Orthopaedics & traumatology, surgery & research : OTSR · 2025
Demographic and radiographic predictors of failed internal fixation in subcapital femoral neck fractures.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Feygelman Shelly, Ronel Dror, Maman David, Peskin Bezalel, Ghrayeb Nabil, Shapira Jackob
Аннотация
BACKGROUND: Internal fixation with three screws remains a common treatment for subcapital femoral neck fractures, particularly when preservation of the native joint is preferred. However, failure rates remain significant, and identifying risk factors for failure is crucial for patient selection and surgical planning. This study aimed to define demographic, laboratory, and radiographic risk factors associated with failed osteosynthesis of intra-capsular femoral neck fractures.
METHODS: We conducted a retrospective case-control study at a single tertiary trauma center in northern Israel, including 735 patients treated between 2004 and 2020. All patients underwent internal fixation using three cannulated screws. Variables analyzed included patient demographics, comorbidities, laboratory values, and radiographic features. Radiographic analysis was performed on all failed cases and a sample of 98 successful cases. Multivariate logistic regression and ROC analysis were used to identify independent predictors of fixation failure.
RESULTS: Of the 735 patients included, 40 (5.4%) experienced fixation failure requiring conversion to total hip arthroplasty. Univariate analysis revealed several associated factors, including smoking, hemoglobin, eGFR, fracture classification, calcar impairment, reduction type, screw convergence, and VN angle as demonstrated in Table 1. Multivariate analysis identified younger age, convergent screw configuration, and increased VN angle as independent risk factors. Thresholds were determined as >2.5 ° of screw convergence and VN angle >13.25 °.
CONCLUSION: Fixation failure was associated with both patient-related and technical factors. Younger age, fracture verticality, and convergent screw configuration significantly increased the risk of failure. Recognizing these variables may assist in preoperative decision-making and optimize treatment strategies for femoral neck fractures.
LEVEL OF EVIDENCE: III; Case control retrospective study.
METHODS: We conducted a retrospective case-control study at a single tertiary trauma center in northern Israel, including 735 patients treated between 2004 and 2020. All patients underwent internal fixation using three cannulated screws. Variables analyzed included patient demographics, comorbidities, laboratory values, and radiographic features. Radiographic analysis was performed on all failed cases and a sample of 98 successful cases. Multivariate logistic regression and ROC analysis were used to identify independent predictors of fixation failure.
RESULTS: Of the 735 patients included, 40 (5.4%) experienced fixation failure requiring conversion to total hip arthroplasty. Univariate analysis revealed several associated factors, including smoking, hemoglobin, eGFR, fracture classification, calcar impairment, reduction type, screw convergence, and VN angle as demonstrated in Table 1. Multivariate analysis identified younger age, convergent screw configuration, and increased VN angle as independent risk factors. Thresholds were determined as >2.5 ° of screw convergence and VN angle >13.25 °.
CONCLUSION: Fixation failure was associated with both patient-related and technical factors. Younger age, fracture verticality, and convergent screw configuration significantly increased the risk of failure. Recognizing these variables may assist in preoperative decision-making and optimize treatment strategies for femoral neck fractures.
LEVEL OF EVIDENCE: III; Case control retrospective study.