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Predictors of early failure of the cannulated screw system in patients, 65 years and older, with non-displaced femoral neck fractures

  • Carlo BizEmail author
  • Jacopo Tagliapietra
  • Filippo Zonta
  • Elisa Belluzzi
  • Nicola Luigi Bragazzi
  • Pietro Ruggieri
Original Article
  • 18 Downloads

Abstract

Background

Hip fractures represent the most common injury and the main cause of morbidity and mortality among patients 65 years and older. About 20% of all femoral neck fractures (FNFs) are non-displaced or valgus impacted, for which internal fixation with the cannulated screws system (CSS) is indicated.

Aims

The aim of this study was to identify predictors of early failure of CSS.

Methods

Patients with non-displaced FNFs (Garden type I and II) treated operatively using the CSS were enrolled. Their characteristics, Pauwels angle, and posterior tilt were assessed and related with outcomes. The primary outcome was fixation failure within 6 months.

Results

259 patients were included with a mean age of 81.44 years. Most patients were female with ASA 3. The majority of fractures were classified as Garden I and Pauwels I. On average, Pauwels angle was 27°, while posterior tilt was 12°. A linear correlation between Pauwels angle and posterior tilt was found; the failure rate was 9.7%. Using the adjusted Cox competing risk regression analysis, posterior tilt was found to be independently associated with failure rate (sub-distribution hazard ratio or SHR 1.14 [95% CI 1.05–1.24], p = 0.0020). A posterior tilt greater than 18° resulted predictive of failure. The 1-year mortality rate was 12%.

Conclusions

Non-displaced Garden type II fractures, Pauwels type II or III fractures, and a posterior tilt greater than 18° represent radiographic predictors of CSS early failure in the elderly.

Level of evidence

Level IV, retrospective cohort study.

Keywords

Elderly patients Non-displaced femoral neck fractures Internal fixation Cannulated screws 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Orthopaedic, Traumatological and Oncological Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOGUniversity of PadovaPaduaItaly
  2. 2.Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOGUniversity of PadovaPaduaItaly
  3. 3.Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM)York UniversityTorontoCanada

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