Posterior Tilt Angle Research Articles

Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression.

To investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre- and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors. Thirty-five patients (mean age, 62.5 ± 8.4years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre-existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < - 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups. Twenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037). The prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing. IV.

Flexor tendon rupture after volar plating of distal radius fracture: A systematic review of the literature

Flexor tendon rupture after volar plate fixation of distal radius fracture (DRF) is rare. There is no consensus as to how to prevent them. The aim of our study was to identify the pathological mechanisms, and to establish the clinical and epidemiological profile of patients suffering from this complication. We carried out a systematic review using the PubMed, Scopus and Cochrane databases. Studies were included if they described complete or partial flexor tendon rupture following volar plate fixation of DRF. Forty-six 46 were included, for a total of 145 patients were reported: 138 from the literature, and 7 from our personal experience. Etiology was usually mechanical, by impingement with either the plate or protruding screws. Plate impingement was due to positioning beyond the watershed line, consolidation with posterior tilt, plate thickness, or low palmar cortical angle. Mean patient age was 62.4 years (range, 23–89 years). Median postoperative interval was 8 months (range, 3–120 months). Flexor pollicis longus was the most frequently injured tendon. The plate should be positioned proximally to the watershed line if possible, to ensure good initial reduction. Hardware should be removed 4 months after surgery if the plate is causing impingement according to the Soong criteria or if signs of tenosynovitis appear.

Trunk rotation enhances movement of the knee abduction angle while running among female collegiate middle- and long-distance runners

This cohort study aimed to i) clarify the relationship between abduction of the knee joint and trunk motion during running in the stance phase, and ii) clarify the relationship between abduction of the knee joint during running in the stance phase and the amount of trunk rotation measured in a static position. Twenty-nine female collegiate middle- and long-distance runners participated. The knee abduction angle and absolute angles to the floor were calculated using a three-dimensional motion analysis device. Static trunk rotation was calculated. Trunk rotation angle to the supporting side (r = 0.525), thigh posterior tilt angle (r = -0.510), thigh adduction angle (r = 0.417), lower leg anterior tilt angle (r = -0.483), and static trunk rotation to the supporting side (r = -0.429) were significantly correlated with knee abduction angle. Trunk rotation angle to the supporting side (s = 0. 465), thigh adduction angle (s = 0.374), lower leg anterior tilt angle (s = 0.228), and static trunk rotation to the supporting side (s = -0.256) (R 2 = .556) were significantly correlated with the knee abduction angle. The increase or decrease in the knee abduction angle should consider the mutual influence of the lower limb and trunk motion.

Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures

IntroductionSevere valgus-impacted femoral neck fractures are associated with femoral neck shortening (FNS). However, no study has focused on the effect of reduction for severe valgus impaction in terms of healing and restoration of the femoral neck length. This study aimed to compare FNS and treatment outcomes of in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures in patients aged 65 years or younger. MethodsThis retrospective study included 55 patients who underwent internal fixation with three parallel screws for femoral neck fractures with valgus impaction >15° (AO/OTA classification 31-B1.1) between January 2006 and December 2018. Twenty-eight and 27 patients underwent in situ fixation (in situ group) and fixation after reduction (reduction group), respectively. In the reduction group, reduction using lateral traction with a Schanz pin was performed before internal fixation. Complications such as fixation failure, non-union, and avascular necrosis (AVN), caput-collum-diaphysis (CCD) angle, posterior tilt angle, amount of FNS, and Harris Hip Score (HHS) were compared between the groups. ResultsBone union was achieved in all patients; AVN occurred in two patients in each group. No significant difference was seen in the preoperative characteristics between the groups. The CCD angle at 1 year postoperatively was significantly different between the groups, whereas the posterior tilt angle at 1 year postoperatively was not different. FNS at 1 year postoperatively was significantly lower in the reduction group than in the in situ group. FNS by >5 mm was significantly less frequent in the reduction group than in the in situ group (11% versus 75%). The mean HHS at 1 year and 2 years postoperatively was significantly higher in the reduction group than in the in situ group. FNS and HHS were negatively correlated; the mean HHS was significantly higher in patients with none/mild shortening (<5 mm) than in those with moderate/severe shortening (≥5 mm). ConclusionIn patients aged 65 years or younger, internal fixation after reduction for severe valgus-impacted femoral neck fractures is safe and effective for achieving successful bone union and restoring the femoral neck length.

Valgus slipped capital femoral epiphysis: a systematic review.

Valgus slipped capital femoral epiphysis (SCFE) is a rare entity which leads to a proximolateral displacement of the hip epiphysis. The literature on valgus SCFE consists of case reports or case series. Since no evidence synthesis has been conducted, a systematic review on all published cases of valgus SCFE was conducted. The search strategy located 27 studies comprising 74 subjects with 96 hips. Demographic results were as follows: female/male ratio was of 1.65, and the mean age at presentation was 13.0 ± 2.54 years. Bilateral cases were recorded in 31.1%. Hip pain was the most frequent symptom followed by limping. The most frequent clinical sign was the limitation of medial internal rotation. Comorbidities were present in 65.6% of patients, mostly as endocrine or metabolic disorders. The mean neck-shaft angle was 149.2 ± 9.2°, the mean physis-shaft angle was 83.3 ± 9.7°, the neck-physis angle was 36.1 ± 21.5°, and the posterior physeal tilt angle was 23 ± 6.07°. The physeal tilt was lateral in 90% of cases. Treatment was based on screws in 70.8% of cases, a femoral osteotomy in 18.75%, and the remaining had a combination of surgical procedures. Two out of the three screw migrations occurred following fixation with more than one screw. All major complications (8.3%) had the potential of developing osteoarthritis in the future. Valgus SCFE entity demonstrates distinctive demographic, clinical and radiological results. This rare entity should be always included in the differential diagnosis of hip pain or limping in children.

Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA

BackgroundLimitations in the lumbar spine movement reduce lumbar vertebral motion and affect spinopelvic kinematics. We studied the influence of lumbar intervertebral disc degeneration on spinofemoral movement, from standing to sitting, in patients undergoing total hip arthroplasty (THA).MethodsOf 138 consecutive patients scheduled for THA due to unilateral avascular necrosis (AVN) of the femoral head, those with ≥3 discs with University of California at Los Angeles (UCLA) disc degeneration score > 1 were defined as the lumbar degenerative disc disease (LDD) group, and the remaining patients constituted d the control group. Full body anteroposterior and lateral EOS images in the standing and sitting positions were obtained. Pelvic incidence (PI), L1 slope (L1 s), lumbar lordosis angle (LL), pelvic tilt (PT), sacral slope (SS), femoral slope (Fs), sagittal vertical axis (SVA), hip flexion, lumbar spine flexion, and total spinofemoral flexion were measured on the images and compared between groups.ResultsNo significant between-group differences were observed in the height, weight, body mass index, AVN staging, or PI, SS, and Fs on standing. The LDD group included more females and older patients, had 5° lesser LL, 5° greater PT, and larger SVA. From standing to sitting, the PI remained constant in both groups. Total spinofemoral flexion was 7° less, lumbar spine flexion 16° less, L1 slope change 6° less, and SS change 8° less, and hip flexion was 7° more in the LDD than in the control group. The spine/hip flexion ratio was significantly lower in the LDD group (0.3 versus 0.7; p < 0.001). On regression analysis, the LDD group (p < 0.001) and older age (p = 0.048) but not sex, weight, or height were significant univariate predictors of decreased spine/hip ratio.ConclusionsPatients with LDD leant more forward and had a larger pelvis posterior tilt angle on standing and a decreased lumbar spine/hip flexion ratio, with more hip joint flexion, on sitting, to compensate for reduced lumbar spine flexion. Surgeons should be aware that elderly patients with multiple LDD have significantly different spinofemoral movements and increased risk of posterior dislocation post-THA. Preoperative patient identification, intraoperative surgical technique modification, and individualized rehabilitation protocols are necessary.

Surgical Outcomes of Internal Fixation Using Multiple Screws in Femoral Neck Fractures with Valgus Impaction: When Should We Consider Hip Arthroplasty? A Retrospective, Multicenter Study.

PurposeWe analyzed the surgical outcomes at two institutions after internal fixation using multiple screws in femoral neck fractures with valgus impaction to determine independent predictors and their cut-off values for nonunion and reoperation.Materials and MethodsBetween January 2006 and December 2016, 104 femoral neck fractures with valgus impaction that underwent internal fixation using multiple screws from two institutions were enrolled. The multiple logistic regression model and receiver operating characteristics analysis were used to determine the independent predictors and cut-off values for nonunion and reoperation.ResultsThere were 20 reoperations (19.2%) due to 11 nonunions (10.6%) and nine cases of femoral head osteonecrosis (8.7%). Multiple logistic regression analysis revealed that independent predictors of nonunion and reoperation were age and posterior tilt angle (P<0.05). The cut-off value for age and the posterior tilt angle for reoperation were 72.5 years and 12.2°, respectively. The patients with a posterior tilt angle of greater than 13° had poorer radiological and clinical outcomes compared with those with a posterior tilt angle of less than 13°, even though they did achieve bone union.ConclusionPrimary hip arthroplasty should be considered in patients older than 73 years of age with a posterior tilt angle greater than 13°.

Analyse 3D pour prédire les résultats des fractures cervicales fémorales Garden 1 et 2 : une étude rétrospective multicentrique

IntroductionThe aim of our study was to (1) report our surgical outcomes of internal fixation in patients with nondisplaced or valgus impaction fractures of the femoral neck; (2) introduce our new three dimensional assessment method using a combination of X-ray and CT imaging, and (3) determine which radiologic measurements significantly predicted fixation failure. HypothesisWe hypothesized that high posterior tilt angle and retroversion angle are related to high incidence of non-union and osteonecrosis. Materials and methodsFrom January 2009 to December 2016, 64 elderly patients in two institutions with nondisplaced or valgus impaction fractures of the femoral neck who had internal fixation using multiple parallel cannulated screws were enrolled. To determine the independent predictors of non-union, osteonecrosis, and reoperation, various clinical variables and radiologic variables, including the valgus angle on coronal CT images, the posterior tilt angle on Lorenz images, and the retroversion angle on axial CT images, were analyzed. ResultsNon-union was identified in nine of the 64 patients (14.1%) and nine of the 55 patients (16.4%) who achieved bony union had femoral head osteonecrosis with subsequent segmental collapse. The multiple logistic regression model showed that a low bone mineral density of the femur, a higher posterior tilt angle on Lorenz image, and a higher retroversion angle on axial CT images were independent predictors of non-union and reoperation. DiscussionPrimary hip arthroplasty should be considered when a posterior tilt angle of more than 9 degrees on Lorenz images or a retroversion angle of more than 13 degrees on axial CT images is identified in patients with osteoporotic valgus impaction fractures. Type of study and level of proofIII, retrospective comparative study.

Three-dimensional analyses to predict surgical outcomes in non-displaced or valgus impaction fractures of the femoral neck: A multicenter retrospective study

IntroductionThe aim of our study was to (1) report our surgical outcomes of internal fixation in patients with non-displaced or valgus impaction fractures of the femoral neck, (2) introduce our new three-dimensional assessment method using a combination of X-ray and CT imaging, and (3) determine which radiologic measurements significantly predicted fixation failure. HypothesisWe hypothesized that high posterior tilt angle and retroversion angle are related to high incidence of non-union and osteonecrosis. Materials and methodsFrom January 2009 to December 2016, 64 elderly patients in two institutions with non-displaced or valgus impaction fractures of the femoral neck who had internal fixation using multiple parallel cannulated screws were enrolled. To determine the independent predictors of non-union, osteonecrosis, and re-operation, various clinical variables and radiologic variables, including the valgus angle on coronal CT images, the posterior tilt angle on Lorenz images, and the retroversion angle on axial CT images, were analyzed. ResultsNon-union was identified in nine of the 64 patients (14.1%) and nine of the 55 patients (16.4%) who achieved bony union had femoral head osteonecrosis with subsequent segmental collapse. The multiple logistic regression model showed that a low bone mineral density of the femur, a higher posterior tilt angle on Lorenz image, and a higher retroversion angle on axial CT images were independent predictors of non-union and re-operation. DiscussionPrimary hip arthroplasty should be considered when a posterior tilt angle of more than 9 degrees on Lorenz images or a retroversion angle of more than 13 degrees on axial CT images is identified in patients with osteoporotic valgus impaction fractures. Type of study and level of proofIII, Retrospective comparative study.

Is non-operative treatment still relevant for Garden Type I fractures in elderly patients? The femoral neck impaction angle as a new CT parameter for determining the indications of non-operative treatment

BackgroundThe indications of non-operative treatment of undisplaced femoral neck fractures are controversial. The objective of this study was to assess whether two computed tomography (CT) parameters, the femoral neck impaction angle (IA) and the femoral neck posterior tilt angle (PTA), were effective in predicting the risk of secondary displacement after non-operative treatment of Garden I femoral neck fractures in patients aged 65 years or over. HypothesisThe working hypotheses were that the IA in the coronal plane and PTA in the axial plane predicted secondary displacement after non-operative treatment of Garden I femoral neck fractures, could be reproducibly and reliably measured on CT scans, and could serve to identify Garden I fractures at risk for secondary displacement after non-operative treatment. MethodsForty-nine patients aged 65 years or over with Garden I fractures treated non-operatively were included in a prospective single-centre study. CT images were used to measure the IA as the position of the fracture line relative to the femoral head in the coronal plane and the PTA as the position of the femoral head centre relative to the femoral neck axis in the axial plane. ResultsAfter non-operative treatment, secondary displacement occurred in 22 (45%) patients. The PTA was not significantly different between the groups with vs. without secondary displacement (p=0.62). IA values≤135° were significantly associated with secondary displacement (odds ratio, 11.73; 95% confidence interval [95%CI], 3.04–45.28; p=0.004). An IA≤135° was 72.73% sensitive and 81.48% specific for predicting secondary displacement. IA measurement was reproducible, with intra-class and inter-class Cohen's kappa values of 0.94 (95%CI, 0.90–0.97) and 0.9011 (95%CI, 0.83–0.94), respectively. DiscussionThe IA measured on CT images may hold promise for identifying Garden I hip fractures at high risk for secondary displacement after non-operative treatment. IA measurement is reproducible and reliable and may help to determine the indications of non-operative treatment. Level of evidenceII, prospective cohort study.

Influence of Brassiere Wearing on Shoulder Kinematics.

Gender differences in scapular kinematics during arm elevation have been reported. Because women wear brassieres (bras) daily, their scapular motion may be restricted by the garment; however, the influence of bra wearing on this motion has not been reported. Therefore, using a three-dimensional electromagnetic tracking device, we investigated the influence of bra wearing on shoulder kinematics during arm elevation. The subjects were 19 healthy women, and the shoulder on the dominant side was evaluated. Subjects performed scapular plane arm elevation while wearing or not wearing bras. Kinematic data were recorded using an electromagnetic tracking device. The glenohumeral elevation angle, scapular upward and internal rotation angles, and the posterior tilt angle were determined from the recorded data. The angles were calculated at 20°-120° arm elevation, and the data were compared between the two conditions. The scapular upward and internal rotation angles and the posterior tilt angle were significantly smaller with the subjects wearing bras than not wearing bras. In contrast, the glenohumeral elevation angle was significantly greater when bras were warn. Bra wearing may influence shoulder kinematics. Consequently, great care should be taken to account for this factor during the evaluation of kinematics in female subjects.

The Relationship between Prolonged Sitting Position and Adaptive Alterations in Lumbar Spine and Pelvic Range of Motion in Cyclists with Chronic Low Back Pain

Background: The majority of low back pain (LBP) problems in athletes are the result of stress induced by prolonged postures or repeated movements. Cycling is a sport that needs prolonged trunk flexion during the activity.& para;& para;Objective: To compare sagittal lumbar spine and sagittal pelvic tilt range of motion (ROM) between athletes with CLBP (chronic low back pain) who regularly ride bicycles and healthy controls without regular bicycle riding.& para;& para;Methods: Nineteen cyclists with CLBP and 20 asymptomatic non-cyclist athletes participated in the study, (mean age: 26.00 +/- 8.67 years). Sagittal lumbar spine and sagittal pelvic tilt range of motion (ROM) were measured during forward bending and backward return clinical tests using a three-dimensional motion capture system.& para;& para;Results: During forward bending. cyclists with CLBP demonstrated a limited anterior pelvic tilt angle (p = 0.03), compared to non-cyclists athletes. No significant differences were found in lumbar flexion angle between the groups during the test. During Backward return, cyclists with CLBP exhibited a limited posterior pelvic tilt angle (p = 0.02) and lumbar-extension range = 0.05). compared to non-cyclist athletes.& para;& para;Conclusions: A regular sitting position on the bicycle for a prolonged period may result in adaptations in sagittal lumbar and pelvic ROM which may contribute to the development of LBP.

Eight orthopedic surgeons achieved moderate to excellent reliability measuring the preoperative posterior tilt angle in 50 Garden-I and Garden-II femoral neck fractures

BackgroundStudies of elderly patients with Garden-I and Garden-II femoral neck fractures (FNFs) suggest that a preoperative posterior tilt of the femoral head of at least 20° increases the risk of fixation failure. A recently published treatment algorithm recommended hemiarthroplasty over internal fixation for elderly patients with Garden-I and Garden-II FNFs and a preoperative posterior tilt of at least 20°. However, the reliability of the method used to measure the posterior tilt has not been assessed according to recommended standards for reliability trials.MethodsFour orthopedic registrars and four consultants measured the posterior tilt angle in 50 preoperative lateral radiographs at two occasions six weeks apart. We estimated inter- and intrarater reliability by intraclass correlation coefficient (ICC). We also assessed repeatability by the repeatability coefficient (RC) and agreement by the minimal detectable change (MDC). Based on the suggested cutoff value of 20°, we reported the overall percentage and specific agreement for the choice of implant.ResultsInter- and intrarater reliability for all raters was excellent with an ICC (95% CI) of 0.77 (0.69–0.85) and 0.77 (0.67–0.86), respectively. The RC was 13.9 and the MDC 14.1. Specific agreement for choosing arthroplasty was 61.3 and 54.6% for the first and second test occasion, respectively.ConclusionsEight orthopedic surgeons measured the posterior tilt in 50 Garden-I and Garden-II FNFs and achieved excellent inter- and intrarater reliability. However, variations in repeated measurements and variations in measurements made by different raters, as assessed by the RC and the MDC respectively, ranged from 13.9° to 14.1°. The variations in posterior tilt measurements should be taken into account when choosing the type of implant for elderly patients with Garden-I and Garden-II femoral neck fractures.

Mechanical effects of traction on lumbar intervertebral discs: A magnetic resonance imaging study

BackgroundAlthough traction has long been used for treating patients with low back pain (LBP), its effects are still inconclusive mainly because of limited high-quality evidence. ObjectiveTo provide evidence of the mechanism of traction on lumbar intervertebral discs. DesignA quantitative approach with a repeated measurement protocol. MethodNine participants (mean age = 22.1 ± 0.8 years) without any LBP history were recruited. Magnetic Resonance Images of the lumbar spine of each participant were recorded before and after 30 min of horizontal lying and directly after 30 min of horizontal traction of 42% body weight. The average, anterior, central, and posterior disc height and tilt angle of each lumbar disc and lumbar lordosis were measured. ResultsA significant increase in the average disc height for all lumbar discs, a significant reduction of lumbar lordosis and changes in tilt angle were observed after the application of 30 min of resting followed by 30 min of traction. A significant increase in the average disc height was observed only in lower lumbar discs after 30 min of traction. The increase in the posterior disc height was more apparent than that in the anterior disc height. ConclusionsHorizontal traction was evidently effective in increasing the disc height of lower lumbar levels, particularly in the posterior regions of the discs. Further evidence of the effects of traction of different modes, magnitudes, and durations on the change in disc height is required for proper control of traction applied to specific disc levels.

Trunk function in hemiplegic wheelchair users when using wheelchair cushions.

[Purpose] The purpose of this study was to investigate adapting wheelchair cushions to hemiplegic individuals based on trunk function and a single-leg driving motion. [Subjects and Methods] Subjects were 18 hemiplegic adults who were able to use and sit up in a wheelchair. Subjects were grouped into Able and Unable groups according to the Functional Assessment for Control of the Trunk (FACT). The posterior pelvic tilt angle and the driving speed and muscle activity at the long head of the biceps femoris at the start of wheelchair use were measured for three wheelchair cushion conditions, and FACT factors and cushion factors were then analyzed. [Results] The cushion with anchoring functionality and no thigh pad on the driving side resulted in significantly lower posterior pelvic tilt and muscle activity of the long head of the biceps femoris. No significant difference was found among the FACT factors. The Unable group did not exhibit a difference in driving speed between no cushion and a single-layer urethane foam cushion. [Conclusion] The results suggest that the cushion with anchoring functionality and thigh pad removed on the driving side was well adapted to hemiplegic wheelchair users and particularly effective for those with low trunk control ability.

Lower trunk muscle activity-induced alignment and cop position during single-leg standing.

[Purpose] The purpose of this study was to clarify fundamental changes induced by lower trunk muscle contraction during single-leg standing. [Subjects and Methods] Ten healthy normal males participated in this study. All subjects could accurately perform lower trunk muscle contraction-type Abdominal Expansion (AE), Abdominal Bracing (AB), and Abdominal Cave-in (AC). The alignment and position of the center of foot pressure (COP) during single-leg standing with SLR and step position after rotating the body from single-leg standing with maximum SLR were measured in each lower trunk muscle contraction type. [Results] When AC was performed during single-leg standing with SLR, the SLR angle increased, COP shifted backward, and the posterior tilt angle of the trunk and cross step distance decreased. [Conclusion] It was assumed that AC during wind-up increases the angle of lower limb elevation and decreases the posterior tilt angle of the trunk and cross step distance.

Effects of volitional spine stabilization on lifting task in recurrent low back pain population.

To examine the influence of volitional preemptive abdominal contraction (VPAC) and recurrent low back pain (rLBP) on trunk mechanics and neuromuscular control during a symmetric lifting task. A 2×2 crossover mixed design was used to examine the effects of VPAC and group. Thirty-seven healthy individuals and 32 rLBP individuals performed symmetric box lifting trials with and without VPAC to a 1-m height table3D trunk, pelvis, and hip joint angle and electromyographic magnitude variables were obtained. Selected variables were analyzed using ANOVA. The VPAC induced differences in joint kinematics and muscle activity in rLBP and healthy subjects during symmetric lifting. A significant two-way interaction effect was observed for the semitendinosus activity. The VPAC increased external oblique muscle activity, reduced erector spinae and multifidus muscles activity, and induced greater trunk flexion angle, greater trunk side flexion angle, and greater hip flexion angle, and decreased pelvis obliquity angle in both groups. In addition, the rLBP subjects presented with a reduced external oblique and gluteus maximus muscle activity, greater erector spinae and multifidus muscles activity, and greater pelvis posterior tilt angle. Our results provide evidence that a VPAC strategy performed during symmetric lifting may potentially reduce exposure to biomechanical factors that can contribute to lumbar spine injury. The hamstring muscles may play an important role in achieving pelvic balance during the lifting maneuver. Incorporating the VPAC during dynamic stressful activities appears to help improve sensorimotor control and facilitate positioning of the lower extremities and the pelvis, while protecting the lumbar spine.

Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture.

Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%-19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60-101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures

Background and purpose — It has been suggested that preoperative posterior tilt of the femoral head may increase the risk of fixation failure in Garden-I and -II femoral neck fractures. To investigate this association, we studied a cohort of 322 such patients.Patients and methods — Patients treated with internal fixation between 2005 and 2012 were retrospectively identified using hospital records and the digital image bank. 2 raters measured the preoperative posterior tilt angle and categorized it into 3 groups: < 10°, 10–20°, and ≥ 20°. The inter-rater reliability (IRR) was determined. Patients were observed until September 2013 (with a minimum follow-up of 18 months) or until failure of fixation necessitating salvage arthroplasty. The risk of fixation failure was assessed using competing-risk regression analysis, adjusting for time to surgery.Results — Patients with a posterior tilt of ≥ 20° had a higher risk of fixation failure: 19% (8/43) as compared to 11% (14/127) in the 10–20° category and 6% (9/152) in the < 10° category (p = 0.03). Posterior tilt of ≥ 20° increased the risk of fixation failure, with an adjusted hazard ratio of 3.4 (95% CI: 1.3–8.9; p = 0.01). The interclass correlation coefficient for angular measurements of posterior tilt was 0.90 (95% CI: 0.87–0.92), and the IRR for the categorization of posterior tilt into 3 groups was 0.76 (95% CI: 0.69–0.81).Interpretation — Preoperative posterior tilt of ≥ 20° in Garden-I and -II femoral neck fractures increased the risk of fixation failure necessitating salvage arthroplasty. The reliability of the methods that we used to measure posterior tilt ranged from good to excellent.

Pre-operative nutritional serum parameters as predictors of failure after internal fixation in undisplaced intracapsular proximal femur fractures

IntroductionCurrent management of undisplaced hip fractures is based on internal fixation. Reported revision rates of 12–17% for this procedure negatively impact on patient morbidity and mortality. The aim of this novel study is to examine if the nutritional status of these patients is associated with failure of internal fixation. Patients and methodsA consecutive series of 111 undisplaced intracapsular hip fractures treated with cannulated screw was identified. These were retrospectively reviewed including routine admission serum investigations (lymphocyte count and albumin levels). Radiological investigations were used to assess fracture classification, posterior-tilt angle, fixation adequacy, screw configuration and failure (avascular-necrosis, non-union and screw cut-out). Results16% of fixations failed (18 patients). Patients with fixation-failure had a significantly lower albumin (35g/l vs. 40g/l, p=0.02) and lymphocyte count (0.7×109l vs. 1.4×109l, p≤0.001) than non-failure patients. Lymphocyte count, albumin level and posterior-tilt angle were independent predicators of failure on binary logistic regression analysis. We suggest that routine laboratory tests can be used to identify patients at greatest risk of failure of internal fixation.