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Femoral Neck FracturesFracture Fixation, InternalHemiarthroplastyFracture HealingFemur NeckHip FracturesArthroplasty, Replacement, HipFractures, BoneFemur HeadFemoral FracturesBone ScrewsFractures, ComminutedHip ProsthesisFemur Head NecrosisFractures, SpontaneousFractures, UnunitedFracture FixationHip DislocationHip JointReoperationBone DensityOsteoporotic FracturesBone NailsArthroplastySpinal FracturesOsteoporosisBone MalalignmentCementationRadius FracturesFractures, MalunitedFracture Fixation, IntramedullaryProsthesis FailureFractures, StressBone PlatesNeckPostoperative ComplicationsOsteoarthritis, HipFemurOsteonecrosisBone CementsHead and Neck NeoplasmsTreatment OutcomeFibulaDislocationsLeg Length InequalityOsteotomyFollow-Up StudiesOsteomalaciaRetrospective StudiesDelayed DiagnosisProsthesis DesignAbsorptiometry, PhotonOrthopedic ProceduresRecovery of FunctionUlna FracturesRange of Motion, ArticularTechnetium Tc 99m MedronateTime-to-TreatmentLithuaniaOsteoporosis, PostmenopausalDurapatiteTime FactorsJoint ProsthesisRib FracturesSkull FracturesAcetabulumProspective StudiesLumbar VertebraeMandibular FracturesBone TransplantationBone WiresNeck PainMetacarpal BonesHipRisk FactorsTooth FracturesBone Diseases, MetabolicFractures, CompressionMultiple TraumaIntra-Articular FracturesBone Density Conservation AgentsTalusJoint CapsuleAccidental Falls

Histoplasmosis as the cause of a pathological fracture. (41/520)

We report the case of an 82-year-old man with a pathological fracture of the hip caused by infection with Histoplasma capsulatum var capsulatum. He was treated by a hemiarthroplasty and with oral itraconazole.  (+info)

Intracapsular hip fractures in patients with rheumatoid arthritis. (42/520)

We reviewed the treatment of 43 patients with rheumatoid arthritis and femoral neck fracture. Patients' average age was 66.4 (36-80) years and average duration of RA was 20.3 (4-42) years. Thirteen patients were treated with primary total hip arthroplasty (THA), and the clinical results were comparable to patients treated conservatively or by osteosynthesis. Eighteen patients were treated with primary bipolar hip prosthesis and after an average of 6.1 (1-13) years there was no acetabular destruction. However, long-term results were inferior to patients treated with THA. Nine patients were treated with osteosynthesis, of which two later had a hip prosthesis. Three cases with impacted fractures were treated conservatively with successful union in all.  (+info)

Femoral neck fractures in the aged. (43/520)

Clinical data were reviewed on 99 patients with 102 fractures of the femoral neck on the Orthopedic Service of the San Diego County General Hospital. All were elderly. Twenty-one were dead within two month of the time the fracture was reduced and 36 within a year. In 14 cases the fracture was impacted or undisplaced; there was only one of these in which the fracture did not unite following treatment, and that was for iatrogenic reasons. Sixty-one per cent of the displaced fractures healed; only 32 per cent of the total number of patients with displaced femoral neck fractures walked again.  (+info)

Fracture thresholds in osteoporosis: implications for hormone replacement treatment. (44/520)

The bone mineral densities of the lumbar spine and femoral neck were determined by dual energy chi ray absorptiometry in 110 women aged 40-82 years (average 65 years) with spinal osteoporosis who had had at least one atraumatic vertebral compression fracture and in 1026 normal women aged 40-79 years (average 52 years). The women with osteoporosis showed a significant decrease in bone mineral density (BMD) at the lumbar spine and femoral neck compared with age matched normal women (sixth decade of life -26% spine, -23% femoral neck; seventh decade -26% spine, -16% femoral neck). The fracture threshold, defined as the 90th centile of spinal BMD for women with osteoporosis, was 0.81 g/cm2 at the lumbar spine and 0.656 g/cm2 at the femoral neck. Five per cent of normal women aged 40-49 years, 20% aged 50-59 years, and 45% aged 60-69 years had a BMD below this threshold. To maintain the bones of women above the fracture threshold until the age of 70 years about 50% of postmenopausal women need hormone replacement therapy. However, if the BMD is to be kept above the fracture threshold for a women's lifetime, e.g. until the age of 80-90 years, then most women will need treatment, though for various lengths of time depending on their initial BMD. Measurements of BMD in postmenopausal women currently help in identifying the risk of osteoporotic fractures but in the lifetime assessment of risk in a single subject they may have a more important role in deciding the duration of hormone replacement therapy.  (+info)

Non-operative management of a peri-prosthetic subcapital fracture after metal-on-metal Birmingham hip resurfacing. (45/520)

We describe a patient who sustained a peri-prosthetic fracture of the femoral neck two weeks after undergoing a resurfacing procedure for osteoarthritis of the hip. The fracture was minimally displaced and a satisfactory outcome was obtained following conservative treatment.  (+info)

Time trends and demography of mortality after fractured neck of femur in an English population, 1968-98: database study. (46/520)

OBJECTIVES: To investigate time trends in mortality after admission to hospital for fractured neck of femur from 1968 to 1998, and to report on the effects of demographic factors on mortality. DESIGN: Analysis of hospital inpatient statistics for fractured neck of femur, incorporating linkage to death certificates. SETTING: Four counties in southern England. SUBJECTS: 32 590 people aged 65 years or over admitted to hospital with fractured neck of femur between 1968 and 1998. MAIN OUTCOME MEASURES: Case fatality rates at 30, 90, and 365 days after admission, and standardised mortality ratios at monthly intervals up to one year after admission. RESULTS: Case fatality rates declined between the 1960s and the early 1980s, but there was no appreciable fall thereafter. They increased sharply with increasing age: for example, fatality rates at 30 days in 1984-98 increased from 4% in men aged 64-69 years to 31% in those aged > or = 90. They were higher in men than women, and in social classes IV and V than in classes I and II. In the first month after fracture, standardised mortality ratios in women were 16 times higher, and those in men 12 times higher, than mortality in the same age group in the general population. CONCLUSIONS: The high mortality rates, and the fact that they have not fallen over the past 20 years, reinforce the need for measures to prevent osteoporosis and falls and their consequences in elderly people. Whether post-fracture mortality has fallen to an irreducible minimum, or whether further decline is possible, is unclear.  (+info)

Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture. (47/520)

OBJECTIVE: To evaluate the contribution of specific nutritional deficiencies (as indicated by zinc; vitamin A, C, and E; albumin; and haemoglobin concentrations) to the risk of pressure sores. DESIGN: Observational cohort study. SETTING: St James's University Hospital, Leeds. SUBJECTS: 21 elderly patients presenting consecutively to the orthopaedic unit with femoral neck fracture. MAIN OUTCOME MEASURE: Full thickness epidermal break over a pressure bearing surface. RESULTS: 10 patients (48%) developed a pressure sore during their hospital stay. Indices of zinc status and concentrations of albumin, haemoglobin, and vitamins A and E were similar in patients who developed a pressure sore and those who did not. Mean leucocyte vitamin C concentration, however, was 6.3 (SD 2.2) micrograms/10(8) cells in patients who developed a pressure sore as compared with 12.8 (4.6) micrograms/10(8) cells in patients who did not. CONCLUSIONS: Low concentrations of leucocyte vitamin C appear to be associated with subsequent development of pressure sores in elderly patients with femoral neck fractures.  (+info)

Functional comparison between uncemented Austin-Moore hemiarthroplasty and osteosynthesis with three screws in displaced femoral neck fractures--a matched-pair study of 168 patients. (48/520)

There is no consensus as to whether osteosynthesis (OS) or hemiarthroplasty (HA) should be used as the primary treatment of displaced femoral-neck fracture. In a prospective matched-pair study, we compared 84 patients treated with OS with three screws and 84 patients treated with uncemented Austin-Moore HA focusing on functional parameters, reoperations and mortality. At 4 months after the fracture, functional recovery was not significantly different between the study groups. However, OS patients tended to have slightly better functional ability than HA patients, as more of them were able to walk out of doors (45.2% versus 39.2%), more were able to walk without walking aids (23.7% versus 16.7%), and more returned to live in their own homes (80%versus 72.9%). OS patients used slightly but not significantly less painkillers and had less hip pain than HA patients. OS patients had had 15.4% more reoperations by 4 months and 14.2% more by 1 year compared to the HA group. The 4-month and 1-year mortality rates of the study groups were of the same order. Functional recovery was slightly better after OS with three screws than after uncemented HA, although no significant differences were seen in a sample of this size. On the other hand, OS was associated with a higher reoperation rate.  (+info)