Test Paper 5
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
An 8-year-old boy presents with a 5-week history of left hip pain and limp. Several previous pelvic X-rays were normal. A bone scan shows reduced uptake in the left femoral epiphysis. A line drawn from the lateral aspect of the femoral neck intersects the femoral head. What is the most likely diagnosis? SUFETransient synovitisPerthes diseaseDevelopmental dysplasia of the hipSickle cell disease
Orthopaedics and Fractures
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
An intoeing gait is a very common cause of parental concern and childhood ‘tripping’ (Table 21.1) It is rarely a cause of orthopaedic concern. The intoeing may orginate from one of three sites: The hip/thigh – femoral neck anteversion (Fig. 21.3).The tibia – internal tibial torsion.The foot – metatarsus adductus (Fig. 21.4).
Femoral shaft, distal femoral and periprosthetic fractures
Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou in Orthopaedic Trauma, 2014
All fractures of the shaft of the femur require specific assessment and documentation of: Other concurrent fractures – femoral fractures frequently result from high-energy trauma. The rate of associated femoral neck fracture is approximately 10 per cent; other associated injuries include hip dislocation, pelvic fracture and knee ligament disruption.Distal neurovascular status.Overlying soft tissues – especially open fractures. Consideration should also be made of compartment syndrome.
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
Wei (2015) used FEA technology to study the valgus impacted type fractures and found that as the femoral neck was shortened due to the insertion, the tensile stress borne above the femoral neck and the compressive stress borne below the femoral neck were reduced. In this way, the fracture end is more stable, and the possibility of internal fixation slippage or even breakage is less. From this perspective, the insertion of femoral neck is beneficial to the stability of the femoral neck fracture end, and does not affect the healing of the fracture end. Even conducive to the healing of fracture ends. This is consistent with the findings in this article that compared with normal femurs, the stress in the femoral neck area is significantly reduced after insertion. Pu et al. (2012) retrospectively studied the clinical data of 106 patients with femoral neck fractures and found that the insertion and shortening of the femoral neck would affect the function of the hip joint, but did not affect the healing of the fracture and the stability of the fracture end.
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.
High rate of reoperation and conversion to total hip arthroplasty after internal fixation of young femoral neck fractures: a population-based study of 796 patients
Published in Acta Orthopaedica, 2019
David J Stockton, Lyndsay M O’Hara, Nathan N O’Hara, Kelly A Lefaivre, Peter J O’Brien, Gerard P Slobogean
Femoral neck fractures in non-geriatric adults are a challenge to treat successfully. They often occur from high-energy trauma and result in displaced fracture patterns (Protzman and Burkhalter 1976, Robinson et al. 1995). Reduction and internal fixation is performed for nearly all younger patients with these fractures in order to preserve the native hip joint (Tooke and Favero 1985, Ly et al. 2008). The risk of a healing complication is often high, with the most common causes being osteonecrosis (14%), nonunion (9%), and severe femoral neck shortening (13–32%) (Slobogean et al. 2015, Stockton et al. 2015, Slobogean et al. 2017). A recent meta-analysis estimated a reoperation rate of 18% following internal fixation of young femoral neck fractures; however, this rate was estimated using predominantly retrospective, short-term, case series data (Slobogean et al. 2015). Lin et al. (2014) estimated the 10-year complication-free rate for femoral neck fractures in patients age 20–40 years to be 67% in Taiwan, but the outcome was an aggregate of reoperations and medical complications. While several case series have described the short-term surgical complications of these injuries, long-term population-based studies remain lacking; it is unknown how many patients treated with internal fixation will eventually require a reoperation or conversion to total hip arthroplasty (THA).
Related Knowledge Centers
- Bone
- Lesser Trochanter
- Puberty
- Femoral Head
- Greater Trochanter
- Body of Femur
- Old Age
- Hip
- Capsule of Hip Joint
- Intertrochanteric Crest