Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Risk Factors for Avascular Necrosis and Nonunion after Multiple Pinning for an Intracapsular Femoral Neck Fracture

대퇴 경부 골절에서 다발성 핀 내고정 후 발생한 무혈성 괴사와 불유합에 영향을 미치는 위험인자

  • Sung, Yerl-Bo (Department of Orthopaedic Surgery, Sang-Gye Paik Hospital) ;
  • Shin, Yong-Woon (Department of Orthopaedic Surgery, Sang-Gye Paik Hospital) ;
  • Park, Chan-Keun (Department of Orthopaedic Surgery, Sang-Gye Paik Hospital)
  • 성열보 (인제대학교 의과대학 상계백병원 정형외과) ;
  • 신용운 (인제대학교 의과대학 상계백병원 정형외과) ;
  • 박찬근 (인제대학교 의과대학 상계백병원 정형외과)
  • Published : 2009.03.31

⟨ Previous Next ⟩

Abstract

Purpose: We wanted to analyze the influences of risk factors on avascular necrosis and nonunion after multiple pinning for a femoral neck fracture. Materials and Methods: Among the cases of multiple pinning for a femoral neck fracture that were seen at our department from June 1995 to May 2006, we analyze 102 cases that had more than 2 years of follow-up. We evaluated the influence of such factors as the age, gender, injury on the right- or left-side, the degree of displacement, the time to operation, the angle of fracture, the accuracy of reduction and posterior cortex comminution on avascular necrosis and nonunion after multiple pinning for a femoral neck fracture. Results: The incidences of AVN and nonunion were 13.7% (14/102) and 10.7% (11/102), respectively. The degree of displacement was a significant factor that influenced the development of nonunion (p<0.05). The time to operation and the angle of fracture were significant factors that influenced nonunion (p<0.05 & p<0.05) and avascular necrosis (p<0.05 & p<0.05). The posterior cortex comminution was a significant factor that influenced nonunion (p<0.05) and avascular necrosis (p<0.05). Conclusion: The important risk factor for avascular necrosis was the angle of fracture over 60 degrees. The important risk factors for nonunion were the time to operation (over 24 hours), posterior cortex comminution and an angle of fracture over 60 degrees.

목적: 다발성 핀 삽입술로 내고정을 시행한 대퇴 경부 골절 환자에서 발생한 무혈성 괴사와 불유합을 분석하여 그 위험 인자를 찾고자 하였다. 대상 및 방법: 1995년 6월부터 2006년 5월까지 본원에서 대퇴 경부 골절로 다발성 핀 삽입술을 시행 받은 환자 중 최소 2년 이상 추시 가능한 102예를 대상으로 무혈성 괴사 및 불유합을 조사하였다. 인자로 나이, 성별, 좌 우측, 골절 편의 전위 정도, 수상 후 수술까지의 시간, 골절 각의 방향(Pauwels’angle), 정복의 정확도 및 후방 피질골 분쇄 유무에 대해 분석을 시행하였다. 결과: 무혈성 괴사와 불유합의 발생빈도는 각각 13.7%(14/102)와 10.7%(11/102)이었다. 불유합의 발생은 비전위 골절보다 전위 골절에서 유의하게 증가하였다(P<0.05). 수상 후 24시간 이내로 수술이 이루어진 경우와 Pauwels 각도가 60도 미만인 경우에 무혈성 괴사 및 불유합이 모두 유의하게 감소하였다(Ps<0.05). 후방 피질골 분쇄 골절이 있을 경우 무혈성 괴사 및 불유합의 발생이 모두 유의하게 증가하였다(Ps<0.05). 결론: 대퇴 경부 골절에서 다발성 핀 내고정 시행 후 발생한 무혈성 괴사 발생의 중요 위험 인자는 골절각의 방향으로 Pauwels 각도가 60도 이상인 경우이며, 불유합 발생의 중요 위험 인자는 수상 후 24시간이 지나 수술이 시행된 경우, 후방 피질골 분쇄 및 Pauwels 각도가 60도 이상인 경우로 판단된다.

Keywords

References

  1. Alberts KA, Jervaeus J: Factors predisposing to healing complications after internal fixation of femoral neck fracture. A stepwise logistic regression analysis. Clin Orthop Relat Res, 257: 129-133, 1990.
  2. Barnes R, Brown JT, Garden RS, Nicoll EA: Subcapital fractures of the femur. A prospective review. J Bone Joint Surg, 58-B: 2-24, 1976.
  3. Boyd HB, Salvatore JE: Acute fracture of the femoral neck: internal fixation or prosthesis? J Bone Joint Surg, 46-A: 1066-1068, 1964.
  4. Bray TJ: Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res, 339: 20-31, 1997. https://doi.org/10.1097/00003086-199706000-00004
  5. Dickson JA: The 'unsolved' fracture: a protest against defeatism. J Bone Joint Surg, 35-A: 805-822, 1953.
  6. Garden RS: Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am, 5: 683-712, 1974.
  7. Garden RS: Stability and union in subcapital fractures of the femur. J Bone Joint Surg, 46-B: 630-47, 1964.
  8. Heetveld MJ, Raaymakers ELFB, van Eck-Smit BL, van Walsum ADP, Luitse JSK: Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome? J Bone Joint Surg 87-B: 367-73, 2005. https://doi.org/10.1302/0301-620X.87B3.15715
  9. Holmberg S, Kalen R, Thorngren KG: Treatment and outcome of femoral neck fractures-an analysis of 2,418 patients admitted from their own homes. Clin Orthop Relat Res, 218: 42-52, 1987.
  10. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN: Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg, 84-A: 1605-1612, 2002.
  11. Lindequist S, Tornkvist H: Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method. J Orthop Trauma, 9: 215-221, 1995. https://doi.org/10.1097/00005131-199506000-00006
  12. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE: Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg, 76-A: 15-25, 1994.
  13. Manninger J, Kazar G, Fekete G, et al.: Significance of urgent (within 6h) internal fixation in the management of fractures of the neck of the femur. Injury, 20: 101-105, 1989. https://doi.org/10.1016/0020-1383(89)90152-6
  14. Massie WK: Extracapsular fractures of the hip treated by impaction using a sliding nail-plate fixation. Clin Orthop Relat Res, 22: 180-202, 1962.
  15. Nilsson LT, Stromqvist B, Thorngren KG: Secondary arthroplasty for complications of femoral neck fracture. J Bone Joint Surg, 71-B: 777-781, 1989.
  16. Parker MJ: Prediction of fracture union after internal fixation of intracapsular femoral neck fracture. Injury, 25(Suppl 2): B3-B6, 1994. https://doi.org/10.1016/0020-1383(94)90175-9
  17. Swiontkowski MF, Winquis RA, Hansen ST Jr: Fracture of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg, 66-A: 837-846, 1984.
  18. Szita J, Cserhati P, Bosch U, et al.: Intracapsular femoral neck fractures: the importance of early reduction and stable osteosynthesis. Injury, 33(Suppl 3): 41-46, 2002.
  19. Yim SJ, Woo SH, Kim MY, et al.: Analysis of affecting factors of fixation failure of femoral neck fractures using internal fixation. J Korean Fracture Soc, Vol. 19, No. 3, July, 2006.