Risk factors for osteonecrosis of femoral head after femoral neck fracture fixation with femoral neck system_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JI Jiachen ^1,2 , CHEN Haojie ³ , YANG Bo ^1,2 , DONG Liang ² , WANG Min ² ,  HUANG Xiaoqiang ⁴

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China;
2. Department of Orthopedics, Honghui Hospital Affiliated to Medicine College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;
3. Department of Orthopedics, the First Affiliated Hospital of Henan Polytechnic University, Jiaozuo Henan, 454000, P. R. China;
4. Department of Orthopedics, Xi’an Fifth Hospital, Xi’an Shaanxi, 710082, P. R. China;

Corresponding?author：

HUANG Xiaoqiang, Email: huangxq73@163.com

Keywords：

Femoral neck system; femoral neck fracture; osteonecrosis of the femoral head; risk factor

DOI：

10.7507/1002-1892.202211004

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Objective To explore the risk factors for osteonecrosis of the femoral head (ONFH) after treatment of femoral neck fractures with femoral neck system (FNS). Methods Between January 2020 and February 2021, 179 patients (182 hips) with femoral neck fractures treated by FNS fixation were selected for retrospective analysis. There were 96 males and 83 females with an average age of 53.7 years (range, 20-59 years). There were 106 cases of low-energy-induced injury and 73 cases of high-energy-induced injury. The fractures were classified as type Ⅱ in 40 hips, type Ⅲ in 78 hips, and type Ⅳ in 64 hips according to Garden classification standard, and as typeⅠin 23 hips, type Ⅱ in 66 hips, and type Ⅲ in 93 hips according to Pauwels classification standard. There were 21 patients with diabetes. Patients were divided into ONFH group and non-ONFH group according to whether ONFH occurred at last follow-up. The data of the patients were collected, including age, gender, body mass index (BMI), trauma mechanism, bone mineral density, having diabetes or not, Garden classification and Pauwels classification of fractures, fracture reduction quality, femoral head retroversion angle, and removal of internal fixator or not. The above factors were analyzed by univariate analysis, and then multivariate logistic regression analysis was used to identify risk factors. Results Total 179 patients (182 hips) were followed up 20-34 months (mean, 26.5 months). Of these, 30 cases (30 hips) developed ONFH at 9-30 months after operation (ONFH group), and the incidence of ONFH was 16.48%. And 149 cases (152 hips) had no ONFH at last follow-up (non-ONFH group). The univariate analysis showed that there were significant differences between groups in bone mineral density, having diabetes or not, Garden classification, femoral head retroversion angle, and fracture reduction quality (P<0.05). The multivariate logistic regression analysis showed that the Garden type Ⅳ fracture, reduction quality of grading Ⅲ, femoral head retroversion angle >15°, complicated with diabetes were the risk factors for ONFH after FNS fixation (P<0.05). Conclusion For the patients with Garden type Ⅳ fracture, poor quality of fracture reduction, femoral head retroversion angle >15°, and diabetes, the risk of ONFH after FNS fixation increases.

Citation： JI Jiachen, CHEN Haojie, YANG Bo, DONG Liang, WANG Min, HUANG Xiaoqiang. Risk factors for osteonecrosis of femoral head after femoral neck fracture fixation with femoral neck system. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(2): 162-167. doi: 10.7507/1002-1892.202211004 Copy

1.	中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
2.	孫偉, 高福強, 李子榮. 股骨頭壞死臨床診療技術專家共識(2022年). 中國修復重建外科雜志, 2022, 36(11): 1319-1326.
3.	Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
4.	Lamb JN, Holton C, O’Connor P, et al. Avascular necrosis of the hip. BMJ, 2019, 365: l2178. doi: 10.1136/bmj.l2178.
5.	冀家琛, 楊博, 王敏, 等. 股骨頸動力交叉釘系統治療青壯年股骨頸骨折的研究進展. 中國修復重建外科雜志, 2022, 36(11): 1434-1439.
6.	Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable Pauwels Ⅲ femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma, 2017, 31(3): 131-137.
7.	Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
8.	Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma, 2019, 33 Suppl 1: S27-S32.
9.	冀家琛, 王敏, 董亮, 等. 股骨頸系統與空心釘固定青壯年股骨頸骨折. 中國矯形外科雜志, 2022, 30(22): 2022-2027.
10.	Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg (Am), 1970, 52(3): 457-467.
11.	蔡樂益, 郭曉山, 鄭文浩, 等. 對Garden指數作為股骨頸骨折復位質量評價標準的再認識. 中華創傷骨科雜志, 2020, 22(3): 232-237.
12.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
13.	Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res, 2017, 475(8): 2011-2023.
14.	嚴才平, 王星寬, 向超, 等. 股骨頸動力交叉釘系統與空心加壓螺釘治療中青年股骨頸骨折的療效比較. 中國修復重建外科雜志, 2021, 35(10): 1286-1292.
15.	楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療PauwelsⅢ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
16.	王永欽, 徐子環, 李鵬飛, 等. 基于骨折地圖技術的青壯年股骨頸骨折特征分析. 中國修復重建外科雜志, 2022, 36(9): 1078-1083.
17.	Wang SH, Yang JJ, Shen HC, et al. Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients. Injury, 2015, 46(10): 1969-1974.
18.	Wang C, Xu GJ, Han Z, et al. Correlation between residual displacement and osteonecrosis of the femoral head following cannulated screw fixation of femoral neck fractures. Medicine (Baltimore), 2015, 94(47): e2139. doi: 10.1097/MD.0000000000002139.
19.	侯洪濤, 劉立平, 李無陰, 等. 正位Garden指數對GardenⅢ型股骨頸骨折移位程度的評價及其價值. 中華創傷雜志, 2022, 38(10): 904-908.
20.	陳芒芒, 呂楊訓, 林勝磊, 等. 壓力側和張力側股骨頸皮質粉碎是股骨頸骨折術后無菌性壞死的獨立危險因素. 中國骨傷, 2021, 34(3): 203-208.
21.	Palm H, Gosvig K, Krasheninnikoff M, et al. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta Orthop, 2009, 80(3): 303-307.
22.	Yamamoto T, Kobayashi Y, Nonomiya H. Undisplaced femoral neck fractures need a closed reduction before internal fixation. Eur J Orthop Surg Traumatol, 2019, 29(1): 73-78.
23.	劉冠虹, 吉萬波, 劉錦濤, 等. 股骨頸骨折內固定術后股骨頭壞死的相關因素分析及生活質量評價. 中國骨傷, 2020, 33(8): 750-757.
24.	Millikan PD, Karas V, Wellman SS. Treatment of osteonecrosis of the femoral head with vascularized bone grafting. Curr Rev Musculoskelet Med, 2015, 8(3): 252-259.
25.	姚強, 鄭劉杰, 李家樂, 等. 股骨頸骨折空心螺釘內固定術后股骨頭壞死危險因素分析. 中華骨與關節外科雜志, 2021, 14(12): 1007-1010.
26.	Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002, (399): 87-109.
27.	Xu JL, Liang ZR, Xiong BL, et al. Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2019, 20(1): 632. doi: 10.1186/s12891-019-2990-5.
28.	Martelli S, Perilli E. Time-elapsed synchrotron-light microstructural imaging of femoral neck fracture. J Mech Behav Biomed Mater, 2018, 84: 265-272.
29.	Lambers FM, Koch K, Kuhn G, et al. Trabecular bone adapts to long-term cyclic loading by increasing stiffness and normalization of dynamic morphometric rates. Bone, 2013, 55(2): 325-334.

1. 中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
2. 孫偉, 高福強, 李子榮. 股骨頭壞死臨床診療技術專家共識(2022年). 中國修復重建外科雜志, 2022, 36(11): 1319-1326.
3. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med, 2017, 377(21): 2053-2062.
4. Lamb JN, Holton C, O’Connor P, et al. Avascular necrosis of the hip. BMJ, 2019, 365: l2178. doi: 10.1136/bmj.l2178.
5. 冀家琛, 楊博, 王敏, 等. 股骨頸動力交叉釘系統治療青壯年股骨頸骨折的研究進展. 中國修復重建外科雜志, 2022, 36(11): 1434-1439.
6. Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable Pauwels Ⅲ femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma, 2017, 31(3): 131-137.
7. Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
8. Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma, 2019, 33 Suppl 1: S27-S32.
9. 冀家琛, 王敏, 董亮, 等. 股骨頸系統與空心釘固定青壯年股骨頸骨折. 中國矯形外科雜志, 2022, 30(22): 2022-2027.
10. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg (Am), 1970, 52(3): 457-467.
11. 蔡樂益, 郭曉山, 鄭文浩, 等. 對Garden指數作為股骨頸骨折復位質量評價標準的再認識. 中華創傷骨科雜志, 2020, 22(3): 232-237.
12. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
13. Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res, 2017, 475(8): 2011-2023.
14. 嚴才平, 王星寬, 向超, 等. 股骨頸動力交叉釘系統與空心加壓螺釘治療中青年股骨頸骨折的療效比較. 中國修復重建外科雜志, 2021, 35(10): 1286-1292.
15. 楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療PauwelsⅢ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
16. 王永欽, 徐子環, 李鵬飛, 等. 基于骨折地圖技術的青壯年股骨頸骨折特征分析. 中國修復重建外科雜志, 2022, 36(9): 1078-1083.
17. Wang SH, Yang JJ, Shen HC, et al. Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients. Injury, 2015, 46(10): 1969-1974.
18. Wang C, Xu GJ, Han Z, et al. Correlation between residual displacement and osteonecrosis of the femoral head following cannulated screw fixation of femoral neck fractures. Medicine (Baltimore), 2015, 94(47): e2139. doi: 10.1097/MD.0000000000002139.
19. 侯洪濤, 劉立平, 李無陰, 等. 正位Garden指數對GardenⅢ型股骨頸骨折移位程度的評價及其價值. 中華創傷雜志, 2022, 38(10): 904-908.
20. 陳芒芒, 呂楊訓, 林勝磊, 等. 壓力側和張力側股骨頸皮質粉碎是股骨頸骨折術后無菌性壞死的獨立危險因素. 中國骨傷, 2021, 34(3): 203-208.
21. Palm H, Gosvig K, Krasheninnikoff M, et al. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta Orthop, 2009, 80(3): 303-307.
22. Yamamoto T, Kobayashi Y, Nonomiya H. Undisplaced femoral neck fractures need a closed reduction before internal fixation. Eur J Orthop Surg Traumatol, 2019, 29(1): 73-78.
23. 劉冠虹, 吉萬波, 劉錦濤, 等. 股骨頸骨折內固定術后股骨頭壞死的相關因素分析及生活質量評價. 中國骨傷, 2020, 33(8): 750-757.
24. Millikan PD, Karas V, Wellman SS. Treatment of osteonecrosis of the femoral head with vascularized bone grafting. Curr Rev Musculoskelet Med, 2015, 8(3): 252-259.
25. 姚強, 鄭劉杰, 李家樂, 等. 股骨頸骨折空心螺釘內固定術后股骨頭壞死危險因素分析. 中華骨與關節外科雜志, 2021, 14(12): 1007-1010.
26. Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002, (399): 87-109.
27. Xu JL, Liang ZR, Xiong BL, et al. Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2019, 20(1): 632. doi: 10.1186/s12891-019-2990-5.
28. Martelli S, Perilli E. Time-elapsed synchrotron-light microstructural imaging of femoral neck fracture. J Mech Behav Biomed Mater, 2018, 84: 265-272.
29. Lambers FM, Koch K, Kuhn G, et al. Trabecular bone adapts to long-term cyclic loading by increasing stiffness and normalization of dynamic morphometric rates. Bone, 2013, 55(2): 325-334.

Chinese Journal of Reparative and Reconstructive Surgery

Risk factors for osteonecrosis of femoral head after femoral neck fracture fixation with femoral neck system

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