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FEMORAL NECK FRACTURE TREATED WITH CANNULATED SCREWS: IS REDUCTION THE KEY POINT?

Department of Orthopedic Surgery, Turin University of Medicine, CTO Hospital of Turin, via Zuretti 29, 10126 Turin, Italy

E-mail Address: enriettiemilio@gmail.com

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Alessandro Aprato

Department of Orthopedic Surgery, Sechenov First Moscow State Medical University, 2-4 Bolshaya Pirogovskaya Street, 119991 Moscow, Russia

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Lorenzo Bellomo

Department of Orthopedic Surgery, Turin University of Medicine, CTO Hospital of Turin, via Zuretti 29, 10126 Turin, Italy

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Alessandro Bistolfi

Department of Orthopedic Surgery, Turin University of Medicine, CTO Hospital of Turin, via Zuretti 29, 10126 Turin, Italy

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Luigi Sabatini

Department of Orthopedic Surgery, Turin University of Medicine, CTO Hospital of Turin, via Zuretti 29, 10126 Turin, Italy

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Walter Daghino

Department of Orthopedic Surgery, Turin University of Medicine, CTO Hospital of Turin, via Zuretti 29, 10126 Turin, Italy

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, and

Alessandro Massè

Department of Orthopedic Surgery, Turin University of Medicine, CTO Hospital of Turin, via Zuretti 29, 10126 Turin, Italy

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https://doi.org/10.1142/S0218957719500106Cited by:0 (Source: Crossref)

Abstract

Background: In middle-aged patients, treatment of femoral neck fractures is still debated between osteosynthesis and replacement. Describing predictive factors is essential to choose the appropriate treatment for each patient. The aim of this study was to describe risk factors for avascular necrosis (AVN) of the femur head in patients with femoral neck fractures treated with three cannulated screws. Methods: We conducted a retrospective study of 91 patients between January of 2011 and February of 2017. Fractures were classified according to Garden and Pauwels classifications, fracture displacement was measured in millimetres (mm), quality of reduction was classified as anatomical or not anatomical; all post-operative radiographs were classified with Garden Alignment Index (GAI). Demographic data were recorded and analyzed. Results: AVN was found in six cases (6.6%). The Garden Classification ( $p = 0.029$ $p = 0.029$ ), GAI classification ( $p = 0.008$ $p = 0.008$ ), fracture displacement in mm ( $p = 0.015$ $p = 0.015$ ) and anatomical reduction ( $p = 0.016$ $p = 0.016$ ) were significantly associated with AVN. The most important risk factor for AVN was suboptimal reduction in axial view evaluated with GAI ( $p = 0.004$ $p = 0.004$ ). One case of AVN occurred in patients with GAI considered excellent (71.42%); no AVN occurred in patients with anatomical reduction (47.2%). Conclusions: Anatomical reduction in patients with femoral neck fractures treated with cannulated screws is mandatory. The degree of displacement before surgery influences the outcome but post-operative anatomical reduction, especially in the lateral view, is the most important predictive factor for the outcome: decreasing the Lateral Garden Angle (LGA) from 180^∘ increases significantly the risk for AVN.

Keywords:

References

1. Alho A, Benterud JG, Rønningen H, Høiseth A. Prediction of disturbed healing in femoral neck fracture: Radiographic analysis of 149 cases. Acta Orthop 63(6) :639–644, 1992. Web of Science, Google Scholar
2. Bartonícek J. Pauwels’ classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 15(5) :358–360, 2001. Web of Science, Google Scholar
3. Bohndorf K, Roth A. Bildgebung und klassifikation der aseptischen hüftkopfnekrose. Orthopade 47(9) :729–734, 2018. Web of Science, Google Scholar
4. Butt MF, Dhar SA, Gani NU, Farooq M, Mir MR, Halwai MA, Kangu KA, Mir BA, Kawoosa AA. Delayed fixation of displaced femoral neck fractures in younger adults. Injury 39(2) :238–243, 2008. Web of Science, Google Scholar
5. Clement ND, Green K, Murray N, Duckworth AD, McQueen MM, Court-Brown CM. Undisplaced intracapsular hip fractures in the elderly: Predicting fixation failure and mortality. A prospective study of 162 patients. J Orthop Sci 18(4) :578–585, 2013. Web of Science, Google Scholar
6. Conn KS, Parker MJ. Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res 421 :249–254, 2004. Web of Science, Google Scholar
7. De Laet CE, Pols HA. Fractures in the elderly: Epidemiology and demography. Baillieres Best Pract Res Clin Endocrinol Metab 14(2) :171–179, 2000. Web of Science, Google Scholar
8. Dolatowski FC, Adampour M, Frihagen F, Stavem K, Erik Utvåg S, Hoelsbrekken SE. Preoperative posterior tilt of at least 20^∘ increased the risk of fixation failure in Garden-I and -II femoral neck fractures: 322 patients followed for a mean of 3 years. Acta Orthop 87(3) :252–256, 2016. Web of Science, Google Scholar
9. Duckworth AD, Bennet SJ, Aderinto J, Keating JF. Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure. Bone Joint J 93-B(6) :811–816, 2011. Google Scholar
10. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br 53(2) :183–197, 1971. Google Scholar
11. Garden RS. Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am 5(4) :683–712, 1974. Web of Science, Google Scholar
12. Gjertsen JE, Vinje T, Lie SA, Engesaeter LB, Havelin LI, Furnes O, Fevang JM. Patient satisfaction, pain, and quality of life 4 months after displaced femoral neck fractures: A comparison of 663 fractures treated with internal fixation and 906 with bipolar hemiarthroplasty reported to the Norwegian Hip Fracture Register. Acta Orthop 79(5) :594–601, 2008. Web of Science, Google Scholar
13. Henari S, Leonard M, Hamadto M, Cogley D. Review of a single contemporary femoral neck fracture fixation method in young patients. Orthopedics 34(3) :171, 2011. Web of Science, Google Scholar
14. Jo S, Lee SH, Lee HJ. The Correlation between the fracture types and the complications after internal fixation of the femoral neck fractures. Hip Pelvis 28(1) :35, 2016. Google Scholar
15. Johansson T. Internal fixation compared with total hip replacement for displaced femoral neck fractures. J Bone Jt Surg 96(6) :e46, 2014. Web of Science, Google Scholar
16. Kang JS, Moon KH, Shin JS, Shin EH, Ahn CH, Choi GH. Clinical results of internal fixation of subcapital femoral neck fractures. CiOS Clin Orthop Surg 8(2) :146–152, 2016. Web of Science, Google Scholar
17. Lowe JA, Crist BD, Bhandari M, Ferguson TA. Optimal treatment of femoral neck fractures according to patient’s physiologic age: An evidence-based review. Orthop Clin North Am 41(2) :157–166, 2010. Web of Science, Google Scholar
18. Nikiforidis P, Babis GC, Papaioannou N, Korres DS, Pantazopoulos T. The role of primary total hip replacement for the treatment of the displaced femoral neck fractures. Eur J Orthop Surg Traumatol 7(1) :23–26, 1997. Google Scholar
19. Raaymakers ELFB. The non-operative treatment of impacted femoral neck fractures. Injury 33 :S-C8–S-C14, 2002. Web of Science, Google Scholar
20. Rockwood CA, Bucholz RW, Court-Brown CM, Heckman JD, Tornetta PJK. Rockwood and Green’s Fractures in Adults, 7th edn. Lippincott Williams & Wilikins, US, 2010. Google Scholar
21. Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury 47(12) :2743–2748, 2016. Web of Science, Google Scholar
22. Swart E, Roulette P, Leas D, Bozic KJ, Karunakar M. ORIF or arthroplasty for displaced femoral neck fractures in patients younger than 65 years old an economic decision analysis. J Bone Jt Surg Am 99(1) :65–75, 2017. Web of Science, Google Scholar
23. van Embden D, Roukema GR, Rhemrev SJ, Genelin F, Meylaerts SAG. The Pauwels classification for intracapsular hip fractures: is it reliable? Injury 42(11) :1238–1240, 2011. Web of Science, Google Scholar
24. Wiss DA. Master Techniques in Orthopaedic Surgery: Fractures, 3rd edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, US, 2013. Google Scholar
25. Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh T Te, Lian YT. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Jt Surg - Ser A 95(1) :61–69, 2013. Google Scholar