Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany.
Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen, Germany.
Orthop Surg. 2024 Dec;16(12):3118-3128. doi: 10.1111/os.14220. Epub 2024 Oct 23.
Closed reduction and dynamic hip screw (DHS) osteosynthesis are preferred as joint-preserving therapy in case of medial femoral neck fractures (MFNFs). A change in the femoral offset (CFO) can cause gait abnormality, impingement, or greater trochanteric pain syndrome. It is unknown whether the femoral offset (FO) can be postoperatively fully restored. The aim of the study was to investigate the extent of a possible CFO in hip joints after DHS osteosynthesis in the case of an MFNF.
In this retrospective study, 104 patients (mean age: 71.02 years, men: n = 50, women: n = 54) with MFNF who underwent closed reduction and DHS osteosynthesis were analyzed by postoperative x-rays to assess CFO between the operated (OS) and nonoperated joint side (NOS). The studies covered the time period 2010-2020. A statistical comparison was performed between the mean values of FO between OS and NOS, taking into account patient age, gender, and fracture severity.
All operated hip joints showed a CFO. In 76.0% (79 of 104), the FO decreased (FOD), and in 24.0% (25 of 104), the FO increased (FOI). A critical CFO (>15% CFO) was detected in 52.9% (55 of 104). In hip joints with postoperative FOD, the mean FO between NOS (49.15 mm [±6.56]) and OS (39.32 mm [±7.87]) and in hip joints with postoperative FOI the mean FO between NOS (41.59 [±8.21]) and OS (47.27 [±6.68]) differed significantly (p < 0.001). Preoperative FO (r : -0.41; p > 0.001) and caput-collum-diaphyseal angle (CCD; r : 0.34; p > 0.001) correlated with postoperative CFO. FOD was found in hip joints with a preoperative FO >44 mm and CCD <134° vice versa FOI in hip joints with a preoperative FO <44 mm and CCD >134°.
Closed reduction and DHS osteosynthesis in patients with MFNF result in a clustered significant CFO. The individual FO should be taken into account pre- and intraoperatively to avoid a postoperative extensive CFO.
对于股骨颈内侧骨折（MFNF），闭合复位和动力髋螺钉（DHS）内固定被认为是一种保留关节的治疗方法。股骨偏移（CFO）的改变可导致步态异常、撞击或大转子疼痛综合征。目前尚不清楚 DHS 内固定术后股骨偏移（FO）是否可以完全恢复。本研究旨在探讨 DHS 内固定治疗 MFNF 后髋关节 CFO 的程度。
在这项回顾性研究中，分析了 104 例接受闭合复位和 DHS 内固定治疗的 MFNF 患者（平均年龄 71.02 岁，男性 50 例，女性 54 例）的术后 X 线片，以评估患侧（OS）和非患侧（NOS）髋关节的 CFO。研究时间为 2010 年至 2020 年。考虑到患者年龄、性别和骨折严重程度，对 OS 和 NOS 之间 FO 的平均值进行了统计学比较。
所有接受手术的髋关节均存在 CFO。76.0%（79/104）的患者 FO 减小（FOD），24.0%（25/104）的患者 FO 增大（FOI）。52.9%（55/104）的患者 CFO 超过 15%。在术后 FOD 的髋关节中，NOS（49.15±6.56）和 OS（39.32±7.87）之间的平均 FO 以及术后 FOI 的髋关节中，NOS（41.59±8.21）和 OS（47.27±6.68）之间的平均 FO 差异有统计学意义（p<0.001）。术前 FO（r：-0.41；p>0.001）和头干角（CCD；r：0.34；p>0.001）与术后 CFO 相关。术前 FO>44mm 和 CCD<134°的髋关节中发现 FOD，反之，术前 FO<44mm 和 CCD>134°的髋关节中发现 FOI。
MFNF 患者闭合复位和 DHS 内固定术后 CFO 明显聚集。术前和术中应考虑个体 FO，以避免术后 CFO 广泛增加。
