Complications of internally fixed femoral neck fractures

Turgut, Ali; Agus, Haluk; ARSLANTAŞ, Mustafa; Kayali, Cemil

Complications of internally fixed femoral neck fractures

Cemil KAYALI, (Tepecik Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İzmir, Türkiye)

Haluk AĞUŞ, (Tepecik Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İzmir, Türkiye)

Mustafa ARSLANTAŞ, (Özel Medicana Hastanesi, İstanbul, Türkiye)

Ali TURGUT (Tepecik Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İzmir, Türkiye)

Ulusal Travma ve Acil Cerrahi Dergisi

2 0

Yıl: 2008 Cilt: 14 Sayı: 3 Sayfa Aralığı: 226 - 230 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Complications of internally fixed femoral neck fractures

Öz:

AMAÇ: Genç hastalarda femur boyun kırıkları kesin redüksiyon ve stabil tespiti gerektiren acil yaralanmalardır. Tüm gelişmelere rağmen femur başı avasküler nekrozu (AVN) ve kaynamama kurtarıcı ameliyatlar gerektiren en önemli komplikasyonlardır. Bu geriye dönük çalışmada, internal tespit yapılan femur boyun kırıklarının komplikasyonları değerlendirildi. GEREÇ-YÖNTEM: Deplase femur kırıklı 32 hasta çalışmaya dahil edildi. Bazı hastalar ilk yaralanmadan sekiz saat sonra hastanemize başvurmalarına rağmen en erken zamanda ameliyata alındılar. Açık redüksiyon gerektiren beş hasta dışında tüm olgulara kapalı redüksiyon ve tespit uygulandı. AVN, Ficat ve Arlet kriterlerine göre değerlendirildi. Klinik değerlendirme Harris tarafından tanımlanan puanlama sistemine göre yapıldı. BULGULAR: Ortalama izlem süresi 49±29 aydı (dağılım 24-126). On üç olguda femur başı avasküler nekrozu belirlendi (%40); ancak yalnızca beş olguda yetersiz sonuca bağlı total kalça protezi uygulandı. Beş olguda da kaynamama saptandı. Yapılan istatistiksel analizde, AVN derecesi ve klinik puanlar arasında ters ilişki belirlendi. Ameliyata alınma süresi ile geç komplikasyonlar arasında ilişki saptanmadı. SONUÇ: Deplase femur boyun kırıklarının en sık komplikasyonu AVN’dir. Ancak olguların yarıdan azına kurtarıcı ameliyat gerekmiştir. Bu olgularda total kalça protezi uygun tedavi seçeneğidir.

Anahtar Kelime: Kırık tespiti, internal Artroplasti, replasman, kalça Tedavi sonucu Femur boynu kırıkları Kırıklar, parçalı Ameliyat sonrası komplikasyonlar Geriyedönük çalışma

Konular: Cerrahi

Femur boyun kırıklarında internal tespit sonrası komplikasyonlar

Öz:

BACKGROUND: Femoral neck fractures in young patients are the emergent injuries that require precise reduction and stable fixation. Despite all advances, nonunion and avascular necrosis (AVN) of the femoral head are the major complications necessitating salvage procedures. In this retrospective series, we evaluated the complications of internally fixed femoral neck fractures. METHODS: This study consisted of 32 cases that had displaced femoral neck fractures. Although some of them admitted to hospital more than 8 hours after initial trauma, all underwent internal fixation as early as possible. All the fractures were reduced and fixed by closed reduction under fluoroscopy control. However, 5 cases needed open reduction. AVN was determined by using Ficat and Arlet criteria. Clinical evaluation was performed based on the scoring system described by Harris. RESULTS: Mean follow-up period was 49±29 months (range 24-126). AVN of the femoral head was observed in 13 cases (40%). However, only 5 of them had unsatisfactory clinical results requiring salvage surgery as total hip replacement. Nonunion of fracture was seen in 5 cases. In the statistical analysis, a negative correlation was observed between the degree of AVN and clinical findings. We found no correlation between the duration of the preoperative period and late complications.CONCLUSION: AVN is the most common complication of displaced femoral neck fractures. However, less than half of these cases require salvage procedures. Total hip replacement is the preferred treatment option for these cases.

Anahtar Kelime: Femoral Neck Fractures Fractures, Ununited Postoperative Complications Retrospective Studies Fracture Fixation, Internal Arthroplasty, Replacement, Hip Treatment Outcome

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Strömqvist B, Hansson LI, Nilsson LT, Thorngren KG. Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases. Clin Orthop Relat Res 1987;(218):58-62.
2. Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years. J Bone Joint Surg [Br] 2002;84:183-8.
3. Holmberg S, Kalén R, Thorngren KG. Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes. Clin Orthop Relat Res 1987;(218):42-52.
4. Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P 3rd, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg [Am] 2003;85-A:1673-81.
5. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg [Am] 1994;76:1793-803.
6. Nikolopoulos KE, Papadakis SA, Kateros KT, Themistocleous GS, Vlamis JA, Papagelopoulos PJ, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury 2003;34:525-8.
7. Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg [Am] 2005;87:1680-8.
8. Garden RS. Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am 1974;5:683-712.
9. Leadbetter GW. Closed reductiton of fractures of the neck of the femur. JBJS 1938;20:108.
10. Ficat P, Arlet J. Pre-radiologic stage of femur head osteonecrosis: diagnostic and therapeutic possibilities. [Article in French] Rev Chir Orthop Reparatrice Appar Mot. 1973;59:Suppl 1:26-38. [Abstract]
11. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg [Am] 1969;51:737-55.
12. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg [Am] 2002;84-A:1605-12.
13. Gerber C, Strehle J, Ganz R. The treatment of fractures of the femoral neck. Clin Orthop Relat Res 1993;(292):77-86.
14. Swiontkowski MF,Winquist RA, Hansen ST Jr. Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg [Am]1984;66:837-46.
15. Franzén H, Nilsson LT, Strömqvist B, Johnsson R, Herrlin K. Secondary total hip replacement after fractures of the femoral neck. J Bone Joint Surg [Br] 1990;72:784-7.
16. Skinner PW, Powles D. Compression screw fixation for displaced subcapital fracture of the femur. Success or failure? J Bone Joint Surg [Br] 1986;68:78-82.
17. Calandruccio RA, Anderson WE 3rd. Post-fracture avascular necrosis of the femoral head: correlation of experimental and clinical studies. Clin Orthop Relat Res 1980;(152):49-84.
18. Ort PJ, LaMont J. Treatment of femoral neck fractures with a sliding compression screw and two Knowles pins. Clin Orthop Relat Res 1984;(190):158-62.
19. Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of the femur. A prospective review. J Bone Joint Surg [Br] 1976;58:2-24.
20. Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res 1980;(152):162-72.
21. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg [Am] 1994;76:15-25.
22. Szita J, Cserháti P, Bosch U, Manninger J, Bodzay T, Fekete K. Intracapsular femoral neck fractures: the importance of early reduction and stable osteosynthesis. Injury 2002;33 Suppl 3:C41-6.

APA	Kayali C, Agus H, ARSLANTAŞ M, Turgut A (2008). Complications of internally fixed femoral neck fractures. , 226 - 230.
Chicago	Kayali Cemil,Agus Haluk,ARSLANTAŞ Mustafa,Turgut Ali Complications of internally fixed femoral neck fractures. (2008): 226 - 230.
MLA	Kayali Cemil,Agus Haluk,ARSLANTAŞ Mustafa,Turgut Ali Complications of internally fixed femoral neck fractures. , 2008, ss.226 - 230.
AMA	Kayali C,Agus H,ARSLANTAŞ M,Turgut A Complications of internally fixed femoral neck fractures. . 2008; 226 - 230.
Vancouver	Kayali C,Agus H,ARSLANTAŞ M,Turgut A Complications of internally fixed femoral neck fractures. . 2008; 226 - 230.
IEEE	Kayali C,Agus H,ARSLANTAŞ M,Turgut A "Complications of internally fixed femoral neck fractures." , ss.226 - 230, 2008.
ISNAD	Kayali, Cemil vd. "Complications of internally fixed femoral neck fractures". (2008), 226-230.

APA	Kayali C, Agus H, ARSLANTAŞ M, Turgut A (2008). Complications of internally fixed femoral neck fractures. Ulusal Travma ve Acil Cerrahi Dergisi, 14(3), 226 - 230.
Chicago	Kayali Cemil,Agus Haluk,ARSLANTAŞ Mustafa,Turgut Ali Complications of internally fixed femoral neck fractures. Ulusal Travma ve Acil Cerrahi Dergisi 14, no.3 (2008): 226 - 230.
MLA	Kayali Cemil,Agus Haluk,ARSLANTAŞ Mustafa,Turgut Ali Complications of internally fixed femoral neck fractures. Ulusal Travma ve Acil Cerrahi Dergisi, vol.14, no.3, 2008, ss.226 - 230.
AMA	Kayali C,Agus H,ARSLANTAŞ M,Turgut A Complications of internally fixed femoral neck fractures. Ulusal Travma ve Acil Cerrahi Dergisi. 2008; 14(3): 226 - 230.
Vancouver	Kayali C,Agus H,ARSLANTAŞ M,Turgut A Complications of internally fixed femoral neck fractures. Ulusal Travma ve Acil Cerrahi Dergisi. 2008; 14(3): 226 - 230.
IEEE	Kayali C,Agus H,ARSLANTAŞ M,Turgut A "Complications of internally fixed femoral neck fractures." Ulusal Travma ve Acil Cerrahi Dergisi, 14, ss.226 - 230, 2008.
ISNAD	Kayali, Cemil vd. "Complications of internally fixed femoral neck fractures". Ulusal Travma ve Acil Cerrahi Dergisi 14/3 (2008), 226-230.