Abstract
PurposeIn this study, we aimed to determine the correlation between the preoperative posterior tilt of the femoral head and treatment failure in patients with a Garden type I and II femoral neck fracture (FNF) treated with the dynamic locking blade plate (DLBP).MethodsPreoperative posterior tilt was measured in a prospective documented cohort of 193 patients with a Garden type I and II FNF treated with the DLBP. The correlation between preoperative posterior tilt and failure, defined as revision surgery because of avascular necrosis, non-union, or cut-out, was analyzed.ResultsPatients with failed fracture treatment (5.5%) had a higher degree of posterior tilt on the initial radiograph than the patients with uneventful healed fractures: 21.4° and 13.8°, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20° and 12.5% if the preoperative posterior tilt was ≥ 20°. A posterior tilt of ≥ 20° was associated with an odds ratio of 4.24 (95% CI 1.09–16.83; p = 0.04).ConclusionGarden type I and II FNFs with a significant preoperative posterior tilt (≥ 20°) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt ≥ 20° of the femoral head should be considered as a significant predictor for failure of treatment in Garden type I and II FNFs treated with the DLBP.
Highlights
The Garden classification is most commonly used to describe displacement of femoral neck fractures (FNF) [1]
These numbers are similar to the failure rates that we found for displaced (Garden III and IV) FNFs in patients age 60 and younger treated with the dynamic locking blade plate (DLBP) [14]
The results of this study show that posterior tilt of 20° or more was associated with a four times higher failure rate in Garden type I and II FNFs treated with the DLBP
Summary
The Garden classification is most commonly used to describe displacement of femoral neck fractures (FNF) [1]. Garden types I and II are relatively undisplaced or stable FNFs, whereas Garden types III and IV are displaced or unstable fractures. This classification is based solely on the review of anteroposterior (AP) radiographs [2]. Most of the studies describing the clinical relevance of a posterior tilt show that it influences the outcome of treatment, with osteosynthesis of undisplaced FNFs [3,4,5,6,7,8,9]. Several researchers have used 20° as the cut-off point above which posterior tilt is assumed to be relevant to the clinical outcome; this value is only founded by a
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