Abstract
Patients aged from 40 to 60 with displaced fractures of the femoral neck (Garden III or IV) who received fixation with three cannulated screws from January 2005 to December 2012 were evaluated retrospectively for the development of nonunion. Plasma HbA1C, a marker for long-term plasma glucose level, anti-T2DM medication, and other potential risk factors were recorded for the purpose of this study. There were no differences between the union and nonunion groups with respect to age, gender, Garden classification, Pauwel's angle, reduction quality, and T2DM presence. There were significant differences in reduction quality and preoperative plasma HbA1C level between patients with and those without union. The odds ratio (OR) for fracture nonunion was 2.659 (95% confidence interval [CI], 1.530–4.620) in subjects with anatomical reduction compared with those without anatomical reduction, 4.797 (95% CI, 1.371–16.778), in subjects with poor blood glucose control (HbA1C > 10%). The metformin usage showed a preventive effect on nonunion development (OR: 0.193 and CI: 0.060–0.616). The nonunion rate of metformin group (6.7%, 6/89) was even much lower than that of patients without T2DM (17.4%, 80/460).
Highlights
The nonunion is one of the common complications after femoral neck fractures
Reduction quality instead of the fractures characteristics was associated with the occurrence of nonunion, which is consistent with previous studies [14]
The odds ratio (OR) for fracture nonunion was 4.797 in subjects with poor blood glucose control (HbA1C > 10%)
Summary
The nonunion is one of the common complications after femoral neck fractures. Reported incidence of nonunion after three-cannulated-screw fixation ranged from 13.3% to 21.8% and many risk factors including impropriate crew fixation configuration, displaced fracture, and poor reduction have been revealed [1,2,3].Type 2 diabetes mellitus (T2DM) affects 382 million individuals across the world and its prevalence is steadily rising [4]. The nonunion is one of the common complications after femoral neck fractures. Reported incidence of nonunion after three-cannulated-screw fixation ranged from 13.3% to 21.8% and many risk factors including impropriate crew fixation configuration, displaced fracture, and poor reduction have been revealed [1,2,3]. Type 2 diabetes mellitus (T2DM) affects 382 million individuals across the world and its prevalence is steadily rising [4]. T2DM leads to the fragility of bones by affecting the bone metabolism [5]. Emerging evidences have indicated T2DM as an independent risk factor for fractures [6, 7]. Management of fractures in T2DM patients has become an increasingly important topic in orthopedic practice and research
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