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Addressing posterior tilt displacement during surgery to lower failure risk of sub-capital Garden types 1 and 2 femoral fractures

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Sub-capital femoral fractures (SCFF) are impacted or non-displaced in Garden types 1 and 2, respectively. Non-surgical treatment is protected weight-bearing combined with physiotherapy and radiographic follow-up in selected patients. Traditionally, in situ pinning is the surgical treatment of choice. The aim of this study was to estimate whether the valgus deformity in Garden types 1 and 2 (AO classification 31B1.1 and 31B1.2) SCFF is a virtual perception of a posterior tilt deformity and if addressing this deformity improves patients’ outcomes.

Materials and methods

The records of 96 patients with Garden Types 1 and 2 SCFF treated in tertiary medical center between 1/2014 and 9/2017 were retrospectively reviewed. They all had preoperative hip joint anteroposterior and lateral radiographic views. 75 patients had additional computed tomography (CT) scans. Femoral head displacement was measured on an anteroposterior and axial radiograph projections and were performed before and after surgery. Preoperative 3D reconstructions were performed for a better fracture characterization, and assessment of the imaging was performed by the first author.

Results

The average age of the study cohort was 73 years (range 28–96, 68% females). There were 58 right-sided and 38 left-sided fractures. Ninety patients had Type 1 and six patients had Type 2 fractures. The average preoperative posterior tilt was 15 degrees and the average valgus displacement was 10 degrees on plain radiographs compared to 28 degrees and 11 degrees, respectively, on CT scans. Posterior tilt was found with a virtual perception as valgus-impacted fractures. The postoperative posterior tilt was corrected to an average of 3 degrees and the valgus displacement to 5 degrees.

Conclusion

CT provides an accurate modality for measuring femoral head displacement and fracture extent. The posterior tilt displacement should be addressed during surgery to lower failure risk and the need for additional procedures.

IRB approval

TLV-0292-15.

Level of evidence

IV.

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Authors and Affiliations

  1. Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel

    Ely L. Steinberg, Assaf Albagli, Nimrod Snir, Moshe Salai, Amal Khoury, Tomer Ben-Tov & Shai Factor

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  1. Ely L. Steinberg
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  2. Assaf Albagli
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  3. Nimrod Snir
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  4. Moshe Salai
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  6. Tomer Ben-Tov
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  7. Shai Factor
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Contributions

ELS and AA are equally contributing first authors to this article. TBT and SF are equally contributing last authors to this article. All authors that have contributed to this manuscript have agreed on the final revised version of this manuscript. Data is available at reasonable request from the corresponding author.

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Correspondence to Shai Factor.

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This study was conducted following IRB approval.

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Steinberg, E.L., Albagli, A., Snir, N. et al. Addressing posterior tilt displacement during surgery to lower failure risk of sub-capital Garden types 1 and 2 femoral fractures. Arch Orthop Trauma Surg 142, 1885–1893 (2022). https://doi.org/10.1007/s00402-021-03900-5

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