Introduction: Bone mineral density (BMD) measured by dual energy x-ray absorbtiometry (DEXA) is widely used in management of patients with osteoporosis. Factors which are specific to machine or operator, can influence the accuracy and precision of BMD estimations. In this study we investigated the effect of leg rotation and femoral Neck on densitometry of Femur. Materials and Methods: In a before and after, interventional study on 200 women between 30-70 years old, without metabolic bone diseases, densitometry was done first in standard position and then in 15° rotation of leg from standard position and then after changing femoral Neck angle from 90° to 80° in relation to central femoral Neck axis. Density of femoral Neck, ward triangle, greater trochanter, shaft of Femur and total hip was measured and data was analyzedby means comparison test. Results: External rotation of leg by 15° from the customary position, increased the average BMD in femoral Neck, wards area, trochanter and shaft (p<0.001, p<0.04, p<0.001, p<0.008 respectively). While no significant change was observed in average BMD of total hip. Change of femoral Neck area angle from 90' to 80' in relation to central femoral axis decreased BMD in femoral Neck (p<0.001), and significantly increased BMD in wards triangle, trochanter, shaft and total hip (p<0.001, p<0.001, p<0.001, p<0.04 respectively). Conclusion: Malrotation of hip can be an important confounding factor when interpreting serial BMD values. Regarding the less effect of malpositioning on BMD of total hip, this area may be preferred for assessment of densitometry result.

Occult ipsilateral femoral Neck fractures associated with femoral shaft fractures are frequently missed. They may lead to adverse outcomes, such as fracture displacement and delayed treatment followed by poor outcomes, including delayed union, malunion, nonunion, and osteonecrosis, which may lead to early arthroplasty. These adverse effects can be prevented by the awareness of this combined injury pattern, the adequate preoperative and intraoperative imaging of the femoral Neck, and proper treatment. A 27-year-old man was admitted with a displaced fracture of the right Femur. Fluoroscopic evaluation was performed after the intramedullary nailing of the shaft fracture. The evaluation revealed an ipsilateral displaced femoral Neck fracture, which was fixed with two cannulated screw inserted anterior to the nail. Between 2% and 9% of all femoral shaft fractures are associated with ipsilateral femoral shaft fractures. This case report necessitates the increase of awareness for the presence of associated femoral shaft and Neck fractures in patients undergoing antegrade femoral nailing. Also, we recommend appropriate preoperative, intraoperative, and postoperative imaging.

Background: Femoral Neck nonunion could be a disaster in young and middle age patients. Conventional valgus osteotomy of Femur is done without freshening of nonunion site. We would like to report our experience with valgus osteotomy of hip after freshening of the nonunion site.Methods: In a case-series study, from all young and middle-aged patients with nonunion femoral Neck fracture who were treated with freshening of nonunion site and valgus osteotomy, 22 patients (18 males, 4 females) with mean age of 34 (20-47) entered the study. There were 10 broken implants in the heads with a one year follow-up. The cases were evaluated for union, necrosis and also changes in Harris hip scores.Results: Preoperative Harris hip score was 63 and postoperative score increased to 89. The Neck shaft angle was reached about 150 degrees. In 2 cases necrosis developed and in 3 cases collapse of Neck occurred with intrusion of implant into the joint and the implants were removed immediately. Mean time to union was 4.5 months.Conclusion: Freshening of nonunion site before valgus osteotomy in nonunion femoral fracture produces high union rate with low complications.

The incidence of Slipped capital femoral epiphysis (SCFE) after management of femoral Neck fracture in pediatrics is very rare. In this case report, a nine-year-old female child sustained left sided Femur Neck fracture after a motor car accident. The fracture was fixed by two cannulated screws and healing with mild varus occurred after six weeks. However, progressive slippage of femoral epiphysis was observed. This was treated by subtrochanteric valgus osteotomy and fixed by tension band and Wagner technique. Better radiological and functional outcomes were obtained at the short term follow up.

Introduction: Osteoporosis, characterized by diminished bone mass and increased fracture susceptibility, prompts the investigation into the impact of a four-month TRX training regimen on Femur Neck bone mineral density (BMD) and its correlation with serum leptin levels in women with osteopenia. Material & Methods: In this quasi-experimental study, 30 women with osteopenia were purposefully selected and randomly assigned to TRX training (n = 15) or control (n = 15) groups. The intervention group underwent TRX exercises thrice weekly for 45-60 minutes per session for four months. Blood samples collected at baseline and post-intervention measured serum leptin levels via ELISA kit (Bio vendor, Czech Republic), while Dexa Lexxos Digital (2D model, USA) determined Femur Neck BMD. SPSS 20 software, dependent/independent samples t-tests, and Pearson correlation were used for data analysis. Results: TRX training significantly increased Femur Neck BMD, reducing serum adiponectin levels versus the control group (P = 0.001 and P = 0.01, respectively). Compared to baseline, TRX training raised Femur Neck BMD and lowered serum leptin levels (P = 0.000 and P = 0.01, respectively). A significant inverse correlation emerged between femoral Neck BMD and serum leptin levels in women with osteopenia (P = 0.00). Conclusion: Findings suggest that TRX resistance training holds promise for enhancing the rehabilitation of women with osteopenia

Background: The aim of this study was to investigate the impact of the COVID-19 pandemic on the management and outcome of patients with Neck of Femur fractures. Methods: Data was collected for 96 patients with Neck of Femur fractures who presented to the emergency department between March 1, 2020 and May 15, 2020. This data set included information about their COVID-19 status. Parameters including inpatient complications, hospital quality measures, mortality rates, and training opportunities were compared between the COVID-19 positive and COVID-19 negative groups. Furthermore, our current cohort of patients were compared against a historical control group of 95 patients who presented with Neck of Femur fractures before the COVID-19 pandemic. Results: Seven (7. 3%) patients were confirmed COVID positive by RT-PCR testing. The COVID positive cohort, when compared to the COVID negative cohort, had higher rates of postoperative complications (71. 4% vs 25. 9%), increased length of stay (30. 3 days vs 12 days) and quicker time to surgery (0. 7 days vs 1. 3 days). The 2020 cohort compared to the 2019 cohort, had an increased 30-day mortality rate (13. 5% vs 4. 2%), increased number of delayed cases (25% vs 11. 8%) as well as reduced training opportunities for Orthopaedic trainees to perform the surgery (51. 6% vs 22. 8%). Conclusion: COVID-19 has had a profound impact on the care and outcome of Neck of Femur fracture patients during the pandemic with an increase in 30-day mortality rate. There were profound adverse effects on patient management pathways and outcomes while also affecting training opportunities.