Key result
Gotfried positive buttress reduction resulted in significantly higher Harris hip scores compared to negative buttress reduction (84.5 vs 74.3, p=0.043), yielding clinical results similar to anatomic reduction.
Why the study?
Does Gotfried positive buttress reduction improve clinical outcomes compared to negative buttress reduction in young adults with femoral neck fracture?
Cohort (n=67)
No
Does Gotfried positive buttress reduction improve clinical outcomes compared to negative buttress reduction in young adults with femoral neck fracture?
Absolute Event Rate: 84.5% vs 74.3%
p-value: p=0.043
Gotfried positive buttress reduction yields similar clinical results to anatomic reduction and is superior to negative buttress reduction for femoral neck fractures in young adults.
Positive buttress reduction may yield outcomes similar to anatomic in young femoral neck fractures; hypothesis-generating, prospective trials needed before adoption.
Background: Although many available surgical procedures for displaced femoral neck fractures in young patients, there are still many challenges to achieve satisfactory results. The incidence of avascular necrosis and nonunion rates remain relatively high despite the progress in our understanding and surgical technique. The purpose of this study was to evaluate the clinical efficacy of gotfried reduction and cannulated screw fixation in the treatment of femoral neck fracture for young adults.Methods: A retrospective analysis was made on 67 cases from May 2013 to March 2019. They were divided into three groups according to the first postoperative anteroposterior view of hip X-ray: Anatomic reduction (group A), Gotfried positive buttress reduction (group B), and Gotfried negative buttress reduction (group C). The incidence of avascular osteonecrosis of the femoral head (AVN) and the Harris scores of hip joints were compared in three groups at the last follow-up.Results: There were 21 cases (mean age,49.7 ± 11.6) in group A, 24 cases (mean age, 48.6 ± 11.3) in group B, 22 cases (mean age,48.3 ± 12.4) in group C. No significant difference in general preoperative demographics (P>0．05).The incidence of avascular necrosis of femoral head in Group A, B, and C was 19.05%,20.83%, and 22.73 %, respectively, showing no significant difference between groups(P=0．156). The mean Harris hip scores at the final follow-up for groups A (85．6±6．7)and B (84．5±6．2) were significantly higher than group C (74．3±8.3), and the difference was statistically significant(P=0．043).Conclusions: Gotfried positive buttress reduction and fixation for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better than Gotfried negative buttress reduction. For the patients of femoral neck fracture with severe displacement and difficulty in reduction, it is not necessary to pursue anatomical reduction。Achieving positive valgus reduction can also obtain satisfactory clinical results, and should try to avoid negative buttress.
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Huang et al. (2020) conducted a cohort in Femoral neck fracture (n=67). Gotfried positive buttress reduction vs. Gotfried negative buttress reduction was evaluated on Harris hip score at final follow-up (p=0.043). Gotfried positive buttress reduction resulted in significantly higher Harris hip scores compared to negative buttress reduction (84.5 vs 74.3, p=0.043), yielding clinical results similar to anatomic reduction.
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