review was made of 62 operations in the elderly patients over the age of 65 years from 1972 to 1974. Seventy-seven percent of the patients were female. Twenty-eight operations were done to the femoral neck or trochanteric fractures. Internal fixations were ordinary done to the trochanteric fracture and the primary prosthetic replacements were performed in 11 cases out of 15 of the femoral neck fracture. Preoperative condition revealed hypertension in 18 patients, in whom cardiac disturbance was 5 and 27 patients had some pathologic ECG. Postoperative complication was urinary infection in 11, acute renal insufficiency, paralytic ileus and serum hepatitis in 2, respectively. No postoperative thromboembolism was observed.
TL;DR: The mortality during the first year after operation was studied in 209 patients with intertrochanteric fracture of the femoral neck, all treated with osteosynthesis, finding the excess mortality due to the fracture and operation proved to be about 20 per cent.
Abstract: The mortality during the first year after operation was studied in 209 patients with intertrochanteric fracture of the femoral neck, all treated with osteosynthesis. The excess mortality due to the fracture and operation proved to be about 20 per cent. Among the great majority of patients who did not have significant cardiac symptoms or signs despite their advanced age, the excess mortality was below 10 per cent. Among patients whose operative risk had been deemed increased due to heart disease, the excess mortality during the first year was about 50 per cent. Language: en
Journal Article•
TL;DR: The results prove that in suitable cases and with correct technique the head-endoprosthesis still has justification, especially as the "protrusio acetabuli", known only as complication of pure head-endsiprosthesis, is mostly avoidable.
Abstract: By clinical, radiographic and scintigraphic means we attempted to examine, whether the implantation of a simple head-endoprosthesis after fractures of the femoral neck still has to be considered as an appropriate operating method or whether on principle, primary endoprosthesis should be used. The results prove that in suitable cases and with correct technique the head-endoprosthesis still has justification, especially as the "protrusio acetabuli", known only as complication of pure head-endoprosthesis, is mostly avoidable. Reference to the choice of cases, operating conditions and appropriate methods of examination are given.
Journal Article•
TL;DR: The follow-up observations revealed that the bone grafts seemed to unite to the acetabular bed 6 to 8 weeks after the operation, and the short-term results were excellent in all cases.
Abstract: In one case of coxarthrosis with hypoplastic acetabulum occurred early loosening of McKee-Farrar's socket which was fixated successfully in the second operation after acetabuloplasty with iliac bone. For the following 8 cases with hypoplastic acetabulum, the roofs were constructed with iliac bone graft or bone graft taken from the resected femoral neck so as to make bony block for the socket.The follow-up observations revealed that the bone grafts seemed to unite to the acetabular bed 6 to 8 weeks after the operation, and the short-term results were excellent in all cases.
TL;DR: Eighteen total hip replacements with Charlney and Charnley-Muller prosthesis for sixteen patients have been carried out since 1971, according to the plan adopted and decided by the Japanese Orthopedic Association.
Abstract: Eighteen total hip replacements with Charlney and Charnley-Muller prosthesis for sixteen patients have been carried out since 1971.Preoperative diagnoses are osteoarthritis, aseptic necrosis, failed endoprosthesis, nonunion of the fracture of the femoral neck, ankylosis and Charcot joint.The time of observation after surgery is not long enongh as 5 months to 3.5 years.The results were assessed for pain relief, function and mobility according to the plan adopted and decided by the Japanese Orthopedic Association.