Document Detail

Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration.
MedLine Citation:
PMID:  23283374     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Intracapsular femoral neck fractures are associated with high rates of nonunion. We aimed to identify risk factors for nonunion in patients with both displaced and nondisplaced intracapsular femoral neck fractures treated with three 7-mm parallel cannulated screws, placed in either a triangle or an inverted triangle configuration, using failure of fixation as the primary outcome.
METHODS: Clinical and radiographic data for patients with intracapsular femoral neck fractures treated with either triangle fixation (one proximal screw and two distal screws) or inverted triangle fixation (two proximal screws and one distal screw), between January 1, 2000, and July 30, 2009, were analyzed.
RESULTS: A total of 202 patients, seventy-six men and 126 women with an average age (and standard deviation) of 64.53 ± 15.81 years (range, nineteen to ninety-three years), were included in the analysis. Union occurred in 158 patients, and nonunion occurred in forty-four. There were no differences between the union and nonunion groups with respect to age, sex, fracture side, fracture angle, fracture level, or estimated bone density. There were significant differences in fracture type, fixation configuration, reduction quality, and screw-tip subchondral purchase between patients with and without union. The estimated odds ratio for fracture nonunion was 2.93 (95% confidence interval [CI], 1.08, 7.96) in subjects with displaced fractures compared with those without displaced fractures (p = 0.035), 18.92 (95% CI, 1.91, 187.09) in subjects with borderline and unacceptable reduction compared with those with anatomic reduction (p = 0.012), and 2.92 (95% CI, 1.27, 6.69) for internal fixation with a triangle configuration compared with fixation with an inverted triangle configuration (p = 0.010).
CONCLUSIONS: Screw fixation with a triangle configuration, a displaced fracture, and poor reduction are risk factors for nonunion in intracapsular femoral neck fractures treated with fixation with multiple screws.
LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Jui-Jung Yang; Leou-Chyr Lin; Kuo-Hua Chao; Shih-Youeng Chuang; Chia-Chun Wu; Tsu-Te Yeh; Yu-Tung Lian
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  95     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  61-9     Citation Subset:  AIM; IM    
Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Gong Road Section 2, Taipei 114, Taiwan, Republic of China. E-mail address for L.-C. Lin:
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