Design and clinical application of a quantitative scale for adult femoral neck fractures

Abstract

Objective To evaluate the consistency and clinical value of a self-designed quantitative scale used in treatment of adult femoral neck fractures.Methods Seven hundred patients with femoral neck fracture were reviewed who had been treated in our hospital from January 2007 to April 2010.Five hundred and two patients were included in this study according to the inclusion criteria of our self-designed quantitative scale.All the 502 cases were divided into 4 groups according to their scale scores and actual treatment:low score internal fixation group(LSIF)(281 cases),total hip replacement group(THA)(94 cases),hemiarthroplasty group(HA)(119 cases),and high score internal fixation group(HSIF)(8 cases).Each group was further divided into a consistency sub-group and an inconsistency sub-group according to the consistency between their actual treatments and scale scores.The operative time,blood loss,blood transfusion,infection rate,re-operation rate,mortality rate,Harris hip score were compared between the consistency sub-group and inconsistency sub-group in LSIF,THA and HA groups respectively.Results The 502 patients were followed up for 1.0 to 4.5 years(average,3.2 years).The Kappa value of 0.549(P =0.000)by the consistency test indicated the quantitative scale was consistent with actual clinical treatments.In the LSIF group,the nonunion rate,femoral head necrosis rate and re-operation rate in the consistency sub-group were significantly lower than in the inconsistency sub-group(1.2％ vs.17.9％,7.4％ vs.33.3％,7.0％ vs.41.0％,respectively),but the Harris hip score were significantly higher(86.4 ±9.9 vs.74.8 ± 10.8)(P ＜0.05).In the THR group,the revision rate and Harris hip score were significantly different between the consistency sub-group and the inconsistency sub-group,favoring the former(1.6％ vs.18.2％,92.0 ± 6.3 vs.85.9 ± 11.6,respectively)(P ＜0.05).In the HA group,the revision rate in the consistency sub-group(5.5％)was significantly lower than in the inconsistency sub-group(18.8％)(x2 =4.746,P =0.029).Conclusion Since our self-designed quantitative scale is an instrument highly consistent with clinical treatments,it is of great value in surgical decision-making for treatment of adult femoral neck fractures. Key words: Femoral neck fractures; Research design; Adult