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Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures

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Abstract

Background

Hip fractures represent the most common injury and the main cause of morbidity and mortality among patients 65 years and older. About 20% of all femoral neck fractures (FNFs) are non-displaced or valgus impacted, for which internal fixation with the cannulated screws system (CSS) is indicated.

Aims

The aim of this study was to identify predictors of early failure of CSS.

Methods

Patients with non-displaced FNFs (Garden type I and II) treated operatively using the CSS were enrolled. Their characteristics, Pauwels angle, and posterior tilt were assessed and related with outcomes. The primary outcome was fixation failure within 6 months.

Results

259 patients were included with a mean age of 81.44 years. Most patients were female with ASA 3. The majority of fractures were classified as Garden I and Pauwels I. On average, Pauwels angle was 27°, while posterior tilt was 12°. A linear correlation between Pauwels angle and posterior tilt was found; the failure rate was 9.7%. Using the adjusted Cox competing risk regression analysis, posterior tilt was found to be independently associated with failure rate (sub-distribution hazard ratio or SHR 1.14 [95% CI 1.05–1.24], p = 0.0020). A posterior tilt greater than 18° resulted predictive of failure. The 1-year mortality rate was 12%.

Conclusions

Non-displaced Garden type II fractures, Pauwels type II or III fractures, and a posterior tilt greater than 18° represent radiographic predictors of CSS early failure in the elderly.

Level of evidence

Level IV, retrospective cohort study.

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References

  1. Singer BR, McLauchlan GJ, Robinson CM et al (1998) Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 80:243–248

    CAS  PubMed  Google Scholar 

  2. Chevalley T, Guilley E, Herrmann FR et al (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–1289

    CAS  PubMed  Google Scholar 

  3. Ju DG, Rajaee SS, Mirocha J et al (2017) Nationwide analysis of femoral neck fractures in elderly patients: a receding tide. J Bone Joint Surg Am 99:1932–1940

    PubMed  Google Scholar 

  4. Piirtola M, Vahlberg T, Isoaho R et al (2007) Incidence of fractures and changes over time among the aged in a Finnish municipality: a population-based 12-year follow-up. Aging Clin Exp Res 19:269–276

    PubMed  Google Scholar 

  5. Katsoulis M, Benetou V, Karapetyan T et al (2017) Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 281:300–310

    CAS  PubMed  Google Scholar 

  6. Biz C, Berizzi A, Crimi A et al (2017) Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. Acta Biomed 88:96–106

    PubMed  PubMed Central  Google Scholar 

  7. Florschutz AV, Langford JR, Haidukewych GJ et al (2015) Femoral neck fractures: current management. J Orthop Trauma 29:121–129

    PubMed  Google Scholar 

  8. Conn KS, Parker MJ (2004) Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res 421:249–254

    Google Scholar 

  9. Gjertsen J-E, Fevang JM, Matre K et al (2011) Clinical outcome after undisplaced femoral neck fractures. Acta Orthop 82:268–274

    PubMed  PubMed Central  Google Scholar 

  10. Lin JC-F, Liang W-M (2015) Outcomes after fixation for undisplaced femoral neck fracture compared to hemiarthroplasty for displaced femoral neck fracture among the elderly. BMC Musculoskelet Disord 16:199

    PubMed  PubMed Central  Google Scholar 

  11. Lu Q, Tang G, Zhao X et al (2017) Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial. Arch Orthop Trauma Surg 137:27–35

    PubMed  Google Scholar 

  12. Palm H, Gosvig K, Krasheninnikoff M et al (2009) A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures. Acta Orthop 80:303–307

    PubMed  PubMed Central  Google Scholar 

  13. Rogmark C, Flensburg L, Fredin H (2009) Undisplaced femoral neck fractures—no problems? A consecutive study of 224 patients treated with internal fixation. Injury 40:274–276

    PubMed  Google Scholar 

  14. Phillips JE, Christie J (1988) Undisplaced fracture of the neck of the femur: results of treatment of 100 patients treated by single Watson-Jones nail fixation. Injury 19:93–96

    CAS  PubMed  Google Scholar 

  15. Xu DF, Bi FG, Ma CY et al (2017) A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res 12:28

    PubMed  PubMed Central  Google Scholar 

  16. Do LND, Kruke TM, Foss OA et al (2016) Reoperations and mortality in 383 patients operated with parallel screws for Garden I-II femoral neck fractures with up to ten years follow-up. Injury 47:2739–2742

    PubMed  Google Scholar 

  17. Clement ND, Green K, Murray N et al (2013) Undisplaced intracapsular hip fractures in the elderly: predicting fixation failure and mortality. A prospective study of 162 patients. J Orthop Sci 18:578–585

    CAS  PubMed  Google Scholar 

  18. Schep NWL, Heintjes RJ, Martens EP et al (2004) Retrospective analysis of factors influencing the operative result after percutaneous osteosynthesis of intracapsular femoral neck fractures. Injury 35:1003–1009

    CAS  PubMed  Google Scholar 

  19. Dolatowski FC, Adampour M, Frihagen F et al (2016) Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures. Acta Orthop 87:252–256

    PubMed  PubMed Central  Google Scholar 

  20. SJöholm P, Otten V, Wolf O et al (2019) Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture. Acta Orthop 3:1–8

    Google Scholar 

  21. Lapidus LJ, Charalampidis A, Rundgren J et al (2013) Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. J Orthop Trauma 27:386–390

    PubMed  Google Scholar 

  22. Garden RS (1971) Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br 53-B:183–197

    Google Scholar 

  23. Padulo J, Oliva F, Frizziero A et al (2016) Muscles, ligaments and tendons journal—basic principles and recommendations in clinical and field science research: 2016 update. Muscles Ligaments Tendons J 6:1–5

    PubMed  PubMed Central  Google Scholar 

  24. Klestil T, Röder C, Stotter C et al (2018) Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 8:13933

    PubMed  PubMed Central  Google Scholar 

  25. Italian Ministry of Health. Percentuale interventi per frattura del femore effettuati entro due giorni, p 7. http://www.salute.gov.it/imgs/C_17_pubblicazioni_1421_allegato.pdf. Accessed 27 Sept 2019

  26. Bout CA, Cannegieter DM, Juttmann JW (1997) Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle. Injury 28:135–139

    CAS  PubMed  Google Scholar 

  27. Hackett NJ, De Oliveira GS, Jain UK et al (2015) ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg (London, England) 18:184–190

    Google Scholar 

  28. Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 43-B:647–663

    Google Scholar 

  29. Der schenkelhalsbruch: Ein mechanisches Problem. By Dr. Friedrich Pauwels (Aachen). Royal 8vo. Pp. 157, with 186 illustrations. 1935. Stuttgart: Ferdinand Enke. Paper covers, RM. 13.60; bound, RM. 15.00 (1936). BJS 23:874–874

  30. Gardner S, Weaver MJ, Jerabek S et al (2015) Predictors of early failure in young patients with displaced femoral neck fractures. J Orthop 12:75–80

    PubMed  Google Scholar 

  31. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet (London, England) 359:1761–1767

    Google Scholar 

  32. Friedman SM, Mendelson DA (2014) Epidemiology of fragility fractures. Clin Geriatr Med 30:175–181

    PubMed  Google Scholar 

  33. Doyle DJ, Garmon EH (2019) American Society of Anesthesiologists Classification (ASA Class). In. StatPearls Publishing LLC., Treasure Island

    Google Scholar 

  34. Bartonicek J (2001) Pauwels’ classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 15:358–360

    CAS  PubMed  Google Scholar 

  35. Cha YH, Yoo JI, Hwang SY et al (2019) Biomechanical evaluation of internal fixation of Pauwels Type III femoral neck fractures: a systematic review of various fixation methods. Clin Orthop Surg 11:1–14

    PubMed  PubMed Central  Google Scholar 

  36. Liporace F, Gaines R, Collinge C et al (2008) Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am 90:1654–1659

    PubMed  Google Scholar 

  37. Ye Y, Chen K, Tian K et al (2017) Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: surgical technique and preliminary results. Injury 48:2189–2193

    PubMed  Google Scholar 

  38. Hoelsbrekken SE, Dolatowski FC (2017) The influence of the hips position on measurements of posterior tilt in a valgus-impacted femoral neck fracture. Injury 48:2184–2188

    PubMed  Google Scholar 

  39. Parker MJ, White A, Boyle A (2008) Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures. Injury 39:791–795

    PubMed  Google Scholar 

  40. Hui AC, Anderson GH, Choudhry R et al (1994) Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. J Bone Joint Surg Br 76:891–894

    CAS  PubMed  Google Scholar 

  41. Sikand M, Wenn R, Moran CG (2004) Mortality following surgery for undisplaced intracapsular hip fractures. Injury 35:1015–1019

    CAS  PubMed  Google Scholar 

  42. Stewart NA, Chantrey J, Blankley SJ et al (2011) Predictors of 5 year survival following hip fracture. Injury 42:1253–1256

    PubMed  Google Scholar 

  43. Iskrant AP (2010) The classic: the etiology of fractured hips in females. 1968. Clin Orthop Relat Res 468:1731–1735

    PubMed  PubMed Central  Google Scholar 

  44. Barnes R, Brown JT, Garden RS et al (1976) Subcapital fractures of the femur. A prospective review. J Bone Joint Surg Br 58:2–24

    CAS  PubMed  Google Scholar 

  45. Min BW, Kim SJ (2011) Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture. Orthopedics 34:349

    PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Orthopaedic, Traumatological and Oncological Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128, Padua, Italy

    Carlo Biz, Jacopo Tagliapietra, Filippo Zonta, Elisa Belluzzi & Pietro Ruggieri

  2. Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128, Padua, Italy

    Elisa Belluzzi

  3. Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON, Canada

    Nicola Luigi Bragazzi

Authors
  1. Carlo Biz
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  2. Jacopo Tagliapietra
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  3. Filippo Zonta
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  4. Elisa Belluzzi
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  5. Nicola Luigi Bragazzi
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Correspondence to Carlo Biz.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Biz, C., Tagliapietra, J., Zonta, F. et al. Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures. Aging Clin Exp Res 32, 505–513 (2020). https://doi.org/10.1007/s40520-019-01394-1

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