Fracture of a 40-mm BIOLOX Delta Femoral Head.
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ABSTRACT:
SUBMITTER: Duensing IM
PROVIDER: S-EPMC8353345 | biostudies-literature | 2021 Aug
REPOSITORIES: biostudies-literature
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Fracture of a 40-mm BIOLOX Delta Femoral Head.
Duensing Ian M IM Stanley Samuel S Bolognesi Michael M
Arthroplasty today 20210805
Ceramic bearing surfaces have gained popularity in total hip arthroplasty as a result of the favorable mechanical properties and low wear rates. Despite the recognition as an attractive articulation, problems such as ceramic head fracture persist. Smaller heads and higher body mass indices are touted as risk factors for ceramic head fracture and are often associated with antecedent trauma. We present a case report of an 83-year-old male with a body mass index of 26.7 kg/m<sup>2</sup> who suffere ...[more]
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Project description:We present a rare case of femoral head indentation fracture without associated hip dislocation in an elderly female secondary to a low-energy trauma. She was managed with primary total hip arthroplasty and achieved an excellent functional outcome. We have proposed the mechanism of injury and discussed shortcomings in the present classification systems. A review of literature of such cases is presented along with the rationale for our management decision and the various other treatment modalities available for the surgeon.
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Project description:PurposeIpsilateral femoral head and neck fractures (iFHNFs) are rare types of fractures that confer extremely poor prognosis among femoral head fractures (FHFs). Owing to the rarity of FHFs, it is challenging to diagnose iFHNFs. In addition, the clinical features of iFHNF have not yet been comprehensively elucidated. Therefore, this retrospective study aimed to summarize and analyze the clinical characteristics of iFHNF using a clinical diagnostic simulation based on a prospectively maintained database.MethodsClinical data of consecutive patients with FHFs, including gender, age, injury side, and associated injuries, were collected and analyzed from a prospectively maintained orthopedic database at a large level-I trauma center for a clinical diagnostic simulation. Patients were stratified according to the presence or absence of iFHNF. Moreover, propensity score matching (PSM) was used to create 1:1 age- and gender-matched couples. Lastly, clinical factors were compared and identified between the two groups before and after matching.ResultsA total of 218 FHF patients were included. Fifteen patients were diagnosed with ipsilateral femoral neck fractures (iFNFs), including preoperative, intraoperative, and postoperative types. There were 177 male and 41 female patients, with a mean age of 40.0 ± 16.5 years. The incidence of two factors, namely acetabular fracture and posterior hip dislocation, were significantly different between the two groups (P < 0.05). Following PSM, 15 pairs of patients were generated. Comparisons revealed that the incidence of posterior hip dislocation was significantly different between the two groups (P < 0.05).ConclusionsThere were three types of iFHNFs. In the context of FHFs, posterior hip dislocation was associated with iFNFs. Thus, surgeons should remain vigilant, not only intraoperatively but also postoperatively, for iFNFs following FHF and concomitant posterior hip dislocation.Level of evidenceDiagnostic level IV.
| S-EPMC10570253 | biostudies-literature
Project description:BackgroundSpontaneous femoral neck fracture is a rare condition that remains controversial due to limited reported cases. This retrospective study aims to provide further insights into the etiology and characteristics of the disease.MethodWe conducted a retrospective review of data from 963 patients with femoral neck fractures. The data encompassed demographic information, medical histories, radiographic records, bone mineral density (BMD) measurements, and pathological examinations. Patients were categorized into two groups: spontaneous femoral neck fracture (SFF) group (30 cases) and control group (933 cases), based on their medical histories. Logistic regression analysis was employed to identify risk factors for SFF. Statistical analysis was performed to compare and elucidate the characteristics of SFF within each group.ResultsLogistic regression analysis revealed osteonecrosis of the femoral head, steroid use, and osteoporosis as three significant risk factors for SFF. Furthermore, a higher proportion of Garden type I and II fractures, as well as Pauwels type I fractures, were observed in the SFF group compared to the control group. Within the SFF group, a higher proportion of patients with osteonecrosis exhibited Garden type III and IV fractures compared to those with osteoporosis. Additionally, both magnetic resonance imaging (MRI) and pathological examinations demonstrated that osteonecrosis in the SFF group predominantly occurred at the lateral femoral head-neck junction.ConclusionsOsteonecrosis of the femoral head, particularly involving the lateral head-neck junction, was confirmed as a major risk factor for SFF. Furthermore, SFF exhibits internal heterogeneity based on its different causes.
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Project description:ObjectiveTo investigate the characteristics of three-dimensional distribution of subchondral fracture lines on the surface of the osteonecrosis femoral head, and to discuss the underlying mechanisms that contribute to its collapse.MethodsWe retrospectively analyzed computed tomography (CT) images from 75 patients (comprising a total of 77 femoral heads) diagnosed with Association Research Circulation Osseous (ARCO) stage IIIA or IIIB femoral head necrosis. The three-dimensional structures of both the femoral head and the subchondral fracture line were reconstructed and subsequently fitted into normal femoral head model. A heat map of fracture line was generated to visualize its spatial distribution across the femoral heads surface.to observe its distribution. In addition to that, the femoral head was partitioned into four zones, and the frequency of each fracture line traversing different zones was calculated and analysed.ResultsHighest and lowest density of subchondral fracture lines was demonstrated in anterolateral and posterolateral zone respectively. and most sparse in posterolateral. Furthermore, the three-dimensional heat map of fracture lines highlighted their most frequent occurrence in the anterolateral area, particularly near the junction of the femoral head and neck. One fracture line may pass through multiple areas, passage frequencies for fracture lines was observed in zones I, II, III and IV for 66 times (85.7 %), 52 times (67.5 %), 25 times (32.5 %) and 46 times (59.7 %), respectively, with a significant difference between zone I and other zones (P < 0.001).ConclusionSubchondral fracture line of femoral head occurs most frequently in anterolateral femoral head, suggesting that the anterolateral part may be the initial location of collapse.Translational potential of this articleWe found that the subchondral fracture line was most frequently located anterolateral to the femoral head, suggesting that this may be the site of initiation of collapse. Furthermore, we propose an innovative method for analyzing and visualizing subchondral fracture distribution in femoral head necrosis in the form of fracture line heat maps. By doing so, we provide a valuable reference for physicians, enabling them to enhance their management strategies for femoral head necrosis. Ultimately, this approach holds the promise of significantly improving the prognosis and outcomes for patients afflicted with this condition.
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Project description:We aimed to analyze the associations of bone mineral density (BMD) of femoral heads, age and gender, and compare the differences in BMD between fracture side and non-fracture side by "3D Spine Exam Analysis" module in QCT Pro software. In this study, we identified patients who had undergone quantitative computed tomography (QCT) examinations between March 2016 and July 2018 and measured their trabecular volumetric BMD (vBMD) of femoral heads. This retrospective study enrolled 367 subjects. A total of 149 participants with images were randomly selected to verify the repeatability of this method. The relationship among the vBMD, age and gender was analyzed (n?=?367), and the difference of vBMD between non-fracture side and fracture side were studied in subjects (n?=?75) with low-energy hip fracture on one side and compared the image quality of bilateral hip joints. The intraclass correlation coefficients (ICCs) between the results measured by 2 operators and the results measured by the same operator showed excellent agreement (ICCs?>?0.9). Multivariate regression equation of vBMD of femoral head, age and gender showed statistical significance (P?<?0.05). vBMD showed negative correlation with age (P?<?0.05), and showed no statistically significant relation with gender (P?>?0.05). vBMD of non-fracture side was higher than that of fracture side, but the difference was statistically significant only at the middle layer (Pmiddle?<?0.05). In conclusions, the vBMD of femoral head as measured by "3D Spine Exam Analysis" module in QCT Pro software showed good repeatability. The trabecular vBMD of femoral head was negatively correlated with age, and not related with gender. The vBMD of femoral head was higher on non-fracture side than that on the fracture side.
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Project description:BackgroundThe absolute number of femoral neck fractures (FNFs) is increasing; however, the prediction of traumatic femoral head necrosis remains difficult. Machine learning algorithms have the potential to be superior to traditional prediction methods for the prediction of traumatic femoral head necrosis.ObjectiveThe aim of this study is to use machine learning to construct a model for the analysis of risk factors and prediction of osteonecrosis of the femoral head (ONFH) in patients with FNF after internal fixation.MethodsWe retrospectively collected preoperative, intraoperative, and postoperative clinical data of patients with FNF in 4 hospitals in Shanghai and followed up the patients for more than 2.5 years. A total of 259 patients with 43 variables were included in the study. The data were randomly divided into a training set (181/259, 69.8%) and a validation set (78/259, 30.1%). External data (n=376) were obtained from a retrospective cohort study of patients with FNF in 3 other hospitals. Least absolute shrinkage and selection operator regression and the support vector machine algorithm were used for variable selection. Logistic regression, random forest, support vector machine, and eXtreme Gradient Boosting (XGBoost) were used to develop the model on the training set. The validation set was used to tune the model hyperparameters to determine the final prediction model, and the external data were used to compare and evaluate the model performance. We compared the accuracy, discrimination, and calibration of the models to identify the best machine learning algorithm for predicting ONFH. Shapley additive explanations and local interpretable model-agnostic explanations were used to determine the interpretability of the black box model.ResultsA total of 11 variables were selected for the models. The XGBoost model performed best on the validation set and external data. The accuracy, sensitivity, and area under the receiver operating characteristic curve of the model on the validation set were 0.987, 0.929, and 0.992, respectively. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the model on the external data were 0.907, 0.807, 0.935, and 0.933, respectively, and the log-loss was 0.279. The calibration curve demonstrated good agreement between the predicted probability and actual risk. The interpretability of the features and individual predictions were realized using the Shapley additive explanations and local interpretable model-agnostic explanations algorithms. In addition, the XGBoost model was translated into a self-made web-based risk calculator to estimate an individual's probability of ONFH.ConclusionsMachine learning performs well in predicting ONFH after internal fixation of FNF. The 6-variable XGBoost model predicted the risk of ONFH well and had good generalization ability on the external data, which can be used for the clinical prediction of ONFH after internal fixation of FNF.
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Project description:BackgroundInternal fixation (IF) has historically been favored for the treatment of femoral neck fractures (FNFs) in young, nongeriatric patients. However, recent literature reporting high reoperation rates among those receiving IF, taken in conjunction with favorable survivorship of modern bearing surfaces in total hip arthroplasty (THA), has begun to question this paradigm. Our study sought to compare outcomes between IF and THA for FNFs in patients aged 40-59 years.MethodsUsing the Truven MarketScan Database, we performed a retrospective propensity-score-matched cohort study on patients aged 40-59 years who underwent surgical management of an isolated FNF (THA or IF). Patients with pathologic fracture were not included. Analysis was conducted on patients aged 40-49 and 50-59 years separately. A subgroup analysis was performed on those patients with 1 year and 3 years of follow-up. Multivariate analysis, controlling for baseline patient information, was then performed.ResultsSeven hundred sevety-eight 40- to 49-year-old patients and 3470 50- to 59-year-old matched patients (IF and THA) were included in this study. A multivariate analysis found that patients aged 40-49 years who underwent IF were at higher odds of both 1-year (odds ratio 2.35, 95% confidence interval 1.22-4.54, P = .011) and 3-year (odds ratio 5.68, 95% confidence interval 2.21-14.60, P < .001) reoperation. Similar results were found in those aged 50-59 years. While complication rates were similar, postoperative anemia and 90-day visits to the emergency room were more common after THA in both age cohorts.ConclusionsWhile THA is associated with increased postoperative anemia and resource utilization compared with IF, patients aged 40-59 years who undergo IF for FNF are at increased risk of reoperation in the first 3 postoperative years. This information should be used to assist in shared decision-making with patients in this age group.
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Project description:Atypical femoral fractures (AFFs) occurring during the course of osteoporosis treatment usually lead to discontinuation of anti-resorptive (AR) drugs. However, the risk of fracture after an AFF is unknown. We conducted a follow-up study of patients with AFF matched 1:3 for age and gender with patients with a peripheral major osteoporotic fracture (pMOF), in the setting of a fracture liaison service, to investigate the incidence of subsequent low-trauma fractures. Fifty-five patients with AFF (95% women, age [mean ± standard deviation] 75 ± 10 years, 89% exposed to AR drugs), followed for 6.2 ± 3.7 years, were compared to 165 matched controls with a pMOF (hip 85%) followed for 4.3 ± 2.6 years. During the follow-up, 38% of patients in the AFF group and 16% in the pMOF group received AR therapies. Continuation of AR drugs after an AFF was associated with contralateral AFF in 27% of subjects. The risks of new low-trauma, major osteoporotic and imminent (within 2 years) fractures, were similar between the two groups: incidence rate ratio (95% confidence interval [CI]) of subsequent fracture following AFF relative to pMOF, 1.30 (95% CI, 0.82-2.04), 1.28 (95% CI, 0.74-2.15), and 1.11 (95% CI, 0.54-2.15), respectively. Moreover, the risk of sustaining multiple fractures per participant was significantly increased among patients with AFF compared to pMOF (hazard ratio 1.48 [95% CI, 1.00-2.19]; p = 0.049). When taking mortality into account, the risk of subsequent fractures tended to be higher in the AFF group (sub-hazard ratio 1.42 [95% CI, 0.95-2.12]). In conclusion, patients who sustained an AFF are at high risk of subsequent fragility fractures, at least equal or even greater to the risk observed after a pMOF. However, continuation of AR drugs increases the risk of contralateral AFF. Therefore, optimal modalities for secondary fracture prevention after AFF require further evaluation. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Project description:To summarize the clinical results of femoral head fracture-dislocation treated according to Pipkin classification.Atotal of 19 patients with femoral head fracture-dislocation were retrospectively analyzed from Mar. 2008 to Mar. 2015. According to the classification of Pipkin criteria, there were 4 cases in Type-I, 6 cases in Type-II, 6 cases in Type-IIIand 3 cases in Type-IV. Various procedures were taken according to the different types of the fracture, the time of the fracture, and the age of the patients. X-ray was examined during the follow-up period and functional evaluation was carried out by Harris Hip Score's criteria. The clinical therapeutic effects were analyzed.All the patientsgot a mean follow-up of 18 months (9-36 months). No patient suffered from infection, skin flap necrosis and X-ray showed no implants loosening or breakage. According to the Harris Hip Score's criteria, in Type-I, 4 cases were rated as excellent. In Type-II, 2 cases rated as excellent, 3 cases as good and 1 case as fair. In Type-III, 3 cases rated as good, 2 cases as fair and 1 case as poor. In Type-IV, 1 case rated as excellent, 1 case as good and 1 case as fair. The overall rate of excellent and good was 73.7%.Pipkin classification is helpful to make preoperative plan and judging the prognosis in cases of femoral head fracture-dislocation. However, multiple factors such as the time from injury to surgery, the ages of patients, the selection of implants should also be considered, which may affect the clinical results.
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