PURPOSE: To identify the anatomic features for clinical applications through a computational simulation of the fixation of three cannulated screws for a femoral neck fracture. MATERIALS AND METHODS: Thirty cadaveric femurs underwent computed tomography and the images were transferred to the Mimics® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the 7.0 mm cannulated screw was performed to enable computerized virtual fixation of multiple cannulated screws for femoral neck fractures. After positioning the screws definitively for cortical support, the intraosseous position of the cannulated screws was evaluated in the anteroposterior image and axial image direction. RESULTS: Three cannulated screws located at the each ideal site showed an array of tilted triangles with anterior screw attachment and the shortest spacing between posterior and central screws. The central screw located at the lower side was placed in the mid-height of the lesser trochanter and slightly posterior, and directed toward the junction of femoral head and neck to achieve medial cortical support. All the posterior screws were limited in height by the trochanteric fossa and were located below the vastus ridge, but the anterior screws were located higher than the vastus ridge in 10 cases. To obtain the maximum spacing of the anterior and posterior screws on the axial plane, they should be positioned parallel to the cervical region nearest the cortical bone at a height not exceeding the vastus ridge. CONCLUSION: The position of cannulated screws for cortical support were irregular triangular arrangements with the anterosuperior apex. The position of the ideal central screw in the anteroposterior view was at the mid-height of the lesser trochanter toward the junction of the femoral head and neck, and the anterior and posterior screws were parallel to the neck with a maximal spread just inferior to the vastus ridge.
Cadaver ; Femoral Neck Fractures ; Femur ; Femur Neck ; Head ; Neck

PURPOSE: Three-dimensional (3D) effects of the single plane osteotomies of the proximal femur are compared and analyzed by the trigonometric method. MATERIALS AND METHODS: The shape of proximal femur was simplified as a bent line. The bent line is the continuation of the three points-the center of the femoral head, the center of femoral neck at the base, and the center of the femoral shaft. Then rotated the proximal femur at the junction of the neck and shaft with the each rotation axis of X, Y, Z, defined the frontal plane as a XY plane, sagittal plane as a YZ plane, and transverse plane as a XZ plane. RESULTS: The varus osteotomy of the proximal femur in the frontal plane with the rotation axis 'Z' that meant the increase of the X coordinate and the decrease of Y coordinate with constant Z coordinate (Deltax>Deltay, Deltaz=0) resulted in decreased anteversion in the transverse plane and increased flexion in the sagittal plane. The derotation osteotomy (Deltax>Deltaz, Deltay=0) resulted in varus in the frontal plane and extension in the sagittal plane. The flexion osteotomy (Deltaz>Deltay, Deltax=0) resulted in increased anteversion in the transverse plane and varus in the frontal plane. CONCLUSION: Single plane osteotomy for the proximal femur results in the angular correction in all three planes and may have the similar 3D effect of the certain double or triple osteotomy. So single plane osteotomy could be enough to correct some complex deformities.
Axis ; Congenital Abnormalities ; Femur Neck ; Femur* ; Head ; Neck ; Osteotomy*

In spite of recent development in fixation technique we still have lots of complication including avascular necrosis of femoral head. For many years, orthopaedic surgeon have been searching for a simple, safe, accurate and reliable clinical test to asses the vascular status of the femoral head. In early detection of viability of the femoral head, nothing is more certain than bone scan at the moment. Bone scan can detect or predict the viability of the femoral head. Subramanian and McAfee introduced 99mTc-Sn-polyphosphate as a bone seeking agents. We applied serial bone scan in 19 cases of femur neck fractures from 1982 to 1985 at the department of orthopaedic surgery, National Medical Center. The results were as follows; 1. The uptake ratio of displaced and undisplaced group based on preoperative radiography was 1.ZO, 1.46, 1.52, 1.55, and 0.63, 1.23, 1.81, 1.58 in average in postoperative bone scan interval 1–2 wks, 3 months, 6 months, 12 months. The bone scan uptake ratio was lower in the former than the latter, but after 3 months, there was no remarkable difference between them. 2. At the time of 1 to 2 weeks, 3 months, 6 months and 12 months, uneventful group was 0.74, 1.27, 1.72, 1.62 and avascular necrosis group 0.13, 0.18, 0.30, 0.67 in the uptake ratio. In 2 cases of avascular necrosis, the uptake ratio was markedly decreased. 3. There was no difference between the group operated within 48 hour after injury and the group delayed later.
Equidae ; Femoral Neck Fractures ; Femur Neck ; Femur ; Head ; Necrosis ; Radiography

PURPOSE: To evaluate the usefulness of proximal femoral nail in the treatment of intertrochanteric fracture. MATERIALS AND METHODS: The authors investigated the classificaton of fracture, operation time, the amount of intraoperative and postoperative bleeding, the amount of transfusion, postoperative ambulation status, bone union time and the complication among 45 cases who were treated with proximal femoral nail from Jan. 2001 to June 2002. RESULTS: The mean operation time was 116 minutes, and the amount of bleeding was 524 ml in average. The amount of intraoperative transfusion was 1.4 pints and that of postoperative transfusion was 1.1 pints. The complications were the intraoperative penetration of antirotational screw through the femoral neck in 2 cases, separation of the fracture fragment while inserting the nail in 4 cases, irritation of skin by retropulsion of antirotation screw in 2 cases, and penetration of antirotation screw through femoral head in 1 case. CONCLUSION: Proximal femoral nail was effective for the treatment of intertrochanteric fracture, however the surgeon should be carful about collision of the insertion handle against pelvis when the fracture line coincides with the insertion point of nail, especially in obese patients.
Femur ; Femur Neck ; Head ; Hemorrhage ; Humans ; Pelvis ; Skin ; Walking

PURPOSE: The proximal femoral morphology of normal Koreans was studied by radiographs. MATERIALS AND METHODS: Proximal femoral morphology and ratio of lever arm in abductor muscle in 101 normal adults were measured and their correlations were comparatively analyzed. RESULTS: The femoral head diameter was 48.7+/-4.0 mm. The femoral neck shaft angle was 127.8+/-5.2 degree. The medial trabeculae angle was 20.0+/-1.2 degree. The femoral offset was 36.5+/-3.9 mm. Also, the tip of the greater trochanter relative to the level of femoral head center lay higher in 91 of 101 subjects (90.1%), upon examination and in average, located 3.8+/-3.4 mm higher. The ratio of the abductor lever arm to the distance between the femoral head center and the body midline was 1: 2.1+/-0.2. CONCLUSIONS: The relationship between the tip of the greater trochanter of femur and the center of femoral head appeared to have wide individual differences with 0.89 coefficient of variation. Therefore, the tip of the greater trochanter was an unreliable anatomical indicator of femoral head center. The femoral neck shaft angle and the length of the medial trabeculae showed a significant correlation (P=0.001). However, a significant negative correlation existed between the femoral neck shaft angle and the femoral offset (P=0.024)
Adult* ; Arm ; Femur ; Femur Neck ; Head ; Humans ; Individuality

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: Bone density changes of the femoral head in transient synovitis of the hip were investigated by analyzing the PACS pixel value. MATERIALS AND METHODS: Seventy seven patients diagnosed as unilateral transient synovitis of the hip were investigated. Conventional plain anteroposterior (AP) and frog-leg lateral projection films of the hip were studied for pixel value measurements in PACS. The pixel values of the center of femur head, the periphery of femur head, the femur neck, and the intertrochanter of proximal femur were measured. RESULTS: The pixel value ratios for healthy versus involved sites at the center of the femoral head, at periphery of the femur head and at the femur neck were 1:0.967, 1:0.967 and 1:0.967 on AP view, and 1:0.961, 1:0.955 and 1:0.965 on frog-leg lateral view. The relative pixelvalues were maximally decreased around 2 weeks after symptom onset. After 2 months pixel values of the involved side were nearly normal. CONCLUSION: There was a significant decrease in the pixel value of the involved side, which may have been due to disuse atrophy. Also, the pixel value seemed to be useful for quantifying changes of the bone density in transient synovitis of the hip.
Bone Density* ; Femur ; Femur Head ; Femur Neck ; Head* ; Hip* ; Humans ; Muscular Disorders, Atrophic ; Synovitis*

In femorsl neck fracture, viability of the femoral head depends on the revascularization of the femoral head. The purpose of this study is to observe the effect of early fixation and anatomical reduction by measuring the Tc-99m-MDP uptake ratio of the femoral head in experimental animsls. Femoral neck region of 20 mature rabbits were osteotomized completely and divided into 2 groups ; each group consisted of 10 rsbbits. Group 1 had two Kirschner wire fixation after osteotomy and anatomic reduction. Group 2 had no fixation after osteotomy. The uptake ratio of Tc-99m-MDP of the femoral head in each group were measured st the intervals of 24 hours, 48 hours, 1 week, 2 weeks, 3 weeks, and 4 weeks, respectively. The results obtained were as follows ; 1. In experimental group 1, the mean uptake ratio of the femoral head was 0.72±0.13 at 1 day after operation, increased to a level of 1.44±0.14 at 1 week, increased to a maximal value of 2. 90±0.36 at 3 weeks and decreased to a level of 1.10+0.12 at 4 weeks. 2. In experimental group 2, the mean uptake ratio of the femoral head was 0.70±0.10 at 1 day, 0.64±0.13 at 1 week, decreased to a maximal value of 0.33±0.05 at 3 weeks and 0.47±0.05 at 4 weeks, showing decreased level below 1.0. The results suggest that early anatomicsl reduction and rigid fixation of femoral neck fracture is helpful for revascularization of the femoral head and prevention of non union.
Femoral Neck Fractures ; Femur Neck ; Head ; Neck ; Osteotomy ; Rabbits

The stability of internal fixation of femoral neck fractures can be obtained through surgical techniques, the configuration of screws and bone grafting, etc. However, the blood supply injury caused by fractures could not be completely reversed by the current medical management. Hence, the comprehensive evaluation of the residual blood supply of the femoral neck, to perioperatively avoid further iatrogenic injury, has become a hotspot. The anatomy of the extraosseous blood supply of the femoral neck has been widely reported, while its clinical application mostly involved the assessment of the medial circumflex femoral artery and retinacular arteries. However, further studies are needed to explore the prognosis of patients with these artery injuries, with different degrees, caused by femoral neck fractures. Direct observations of nutrient foramina in vivo are not possible with current clinical technologies, but it is possible to make reasonable preoperative planning to avoid subsequent femoral head necrosis based on the distribution features of nutrient foramina. The anatomy and clinical application studies of the intraosseous blood supply focused on the junction area of the femoral head and neck to probe the mechanism of femoral head necrosis. Thus, the intraosseous blood supply of other regions in the femoral neck remains to be further investigated. In addition, a blood supply evaluation system based on a three-level structure, extraosseous blood vessels, nutrient foramina, and intraosseous vascular network, could be explored to assist in the treatment of femoral neck fractures.
Humans ; Femur Head Necrosis ; Femoral Neck Fractures/surgery* ; Femur Neck ; Femur Head/surgery* ; Femoral Artery ; Fracture Fixation, Internal

The stress fracture of the femoral neck is an uncommon injury and delay in diagnosis occurs occasionally. It is generally classified as the compression type and the tension type. The compression type fracture of the femoral neck is stable, and could be treated nonoperatively. Tension type fracture is potentially unstable, and could require operative stabilization. The displacement of the femoral neck stress fractures has potential complications such as osteonecrosis of femoral head, malunion and nonunion. We have experienced two cases of compression type fractures that progressed to entire femoral neck despite conservative treatment with avoidance of weight bearing. These two cases shows even compression type of femoral neck fracture could further progress to entire femoral neck after conservative treatment, which could require operative treatment.
Displacement (Psychology) ; Femoral Neck Fractures ; Femur ; Femur Neck ; Fractures, Stress ; Head ; Neck ; Osteonecrosis ; Weight-Bearing