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Surgical Outcomes of Internal Fixation Using Multiple Screws in Femoral Neck Fractures with Valgus Impaction: When Should We Consider Hip Arthroplasty? A Retrospective, Multicenter Study

Hip & Pelvis 2019년 31권 3호 p.136 ~ 143
 ( Moon Nam-Hoon ) - Pusan National University Hospital Department of Orthopaedic Surgery

 ( Shin Won-Chul ) - Pusan National University Yangsan Hospital Department of Orthopedic Surgery
 ( Jang Jae-Hoon ) - Pusan National University Hospital Department of Orthopaedic Surgery
 ( Seo Han-Ul ) - Pusan National University Hospital Department of Orthopaedic Surgery
 ( Bae Jung-Yun ) - Pusan National University Yangsan Hospital Department of Orthopedic Surgery
 ( Suh Kuen-Tak ) - Pusan National University Hospital Department of Orthopaedic Surgery

Abstract


Purpose: We analyzed the surgical outcomes at two institutions after internal fixation using multiple screws in femoral neck fractures with valgus impaction to determine independent predictors and their cut-off values for nonunion and reoperation.

Materials and Methods: Between January 2006 and December 2016, 104 femoral neck fractures with valgus impaction that underwent internal fixation using multiple screws from two institutions were enrolled. The multiple logistic regression model and receiver operating characteristics analysis were used to determine the independent predictors and cut-off values for nonunion and reoperation.

Results: There were 20 reoperations (19.2%) due to 11 nonunions (10.6%) and nine cases of femoral head osteonecrosis (8.7%). Multiple logistic regression analysis revealed that independent predictors of nonunion and reoperation were age and posterior tilt angle (P<0.05). The cut-off value for age and the posterior tilt angle for reoperation were 72.5 years and 12.2°, respectively. The patients with a posterior tilt angle of greater than 13° had poorer radiological and clinical outcomes compared with those with a posterior tilt angle of less than 13°, even though they did achieve bone union.

Conclusion: Primary hip arthroplasty should be considered in patients older than 73 years of age with a posterior tilt angle greater than 13°.

키워드

Femoral neck fractures; Valgus impaction; Valgus angle; Posterior tilt angle
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