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The incidence of focal osteonecrosis of the femoral head and its impact on conversion hip arthroplasty after screw fixation of femoral neck fractures: a multicenter retrospective study based on postoperative magnetic resonance imaging

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Osteonecrosis of the femoral head (ONFH) and subsequent head collapse is a major concern after internal fixation of femoral neck fracture (FNF). Previous studies focused on ONFH incidence using plain radiography; postoperative magnetic resonance imaging (MRI) was rarely performed. We performed a multicenter retrospective study to investigate the incidence of ONFH and the need for conversion hip arthroplasty after FNF screw fixation.

Methods

We reviewed 195 patients who underwent screw fixation during closed FNF reduction between 2012 and 2017 at three institutions. Except for patients who did not consent to MRI, all patients underwent postoperative MRI either 1–3 years after screw fixation. The occurrence of ONFH was investigated through plain radiography and MRI.

Results

Thirty patients were diagnosed with ONFH through plain radiography, and an additional 33 patients were diagnosed with MRI, resulting in a total of 63 patients (32.3%) diagnosed with ONFH. The mean time to ONFH diagnosis was 18.9 months and the conversion rate to hip arthroplasty was 10.2%. Of the 33 patients who were normal on hip radiography but exhibited ONFH on MRI, all had small focal lesions not associated with head collapse at the last follow-up. The ONFH group diagnosed through plain radiography had more unstable FNFs than the group diagnosed through MRI.

Conclusion

Although postoperative MRI revealed a higher incidence of ONFH after FNF screw fixation than reported previously, the small focal MRI lesions were not associated with increased risks of femoral head collapse or conversion to arthroplasty.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, College of Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea

    Hwan-Hee Lee & Hee-Man Chi

  2. Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hwan-Hee Lee, Young-Wook Lim, Woo-Lam Jo, Soon-Yong Kwon & Seung-Chan Kim

  3. Department of Orthopedic Surgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Young-Wook Lim, Woo-Lam Jo & Soon-Yong Kwon

  4. Department of Orthopedic Surgery, College of Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, 1021, Tongil-Ro, Eunpyeong-Gu, Seoul, 03312, Republic of Korea

    Seung-Chan Kim

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This study was approved by the Institutional Review Board (IRB) of The Catholic University of Korea. (Approval no. XC21RIDI0027).

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Lee, HH., Lim, YW., Jo, WL. et al. The incidence of focal osteonecrosis of the femoral head and its impact on conversion hip arthroplasty after screw fixation of femoral neck fractures: a multicenter retrospective study based on postoperative magnetic resonance imaging. Eur J Trauma Emerg Surg 49, 991–1000 (2023). https://doi.org/10.1007/s00068-022-02122-7

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