Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2016 Jun;87(3):252-6.
doi: 10.3109/17453674.2016.1155253. Epub 2016 Mar 3.

Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures

Filip C Dolatowski  1   2 , Mina Adampour  3 , Frede Frihagen  4 , Knut Stavem  2   5 , Stein Erik Utvåg  1   2 , Sigurd Erik Hoelsbrekken  6
Affiliations
Comment

Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures

Filip C Dolatowski et al. Acta Orthop. 2016 Jun.

Abstract

Background and purpose - It has been suggested that preoperative posterior tilt of the femoral head may increase the risk of fixation failure in Garden-I and -II femoral neck fractures. To investigate this association, we studied a cohort of 322 such patients. Patients and methods - Patients treated with internal fixation between 2005 and 2012 were retrospectively identified using hospital records and the digital image bank. 2 raters measured the preoperative posterior tilt angle and categorized it into 3 groups: < 10°, 10-20°, and ≥ 20°. The inter-rater reliability (IRR) was determined. Patients were observed until September 2013 (with a minimum follow-up of 18 months) or until failure of fixation necessitating salvage arthroplasty. The risk of fixation failure was assessed using competing-risk regression analysis, adjusting for time to surgery. Results - Patients with a posterior tilt of ≥ 20° had a higher risk of fixation failure: 19% (8/43) as compared to 11% (14/127) in the 10-20° category and 6% (9/152) in the < 10° category (p = 0.03). Posterior tilt of ≥ 20° increased the risk of fixation failure, with an adjusted hazard ratio of 3.4 (95% CI: 1.3-8.9; p = 0.01). The interclass correlation coefficient for angular measurements of posterior tilt was 0.90 (95% CI: 0.87-0.92), and the IRR for the categorization of posterior tilt into 3 groups was 0.76 (95% CI: 0.69-0.81). Interpretation - Preoperative posterior tilt of ≥ 20° in Garden-I and -II femoral neck fractures increased the risk of fixation failure necessitating salvage arthroplasty. The reliability of the methods that we used to measure posterior tilt ranged from good to excellent.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Internal fixation of a Garden I–II femoral neck fracture with 2 parallel cannulated screws.
Figure 2.
Figure 2.
Garden I–II fracture of the right femoral neck. The posterior tilt angle (α) is defined by the mid-collum line (MCL) and the radius collum line (RCL) (Palm et al. 2009).
See this image and copyright information in PMC

Comment on

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Altman D. Practical Statistics for Medical Research. Chapman & Hall: London; 1991; 404.
    1. Audige L, Bhandari M, Kellam J.. How reliable are reliability studies of fracture classifications? A systematic review of their methodologies. Acta Orthop Scand 2004; 75 (2): 184–94. - PubMed
    1. Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J.. Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients. Acta Orthop 2006; 77 (4): 638–43. - PubMed
    1. Blundell C M, Parker M J, Pryor G A, Hopkinson-Woolley J, Bhonsle S S.. Assessment of the AO classification of intracapsular fractures of the proximal femur. J Bone Joint Surg Br 1998; 80 (4): 679–83. - PubMed
    1. Cicchetti D. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assessment 1994; 6 (4): 286.

LinkOut - more resources