1.Why is femoral head necrosis easy to occur after femoral neck fracture in young and middle-aged people?
A: Most femoral neck fractures occur in the elderly, if they occur in young and middle-aged people, they are often due to greater violence (such as: car accidents, high falls, sports accidents, etc.), usually the fracture displacement is obvious, and the more obvious the fracture displacement, the greater the chance of damage to the blood vessels supplying the femoral head, so the chance of femoral head necrosis occurring in young and middle-aged people with femoral neck fractures is much greater than that of the elderly. According to statistics, the incidence of femoral neck fracture in young and middle-aged people reaches 30%~80%.
2.How can we confirm the occurrence of femoral head necrosis at an early stage after femoral neck fracture in young and middle-aged people?
A: If the material of internal fixation is titanium alloy, magnetic resonance examination can be performed 3-6 months after surgery to confirm the occurrence of femoral head necrosis; if the material of internal fixation is stainless steel, isotope scan (ECT) examination can be performed to detect the occurrence of femoral head necrosis at an early stage. In this regard, our hospital has rich experience and good equipment, which can realize early diagnosis.
3.What should I do if femoral head necrosis occurs after femoral neck fracture in young and middle-aged people?
A: Once the complication of femoral head necrosis is confirmed, targeted measures need to be taken according to the extent of necrosis, necrosis site, and clinical symptoms.
4.What kind of non-surgical treatment is recommended for young and middle-aged people with femoral head necrosis after femoral neck fracture?
A: Non-operative treatment can be adopted if the following conditions are met (1) no pain; (2) no bone marrow edema on magnetic resonance imaging (MRI); (3) necrosis less than 30%; (4) no collapse; (5) necrosis site is located in the non-weight-bearing area of the femoral head (medial or central).
5.What are the non-surgical treatment methods in your hospital?
A: The non-surgical treatment in our hospital mainly takes internal Chinese medicine treatment. If necessary, it is combined with weight-bearing restriction (supplemented by walking with crutches)
6.What kind of cases of femoral head necrosis occurring after femoral neck fracture in young and middle-aged people are recommended to be treated by surgery?
A: Surgery is recommended in the following cases (1) pain in the hip; (2) magnetic resonance imaging (MRI) examination, which reveals bone marrow edema; (3) necrosis greater than 30%; (4) necrosis involving the lateral column of the femoral head; (5) collapse of the femoral head.
7.What is the general surgical method adopted by your hospital for femoral head necrosis after femoral neck fracture in young and middle-aged people and what is the result?
A: If the femoral head is not collapsed, it is recommended to adopt minimally invasive compression-supported bone grafting, and the postoperative recovery time is about six months; if the collapse has occurred and the collapse time does not exceed 6 months, it is recommended to adopt incision or non-incision joint, dead bone removal, compression-supported bone grafting, and the postoperative recovery time is about 1 year; if the collapse time exceeds 6 months and the patient is young, it is recommended to adopt incision joint, dead bone removal, compression-supported bone grafting, and compression-supported bone grafting, and the postoperative recovery time is about 1 year. If the collapse time is more than 6 months and the patient is very young, it is recommended to adopt incision, dead bone removal, compression bone grafting, bone flap grafting with blood vessels and cartilage repair, which takes about one and a half years to recover; the success rate of the above procedures is about 80%.
8.Does the femoral head necrosis and collapse occur in young and middle-aged people after femoral neck fracture, it is necessary to replace the joint?
A: It is not necessary to replace the joint, especially for young patients. Within 6 months after the collapse, there is still a good chance to obtain satisfactory results through our designed hip preservation surgery.
9.When is artificial joint replacement necessary for young and middle-aged patients with femoral head necrosis and collapse after femoral neck fracture?
A: In case of femoral head necrosis and collapse after femoral neck fracture in young and middle-aged people, artificial joint replacement is recommended under the following conditions: (1) obvious pain and functional limitation of the hip; (2) old age (more than 45 years old); (3) patient’s own reasons, recovery time is not allowed to exceed 1 year; (4) serious collapse, collapse time more than 6 months, and obvious cartilage degeneration.
10.Is it necessary to take out the steel nail for fixing femoral neck fracture?
A: It is not necessary to remove it, but it is recommended to remove it when: (1) the internal fixation is loose; (2) the internal fixation penetrates the joint surface of the femoral head; (3) the patient himself strongly requests it.
11.When is it appropriate to remove the nail for fixing femoral neck fracture?
A: It is more appropriate to remove it when the following two conditions are met: (1) the fracture is completely healed; (2) the femoral head is not necrotic, or the necrosis repair is more adequate and collapse will not occur.
12.How much experience have you accumulated in young and middle-aged femoral neck fractures?
A: I have always been very concerned about young and middle-aged femoral neck fractures, and have accumulated more than 25 years of experience in treating more than 1000 cases, from how to correctly deal with fresh fractures to the diagnosis and treatment of concurrent femoral head necrosis, as well as the treatment of femoral neck fracture non-union and neck resorption, through the repeated cycle of practice, theory, practice and theory again, I have formed a relatively complete and practice-tested treatment system .