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A screening model for osteoporosis using dermal skin thickness and bone densitometry
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
M. P. Brincat, R. Galea, Y. Muscat Baron
By the age of 75 years, more than 25% of women develop osteoporotic fractures10. The three classic osteoporotic fractures are: fractures of the vertebrae, distal end of the radius and neck of the femur. Fractures of the femoral neck lead to considerable morbidity and mortality.
Complications of surgical treatment for osteoporotic fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Paul C. Baldwin, Christian Krettek
Fortunately, many fixation options exist in the treatment of hip fractures dependent on fracture characteristics and location. With femoral neck fractures, the majority of patients are treated with either fixation or arthroplasty. Nondisplaced femoral neck fracture can be treated with multiple cancellous screws or sliding hip screw constructs. While the majority of surgeons treat these nondisplaced fractures with cancellous screws, some studies have indicated a reduction in failure and complications with the use of a sliding hip screw (67). In a randomized controlled trial by Kuokkanen et al., 33 patients with nondisplaced femoral neck fractures were treated with either cancellous screws (n = 16) or a sliding hip screw (n = 17) (68). Three of the 16 patients (19%) treated with cancellous screws had failure that required revision surgery, while none of the patients treated with a sliding hip screw required revision. Ma et al. supported this finding in a more recent systematic review where treatment with a sliding hip screw demonstrated fewer complications and faster time to union (69).
Valgus osteotomy for femoral neck pseudoarthrosis
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
Ashok S. Gavaskar, David Rojas
The resultant force R acts on the center of rotation of the hip joint in an inclined direction, subtending an angle of 16° with the vertical (body axis).13,17 A horizontal fracture plane will position the fracture perpendicular to the line of the resultant force R and hence will be subjected to predominantly compressive forces. This forms the biomechanical basis of VITO. Repositioning of the femoral neck will ensure stability. Once stable, the intervening fibrous tissue will be rapidly mineralized and invaded by angiogenesis, allowing for endochondral ossification and successful osteosynthesis (Figure 18.3).
Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Yahui Dai, Ming Ni, Bang Dou, Zhiyuan Wang, Yushan Zhang, Xueliang Cui, Wenqian Ma, Tao Qin, Xiaobin Xu, Jiong Mei
Cannulated screws and SHS are the most commonly used implants for fixation of femoral neck fractures, and we compared biomechanical characteristics of them for valgus-impacted femoral neck fractures. Our results showed that von Mises stress was concentrated at the medial and inferior sides in the intact femur, the same as the calcar femorale located. The calcar femorale acts an important role in the transmission of forces from femoral neck to the shaft. Zhang et al. stated that the calcar femorale redistributes stress in the proximal femur by decreasing the load in the posterior and medial aspects and increasing the load in the anterior and lateral aspects (Zhang et al. 2009). All 4 surgical methods increased the stress at the medial and inferior sides of the femoral neck in the rank order of Model 7 < Model 6 < Model 5 < Model 4. The stress in Model 7 (15.921 MPa) and displacements in Models 2 and 7 (0.332 and 0.329 mm, respectively) were closest to the values for the intact femur (Model 1: stress, 11.911 MPa; displacement, 0.38 mm). The latter result indicates that the valgus-impacted fracture was stable in Models 2 and 7, and explains why some patients can move the hip joint and feel no pain. Fixing the fracture by cannulated screws after reduction (Model 5) significantly increased the displacement (0.45 mm), making it the most unstable treatment option.
A finite element analysis study based on valgus impacted femoral neck fracture under diverse stances
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Haowei Zhang, Xinsheng Xu, Shenghui Wu, Ying Liu, Jiong Mei
A retrospective study of X-ray and CT images of the femoral neck of 192 patients with femoral neck fractures by Li et al. (2011) found that about 40% of patients with femoral neck fractures had a rotational displacement of the femoral head. At present, the clinical practice of inserting femoral neck fractures Most of the patients were treated directly with internal fixation without reduction. Four cases of insertion fracture patients were examined by spiral CT and showed that the femoral head had relatively large sliding and rotational displacement. Wei et al. (2005) conducted a retrospective study on the data of 137 patients with femoral neck fractures. The probability of femoral head necrosis in femoral neck insertion and shortening was significantly higher than that in the normal femoral neck group. Therefore, this study believes that in addition to the factors that cause the stress change of the femoral head due to anatomical reduction, there are also factors of poor fracture reduction. The relative slippage of the femoral neck section due to poor reduction of femoral neck fractures, slippage and rotational displacement will lead to changes in the weight-bearing area of the femur. The change of the weight-bearing area makes the trabecular bone of the non-main weight-bearing area bear much greater pressure than usual, so it is prone to secondary fractures such as trabecular bone fractures.
Exposure to tobacco smoke increases bone loss in spontaneously hypertensive rats
Published in Inhalation Toxicology, 2018
Jingyi Xu, Xing Qiu, Zhou Liang, Suzette Smiley-Jewell, Faqiang Lu, Mang Yu, Kent E. Pinkerton, Dewei Zhao, Bingyin Shi
Clinically, the rate of concurrent hypertension and osteoporosis is high, and epidemiological studies show that hypertension may be a risk factor for increased fractures risk (Vestergaard et al., 2009). Femoral neck fracture is one of the most common fractures in the elderly population (90% of hip fractures), with high morbidity and mortality (Parker, 2008; Schmidt et al., 2009). Spontaneously hypertensive (SH) rats are widely used to study hypertension (Okamoto and Aoki, 1963), which have several hormonal imbalances and phenotypic features of human diseases (Schmid-Schonbein et al., 1991; Amagasa et al., 2005; Kobayashi et al., 2005; Yanbaeva et al., 2007) that influence chondrogenesis and bone reconstruction process (Meurrens et al., 2007). Through imaging and histological studies, Komiyama et al. (Komiyama et al., 2006) found that 5 to 20 weeks of age was a critical period for the exhibition of ossification disturbance, incomplete ossification, and osteonecrosis in the SH rats, and vascular endothelial growth factor (VEGF) played an important role in such processes.