Limits...
Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction.

Liu C, Liu MT, Li P, Xu HH - Chin. Med. J. (2015)

Bottom Line: The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score.The above index of two groups was considered statistically significant (P < 0.05).It is a safe and effective operation for subcapital femoral neck fracture.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China.

ABSTRACT

Background: Subcapital femoral neck fracture in young adults has many complications, and the incidence is increasing year-by-year. The selection of the proper operation method to avoid them is an ambiguous matter. This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and internal fixation in young adults.

Methods: From March 2003 to February 2010, 65 young patients with subcapital femoral neck fractures were treated, including 39 males and 26 females with average age of 34.5 years (range, 19-50 years); 29 cases of the left side and 36 cases of the right side. They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting. The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score. The observation criteria involved the length of the incision, blood loss, operation time, nonunion rate, avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score.

Results: Four of 65 patients were lost follow-up, and the follow-up rate was 93.8%, the average follow-up time was 38.7 months (range, 33-47 months). In Group A, the incision length was 5.1 ± 2.2 cm, blood loss was 84.0 ± 13.2 ml, and operation time was 52.9 ± 10.2 min. In Group B, the incision length was 15.4 ± 4.6 cm, blood loss was 396.0 ± 21.3 ml, and operation time was 116.5 ± 15.3 min. Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B. ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B. Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B. The above index of two groups was considered statistically significant (P < 0.05).

Conclusions: Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing, reduce ANFH in young adults. It is a safe and effective operation for subcapital femoral neck fracture.

Show MeSH

Related in: MedlinePlus

A 34-year-old male patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by the capsulotomy and internal fixation with iliac bone grafting. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 year after operation; (d) X-rays of screw removed 1.5 years after operation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4836251&req=5

Figure 2: A 34-year-old male patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by the capsulotomy and internal fixation with iliac bone grafting. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 year after operation; (d) X-rays of screw removed 1.5 years after operation.

Mentions: Compared with the closed reduction and internal fixation, capsulotomy reduction and iliac crest graft and internal fixation has the following characteristics: (1) Accurate anatomic reduction:[18] With direct visualization and sufficiently exposure, satisfactory anatomic reduction can be achieved which provides basis for fracture healing. In addition, it may open some of the retinacular vessels that are temporarily closed by kinking or stretching and may permit the reestablishment of some vascular. (2) Stable internal fixation: With direct visualization and chipped bone groove, the trace of the two or three cannulated screws crossing the fracture line can be seen clearly, which ensure they can be placed to the best position.[3031] The harvested bone blocks are put back, and iliac bone granules are grafted into the bone groove, which will recover local bone conditions effectively and provide mechanical support.[30] Moreover, stable fixation gives support for the new capillary around to grow into the ossiferous place which can avoid capillary fracture again. It is a solid foundation for fracture healing. (3) Iliac cancellous bone grafting: This is good for osteogenesis and fracture healing.[24] (1) Recovering normal length: It can prevent shortening deformity or joint dislocation. (2) Induction osteogenesis: Protein factors in bone tissue, such as bone morphogenetic protein transforming growth factor-β basic fibroblast growth factor, can induce the collagen secretion from nearby tissues and promote the generation and differentiation of bone.[323334] (3) Osteoconduction function: The bone grafted provide scaffolding for the new bone cells and collagen. (4) Accelerate vascularization: The cancellous bone has faster process of vascularization than cortical bone. It can accelerate the healing of cortical bone. Meanwhile, it can prevent soft tissue, and joint fluid enter into the fracture site which would result in delayed union or nonunion.[272829] (4) Capsulotomy reconstructs the blood supply: Schep et al.[35] found that capsule in high pressure is a key factor influencing the blood supply for the femoral head capsulotomy gives chance for the peripheral capillary blood vessels to grow into the fracture end as well as reducing the pressure, so the blood supply of the fracture and femoral head would be reconstructed. (5) Joint fluid drainage: Joint fluid drains out from the capsule to avoid nonunion. So the open group including 30 cases presented lower nonunion, ANFH rate and higher Harris Hip Score (1 case accounts for 3.3%, 2 cases account for 6.7% and 95.0 ± 4.5 points respectively), even though worse in trauma index (the incision length was 15.4 ± 4.6 cm, total blood loss was 396.0 ± 21.3 ml, and operation period was 116.0 ± 15.3 min) [Figure 2].


Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction.

Liu C, Liu MT, Li P, Xu HH - Chin. Med. J. (2015)

A 34-year-old male patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by the capsulotomy and internal fixation with iliac bone grafting. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 year after operation; (d) X-rays of screw removed 1.5 years after operation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836251&req=5

Figure 2: A 34-year-old male patient was involved in a car accident which resulted in subcapital femoral neck fracture of her right leg who was treated by the capsulotomy and internal fixation with iliac bone grafting. (a) Preoperative X-rays; (b) X-rays of half a year after operation; (c) X-rays of 1.5 year after operation; (d) X-rays of screw removed 1.5 years after operation.
Mentions: Compared with the closed reduction and internal fixation, capsulotomy reduction and iliac crest graft and internal fixation has the following characteristics: (1) Accurate anatomic reduction:[18] With direct visualization and sufficiently exposure, satisfactory anatomic reduction can be achieved which provides basis for fracture healing. In addition, it may open some of the retinacular vessels that are temporarily closed by kinking or stretching and may permit the reestablishment of some vascular. (2) Stable internal fixation: With direct visualization and chipped bone groove, the trace of the two or three cannulated screws crossing the fracture line can be seen clearly, which ensure they can be placed to the best position.[3031] The harvested bone blocks are put back, and iliac bone granules are grafted into the bone groove, which will recover local bone conditions effectively and provide mechanical support.[30] Moreover, stable fixation gives support for the new capillary around to grow into the ossiferous place which can avoid capillary fracture again. It is a solid foundation for fracture healing. (3) Iliac cancellous bone grafting: This is good for osteogenesis and fracture healing.[24] (1) Recovering normal length: It can prevent shortening deformity or joint dislocation. (2) Induction osteogenesis: Protein factors in bone tissue, such as bone morphogenetic protein transforming growth factor-β basic fibroblast growth factor, can induce the collagen secretion from nearby tissues and promote the generation and differentiation of bone.[323334] (3) Osteoconduction function: The bone grafted provide scaffolding for the new bone cells and collagen. (4) Accelerate vascularization: The cancellous bone has faster process of vascularization than cortical bone. It can accelerate the healing of cortical bone. Meanwhile, it can prevent soft tissue, and joint fluid enter into the fracture site which would result in delayed union or nonunion.[272829] (4) Capsulotomy reconstructs the blood supply: Schep et al.[35] found that capsule in high pressure is a key factor influencing the blood supply for the femoral head capsulotomy gives chance for the peripheral capillary blood vessels to grow into the fracture end as well as reducing the pressure, so the blood supply of the fracture and femoral head would be reconstructed. (5) Joint fluid drainage: Joint fluid drains out from the capsule to avoid nonunion. So the open group including 30 cases presented lower nonunion, ANFH rate and higher Harris Hip Score (1 case accounts for 3.3%, 2 cases account for 6.7% and 95.0 ± 4.5 points respectively), even though worse in trauma index (the incision length was 15.4 ± 4.6 cm, total blood loss was 396.0 ± 21.3 ml, and operation period was 116.0 ± 15.3 min) [Figure 2].

Bottom Line: The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score.The above index of two groups was considered statistically significant (P < 0.05).It is a safe and effective operation for subcapital femoral neck fracture.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710061, China.

ABSTRACT

Background: Subcapital femoral neck fracture in young adults has many complications, and the incidence is increasing year-by-year. The selection of the proper operation method to avoid them is an ambiguous matter. This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and internal fixation in young adults.

Methods: From March 2003 to February 2010, 65 young patients with subcapital femoral neck fractures were treated, including 39 males and 26 females with average age of 34.5 years (range, 19-50 years); 29 cases of the left side and 36 cases of the right side. They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting. The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score. The observation criteria involved the length of the incision, blood loss, operation time, nonunion rate, avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score.

Results: Four of 65 patients were lost follow-up, and the follow-up rate was 93.8%, the average follow-up time was 38.7 months (range, 33-47 months). In Group A, the incision length was 5.1 ± 2.2 cm, blood loss was 84.0 ± 13.2 ml, and operation time was 52.9 ± 10.2 min. In Group B, the incision length was 15.4 ± 4.6 cm, blood loss was 396.0 ± 21.3 ml, and operation time was 116.5 ± 15.3 min. Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B. ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B. Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B. The above index of two groups was considered statistically significant (P < 0.05).

Conclusions: Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing, reduce ANFH in young adults. It is a safe and effective operation for subcapital femoral neck fracture.

Show MeSH
Related in: MedlinePlus