Key result
Perfect reduction of femoral neck fractures significantly reduced the risk of reoperation compared to imperfect reduction (HR 0.15) in non-elderly patients.
Why the study?
The failure rate of internal fixation for femoral neck fractures has remained unchanged over the past 30 years, prompting this study to identify controllable variables influencing failure.
Does perfect reduction reduce the need for reoperation in non-elderly patients with femoral neck fractures treated with internal fixation?
Observational (n=190)
No
Does perfect reduction reduce the need for reoperation in non-elderly patients with femoral neck fractures treated with internal fixation?
Hazard Ratio: 0.15 (95% CI 0.048–0.47)
Absolute Event Rate: 12.8% vs 43.6%
p-value: p=0.001
Achieving perfect anatomical reduction significantly reduces the risk of reoperation in non-elderly patients undergoing internal fixation for femoral neck fractures.
May identify modifiable fixation factors in young adults; leaves open whether findings warrant practice change pending validation.
Background: The rate of failure of internal fixation for femoral neck fractures has remained largely unchanged over the past 30 years. The current study attempted to identify the controllable variables influencing the failure of internal fixation of femoral neck fractures. Methods:The study included 190 patients aged from 20 to 65 with femoral neck fracture caused by low energy violent injuries, who were treated with multiple cannulated screws over the period 2005-2019 at a single centre. Kaplan-Meier (KM) survival analysis was firstly utilized to evaluate the potential interaction between each variable and cumulative rates of reoperation. If P < 0.1 in KM survival analysis, the variables would be included in subsequent Cox survival analysis to explore the influencing need for reoperation of a femoral neck fracture. Next, all of the 190 patients were divided into perfect reduction group (Garden Alignment Index Ⅰ) and imperfect reduction group (Garden Alignment Index Ⅱ, Ⅲ, Ⅳ). Propensity score matching (PSM) analysis resulted in 39 pairs. After the baseline variables were balanced between the two groups, Cox survival analysis was utilized again to explore the variables influencing the need of reoperation of a femoral neck fracture. Finally, KM survival analysis was utilized to compare the cumulative rate of reoperation between perfect reduction (Group PR) and imperfect reduction（Group IR）as a subgroup analysis. Results: Before PSM analysis, the mean age was 49.96±12.02 years and the total reoperation rate was 17.40%. Cox survival analysis showed that only reduction quality was interrelated with the need for reoperation before PSM analysis and after PSM analysis. Kaplan–Meier cumulative reoperation rate was higher in Group IR than in Group PR after PSM analysis. Conclusion: To prolong the service life of the original femoral head, it is essential to achieve a completely anatomical reduction and maintain the reduction quality until the patient fully recovers.
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Qiu et al. (2021) conducted an observational in Femoral neck fractures (n=190). Perfect reduction (Garden Alignment Index I) vs. Imperfect reduction (Garden Alignment Index II, III, IV) was evaluated on Need for reoperation (hemiarthroplasty, total hip arthroplasty, or revision surgery) (HR 0.15, 95% CI 0.048-0.47, p=0.001). Perfect reduction of femoral neck fractures significantly reduced the risk of reoperation compared to imperfect reduction (HR 0.15) in non-elderly patients.
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