Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients

Abstract

Purpose: The aim of this study was to evaluate outcomes of internal fixation for displaced femoral neck fracture (FNF) between 50 and 60 years old. The patient and surgical factors for the failure were identified. Methods: We retrospectively reviewed the records of 102 displaced FNF patients between 50 and 60 years old (mean age 54.9 years) who had undergone internal fixation between 2005 and 2016. The minimum follow-up was 12 months. Primary end points included loss of reduction, non-union, and osteonecrosis of the femoral head (ONFH). Preoperative Pauwel’s angle, fixation timing and methods, reduction quality, removal of implant and medical comorbidities were analysed. Results: The overall failure rate was 44.1%. In multivariate logistic regression analysis, poor reduction quality (adjusted odds ratio [aOR] 4.38; 95% confidence interval [CI], 1.54–12.46) and internal fixation delayed more than 6 hours (aOR 3.24; 95% CI, 1.08–9.69) were risk factors for all causes of failure. In a stratified analysis, poor reduction quality (aOR 3.81; 95% CI, 1.11–13.04) and a history of alcohol dependency (aOR 4.91; 95% CI, 1.09–22.13) were risk factors for loss of reduction. Internal fixation delayed >6 hours (aOR 3.67; 95% CI, 1.05–12.77) and removal of implant (aOR 3.32; 95% CI, 1.02–10.77) were risk factors for ONFH. Conclusions: The outcome of internal fixation of displaced FNF in patients between 50 and 60 years old is suboptimal. The patient selection is important. Non-alcohol dependency lowered early failure. Implant retention reduced ONFH. Surgery within 6 hours and good quality of reduction yield better results.

Comparison of femoral mechanics before and after internal fixation removal and the effect of sclerosis on femoral stress: a finite element analysis

“…The elastic modulus of the sclerotic region is three times higher than that of the normal cancellous bone, which is in line with our hypothesis. Moreover, this value is within the range of cancellous bone elastic moduli determined in other studies [17,18] .…”

Risk factors for and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures

“…7 Conservative treatment is rarely applied because of poor outcomes. 8 Thus, most femoral neck fractures are treated surgically. Elderly patients with femoral neck fractures often develop ALI, and hypoxaemia is the most common symptom in patients with ALI.…”

“…7 Conservative treatment is rarely applied because of poor outcomes. 8 Thus, most femoral neck fractures are treated surgically.…”

Biomechanical effects of internal fixation with self-lock compression anti-rotation blade for Pauwels type III femoral neck fractures: a comparative finite element analysis

“…A metaanalysis study also pointed out that DHS and CS showed no difference in the rates of reoperation, nonunion and mortality, and CS was superior to DHS on femoral head necrosis [34]. Moreover, DHS has the shortcomings of longer operation time, larger operative trauma, more bleeding, less bone preservation after implantation, and more serious bone damage [6]. In contrast, CS has the advantages of less invasion of soft tissues, less bone damage, simpler procedure and so on, which can well avoid the deficiencies of DHS.…”

“…However, vertical Pauwels type III FNFs are unstable due to shearing forces [3] and after internal fixation the fracture fragments tend to displace, resulting in a high incidence of complications. According to the literature, the incidence of non-union after internal fixation of Pauwels type III FNF ranges from 16% to over 30%, and the incidence of femoral head necrosis from 11% to over 45%, seriously obstructing the prognosis of patients [4][5][6].…”