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Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation. METHODS: A retrospective mult...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Journal of Bone and Joint Surgery, Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568471/ https://www.ncbi.nlm.nih.gov/pubmed/34746632 http://dx.doi.org/10.2106/JBJS.OA.21.00045 |
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author | Sjöholm, Pontus Sundkvist, Jonas Wolf, Olof Sköldenberg, Olof Gordon, Max Mukka, Sebastian |
author_facet | Sjöholm, Pontus Sundkvist, Jonas Wolf, Olof Sköldenberg, Olof Gordon, Max Mukka, Sebastian |
author_sort | Sjöholm, Pontus |
collection | PubMed |
description | The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation. METHODS: A retrospective multicenter study was performed on a consecutive series of patients ≥60 years of age who had undergone primary internal fixation for the treatment of Garden Type-I and II femoral neck fractures. The study included 1,505 patients with a minimum follow-up of 2 years. Radiographic assessments encompassed preoperative and postoperative tilt, implant inclination, and treatment failure. Data on reoperation and mortality were collected. The risk of treatment failure was assessed with use of Cox proportional hazard regression analysis. RESULTS: The study comprised 1,505 patients (71% female) with a median age of 81 years (range, 60 to 108 years). Overall, 234 patients (16%) were classified as having a treatment failure and 251 patients (17%) underwent reoperation. A preoperative anterior tilt of >10° and a posterior tilt of >20° were predictors of treatment failure and reoperation, respectively. Treatment failure occurred in 74 (25%) of 301 patients with a posterior tilt of >20° and in 17 (43%) of 40 patients with an anterior tilt of >10°. CONCLUSIONS: This multicenter cohort study identified a subgroup of patients with Garden Type-I and II femoral neck fractures with an anterior tilt of >10° as having high treatment failure rates and major reoperation rates comparable with those associated with displaced femoral neck fractures. A preoperative posterior tilt of >20° increases the risk of treatment failure, and the potential benefit of arthroplasty in this subgroup of patients remains to be further investigated. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence. |
format | Online Article Text |
id | pubmed-8568471 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Journal of Bone and Joint Surgery, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85684712021-11-05 Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years Sjöholm, Pontus Sundkvist, Jonas Wolf, Olof Sköldenberg, Olof Gordon, Max Mukka, Sebastian JB JS Open Access Scientific Articles The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation. METHODS: A retrospective multicenter study was performed on a consecutive series of patients ≥60 years of age who had undergone primary internal fixation for the treatment of Garden Type-I and II femoral neck fractures. The study included 1,505 patients with a minimum follow-up of 2 years. Radiographic assessments encompassed preoperative and postoperative tilt, implant inclination, and treatment failure. Data on reoperation and mortality were collected. The risk of treatment failure was assessed with use of Cox proportional hazard regression analysis. RESULTS: The study comprised 1,505 patients (71% female) with a median age of 81 years (range, 60 to 108 years). Overall, 234 patients (16%) were classified as having a treatment failure and 251 patients (17%) underwent reoperation. A preoperative anterior tilt of >10° and a posterior tilt of >20° were predictors of treatment failure and reoperation, respectively. Treatment failure occurred in 74 (25%) of 301 patients with a posterior tilt of >20° and in 17 (43%) of 40 patients with an anterior tilt of >10°. CONCLUSIONS: This multicenter cohort study identified a subgroup of patients with Garden Type-I and II femoral neck fractures with an anterior tilt of >10° as having high treatment failure rates and major reoperation rates comparable with those associated with displaced femoral neck fractures. A preoperative posterior tilt of >20° increases the risk of treatment failure, and the potential benefit of arthroplasty in this subgroup of patients remains to be further investigated. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence. Journal of Bone and Joint Surgery, Inc. 2021-10-28 /pmc/articles/PMC8568471/ /pubmed/34746632 http://dx.doi.org/10.2106/JBJS.OA.21.00045 Text en Copyright © 2021 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Scientific Articles Sjöholm, Pontus Sundkvist, Jonas Wolf, Olof Sköldenberg, Olof Gordon, Max Mukka, Sebastian Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years |
title | Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years |
title_full | Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years |
title_fullStr | Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years |
title_full_unstemmed | Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years |
title_short | Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years |
title_sort | preoperative anterior and posterior tilt of garden i-ii femoral neck fractures predict treatment failure and need for reoperation in patients over 60 years |
topic | Scientific Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568471/ https://www.ncbi.nlm.nih.gov/pubmed/34746632 http://dx.doi.org/10.2106/JBJS.OA.21.00045 |
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