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Femoral Neck Stress Fracture

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61. Management of osteoporosis and the prevention of fragility fractures

by fractures and osteoporosis and their carers may also find the guideline to be of interest. 1.2.3 DEFINITIONS Osteoporosis is defined as a syndrome associated with low bone mass and microarchitectural deterioration of bone tissue which lead to an increased risk of fractures. 3 The World Health Organization (WHO) has defined osteoporosis to exist in postmenopausal women or men when axial bone density T-score (measured by dual-energy X-ray absorptiometry (DXA)) at the femoral neck falls 2.5 standard (...) deviations (SD) or more below the average value in young healthy women (T-score = -2.5 SD). 4,5 The International Society for Clinical Densitometry has published an Official Position which states that osteoporosis may be diagnosed in postmenopausal women and in men aged 50 and older if the T-score of the lumbar spine, total hip, or femoral neck is -2.5 or less. 6 Although the risk of fractures is substantially increased in people with osteoporosis, about two thirds of non-vertebral fractures occur

2015 SIGN

62. Bisphosphonates: atypical femoral fractures

for: prophylaxis and treatment of osteoporosis treatment of Paget’s disease as part of some cancer regimens, particularly for bone metastases and multiple myeloma In 2008, a Europe-wide review of bisphosphonates and atypical stress fractures concluded that alendronic acid use was associated with an increased risk of atypical stress fractures of the proximal femoral shaft and a warning was subsequently added to alendronic acid product information. At that time, the available data neither supported nor refuted (...) : atypical femoral fractures have been reported rarely with bisphosphonate therapy, mainly in patients receiving long-term treatment for osteoporosis; atypical femoral fractures are considered a class effect of bisphosphonates they can occur after minimal or no trauma - some patients experience thigh or groin pain, often associated with features of stress fractures on radiograph, weeks to months before presenting with a completed femoral fracture; poor healing of these fractures has been reported

2011 MHRA Drug Safety Update

63. Pathological fractures of the femoral neck Full Text available with Trip Pro

Pathological fractures of the femoral neck In a review of subcapital fractures due to metastases in the femoral neck it was found that in the majority of cases pain in the region of the hip developed a few days prior to fracture. While the majority of subcapital fractures are sustained as the result of a single incident of trauma, in cases with metastases trabecular stress fractures occur in increasing numbers until finally femoral neck fracture occurs. It would seem that once a critical number (...) of trabecular stress fractures has been reached the patient develops pain. Immediate radiologic examination should be performed, and if there is evidence of bone destruction approaching 50% of the cortex, prophylactic hip pinning is strongly indicated.

1974 Canadian Medical Association Journal

64. Australian and New Zealand Guideline for Hip Fracture Care - Improving Outcomes in Hip Fracture Management of Adults

-based recommendation Schedule hip fracture surgery on a planned list or planned trauma list where an appropriately skilled team is available to undertake the procedure. - 4.2 Operative intervention Evidence-based recommendation Perform replacement arthroplasty (hemiarthroplasty or total hip replacement) in patients with a displaced intracapsular fracture. C 5.1 Consensus-based recommendation Use a femoral stem design other than Austin Moore or Thompson stems for arthroplasties. - 5.1 Evidence-based (...) Australian and New Zealand Guideline for Hip Fracture Care - Improving Outcomes in Hip Fracture Management of Adults Australian and New Zealand Guideline for Hip Fracture Care Improving Outcomes in Hip Fracture Management of Adults September 2014© Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group 2014 ISBN Print: 978-0-7334-3450-1 ISBN Online: 978-0-7334-3451-8 Published: September 2014 Suggested citation: Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering

2014 Clinical Practice Guidelines Portal

65. Exercise loading history and femoral neck strength in a sideways fall: A three-dimensional finite element modeling study. Full Text available with Trip Pro

Exercise loading history and femoral neck strength in a sideways fall: A three-dimensional finite element modeling study. Over 90% of hip fractures are caused by falls. Due to a fall-induced impact on the greater trochanter, the posterior part of the thin superolateral cortex of the femoral neck is known to experience the highest stress, making it a fracture-prone region. Cortical geometry of the proximal femur, in turn, reflects a mechanically appropriate form with respect to habitual exercise (...) loading. In this finite element (FE) modeling study, we investigated whether specific exercise loading history is associated with femoral neck structural strength and estimated fall-induced stresses along the femoral neck. One hundred and eleven three-dimensional (3D) proximal femur FE models for a sideways falling situation were constructed from magnetic resonance (MR) images of 91 female athletes (aged 24.7±6.1years, >8years competitive career) and 20 non-competitive habitually active women (aged

2016 Bone

66. Unusual presentation of a femoral stress fracture Full Text available with Trip Pro

Unusual presentation of a femoral stress fracture Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation.

2013 BMJ case reports

67. Stress fractures of the neck of the femur. Full Text available with Trip Pro

Stress fractures of the neck of the femur. 5525850 1972 08 09 2018 11 13 0041-6193 39 2 1970 The Ulster medical journal Ulster Med J Stress fractures of the neck of the femur. 111-8 Parks T G TG Baird D S DS Wilson R I RI eng Journal Article Northern Ireland Ulster Med J 0417367 0041-6193 IM Adult Aged Arthritis, Rheumatoid complications Female Femoral Neck Fractures complications diagnostic imaging etiology Humans Male Middle Aged Osteoporosis complications Radiography Stress, Physiological

1970 The Ulster medical journal

68. Femoral Shaft Stress Fracture

Femoral Shaft Stress Fracture Femoral Shaft Stress Fracture Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Femoral Shaft Stress (...) Fracture Femoral Shaft Stress Fracture Aka: Femoral Shaft Stress Fracture From Related Chapters II. Epidemiology Less common than III. Symptoms Mild deep thigh soreness IV. Signs Deep thigh tenderness to palpation Positive Positive V. Management Manage non-surgically Return to sport in 8-14 weeks Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Femoral Shaft Stress Fracture." Click on the image (or right click) to open the source

2015 FP Notebook

69. A curious case of stress fracture in a transsexual athlete Full Text available with Trip Pro

A curious case of stress fracture in a transsexual athlete Femoral neck stress fractures in young healthy individuals are rare and occur in those who take part in physical training with repetitive loading and those with osteoporosis. Bone density is related to sex hormone status, which is artificially manipulated during gender reassignment. Conflicting evidence currently exists on the effect of cross sex hormone treatment on bone density, with no literature suggesting a link between hormone (...) treatment in gender reassignment and stress fractures. Our aim is to highlight the potential risk of stress fractures amongst transsexual patients receiving cross sex hormones as part of gender reassignment. The patient presented with groin pain after competing in a running event. Despite a number of risk factors, there was a delay in diagnosis, which could have led to complications compromising outcome. Femoral neck stress fractures should be considered in the differential diagnosis of transsexual

2016 BMJ case reports

70. Changes in the stress in the femoral head neck junction after osteochondroplasty for hip impingement: A finite element study. (Abstract)

Changes in the stress in the femoral head neck junction after osteochondroplasty for hip impingement: A finite element study. The surgical treatment of femoroacetabular impingement (FAI) often involves femoral osteochondroplasty. One risk of this procedure is fracture of the femoral neck. We developed a finite element (FE) model to investigate the relationship between depth of resection and femoral neck stress. CT data were used to obtain the geometry of a typical cam-type hip, and a 3D FE (...) Mises stresses and the area of bone that yielded significantly increased at a resection depth of ≥10 mm. The knee bend and walking down stairs demonstrated the highest stresses. The FE model predicts that fracture is likely to occur in the resection area first following removal of a third (10 mm) or more of the diameter of the femoral neck. We suggest that when surgeons perform osteochondroplasty for hip impingement, the depth of resection should be limited to 10 mm.Copyright © 2012 Orthopaedic

2012 Journal of Orthopaedic Research

71. Biofidelic finite element models for accurately classifying hip fracture in a retrospective clinical study of elderly women from the AGES Reykjavik cohort. (Abstract)

biofidelic models, one with linear elastic and the other with non-linear stress-strain relationships in the proximal femur. The expected end-point value (EEV) was defined as the FR weighted by the probability of one sideways fall over five years, based on self-reported fall frequency at baseline. The change in maximum volumetric strain (ΔMVS) on the surface of the femoral neck was calculated between time of ultimate femur force and 90% post-ultimate force in order to assess the extent of tensile tissue (...) difference in AUC was detected between ΔMVS (0.85), and aBMD (0.74). Multivariable linear regression suggested that the variance in maximum elastic femur force was best explained by femoral head radius, pelvis width, and soft tissue thickness (R2 = 0.79; RMSE = 0.46 kN; p < 0.005). Weighting the hip fracture prediction models based on self-reported fall frequency did not improve the models' sensitivity, however excluding non-fallers lead to significant differences between aBMD and FE based models

2018 Bone

72. Mechanical simulation study of postoperative displacement of trochanteric fractures using the finite element method Full Text available with Trip Pro

the femoral neck axis (type B). Thereafter, FE models of the femur and a sliding hip screw mounted on a 135° three-hole side-plate were constructed. A 2010-N load was applied to the femoral head, and a 1086-N load was applied to the greater trochanter. Under this condition, the maximum value of the von Mises stress distribution and the amount of displacement of the femoral head vertex in the distal direction were investigated.A larger maximum stress value at the medial femoral neck cortex and a higher (...) Mechanical simulation study of postoperative displacement of trochanteric fractures using the finite element method Femoral trochanteric fractures are common among older adults. In the reduction of trochanteric fractures, acquiring the support of the anterior cortex at the fracture site on lateral view immediately after surgery is important. However, even if the cortical support is acquired, postoperative displacement due to the loss of this support often occurs. This study aimed to investigate

2018 Journal of orthopaedic surgery and research

73. Hyponatremia in Elderly Patients With Hip Fractures

, and congestive heart failure), polypharmacy (e.g., antihypertensives, antidepressants, and antiepileptics), hospitalization, perioperative fluid restrictions, and homeostatic stress from the fracture itself and the subsequent surgery. The aim of this study is to compare incidence of hyponatremia in elderly patients (>70 years) with hip fractures (case group) to incidence of hyponatremia in elderly patients(>70 years) undergoing joint replacement or prostate surgery(control group). Condition or disease (...) assessment must be made, focusing on fluid status, examining the potential etiology, and conducting the appropriate investigations. In approximately 50% of patients, chronic hyponatremia results from inappropriate antidiuretic hormone secretion. Chronic mild hyponatremia is usually asymptomatic and is traditionally regarded as benign. However, it is associated with a lower bone mineral content and density in nearly all regions of the hip, with more pronounced losses in the trochanteric and femoral neck

2018 Clinical Trials

74. Fundamental differences in axial and appendicular bone density in stress fractured and uninjured Royal Marine recruits--a matched case-control study. (Abstract)

, body size and physical fitness; and poor sample size. The aim of this study was to investigate bone differences between male Royal Marine recruits who suffered a stress fracture during the 32 weeks of training and uninjured control recruits, matched for age, body weight, height and aerobic fitness. A total of 1090 recruits were followed through training and 78 recruits suffered at least one stress fracture. Bone mineral density (BMD) was measured at the lumbar spine (LS), femoral neck (FN (...) Fundamental differences in axial and appendicular bone density in stress fractured and uninjured Royal Marine recruits--a matched case-control study. Stress fracture is a common overuse injury within military training, resulting in significant economic losses to the military worldwide. Studies to date have failed to fully identify the bone density and bone structural differences between stress fractured personnel and controls due to inadequate adjustment for key confounding factors; namely age

2015 Bone

75. A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures. Full Text available with Trip Pro

A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures. The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head.6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent (...) micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head.The greatest density and trabecular thickness was found in the central core that extended from the medial calcar

2013 Acta Orthopaedica

76. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study Full Text available with Trip Pro

in the regions where the proximal lag screw passes through the proximal femoral nail hole, the small diameter portion of stem joints with a large diameter and lag screw mounts to the stem. The most suitable position of the proximal lag screw was found at the middle position of the tip-apex distance (20 mm) and femoral neck (anterior-posterior, inferior-superior=0°), according to von Mises compression stress values occurring on the fracture line.In our study, we couldn't find any correlation between proximal (...) lag screw movement and tip-apex distance on stresses of the fracture surfaces, but the proximal lag screw position in the inferior (inferior-superior<0)-superior (inferior-superior>0) and posterior-anterior directions of the femur neck significantly increased these stresses. The most suitable position of the proximal lag screw was confirmed as the middle of the femoral neck by using optimized finite element analysis.

2017 Balkan medical journal

77. Burnei’s technique of femoral neck variation and valgisation by using the intramedullary rod in Osteogenesis imperfecta Full Text available with Trip Pro

Burnei’s technique of femoral neck variation and valgisation by using the intramedullary rod in Osteogenesis imperfecta Varus or valgus deviations of the femoral neck in osteogenesis imperfecta have been an ignored chapter because the classic correction procedures were applied in medical practice with unsatisfying results. Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially (...) articles in literature, which approach corrections of vara or valgus deviations in osteogenesis imperfecta. Some of them are the techniques described by Finidori, Wagner and Fassier.Burnei's technique is simple; it corrects the varus and valgus deviations concomitantly with Sofield-Millar. Even though only a telescopic rod is used, no stress fractures were seen postoperatively, deviation recurrence or assembly loss.

2014 Journal of medicine and life

78. Prehospital intravenous fentanyl to patients with hip fracture: an observational cohort study of risk factors for analgesic non-treatment. Full Text available with Trip Pro

to alleviate the stress that follows acute pain, to facilitate transportation, and to improve quality of care. The objectives of this study were to explore the prevalence of prehospital administration of intravenous fentanyl to patients with proximal femoral neck fracture in the ambulances and to assess risk factors for analgesic non-treatment.This was a register-based observational cohort study of patients with proximal femoral neck fracture from the North Denmark Region transported by ambulance (...) Prehospital intravenous fentanyl to patients with hip fracture: an observational cohort study of risk factors for analgesic non-treatment. Patients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatment of these patients is to administer systemic opioids fast and properly. Effective analgesic prehospital treatment ought be initiated rapidly in order

2017 Scandinavian journal of trauma, resuscitation and emergency medicine

79. Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study. (Abstract)

fracture and FRIs derived from automated finite element analysis (FEA) of DXA hip scans. Femoral neck, intertrochanteric, and subtrochanteric FRIs were calculated as the von Mises stress induced by a sideways fall divided by the bone yield stress over the specified region of interest (ROI).Using the Manitoba Bone Mineral Density Database, we selected women age ≥ 65 years with femoral neck T-scores below - 1 and no osteoporosis treatment. From this population, we identified 324 older women with hip (...) Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study. Fracture risk indices (FRIs) generated from DXA-based finite element analysis were associated with hip fracture independent of FRAX score computed with femoral neck bone mineral density (BMD). Prospective studies are warranted to determine whether FRIs represent an improvement over BMD for predicting incident hip fractures.The study aims to examine the association between prior hip

2017 Osteoporosis International

80. Are Women with Thicker Cortices in the Femoral Shaft at Higher Risk of Subtrochanteric/Diaphyseal Fractures? The Study of Osteoporotic Fractures. Full Text available with Trip Pro

Are Women with Thicker Cortices in the Femoral Shaft at Higher Risk of Subtrochanteric/Diaphyseal Fractures? The Study of Osteoporotic Fractures. Femoral shaft cortical thickening has been mentioned in reports of atypical subtrochanteric and diaphyseal (S/D) femur fractures, but it is unclear whether thickening precedes fracture or results from a preceding stress fracture and what role bisphosphonates might play in cortical thickening.Our objective was to examine the relationship of cortical (...) thickness to S/D fracture risk as well as establish normal reference values for femoral cortical thickness in a large population-based cohort of older women.Using pelvic radiographs obtained in 1986-1988, we measured femoral shaft cortical thickness 3 cm below the lesser trochanter in women in the Study of Osteoporotic Fractures. We measured this in a random sample and in those with S/D fractures and femoral neck and intertrochanteric fractures. Low-energy S/D fractures were identified from review

2012 Journal of Clinical Endocrinology and Metabolism

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