Proximal femoral nail anti-rotation (PFNA) with a lag screw that is shaped like a spiral blade shape is an orthopedic implant to fix trochanteric fractures of the proximal femur. In addition the reason of the biomechanical advantages, PFNA widely been used recently. We report an 83-year-old man with excessive sliding of the helical blade and a femoral neck fracture after AO/OTA type A2 intertrochanteric fracture, which was fixed with a PFNA.
Femoral Neck Fractures ; Femur ; Femur Neck ; Hip Fractures ; Nails ; Orthopedics

Retrospective 104 patients with a femoral neck fracture had been underwent partial hip replacement in Viet Duc Hospital for 5 year (1/1998-4/2003): 61 male, 43 female, average age 70.71 (43-89), 72 patients used cement prostheses and 32 patients had prostheses without cement; 69 cases inserted with Austin Moore, 2 with Thompson, 1 with Monk and were followed for an average of 28.18 months. The results: 6 patients died; four prostheses had been changed to a total hip replacement. 65 patients were reexamined: joint function was excellent or good in about 61.98%; fair or unsatisfactory in 30.77%, and 46.15% patients had painful prostheses; 29.41% erosion of acetabulum; 21.56% with a radiolucent zone around the femoral stem were found.
Femoral Neck Fractures ; Arthroplasty, Replacement, Hip

We studied 16 cases intracapsular pressure in displaced fracture of femoral neck(Garden stage III, IV), the pressures were measured range between 12-62 mmHg(mean, 23.4 mmHg). Aspirated blood amount from hip joint did not exceed 3cc, this amount not correlate with intracaspsular pressure. Of 10 cases examined scintimetry, 2 had incressed uptake after aspiraton, it is suggested that early decompression of hemarthrosis in femur neck fracture regaredless of displacement may be considered.
Decompression ; Femoral Neck Fractures ; Femur Neck ; Hemarthrosis ; Hip Joint ; Hip

OBJECTIVE: To summarize the research progress on the evaluation methods of head-neck nail positions in femoral intertrochanteric fractures. METHODS: The literature about the evaluation methods of head-neck nail positions for femoral intertrochanteric fractures in recent years was extensively reviewed, and research progress in the aspects of evaluation methods, clinical applications, and limitations were summarized. RESULTS: The position of head-neck nails in femoral intertrochanteric fractures is closely related to postoperative complications of head-neck nail cutting. Currently, the tip-apex distance (TAD) and femoral head zoning are widely used to evaluate the position of head-neck nails. The main opinion in the literature is that the use of TAD and femoral head zoning can effectively reduce the incidence of head-neck nails cutting. Parker's ratio, as one of the evaluation methods, has been controversial in subsequent studies and has not been widely used in clinical practice. The TAD as referenced to the calcar (CalTAD), which was modified based on TAD, has been gradually accepted by the clinic, but whether it is better than the TAD has not yet been conclusively determined. In recent years, new evaluation methods have been proposed to supplement the previous evaluation methods, such as the tip-neck distance ratio (TNDR) and the standardized TAD (STAD) to avoid the limitations of the TAD and the CalTAD by the volume of the femoral head, and the axis-blade angle (ABA) to supplement the direction of the head-neck nails channel, but at present the clinical application is relatively underutilized, and the validity of the method needs to be further verified. CONCLUSION Currently, there are many methods for evaluating the position of head-neck nails in femoral intertrochanteric fractures, TAD<25 mm combined with head-neck nails placed in the middle-middle quadrant or lower-middle quadrant of the femoral head division is currently a highly recognized assessment in the literature, but the optimal assessment is still controversial, and further research needs to be studied.
Humans ; Nails ; Head ; Neck ; Femoral Fractures ; Hip Fractures/surgery*

PURPOSE: The purpose of this study is to investigate the relative surgical risk and problems in hip hemiarthroplasty for treatment of an unstable intertrochanteric fracture in elderly patients over 80 years old. MATERIALS AND METHODS: Between April 2005 and May 2010, 58 patients whose age was over 80 years were available for inclusion in this study. They were divided into two groups: group 1 included 30 patients with femoral neck fracture and group 2 included 28 patients with intertrochanteric fracture. No significant differences in average age, concomitant disease, and walking ability before development of fracture were noted between the two groups. The following factors, including interval from development of fracture to operation, operation time, amount of blood loss, start time of walking after operation, duration of hospital stay, complications, revision rate, and walking ability were compared between the two groups. RESULTS: Operation time was an average of 85.2 minutes in group 1 and 97.5 minutes in group 2(P=0.03). The amount of bleeding was an average of 483 cc in group 1 and 695 cc in group 2(P=0.006). Similar results for walking start and recovery of walking ability after operation were observed in the two groups. No significant differences were observed in duration of hospital stay, complications, and revision rate. While 25 patients in group 1(83.3%) showed restoration of walking ability after operation to the same level of walking before injury, 19 patients in group 2(67.8%) showed restoration of walking ability postoperatively. CONCLUSION: Even though patients in group 2 showed a longer operation time and a higher amount of blood loss, compared with those in group 1, patients in group 2 had similar surgical risk and complications, compared with those in group 1. Therefore, primary hip hemiarthropalsty could be a good treatment option for intertrochanteric fracture in elderly.
Aged ; Femoral Neck Fractures ; Femur Neck ; Hemiarthroplasty ; Hemorrhage ; Hip ; Hip Fractures ; Humans ; Length of Stay ; Walking

PURPOSE: The Garden classification by which femur neck fracture is classified and the Boyd-Griffin classification by which trochanteric fracture is classified are studied on the reproducibility, repeatability, interobserver's and intraobserver's reliability and then reliability. MATERIALS AND METHODS: 56 cases in femoral neck fracture and 60 cases in trochanteric fracture who were operated from May 1999 to December 2003 were classified by three observers who are hip surgeon, orthopaedic surgeon and senior residentship doctors three times. Femur neck fracture was classified by Garden's method which used commonly and trochanteric fracture was classified by Boyd-Griffin method which is classified by the pattern of fracture and degree of comminution. We got the interobserver's and intraobserver's Kappa score using the Stata 7.0 statistically. The statistical analysis was made by Stata 7.0. RESULTS: Garden classification in femur neck fracture showed moderate agreement in intraobserver reliability and fair agreement in interobserver reliability. Boyd-Griffin classification in trochanteric fracture showed substantial agreement in intraobserver reliability and moderate agreement in interobserver reliability. CONCLUSION: Boyd-Griffin classification showed over moderate agreement but Garden classification showed fair agreement, so using Garden classification in femur neck fracture has some problem in reliability and application.
Classification* ; Femoral Neck Fractures ; Femur ; Femur Neck ; Hip

PURPOSE: This study aims to determine the correlation between the fracture patterns and the complications in patients with femoral neck fracture treated with internal fixation. MATERIALS AND METHODS: The study comprises 45 patients with femoral neck fracture treated with multiple screws or compression hip screw between May 2008 and April 2012. The mean age was 48 years at the time of the surgery and the mean duration from initial injury to surgery was 20 hours. The fracture patterns were identified according to the anatomical location, the Garden classification and the Pauwels classification. The occurrence of nonunion and avascular necrosis were reviewed with clinical results including Harris hip score and Lunceford hip function test. The correlation between the fracture pattern and occurrence of complications were analyzed. RESULTS: Fracture site union was achieved in 40 hips with the average union time of 17 weeks. Five nonunions occurred which showed high likelihood to occur in subcapital type, displaced (Garden stage III or IV) and Pauwels type III fractures (P<0.05). Avascular necrosis was developed in 10 hips which was mostly in subcapital type and Pauwels type III fracture but no statistical significance was found (P>0.05). The mean Harris hip score was 91 points, and Lunceford functional results were excellent in 15 hips, good in 24, fair in 4 and poor in 2. CONCLUSION: There was high risk of nonunion in subcapital type fracture, displaced fracture (Garden stage III and IV) and vertically oriented fracture (Pauwels type III). Careful attention is needed in these fracture types.
Classification ; Femoral Neck Fractures* ; Femur Neck* ; Hip ; Humans ; Necrosis

PURPOSE: To evaluate the difference between dynamic hip screw and cannulated screw for stability, complication and patient s functional recovery in intracapsular fracture of femoral neck. MATERIALS AND METHODS: Eight-four patients were randomly assigned into dynamic hip screw fixation and cannulated screw fixation groups. Clinical information included age and sex distribution, operation time, total blood loss, interval from injury to operation, etiology of fracture, associated fracture, and functional outcome. Preoperative X-ray information included fracture type by Garden stage, Singh index, and posterior comminution. Postoperative information included quality of reduction, pin and screw position, Garden alignment index, evidence of union, complication and failure. RESULTS: No difference was noted between the two fixation methods regarding gender, initial fracture displacement, postoperative reduction or position of the fixation device, functional outcome using Robinson's method, and complication. In operation time and total blood loss, however, cannulated screw fixation group was significantly lower (P<0.05). CONCLUSIONS: Therefore, to decrease operation time and blood loss, cannulated screw fixation was considered to be more useful as a fixation method in a intracapsular fracture of femoral neck.
Femoral Neck Fractures* ; Femur Neck* ; Hip* ; Humans ; Sex Distribution

PURPOSE: We wanted to compare the stability, the complications and the patients' functional recovery after undergoing internal fixation with dynamic hip screws or cannulated hip screws for treating fracture of the femoral neck. MATERIALS AND METHODS: Out of one hundred twenty six patients who had fracture of the femoral neck, seventy six patients were treated with cannulated screws and fifty patients were treated with dynamic hip screws from October 2000 to January 2007. The clinical information included the age and gender distribution, the operation time, the total blood loss, the interval from injury to operation, the etiology of the fractures and the functional outcome. The preoperative X-ray information included the fracture type by the Garden stage, the Singh index and the posterior cortex comminution. The postoperative information included the quality of reduction and the pin and screw position. The Garden alignment index, evidence of union, the FIM(TM) score, the complications and the failure rate. RESULTS: No statistical difference was noted between the two fixation methods regarding the gender, the initial fracture displacement, the postoperative reduction or the position of the fixation device, the functional outcome using FIMTM score and the complication. Yet the cannulated screw fixation group showed a significantly shorter operation time and less total blood loss (P<0.05). CONCLUSION: To decrease the operation time and blood loss, cannulated screw fixation is considered to be the more useful fixation method for treating fracture of the femoral neck.
Displacement (Psychology) ; Femoral Neck Fractures ; Femur Neck ; Hip ; Humans

The displaced femoral neck fracture continues to be a difficult problems such as high percentage of avascular necrosis and non-union. Compression hip screw was designed to aliow firm impaction at the time of operation and secondarily, for continued impaction if resorption occurs at the fracture line during healing. 22 cases of femoral neck fracture treated by compression hip screw in the department of orthopaedic surgery at National Medical Center were analyzed, and results were as follow. 1. The average of patient was fifty-three years, and man was predominant. 2. Average 8.9 days was elapsed from initial injury to hospital, and good results were observed in the cases of operation within 3 days. 3. The end results were good when the fragment was reduced within 165°–180° of Garden's angle in A-P film and 20° of anterior and posterior angulation in lateral film. 4. The good results were observed in the position of the screw center and low in A-P film, and center and posterior in lateral film. 5. The positive findings of the intraosseous-venogram was observed in 6 weeks from operation and apparent in all cases done after 6 months. 6. Bony union was obtained within 5.9 months, and avascular necrosis was established in 29 months. 7. Developed 3 avascular necrosis, 1 non-union, and 2 degenerative arthritis of 22 cases.
Femoral Neck Fractures ; Femur ; Hip ; Humans ; Neck ; Necrosis ; Osteoarthritis