Risk factors for nonunion or malunion after internal fixation of femoral neck fracture / 中华创伤骨科杂志

ABSTRACT

Objective:To explore the risk factors for nonunion or malunion after internal fixation of femoral neck fracture.Methods:A retrospective analysis was done of the 140 patients with femoral neck fracture who had been admitted to Department of Traumatology and Orthopedics, Weifang People's Hospital from January 2013 through June 2019. They were 61 males and 79 females, aged from 18 to 65 years (average, 51.3 years). All patients received "inverted triangle" internal fixation with 3 hollow nails after reduction. The univariate analysis was conducted of the 9 factors age, gender, fracture side, Garden classification, injury-to-operation time, reduction quality, postoperative ambulation with crutches but no weight-bearing, preoperative bone density, and preoperative 25-hydroxyvitamin D3 concentration. Multivariate logistic regression analysis was used for the factors with P<0.05 to identify risk factors. P<0.05 was considered statistically significant. Results:This cohort of 140 patients obtained follow-up for 6 to 12 months (average, 10.8 months). Nonunion or malunion occurred in 25 cases of them (17.86%). The multivariate logistic regression analysis showed that Garden types Ⅲ&Ⅳ ( OR=2.873, 95% CI 1.027~8.039, P=0.044), non-anatomic reduction ( OR=4.678, 95% CI 1.133~19.310, P=0.033), postoperative ambulation time with crutches but no weight-bearing <3 months ( OR=0.230, 95% CI 0.072~0.737, P=0.013), and preoperative 25-hydroxyvitamin D3 concentration<30 ng/mL ( OR=3.718, 95% CI 1.337~10.341, P=0.012) were the risk factors for nonunion or malunion after internal fixation of femoral neck fracture. Conclusion:The risk factors for nonunion or malunion after internal fixation of femoral neck fracture may be the Garden types Ⅲ&Ⅳ, non-anatomic reduction, postoperative ambulation time with crutches but no weight-bearing <3 months, and preoperative 25-hydroxyvitamin D3 concentration < 30 ng/mL.