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Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study

BACKGROUND: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior til...

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Autores principales: Nie, Sheng-Bo, Liu, Jun-Feng, Zhu, Jiang-Hua, Zhou, Zi-Fei, Zhang, Lei, Zheng, Long-Po
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127219/
https://www.ncbi.nlm.nih.gov/pubmed/34001151
http://dx.doi.org/10.1186/s13018-021-02456-9
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author Nie, Sheng-Bo
Liu, Jun-Feng
Zhu, Jiang-Hua
Zhou, Zi-Fei
Zhang, Lei
Zheng, Long-Po
author_facet Nie, Sheng-Bo
Liu, Jun-Feng
Zhu, Jiang-Hua
Zhou, Zi-Fei
Zhang, Lei
Zheng, Long-Po
author_sort Nie, Sheng-Bo
collection PubMed
description BACKGROUND: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt. METHODS: We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt. RESULTS: Age, gender, Garden classification, posterior comminution, and reduction quality showed no significant difference between the groups. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1–4.3°) than that in the NTS group (5.3°, 4.2–8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1–4.7) mm vs. 4.3 (3.1–6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0–90.0 vs. 82.0, 76.0–84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6–70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6–56.1, p = 0.002), and NTS configuration (reference: ALTS configuration) (OR 21.9, 95% CI 4.1–116.4, p < 0.001) as risk factors for developing posterior tilt. CONCLUSIONS: Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (reference: ALTS) are risk factors for developing posterior tilt. TRIAL REGISTRATION: The trial registration number was ChiCTR2000039482.
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spelling pubmed-81272192021-05-17 Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study Nie, Sheng-Bo Liu, Jun-Feng Zhu, Jiang-Hua Zhou, Zi-Fei Zhang, Lei Zheng, Long-Po J Orthop Surg Res Research Article BACKGROUND: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt. METHODS: We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt. RESULTS: Age, gender, Garden classification, posterior comminution, and reduction quality showed no significant difference between the groups. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1–4.3°) than that in the NTS group (5.3°, 4.2–8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1–4.7) mm vs. 4.3 (3.1–6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0–90.0 vs. 82.0, 76.0–84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6–70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6–56.1, p = 0.002), and NTS configuration (reference: ALTS configuration) (OR 21.9, 95% CI 4.1–116.4, p < 0.001) as risk factors for developing posterior tilt. CONCLUSIONS: Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (reference: ALTS) are risk factors for developing posterior tilt. TRIAL REGISTRATION: The trial registration number was ChiCTR2000039482. BioMed Central 2021-05-17 /pmc/articles/PMC8127219/ /pubmed/34001151 http://dx.doi.org/10.1186/s13018-021-02456-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Nie, Sheng-Bo
Liu, Jun-Feng
Zhu, Jiang-Hua
Zhou, Zi-Fei
Zhang, Lei
Zheng, Long-Po
Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
title Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
title_full Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
title_fullStr Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
title_full_unstemmed Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
title_short Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
title_sort anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127219/
https://www.ncbi.nlm.nih.gov/pubmed/34001151
http://dx.doi.org/10.1186/s13018-021-02456-9
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