Femoral head and ipsilateral femoral neck fractures are serious and complicated injuries, which usually yield unsatisfactory results using conventional hip-preserving surgery. The key point of the management and prognosis mainly lies in femoral neck fractures. An apparent and consecutive relationship exists between femoral neck fractures and femoral head fracture-hip dislocation in such injuries. It is believed that disastrous triad of femoral head (DTFH) could summarize these specific injuries, and reflect the injury mechanism and prognostic characteristics. Based on our clinical observation and literature review, DTFH could be divided into three subgroups:TypeⅠ, common DTFH, in which femoral neck fractures occur following femoral head fractures-hip dislocation due to the same trauma; TypeⅡ, iatrogenic DTFH, in which femoral neck fractures come out in the caring process of femoral head fractures-hip dislocation; Type Ⅲ, stressed DTFH, in which femoral neck fractures occur after the management of femoral head fractures-hip dislocation. In the scenario, the line of femoral neck fractures locates distally to the femoral head fractures. Herein, we will discuss clinical characteristics of these types of DTFH.
Humans ; Femoral Fractures/complications* ; Femoral Neck Fractures/complications* ; Femur Head/injuries* ; Fracture Dislocation ; Fracture Fixation, Internal/methods* ; Hip Dislocation/surgery* ; Prognosis

Heterotopic ossification(H.O.) is a common complication in spinal cord injured patients. The majority of heterotopic ossification in spinal cord injury occurs around hip joints. Fracture of femur is also a quite common complication in spinal cord injured patient, however H.O. associated with femur fracture at the hip was rarely reported. The author experienced femur neck fracture in a spinal cord injured patient with preexisting H.O. The proper management of femur neck fracture and the prevention of H.O. were reviewed and discussed.
Femoral Neck Fractures ; Femur Neck* ; Femur* ; Hip ; Hip Joint ; Humans ; Ossification, Heterotopic* ; Spinal Cord Injuries ; Spinal Cord*

Vascular complication of hip arthroplasty is relatively rare, and usually involves iatrogenic injury or thrombus formation of main vessels. No case of vascular injury associated with closed suction drainage has been reported. The current report describes an injury of a branch from the lateral circumflex femoral artery caused by a trocar of closed suction drainage in a 72-year-old man who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. We report on this case with a review of the literature in order to avoid similar complications.
Aged ; Arthroplasty ; Femoral Artery ; Femoral Neck Fractures ; Hemiarthroplasty* ; Hip* ; Humans ; Suction* ; Surgical Instruments* ; Thrombosis ; Vascular System Injuries

PURPOSE: This study retrospectively reviewed the results of a closed reduction and internal fixation with cannulated screws for a displaced femoral neck fracture. MATERIALS AND METHODS: Among 631 patients between January 1991 and December 2000, 27 patients classified as Garden stage III or IV were treated with a closed reduction and internal fixation with cannulated screws. The mean follow-up duration was 4.5 years. The mean age of the patients was 56.5 years. RESULTS: Union and the restoration of function was observed in 15 cases (55.6%), and failure occurred in 12 cases (44.4%). The cause of failure was early stage reduction loss due to a failure to obtain anatomical reduction on the surgical field in 4 cases, reduction loss and displacement during the follow up period after an appropriate reduction at surgery in 4 cases and avascular necrosis in 4 cases. Seven cases were converted to a total hip arthroplasty, 4 cases were converted to bipolar hemiarthroplasty and 1 case is currently being followed up. CONCLUSION: A closed reduction and internal fixation for displaced femoral neck fracture showed a high failure rate. Therefore, an accurate anatomical reduction, firm internal fixation and efforts to prevent further unnecessary vascular injury will be needed to reduce the high failure rate and complications.
Arthroplasty, Replacement, Hip ; Femoral Neck Fractures* ; Femur Neck* ; Follow-Up Studies ; Hemiarthroplasty ; Humans ; Necrosis ; Retrospective Studies ; Vascular System Injuries

Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English language literature.
Accidents, Traffic ; Hip Dislocation ; complications ; Hip Fractures ; complications ; Humans ; Male ; Middle Aged ; Osteonecrosis ; etiology ; Sciatic Nerve ; injuries ; Sciatic Neuropathy ; etiology

We have experienced 20 cases of anesthesia for Total Hip Replacement(Charnleys Lov Frictinn Arthroplasty), which had been done under the Filtered Air Flow System for the prevention of wound contamination due to long term exposure. Preoperative diagnosis was, 7 cases of Hip Joint Tuberculosis, 6 cases of Femur Neck Fracture, 5 cases, of Osteoarthritis of Hip Joint, and 2 cases, of Avascular Necrosis. Average blood loss has 1500 ml for one side operation, and 2400 ml for bilateral one. In 12 cases, hypotensive response was occurred during the application of Acrylic bone cement to the medullary canal of femur, however in 4 cases, hypotensive responses was more prominentafter the application of Acrylic bone cement to the Acetabulum fossa and the rest of cases were no changes in blood pressure and pulse rate whatsoever. In two cases, hypotensive range was over 30%(in compare with preoperative one), but recovery was soon after administration of Effortil corticosteroids, volume expanders etc. There was no mortality.
Acetabulum ; Adrenal Cortex Hormones ; Anesthesia* ; Blood Pressure ; Clinical Study* ; Diagnosis ; Etilefrine ; Femoral Neck Fractures ; Femur ; Heart Rate ; Hip ; Hip Joint ; Joints ; Mortality ; Necrosis ; Osteoarthritis, Hip ; Polymethyl Methacrylate ; Tuberculosis ; Wounds and Injuries

We have many unsolved problems about the femoral neck fracture, especially non-union of the fracture and avascular necrosis of the femoral head. It seems clear that underlying these are two basic problems; first, the mechanical difficulties in maintaining secure fixation; and second, biological factors interfering with union, paramount of which is damage to the blood supply of the femoral head. Intra-capsular fracture of the femoral neck heals in the same way as other intra-articular fractures-only by endosteal and not by periosteal repair. If the femoral head has an intact blood supply, repair appears early on both sides of the fracture. But if the femoral head is not viable, this repair appears only on the neck side of the fracture. It can migrate into the head and heal the fracture only if there is close apposition and rigid fixation of well reduced fracture fragments. Clearly the femoral neck fracture heals not by periosteal callus but by callus arising from the marrow supporting structure. Yet there is still no reliable clinical method of determining early the union of the femoral neck fracture and the viability of the femoral head. The femoral head intra-osseous venography, first described by Hulth (1953), to predict viability of the femoral head after fracture of the femoral neck has been carried by various previous authors (Hulth1953 1956 1958, Dahlgren 1959, Harrison 1962, Hulth and Johansson 1962, Nagai 1962). However, they did not mention healing process of fractures of the femoral neck in these studies. To observe the fracture healing and to predict the viability of the femoral head, authors adopted a femoral trochanteric intra-osseous venographic technique. The precedure was carried out under the control of a T-V image intensifier. Venous drainage of the femoral head parallels the arterial supply. There are several venous drainage routes in the hip region; the medial and lateral circumflex vein, gluteal vein, nutrient vein, femoral vein, vein of the ligamentum teres and obturator vein. With the aid of a T-V image intensifier, a bone marrow needle is driven 1 inch below the femoral greater trochanter. When the tip of the needle is in the marrow cavity, about 30cc, of 75% Urograffin is injected. Next X-rays are taken at intervals of 2 seconds, the last film at 5 minutes. A positive venography is one in which venous drainage is seen, and opaque fluid is seen in mottled distribution throughout neck region and part of the head. A negative venography is one in which no venous drainage is seen, on the contrary, opaque fluid pools within the trochanteric region are evident and remain for at least 5 minutes. A positive venography indicates that the head has an intact circulation, thus it may be predicted that the fracture can unite and the head is alive. Negative venography suggests that fracture union is not and will not take place and that the head may be dead. This study provided information about fracture heaIing processes and vascularities of the femoral head and its surrounding tissues during and after fractures healing. We have found that trochanteric intra-osseous venography is a useful diagnostic tool in hip injuries.
Biological Factors ; Bone Marrow ; Bony Callus ; Drainage ; Femoral Neck Fractures ; Femoral Vein ; Femur ; Femur Neck ; Fracture Healing ; Head ; Hip Injuries ; Hip ; Methods ; Neck ; Necrosis ; Needles ; Phlebography ; Round Ligaments ; Veins

The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the absence of other major traumas is a distinctly rare injury pattern. We report such a case, along with a review of previous cases. A 40-year-old male patient after motorcycle skidding had posterior dislocation of the left hip and anterior dislocation of the right one without other associated injuries. The patient underwent successful closed reduction of both hips. The clinical course and follow-up assessment of the patient was uneventful.
Anemia, Sickle Cell ; Femur Head ; injuries ; Femur Head Necrosis ; Femur Neck ; Fractures, Spontaneous ; Hip Dislocation ; Humans

PURPOSE: Heterotopic ossification in pressure sore patients is reported to rarely develop, but once it occurs, it frequently causes joint stiffness and mobilization restriction. The aim of this article is to report our experience of atypical bone growing at femur neck fracture site with chronic, extensive pressure sore in patient with paraplegia secondary to spinal injury. METHODS: A 28-year-old male patient presented with atypical bone growth at femur neck fracture site with pressure sore. He had undergone atypical growth bone removal and separation of united iliac bone and femur, and then pressure sore was covered by advanced rotation flap. RESULTS: The patient mobilized hip joint and rode in a wheelchair. Complications such as dehiscence, infection, hematoma and flap necrosis did not occur. CONCLUSION: We experienced successful correction of atypical bone growth removal and recovery of pressure sore. We report our experience of atypical bone growth of fracture site and the related literature was reviewed.
Adult ; Bone Development ; Femoral Neck Fractures ; Femur ; Femur Neck ; Hematoma ; Hip Joint ; Humans ; Joints ; Male ; Necrosis ; Ossification, Heterotopic ; Paraplegia ; Pressure Ulcer ; Spinal Injuries ; Wheelchairs

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Female ; Femoral Fractures ; surgery ; Femur Neck ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Internal Fixators ; Male ; Middle Aged