Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland.
Department of Orthopedics and Traumatology, Zug Cantonal Hospital, 6340 Baar, Switzerland.
Medicina (Kaunas). 2022 Dec 9;58(12):1812. doi: 10.3390/medicina58121812.
The ideal surgical treatment of femoral neck fractures remains controversial. When treating these fractures with internal fixation, many fixation constructs exist. The primary aim of this study was to evaluate the incidence and specific risk factors associated with complication and re-operation following fixation of intracapsular proximal femoral fractures using the Targon-FN system (B.Braun Melsungen AG). A secondary aim was to identify if lateral prominence of the implant relative to the lateral border of the vastus ridge was a specific risk factor for elective plate removal. Methodically, a retrospective case series was conducted of all consecutive adult patients treated at a single level 1 trauma center in Switzerland for an intracapsular proximal femoral fracture with the Targon-FN. Demographic data were collected. Patients with a follow-up of less than three months were excluded. Complications as well as plate position were recorded. Statistical analysis to identify specific risk factors for re-operation and complications was performed. In result, a total of 72 cases with intracapsular femoral neck fractures were treated with the Targon-FN locking plate system between 2010 and 2017. Thirty-four patients (47.2%) experienced one or more complications. The most common complication was mechanical irritation of the iliotibial band (ITB) (23.6%, = 17). Complications included intraarticular screw perforation (6.9%, n = 5), avascular necrosis (5.6%, n = 4), non-union (5.6%, n = 4) among others. In total, 46 re-operations were required. Younger age, fracture displacement and time to postoperative weight bearing were identified as risk factors for re-operation. In conclusion, intracapsular femoral neck fractures treated with the Targon-FN system resulted in a high rate of post-operative complication and re-operation. Statistical analysis revealed patient age, fracture displacement, time to postoperative full weight bearing were risk factors for re-operation. The main limitation is the limited number of cases and a short follow-up of less than 12 months in a subgroup of our patients.
股骨颈骨折的理想手术治疗仍存在争议。当采用内固定治疗这些骨折时，存在许多固定结构。本研究的主要目的是评估使用 Targon-FN 系统（B.Braun Melsungen AG）固定囊内股骨近端骨折后并发症和再次手术的发生率及特定危险因素。次要目的是确定相对于股外侧肌嵴外侧的植入物的外侧突出是否是择期钢板取出的特定危险因素。方法，对瑞士一家 1 级创伤中心连续收治的所有 Targon-FN 治疗的囊内股骨近端骨折的成年患者进行回顾性病例系列研究。收集了人口统计学数据。排除随访时间少于 3 个月的患者。记录并发症和钢板位置。进行了统计学分析以确定再次手术和并发症的特定危险因素。结果，2010 年至 2017 年间，共使用 Targon-FN 锁定钢板系统治疗 72 例囊内股骨颈骨折患者。34 例（47.2%）发生 1 种或多种并发症。最常见的并发症是髂胫束（ITB）的机械性刺激（23.6%， = 17）。并发症包括关节内螺钉穿孔（6.9%，n = 5）、股骨头坏死（5.6%，n = 4）、骨折不愈合（5.6%，n = 4）等。共需进行 46 次再手术。年龄较小、骨折移位和术后负重时间被确定为再次手术的危险因素。结论，使用 Targon-FN 系统治疗囊内股骨颈骨折术后并发症和再次手术率较高。统计分析显示，患者年龄、骨折移位、术后完全负重时间是再次手术的危险因素。主要局限性是我们患者的一部分病例数量有限且随访时间短于 12 个月。
