A1 Refereed original research article in a scientific journal

Preoperative Posterior Tilt Increases the Risk of Later Conversion to Arthroplasty After Osteosynthesis for Femoral Neck Fracture




AuthorsHonkanen Jukka S, Ekman Elina M, Huovinen Ville K, Mäkelä Keijo T, Koivisto Mari, Karvonen Mikko P, Laaksonen Inari

PublisherElsevier

Publication year2021

JournalJournal of Arthroplasty

Journal name in sourceThe Journal of arthroplasty

Journal acronymJ Arthroplasty

Volume36

Issue9

First page 3187

Last page3193

ISSN0883-5403

eISSN1532-8406

DOIhttps://doi.org/10.1016/j.arth.2021.04.039(external)

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/58610167(external)


Abstract

Background

Femoral neck fractures(external) (FNFs) are one of the most common injuries in the elderly. Treatment is either internal fixation or primary arthroplasty(external). The main aim of this study is to assess the risk factors associated with fixation failure(external) leading to further arthroplasty in FNFs treated with cannulated screws.


Methods

Data on internal fixations of FNFs performed at Turku University Hospital between January 1, 2012 and December 31, 2017 were collected retrospectively from the patient database. Radiographical measurements were performed for preoperative displacement and posterior tilt, postoperative displacement, reduction quality, and implant shaft angle.


Results

Altogether 301 cases were included in the study. The overall reoperation(external) rate was 25% and conversion to arthroplasty was performed in 16% of cases. In the multiple variant analysis, adjusted for age and gender, nondisplaced fractures with a 0°-20° preoperative posterior tilt had a significantly lower risk of later conversion to arthroplasty than did nondisplaced fractures with a ≤0° or ≥20° posterior tilt (odds ratio [OR] 4.0, 95% confidence interval [Cl] 1.8-8.6, P = .0005) and displaced fractures (OR 7.2, 95% CI 3.0-17.4, P < .0001). No statistically significant association was found between preoperatively nondisplaced fractures with a <0° or ≥20° posterior tilt and displaced fractures (OR 0.6, 95% Cl 0.2-1.3, P = .2).


Conclusion

Displaced fractures and fractures with a preoperative posterior tilt of <0° or ≥20° have a considerably increased risk of reoperation and conversion to arthroplasty. Primary arthroplasty should be considered as treatment for displaced FNFs and fractures with >20° or <0° posterior tilt, especially in fragile patients, to avoid further operations.


Keywords
internal fixationarthroplastyreoperationfixation failureposterior tiltfemoral neck fracture

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Last updated on 2024-26-11 at 10:43