Eight orthopedic surgeons achieved moderate to excellent reliability measuring the preoperative posterior tilt angle in 50 Garden-I and Garden-II femoral neck fractures

Dolatowski, Filip C.; Hoelsbrekken, Sigurd Erik

doi:10.1186/s13018-017-0632-x

Cited by 9 publications

(13 citation statements)

References 13 publications

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“…We did not perform any validation of the measurements; however, the inter- and intra-rater reliability of posterior tilt measurements in cases of minimally displaced FNFs has previously been reported to be excellent although the repeatability and agreement by the minimal detectable change were found to be 14° (Palm et al. 2009, Dolatowski and Hoelsbrekken 2017).…”

Section: Discussionmentioning

confidence: 97%

Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture

et al. 2019

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Background and purpose — Preoperative posterior tilt of the femoral head as seen on lateral radiographs has been reported to affect the risk of fixation failure in cases of minimally displaced femoral neck fractures (Garden I–II). We investigated radiological risk factors of treatment failure.Patients and methods — We included 417 patients (68% women, median age: 78 years (50–108) with a minimally displaced femoral neck fracture (Garden I–II) treated with internal fixation in a retrospective cohort study. The patients were followed for 3.4 years (2–14). Data on age, sex, housing, cognitive impairment, implant angulation, pre- and postoperative tilt, hip complications, and reoperations were recorded. The risk of fixation failure was assessed using Cox proportional hazards regression analysis.Results — The overall reoperation rate was 17%, and the rate of treatment failure (fixation failure, nonunion, avascular necrosis, or posttraumatic osteoarthritis) was 13%. Cox proportional hazard analysis revealed an increased risk of treatment failure with a preoperative posterior tilt of at least 20° and a preoperative anterior tilt greater than 10°. A failure occurred in 13 of the 65 patients with a posterior tilt of at least 20° and in 5 of the 9 patients with an anterior tilt greater than 10°.Interpretation — A preoperative posterior tilt of 20° and an anterior tilt greater than 10° in cases of Garden I and II femoral neck fractures increase the risk of fixation failure necessitating additional surgery. In this group of patients, there is a need for future interventional studies regarding the feasibility of primary hip arthroplasty.

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Section: Discussionmentioning

confidence: 97%

Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture

et al. 2019

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“…Two studies have indicated that a posterior tilt of >20° is associated with an increased risk of fixation failure 2,3 , but those findings have been contested by the authors of a third study 17 . The conflicting results could possibly be explained by measurements having poor reliability, but the reliability has been reported to be moderate to excellent 2,4 . It is therefore unlikely that low reliability is the cause of the observed inconsistencies, which underlines the importance of determining the validity of the measurements.…”

Section: Discussionmentioning

confidence: 99%

“…CT images were compared with the corresponding radiographs, but minor changes are difficult to evaluate and we cannot exclude the possibility of a change occurring between CT scans and radiographic examinations. We also did not assess the reliability of the measurements used in the present study, but we previously evaluated both test-retest and intertester reliability of these measurements 4,9 . The measurements were all found to be acceptable, with the exception of femoral head rotation in 3D models 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Angular measurements can be used to express the severity of posterior tilt, and previous findings have suggested that fractures with a posterior tilt of >20° are associated with an increased risk of treatment failure after internal fixation 2,3 . These angular measurements have been shown to be both reliable and independent of the position of the injured hip during radiographic examinations 2,4,5 ; however, to our knowledge, the measurements have never been validated against a reference or gold standard despite their potential importance in the decision-making process.…”

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confidence: 99%

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Cross-Table Lateral Radiographs Accurately Predict Displacement in Valgus-Impacted Femoral Neck Fractures

Temmesfeld

Dolatowski

Borthne

et al. 2019

JBJS OA

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Background: Femoral neck fractures are classified as nondisplaced (Garden types I and II) or displaced (Garden types III and IV) on the basis of anteroposterior radiographs. Cross-table lateral radiographs are important in the assessment of Garden type-I and II fractures as posterior tilt of the femoral head may influence treatment results. A posterior tilt of >20° has been associated with an increased risk of treatment failure after internal fixation, although the precision of these measurements has not been validated. Therefore, the purpose of the present study was to compare cross-table lateral radiographs with 3-dimensional computed tomographic (3D-CT) reconstructions of Garden type-I and II femoral neck fractures. Methods: Twenty-three patients presenting with Garden type-I and II femoral neck fractures that were verified on anteroposterior radiographs underwent CT scanning immediately after radiographic examination. 3D models of the fractured and uninjured femora were reconstructed from the CT images, and displacement of the 3D models was determined by superimposing the fractured and uninjured femora. We defined a coordinate system with its origin at the center of the uninjured femoral head with the x axis oriented medially; the y axis, posteriorly; and the z axis, cranially. Correlations between lateral radiographs and 3D models were assessed with the Spearman rank coefficient, mean difference, and limits of agreement. Results: Posterior tilt of the femoral head on lateral radiographs was strongly correlated with displacement of the femoral head along the y axis of the 3D models, with a correlation coefficient of 0.86 (p < 0.001). Correlations between the findings on lateral radiographs and displacements along the x or z axis were weak, with coefficients of −0.30 (p = 0.18) and 0.21 (p = 0.34), respectively. The mean difference between displacement on lateral radiographs and displacement along the y axis of the 3D models was smaller, and demonstrated a smaller limits-of-agreement interval, compared with the x or z axis. Conclusions: Our results demonstrated a strong correlation between posterior displacement of the femoral head on lateral radiographs and displacement along the y axis in 3D models of Garden type-I and II femoral neck fractures. This finding indicates that lateral radiographs provide an accurate assessment of posterior tilt.

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“…The femoral neck fractures are classified into Garden type I and II (NDFNFs) and Garden type III and IV (displaced femoral neck fractures) (Table 1 ). The NDFNFs are prone to re-displacement, resulting in a fracture healing rate of 44.3% and a postoperative re-displacement rate of 33% to 44% [ 3 , 4 ]. Therefore, surgical treatments may be a better option for the elderly [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

An overview on the treatment strategies of non-displaced femoral neck fracture in the elderly

Zhou

Zhang

et al. 2022

Arthroplasty

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Background This paper aimed to review the databases on non-displaced femoral neck fractures in elderly patients. We also discussed the surgical and non-surgical treatments and selection of implants. Methods Reviewed was the literature on non-displaced femoral neck fractures in elderly patients. Four major medical databases and a combination of the search terms of “femoral neck fractures”, “nondisplaced”, “undisplaced”, “non-displaced”, “un-displaced”, “aged”, “the elderly”, and “geriatric” were used to search the literature relevant to the topic of the review. Results Patients who were unable to tolerate the operation and anesthesia could be treated conservatively. Otherwise, surgical treatment was a better choice. Specific surgical strategies and implant selection were important for the patient’s functional recovery. Conclusions The non-displaced femoral neck fractures are relatively stable but carry a risk of secondary displacement. Surgical treatments may be a better option because the implants provide additional stability and allow early exercise and ambulation. Hemiarthroplasty is also an alternative for old patients with higher risks of displacement and avascular necrosis of the femoral head.

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Eight orthopedic surgeons achieved moderate to excellent reliability measuring the preoperative posterior tilt angle in 50 Garden-I and Garden-II femoral neck fractures

Cited by 9 publications

References 13 publications

Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture

Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture

Cross-Table Lateral Radiographs Accurately Predict Displacement in Valgus-Impacted Femoral Neck Fractures

An overview on the treatment strategies of non-displaced femoral neck fracture in the elderly

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