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 |
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| Institution: | 1. Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea;2. Department of Orthopaedic Surgery, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea;1. Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA;2. Division of Trauma, Kings County Hospital Medical Center, Brooklyn, NY 11203, USA;3. Department of Family Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA;4. Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA;1. Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland;2. Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland;3. Division of Anatomy, University of Geneva Medical Center, Geneva, Switzerland;4. Faculté de Médecine, University of Geneva Medical Center, Geneva, Switzerland;1. Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea;2. Department of Mathematics, College of Natural Science, Ajou University, Gyeonggi, South Korea;1. Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK;2. Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, UK;1. Department of Surgery, University of Calgary, Calgary, Alberta, Canada;2. Department of Surgery, University of California, San Francisco, CA, United States;1. R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States;2. R Adams Cowley Shock Trauma Center, Division of Infectious Disease, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States;3. Laboratories of Pathology, University of Maryland Medical System, Baltimore, MD, United States |
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| Abstract: | IntroductionThe aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures.Patients and methodsWe conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50–97 years), with a mean follow-up of 21.4 months (range, 12–64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses.ResultsFIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt > 15° (p = 0.023), posterior tilt > 15° (p = 0.012), and screw sliding distance (p = 0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p < 0.001). The odds of FIT were 17-fold higher in patients with initial valgus and posterior tilts > 15° (B1.1.2) compared to patients with <15° of tilt in both planes (B1.2.1).ConclusionThe severity of initial deformity predicts AVN and FF in patients with valgus angulated femoral neck fractures. Patients with an initial valgus and posterior tilt > 15° are reasonable candidates for primary arthroplasty due to high risk of FIT. |
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| Keywords: | Femur neck fracture Valgus angulated Screw osteosynthesis Fixation failure Avascular necrosis |
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