More than 20 degrees posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

Kalsbeek, J.; Walsum, A. van; Roerdink, H.; Schipper, I.

doi:doi:10.1007/s00068-021-01673-5

Purpose In 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). Methods Preoperative 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. Results Patients 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 degrees and 13.8 degrees, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20 degrees and 12.5% if the preoperative posterior tilt was >= 20 degrees. A posterior tilt of >= 20 degrees...Show morePurpose In 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). Methods Preoperative 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. Results Patients 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 degrees and 13.8 degrees, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20 degrees and 12.5% if the preoperative posterior tilt was >= 20 degrees. A posterior tilt of >= 20 degrees was associated with an odds ratio of 4.24 (95% CI 1.09-16.83; p = 0.04). Conclusion Garden type I and II FNFs with a significant preoperative posterior tilt (>= 20 degrees) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt >= 20 degrees 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.Show less

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More than 20 degrees posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure