Key result
Posterior medial cortex comminution significantly increased the risk of femoral neck shortening after internal fixation in young patients with Pauwels type II fractures (OR 27.88).
Why the study?
Femoral neck shortening can affect hip function after closed reduction and internal fixation for Pauwels type II femoral neck fracture in young patients, but the risk factors remain unclear.
What are the risk factors for femoral neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients?
Cohort (n=122)
No
What are the risk factors for femoral neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients?
Odds Ratio: 27.88 (95% CI 6.26–41.17)
Absolute Event Rate: 39% vs 12.5%
p-value: p=<0.001
Fracture type, posterior medial cortex comminution, and reduction quality are significant risk factors for femoral neck shortening after internal fixation in young patients with Pauwels type II fractures.
Fracture type, comminution, and reduction quality predict neck shortening; leaves open whether these warrant modified techniques pending prospective validation.
Background: Femoral neck shortening can occur in young patients receiving closed reduction and internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after closed reduction and internal fixation with parallel partially threaded cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.Methods: Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. These patients were followed (average follow-up: 12 months). And the chi-square test or t test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. Results: Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. Conclusion：Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after closed reduction and internal fixation with parallel, partially threaded, cannulated cancellous screws for Pauwels type II femoral neck fracture in young patients.BMD and BMI may be also risk factors.
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Guo et al. (2020) conducted a cohort in Pauwels type II femoral neck fracture (n=122). Posterior medial cortex comminution vs. No posterior medial cortex comminution was evaluated on Femoral neck shortening (>5mm) (OR 27.88, 95% CI 6.26-41.17, p=<0.001). Posterior medial cortex comminution significantly increased the risk of femoral neck shortening after internal fixation in young patients with Pauwels type II fractures (OR 27.88).
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