Risk factors for ischemic osteonecrosis of the femoral head after internal fixation with multiple cannulated screws for Pauwels type III femoral neck fracture
Abstract
Background/Aim. Numerous factors lead to hip fractures that are common and often devastating in the geriatric population. The aim of the study was to determine the risk factors for ischemic osteonecrosis of the femoral head (ONFH) in patients after internal fixation with multiple cannulated screws for Pauwels type III femoral neck fracture (FNF). Methods. A total of 212 patients with Pauwels type III FNF, who underwent internal fixation with multiple cannulated screws from January 2019 to September 2022 and received one-year follow-up after surgery, were selected. Based on their clinical data and the incidence of ONFH, they were divided into two groups: the group with ischemic ONFH occurrence (n = 30) and the ischemic ONFH non-occurrence group (n = 182). Logistic regression analysis was conducted to analyze the risk factors for postoperative ischemic ONFH. Results. Age, body mass index (BMI), time from injury to surgery, partial weight bearing (PWB) time after surgery, and preoperative diabetes mellitus (DM) were significantly different between the ischemic ONFH occurrence and ischemic ONFH non-occurrence groups (p < 0.05), while other clinical data showed no significant differences (p > 0.05). The results of logistic regression analysis revealed that age (> 55 years), PWB time after surgery (≤ 3 months), BMI (≥ 24 kg/m2), time from injury to surgery (> 2 days), and preoperative DM were independent risk factors for postoperative ischemic ONFH (p < 0.05). Conclusion. The incidence of postoperative ischemic ONFH can be prevented by effectively controlling the following factors: age, BMI, PWB after surgery, and preoperative DM.
References
Liu P, Zhang Y, Sun B, Chen H, Dai J, Yan L. Risk factors for femoral neck fracture in elderly population. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46(3): 272–7.
Ziesler C, Engebretsen L. Femoral neck stress fracture. Tidsskr Nor Laegeforen 2020; 140(5). (Norwegian)
Bernstein EM, Kelsey TJ, Cochran GK, Deafenbaugh BK, Kuhn KM. Femoral Neck Stress Fractures: An Updated Review. J Am Acad Orthop Surg 2022; 30(7): 302–11.
Wang Y, Ma JX, Yin T, Han Z, Cui SS, Liu ZP, et al. Correla-tion Between Reduction Quality of Femoral Neck Fracture and Femoral Head Necrosis Based on Biomechanics. Orthop Surg 2019; 11(2): 318–24.
Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, et al. Guide-lines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat 2020; 21: 100–10.
Bastard C. Femoral neck fracture. Rev Prat 2019; 69(10): 1124–8. (French)
Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, et al. Avascular Necrosis of Femoral Head-Overview and Current State of the Art. Int J Environ Res Public Health 2022; 19(12): 7348.
Steele CE, Cochran G, Renninger C, Deafenbaugh B, Kuhn KM. Femoral Neck Stress Fractures: MRI Risk Factors for Progres-sion. J Bone Joint Surg Am 2018; 100(17): 1496–502.
Su Z, Liang L, Hao Y. Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis. J Back Musculoskelet Rehabil 2021; 34(2): 169–77.
Lim EJ, Shon HC, Cho JW, Oh JK, Kim J, Kim CH. Dynamic Hip Screw versus Cannulated Cancellous Screw in Pauwels Type II or Type III Femoral Neck Fracture: A Systematic Re-view and Meta-Analysis. J Pers Med 2021; 11(10): 1017.
Gao Z, Wang M, Shen B, Chu X, Ruan D. Treatment of Pau-wels type III femoral neck fracture with medial femoral neck support screw: a biomechanical and clinical study. Sci Rep 2021; 11(1): 21418.
Teng Y, Zhang Y, Guo C. Finite element analysis of femoral neck system in the treatment of Pauwels type III femoral neck fracture. Medicine (Baltimore) 2022; 101(28): e29450.
Xu JL, Liang ZR, Xiong BL, Zou QZ, Lin TY, Yang P, et al. Risk factors associated with osteonecrosis of femoral head af-ter internal fixation of femoral neck fracture: a systematic re-view and meta-analysis. BMC Musculoskelet Disord 2019; 20(1): 632.
Wang W, Li Y, Xiong Z, Guo Y, Li M, Mei H, et al. Effect of the Number, Size, and Location of Cannulated Screws on the Incidence of Avascular Necrosis of the Femoral Head in Pedi-atric Femoral Neck Fractures: A Review of 153 Cases. J Pedi-atr Orthop 2022; 42(3): 149–57.
Kim CH, Kim JW. A recent update on the fixation techniques for femoral neck fractures: A narrative review. J Clin Orthop Trauma 2024; 54: 102497.
Zhao C, Kan J, Xu Z, Zhao D, Lu A, Liu Y, et al. Higher BMI and lower femoral neck strength in males with type 2 diabetes mellitus and normal bone mineral density. Am J Med Sci 2022; 364(5): 631–7.
Trauma Orthopedics Group, Orthopedics Branch, Chinese Medical Association, Fixation and Limb Reconstruction Group, Orthopedics Branch, Chinese Medical Association. Expert consensus on weight bearing after lower limb fractures. Chin J Orthop Trauma 2023; 25(2): 93–100.
Yuan KX, Yang F, Fu K, Zhu DY, Jiang CY, Jin DX, et al. In-ternal fixation using fully threaded cannulated compression screws for fresh femoral neck fractures in adults. J Orthop Surg Res 2022; 17(1): 108.
Lai SW, Lin CL, Liao KF. Real-world database examining the association between avascular necrosis of the femoral head and diabetes in Taiwan. Diabetes Care 2019; 42(1): 39–43