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Results of femoral neck screw fixation in 112 under 65-years-old at a minimum 2 years’ follow-up

Abstract : Introduction Failure rates for screw fixation in femoral neck fracture in young patients are often high, with risk of aseptic femoral head osteonecrosis and non-consolidation. The present study sought to identify factors for success or failure of internal fixation according to: 1) initial treatment; 2) initial reduction quality; and 3) population characteristics. Hypothesis The study hypothesis was that population, fracture type, initial treatment and reduction quality can predict survival. Material and methods A retrospective study included all cases of femoral neck fracture in under 65-years-old treated by screwing in our center: i.e., 112 patients. Patient characteristics, time to surgery were collated; surviving patients were followed up at a minimum 24 months. Reduction quality was assessed on X-rays in 3 dimensions and cervico-diaphyseal angle. Results Mean follow-up was 5.3 ± 3.0 years [range, 2.0–13.6 years]. At 2 years, 23 of the 112 patients (20.5%) had developed complications: 10 osteonecroses (8.9%) and 13 non-unions (11.6%). Known hip osteonecrosis risk factors showed no significant association with survival. Failure rates were significantly higher in unstable (Garden ≥ 3) than stable (Garden ≤ 2) fracture: HR = 2.77 [95%CI: 1.09–7.02]; p = 0.025. There was no significant association with time to treatment (≤ 6 hours): HR = 1.08 [95%CI: 0.46–2.54]; p = 0.86. On 2-year radiographs, mean shortening on the z-axis was 12.3 ± 4.8 mm [−0.7 to 26.2], 8.5 ± 5.0 mm [−6.8 to 23.9] on the x-axis, and 6.4 ± 6.1 mm [−6.3 to 25.3] on the y-axis. There was a significant negative correlation between z shortening and HOOS pain component (r = −0.38; p = 0.005), a non-significant negative correlation with quality of life (r = −0.20; p = 0.16), and a significant negative correlation with sports activity (r = −0.28; p = 0.039). Conclusion The present series showed lower rates of complications and of arthroplasty than in the literature. Internal fixation seemed to be indicated even at an interval of 6 hours or more. Level of evidence IV, retrospective study.
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Submitted on : Tuesday, February 16, 2021 - 4:43:15 PM
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Roger Erivan, Guillaume Fassot, Guillaume Villatte, Aurélien Mulliez, Stéphane Descamps, et al.. Results of femoral neck screw fixation in 112 under 65-years-old at a minimum 2 years’ follow-up. Orthopaedics and Traumatology - Surgery and Research, Elsevier, 2020, 106 (7), pp.1425-1431. ⟨10.1016/j.otsr.2020.06.011⟩. ⟨hal-03143238⟩



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