Factors influencing femoral neck fracture healing after internal fixation with dynamic locking plate. 2019

Radoslav Morochovič, and Katarína Takáčová, and Ľuboš Tomčovčík, and Peter Cibur, and Rastislav Burda
Department of Trauma Surgery, Faculty of Medicine P.J.Šafárik University, University Hospital of L. Pasteur, Rastislavova 43, 041 90, Košice, Slovakia. rrrr@email.cz.

BACKGROUND The purpose of this study was to determine factors that affect the early failure of femoral neck fracture healing after internal fixation with a dynamic locking plate implant. METHODS Retrospective analysis of all cases of femoral neck fracture (FNF) primarily treated with dynamic locking plate implant from 04/2014 to 04/2017 with a minimum of 6 month follow-up. For the purpose of the study age, sex and time from admission to surgery were retrieved from the hospital medical database. Patient's pre- and postoperative hip radiographs were reviewed by the authors. Radiographically detected fracture healing failure (non-union and screw cut-out) was recorded. RESULTS For the period of the study, there were 77 consecutive FNF (76 patients) treated with the dynamic locking plate implant. Eight (10%) patients were lost to follow-up, 13 (17%) patients died within 6 months after surgery. Healing failure was identified in 23 (41%) of remaining 56 cases. Three of four (75% failure rate) failures were observed in cases with fair-quality reduction and two of two (100% failure rate) failures were noticed in the case of none telescoping screw located within subchondral bone. Multiple logistic regression showed an increased risk of fracture failure in cases with at least one completely collapsed telescoping screw (OR = 73.2; 95% CI 9.4-568.5, p < 0.01), while telescoping screws' location around centre of the femoral head reduces the risk of failure (OR = 14.7; 95% CI 1.6-135.1, p = 0.02). CONCLUSIONS In our group of patients, fracture healing failure of the FNF treated with dynamic locking plate reached 41%. This high failure rate was associated with poor fracture reduction, not subchondrally and centrally placed telescoping screws and in the case of complete collapse on at least one of the telescoping screws.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D001860 Bone Plates Implantable fracture fixation devices attached to bone fragments with screws to bridge the fracture gap and shield the fracture site from stress as bone heals. (UMDNS, 1999) Bone Plate,Plate, Bone,Plates, Bone
D001863 Bone Screws Specialized devices used in ORTHOPEDIC SURGERY to repair bone fractures. Bone Screw,Screw, Bone,Screws, Bone
D005260 Female Females
D005265 Femoral Neck Fractures Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are HIP FRACTURES. Femur Neck Fractures,Femoral Neck Fracture,Femur Neck Fracture
D005592 Fracture Fixation The use of metallic devices inserted into or through bone to hold a fracture in a set position and alignment while it heals. Skeletal Fixation,Fracture Reduction,Fixation, Fracture,Fixation, Skeletal,Fixations, Fracture,Fixations, Skeletal,Fracture Fixations,Fracture Reductions,Reduction, Fracture,Reductions, Fracture,Skeletal Fixations
D005593 Fracture Fixation, Internal The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment. Osteosynthesis, Fracture,Fixation, Internal Fracture,Fixations, Internal Fracture,Fracture Fixations, Internal,Fracture Osteosyntheses,Fracture Osteosynthesis,Internal Fracture Fixation,Internal Fracture Fixations,Osteosyntheses, Fracture
D005599 Fractures, Ununited A fracture in which union fails to occur, the ends of the bone becoming rounded and eburnated, and a false joint occurs. (Stedman, 25th ed) Fracture, Ununited,Ununited Fracture,Ununited Fractures
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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