Abstract
ObjectiveTo investigate the risk factors for osteonecrosis of the femoral head (ONFH) after the treatment of femoral neck fracture in patients under 60 years old.MethodsA total of 250 cases of femoral neck fracture treated at 3 hospitals in Xuzhou from January 2002 to January 2016 were studied. The patients were followed up for 1~15 years, and the clinical data on femoral head necrosis after the femoral neck operation were analysed retrospectively. Risk factors were recorded, including age, gender, preoperative traction, time from injury to operation, reduction method, type of reduction, BMI, ASA classification, and quality of reduction. Logistic regression analysis was used to evaluate the independent risk factors for ONFH after treatment of femoral neck fracture.ResultsThe duration of follow-up was 1~15 years, with an average of 7.5 years. None of the 250 patients had fracture non-union, but 40 (16%) had necrosis of the femoral head. The time to necrosis of the femoral head was 1~7 years after the operation, with an average of 3.8 years. Univariate analysis showed that the type of fracture, the quality of reduction, the removal of internal fixation, BMI and ASA classification were risk factors affecting necrosis of the femoral head in patients with femoral neck fracture, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that internal fixation, fracture type (displacement), reduction quality (dissatisfaction), BMI (> 25), and ASA grade (III + IV) were independent risk factors affecting femoral head necrosis in patients with femoral neck fracture.ConclusionA variety of high-risk factors for femoral head necrosis are present after surgery with hollow compression screws for femoral neck fracture in adults. Removal of internal fixation, type of fracture, quality of reduction, BMI, and ASA classification were the most important risk factors influencing the development of femoral head necrosis. During treatment, there should be some targeted measures to reduce the incidence of necrosis of the femoral head.
Highlights
With the gradual aging of China’s population, the proportion of elderly diseases in the overall disease spectrum is increasing
A variety of high-risk factors for femoral head necrosis are present after surgery with hollow compression screws for femoral neck fracture in adults
Type of fracture, quality of reduction, BMI, and American Society of Anaesthesiologists (ASA) classification were the most important risk factors influencing the development of femoral head necrosis
Summary
With the gradual aging of China’s population, the proportion of elderly diseases in the overall disease spectrum is increasing. There is a special blood supply system in the neck of the femur, and a series of complications, such as necrosis of the femoral head, can be caused by improper treatment after the fracture, which brings great pain to the patients. Femoral neck fracture in patients under 60 years of age is related to trauma of the femoral neck and has a high incidence of necrosis of the femoral head, which will seriously affect quality of life [10]. The younger the patient is, the greater the need for the operation to recover original hip function; doctors in the Department of Orthopedics require knowledge on femoral head necrosis after the femoral neck fracture. There is still much controversial over the treatment of femoral neck fractures in patients under 60 years of age
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