Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18–65 Years
| Autor: | Antonios Tsismenakis, Saam Morshed, Darin Friess, Clifford B. Jones, William T. Obremskey, David Teague, Ross Leighton, Theodore Miclau, Brian Mullis, Andrew H. Schmidt, J. Spence Reid, Paul Tornetta, Anas Saleh, Keisuke Ishii, John A. Ruder, Robert F. Ostrum, Jerald R. Westberg, Joseph T. Patterson, Jeffrey MacLean, Ari D. Levine |
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| Rok vydání: | 2020 |
| Předmět: |
030222 orthopedics
medicine.medical_specialty business.industry medicine.medical_treatment 030208 emergency & critical care medicine Retrospective cohort study General Medicine Arthroplasty Femoral Neck Fractures Surgery 03 medical and health sciences Femoral head 0302 clinical medicine medicine.anatomical_structure Propensity score matching medicine Internal fixation Orthopedics and Sports Medicine business Reduction (orthopedic surgery) Femoral neck |
| Zdroj: | Journal of Orthopaedic Trauma. 34:294-301 |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0000000000001711 |
| Popis: | Objectives To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation. Design Retrospective cohort study with radiograph and chart review. Setting Twelve Level 1 North American trauma centers. Patients Two hundred thirty-four adults 18-65 years of age with an isolated, displaced, OTA/AO type 31-B2 or type 31-B3 femoral neck fracture treated with internal fixation with minimum of 6-month follow-up or reoperation. Exclusion criteria were pathologic fractures, associated femoral head or shaft fractures, and primary arthroplasty. Intervention Open or closed reduction technique during internal fixation. Main outcome Cox proportional hazard of reoperation adjusting for propensity score for open reduction based on injury, demographic, and medical factors. Reduction quality was assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs. Results Median follow-up was 1.5 years. One hundred six (45%) patients underwent open reduction. Reduction quality was not significantly affected by open versus closed approach (71% vs. 69% acceptable, P = 0.378). The propensity to receive an open reduction was associated with study center; younger age; male sex; no history of injection drug use, osteoporosis, or cerebrovascular disease; transcervical fracture location; posterior fracture comminution; and surgery within 12 hours. A total of 35 (33%) versus 28 (22%) reoperations occurred after open versus closed reduction (P = 0.056). Open reduction was associated with a 2.4-fold greater propensity-adjusted hazard of reoperation (95% confidence interval 1.3-4.4, P = 0.004). A total of 35 (15%) patients underwent subsequent total hip arthroplasty or hemiarthroplasty. Conclusions Open reduction of displaced femoral neck fractures in nonelderly adults is associated with a greater hazard of reoperation without significantly improving reduction. Prospective randomized trials are indicated to confirm a causative effect of open versus closed reduction on outcomes after femoral neck fracture. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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