OBJECTIVE: To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture. METHODS: A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups. RESULTS: There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012). CONCLUSION Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.
Aged ; Female ; Humans ; Male ; Aged, 80 and over ; Retrospective Studies ; Hip Fractures/surgery* ; Femoral Neck Fractures ; Heart Failure/etiology* ; Prognosis ; Heart Diseases ; Risk Factors ; Postoperative Complications/etiology* ; Dementia ; Arrhythmias, Cardiac

OBJECTIVE: To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors. METHODS: Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(β-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve. RESULTS: There was no significant difference in the levels of serum PINP and β-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation( CONCLUSION The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.
Female ; Femoral Neck Fractures/surgery* ; Femur Head ; Femur Head Necrosis/etiology* ; Fracture Fixation, Internal/adverse effects* ; Humans ; Male ; Osteonecrosis ; Retrospective Studies ; Risk Factors

OBJECTIVES: To explore the risk factors for femoral neck fracture in elderly population. METHODS: A total of 124 elderly patients (≥60 years old) in hospital for trauma were enrolled, including 71 patients (57%) with femoral neck fracture and 53 non-femoral neck fracture patients (43%). All patients' age, gender, body mass index (BMI), bone mineral density (BMD), thigh length and average circumference were collected. Single factor analysis and multivariate logistic regression analysis were performed to explore whether the above factors were risk factors for femoral neck fracture. RESULTS: Single factor analysis showed that the age, gender, BMI, BMD, thigh length, and average thigh circumference between the 2 groups were statistically different (all CONCLUSIONS Older age, female, lower BMI index (low body weight), lower BMD (osteoporosis), longer thigh length, and lower average circumference are risk factors for femoral neck fracture in the elderly population.
Absorptiometry, Photon ; Aged ; Body Mass Index ; Bone Density ; Female ; Femoral Neck Fractures/etiology* ; Humans ; Middle Aged ; Osteoporosis ; Risk Factors

INTRODUCTIONTraumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.

METHODSThe data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.

RESULTSThere were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53-99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.

CONCLUSIONCemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients.

Aged ; Aged, 80 and over ; Bone Cements ; Female ; Femoral Neck Fractures ; complications ; surgery ; Hemiarthroplasty ; adverse effects ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Management ; Singapore ; epidemiology ; Venous Thrombosis ; epidemiology ; etiology

Simultaneous bilateral fractures of the femoral neck are rare injuries, which are reportedly induced by low-speed energy with predisposing factors including systemic diseases, medications and eclamptic seizures. Those caused by high energy are even rarer. High energy-induced bilateral fractures of the femoral neck conceive of high incidence of mortality and present great challenges in the early management. We report one case of a 52-year-old man with simultaneous bilateral fractures of the femoral neck which resulted from a motor pedestrian accident. One-stage closed reduction and internal fixation was done following the emergent resuscitation and neurosurgical management for concomitant brain injuries. The fractures united. There was no pain in the hips, and they had a normal range of motion. The treatment protocol, mechanism of the injury and possible postoperative complications were discussed to expand a comprehensive understanding about these infrequent types of fractures.
Femoral Neck Fractures ; diagnostic imaging ; etiology ; surgery ; Fracture Fixation, Internal ; adverse effects ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Tomography, X-Ray Computed

Simultaneous bilateral fractures of the femoral necks are rare injuries, especially when there is no underlying pathological condition. We report a 20-year-old man who sustained bilateral femoral neck fractures resulting from an accidental electric shock with 440 V direct current. Simultaneous bilateral femoral neck fractures after electrical shock injury without falling from a height are rather uncommon in clinic. The main cause of the fracture may be muscle contraction. This case highlights that even in the absence of primary and secondary bone disease, bilateral fractures of the femoral necks can occur following electric shock injury. We successfully managed this case with bilateral cannulated screw fixation without bone grafting. Surgeons caring for patients with electrical injury should be aware of the possibility of skeletal injuries which can go unnoticed, leading to delay in diagnosis and increased risk of complications.
Adult ; Electric Injuries ; complications ; Femoral Neck Fractures ; etiology ; surgery ; Humans ; Male

OBJECTIVETo compared the effect between early anatomical open reduction, internal fixation (ORIF) and closed reduction, internal fixation (CRIF) for treatment of children displaced femoral neck fracture.

METHODSFrom March 2006 to May 2010,34 children with displaced femoral neck fractures were reviewed retrospectively. These patients were divided into two groups. Among them, 19 cases were treated by open reduction and internal fixation (ORIF) as group A, included 11 males and 8 females with an average age of (8.1 +/- 1.3), the other 15 cases were treated by closed reduction and internal fixation (CRIF) as group B, included 9 males and 6 females with an average age of (7.9 +/- 1.5). Complications were observed and the short term effectiveness was evaluated by Ratliff standard.

RESULTSAll children were followed-up from 1 to 3 years (means 1.2 years). All fractures were healed. There was statistical different in the curative effects between the two groups (Z=2.389, P= 0.017). The incidence of complications in two groups had statistical different (P=0.046).

CONCLUSIONThe early ORIF could get better reduction with fewer complications than CRIF in fractures of the displaced femoral neck in children in Delbet type-II and type-III, therefore, ORIF should be considered.

Adolescent ; Child ; Female ; Femoral Neck Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Male ; Postoperative Complications ; etiology ; Retrospective Studies ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo investigate the association between femoral neck fracture and deep vein thrombosis (DVT) in patients undergoing prosthetic hip surgery.

METHODSThe data of patients who underwent prosthetic hip surgery from January 2005 to July 2010 were collected, the cases were included into the study after exclusion of those could not be suitable for the study. The patients with diagnosis of deep-vein thrombosis (DVT) were identified together as the case group, and the patients without DVT were selected randomly and matched with frequency as the control group. The matching characteristics included age, gender and body weight. The patients with femoral neck fracture were counted in both case and control group. The odds ratio was calculated and the exposure rate of both group were compared.

RESULTSThere were total 670 patients underwent prosthetic hip surgery during the period, and after exclusion,the data of 408 patients were collected into the study. There were 13 patients in the case group (4 males and 9 females, ranging in age fram 57 to 91 years), all of them suffering from femoral neck fracture and the exposure rate was 100.0% (13/13). There were 52 patients in the control group (18 males and 34 females, ranging in age from 57 to 91 years), 39 of them suffering from femoral neck fracture, the exposure rate was 75.0% (39/52); there was no statistically significant difference in exposure rate of two groups.

CONCLUSIONThe diagnosis of femoral neck fracture is not the independent risk factor for postoperative DVT of prosthetic hip surgery. The epidemiologic characteristics of femoral neck fracture indicate that the patients are in high risk of DVT, who meanwhile are the most of patients undergoing the prosthetic hip surgery. Though the surgery itself is a risk of DVT, it can reduce the risks for patients with femoral neck fracture through some therapeutic effects.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; Case-Control Studies ; Female ; Femoral Neck Fractures ; complications ; Humans ; Male ; Middle Aged ; Risk Factors ; Venous Thrombosis ; etiology

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome