scholarly journals Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years

2021 ◽  
Vol 6 (4) ◽  
Author(s):  
Pontus Sjöholm ◽  
Jonas Sundkvist ◽  
Olof Wolf ◽  
Olof Sköldenberg ◽  
Max Gordon ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Treatment Failure ◽  
Femoral Neck Fractures ◽  
Posterior Tilt ◽  
Predict Treatment Failure

scholarly journals More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

2021 ◽  
Author(s):  
Jorn Kalsbeek ◽  
Ariaan van Walsum ◽  
Herbert Roerdink ◽  
Inger Schipper
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Treatment Failure ◽  
Femoral Neck Fractures ◽  
Type I ◽  
Non Union ◽  
Initial Radiograph ◽  
Neck Fracture ◽  
Posterior Tilt ◽  
Risk Of Treatment

Abstract Purpose In this study, we aimed to determine the correlation between the preoperative posterior tilt of the femoral head and treatment failure in patients with a Garden type I and II femoral neck fracture (FNF) treated with the dynamic locking blade plate (DLBP). Methods Preoperative posterior tilt was measured in a prospective documented cohort of 193 patients with a Garden type I and II FNF treated with the DLBP. The correlation between preoperative posterior tilt and failure, defined as revision surgery because of avascular necrosis, non-union, or cut-out, was analyzed. Results Patients with failed fracture treatment (5.5%) had a higher degree of posterior tilt on the initial radiograph than the patients with uneventful healed fractures: 21.4° and 13.8°, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20° and 12.5% if the preoperative posterior tilt was ≥ 20°. A posterior tilt of ≥ 20° was associated with an odds ratio of 4.24 (95% CI 1.09–16.83; p = 0.04). Conclusion Garden type I and II FNFs with a significant preoperative posterior tilt (≥ 20°) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt ≥ 20° of the femoral head should be considered as a significant predictor for failure of treatment in Garden type I and II FNFs treated with the DLBP.

scholarly journals Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture

2016 ◽  
Vol 98 (6) ◽  
pp. 376-379 ◽  
Author(s):  
O Riaz ◽  
R Arshad ◽  
S Nisar ◽  
R Vanker
Keyword(s):  
Femoral Neck ◽  
Serum Albumin ◽  
Femoral Neck Fracture ◽  
Femoral Neck Fractures ◽  
Fixation Failure ◽  
Non Union ◽  
Preoperative Serum ◽  
Neck Fracture ◽  
Posterior Tilt ◽  
Intracapsular Femoral Neck Fracture

Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%–19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60–101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

scholarly journals Anterior Positioning Screw in Proximal Femoral Plating Restricts Posterior Tilt of Retroverted Femoral Neck Fractures: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Sheng-Bo Nie ◽  
Jun-Feng Liu ◽  
Jiang-Hua Zhu ◽  
Zi-Fei Zhou ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Demographic Data ◽  
Multivariable Analysis ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Fixation Failure ◽  
Significant Difference ◽  
Posterior Tilt ◽  
Posterior Comminution

Abstract Background: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt.Methods: We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt.Results: Demographic data showed no significant difference. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1 – 4.3°) than that in the NTS group (5.3°, 4.2 – 8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1 – 4.7) mm vs. 4.3 (3.1 – 6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0 – 90.0 vs. 82.0, 76.0 – 84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6 – 70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6 – 56.1, p = 0.002), and NTS configuration (ref: ALTS configuration) (OR 21.9, 95% CI 4.1 – 116.4, p < 0.001) as risk factors for developing posterior tilt.Conclusions: Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (ref: ALTS) are risk factors for developing posterior tilt.Trial registration: Retrospectively registered.

Finite Element Analysis of Necessity of Reduction and Selection of Internal Fixation for Valgus-impacted Femoral Neck Fracture

2020 ◽  
Author(s):  
Yahui Dai ◽  
Ming Ni ◽  
Bang Dou ◽  
Zhiyuan Wang ◽  
Yushan Zhang ◽  
...  
Keyword(s):  
Finite Element ◽  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Cannulated Screw ◽  
Von Mises Stress ◽  
Valgus Angle ◽  
Anatomic Reduction ◽  
Posterior Tilt ◽  
Von Mises ◽  
Intact Femur

Abstract BackgroundAlthough valgus-impacted fractures don’t displace obviously, a larger valgus angle and posterior tilt of the femoral head can cause hip joint dysfunction and femoral head necrosis. The optimal surgical approach for valgus-impacted femoral neck fractures remains controversial. This study compared the biomechanical characteristics of different treatment strategies based on finite element analysis.MethodsTen valgus-impacted femoral neck fractures were analyzed in terms of posterior tilt and valgus angle measured on X-ray radiographs. Using these data, we generated 7 finite element models that were compared in terms of von Mises stress distribution and displacement.ResultsIn the intact femur, von Mises stress was concentrated at the medial and inferior sides of the femoral neck. In valgus-impacted femoral neck fractures, von Mises stress was at the same locations but was 5.66 times higher than that in the intact femur. When 3 cannulated screws were used for internal fixation, anatomic reduction diminished the stress at the fracture end from 140.6 to 59.14 MPa, although displacement increased from 0.228 to 0.450 mm. When the fracture was fixed with a sliding hip screw (SHS) + cannulated screw, there was less stress at the fracture end and greater displacement with anatomic reduction than that without reduction (stress: 15.9 vs 37.9 MPa; displacement: 0.329 vs 0.168 mm).ConclusionsThe SHS + cannulated screw has superior biomechanical stability than 3 cannulated screws, and is recommended following anatomic reduction to treat valgus-compacted femoral neck fractures.

scholarly journals Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sheng-Bo Nie ◽  
Jun-Feng Liu ◽  
Jiang-Hua Zhu ◽  
Zi-Fei Zhou ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Multivariable Analysis ◽  
Femoral Neck Fractures ◽  
Trial Registration ◽  
Harris Hip Score ◽  
Fixation Failure ◽  
Significant Difference ◽  
Posterior Tilt ◽  
Posterior Comminution

Abstract Background Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt. Methods We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt. Results Age, gender, Garden classification, posterior comminution, and reduction quality showed no significant difference between the groups. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1–4.3°) than that in the NTS group (5.3°, 4.2–8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1–4.7) mm vs. 4.3 (3.1–6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0–90.0 vs. 82.0, 76.0–84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6–70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6–56.1, p = 0.002), and NTS configuration (reference: ALTS configuration) (OR 21.9, 95% CI 4.1–116.4, p < 0.001) as risk factors for developing posterior tilt. Conclusions Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (reference: ALTS) are risk factors for developing posterior tilt. Trial registration The trial registration number was ChiCTR2000039482.

Validation of two methods to measure posterior tilt in femoral neck fractures

Injury ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 380-383 ◽  
Author(s):  
J.H. Kalsbeek ◽  
A.D.P. van Walsum ◽  
W.H. Roerdink ◽  
A.B. van Vugt ◽  
H. van de Krol ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Posterior Tilt
Sign in / Sign up

Export Citation Format

Share Document