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Similar reoperation rate seen with cancellous vs sliding hip screws for femoral neck fractures
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NATIONAL HARBOR, Md. — At the Orthopaedic Trauma Association Annual Meeting, a presenter said the risk for reoperation at 2 years was similar for patients older than 50 years with femoral neck fractures treated with either sliding hip screws or cancellous screws.
“Our interpretation is that there is, overall, similar risk of operation between sliding hip screw and cancellous hip screw for all patients included in the trial. Osteonecrosis [was] more frequent in the sliding hip screw [group], and the subgroup analysis suggested hip screws reduce the rate of reoperation in patients with displaced femoral neck fractures, fractures at the base of the femoral neck and in current smokers,” Marc F. Swiontkowski, MD, said during his presentation. “So the osteonecrosis finding does challenge prior research.”
Swiontkowski and colleagues performed a randomized, multicenter, blinded trial of about 1,100 patients older than 50 years with either displaced or undisplaced femoral neck fractures. Patients were randomized to be treated with either multiple small-diameter cancellous screws or with a single large-diameter screw with a side plate. Swiontkowski noted the primary study outcome was the need for reoperation within 2 years postoperatively. Other outcomes included complications, osteonecrosis, patient mortality, fracture healing and shortening, adverse events and health-related quality of life.
Results showed revision surgery was needed in about 20% of patients. Swiontkowski noted patients treated with cancellous screws had higher rates of implant removal. There was a slightly higher rate of implant exchange and conversion to total hip arthroplasty in patients treated with sliding hip screws.
According to Swiontkowski, a significant finding was that 9% of patients treated with sliding hip screws had osteonecrosis compared with 5.2% of patients treated with cancellous screws. No meaningful differences were seen between the groups overall regarding nonunion, implant failure, infection, fractures healing and the health-related quality of life.
“The subgroup analysis, however, identified an important interaction in that displaced femoral neck fractures favor the sliding hip screw,” he said. “The subgroup analysis further determines significantly reduced reoperations as noted with displaced femoral neck fractures and, again, somewhat of a surprise in smokers.”– by Monica Jaramillo
Reference:
Swiontkowski MF, et al. Paper #32. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 5-8, 2016; National Harbor, Md.
Disclosure: Swiontkowski reports he receives research support from FAITH Investigators and other financial support from the U.S. Department of Defense, Chair METRC, USDOD and SPRINT Investigators.