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Injury-to-surgery interval does not affect postfracture osteonecrosis of the femoral head in young adults: a systematic review

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Osteonecrosis of the femoral head (ONFH) is a common and severe complication following femoral neck fractures in young adults. Despite significant advances in surgical techniques, radiological evaluation and comprehensive treatment for the prevention of ONFH, the incidence of traumatic ONFH has remained unchanged at approximately 20% in recent decades. The injury-to-surgery interval is considered as a principal factor affecting the occurrence of ONFH, and traditionally, femoral neck fractures are treated emergently. However, the relationship between the injury-to-surgery interval and ONFH occurrence is poorly understood, and previous reviews have not provided a precise explanation due to the lack of strict selection criteria for studies.

Methods

We reviewed previously published articles and included in current systematic review those studies with accurate multivariate analyses that included age, fracture type, operation method, follow-up, ONFH occurrence and injury-to-surgery interval.

Results

Six case studies were included and reevaluated. The studies included 263 hips for final analysis, with an overall incidence of postfracture ONFH of 17.5%. Patients were categorized into groups of less/more than 8 h, less/more than 24 h, less/more than 48 h and less/more than 3 weeks based on the individual injury-to-surgery interval. The postfracture ONFH incidence ranged from 13.3% (<8 weeks) to 21.7% (>3 weeks). Operations performed within 3 weeks of injury resulted in a lower ONFH incidence compared with operations performed after 3 weeks; however, this difference was not statistically significant. The ONFH incidence remained relatively stable when the operations were performed within 3 weeks of injury.

Conclusions

The injury-to-surgery interval did not significantly affect the incidence of postoperative ONFH.

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Acknowledgments

The current research was financially supported by a Creative Research Scholarship for PhD candidates of Shanghai Jiao Tong University School of Medicine (No. BXJ2011038) and Key Project of Science and Technology Commission Foundation of Shanghai (No. 11411950400).

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China

    You-Shui Gao, Zhen-Hong Zhu, Xiao-Wei Yu & Chang-Qing Zhang

  2. Department of Preventive Medicine, College of Medicine, Tongji University, Shanghai, 200092, China

    Zi-Sheng Ai

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  1. You-Shui Gao
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Correspondence to Chang-Qing Zhang.

Additional information

You-Shui Gao and Zi-Sheng Ai contributed equally to the manuscript.

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Gao, YS., Ai, ZS., Zhu, ZH. et al. Injury-to-surgery interval does not affect postfracture osteonecrosis of the femoral head in young adults: a systematic review. Eur J Orthop Surg Traumatol 23, 203–209 (2013). https://doi.org/10.1007/s00590-012-0948-5

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