In divergent cases, a third trauma surgeon helped make the right decision. The included fracture types were classified by two experienced trauma surgeons independently (κ = 0.96) on admission X-ray images according to the classification of Garden and Pauwels. 5 patients, who died during the follow-up time, were excluded from the study. Information on their outcome was collected after evaluation of current x-ray images in the hospital information system and on request from the responsible further treatment physician. The observation period of the included patients by our retrospective study was up to 12 months. In the process, surgical reports, discharge letters and quality assurance data sheets were evaluated. The investigated factors were taken from the hospital information system Cerner Soarian Clinicals Version 4.1. The aim was to investigate the influence of various factors on the two outcome parameters “procedure - specific complication” and “functional outcome”.Īll cases of a femoral neck fracture, operated by cannulated screw fixation, in the period from December 2014 to December 2017 were included. The subject of this study is the displaced and undisplaced femoral neck fracture treated by cannulated screw fixation. However, the factors affecting the outcome of displaced and undisplaced femoral neck fractures treated by a head-preserving operative method have not been adequately studied. Other studies have shown that age is not associated with earlier mortality, osteosynthesis failure, or functional outcome 11, 12, 13, 14. Some studies about non-displaced femoral neck fractures with head-preserving operation have shown that higher age is associated with an increase in revisions, complications, nonunion and poor functional outcome 8, 9, 10. Numerous studies on the outcome of head-preserving femoral neck fractures have a relatively high rate of osteosynthesis failure, in some cases >40% 3, 4, 5, 6, 7. However, the benefit of maintaining the femoral head can be associated with numerous complications: femoral head necrosis, nonunion, femoral neck shortening, screw loosening, implant penetration 2. The choice is between endoprosthetic and femoral head preserving methods 2. The treatment of femoral neck fractures gives the surgeon almost a free decision on the surgical procedure within the scope of applicable guidelines. The number of hip fractures worldwide is expected to increase to 2.6 million in 2025 and 4.5 million in 2050 1. A more stable head-perserving operative method or an endoprosthetic procedure should be considered in high-risk patients (≥80 y.o.). The increasing risk of procedure-specific complications for patients with a femoral neck fracture treated by cannulated screw fixation is associated with rising patient age. A rate of 41% procedure-specific complications as an outcome parameter in trauma surgery shows a necessity for improvement. 69% of the patients from age 80 onwards suffered a procedure-specific complication. None of the remaining factors examined showed a statistically significant influence on both outcome parameters procedure-specific complication and functional outcome. The factor patient age showed a statistically significant influence on the outcome parameter procedure-specific complication. The femoral neck fractures were classified as follows: Garden I: 73%, Garden II: 16%, Garden III: 11%, Pauwels I: 73%, Pauwels II: 21%, Pauwels III: 5%, 31-B1: 73%, 31-B2: 27%, 31-B3: 0%. The likelihood ratio test was used to test for deviation from linearity. The null hypothesis Odds Ratio = 1 was checked by the Wald test. The effect of potential factors on endpoints was estimated with a multivariable logistic regression analysis and 95% confidence intervals calculated. Continuous data were presented as mean value ± standard deviation, categorical data as absolute and relative frequency. Information on their outcome was collected after evaluation of current x-ray images and on request from the responsible further treatment physician. The observation period of the included patients was 12 months. All cases of a femoral neck fracture, operated by cannulated screw fixation, in the period from December 2014 to December 2017 were included. To investigate the influence of various factors on the two outcome parameters “procedure - specific complication” (femoral head necrosis, infection, nonunion, femoral neck shortening, screw loosening, implant penetration) and “functional outcome” in patients with displaced and undisplaced femoral neck fracture treated by cannulated screw fixation.
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