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Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Acta+Orthop 2016 ; 87 (3): 252-6 Nephropedia Template TP
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Preoperative posterior tilt of at least 20 degrees increased the risk of fixation failure in Garden-I and -II femoral neck fractures #MMPMID26937557
Dolatowski FC; Adampour M; Frihagen F; Stavem K; Erik Utvag S; Hoelsbrekken SE
Acta Orthop 2016[Jun]; 87 (3): 252-6 PMID26937557show ga
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 degrees , 10-20 degrees , and >/= 20 degrees . 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 degrees had a higher risk of fixation failure: 19% (8/43) as compared to 11% (14/127) in the 10-20 degrees category and 6% (9/152) in the < 10 degrees category (p = 0.03). Posterior tilt of >/= 20 degrees 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 degrees 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.