Analysis on risk factors for neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients

Fulong Zhao,Lijuan Guo,Xuefei Wang,Yakui Zhang

doi:10.1186/s40001-021-00531-9

Abstract

BackgroundFemoral neck shortening can occur in young patients receiving internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws (FPTCS) for Pauwels type II femoral neck fracture in relatively young patients.MethodsClinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. And the Chi-squared test or Fisher’s exact test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis.ResultsStatistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening.ConclusionFracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after internal fixation with FPTCS for Pauwels type II femoral neck fracture in young patients. BMD and BMI may be also risk factors.

Highlights

Femoral neck shortening can occur in young patients receiving internal fixation for Pauwels type II femoral neck fracture
In treatment of femoral neck fracture in the young, shortening of the femoral neck can occur after fixation with multiple cancellous screws, and this affects the function of the hip joint [14, 15]
Based on satisfactory fracture reduction, three FPTCS (7.0 mm, titanium alloy, American General Corporation, USA), were implanted in the femoral neck in an inverted triangle configuration: the inferior screw was placed on the coronal axis of the proximal femur, close to the femoral calcar; the superior screw was placed in the anterior superior cortex of the femoral neck; and the third screw was placed in the posterior cortex for support (Fig. 1)

Summary

Introduction

Femoral neck shortening can occur in young patients receiving internal fixation for Pauwels type II femoral neck fracture. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws (FPTCS) for Pauwels type II femoral neck fracture in relatively young patients. In treatment of femoral neck fracture in the young, shortening of the femoral neck can occur after fixation with multiple cancellous screws, and this affects the function of the hip joint [14, 15]. This has led to more research on the incidence and resolution of this complication [16, 17]. Few studies have attempted to determine the risk factors for shortening by using multivariate regression analysis

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