Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients

2019 ◽  
Vol 30 (4) ◽  
pp. 474-480
Author(s):  
Chun-Hung Chang ◽  
Shang-Wen Tsai ◽  
Po-Kuei Wu ◽  
Chao-Ming Chen ◽  
Ming-Chau Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Multivariate Logistic Regression Analysis ◽  
Alcohol Dependency ◽  
Old Patients ◽  
Non Union ◽  
Loss Of Reduction ◽  
Implant Retention ◽  
Neck Fracture

Purpose: The aim of this study was to evaluate outcomes of internal fixation for displaced femoral neck fracture (FNF) between 50 and 60 years old. The patient and surgical factors for the failure were identified. Methods: We retrospectively reviewed the records of 102 displaced FNF patients between 50 and 60 years old (mean age 54.9 years) who had undergone internal fixation between 2005 and 2016. The minimum follow-up was 12 months. Primary end points included loss of reduction, non-union, and osteonecrosis of the femoral head (ONFH). Preoperative Pauwel’s angle, fixation timing and methods, reduction quality, removal of implant and medical comorbidities were analysed. Results: The overall failure rate was 44.1%. In multivariate logistic regression analysis, poor reduction quality (adjusted odds ratio [aOR] 4.38; 95% confidence interval [CI], 1.54–12.46) and internal fixation delayed more than 6 hours (aOR 3.24; 95% CI, 1.08–9.69) were risk factors for all causes of failure. In a stratified analysis, poor reduction quality (aOR 3.81; 95% CI, 1.11–13.04) and a history of alcohol dependency (aOR 4.91; 95% CI, 1.09–22.13) were risk factors for loss of reduction. Internal fixation delayed >6 hours (aOR 3.67; 95% CI, 1.05–12.77) and removal of implant (aOR 3.32; 95% CI, 1.02–10.77) were risk factors for ONFH. Conclusions: The outcome of internal fixation of displaced FNF in patients between 50 and 60 years old is suboptimal. The patient selection is important. Non-alcohol dependency lowered early failure. Implant retention reduced ONFH. Surgery within 6 hours and good quality of reduction yield better results.

scholarly journals The Probability of and Risk Factors for Femoral Neck Shortening and Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With a Medial Buttress Plate

2021 ◽  
Author(s):  
Jinglei Xu ◽  
Xue Bai ◽  
Chenyang Xu ◽  
Xianzhong Ma
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Fracture Site ◽  
Cannulated Screws ◽  
Fixation Failure ◽  
Neck Fracture ◽  
Buttress Plate

Abstract Background: A range of postoperative complications make femoral neck fracture difficult to treat. Femoral neck shortening and internal fixation failure are two most prevalent complications associated with many surgical strategies. This study evaluates the probability of and risk factors for these complications after the treatment of femoral neck fracture using cannulated screws combined with a medial buttress plate.Methods: Data of 70 patients with femoral neck fractures treated using cannulated screws combined with a medial buttress plate in our hospital between March 2016 and March 2019 were retrospectively analyzed, and 40 patients who were followed up for more than 3 months were enrolled in the study. We evaluated the probability of postoperative femoral neck shortening and internal fixation failure and conducted multivariate logistic regression analysis to determine risk factors.Results: All 40 patients had Garden III/IV or Pauwels II/III fractures. Of these patients, 11 had femoral neck shortening greater than 5 mm and 8 had fracture nonunion or screw cutout requiring reoperation. There were no differences in age, sex, fracture site, Pauwels classification, and reduction quality between the shortening and non-shortening groups; however, there were significant differences in screw quality. Similarly, there were no differences in age, sex, Pauwels classification, reduction quality, and screw quality between the fixation failure and non-failure groups, but there were significant differences in fracture site and shortening. According to the multivariate analyses, screw quality was an independent risk factor for femoral neck shortening (odds ratio [OR]: 8.58; 95% confidence interval [CI]: 1.35–50.57; P=0.022), and femoral neck shortening was an independent risk factor for internal fixation failure (OR: 11.82; 95% CI: 1.66–84.36; P=0.014).Conclusions: Femoral neck fracture treatment using cannulated screws combined with a medial buttress plate led to a femoral neck shortening rate lower than that of other internal fixation methods and an internal fixation failure rate lower than or equivalent to that of other internal fixation methods. The quality of cannulated screws is a risk factor for postoperative shortening of the femoral neck, and femoral neck shortening is a risk factor for postoperative internal fixation failure.

scholarly journals Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

2020 ◽  
Author(s):  
Qiang Xu ◽  
Bin Zhang ◽  
Min Dai ◽  
Xuqiang Liu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Internal Fixation ◽  
Weight Bearing ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Fracture Type ◽  
Multivariate Logistic Regression ◽  
Non Union ◽  
Limb Fractures

Abstract Objective: Although a large number of clinical and animal experimental studies have explored factors affecting fracture healing, there are only a few examples of systematic research on these factors for limb fractures. The purpose of this study was to analyse the risk factors for limb fracture non-union in order to improve non-union prevention and early detection.Methods: A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analysed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union.Results: The multivariate logistic regression analysis revealed that osteoporosis, open fractures, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were independent risk factors for non-union after surgery for limb fractures.Conclusions: Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.

scholarly journals The Probability of And Risk Factors For Femoral Neck Shortening And Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With A Medial Buttress Plate

2021 ◽  
Author(s):  
Jinglei Xu ◽  
Xue Bai ◽  
Chenyang Xu ◽  
Xianzhong Ma
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Independent Risk Factor ◽  
Cannulated Screws ◽  
Fixation Failure ◽  
Neck Fracture ◽  
Buttress Plate

Abstract Background: Femoral neck shortening and internal fixation failure are two most prevalent complications associated with surgical treatment of femoral neck fracture. This study evaluates the probability of and risk factors for these complications after the treatment of femoral neck fracture using cannulated screws combined with a medial buttress plate.Methods: Data of 70 patients with femoral neck fractures treated using cannulated screws combined with a medial buttress plate in our hospital between March 2016 and March 2019 were retrospectively analyzed, and 40 patients who were followed up for no less than 6 months were enrolled in the study. We evaluated the probability of postoperative femoral neck shortening and internal fixation failure and conducted multivariate logistic regression analysis to determine risk factors.Results: Among 40 patients, 11 had femoral neck shortening＞5 mm and 8 had fracture nonunion or screw cutout. There were significant differences in screw quality between the shortening and non-shortening groups; There were significant differences in fracture site and shortening between the fixation failure and non-failure groups. According to the multivariate analysis, screw quality was an independent risk factor for femoral neck shortening (odds ratio [OR]: 8.58; 95% confidence interval [CI]: 1.35–50.57; P=0.022), and femoral neck shortening was an independent risk factor for internal fixation failure (OR: 11.82; 95% CI: 1.66–84.36; P=0.014).Conclusions: Femoral neck fracture treatment using cannulated screws combined with a medial buttress plate led to a femoral neck shortening rate lower than that of other internal fixation methods and an internal fixation failure rate lower than or equivalent to that of other internal fixation methods. The quality of cannulated screws is a risk factor for postoperative shortening of the femoral neck, and femoral neck shortening is a risk factor for postoperative internal fixation failure.

scholarly journals Analysis on Risk Factors for Neck Shortening After Internal Fixation for Pauwels II Femoral Neck Fracture in Young Patients

2020 ◽  
Author(s):  
Fulong Zhao ◽  
Lijuan Guo ◽  
xuefei wang ◽  
Yakui Zhang
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Young Patients ◽  
Type Ii ◽  
Fracture Type ◽  
Medial Cortex ◽  
Neck Fracture ◽  
Cancellous Screws

Abstract Background:Femoral neck shortening can occur in in young patients receiving internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws for Pauwels type II femoral neck fracture in relatively young patients. Methods: Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. And the chi-squared test or Fisher’s exact test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. Results: Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. Conclusion：Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after internal fixation with parallel, partially threaded, cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.BMD and BMI may be also risk factors.

scholarly journals Analysis on risk factors for neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Fulong Zhao ◽  
Lijuan Guo ◽  
Xuefei Wang ◽  
Yakui Zhang
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Young Patients ◽  
Type Ii ◽  
Fracture Type ◽  
Medial Cortex ◽  
Neck Fracture

Abstract Background Femoral neck shortening can occur in young patients receiving internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws (FPTCS) for Pauwels type II femoral neck fracture in relatively young patients. Methods Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. And the Chi-squared test or Fisher’s exact test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. Results Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. Conclusion Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after internal fixation with FPTCS for Pauwels type II femoral neck fracture in young patients. BMD and BMI may be also risk factors.

scholarly journals Analysis on risk factors for neck shortening after internal fixation for Pauwels type II femoral neck fracture in young patients

2020 ◽  
Author(s):  
Fulong Zhao ◽  
Lijuan Guo ◽  
xuefei wang ◽  
Yakui Zhang
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Young Patients ◽  
Type Ii ◽  
Fracture Type ◽  
Medial Cortex ◽  
Neck Fracture ◽  
Cancellous Screws

Abstract Background:Femoral neck shortening can occur in in young patients receiving internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws for Pauwels type II femoral neck fracture in relatively young patients. Methods: Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. And the chi-squared test or Fisher’s exact test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. Results: Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. Conclusion：Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after internal fixation with parallel, partially threaded, cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.BMD and BMI may be also risk factors. Key words: Young patients, Femoral neck fracture, Internal fixation, Neck shortening, Risk factors

scholarly journals Analysis on risk factors for neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients

2021 ◽  
Author(s):  
Fulong Zhao ◽  
Lijuan Guo ◽  
xuefei wang ◽  
Yakui Zhang
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Young Patients ◽  
Type Ii ◽  
Fracture Type ◽  
Medial Cortex ◽  
Neck Fracture

Abstract Background: Femoral neck shortening can occur in young patients receiving internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws (FPTCS) for Pauwels type II femoral neck fracture in relatively young patients. Methods: Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. And the chi-squared test or Fisher’s exact test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. Results: Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. Conclusion：Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after internal fixation with FPTCS for Pauwels type II femoral neck fracture in young patients.BMD and BMI may be also risk factors.

scholarly journals Primary Total Hip Arthroplasty versus Open Reduction and Internal Fixation in Displaced Fracture of Femoral Neck in Adults

2021 ◽  
Author(s):  
Kamran Asadi ◽  
Yasaman Soleimanmanesh ◽  
Arman Keymoradzadeh ◽  
Nazanin Soleimanmanesh
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Fixation Device ◽  
Non Union ◽  
Internal Fixation Device ◽  
Fixation Group ◽  
Neck Fracture ◽  
Hip Function ◽  
Displaced Fracture

Background: Femoral neck fracture as a prevalent skeletal injury accounts for 7% of orthopedic hospital admission. The aim of the present study is to evaluate the functional outcome of patients with femoral neck fracture treated with total hip arthroplasty (THA) and compare them with those undergoing fixation treatment. Methods: In this study, we reviewed patients in the age range of 45-60 years old with femoral neck fracture during 2007-2017. The subjects were assigned to either THA or fixation group. The primary outcome was hip function, evaluated with the Harris Hip Scale (HHS). Secondary outcomes included pain, local infection, avascular necrosis (AVN), thromboembolic event, loosening of the prosthetic and internal fixation device, prosthetic dislocation, non-union, and delayed-union. Results: In this study, 34 patients with displaced fracture of femoral neck were treated with acute THA and 38 patients were treated with fixation. The HHS was higher in the THA group compared to the fixation group (P < 0.050). The results of the present study indicated no significant difference in early postoperative complications over the first month between the two groups, but frequency of complications such as non-union, AVN, pain and loosening of the internal fixation device in the fixation group were significantly higher than the THA group after six months (P < 0.050). Conclusion: Over a period of six months, THA provided better hip function and significantly fewer postoperative complications compared to fixation.

scholarly journals Analysis on risk factors for neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients

2020 ◽  
Author(s):  
Fulong Zhao ◽  
Lijuan Guo ◽  
xuefei wang ◽  
Yakui Zhang
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Closed Reduction ◽  
Young Patients ◽  
Type Ii ◽  
Fracture Type ◽  
Medial Cortex ◽  
Neck Fracture

Abstract Background: Femoral neck shortening can occur in young patients receiving closed reduction and internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after closed reduction and internal fixation with parallel partially threaded cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.Methods: Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. These patients were followed (average follow-up: 12 months). And the chi-square test or t test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. Results: Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. Conclusion：Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after closed reduction and internal fixation with parallel, partially threaded, cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.BMD and BMI may be also risk factors.

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