The clinical significance of impaction at the femoral neck fracture site in the elderly

INTRODUCTION

Factors influencing clinical outcomes of osteosynthesis for elderly patients with Garden stage I and II femoral neck fractures are not well understood.

MATERIALS AND METHODS

To determine the factors influencing the clinical outcomes of in situ osteosynthesis in non-displaced femoral neck fractures in the elderly, radiographs and clinical data of patients were retrospectively analyzed. The subjects were 49 patients with femoral neck fractures (Garden stages I and II), who underwent osteosynthesis, with correctly inserted screws and with more than 2 years of follow up. The relationships between preoperative anteroposterior X-ray parameters including Garden stage, the presence or absence of spikes, the Singh grade, the Garden alignment index, the degree of impaction at the fracture site (the capital impaction index) and postoperative outcomes were analyzed.

RESULTS

Among the 49 cases, there were eight unsuccessfully treated patients, two with non-union and six with late segmental collapse. The "without spikes" fracture type (P < 0.05) and the degree of capital impaction when the capital impaction index (P < 0.0001) was greater than the mean plus the standard deviation, were significantly associated with unsuccessful outcomes.

CONCLUSION

Excessive shortening at the fracture site on the anteroposterior radiograph in the femoral neck fracture of Garden stages I and II can be used to predict poor outcomes from in situ osteosynthesis.

Interpreting preoperative radiographs in displaced femoral neck fractures: observer variability in evaluating signs of poor outcome

OBJECTIVE

To evaluate the reproducibility of four preoperative radiographic signs thought to be associated with negative prognosis in dislocated femoral neck fractures when treated with internal fixation.

SETTING

University Hospital.

DESIGN

Standard hip radiographs of ten patients with displaced subcapital femoral neck fractures were studied by five orthopaedic surgeons. The radiographs were studied twice; the second time on average 3 months after the first reading. Inter- and intra-observer reliability of four radiological parameters was estimated.

RESULTS

Poor intra- and inter-observer reproducibility of all four signs tested was observed.

CONCLUSIONS

The decision to treat an intracapsular femoral neck fracture with either prosthesis or internal fixation has to be based on other variables than the preoperative radiographic signs evaluated in this study.

Radiographic factors predicting non-union of displaced intracapsular femoral neck fractures

After 82 patients underwent osteosynthesis with multiple pinning for a displaced intracapsular femoral neck fracture, 58 fractures were united, and 24 were not. These 82 patients were included in a discriminant analysis. Union and non-union groups were the dependent variables. Eleven presumably predictive factors measured on X-ray films obtained from these patients before and immediately after operation were taken as independent variables. Three radiographic factors were selected by a stepwise method according to the effect they had on union. These were: the distance of medial displacement between fragments before reduction; the varus angle after reduction; and the distance of medial displacement between fragments after reduction. The distance of medial displacement between fragments before reduction proved the most important factor in making a choice between osteosynthesis and primary arthroplasty, and it was revealed that osteosynthesis could not be expected to provide union if the distance was 20 mm or more. It was also confirmed that union was promoted, if the cranial fragment was reduced to a valgus position and the medial cortical bones were aligned as much as possible at the time of osteosynthesis.

Radiographic prediction of failure after fixation of cervical hip fracture

During 1984-1985, 410 patients with cervical hip fracture were randomized between 2 methods of internal fixation--a single nail (Rydell) or 2 LIH hook pins (LIH). The patients were followed-up prospectively for at least 2 years. Radiographs were taken after 1 week, 1, 3, 6, 12, and 24 months. The radiographs of the 295 patients alive 2 years postoperatively were examined by one of the authors. The sliding and the diversion of the pins and the nail in the anteroposterior projection and the diversion in the lateral projection were measured. In the failure group (non-union, late segmental collapse), the greatest sliding was noted within 1 month postoperatively and the diversion increased up to 3 months. Significant differences between the failure and the non-failure groups could be seen even after 1 week. We also found that the degree of sliding of the LIH pins and the Rydell nail 1 month postoperatively is comparable to the scintigraphic pattern 2 weeks postoperatively in predicting failure after internal fixation of cervical hip fractures.