Optimal Technical Factors During Operative Management of Low-Energy Femoral Neck Fractures.

Abstract:

OBJECTIVE:To determine if cancellous screw (CS) and sliding hip screw (SHS) technical factors during low-energy femoral neck fracture fixation affects a 24-month revision surgery rate and health-related quality of life (HRQL). DESIGN:Prospective randomized controlled study. SETTING:International, multicenter. PATIENTS:Eight hundred ninety-eight femoral neck fracture patients age 50 years and older. INTERVENTION:Patients were randomized to fracture stabilization with either CSs or a SHS device as part of the Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial. CS technical factors analyzed included screw diameter, short versus long screw threads, screw number and formation, screw orientation, and washer use. SHS technical factors studied were side plate length, supplemental screw use, lag screw position, and tip-apex distance. MAIN OUTCOME MEASUREMENTS:Revision surgeries within 24 months to promote fracture healing, relieve pain, treat infection, or improve function. In addition, HRQL measures were collected, including the SF-12 Physical Component Score and Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS:The 3-screw inverted triangle pattern had a significantly lower revision surgery rate than a 3-screw triangle formation (P = 0.004). No other CS or SHS technical factors were predictive of revision surgery or affected a patient's HRQL (P > 0.05). CONCLUSIONS:A 3-screw inverted triangle pattern was superior to a 3-screw triangle formation. However, injury and patient factors such as fracture displacement, age, smoking status and sex play a more significant role in clinical outcomes for low-energy femoral neck fracture treatment. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

authors

Schottel PC,Blankstein M,Sprague S,Swiontkowski M,Bzovsky S,Bhandari M,Schemitsch EH,FAITH Investigators.

doi

10.1097/BOT.0000000000001891

subject

Has Abstract

pub_date

2021-02-01 00:00:00

pages

92-99

issue

2

eissn

0890-5339

issn

1531-2291

pii

00005131-202102000-00009

journal_volume

35

pub_type

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