Research progress in osteonecrosis of femoral head following femoral intertrochanteric fractures in adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Yu , HUANG Xin , ZHU Yingbo ,  WANG Xiaoning , WU Kejian

Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P.R.China;

Corresponding author：

WANG Xiaoning, Email: wxn304@126.com

Keywords：

Femoral intertrochanteric fracture; osteoecrosis of femoral head; pathogenesis; high-risk factor

DOI：

10.7507/1002-1892.202002111

Video：

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Objective To summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults.Methods Relevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults.Results ONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results.Conclusion Addressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.

Citation： JIANG Yu, HUANG Xin, ZHU Yingbo, WANG Xiaoning, WU Kejian. Research progress in osteonecrosis of femoral head following femoral intertrochanteric fractures in adults. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(11): 1458-1461. doi: 10.7507/1002-1892.202002111 Copy

1.	Taylor GM, Neufeld AJ, Nickel VL. Complications and failures in the operative treatment of intertrochanteric fractures of the femur. J Bone Joint Surg (Am), 1955, 37-A(2): 306-316.
2.	Baixauli EJ, Baixauli F, Baixauli F, et al. Avascular necrosis of the femoral head after intertrochanteric fractures. J Orthop Trauma, 1999, 13(2): 134-137.
3.	Barquet A, Mayora G, Guimaraes JM, et al. Avascular necrosis of the femoral head following trochanteric fractures in adults: a systematic review. Injury, 2014, 45(12): 1848-1858.
4.	Bartonicek J, Fric V, Skala-Rosenbaum J, et al. Avascular necrosis of the femoral head in pertrochanteric fractures: a report of 8 cases and a review of the literature. J Orthop Trauma, 2007, 21(4): 229-236.
5.	Tsunoda K, Aya Y, Motomatsu S, et al. Avascular necrosis of femoral head after intertrochanteric fracture: A case report. Orthop Traumatol, 2009, 58(4): 703-707.
6.	Ho M, Garau G, Walley G, et al. Minimally invasive dynamic hip screw for fixation of hip fractures. Int Orthop, 2009, 33(2): 555-560.
7.	Tornetta III P, Ricci W, McQueen MM. Rockwood and Green’s fractures in adults. Philadelphia: Lippincott Williams & Wilkins, 2019: 5626-5718.
8.	Shih LY, Chen TH, Lo WH. Avascular necrosis of the femoral head—an unusual complication of an intertrochanteric fracture. J Orthop Trauma, 1992, 6(3): 382-385.
9.	Chen CM, Chiu FY, Lo WH. Avascular necrosis of femoral head after gamma-nailing for unstable intertrochanteric fractures. Arch Orthop Trauma Surg, 2001, 121(9): 505-507.
10.	Mattan Y, Dimant A, Mosheiff R, et al. Avascular necrosis and related complications following healed osteoporotic intertrochanteric fractures. Isr Med Assoc J, 2002, 4(6): 434-437.
11.	Tanaka H, Komine M. Avascular necrosis of femoral head after intertrochanteric fracture-A case report. Orthop Traumatol, 2004, 53(1): 121-124.
12.	Minoru K. Two cases of avascular necrosis of femoral head after treatment of intertrochanteric fracture. Orthop Traumatol, 2008, 57(2): 287-289.
13.	Gautier E, Ganz K, Krügel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg (Br), 2000, 82(5): 679-683.
14.	Bartonícek J. Weitbrecht’s retinacula of the hip joint. Acta Chir Orthop Traumatol Cech, 1990, 57(5): 385-391.
15.	Yin W, Xu Z, Sheng J, et al. Logistic regression analysis of risk factors for femoral head osteonecrosis after healed intertrochanteric fractures. Hip Int, 2016, 26(3): 215-219.
16.	Müssbichler H. Arteriographic studies in fractures of the femoral neck and trochanteric region. Type and incidence of findings in pre- and postoperative examinations, relation to fracture dislocation and prognostic value. Angiology, 1970, 21(6): 385-402.
17.	Crock HV. An atlas of the arterial supply of the head and neck of the femur in man. Clin Orthop Relat Res, 1980, (152): 17-27.
18.	Dora C, Leunig M, Beck M, et al. Entry point soft tissue damage in antegrade femoral nailing: a cadaver study. J Orthop Trauma, 2001, 15(7): 488-493.
19.	Brodetti A. The blood supply of the femoral neck and head in relation to the damaging effects of nails and screws. J Bone Joint Surg (Br), 1960, 42(4): 794-801.
20.	Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res, 2017, 475(8): 2011-2023.
21.	Vicario C, Marco F, Ortega L, et al. Necrosis of the femoral head after fixation of trochanteric fractures with Gamma Locking Nail. A cause of late mechanical failure. Injury, 2003, 34(2): 129-134.
22.	Ricci MJ, McAndrew CM, Miller AN, et al. Are two-part intertrochanteric femur fractures stable and does stability depend on fixation method? J Orthop Trauma, 2019, 33(9): 428-431.
23.	Mallina R, Dinah F. Avascular necrosis of femoral head: a rare complication of a common fracture in an octogenarian. Geriatr Orthop Surg Rehabil, 2013, 4(3): 74-77.
24.	Darshankumar S. Avascular necrosis of the femoral head in a case of intertrochanteric fracture of the femur: A case report. Indian J Res, 2012, 1(3): 159-160.
25.	Ferreres-Claramunt A, Castillo-García F, Maculé-Beneyto F, et al. Femoral head necrosis after intertrochanteric fracture: a case report after synthesis with Ender nails. J Trauma, 1995, 39(5): 1000-1002.
26.	Meyers MH. Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment. Clin Orthop Relat Res, 1988, (231): 51-61.
27.	Lee J, Ozdoganlar OB, Rabin Y. An experimental investigation on thermal exposure during bone drilling. Med Eng Phys, 2012, 34(10): 1510-1520.
28.	Deleanu B, Prejbeanu R, Vermesan D, et al. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report. Ann Med Surg (Lond), 2016, 5: 106-109.
29.	Min BW, Cho YS, Lee JH, et al. Avascular necrosis of the femoral head after intertrochanteric fracture. J Korean Hip Soc, 2006, 18(5): 486-492.
30.	Kim KH, Han KY, Kim KW, et al. Local postoperative complications after surgery for intertrochanteric fractures using cephalomedullary nails. Hip Pelvis, 2018, 30(3): 168-174.

1. Taylor GM, Neufeld AJ, Nickel VL. Complications and failures in the operative treatment of intertrochanteric fractures of the femur. J Bone Joint Surg (Am), 1955, 37-A(2): 306-316.
2. Baixauli EJ, Baixauli F, Baixauli F, et al. Avascular necrosis of the femoral head after intertrochanteric fractures. J Orthop Trauma, 1999, 13(2): 134-137.
3. Barquet A, Mayora G, Guimaraes JM, et al. Avascular necrosis of the femoral head following trochanteric fractures in adults: a systematic review. Injury, 2014, 45(12): 1848-1858.
4. Bartonicek J, Fric V, Skala-Rosenbaum J, et al. Avascular necrosis of the femoral head in pertrochanteric fractures: a report of 8 cases and a review of the literature. J Orthop Trauma, 2007, 21(4): 229-236.
5. Tsunoda K, Aya Y, Motomatsu S, et al. Avascular necrosis of femoral head after intertrochanteric fracture: A case report. Orthop Traumatol, 2009, 58(4): 703-707.
6. Ho M, Garau G, Walley G, et al. Minimally invasive dynamic hip screw for fixation of hip fractures. Int Orthop, 2009, 33(2): 555-560.
7. Tornetta III P, Ricci W, McQueen MM. Rockwood and Green’s fractures in adults. Philadelphia: Lippincott Williams & Wilkins, 2019: 5626-5718.
8. Shih LY, Chen TH, Lo WH. Avascular necrosis of the femoral head—an unusual complication of an intertrochanteric fracture. J Orthop Trauma, 1992, 6(3): 382-385.
9. Chen CM, Chiu FY, Lo WH. Avascular necrosis of femoral head after gamma-nailing for unstable intertrochanteric fractures. Arch Orthop Trauma Surg, 2001, 121(9): 505-507.
10. Mattan Y, Dimant A, Mosheiff R, et al. Avascular necrosis and related complications following healed osteoporotic intertrochanteric fractures. Isr Med Assoc J, 2002, 4(6): 434-437.
11. Tanaka H, Komine M. Avascular necrosis of femoral head after intertrochanteric fracture-A case report. Orthop Traumatol, 2004, 53(1): 121-124.
12. Minoru K. Two cases of avascular necrosis of femoral head after treatment of intertrochanteric fracture. Orthop Traumatol, 2008, 57(2): 287-289.
13. Gautier E, Ganz K, Krügel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg (Br), 2000, 82(5): 679-683.
14. Bartonícek J. Weitbrecht’s retinacula of the hip joint. Acta Chir Orthop Traumatol Cech, 1990, 57(5): 385-391.
15. Yin W, Xu Z, Sheng J, et al. Logistic regression analysis of risk factors for femoral head osteonecrosis after healed intertrochanteric fractures. Hip Int, 2016, 26(3): 215-219.
16. Müssbichler H. Arteriographic studies in fractures of the femoral neck and trochanteric region. Type and incidence of findings in pre- and postoperative examinations, relation to fracture dislocation and prognostic value. Angiology, 1970, 21(6): 385-402.
17. Crock HV. An atlas of the arterial supply of the head and neck of the femur in man. Clin Orthop Relat Res, 1980, (152): 17-27.
18. Dora C, Leunig M, Beck M, et al. Entry point soft tissue damage in antegrade femoral nailing: a cadaver study. J Orthop Trauma, 2001, 15(7): 488-493.
19. Brodetti A. The blood supply of the femoral neck and head in relation to the damaging effects of nails and screws. J Bone Joint Surg (Br), 1960, 42(4): 794-801.
20. Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res, 2017, 475(8): 2011-2023.
21. Vicario C, Marco F, Ortega L, et al. Necrosis of the femoral head after fixation of trochanteric fractures with Gamma Locking Nail. A cause of late mechanical failure. Injury, 2003, 34(2): 129-134.
22. Ricci MJ, McAndrew CM, Miller AN, et al. Are two-part intertrochanteric femur fractures stable and does stability depend on fixation method? J Orthop Trauma, 2019, 33(9): 428-431.
23. Mallina R, Dinah F. Avascular necrosis of femoral head: a rare complication of a common fracture in an octogenarian. Geriatr Orthop Surg Rehabil, 2013, 4(3): 74-77.
24. Darshankumar S. Avascular necrosis of the femoral head in a case of intertrochanteric fracture of the femur: A case report. Indian J Res, 2012, 1(3): 159-160.
25. Ferreres-Claramunt A, Castillo-García F, Maculé-Beneyto F, et al. Femoral head necrosis after intertrochanteric fracture: a case report after synthesis with Ender nails. J Trauma, 1995, 39(5): 1000-1002.
26. Meyers MH. Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment. Clin Orthop Relat Res, 1988, (231): 51-61.
27. Lee J, Ozdoganlar OB, Rabin Y. An experimental investigation on thermal exposure during bone drilling. Med Eng Phys, 2012, 34(10): 1510-1520.
28. Deleanu B, Prejbeanu R, Vermesan D, et al. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report. Ann Med Surg (Lond), 2016, 5: 106-109.
29. Min BW, Cho YS, Lee JH, et al. Avascular necrosis of the femoral head after intertrochanteric fracture. J Korean Hip Soc, 2006, 18(5): 486-492.
30. Kim KH, Han KY, Kim KW, et al. Local postoperative complications after surgery for intertrochanteric fractures using cephalomedullary nails. Hip Pelvis, 2018, 30(3): 168-174.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress in osteonecrosis of femoral head following femoral intertrochanteric fractures in adults

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