Optimal sliding distance in femoral neck system for displaced femoral neck fractures: a retrospective cohort study.
Femoral Neck System
Femoral Neck fractures
Internal fixation
Postoperative shortening
Sliding Distance
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
26 Oct 2024
26 Oct 2024
Historique:
received:
14
09
2024
accepted:
20
10
2024
medline:
26
10
2024
pubmed:
26
10
2024
entrez:
25
10
2024
Statut:
epublish
Résumé
Displaced femoral neck fractures frequently result in considerable patient morbidity, with complications such as postoperative femoral neck shortening occurring in up to 39.1% of cases. This shortening is associated with reduced hip function and mobility. The Femoral Neck System (FNS), which allows for controlled sliding to facilitate fracture reduction and healing, may mitigate these issues. However, the ideal sliding distance to balance fracture healing and minimize complications is not well defined. We performed a retrospective cohort study of 179 patients who underwent FNS fixation for displaced femoral neck fractures at our institution from September 2019 to September 2023. Patients were categorized into three groups based on the intraoperative sliding distance allowed by the FNS: the Minimal Slide group (≤ 5 mm), the Moderate Slide group (> 5 to ≤ 10 mm), and the Extensive Slide group (> 10 to 20 mm). Primary outcomes included postoperative femoral neck shortening, the incidence of moderate to severe shortening, time to fracture union, and hip joint function as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score. Secondary outcomes included complication rates such as implant cut-out, nonunion, avascular necrosis of the femoral head, and the need for secondary surgery. The Extensive Slide group of moderate to severe shortening at 32.31%, which was 1.59-fold and 8.88-fold that of the Moderate Slide (20.34%) and Minimal Slide group's (3.64%), respectively (P < 0.01). The sliding predominantly occurred within the first three months postoperatively and had substantially ceased by six months. At one year postoperatively, the median shortening was 2.7 mm (IQR, 0.7 to 3.5 mm) for the Minimal Slide group, a value that was notably lower compared to the 3.2 mm (IQR, 2.4 to 4.6 mm) for the Moderate Slide group and the 3.5 mm (IQR, 1.3 to 8.1 mm) for the Extensive Slide group. The average time to achieve union was similar across all groups, with no significant differences. Functional outcomes, as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score, the Harris Hip Score (HHS) demonstrated statistical significance, the Parker Mobility Score did not reach statistical significance. Restricting FNS slide to ≤ 5 mm in surgery may reduce shortening, improve hip function, and not hinder fracture healing or implant stability. Considering the key 3-month sliding timeline postoperatively is advisable in clinical practice. Further research with a broader patient cohort is vital to confirm these findings and to anchor them in evidence-based practice.
Sections du résumé
BACKGROUND
BACKGROUND
Displaced femoral neck fractures frequently result in considerable patient morbidity, with complications such as postoperative femoral neck shortening occurring in up to 39.1% of cases. This shortening is associated with reduced hip function and mobility. The Femoral Neck System (FNS), which allows for controlled sliding to facilitate fracture reduction and healing, may mitigate these issues. However, the ideal sliding distance to balance fracture healing and minimize complications is not well defined.
METHODS
METHODS
We performed a retrospective cohort study of 179 patients who underwent FNS fixation for displaced femoral neck fractures at our institution from September 2019 to September 2023. Patients were categorized into three groups based on the intraoperative sliding distance allowed by the FNS: the Minimal Slide group (≤ 5 mm), the Moderate Slide group (> 5 to ≤ 10 mm), and the Extensive Slide group (> 10 to 20 mm). Primary outcomes included postoperative femoral neck shortening, the incidence of moderate to severe shortening, time to fracture union, and hip joint function as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score. Secondary outcomes included complication rates such as implant cut-out, nonunion, avascular necrosis of the femoral head, and the need for secondary surgery.
RESULTS
RESULTS
The Extensive Slide group of moderate to severe shortening at 32.31%, which was 1.59-fold and 8.88-fold that of the Moderate Slide (20.34%) and Minimal Slide group's (3.64%), respectively (P < 0.01). The sliding predominantly occurred within the first three months postoperatively and had substantially ceased by six months. At one year postoperatively, the median shortening was 2.7 mm (IQR, 0.7 to 3.5 mm) for the Minimal Slide group, a value that was notably lower compared to the 3.2 mm (IQR, 2.4 to 4.6 mm) for the Moderate Slide group and the 3.5 mm (IQR, 1.3 to 8.1 mm) for the Extensive Slide group. The average time to achieve union was similar across all groups, with no significant differences. Functional outcomes, as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score, the Harris Hip Score (HHS) demonstrated statistical significance, the Parker Mobility Score did not reach statistical significance.
CONCLUSIONS
CONCLUSIONS
Restricting FNS slide to ≤ 5 mm in surgery may reduce shortening, improve hip function, and not hinder fracture healing or implant stability. Considering the key 3-month sliding timeline postoperatively is advisable in clinical practice. Further research with a broader patient cohort is vital to confirm these findings and to anchor them in evidence-based practice.
Identifiants
pubmed: 39456012
doi: 10.1186/s13018-024-05190-0
pii: 10.1186/s13018-024-05190-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
690Subventions
Organisme : Project of Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma
ID : 2020Y2014
Organisme : Project of Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma
ID : 2020Y2014
Organisme : Natural Science Foundation of Fujian Province
ID : 2023J011514
Organisme : Youth Research Project of Fujian Provincial Health Commission
ID : 2022QNA086
Organisme : Medical Innovation Project of Fujian Province
ID : 2022CXA054
Informations de copyright
© 2024. The Author(s).
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