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Femoral Neck Stress Fracture

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141. Femoral Head Avascular Necrosis (Overview)

to the femoral head is principally provided by 3 sources: (1) an extracapsular arterial ring at the base of the femoral neck, (2) ascending branches of the arterial ring on the femoral neck surface, and (3) arteries of the round ligament. This arterial supply is well affixed to the femoral neck and is easily damaged with any femoral neck fracture displacement. Furthermore, nutrient vessels to the femoral head terminate in small arterioles that are easily occluded with small embolic matter (ie, lipids). (See (...) of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci . 2012 Nov 1. . Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am . 1995 Mar. 77(3):459-74. . Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury . 2016 Oct 19. . Maini L, Kumar S, Batra S, Gupta R, Arora S. Evaluation

2014 eMedicine.com

142. Femoral Head Avascular Necrosis (Treatment)

the relatively high failure rate in some clinical series. [ ] Nonetheless, refinements in both technique and design predict improved outcomes. Resurfacing arthroplasty remains a controversial procedure that likely will not last a patient’s lifetime. Current recommendations are that resurfacing is contraindicated if the avascular area exceeds one third of the femoral head. Furthermore, there is a 1% incidence of femoral neck fracture with this procedure. Lastly, the issue of metal ion release has spurred much (...) analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci . 2012 Nov 1. . Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am . 1995 Mar. 77(3):459-74. . Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury . 2016 Oct 19

2014 eMedicine.com

143. Femoral Osteotomy (Diagnosis)

, as in intertrochanteric fracture malunion with varus, external rotation, and shortening deformity Simultaneous femoral osteotomy and total hip arthroplasty Hip or in the young, active patient Femoral neck nonunion In femoral neck nonunion, the fracture fails to heal despite an adequate blood supply. Weightbearing forces across a vertically oriented fracture line produce shear stresses at the fracture site that favor the production of fibrous tissue. Valgus intertrochanteric osteotomy reorients the fracture site (...) this position are yet lacking. Next: Indications The bases for performing a proximal femoral osteotomy can vary. In the presence of deformity, the goal is to correct the deformity and, in so doing, to realign the hip and lower extremity. This may include frontal, sagittal, and rotational corrections and perhaps even lengthening through the osteotomy. [ ] Indications for proximal femoral osteotomy in adults include the following: Nonunion of a femoral neck fracture Nonunion or malunion of an deformity

2014 eMedicine Surgery

144. Femoral Osteotomy (Overview)

, as in intertrochanteric fracture malunion with varus, external rotation, and shortening deformity Simultaneous femoral osteotomy and total hip arthroplasty Hip or in the young, active patient Femoral neck nonunion In femoral neck nonunion, the fracture fails to heal despite an adequate blood supply. Weightbearing forces across a vertically oriented fracture line produce shear stresses at the fracture site that favor the production of fibrous tissue. Valgus intertrochanteric osteotomy reorients the fracture site (...) this position are yet lacking. Next: Indications The bases for performing a proximal femoral osteotomy can vary. In the presence of deformity, the goal is to correct the deformity and, in so doing, to realign the hip and lower extremity. This may include frontal, sagittal, and rotational corrections and perhaps even lengthening through the osteotomy. [ ] Indications for proximal femoral osteotomy in adults include the following: Nonunion of a femoral neck fracture Nonunion or malunion of an deformity

2014 eMedicine Surgery

145. Avascular Necrosis, Femoral Head

the major blood supply to the epiphysis. They traverse the femoral neck and are contained within the joint capsule and give rise to the lateral epiphyseal vessels at the junction of the femoral head and neck. From there, they penetrate the femur and supply the femoral epiphysis. A. = artery. Avascular necrosis of the femoral head. Illustration demonstrating that the blood supply to the femoral head is compromised by subcapital femoral fractures or slipped capital femoral epiphysis. As the epiphysis (...) . A. = artery. Avascular necrosis of the femoral head. Illustration demonstrating that the blood supply to the femoral head is compromised by subcapital femoral fractures or slipped capital femoral epiphysis. As the epiphysis or femoral neck separates from the femoral head, the femoral metaphysis displaces superolaterally and the femur rotates externally. This causes the distal posterior-superior retinacular arteries and proximal lateral epiphyseal vessels to kink or rotate, compromising the blood flow

2014 eMedicine Radiology

146. Slipped Capital Femoral Epiphysis (Diagnosis)

). A: The entry point must be at or above the level of the lesser trochanter to avoid the risk of subtrochanteric fracture. B: The pin (screw) should be in the center of the epiphysis. C: At least 2.5 threads engaging the epiphysis should be used for a secure hold. Pin placement (lateral view). Arrow shows entry point in the anterolateral cortex. Osteotomies in slipped capital femoral epiphysis (SCFE). A: Subcapital osteotomy. B: Base of the neck compensatory osteotomy. C: Intertrochanteric compensatory (...) > Slipped Capital Femoral Epiphysis Surgery Updated: Mar 24, 2017 Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho; Chief Editor: William L Jaffe, MD Share Email Print Feedback Close Sections Sections Slipped Capital Femoral Epiphysis Surgery Overview Background Slipped capital femoral epiphysis (SCFE) was first described by Ernst Müller, who called it Schenkelhalsverbiegungen im Jungesalter ("bending of the femoral neck in adolescence"). The term slipped capital femoral epiphysis

2014 eMedicine Surgery

147. Femoral Head Avascular Necrosis (Diagnosis)

to the femoral head is principally provided by 3 sources: (1) an extracapsular arterial ring at the base of the femoral neck, (2) ascending branches of the arterial ring on the femoral neck surface, and (3) arteries of the round ligament. This arterial supply is well affixed to the femoral neck and is easily damaged with any femoral neck fracture displacement. Furthermore, nutrient vessels to the femoral head terminate in small arterioles that are easily occluded with small embolic matter (ie, lipids). (See (...) of the femoral head following femoral neck fractures in middle-aged and elderly patients. J Orthop Sci . 2012 Nov 1. . Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am . 1995 Mar. 77(3):459-74. . Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury . 2016 Oct 19. . Maini L, Kumar S, Batra S, Gupta R, Arora S. Evaluation

2014 eMedicine.com

148. Femoral Osteotomy (Treatment)

, as in intertrochanteric fracture malunion with varus, external rotation, and shortening deformity Simultaneous femoral osteotomy and total hip arthroplasty Hip or in the young, active patient Femoral neck nonunion In femoral neck nonunion, the fracture fails to heal despite an adequate blood supply. Weightbearing forces across a vertically oriented fracture line produce shear stresses at the fracture site that favor the production of fibrous tissue. Valgus intertrochanteric osteotomy reorients the fracture site (...) this position are yet lacking. Next: Indications The bases for performing a proximal femoral osteotomy can vary. In the presence of deformity, the goal is to correct the deformity and, in so doing, to realign the hip and lower extremity. This may include frontal, sagittal, and rotational corrections and perhaps even lengthening through the osteotomy. [ ] Indications for proximal femoral osteotomy in adults include the following: Nonunion of a femoral neck fracture Nonunion or malunion of an deformity

2014 eMedicine Surgery

149. Slipped Capital Femoral Epiphysis (Overview)

). A: The entry point must be at or above the level of the lesser trochanter to avoid the risk of subtrochanteric fracture. B: The pin (screw) should be in the center of the epiphysis. C: At least 2.5 threads engaging the epiphysis should be used for a secure hold. Pin placement (lateral view). Arrow shows entry point in the anterolateral cortex. Osteotomies in slipped capital femoral epiphysis (SCFE). A: Subcapital osteotomy. B: Base of the neck compensatory osteotomy. C: Intertrochanteric compensatory (...) > Slipped Capital Femoral Epiphysis Surgery Updated: Mar 24, 2017 Author: Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho; Chief Editor: William L Jaffe, MD Share Email Print Feedback Close Sections Sections Slipped Capital Femoral Epiphysis Surgery Overview Background Slipped capital femoral epiphysis (SCFE) was first described by Ernst Müller, who called it Schenkelhalsverbiegungen im Jungesalter ("bending of the femoral neck in adolescence"). The term slipped capital femoral epiphysis

2014 eMedicine Surgery

150. Femoral Osteotomy (Follow-up)

, as in intertrochanteric fracture malunion with varus, external rotation, and shortening deformity Simultaneous femoral osteotomy and total hip arthroplasty Hip or in the young, active patient Femoral neck nonunion In femoral neck nonunion, the fracture fails to heal despite an adequate blood supply. Weightbearing forces across a vertically oriented fracture line produce shear stresses at the fracture site that favor the production of fibrous tissue. Valgus intertrochanteric osteotomy reorients the fracture site (...) this position are yet lacking. Next: Indications The bases for performing a proximal femoral osteotomy can vary. In the presence of deformity, the goal is to correct the deformity and, in so doing, to realign the hip and lower extremity. This may include frontal, sagittal, and rotational corrections and perhaps even lengthening through the osteotomy. [ ] Indications for proximal femoral osteotomy in adults include the following: Nonunion of a femoral neck fracture Nonunion or malunion of an deformity

2014 eMedicine Surgery

151. In vivo microdamage is an indicator of susceptibility to initiation and propagation of microdamage in human femoral trabecular bone. Full Text available with Trip Pro

In vivo microdamage is an indicator of susceptibility to initiation and propagation of microdamage in human femoral trabecular bone. Microdamage has been cited as an important element of trabecular bone quality and fracture risk, as materials with flaws have lower modulus and strength than equivalent undamaged materials. However, the magnitude of the effect of damage on failure properties depends on its tendency to propagate. Human femoral trabecular bone from the neck and greater trochanter (...) reflect stress redistribution away from damaged trabeculae, resulting in new damage sites. However, the accumulation of new damage was positively correlated with quantity of pre-existing damage in all loading modes, indicating that damaged bone is inherently more prone to further damage formation. Moreover, about 50% of in vivo microcracks propagated under each type of loading. Finally, damage formation was positively correlated to decreased compressive stiffness following both axial and shear loading

2013 Bone

152. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report Full Text available with Trip Pro

A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed (...) on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad.

2010 Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology: SMARTT

153. Fracture-Dislocation of the Midfoot (Lisfranc Injury)

TOPICS IN THIS CHAPTER Test your knowledge Overview of Heat Illness Withdrawal from which of the following substances is most likely to increase a patient’s heat input? Alcohol Cannabis Cocaine Phencyclidine NEWS & VIDEOS Some Lose Independence After Surgical Tx of Femoral Neck Fx WEDNESDAY, March 6, 2019 (HealthDay News) -- A considerable proportion of older patients with femoral neck fracture are institutionalized or require walking aids 12 months after surgical treatment... 3D Model (...) Fracture-Dislocation of the Midfoot (Lisfranc Injury) Fracture-Dislocation of the Midfoot (Lisfranc Injury) - Injuries; Poisoning - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER

2013 Merck Manual (19th Edition)

154. Hip Fractures

from which of the following substances is most likely to increase a patient’s heat input? Alcohol Cannabis Cocaine Phencyclidine NEWS & VIDEOS Some Lose Independence After Surgical Tx of Femoral Neck Fx WEDNESDAY, March 6, 2019 (HealthDay News) -- A considerable proportion of older patients with femoral neck fracture are institutionalized or require walking aids 12 months after surgical treatment... 3D Model Musculoskeletal Connective Tissues Video Prone Quadriceps Stretch 1. Lie on stomach. 2 (...) , particularly those with osteoporosis, and usually result from ground level falls. Diagnosis is by x-rays or, if needed, MRI. Treatment is usually with open reduction with internal fixation or sometimes hemiarthroplasty or total hip arthroplasty. Most hip fractures result from falls, but in the elderly, seemingly minimal force (eg, rolling over in bed, getting up from a chair, walking) can result in fracture, usually because has weakened the bone. Fracture locations include Femoral head Femoral neck

2013 Merck Manual (19th Edition)

155. Overview of Fractures, Dislocations, and Sprains

of the vascular supply, and patient factors that impair healing (eg, use of corticosteroids or thyroid hormone). Malunion: Malunion is healing with residual deformity. It is more likely if a fracture is not adequately reduced and stabilized. Osteonecrosis: Part of a fracture fragment can become necrotic, primarily when the vascular supply is damaged. Closed fractures prone to osteonecrosis include scaphoid fractures, displaced femoral neck fractures, and displaced talar neck fractures. Osteoarthritis (...) projections are negative. They are routine for certain joints (eg, a mortise view for evaluating an ankle, an oblique view for evaluating a foot). Certain abnormalities are suspected. For lateral views of digits, the digit of interest should be separated from the others. MRI or CT can be used if A fracture is not visible on plain x-rays but is strongly suspected clinically (common with scaphoid fractures and impacted femoral neck [subcapital] hip fractures). More detail is needed to guide treatment (eg

2013 Merck Manual (19th Edition)

156. Akt phosphorylation in human chondrocytes is regulated by p53R2 in response to mechanical stress. Full Text available with Trip Pro

investigated the function of p53R2 in relation to mechanotransduction.Osteoarthritis (OA) cartilage obtained from total knee replacements and normal cartilage obtained from femoral neck fractures was used to measure p53R2 expression by using immunohistochemistry, western blotting, and real-time polymerase chain reaction (PCR). The OA chondrocytes were subjected to a high magnitude of cyclical tensile strain by using an FX-2000 Flexercell system. Next, sulfated glycosaminoglycan (sGAG) production (...) Akt phosphorylation in human chondrocytes is regulated by p53R2 in response to mechanical stress. The p53 tumor-suppressor protein p53R2 is activated in response to various stressors that act on cell signaling. When DNA is damaged, phosphorylation of p53 at its Ser 15 residue induces p53R2 production. The role of p53R2 in chondrocytes remains poorly understood. In this study, we evaluated in chondrocytes, p53R2 expression and its regulation in response to mechanical stress. Furthermore, we

2012 Osteoarthritis and Cartilage

157. Hip fracture

of the trochanter or femoral neck will typically cause external rotation and shortening of the leg when the patient is laying supine. Imaging [ ] Typically, radiographs are taken of the hip from the front (AP view), and side (lateral view). Frog leg views are to be avoided, as they may cause severe pain and further displace the fracture. In situations where a hip fracture is suspected but not obvious on x-ray, an MRI is the next test of choice. If an MRI is not available or the patient can not be placed (...) without having to wait for healing. In elderly patients who are medically well and still active, a may be indicated. Traction is contraindicated in femoral neck fractures due to it affecting blood flow to the head of the femur. Trochanteric fracture [ ] Fracture supported by A trochanteric fracture, below the neck of the femur, has a good chance of healing. may not be satisfactory and then becomes necessary. The use of open reduction has been reported as 8-13% among pertrochanteric fractures, and 52

2012 Wikipedia

158. Higher Incidence of Bone Stress Injuries With Increasing Female Athlete Triad-Related Risk Factors: A Prospective Multisite Study of Exercising Girls and Women. Full Text available with Trip Pro

Higher Incidence of Bone Stress Injuries With Increasing Female Athlete Triad-Related Risk Factors: A Prospective Multisite Study of Exercising Girls and Women. Identifying the risk factors associated with a bone stress injury (BSI), including stress reactions and stress fractures, may aid in targeting those at increased risk and in formulating prevention guidelines for exercising girls and women.To evaluate the effect of single or combined risk factors as defined by the female athlete triad (...) assessed. Dual-energy x-ray absorptiometry (DXA) measured the bone mass of the whole body, total hip, femoral neck, lumbar spine, and body composition. Participants were followed prospectively for the occurrence of injuries; those injuries confirmed by a physician were recorded.Twenty-eight participants (10.8%) incurred a BSI. Forty-six percent of those who had ≥12 h/wk of purposeful exercise, a bone mineral density (BMD) Z score <-1.0, and who exhibited 3 to 4 of the following: BMI <21.0 kg/m2, oligo

2014 American Journal of Sports Medicine

159. Clinical care of severe acute respiratory infections – Tool kit

systolic blood pressure (not reliable in children and the elderly): Carotid (neck) pulse ? SBP = 60 mmHg Femoral (groin) pulse ? SBP = 70 mmHg Radial (wrist) pulse ? SBP =80 mmHg SAMPLE History Signs & Symptoms Allergies Medications PMH Last oral intake Events APPROACH TO THE PATIENT WITH TRAUMA Key fi ndings from the Trauma Primary Survey [see also ABCDE card] ASSESSMENT FINDINGS IMMEDIATE MANAGEMENT Airway A Not speaking, with limited or no air movement Use jaw thrust with c-spine protection. Suction (...) external bleeding Apply pressure, deep wound packing or tourniquet as indicated. Signs of tamponade (poor perfusion, distended neck veins, mu ed heart sounds) Give IV uids, oxygen. Disability D Signs of brain injury (AMS with wound, deformity or bruising of head/face) Immobilize cervical spine, check glucose, give nothing by mouth. ? Will need neurosurgical care Signs of open skull fracture (as above, with blood or uid from the ears/nose) As above, and give IV antibiotics per local protocol. REMEMBER

2020 WHO Coronavirus disease (COVID-19) Pandemic

160. Osseointegrated Prosthetic Implants for People With Lower-Limb Amputation

infection, occurring in about half of patients in some studies. Deep or bone infection was a serious adverse event, with variable rates among the studies depending on the length of follow-up. The treatment of deep or bone infection required long- term antibiotic use, surgical debridement, revision surgery, and implant extraction in some cases. Other adverse events included femoral bone fracture, implant breakage, issues with extramedullary parts that required replacement, and implant removal. Our (...) . It also looked at the budget impact of publicly funding them and at the experiences, preferences, and values of people with a lower-limb amputation. What Did This Health Technology Assessment Find? Osseointegrated prosthetic implants improve people’s ability to walk and function in daily life, but their use can lead to serious adverse events such as bone infection or fractures, which may require additional surgeries. Compared with conventional socket prostheses for people with chronic socket-related

2019 Health Quality Ontario

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