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.	中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
2.	孙伟, 高福强, 李子荣. 股骨头坏死临床诊疗技术专家共识(2022年). 中国修复重建外科杂志, 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, 杨博, 王敏, 等. 股骨颈动力交叉钉系统治疗青壮年股骨颈骨折的研究进展. 中国修复重建外科杂志, 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. 股骨颈系统与空心钉固定青壮年股骨颈骨折. 中国矫形外科杂志, 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.	蔡乐益, 郭晓山, 郑文浩, 等. 对Garden指数作为股骨颈骨折复位质量评价标准的再认识. 中华创伤骨科杂志, 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.	严才平, 王星宽, 向超, 等. 股骨颈动力交叉钉系统与空心加压螺钉治疗中青年股骨颈骨折的疗效比较. 中国修复重建外科杂志, 2021, 35(10): 1286-1292.
15.	杨家赵, 周雪锋, 李黎, 等. 股骨颈动力交叉钉系统和倒三角空心钉治疗PauwelsⅢ型股骨颈骨折疗效比较. 中国修复重建外科杂志, 2021, 35(9): 1111-1118.
16.	王永钦, 徐子环, 李鹏飞, 等. 基于骨折地图技术的青壮年股骨颈骨折特征分析. 中国修复重建外科杂志, 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.	侯洪涛, 刘立平, 李无阴, 等. 正位Garden指数对GardenⅢ型股骨颈骨折移位程度的评价及其价值. 中华创伤杂志, 2022, 38(10): 904-908.
20.	陈芒芒, 吕杨训, 林胜磊, 等. 压力侧和张力侧股骨颈皮质粉碎是股骨颈骨折术后无菌性坏死的独立危险因素. 中国骨伤, 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.	刘冠虹, 吉万波, 刘锦涛, 等. 股骨颈骨折内固定术后股骨头坏死的相关因素分析及生活质量评价. 中国骨伤, 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.	姚强, 郑刘杰, 李家乐, 等. 股骨颈骨折空心螺钉内固定术后股骨头坏死危险因素分析. 中华骨与关节外科杂志, 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. 中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
2. 孙伟, 高福强, 李子荣. 股骨头坏死临床诊疗技术专家共识(2022年). 中国修复重建外科杂志, 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, 杨博, 王敏, 等. 股骨颈动力交叉钉系统治疗青壮年股骨颈骨折的研究进展. 中国修复重建外科杂志, 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. 股骨颈系统与空心钉固定青壮年股骨颈骨折. 中国矫形外科杂志, 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. 蔡乐益, 郭晓山, 郑文浩, 等. 对Garden指数作为股骨颈骨折复位质量评价标准的再认识. 中华创伤骨科杂志, 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. 严才平, 王星宽, 向超, 等. 股骨颈动力交叉钉系统与空心加压螺钉治疗中青年股骨颈骨折的疗效比较. 中国修复重建外科杂志, 2021, 35(10): 1286-1292.
15. 杨家赵, 周雪锋, 李黎, 等. 股骨颈动力交叉钉系统和倒三角空心钉治疗PauwelsⅢ型股骨颈骨折疗效比较. 中国修复重建外科杂志, 2021, 35(9): 1111-1118.
16. 王永钦, 徐子环, 李鹏飞, 等. 基于骨折地图技术的青壮年股骨颈骨折特征分析. 中国修复重建外科杂志, 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. 侯洪涛, 刘立平, 李无阴, 等. 正位Garden指数对GardenⅢ型股骨颈骨折移位程度的评价及其价值. 中华创伤杂志, 2022, 38(10): 904-908.
20. 陈芒芒, 吕杨训, 林胜磊, 等. 压力侧和张力侧股骨颈皮质粉碎是股骨颈骨折术后无菌性坏死的独立危险因素. 中国骨伤, 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. 刘冠虹, 吉万波, 刘锦涛, 等. 股骨颈骨折内固定术后股骨头坏死的相关因素分析及生活质量评价. 中国骨伤, 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. 姚强, 郑刘杰, 李家乐, 等. 股骨颈骨折空心螺钉内固定术后股骨头坏死危险因素分析. 中华骨与关节外科杂志, 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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