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首页> 外文期刊>Injury >Femoral neck fractures after removal of hardware in healed trochanteric fractures
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Femoral neck fractures after removal of hardware in healed trochanteric fractures

机译：在愈合的Trochanteric骨折中除去硬件后股骨颈骨折

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Abstract Introduction Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention. Materials and methods A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of FNFARIHTF and series of TF with cases of FNFARIHTF due to pain or discomfort published between inception of journals to December 2016 were eligible for inclusion. Relevant information was divided in two parts. Part I included the analysis of cases of FNFARIHTF, with the objective of establishing the eventual risk factors, mechanisms and pathoanatomy, clinical presentation and diagnosis, treatment and prevention. Part II analyzed series of TF which included cases of FNFARIHTF for assessing the incidence of femoral neck fractures in this condition. Results Overall 24 publications with 45 cases of FNFARIHTF met the inclusion criteria. We found that the only prevalent factors for FNFARIHTF were: 1) preexisisting systemic osteoporosis, as most patients were older and elder females, with lower bone mineral density and bone mass; 2) local osteoporosis as a result of preloading by the fixation device in the femoral neck, leading to stress protection, reducing the strain at the neck, and increasing bone loss and weakness; and 3) the removal of hardware from the femoral neck, with reduction of the failure strength of the neck. The femoral neck fractures were spontaneous, i.e. not related to trauma or fall, in 87.5% of the cases, mostly subcapital, and with no prevalence between displaced and undisplaced fractures. The clinical presentation was that of a spontaneous fracture, and most of the patients consulted because of hip pain and presented in the emergency room walking by themselves which led to delayed diagnosis in several instances. Radiological diagnosis was mostly with radiographs, though in some cases CT scans or MRI were necessary. The overall median incidence of this complication was 14.5% after hardware removal because of pain or discomfort in healed trochanteric fractures. Conclusion The risk factors for FNFARIHTF seem to be preexisisting systemic osteoporosis, local osteoporosis as a result of preloading by the fixation device in the femoral neck, and the removal of hardware from the femoral neck, with reduction of the strength of the neck. The clinical presentation may be obscure as most of the patients complain of hip pain of some days or weeks, and arrive in the hospital walking. Therefore, the attending physician should be alert in order to request the appropriate radiological investigation and if this is not clear CT scan or MRI should be done in order to diagnose promptly these “spontaneous” fractures. Treatment should be replacement surgery in most cases; however, there is some place for internal fixation especially in undisplaced fractures or younger patients. The occurrence of the femoral neck fracture after hardware removal may be prevented with re-osteosynthesis and the use of bone chips or bone substitutes. Finally, the relatively high incidence of this complication should alert orthopaedic surgeons to reduce the removal of hardware in healed trochanteric fractures to very selected cases.
机译：摘要在没有感染或显着的机械并发症的情况下，在没有感染或显着的机械并发症中，愈合的Trochanteric骨折（TF）中的硬件去除率很少。然而，在日常生活活动中持续疼痛，突出材料和不适的患者中，最终将植入物去除。从愈合的Trochanteric骨折（FNFarihtf）中除去植入物后，Ipsilidal股骨颈骨折的出版物只是因为疼痛或不适是罕见的。对文献的这种系统审查的目的是报告最终的风险因素，机制，临床介绍和频率，并特别强调预防。材料和方法对文献进行了全面的审查，采用了不含语言限制的PRISMA指南进行了综合。 FNFarihtf和TF系列与FNFarihtf案例的病例报告，由于期刊在2016年12月开始期刊上发表的疼痛或不适，有资格包容。相关信息分为两部分。第一部分包括对FNFarihtf病例的分析，目的是建立最终风险因素，机制和病理疾病，临床介绍和诊断，治疗和预防。第二部分分析了TF系列，包括用于评估这种条件下股骨颈骨折发病率的FNFariHTF病例。结果总体上24例出版物45例FNFariHTF符合纳入标准。我们发现，FNFarihtf的唯一普遍因素是：1）预先表达全身性骨质疏松症，大多数患者年龄较大的女性，骨密度和骨质较低; 2）局部骨质疏松因子由股骨颈中的固定装置预加载，导致应力保护，减少颈部的应变，增加骨质损失和弱点; 3）从股骨颈中移除硬件，减少颈部的故障强度。股骨颈骨折是自发的，即与创伤或秋季无关，在87.5％的病例中，大多数是亚这些骨折，并且在流离失所和未偏向的骨折之间没有普遍存在。临床介绍是自发性骨折，大多数患者因髋关节疼痛而咨询，并在急诊室展示自己的急诊室，这导致了几种情况下延迟诊断。放射学诊断主要是用射线照相，但在某些情况下，CT扫描或MRI是必要的。由于愈合的Trochanteric骨折中的疼痛或不适，但在硬件去除后，这种并发症的整体中位发病率为14.5％。结论FNFariHTF的危险因素似乎是预先表达的全身性骨质疏松症，由于股骨颈中的固定装置预先加载，局部骨质疏松症，以及从股骨颈中取出硬件，减少了颈部的强度。临床介绍可能是模糊的，因为大多数患者抱怨髋关节或几周的髋关节疼痛，并抵达医院行走。因此，主治医师应该是警报才能要求采取适当的放​​射学调查，如果这不清楚，应扫描或MRI应迅速诊断这些“自发性”骨折。在大多数情况下，治疗应该是替代手术;然而，有一些内部固定的地方，特别是在未偏向的骨折或较年轻的患者中。可以防止硬骨混合和骨碎片或骨代替氏素后防止硬件去除后的股骨颈骨折发生。最后，这种并发症的相对较高的发生率应该提醒整形外科医生以减少治愈的Troochanteric骨折中的硬件去除以非常选择的情况。

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