Can we predict failure of percutaneous fixation of femoral neck fractures?
| Autor: | Jodi Siegel, Jacob Jo, Paul E. Matuszewski, Christina Kane, Eric F. Swart |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Coxa Vara
Male Reoperation medicine.medical_specialty medicine.medical_treatment Bone Screws Femoral Neck Fractures 03 medical and health sciences 0302 clinical medicine Fracture Fixation Coxa Valga Humans Medicine Treatment Failure Aged Retrospective Studies General Environmental Science Femoral neck Aged 80 and over 030222 orthopedics Hip fracture biology business.industry Trauma center Reproducibility of Results 030208 emergency & critical care medicine medicine.disease biology.organism_classification Arthroplasty Closed Fracture Reduction Surgery Radiography Percutaneous pinning Valgus medicine.anatomical_structure Case-Control Studies Orthopedic surgery General Earth and Planetary Sciences Female business Follow-Up Studies |
| Zdroj: | Injury. 51:357-360 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2019.10.068 |
| Popis: | Purpose This study evaluated a series of geriatric femoral neck fracture treated with closed reduction percutaneous pinning (CRPP) at a single level-1 trauma center to determine if there are any simple, reliable, radiographic characteristics that can be used to predict increased risk of post-operative failure in nondisplaced and valgus impacted fracture patterns. Methods We conducted a retrospective cohort study of all patients with femoral neck fractures (AO/OTA 31B) who underwent CRPP over a 12-year period at a single Level 1 trauma center. Failure was defined as radiographic failure within the first year after the index operation requiring revision surgery. Common patterns identified on initial review were the presence of a visible medial transcervical line (MTL) felt to indicate a tension-sided failure, a straight inferior calcar (SIC) indicating severe valgus impaction, and quality of intra-operative screw positioning. X-rays of patients were then reviewed for these characteristics in a blinded manner by three different trauma-fellowship trained orthopedic surgeons. Inter-rater reliability was calculated using Fleiss’ Kappa Coefficient. Comparisons of failure rates between groups were made using a Fisher's Exact test. Results 139 patients who underwent CRPP for a femoral neck fracture and follow-up for at least 90 days were identified and reviewed. There were a total of 19 failures (13.6%) within one year. The patients with a varus fracture had a failure rate of 9/24 (37.5%). Of the valgus/nondisplaced fractures, MTL was identified in 42/115 (36%) patients. Inter-rater agreement was high for the presence of an MTL (84%, Kappa 0.69). Patients with an MTL had a fourfold increase in risk of failure (7/42=17% with an MTL vs. 3/73=4% without, p 0.03). The presence of a SIC and quality of screw placement were not predictive of failure. Conclusion Varus femoral neck fractures fixed with CRPP have a high rate of failure (37.5%). Nondisplaced or valgus impacted fractures with the presence of a visible medial transcervical line on pre-operative radiographic imaging resulted in a fourfold increase in the risk of failure after CRPP. Identification of the MTL will help treating surgeons better council patients when making pre-operative decisions between arthroplasty and CRPP. |
| Databáze: | OpenAIRE |
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