Femoral Neck Shortening After Hip Fracture Fixation Is Associated With Inferior Hip Function: Results From the FAITH Trial

Abstract

Objective: To describe the distribution of femoral neck shortening after internal fixation and to determine whether shortening is associated with inferior hip function at 24 months after a hip fracture in patients 50 years of age or older. Design: Retrospective cohort study. Setting: A secondary analysis of data from 81 clinical centers included in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial. Participants: Three hundred fifty patients, 50 years of age or older, who had an isolated femoral neck fracture and underwent timely operative fixation of the fracture. Intervention: Femoral neck shortening was measured as a categorical variable and classified into one of the following groups, as determined by the Central Adjudication Committee: no shortening, mild shortening (≤5 mm), moderate shortening (6–10 mm), or severe shortening (>10 mm). Main Outcome Measurement: The primary outcome for the current analysis was hip function, as measured by the Western Ontario & McMaster Universities Osteoarthritis Index questionnaire, at 24 months after injury. Results: Two-thirds of patients had no or mild shortening (≤5 mm), whereas one-third of patients had moderate or severe shortening (>5 mm). After adjusting for surgical treatment, a greater amount of femoral neck shortening was found to be associated with poorer hip function (P < 0.01). Conclusions: We found that increasing femoral neck shortening was associated with inferior hip function. Although internal fixation often results in successful union, patients who heal in a shortened position report poorer functional outcomes. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Osteosynthesis of Non-displaced Femoral Neck Fractures in the Elderly Population Using the Femoral Neck System (FNS): Short-term Clinical and Radiological Outcomes

“…Standardized radiographic images were obtained pre-operatively, post-operatively, and at 3 and 6 months after surgery, as per standard institutional protocol. Radiological analysis of proximal femur shortening was assessed according to Zhang et al [27] and Felton et al [13] (Fig. 2).…”

“…Stable non-displaced (Garden I and II) FNF may be managed with either hip arthroplasty or osteosynthesis [9] and the optimal treatment for such fractures is still subject to debate, depending on several parameters, including the amount of posterior tilt on the axial view [8], [10]. Osteosynthesis is associated with higher complication rates than arthroplasty, such as non-union (20 to 35%) [11], avascular necrosis of the femoral head (23%) [12] fracture impaction and consecutive abductor insufficiency (27%) [13]. This results in revision rates up to 3 times higher than with arthroplasty ranging from 10% to 49% [14,15] .…”

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

“…However, the stability of intertrochanteric fractures involving medial wall injury was not universally affected; medial wall injury accounted for (97.4%) of the patients with posterior-medial fractures, but the radiographic results in patients with type III, IV, and V fractures suggested that the fracture type was relatively stable. HHS function scores indicated a signi cant difference between type I fracture and other fracture classi cations, which also con rmed that neck shortening signi cantly reduced Harris hip scores 18,21,23,5 . Moreover, the postoperative HHS function score of type II fracture with the same posterior-medial involvement was satisfactory.…”

Proximal Femoral Nail Unlocked versus Locked (ProFNUL): a protocol for a multicentre, parallel-armed randomised controlled trial for the effect of femoral nail mode of lag screw locking and screw configuration in the treatment of intertrochanteric femur fractures

“…Femoral neck shortening will be measured from the AP radiograph along the long axis of the femur. This is a frequently used measure after surgical treatment of hip fractures61 62 and is regarded a reliable measure 63…”