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Femoral Neck Stress Fracture

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141. Subtrochanteric Hip Fractures (Treatment)

evolve and improve, applications in high-energy proximal femoral fractures may become feasible and allow for a more biologically favorable approach with less soft-tissue dissection and disruption of native blood supply. There is no literature regarding total hip arthroplasty (THA) for subtrochanteric fractures in patients, and any conclusions must be extrapolated from data regarding THA for femoral neck fractures or intertrochanteric fractures. This body of literature suggests possible functional (...) are probably similar to those with angled blade plates and are reliant on biologically favorable, indirect reduction techniques. Intramedullary nails are emerging as the treatment of choice for subtrochanteric femur fractures. [ , , ] The most widely used nails are either centromedullary (contained within the medullary canal) or cephalomedullary (including those that affix to the femoral neck and head; see the image below). Subtrochanteric femur fracture repaired with cephalomedullary device Essentially

2014 eMedicine Surgery

142. Intertrochanteric Hip Fractures (Treatment)

trochanter, with a compression hip screw inserted through the proximal portion of the nail into the femoral head, is now being used, especially for unstable fracture patterns. [ , ] (See the image below.) Femur with intramedullary rod and screw. Cephalomedullary fixation may help with reduction of unstable fractures and prevent excessive shortening from collapse, in that the nail acts as a calcar rand lateral wall replacement to support the femoral neck. This percutaneous technique has the potential (...) fracture before fixation [ ] but generally is not indicated in current practice. Arthroplasty Replacement of the hip may be perfomed either by replacing only the femoral side (hemiarthroplasty) or by replacing both the acetabulum and the femoral side (total hip arthroplasty). These two surgical treatment options, though common for displaced femoral neck fractures in the elderly, have not been a popular form of therapy for intertrochanteric fractures. The reluctance to employ these options is due

2014 eMedicine Surgery

143. Lumbar Spine Fractures and Dislocations (Treatment)

, Hurlbert RJ, Anderson P, Fehlings M, Rampersaud R, Massicotte EM, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study. Spine (Phila Pa 1976) . 2006 Feb 15. 31 (4):451-8. . Kinoshita T, Ebara S, Kamimura M, Tateiwa Y, Itoh H, Yuzawa Y, et al. Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients. J Bone Miner Metab . 1999. 17 (3):201-5. . Castaño-Betancourt MC (...) Lumbar Spine Fractures and Dislocations (Treatment) Lumbar Spine Fractures and Dislocations Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache

2014 eMedicine Surgery

144. Diaphyseal Femur Fractures (Treatment)

, and higher rate of complications tend to favor other methods of treatment. Healing occurs without callus formation, and the bone is slower to regain strength. Bone under the plate is also prone to stress shielding and may become osteopenic. Compression plating may be used in distal metaphyseal-diaphyseal junction fractures and in certain situations with ipsilateral femoral-neck fractures. Plating is done via a lateral approach in the skin and spitting the vastus lateralis. One should be careful to avoid (...) . Its use has been studied extensively, and it has proved effective in the short and long terms. An unscrubbed assistant surgeon must assist by first examining the radiographs and determining the appropriate direction of force needed to reduce the fracture. After reduction, anteroposterior (AP) and lateral imaging with fluoroscopy should be performed to confirm the reduction. At this time, the femoral neck also can be critically examined with fluoroscopy. The patient is positioned on the fracture

2014 eMedicine Surgery

145. General Principles of Fracture Care (Treatment)

. Stuttgart: Verlag von Ferdinand Enke; 1872. Vol 2: 234-920. Bryant LR, Song WS, Banks KP, Bui-Mansfield LT, Bradley YC. Comparison of planar scintigraphy alone and with SPECT for the initial evaluation of femoral neck stress fracture. AJR Am J Roentgenol . 2008 Oct. 191(4):1010-5. . Yang HL, Wang GL, Niu GQ, Liu JY, Hiltner E, Meng B, et al. Using MRI to determine painful vertebrae to be treated by kyphoplasty in multiple-level vertebral compression fractures: a prospective study. J Int Med Res . 2008 (...) Sep-Oct. 36(5):1056-63. . McManus JG, Morton MJ, Crystal CS, McArthur TJ, Helphenstine JS, Masneri DA, et al. Use of ultrasound to assess acute fracture reduction in emergency care settings. Am J Disaster Med . 2008 Jul-Aug. 3(4):241-7. . Rang M. Children’s Fractures . 2nd ed. Philadelphia: JB Lippincott; 1983. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am . 2008 Oct. 90(10):2254-66. . [Guideline] Brox WT, Roberts KC, Taksali S, et al

2014 eMedicine Surgery

146. Diaphyseal Femur Fractures (Overview)

. Rockwood and Green's Fractures in Adults . 8th ed. Philadelphia: Wolters Kluwer; 2015. Vol 2: 2149-228. Kanlic E, Cruz M. Current concepts in pediatric femur fracture treatment. Orthopedics . 2007 Dec. 30(12):1015-9. . Poolman RW, Kocher MS, Bhandari M. Pediatric femoral fractures: a systematic review of 2422 cases. J Orthop Trauma . 2006 Oct. 20(9):648-54. . Lee SH, Baek JR, Han SB, Park SW. Stress fractures of the femoral diaphysis in children: a report of 5 cases and review of literature. J Pediatr (...) fractures. J Pediatr Orthop . 2000 May-Jun. 20(3):405-10. . Baumgaertner, M, Tornetta III, P. Orthopaedic Knowlodge Update, Trauma 3. Book . 2005. 93-106, 387-395. O'toole RV, Dancy L, Dietz AR, Pollak AN, Johnson AJ, Osgood G. Diagnosis of femoral neck fracture associated with femoral shaft fracture: blinded comparison of computed tomography and plain radiography. J Orthop Trauma . 2013 Jun. 27(6):325-30. . Hwang JS, Gibson PD, Koury KL, Stekas N, Sirkin MS, Reilly MC, et al. The role of computed

2014 eMedicine Surgery

147. General Principles of Fracture Care (Overview)

for the initial evaluation of femoral neck stress fracture. AJR Am J Roentgenol . 2008 Oct. 191(4):1010-5. . Yang HL, Wang GL, Niu GQ, Liu JY, Hiltner E, Meng B, et al. Using MRI to determine painful vertebrae to be treated by kyphoplasty in multiple-level vertebral compression fractures: a prospective study. J Int Med Res . 2008 Sep-Oct. 36(5):1056-63. . McManus JG, Morton MJ, Crystal CS, McArthur TJ, Helphenstine JS, Masneri DA, et al. Use of ultrasound to assess acute fracture reduction in emergency care (...) settings. Am J Disaster Med . 2008 Jul-Aug. 3(4):241-7. . Rang M. Children’s Fractures . 2nd ed. Philadelphia: JB Lippincott; 1983. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am . 2008 Oct. 90(10):2254-66. . [Guideline] Brox WT, Roberts KC, Taksali S, et al. The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Hip Fractures in the Elderly. J Bone Joint Surg Am . 2015 Jul 15. 97 (14):1196-9. . Bhandari M. Evidence

2014 eMedicine Surgery

148. Periprosthetic Fractures (Overview)

original strength. Some 90% of fractures around fracture fixation implants occur through a drill hole (see the image below). [ ] Failed fixation caused by fracture through screw holes. Displacement of unrecognized femoral neck fracture or new fracture occurs in 3% of intramedullary nailings of femoral shaft fractures. [ , ] With any implant, the end of the device becomes a stress riser in which the weaker osteoporotic bone tends to fracture first when excessive load is applied. [ ] Removal of devices (...) , ed. Complications in Orthopaedic Surgery . 3rd ed. Philadelphia: JB Lippincott; 1994. 131-54. Wu CC, Shih CH. Ipsilateral femoral neck and shaft fractures. Retrospective study of 33 cases. Acta Orthop Scand . 1991 Aug. 62(4):346-51. . Azer SN, Rankin EA. Complications of treatment of femoral shaft fractures. Epps CH, ed. Complications in Orthopaedic Surgery . 3rd ed. Philadelphia: JB Lippincott; 1994. 487-524. Chmell MJ, Moran MC, Scott RD. Periarticular Fractures After Total Knee Arthroplasty

2014 eMedicine Surgery

149. Periprosthetic Fractures (Treatment)

hip arthroplasties: a 40-year experience. Bone Joint J . 2016 Apr. 98-B (4):468-74. . Koval KJ, Frankel VH, Kummer F, Green S. Complications of fracture fixation devices. Epps CH, ed. Complications in Orthopaedic Surgery . 3rd ed. Philadelphia: JB Lippincott; 1994. 131-54. Wu CC, Shih CH. Ipsilateral femoral neck and shaft fractures. Retrospective study of 33 cases. Acta Orthop Scand . 1991 Aug. 62(4):346-51. . Azer SN, Rankin EA. Complications of treatment of femoral shaft fractures. Epps CH, ed (...) arthroplasty. J Trauma . 2010 Jun. 68(6):1464-70. . Ozdemir G, Azboy I, Yilmaz B. Bilateral periprosthetic tibial stress fracture after total knee arthroplasty: A case report. Int J Surg Case Rep . 2016. 24:175-8. . Fonseca F, Rebelo E, Completo A. TIBIAL PERIPROSTHETIC FRACTURE COMBINED WITH TIBIAL STEM STRESS FRACTURE FROM TOTAL KNEE ARTHROPLASTY. Rev Bras Ortop . 2011 Nov-Dec. 46 (6):745-50. . Wada M, Imura S, Bo A, Baba H, Miyazaki T. Stress fracture of the femoral component in total knee replacement

2014 eMedicine Surgery

150. Subtrochanteric Hip Fractures (Follow-up)

evolve and improve, applications in high-energy proximal femoral fractures may become feasible and allow for a more biologically favorable approach with less soft-tissue dissection and disruption of native blood supply. There is no literature regarding total hip arthroplasty (THA) for subtrochanteric fractures in patients, and any conclusions must be extrapolated from data regarding THA for femoral neck fractures or intertrochanteric fractures. This body of literature suggests possible functional (...) are probably similar to those with angled blade plates and are reliant on biologically favorable, indirect reduction techniques. Intramedullary nails are emerging as the treatment of choice for subtrochanteric femur fractures. [ , , ] The most widely used nails are either centromedullary (contained within the medullary canal) or cephalomedullary (including those that affix to the femoral neck and head; see the image below). Subtrochanteric femur fracture repaired with cephalomedullary device Essentially

2014 eMedicine Surgery

151. Periprosthetic Fractures (Follow-up)

hip arthroplasties: a 40-year experience. Bone Joint J . 2016 Apr. 98-B (4):468-74. . Koval KJ, Frankel VH, Kummer F, Green S. Complications of fracture fixation devices. Epps CH, ed. Complications in Orthopaedic Surgery . 3rd ed. Philadelphia: JB Lippincott; 1994. 131-54. Wu CC, Shih CH. Ipsilateral femoral neck and shaft fractures. Retrospective study of 33 cases. Acta Orthop Scand . 1991 Aug. 62(4):346-51. . Azer SN, Rankin EA. Complications of treatment of femoral shaft fractures. Epps CH, ed (...) arthroplasty. J Trauma . 2010 Jun. 68(6):1464-70. . Ozdemir G, Azboy I, Yilmaz B. Bilateral periprosthetic tibial stress fracture after total knee arthroplasty: A case report. Int J Surg Case Rep . 2016. 24:175-8. . Fonseca F, Rebelo E, Completo A. TIBIAL PERIPROSTHETIC FRACTURE COMBINED WITH TIBIAL STEM STRESS FRACTURE FROM TOTAL KNEE ARTHROPLASTY. Rev Bras Ortop . 2011 Nov-Dec. 46 (6):745-50. . Wada M, Imura S, Bo A, Baba H, Miyazaki T. Stress fracture of the femoral component in total knee replacement

2014 eMedicine Surgery

152. Fracture, Hip (Diagnosis)

- Stress fractures or incomplete fractures (see image below) Type 2 - Impacted fractures (see image below) Femoral neck fractures. Top diagram is a nondisplaced, or incomplete, femoral neck fracture. Bottom diagram is an impacted femoral neck fracture. Type 3 - Partially displaced fractures (see image below) Partially displaced femoral neck fracture. Type 4 - Completely displaced or comminuted fractures (see image below) Completely displaced femoral neck fracture. Trochanteric fractures Greater (...) in Emergency Medicine Updated: Feb 28, 2016 Author: Moira Davenport, MD; Chief Editor: Trevor John Mills, MD, MPH Share Email Print Feedback Close Sections Sections Hip Fracture in Emergency Medicine Overview Practice Essentials Hip fracture occurs in approximately 341,000 persons in the United States each year. [ ] The rate of hip fracture increases with age, doubling every 5-6 years after age 60 years. [ ] See the image below. Femoral neck fractures. Top diagram is a nondisplaced, or incomplete, femoral

2014 eMedicine Emergency Medicine

153. Fracture, Hip (Overview)

- Stress fractures or incomplete fractures (see image below) Type 2 - Impacted fractures (see image below) Femoral neck fractures. Top diagram is a nondisplaced, or incomplete, femoral neck fracture. Bottom diagram is an impacted femoral neck fracture. Type 3 - Partially displaced fractures (see image below) Partially displaced femoral neck fracture. Type 4 - Completely displaced or comminuted fractures (see image below) Completely displaced femoral neck fracture. Trochanteric fractures Greater (...) in Emergency Medicine Updated: Feb 28, 2016 Author: Moira Davenport, MD; Chief Editor: Trevor John Mills, MD, MPH Share Email Print Feedback Close Sections Sections Hip Fracture in Emergency Medicine Overview Practice Essentials Hip fracture occurs in approximately 341,000 persons in the United States each year. [ ] The rate of hip fracture increases with age, doubling every 5-6 years after age 60 years. [ ] See the image below. Femoral neck fractures. Top diagram is a nondisplaced, or incomplete, femoral

2014 eMedicine Emergency Medicine

154. Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2)

(i.e. soft tissue or bone). Stress fracture of the femoral neck. Pathologic fractures secondary to neoplasm or other bone lesion. Patients with known or likely undiagnosed disorders of bone metabolism such as Paget's disease, osteomalacia, osteopetrosis, osteogenesis imperfect, etc. Patients with hyperhomocysteinemia. Patient has an allergy to vitamin D or another contraindication to being prescribed vitamin D. Patient is currently taking an over counter drug and/or food supplement that contains (...) Phase Femoral Neck Fractures Procedure: Sliding Hip Screw Procedure: Cancellous Screws Drug: Vitamin D Drug: Vitamin D Placebo Phase 3 Detailed Description: Femoral neck fractures are a type of hip fracture associated with high complication rates and poor functional outcomes. It is estimated that over 300,000 hip fractures occur in patients under age 50 annually. Hip fractures in younger aged patients are particularly devastating with profound impairments of quality of life and function. Virtually

2013 Clinical Trials

155. The science of pinning the neck of the femur. (PubMed)

The science of pinning the neck of the femur. Experiments show that the cancellum of some femoral heads and of the trochanteric region is too weak to support a nail. A simple classification of traumatic femoral neck fractures is presented. These are either vertical or, less commonly, transversely disposed. Either type may be undisplaced, impacted, or displaced. For adequate fixation of undisplaced vertical and all displaced fractures a nail plate is essential. For undisplaced transverse (...) fractures and impacted vertical fractures two screws usually suffice. Impacted transverse fractures require no active treatment. Hammering nails into the femoral head can cause fractures of the articular cartilage, split the femoral head in two, lead to avulsion of articular cartilage under the weight-bearing area, and osteoarthrosis. Early weight-bearing on weak implants can be disastrous. For the unsolved fracture a sliding pin compressing the fragments should be used. In a series of 54 displaced

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1977 Annals of the Royal College of Surgeons of England

156. Akt phosphorylation in human chondrocytes is regulated by p53R2 in response to mechanical stress. (PubMed)

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

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2012 Osteoarthritis and Cartilage

157. Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures. (PubMed)

Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures. Acetabular retroversion (AR) alters load distribution across the hip and is more prevalent in pathologic conditions involving the hip. We hypothesized the abnormal orientation and mechanical changes may predispose certain individuals to stress injuries of the femoral neck. We retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 54 patients (108 hips) treated for a femoral neck stress fracture (...) (FNSF) and compared these radiographs with those for a control group of patients with normal pelvic radiographs. We determined presence of a crossover sign (COS), femoral neck abnormalities, and neck shaft angle. The prevalence of a positive COS was greater in patients with stress fractures than in the control subjects (31 of 54 [57%] versus 17 of 54 [31%], respectively) and higher than for control subjects reported in the literature. Thirteen patients had radiographic changes of the femoral neck

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2009 Clinical Orthopaedics and Related Research

158. Higher Incidence of Bone Stress Injuries With Increasing Female Athlete Triad-Related Risk Factors: A Prospective Multisite Study of Exercising Girls and Women. (PubMed)

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. 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)

160. 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)

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