Validation of two methods to measure posterior tilt in femoral neck fractures

Kalsbeek, J H; Walsum, A. D. P. van; Roerdink, W.H.; Vugt, A.B. van; Krol, H. van de; Schipper, I.B.

doi:10.1016/j.injury.2019.12.002

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…Clement et al used the LGA to measure posterior tilt of the femoral head. We believe that the LGA is a reliable method to measure; however, it is inferior to the PTM of Palm et al, which has a better interobserver reliability [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

Kalsbeek

Walsum

Roerdink

et al. 2021

Eur J Trauma Emerg Surg

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Purpose In this study, we aimed to determine the correlation between the preoperative posterior tilt of the femoral head and treatment failure in patients with a Garden type I and II femoral neck fracture (FNF) treated with the dynamic locking blade plate (DLBP). Methods Preoperative posterior tilt was measured in a prospective documented cohort of 193 patients with a Garden type I and II FNF treated with the DLBP. The correlation between preoperative posterior tilt and failure, defined as revision surgery because of avascular necrosis, non-union, or cut-out, was analyzed. Results Patients with failed fracture treatment (5.5%) had a higher degree of posterior tilt on the initial radiograph than the patients with uneventful healed fractures: 21.4° and 13.8°, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20° and 12.5% if the preoperative posterior tilt was ≥ 20°. A posterior tilt of ≥ 20° was associated with an odds ratio of 4.24 (95% CI 1.09–16.83; p = 0.04). Conclusion Garden type I and II FNFs with a significant preoperative posterior tilt (≥ 20°) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt ≥ 20° of the femoral head should be considered as a significant predictor for failure of treatment in Garden type I and II FNFs treated with the DLBP.

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Section: Discussionmentioning

confidence: 99%

More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

Kalsbeek

Walsum

Roerdink

et al. 2021

Eur J Trauma Emerg Surg

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“…The sample size was a total of 16 images based on data (expected intraclass coefficient [ICC] of inter-rater reliability = 0.8, precision [±expected] = 0.1, number of raters = 4, α = 0.05) reported in reliability studies [ 9 , 17 ]. Lastly, we set a sample size of 50 images because earlier reliability studies evaluated 50 images [ 9 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…Posterior tilt measurement using lateral radiography was first presented as an assessment of lateral alignment in 2009 [ 8 ]. The reliability of the measurement ranges from substantial to excellent [ 9 , 10 , 11 ]. On the other hand, AP alignment is generally measured using the Garden alignment index (GAI) [ 12 ], but its reliability remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Reliability of the Garden Alignment Index and Valgus Tilt Measurement for Nondisplaced Femoral Neck Fractures

Yamakawa

Yamamoto

Tomita

et al. 2022

JPM

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Anteroposterior (AP) alignment assessment for nondisplaced femoral neck fractures is important for determining the treatment strategy and predicting postoperative outcomes. AP alignment is generally measured using the Garden alignment index (GAI). However, its reliability remains unknown. We compared the reliability of GAI and a new AP alignment measurement (valgus tilt measurement [VTM]) using preoperative AP radiographs of nondisplaced femoral neck fractures. The study was designed as an intra- and inter-rater reliability analysis. The raters were four trauma surgeons who assessed 50 images twice. The main outcome was the intraclass correlation coefficient (ICC). To calculate intra- and inter-rater reliability, we used a mixed-effects model considering rater, patient, and time. The overall ICC (95% CI) of GAI and VTM for intra-rater reliability was 0.92 (0.89–0.94) and 0.86 (0.82–0.89), respectively. The overall ICC of GAI and VTM for inter-rater reliability was 0.92 (0.89–0.95), and 0.85 (0.81–0.88), respectively. The intra- and inter-rater reliability of GAI was higher in patients aged <80 years than in patients aged ≥80 years. Our results showed that GAI is a more reliable measurement method than VTM, although both are reliable. Variations in patient age should be considered in GAI measurements.

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“…Decreased CCD angle was calculated by comparing CCD angle measured at 12 months postoperatively with that of the unaffected side measured before surgery. Posterior tilt was measured using the method as described in the literature [11,12]. Nonunion was de ned as a clear fracture line on the X-ray at follow-up of six months [13].…”

Section: Clinical and Radiological Outcome Measurementmentioning

confidence: 99%

Anterior Positioning Screw in Proximal Femoral Plating Restricts Posterior Tilt of Retroverted Femoral Neck Fractures: a Retrospective Cohort Study

Nie

Liu

Zhu

et al. 2021

Preprint

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Background: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt.Methods: We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt.Results: Demographic data showed no significant difference. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1 – 4.3°) than that in the NTS group (5.3°, 4.2 – 8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1 – 4.7) mm vs. 4.3 (3.1 – 6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0 – 90.0 vs. 82.0, 76.0 – 84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6 – 70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6 – 56.1, p = 0.002), and NTS configuration (ref: ALTS configuration) (OR 21.9, 95% CI 4.1 – 116.4, p < 0.001) as risk factors for developing posterior tilt.Conclusions: Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (ref: ALTS) are risk factors for developing posterior tilt.Trial registration: Retrospectively registered.

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Validation of two methods to measure posterior tilt in femoral neck fractures

Cited by 8 publications

References 14 publications

More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

Reliability of the Garden Alignment Index and Valgus Tilt Measurement for Nondisplaced Femoral Neck Fractures

Anterior Positioning Screw in Proximal Femoral Plating Restricts Posterior Tilt of Retroverted Femoral Neck Fractures: a Retrospective Cohort Study

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