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Relevance of primary reduction for the clinical outcome of femoral neck fractures treated with cancellous screws

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Abstract

Introduction

Femoral head-preserving treatment for femoral neck fractures with cancellous screws is a method widely performed, but its success depends on the quality of primary reduction. The goal of our study was to evaluate the relevance of reduction quality on the clinical outcome.

Patients and methods

We retrospectively analyzed the postoperative reduction result of 39 patients. The angular rotation and the inferior displacement of the proximal fracture fragment were digitally assessed from AP radiographs. The clinical outcome was recorded by a follow-up after a mean 5.5 years.

Results

Unsuccessful healing was observed in eight patients, femoral head necrosis in three patients, non-union in two patients, implant loosening in one patient, and posttraumatic arthritis in two patients, all resulting in the need for a total hip replacement. This clinical course was strongly associated with a primary reduction in varus position, whereas reduction in anatomic or valgus angulation had no negative effect on the clinical outcome. An inferior offset was no negative predictor for successful healing.

Conclusion

We conclude that a non-anatomic reduction in varus angulation significantly increases the risk of healing failure and therefore should be avoided. Reduction in valgus position should be performed if secondary redislocation is imminent.

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Acknowledgements

The authors confirm that all experiments comply with the current laws of the Federal Republic of Germany. They wish to thank Mrs. Annabell Krischak, Mrs. Astrid Helble, and Mr. Joe Whitney for proofreading the manuscript.

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Authors and Affiliations

  1. Abteilung Unfall-, Hand- und Wiederherstellungschirurgie, Universität Ulm, Steinhövelstr. 9, 89070, Ulm, Germany

    G. Krischak

  2. Department of Traumatology, Hand and Reconstructive Surgery, University of Ulm, Germany

    G. Krischak, A. Beck, N. Wachter, R. Jakob, L. Kinzl & G. Suger

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  1. G. Krischak
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  2. A. Beck
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  3. N. Wachter
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Correspondence to G. Krischak.

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Krischak, G., Beck, A., Wachter, N. et al. Relevance of primary reduction for the clinical outcome of femoral neck fractures treated with cancellous screws. Arch Orthop Trauma Surg 123, 404–409 (2003). https://doi.org/10.1007/s00402-003-0571-3

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  • DOI: https://doi.org/10.1007/s00402-003-0571-3

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