The Incidence of Focal Osteonecrosis of the Femoral Head and Its Impact on Conversion Hip Arthroplasty After Screw Fixation of Femoral Neck Fractures: a Multicenter Retrospective Study Based on Postoperative Magnetic Resonance Imaging

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2022 Nov 29

PMID 36446946

Authors

Hwan-Hee Lee

Young-Wook Lim

Woo-Lam Jo

Soon-Yong Kwon

Hee-Man Chi

Seung-Chan Kim

Affiliations

Soon will be listed here.

Abstract

Purpose: Osteonecrosis of the femoral head (ONFH) and subsequent head collapse is a major concern after internal fixation of femoral neck fracture (FNF). Previous studies focused on ONFH incidence using plain radiography; postoperative magnetic resonance imaging (MRI) was rarely performed. We performed a multicenter retrospective study to investigate the incidence of ONFH and the need for conversion hip arthroplasty after FNF screw fixation.

Methods: We reviewed 195 patients who underwent screw fixation during closed FNF reduction between 2012 and 2017 at three institutions. Except for patients who did not consent to MRI, all patients underwent postoperative MRI either 1-3 years after screw fixation. The occurrence of ONFH was investigated through plain radiography and MRI.

Results: Thirty patients were diagnosed with ONFH through plain radiography, and an additional 33 patients were diagnosed with MRI, resulting in a total of 63 patients (32.3%) diagnosed with ONFH. The mean time to ONFH diagnosis was 18.9 months and the conversion rate to hip arthroplasty was 10.2%. Of the 33 patients who were normal on hip radiography but exhibited ONFH on MRI, all had small focal lesions not associated with head collapse at the last follow-up. The ONFH group diagnosed through plain radiography had more unstable FNFs than the group diagnosed through MRI.

Conclusion: Although postoperative MRI revealed a higher incidence of ONFH after FNF screw fixation than reported previously, the small focal MRI lesions were not associated with increased risks of femoral head collapse or conversion to arthroplasty.

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References

Cooper C, Cole Z, Holroyd C, Earl S, Harvey N, Dennison E . Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2011; 22(5):1277-88. PMC: 3546313. DOI: 10.1007/s00198-011-1601-6. View

Johansson T, Bachrach-Lindstrom M, Aspenberg P, Jonsson D, Wahlstrom O . The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips. Int Orthop. 2005; 30(1):1-6. PMC: 2254670. DOI: 10.1007/s00264-005-0037-z. View

Florschutz A, Langford J, Haidukewych G, Koval K . Femoral neck fractures: current management. J Orthop Trauma. 2015; 29(3):121-9. DOI: 10.1097/BOT.0000000000000291. View

Bhandari M, Swiontkowski M . Management of Acute Hip Fracture. N Engl J Med. 2017; 377(21):2053-2062. DOI: 10.1056/NEJMcp1611090. View

Wendt K, Heim D, Josten C, Kdolsky R, Oestern H, Palm H . Recommendations on hip fractures. Eur J Trauma Emerg Surg. 2016; 42(4):425-431. PMC: 4969356. DOI: 10.1007/s00068-016-0684-3. View

Miller B, Callaghan J, Cram P, Karam M, Marsh J, Noiseux N . Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database. J Bone Joint Surg Am. 2014; 96(17):e149. DOI: 10.2106/JBJS.M.01122. View

Grau L, Summers S, Massel D, Rosas S, Ong A, Hernandez V . Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty. Geriatr Orthop Surg Rehabil. 2018; 9:2151459318760634. PMC: 5871053. DOI: 10.1177/2151459318760634. View

Knobe M, Altgassen S, Maier K, Gradl-Dietsch G, Kaczmarek C, Nebelung S . Screw-blade fixation systems in Pauwels three femoral neck fractures: a biomechanical evaluation. Int Orthop. 2017; 42(2):409-418. DOI: 10.1007/s00264-017-3587-y. View

Schopper C, Zderic I, Menze J, Muller D, Rocci M, Knobe M . Higher stability and more predictive fixation with the Femoral Neck System versus Hansson Pins in femoral neck fractures Pauwels II. J Orthop Translat. 2020; 24:88-95. PMC: 7387742. DOI: 10.1016/j.jot.2020.06.002. View

10.

Slobogean G, Sprague S, Scott T, Bhandari M . Complications following young femoral neck fractures. Injury. 2014; 46(3):484-91. DOI: 10.1016/j.injury.2014.10.010. View

11.

Nikolopoulos K, Papadakis S, Kateros K, Themistocleous G, Vlamis J, Papagelopoulos P . Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury. 2003; 34(7):525-8. DOI: 10.1016/s0020-1383(02)00367-4. View

12.

Augat P, Bliven E, Hackl S . Biomechanics of Femoral Neck Fractures and Implications for Fixation. J Orthop Trauma. 2018; 33 Suppl 1:S27-S32. DOI: 10.1097/BOT.0000000000001365. View

13.

Shen M, Wang C, Chen H, Rui Y, Zhao S . An update on the Pauwels classification. J Orthop Surg Res. 2016; 11(1):161. PMC: 5154085. DOI: 10.1186/s13018-016-0498-3. View

14.

Jung C, Cha Y, Yoon H, Park C, Yoo J, Kim J . Mechanical effects of surgical variations in the femoral neck system on Pauwels type III femoral neck fracture : a finite element analysis. Bone Joint Res. 2022; 11(2):102-111. PMC: 8882323. DOI: 10.1302/2046-3758.112.BJR-2021-0282.R1. View

15.

Xu D, Bi F, Ma C, Wen Z, Cai X . A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res. 2017; 12(1):28. PMC: 5301374. DOI: 10.1186/s13018-017-0528-9. View

16.

Moya-Angeler J, Gianakos A, Villa J, Ni A, Lane J . Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015; 6(8):590-601. PMC: 4573503. DOI: 10.5312/wjo.v6.i8.590. View

17.

Zhao D, Qiu X, Wang B, Wang Z, Wang W, Ouyang J . 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. PMC: 5498378. DOI: 10.1007/s11999-017-5318-5. View

18.

Liporace F, Gaines R, Collinge C, Haidukewych G . Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008; 90(8):1654-9. DOI: 10.2106/JBJS.G.01353. View

19.

Ju F, Hou R, Xiong J, Shi H, Chen Y, Wang J . Outcomes of Femoral Neck Fractures Treated with Cannulated Internal Fixation in Elderly Patients: A Long-Term Follow-Up Study. Orthop Surg. 2020; 12(3):809-818. PMC: 7307235. DOI: 10.1111/os.12683. View

20.

Manenti G, Altobelli S, Pugliese L, Tarantino U . The role of imaging in diagnosis and management of femoral head avascular necrosis. Clin Cases Miner Bone Metab. 2016; 12(Suppl 1):31-8. PMC: 4832402. DOI: 10.11138/ccmbm/2015.12.3s.031. View