Displaced femoral neck fractures : studies on osteosynthesis and total hip arthroplasty
Author: Neander, Gustaf
Date: 2000-05-19
Location: Aulan, plan 3, Danderyds sjukhus
Time: 9.00
Department: Karolinska Institutet, Danderyds Sjukhus / Karolinska Institutet at Danderyds Hospital
Abstract
The treatment of femoral neck fractures has for many years in Sweden been reduction and osteosynthesis with nails or screws. For displaced fractures the risk of complications such as avascular necrosis and non-union is up to 50 %, often leading to a secondary operation with an arthroplasty. Because of this high risk of complications the primary treatment in many countries is an arthroplasty. There is no consensus of which treatment that is to be recommended for a patient with a displaced femoral neck fracture. We performed a prospective randomized study between ostosynthesis and cemented total hip arthroplasty in 100 patients. All fractures were displaced, and patients participating in the study were independently living and without any other serious medical condition. Bone mass and muscle volume measurements were also performed. Scintigraphy of extracted femoral head specimens was also done. At the time of fracture there was no difference in bone mass between the fractured and the uninjured leg, but after six months there was a loss of trabecular bone on both sides, more pronounced on the fractured side. The muscle volume decreased on the fractured side, but increased on the uninjured side.
Independently of which treatment the patient had undergone, osteosynthesis or total hip arthroplasty, there was a loss of bone mass and muscle volume after eighteen months on the fractured side. The bone loss on the fractured side, in patients with avascular necrosis after a displaced femoral neck fracture, was still persistent six months after a reoperation with a total hip arthroplasty despite the gain in muscle volume on that side. The radionuclide inside the femoral head after a displaced femoral neck fracture was distributed in three different patterns, general uptake, uptake close to the fracture and uptake at the ligamentum capitis femoris. In this selected group of patients with displaced femoral neck fractures the functional results were better after total hip arthroplasty than osteosynthesis already after three months, and the superior results remained up to four years. The risk for a reoperation for patients treated with osteosynthesis was over 50 %.
Independently of which treatment the patient had undergone, osteosynthesis or total hip arthroplasty, there was a loss of bone mass and muscle volume after eighteen months on the fractured side. The bone loss on the fractured side, in patients with avascular necrosis after a displaced femoral neck fracture, was still persistent six months after a reoperation with a total hip arthroplasty despite the gain in muscle volume on that side. The radionuclide inside the femoral head after a displaced femoral neck fracture was distributed in three different patterns, general uptake, uptake close to the fracture and uptake at the ligamentum capitis femoris. In this selected group of patients with displaced femoral neck fractures the functional results were better after total hip arthroplasty than osteosynthesis already after three months, and the superior results remained up to four years. The risk for a reoperation for patients treated with osteosynthesis was over 50 %.
List of papers:
I. Neander G, Adolphson P, Hedström M, von Sivers K, Dahlborn M, Dalén N (1997). Decrease in bone mineral density and muscle mass after femoral neck fracture. A quantitative computed tomography study in 25 patients. Acta Orthop Scand. 68(5):451-5.
Pubmed
II. Neander G, Öberg M, Dahlborn M, Mesko L, Dalén N (2000). Radionuclide uptake in the femoral head after displaced femoral neck fracture. [Submitted]
III. Neander G, Adolphson P, von Sivers K, Dahlborn M, Dalen N (1997). Bone and muscle mass after femoral neck fracture. A controlled quantitative computed tomography study of osteosynthesis versus primary total hip arthroplasty. Arch Orthop Trauma Surg. 116(8):470-4.
Pubmed
IV. Neander G, Révay S, Dalén N (2000). Reduction and fixation versus total hip arhroplasty in the treatment of displaced femoral neck fractures. Results after four years of a prospective randomized study in 100 patients. [Submitted]
V. Neander G, von Sivers K, Adolphson P, Dahlborn M, Dalén N. (1999). An evaluation of bone loss after total hip arthroplasty for femoral head necrosis after femoral neck fracture: a quantitative CT study in 16 patients. J Arthroplasty. 14(1):64-70.
Pubmed
I. Neander G, Adolphson P, Hedström M, von Sivers K, Dahlborn M, Dalén N (1997). Decrease in bone mineral density and muscle mass after femoral neck fracture. A quantitative computed tomography study in 25 patients. Acta Orthop Scand. 68(5):451-5.
Pubmed
II. Neander G, Öberg M, Dahlborn M, Mesko L, Dalén N (2000). Radionuclide uptake in the femoral head after displaced femoral neck fracture. [Submitted]
III. Neander G, Adolphson P, von Sivers K, Dahlborn M, Dalen N (1997). Bone and muscle mass after femoral neck fracture. A controlled quantitative computed tomography study of osteosynthesis versus primary total hip arthroplasty. Arch Orthop Trauma Surg. 116(8):470-4.
Pubmed
IV. Neander G, Révay S, Dalén N (2000). Reduction and fixation versus total hip arhroplasty in the treatment of displaced femoral neck fractures. Results after four years of a prospective randomized study in 100 patients. [Submitted]
V. Neander G, von Sivers K, Adolphson P, Dahlborn M, Dalén N. (1999). An evaluation of bone loss after total hip arthroplasty for femoral head necrosis after femoral neck fracture: a quantitative CT study in 16 patients. J Arthroplasty. 14(1):64-70.
Pubmed
Issue date: 2000-04-28
Publication year: 2000
ISBN: 91-628-4167-X
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