Stockton David J, Dua Karan, O'Brien Peter J, Pollak Andrew N, Hoshino C Max, Slobogean Gerard P
Orthopedics. 2019 Jul 1;42(4):e376-e380. doi: 10.3928/01477447-20190321-03. Epub 2019 Mar 27.
The primary purpose of this study was to describe the failure patterns of femoral neck fracture fixation in young patients. The secondary purpose was to determine if pattern of failure varies by type of implant. Adult patients (age range, 18-55 years) who experienced a "fixation failure" following internal fixation of a femoral neck fracture were identified from 5 level 1 trauma centers. Failure was defined by screw cutout, implant breakage, varus collapse (<120° neck-shaft angle), or severe fracture shortening (≥1 cm). When multiple complications were identified, mechanical failures were preferentially noted for the analysis. Failure patterns were compared between patients who received multiple cancellous screws and patients who received a sliding hip screw plus a derotation screw. Severe fracture shortening was the most common complication identified (61%). No differences in the incidence of severe shortening (P=.750) or implant breakage (P=1.000) were detected between the fixation groups. However, among the failures with a sliding hip screw plus a derotation screw construct, a greater portion were related to screw cutout (38% for a sliding hip screw plus a derotation screw vs 7% for screws, P=.019). Failures with multiple screws were associated with varus collapse (25% for screws vs 0% for a sliding hip screw plus a derotation screw, P=.037). Severe shortening was the most common fixation failure. Sliding hip screw plus derotation screw implants were associated with screw cutout. Multiple cancellous screw implants failed by varus collapse. Selecting a surgical implant based on its likely failure pattern may allow surgeons to minimize the severity of failure or the need for secondary conversion to hip arthroplasty. [Orthopedics. 2019; 42(4):e376-e380.].
本研究的主要目的是描述年轻患者股骨颈骨折内固定失败的模式。次要目的是确定失败模式是否因植入物类型而异。从5个一级创伤中心识别出股骨颈骨折内固定术后出现“固定失败”的成年患者（年龄范围为18 - 55岁）。失败定义为螺钉穿出、植入物断裂、内翻塌陷（颈干角<120°）或严重骨折短缩（≥1 cm）。当发现多种并发症时，分析优先记录机械性失败情况。比较接受多枚松质骨螺钉的患者和接受滑动髋螺钉加抗旋螺钉的患者的失败模式。严重骨折短缩是最常见的并发症（61%）。在固定组之间未检测到严重短缩发生率（P = 0.750）或植入物断裂发生率（P = 1.000）的差异。然而，在使用滑动髋螺钉加抗旋螺钉结构的失败病例中，更大比例与螺钉穿出有关（滑动髋螺钉加抗旋螺钉为38%，螺钉为7%，P = 0.019）。多枚螺钉固定失败与内翻塌陷有关（螺钉固定为25%，滑动髋螺钉加抗旋螺钉为0%，P = 0.037）。严重短缩是最常见的固定失败类型。滑动髋螺钉加抗旋螺钉植入物与螺钉穿出有关。多枚松质骨螺钉植入物因内翻塌陷而失败。根据可能的失败模式选择手术植入物可能使外科医生将失败的严重程度或二次转换为髋关节置换术的需求降至最低。[《骨科》。2019年；42(4):e376 - e380。]
