Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures

Abstract

The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis

“…Of the 16 included studies, 4 reported [16, 19, 26, 33] the correlation between gender and ONFH after IFFNF. Because of nonsignificant heterogeneity among the studies, the fixed effect model was utilized ( I 2 = 25%, P = 0.26).…”

“…Data on age were available for the meta-analysis from 4 studies [16, 17, 19, 28], and nonsignificant heterogeneity was presented among the studies ( I 2 = 17%, P = 0.31). Therefore, the fixed effect model was applied.…”

“…Though various treatments for FNF have sprung up, IF with autologous hip joint is still the mainstream [3–5]. ONFH, or avascular necrosis of femoral head, is the ultimate consequence of impaired blood supply.…”

Operative Therapie medialer Oberschenkelhalsbrüche

“…Keinesfalls sollte eine im Valgus impaktierte Fraktur während der Operation disloziert und somit destabilisiert werden -die Osteosynthese erfolgt in situ. Vor einer zu starken Valgisierung unter der Operation sei gewarnt, da diese mit einem erhöhten Hüftkopfnekroserisiko vergesellschaftet ist (2,12). Dislozierte mediale Schenkelhalsfrakturen (Garden-Typen III und IV) sollten nur bei jungen Patienten exakt reponiert und einer Osteosynthese zugeführt werden, um das Hüftgelenk zu erhalten.…”

Poor Outcomes of Children and Adolescents with Femoral Neck Fractures: A Meta‐Analysis Based on Clinical Studies

“…Avascular necrosis of the femoral head and nonunion of fractures are the two major complications in the therapy of femoral neck fractures. The optimal treatment method of femoral neck fractures is manual reduction and internal fixation, and the healing rate is 80% to 90%. Therefore, the treatment principle of femoral neck fractures is early non‐traumatic reduction, reasonable multiple nail fixation, and early recovery.…”