Abstract
Purpose The study is aimed at investigating the association between different reduction classifications (anatomic reduction, positive buttress position reduction, and negative buttress position reduction) and two end points (complications and reoperations). Methods The study retrospectively analyzed 110 patients undergoing internal fixation with three parallel cannulated screws from January 2012 to January 2019 in Huashan Hospital. Based on the principles of the “Gotfried reduction,” all enrolled patients were divided into three groups: anatomic reduction, positive buttress position reduction, and negative buttress position reduction intraoperatively or immediately after surgery. Clinical characteristics including age, sex, side, Garden classification, Pauwels classification, fracture level, reduction classification, Garden alignment index angles, cortical thickness index (CTI), tip-caput distance (TCD), angle of the inferior screw, and the two ending points (complications and reoperations) were included in the statistical analysis. The Mann-Whitney U-test, the chi-square test, Fisher's exact test, and multiple logistic regression analysis were used in the study. Results Of the 110 patients included in our study, the mean ± standard deviation (SD) of age was 51.4 ± 10.4 years; 41 patients showed anatomic reduction, 35 patients showed positive buttress position reduction, and 34 patients showed negative buttress position reduction. For the outcomes, 24 patients (anatomic reduction: 6 [14.6%]; positive buttress position reduction: 5 [14.3%]; negative buttress position reduction: 13 [38.2%]) had complications, while 18 patients (anatomic reduction: 5 [12.2%]; positive buttress position reduction: 3 [8.6%]; negative buttress position reduction: 10 [29.4%]) underwent reoperations after surgery. In the multivariate logistic regression analysis of complications, negative buttress position reduction (negative buttress position reduction vs. anatomic reduction, OR = 4.309, 95%CI = 1.137 to 16.322, and p = 0.032) was found to be correlated with higher risk of complications. The same variable (negative buttress position reduction vs. anatomic reduction, OR = 5.744, 95%CI = 1.177 to 28.042, and p = 0.031) was also identified as risk factor in the multivariate logistic regression analysis of reoperations. However, no significant difference between positive reduction and anatomical reduction was investigated in the analysis of risk factors for complications, not reoperations. Conclusion Positive buttress position reduction of femoral neck fractures in young patients showed a similar incidence of complications and reoperations compared with those of anatomic reduction. For irreversible femoral neck fractures, if positive buttress position reduction has been achieved intraoperatively, it is not necessary to pursue anatomical reduction; however, negative reduction needs to be avoided.
Highlights
Worldwide, 4.5 million patients suffer from hip fractures every year, and femoral neck fractures account for a large proportion of hip fractures [1]
Inclusion criteria are as follows: (1) diagnosed with femoral neck fracture from January 2012 to January 2019, (2) age ≤ 65 years old, (3) undergoing closed reduction and internal fixation surgery, (4) the reduction was of high quality (Garden alignment index was within the range of 155°-180° in both anteroposterior (AP) and lateral radiographs) [11], and (5) no decreased mobility and other severe hip diseases before femoral neck fracture
The “Gotfried reduction” is a nonanatomical reduction method proposed by Gotfried et al [10] in 2013, in which positive buttress position reduction is defined as the distal
Summary
4.5 million patients suffer from hip fractures every year, and femoral neck fractures account for a large proportion of hip fractures [1]. For old patients (age > 65 years) with femoral neck fractures, hemiarthroplasty and total hip arthroplasty are the common treatment methods for patients with poor physical condition, while reduction and internal fixation can be an effective therapy in patients with good physical condition [1, 2]. For young patients (age ≤ 65 years) with femoral neck fractures, reduction and internal fixation are always the first choice in order to keep the native hip joint [1, 3]. The issue of how to improve the prognosis of young patients with femoral neck fractures is still a challenge for orthopedists. It is worth mentioning that good results were shown in a series of 5 patients (53-75 years old) treated by the “Gotfried positive buttress position reduction” method with a minimum 1-year follow-up (1-2 years). In a cohort of 46 patients (19-60 years old) with a mean follow-up of 22 months, Xiong et al [8] reported satisfactory results in patients with the “Gotfried positive buttress position reduction.” the number of cases in both studies was small, and there was no other relevant large sample size in the literature
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