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Femoral neck shortening as a sequela of internal fixation for femoral neck fractures and its effect on the coronal alignment of the limb: a pilot study

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

Abstract

Introduction

Femoral neck shortening is a common phenomenon following osteosynthesis for femoral neck fractures, which was shown to have a negative effect on hip function. There is paucity of literature on the effect of shortening on the ipsilateral limb mechanical axis and knee coronal alignment. We hypothesized that postoperative femoral neck shortening can alter the limb’s mechanical axis into valgus.

Methods

Of 583 patients screened, 13 patients with severe neck shortening (< 10 mm) following femoral neck fracture fixation, were found eligible and agreed to participate. A full-length lower limb radiographs were obtained and radiographic parameters (offset, neck-shaft angle, HKA, mLPFA, mDLFA, mMPTFA, MAD, MAD-r) as well as functional scores were obtained.

Results

Statistically significant differences in mechanical axis deviation ratio (MAD-r) were found between the ipsilateral and the contralateral extremities (0.41 ± 0.16 versus 0.55 ± 0.11, p = 0.03). A correlation between femoral neck length differences and MAD was not statistically significant although a tendency towards lateral deviation of the mechanical axis was noted (r = − 0.5, p = 0.077). A negative correlation was found between a greater difference in the femoral neck length and the SF12 score, both in the physical and the mental parts (r = − 0.69, p = 0.008; r = − 0.58, p = 0.035, respectively).

Conclusion

We found a more lateralized mechanical axis in limbs that demonstrated post-operative ipsilateral femoral neck severe shortening. These findings may provide a possible explanation and rationale for knee pain and perhaps for the development of knee osteoarthritis as a sequalae of femoral neck shortening. Further investigation and larger cohort, long-term studies are needed to further explore this hypothesis.

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Data availability

Data is available as per request from the corresponding author.

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Funding

The authors received no grants, funding, or any other additional benefits in the preparation or execution of this study.

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Author notes

  1. Ehud Hamburger and Nir Cohen have contributed equally.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rabin Medical Center, Petach Tikva, Israel

    Ehud Hamburger, Nir Cohen & Yoav Rosenthal

  2. Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel

    Ehud Hamburger, Nir Cohen & Yoav Rosenthal

  3. Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, 7, Ha’Refua Street, 7747629, Ashdod, Israel

    Bar Mazilis, Michael Drexler & Shai Shemesh

  4. Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

    Bar Mazilis, Michael Drexler & Shai Shemesh

Authors
  1. Ehud Hamburger
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  2. Nir Cohen
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  3. Yoav Rosenthal
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  4. Bar Mazilis
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Corresponding author

Correspondence to Shai Shemesh.

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Conflict of interest

The authors declare that they have no conflict of interest. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Rabin Medical Center on May 1st, 2018/ No. RMC-0321-18. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/ or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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

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Hamburger, E., Cohen, N., Rosenthal, Y. et al. Femoral neck shortening as a sequela of internal fixation for femoral neck fractures and its effect on the coronal alignment of the limb: a pilot study. Arch Orthop Trauma Surg 144, 723–729 (2024). https://doi.org/10.1007/s00402-023-05128-x

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  • DOI: https://doi.org/10.1007/s00402-023-05128-x

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