Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Zhang, Yue-Lei; Chen, Song; Ai, Zisheng; Gao, You-Shui; Mei, Jiong; Zhang, Changqing

doi:10.1097/md.0000000000003706

Cited by 31 publications

(29 citation statements)

References 29 publications

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“…In our study, all patients had Pauwels type II/III or Garden III/IV fractures, although all had displaced fractures and high shear force, with an internal xation failure rate that was 20% lower than that of xation using simple cannulated screws. The nonunion rate of fractures after xation with cannulated screws, SHS + screw, and locking compression plate is up to 11.9% according to a previous report [30]. However, many patients with Garden II femoral neck fractures had been included in this previous report, and thus, the results are not directly comparable with those of our study.…”

Section: Discussioncontrasting

confidence: 73%

The Probability of and Risk Factors for Femoral Neck Shortening and Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With a Medial Buttress Plate

Bai

et al. 2021

Preprint

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Background: A range of postoperative complications make femoral neck fracture difficult to treat. Femoral neck shortening and internal fixation failure are two most prevalent complications associated with many surgical strategies. This study evaluates the probability of and risk factors for these complications after the treatment of femoral neck fracture using cannulated screws combined with a medial buttress plate.Methods: Data of 70 patients with femoral neck fractures treated using cannulated screws combined with a medial buttress plate in our hospital between March 2016 and March 2019 were retrospectively analyzed, and 40 patients who were followed up for more than 3 months were enrolled in the study. We evaluated the probability of postoperative femoral neck shortening and internal fixation failure and conducted multivariate logistic regression analysis to determine risk factors.Results: All 40 patients had Garden III/IV or Pauwels II/III fractures. Of these patients, 11 had femoral neck shortening greater than 5 mm and 8 had fracture nonunion or screw cutout requiring reoperation. There were no differences in age, sex, fracture site, Pauwels classification, and reduction quality between the shortening and non-shortening groups; however, there were significant differences in screw quality. Similarly, there were no differences in age, sex, Pauwels classification, reduction quality, and screw quality between the fixation failure and non-failure groups, but there were significant differences in fracture site and shortening. According to the multivariate analyses, screw quality was an independent risk factor for femoral neck shortening (odds ratio [OR]: 8.58; 95% confidence interval [CI]: 1.35–50.57; P=0.022), and femoral neck shortening was an independent risk factor for internal fixation failure (OR: 11.82; 95% CI: 1.66–84.36; P=0.014).Conclusions: Femoral neck fracture treatment using cannulated screws combined with a medial buttress plate led to a femoral neck shortening rate lower than that of other internal fixation methods and an internal fixation failure rate lower than or equivalent to that of other internal fixation methods. The quality of cannulated screws is a risk factor for postoperative shortening of the femoral neck, and femoral neck shortening is a risk factor for postoperative internal fixation failure.

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Section: Discussioncontrasting

confidence: 73%

The Probability of and Risk Factors for Femoral Neck Shortening and Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With a Medial Buttress Plate

Bai

et al. 2021

Preprint

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“…It has not been copyedited, proofread, or typeset and is not a final version. 8 (I 2 =0%,P=0.57) ( Figure 10).…”

Section: Results Of the Meta-analysismentioning

confidence: 97%

Can Total Joint Arthroplasty Be Safely Performed in Patients with Chronic Kidney Disease?

Fan¹,

Sun²,

Jaing³

2021

Journal of the American Podiatric Medical Association

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BACKGROUND: Patients suffered from chronic kidneydisease are at greater risk of perioperative and postoperative complications. Actually there is no systerm review study demonstrating advantages of total joint arthroplasty can be safely performed in patients with chronic kidney disease.METHODS: Literature search was performed inPubMed, Embase, Web of Science, China National Knowledge Infrastructure(CNKI),Wanfang and Cochrane Library for information from the earliest date of data collection to September 2018. Studies comparing the perioperative, postoperative outcomes of No-CKD with those of CKD patients were included. Statistical heterogeneity was quantitatively evaluated by X2 test with the significance set P<0.10 or I2 > 50%.RESULTS:Three papers consisting of 38,209 patients were included (35,363 No-CKD patients; 2,846 CKD patients). The results showed that CKD was related to a greater increase in postoperative infection rate, deep vein thrombosis, re-admission and mortality(P<0.1). No differences inlength of surgery, length of stay, pulmonary embolism and revision (P>0.10).CONCLUSIONS:Compared with No-CKD patients, CKD patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between No-CKD and CKD about patients with chronic kidneydisease.

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“…An accurate estimation of the risk of avascular necrosis is essential before surgeons and patients make optimized treatment plans. Several factors have been found to be predictive of the development of avascular necrosis, including age, sex, procedure delay, and fracture type [ 9 , 10 ]. There is strong evidence to suggest that the incidence of ONFH is higher among patients with displaced fractures than among those with undisplaced fractures, because displaced fractures are more likely to cause vascular lesions and disrupt the blood supply [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Identifying Patients Who Will Most Benefit from Single Photon Emission Computerized Tomography and Computerized Tomography After Femoral Neck Fracture

et al. 2017

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BackgroundSingle photon emission computerized tomography and computerized tomography (SPECT/CT) is useful for assessing blood supply within the femoral head after femoral neck fracture, but its use in all femoral neck fracture patients is not feasible. Therefore, the present study aimed to identify the patients for whom SPECT/CT examination will be most beneficial.Material/MethodsSixty-five patients with a unilateral femoral neck fracture who underwent SPECT/CT examination of the hip and were treated via closed reduction and internal fixation with three screws were enrolled between January 2009 and March 2011. A decision tree model (C 5.0) was used to identify the factors that best reflect blood supply and to build a flowchart for identifying patients who would benefit from SPECT/CT.ResultsFracture type was most strongly associated with the Fracture/Normal (F/N) ratio, which reflects the blood supply to the fractured femoral head. Age and the time interval from injury to examination were also associated with the F/N ratio. SPECT/CT examination is most beneficial for patients with a displaced fracture, especially if they are over 58 years old and the time interval from injury to examination is less than 10 days.ConclusionsOur results indicate that elderly people with a displaced fracture are most likely to benefit from SPECT/CT examination, which can show the blood supply to the femoral head within a relatively short window of time after the injury.

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Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Cited by 31 publications

References 29 publications

The Probability of and Risk Factors for Femoral Neck Shortening and Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With a Medial Buttress Plate

The Probability of and Risk Factors for Femoral Neck Shortening and Internal Fixation Failure After Femoral Neck Fracture Treatment Using Cannulated Screws Combined With a Medial Buttress Plate

Can Total Joint Arthroplasty Be Safely Performed in Patients with Chronic Kidney Disease?

Identifying Patients Who Will Most Benefit from Single Photon Emission Computerized Tomography and Computerized Tomography After Femoral Neck Fracture

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