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While arthroplasty is the preferred treatment for most elderly patients with displaced femoral neck fractures, internal fixation is the treatment of choice in the majority of patients below the age of 65 as a joint-preserving procedure. The osteosynthesis of fractures of the femoral neck in the elderly has been partly abandoned during the last years due to the poor clinical outcomes following the conventional fixation with parallel screws or DHS. Based on clinical evidence and laboratory testing, the novel method of biplane double-supported screw fixation (BDSF) offers much better fixation stability, reflecting in excellent clinical outcomes. With its innovative biomechanic principle, the BDSF method provides supreme stability for cannulated screw fixation, achieving up to 44% higher axial fixation strength in vitro, and a rate of bone union reaching up to 96.6% in clinical practice, which is much higher than the conventional parallel screw fixation data.The method of BDSF provides supreme stability by buttressing two out of three medially diverging cannulated screws on the inferior femoral neck cortex and supporting the steeper inferior screw on the posterior femoral neck cortex. The two calcar screws are oriented in different coronal inclinations intended to provide constant fixation strength during different patient activities and load directions. Biomechanically, the most effective component is the inferior screw placed at an obtuse angle and supported on a large area along the inferior and posterior cortex of the femoral neck following its spiral anterior curve.Given the clinical outcomes, BDSF is the perfect technique for femoral neck fracture fixation, as the fracture healing rate is high at 96% with this approach. Therefore, BDSF is not only a treatment alternative to conventional fixation, but also a much better procedure. Thus, BDSF should be routinely applied, and conventional fixation gradually abandoned in clinical practice (this has been the approach in our institution over the last ten years).This book describes the full surgical technique of the method of BDSF for femoral neck fracture osteosynthesis; quality criteria and surgical recommendations for successful BDSF implementation, according to the vast clinical experience of ten years with this highly effective method.A novel surgical approach for hip arthroplasty is described in this book. The current trends aimed at decreasing operative trauma and blood loss have been not entirely satisfied with respect to most of the standard approaches for hip arthroplasty. These surgeries are often associated with considerable blood loss and the necessity for restricting patients activities in the postoperative period due to impaired joint stability and risk of dislocations.This book describes the full surgical technique of the novel anatomical direct lateral approach for hip arthroplasty, aimed at decreasing blood loss, minimizing operative trauma, and optimizing joint stability. This technique is associated with minimal blood loss and high joint stability. Patients are allowed to perform activities within the normal range of motion and without any special restrictions in the early postoperative period.This book describes also the history of internal fixation in femoral neck fractures, as well as the biomechanics of femoral neck fracture osteosynthesis and the role of the implants.
The global burden of geriatric hip fractures is enormous. From both the patient's and physician’s perspective, the injury is complex. A hip fracture often changes a patient’s life and/or the life of the patient’s family permanently. From the physician’s perspective, care of geriatric hip fracture patients requires a multidisciplinary team, which is led by the surgeon and which includes internists and other subspecialists within internal medicine, anesthesiologists, nurses, operating room technicians, social workers, physical therapists, and rehabilitation center coordinators and staff. Nowhere in the orthopedic literature is there a text that guides care for these complex patients from injury through recovery. This text is the first to do so by organizing and synthesizing a large body of literature. Its main themes include pre-operative, operative, and post-operative care of the patient who sustains a geriatric hip fracture. Its main objective is to organize the current body of literature into a cohesive whole so that the busy orthopedic surgeon does not have to undertake a literature search each time he or she wants an answer to the myriad questions that characterize a patient’s injury, treatment, and recovery course. With regard to pedagogy, because orthopedic surgeons in training will utilize this book, and because the case study is the central pedagogical tool in the field of orthopedic surgery, this book includes case studies within each chapter, with the author’s preferred treatment and decision-making rationale for each case. Selected video supplements reinforce real-world application of knowledge. Practicing orthopedic surgeons, as well as orthopedic residents and fellows in training, will find Geriatric Hip Fractures: A Practical Approach a highly useful and informative resource.
This illustrated atlas provides a comprehensive monograph of femoral neck fractures. It has more than 800 representative figures, x-rays and drawings, and describes in detail non-invasive internal fixation.
Utilizing detailed case presentations from experts in the field, this book presents common clinical scenarios involving patients who have sustained displaced femoral neck fractures, discussing the injury mechanism, early treatment, potential treatment options, risks and complications involved. The style of presentation, the ease of readability, the use of appropriate and relevant cases to highlight the learning points, and the discussion of the decision-making process are all unique features of the book's approach. Using this tailored process, the each topic is reviewed and the rationale for what appears to be the optimal treatment - hemiarthroplasty or total hip replacement, for example - is provided to the reader, emphasizing that the ultimate decision requires the combination of science and judgment, both of which are continually evolving. Additional chapters present ongoing controversies in the management of these challenging fractures, as well as complications such as aseptic necrosis, symptomatic hardware and nonunions. Portable and concise, orthopedic and trauma surgeons, residents and fellows alike will find Displaced Femoral Neck Fractures a practical and user-friendly resource.
The field of hip preservation surgery has evolved over the past decade as our understanding of hip pathomechanics and pathomorphology has expanded. The published literature on non-arthritic hip pathology, for example, has grown exponentially. The topics of controversy in the past decade have been answered in some cases, but new questions have also arisen. In addition to the 99 chapters in the original edition – most of which will be retained and updated as applicable – there will be over 30 brand new chapters focusing on new and more sophisticated techniques from authors that have been the pioneers of the field. The text is divided into nine thematic sections, covering the breadth of the topic and the current state of the art: basic science of the hip; operative basics for hip arthroscopy and open hip preservation surgery; pediatric hip conditions; approaches to disorders of the hip and pelvis; enthesopathy and neuromuscular disorders; hip fractures and instability; avascular necrosis; hip cartilage restoration; and oncologic conditions. Throughout, there is a heavy emphasis on surgical techniques, and video clips will be included in selected chapters. Written by edited by thought leaders and seasoned practitioners in the field, this new edition of Hip Arthroscopy and Hip Joint Preservation Surgery will remain the gold standard for orthopedic surgeons and sports medicine specialists, expanding on the range of techniques available to clinicians treating injuries to and disorders of the hip.
This book is published open access under a CC BY 4.0 license. White Paper on Joint Replacement This White Paper details the status of hip and knee arthroplasty care in Germany. Hip and knee replacements are amongst the most frequently performed procedures and usually become necessarily due to age-related wear of the joint, osteoarthritis and fractures of the femoral neck. In light of demographic change, demands with regard to standards of care and the procedures are likely to rise. Contents • This White Paper contains information on indications, procedures, health economic aspects and the healthcare system stakeholders involved. • It portrays current developments with regard to the prevalence of hip and knee arthroplasty, the healthcare situation and quality of care within the chain of medical care. • This book is complemented by a chapter assessing the current situation from an expert perspective with contributions from renowned experts in the fields of science, medical technology and medical practice. This book addresses people involved in shaping and representing the healthcare system from a variety of fields including medical professions, health insurances and health sciences as well as journalists and patient representatives.
This book is the second volume on Osteosynthesis of Fractures and focuses on fractures of the spine-pelvis and lower extremities. It illustrates the techniques of fracture reduction clearly, using a step-wise approach with real time intra-operative photographs. Tips and tricks for how to avoid pitfalls are presented by a panel of experts to give the readers a complete overview of how to perform reduction techniques for different fracture types. This book will be an essential guide for surgeons to utilise the available reduction instruments and preserve the vitality of the bone and surrounding soft tissues.
This new open access edition supported by the Fragility Fracture Network aims at giving the widest possible dissemination on fragility fracture (especially hip fracture) management and notably in countries where this expertise is sorely needed. It has been extensively revised and updated by the experts of this network to provide a unique and reliable content in one single volume. Throughout the book, attention is given to the difficult question of how to provide best practice in countries where the discipline of geriatric medicine is not well established and resources for secondary prevention are scarce. The revised and updated chapters on the epidemiology of hip fractures, osteoporosis, sarcopenia, surgery, anaesthesia, medical management of frailty, peri-operative complications, rehabilitation and nursing are supplemented by six new chapters. These include an overview of the multidisciplinary approach to fragility fractures and new contributions on pre-hospital care, treatment in the emergency room, falls prevention, nutrition and systems for audit. The reader will have an exhaustive overview and will gain essential, practical knowledge on how best to manage fractures in elderly patients and how to develop clinical systems that do so reliably.
An in-depth understanding of a comprehensive approach to the management of radius fractures and their complications. The authors -- world renowned experts in the field -- present practical, clinical information from their extensive experience in the treatment of these fractures. Topics include the authors' classification as well as decision- making and tactics in the conservative and operative management of all types of radius fractures. Topics covered include: bending fractures of the metaphysis, shearing and compression fractures of the joint surface, avulsion fractures, radio-carpal fracture and dislocation, combined fractures, high velocity injury and malunions. In addition, chapters deal with surgical techniques and approach as well as with complications. With over 500 illustrations, this is the definitive volume on these challenging fractures, their complete treatment, and the management of complications.
It has been a pleasure to comply with requests to publish this book in English. During the intervening years, there has been little to add to our views as to the best management of acetabular fractures, but an additional chapter has been incorporated comprising recent findings in our patients and slight changes in emphasis on the indications for operations. Additionally, having recognised that one of the greatest difficulties in this method of treatment lies in the pre-operative assessment of the standard radiographs, we have prepared a short series of radiographs which the reader may find advantageous for study. We are grateful to Mr. Reginald Eison who has translated and revised the French edition. Considerable alteration of the text and the general presen tation was necessary in order to make the material palatable in English. Our thanks are due to our new publishers, Springer-Verlag, for their keen interest and skill. E. LETOURNEL R. JUDET Preface to the French Edition It is a long time since we first attempted surgical treatment of fractures of the acetabulum accompanied by displacement, with the aim of restoring perfect articulation. Such treatment demands an exact reconstitution of the anatomy of the acetabulum and pelvic bone. This volume comprises an account of our efforts to assess the place of open reduction and internal fixation of displaced fractures of the acetabulum. The principal aim is simple: the perfect restoration of the articular surface and the associated bony architecture.