Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years

Background:. The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation. Methods:. A retr...

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Autores principales:	Pontus Sjöholm, MD, Jonas Sundkvist, MD, Olof Wolf, MD, PhD, Olof Sköldenberg, MD, PhD, Max Gordon, MD, PhD, Sebastian Mukka, MD, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/b8f71ee4a9404d60a531de15ab4a7d9f
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spelling	oai:doaj.org-article:b8f71ee4a9404d60a531de15ab4a7d9f2021-11-25T07:59:02ZPreoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years2472-724510.2106/JBJS.OA.21.00045https://doaj.org/article/b8f71ee4a9404d60a531de15ab4a7d9f2021-12-01T00:00:00Zhttp://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00045https://doaj.org/toc/2472-7245Background:. The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation. Methods:. A retrospective multicenter study was performed on a consecutive series of patients ≥60 years of age who had undergone primary internal fixation for the treatment of Garden Type-I and II femoral neck fractures. The study included 1,505 patients with a minimum follow-up of 2 years. Radiographic assessments encompassed preoperative and postoperative tilt, implant inclination, and treatment failure. Data on reoperation and mortality were collected. The risk of treatment failure was assessed with use of Cox proportional hazard regression analysis. Results:. The study comprised 1,505 patients (71% female) with a median age of 81 years (range, 60 to 108 years). Overall, 234 patients (16%) were classified as having a treatment failure and 251 patients (17%) underwent reoperation. A preoperative anterior tilt of >10° and a posterior tilt of >20° were predictors of treatment failure and reoperation, respectively. Treatment failure occurred in 74 (25%) of 301 patients with a posterior tilt of >20° and in 17 (43%) of 40 patients with an anterior tilt of >10°. Conclusions:. This multicenter cohort study identified a subgroup of patients with Garden Type-I and II femoral neck fractures with an anterior tilt of >10° as having high treatment failure rates and major reoperation rates comparable with those associated with displaced femoral neck fractures. A preoperative posterior tilt of >20° increases the risk of treatment failure, and the potential benefit of arthroplasty in this subgroup of patients remains to be further investigated. Level of Evidence:. Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.Pontus Sjöholm, MDJonas Sundkvist, MDOlof Wolf, MD, PhDOlof Sköldenberg, MD, PhDMax Gordon, MD, PhDSebastian Mukka, MD, PhDWolters KluwerarticleOrthopedic surgeryRD701-811ENJBJS Open Access, Vol 6, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Pontus Sjöholm, MD Jonas Sundkvist, MD Olof Wolf, MD, PhD Olof Sköldenberg, MD, PhD Max Gordon, MD, PhD Sebastian Mukka, MD, PhD Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
description	Background:. The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation. Methods:. A retrospective multicenter study was performed on a consecutive series of patients ≥60 years of age who had undergone primary internal fixation for the treatment of Garden Type-I and II femoral neck fractures. The study included 1,505 patients with a minimum follow-up of 2 years. Radiographic assessments encompassed preoperative and postoperative tilt, implant inclination, and treatment failure. Data on reoperation and mortality were collected. The risk of treatment failure was assessed with use of Cox proportional hazard regression analysis. Results:. The study comprised 1,505 patients (71% female) with a median age of 81 years (range, 60 to 108 years). Overall, 234 patients (16%) were classified as having a treatment failure and 251 patients (17%) underwent reoperation. A preoperative anterior tilt of >10° and a posterior tilt of >20° were predictors of treatment failure and reoperation, respectively. Treatment failure occurred in 74 (25%) of 301 patients with a posterior tilt of >20° and in 17 (43%) of 40 patients with an anterior tilt of >10°. Conclusions:. This multicenter cohort study identified a subgroup of patients with Garden Type-I and II femoral neck fractures with an anterior tilt of >10° as having high treatment failure rates and major reoperation rates comparable with those associated with displaced femoral neck fractures. A preoperative posterior tilt of >20° increases the risk of treatment failure, and the potential benefit of arthroplasty in this subgroup of patients remains to be further investigated. Level of Evidence:. Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.
format	article
author	Pontus Sjöholm, MD Jonas Sundkvist, MD Olof Wolf, MD, PhD Olof Sköldenberg, MD, PhD Max Gordon, MD, PhD Sebastian Mukka, MD, PhD
author_facet	Pontus Sjöholm, MD Jonas Sundkvist, MD Olof Wolf, MD, PhD Olof Sköldenberg, MD, PhD Max Gordon, MD, PhD Sebastian Mukka, MD, PhD
author_sort	Pontus Sjöholm, MD
title	Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
title_short	Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
title_full	Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
title_fullStr	Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
title_full_unstemmed	Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years
title_sort	preoperative anterior and posterior tilt of garden i-ii femoral neck fractures predict treatment failure and need for reoperation in patients over 60 years
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/b8f71ee4a9404d60a531de15ab4a7d9f
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Preoperative Anterior and Posterior Tilt of Garden I-II Femoral Neck Fractures Predict Treatment Failure and Need for Reoperation in Patients Over 60 Years

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