Nonanatomical reduction of femoral neck fractures in young patients treated with femoral neck system: a retrospective cohort study

Abstract

Purpose Negative buttress reduction should be avoided in the treatment of femoral neck fractures (FNFs) using conventional fixation. As the femoral neck system (FNS) has been recently developed and utilized widely to treat FNFs, the association of reduction quality with postoperative complications and clinical function has not been clarified. The purpose of this study was to evaluate the clinical effect of nonanatomical reduction in young patients with FNFs treated with FNS. Methods This multicenter, retrospective cohort study included 58 patients with FNFs treated with FNS between September 2019 and December 2021. According to the reduction quality immediately following surgery, patients were classified into positive, anatomical, and negative buttress reduction groups. Postoperative complications were assessed with 12 months of follow-up. The logistic regression model was used to identify risk factors for postoperative complications. The postoperative hip function was assessed using the Harris hip scores (HHS) system. Results At a follow-up of 12 months, a total of eight patients (8/58, 13.8%) had postoperative complications in three groups. Compared with the anatomical reduction group, negative buttress reduction was significantly associated with a higher complication rate (OR = 2.99, 95%CI 1.10–8.10, P = 0.03). No significant associations were found between positive buttress reduction and the incidence of postoperative complications (OR = 1.21, 95%CI 0.35–4.14, P = 0.76). The difference was not statistically significant in Harris hip scores. Conclusion Negative buttress reduction should be avoided in young patients with FNFs treated with FNS.

Positive buttress reduction in femoral neck fractures: a literature review

“…However, in some studies, patients treated with positive buttress reduction had a higher rate of excellent Harris scores (> 80 points) than those treated with anatomical reduction [ 26 , 27 ] ( P < 0.05). The patients treated with positive buttress reduction and anatomical reduction had a better Harris hip score than those treated with negative buttress reduction ( P < 0.05) [ 28 – 33 ].…”

Multidimensional Fluoroscopy to Assess Closed Reduction in Displaced Young Femoral Neck Fractures

“…Quality of reduction in displaced femoral neck fractures is known to influence patient outcomes and postoperative complications 5,[7][8][9]15,16 . Assessing reductions with 2D fluoroscopy can be limited.…”

Pre-sliding of the femoral neck system to prevent postoperative shortening of femoral neck fractures

“…Although FNS has stronger anti-rotation and anti-inversion capabilities than cannulated screw, it must rely on the contact of the fracture to provide anti-shortening reaction force, and the reduction of the effective contact surface of the fracture due to cortical comminution and poor reduction will lead to an increase in the incidence of shortening. The main risk factors for shortening after FNS fixation include the combination of cortical comminution, displaced fracture, and the quality of reduction [ 19 , 32 , 33 ]. At the same time, the FNS reserved 20 mm of sliding space, and the resistance to shortening was based on the cortical contact of the fracture, which was prone to over shortening in the postoperative period due to poor fracture reduction and cortical comminution that prevented the formation of cortical contact.…”