Abstract:
INTRODUCTION:Internal fixation is the preferred treatment of Garden I femoral neck fractures in the elderly. High re-operation rates have however been reported, and the results of arthroplasty performed following internal fixation failure are not as good as those of primary arthroplasty. This is why we are advocating functional treatment. Our hypothesis is that this treatment leads to fewer decubitus complications than strict orthopaedic treatment and no more mechanical complications than internal fixation in a selected population sample. Therefore, the objective of our prospective work was: (1) to assess the results of functional treatment of Garden I femoral neck fractures in elderly subjects, and (2) to investigate predictive factors of secondary displacement. PATIENTS AND METHODS:All patients over age 65 years, admitted for a Garden I femoral neck fracture between January 2006 and May 2008, were included in this prospective study representing 56 cases (57 fractures) with an average age of 82 years. Functional treatment was performed, including early weight-bearing mobilisation, followed by radiographic evaluation at days 2, 7, 21 and 45, then at 3, 6 and 12 months. In the absence of displacement, discharge was planned at day 5 (Non-Displaced [ND] group). Otherwise, arthroplasty was performed (Displaced [D] group). Parker score and Harris Hip Score (HHS) were used for functional evaluation. RESULTS:The observed displacement rate was 33.3% (19 patients) within an average period of 10 days. In the ND group, one case of osteonecrosis was observed and treated by arthroplasty. The average Parker score was 6.9 and the HHS 82 in the ND group, and 7 and 85, respectively, in the D group. None of the factors studied (age, gender, side, fracture type, inclination angle, degree of outward displacement, sagittal displacement, general status) was statistically predictive of final displacement. DISCUSSION:The medical complication rate was only 7% in our series, which seems to be lower than that resulting from orthopaedic treatment. The observed secondary displacement rate seemed to be higher than the rate found in the literature on surgical treatment (5.4 to 20%), but the osteonecrosis rate appeared to be lower (11 to 25%). In addition, surgical treatment was the purveyor of specific complications in over 10% of cases. CONCLUSIONS:The present prospective study with minimum 1-year follow-up shows that functional treatment results in fewer decubitus complications than orthopaedic treatment and a rate of revision surgery comparable to internal fixation since 70% of included patients could have been successfully treated without surgical intervention. However, the investigation of a larger cohort would be necessary to identify predictive factors for the treatment's failure. LEVEL OF EVIDENCE:Level III prospective non-comparative cohort study.
journal_name
Orthop Traumatol Surg Resjournal_title
Orthopaedics & traumatology, surgery & research : OTSRauthors
Buord JM,Flecher X,Parratte S,Boyer L,Aubaniac JM,Argenson JNdoi
10.1016/j.otsr.2009.11.012subject
Has Abstractpub_date
2010-05-01 00:00:00pages
228-34issue
3issn
1877-0568pii
S1877-0568(10)00026-5journal_volume
96pub_type
杂志文章abstract:INTRODUCTION:A number of techniques have been described in the management of thoracolumbar spinal fractures, testimony to the absence of consensus on their treatment. For the past few years, minimally invasive techniques have been developed to limit surgery-related iatrogenic injury. The objective of this study was to ...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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abstract:INTRODUCTION:Management of septic non-union of the tibia requires debridement and excision of all infected bone and soft tissues. Various surgical techniques have been described to fill the bone defect. The "Induced Membrane" technique, described by A. C. Masquelet in 1986, is a two-step procedure using a PMMA cement s...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 临床试验,杂志文章
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abstract:INTRODUCTION:Elastic stable intramedullary nailing (ESIN) has transformed children's femoral shaft fracture treatment, but this technique requires an image intensifier. Without it, open reduction is used to check fracture reduction and pin passage. The aim of this study was to describe our techniques and to evaluate ou...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,评审
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2020.05.014
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abstract::Surgical site infection (SSI) is the third most frequent healthcare-associated infection in France. SSI rates in total hip or knee replacement are around 2%. The main bacteria implicated in SSI in clean surgery are those of the skin flora, whence the importance of skin preparation to eliminate transient flora and redu...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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abstract:INTRODUCTION:Adipose tissue represents an abundant and accessible source of adult stem cells that can differentiate into cells and tissues of mesodermal origin, including osteogenic cells. METHODS:This paper describes the procedure to obtain a 5-cm3 saline sample, containing the adipose-derived stem cells (ASCs) pelle...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,评审
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2018.01.015
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2017.07.007
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2012.02.004
更新日期:2012-06-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,评审
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2011.01.015
更新日期:2011-06-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2009.05.007
更新日期:2009-11-01 00:00:00
abstract:INTRODUCTION:Prevention of venous thromboembolism (VTE) generally consists of low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Enhanced recovery after surgery (ERAS) protocols may reduce the VTE risk after these procedures. Th...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2020.02.026
更新日期:2020-12-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,评审
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更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:The risk of damage to cutaneous sensory nerves located near portals has been evaluated for both conventional arthroscopy and extra-articular posterior ankle endoscopy. The objective of the anatomic study reported here was to assess the risk of injury to the sural nerve or lateral calcaneal nerve while using ...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2014.10.019
更新日期:2015-02-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2013.03.005
更新日期:2013-06-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2014.07.020
更新日期:2014-12-01 00:00:00
abstract::Alternatives to internal fixation of long-bone fracture comprise, depending on location, external fixation or joint replacement. Limitations comprise risk of infection and functional outcome quality, which vary according to technique. The present study examines these limitations, based on comparative or large-scale st...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,评审
doi:10.1016/j.otsr.2016.11.006
更新日期:2017-02-01 00:00:00
abstract:INTRODUCTION:Infection is a serious complication of total hip arthroplasty (THA) and is one of the most frequent causes of failure. The goal of this study was to evaluate the importance of infection among the different causes of revision THA and identify any risk factors specifically associated with this cause of revis...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,多中心研究
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更新日期:2013-09-01 00:00:00