Risk Factors for Nonunion in Patients with Intracapsular Femoral Neck Fractures Treated with Three Cannulated Screws Placed in Either a Triangle or an Inverted Triangle Configuration

Yang, Jui-Jung; Lin, Leou-Chyr; Chao, Kuo-Hua; Chuang, Shih-Youeng; Wu, Chia-Chun; Lian, Yu-Tung

doi:10.2106/jbjs.k.01081

Cited by 182 publications

(128 citation statements)

References 22 publications

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“…Minimal displacement, adequate stability, sufficient nutrition and absence of infection are some of the factors that support fracture repair. Western literature identify the risk factors for non-union to include displacement, smoking/nicotine use, infection, magnitude of injury, biomechanical instability, malnutrition and vitamin deficiency, iatrogenic factors, diabetes mellitus and nonsteroidal anti-inflammatory drugs use [6,7,[13][14][15]. The role of osteoporosis is inconclusive [13].…”

Section: Discussionmentioning

confidence: 99%

Long Bone Non-Unions and Malunions: Risk Factors and Treatment Outcomes in Calabar, Southern Nigeria

Ikpeme¹,

Mkpanam²,

Abang³

et al. 2013

OJO

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Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible after a fracture incident. Malunions and non unions present a treatment challenge with the need for prolonged hospitalization, multiple surgical interventions and economic burden. In the developing world, traditional bonesetting practices are popular and these often result in a host of preventable complications. The added socioeconomic costs of treating these complications present a considerable strain on the resources of these already fragile economies and households. Aim: To document the risk factors, treatment options and outcomes for diaphyseal non-unions and malunions in our environment. Patients and Methods: Fifty-two consecutive patients comprising 37 non-unions and 15 malunions who presented in the orthopaedic unit of a tertiary hospital in Southern Nigeria were evaluated. Information sought included biodata, location of pathology, type of incident fracture, local risk factors including traditional bonesetting; treatment options and final outcomes. Information obtained was analyzed using SPSS version 20 (IBM, New York). Results are presented in simple frequency tables. Results: There were 34 males and 18 females (M:F = 1.9:1) with a mean age of 38.76 ± 14.55 years. There were 37 non-unions and 15 malunions. The femur was the commonest site of pathology in 21 (40.4%) cases, and among the non-unions, the atrophic variety was the commonest type (n = 26; 70.3%). The mean fracture-to-surgery interval was 11.35 ± 7.95 months and traditional bonesetting was the commonest risk factor (n = 36; 69.2%). Plate and screw Osteosynthesis with bonegraft augmentation was the commonest treatment modality and the overall union rate was 94%. Conclusion: Traditional bonesetting plays a major role in the health seeking behaviour of many African societies. The complications are varied and add to the overall socioeconomic burden of fracture care in these developing economies. Identification of traditional bonesetting practices as an important risk factor should translate into a focus on these practices in preventive public health decisions in fracture care. Continuing public health education backed by political will and can potentially drive a paradigm shift in health seeking attitudes in the developing world.

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Section: Discussionmentioning

confidence: 99%

Long Bone Non-Unions and Malunions: Risk Factors and Treatment Outcomes in Calabar, Southern Nigeria

Ikpeme¹,

Mkpanam²,

Abang³

et al. 2013

OJO

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“…Regarding fixation with three screws, experimental studies have shown increased mechanical stability using a triangular pattern compared to a vertical screw orientation and that the apex down configuration reduces the risk of a later subtrochanteric fracture compared to apex up configuration (Selvan et al 2004, Oakey et al 2006, Lichtblau et al 2008. A recent clinical report including 202 patients treated for a femoral neck fracture with either a triangle screw configuration or an inverted triangle configuration, found a significant difference in union rate in favor of the inverted triangle configuration (Yang et al 2013). They also discussed an apparent increased risk of subtrochanteric fractures when two distal screws are placed horizontally.…”

Section: Multiple Pins and Screwsmentioning

confidence: 99%

Internal fixation of fragility fracturesof the femoral neck

Basso¹

2015

Acta Orthopaedica

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“…Another departure from the traditional inverted triangle configuration is the use of triangular parallel screws, which feature 2 inferior screws and 1 superior screw. Yang et al found that femoral neck fractures stabilised the triangle configuration and had a significantly higher nonunion rate than those fixed with the traditional inverted triangle pattern [17].…”

Section: Biomechanical Studiesmentioning

confidence: 99%

Fixed angle devices versus multiple cancellous screws: What does the evidence tell us?

Hoshino

O’Toole

2015

Injury

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Risk Factors for Nonunion in Patients with Intracapsular Femoral Neck Fractures Treated with Three Cannulated Screws Placed in Either a Triangle or an Inverted Triangle Configuration

Abstract: Screw fixation with a triangle configuration, a displaced fracture, and poor reduction are risk factors for nonunion in intracapsular femoral neck fractures treated with fixation with multiple screws.

Cited by 182 publications

References 22 publications

Long Bone Non-Unions and Malunions: Risk Factors and Treatment Outcomes in Calabar, Southern Nigeria

Long Bone Non-Unions and Malunions: Risk Factors and Treatment Outcomes in Calabar, Southern Nigeria

Internal fixation of fragility fracturesof the femoral neck

Fixed angle devices versus multiple cancellous screws: What does the evidence tell us?

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