Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation
OBJECTIVES:To determine whether Hounsfield units (HU) measured on perioperative computed tomographic (CT) scans are associated with radiographic outcomes and reoperations after femoral neck fracture fixation. DESIGN:Retrospective cohort study. SETTING:Level I trauma center. PATIENTS:One hundred four...
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| Veröffentlicht in: | Journal of orthopaedic trauma 2020-12, Vol.34 (12), p.632-638 |
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| container_title | Journal of orthopaedic trauma |
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| creator | Lund, Erik A. Samtani, Rahul Winston, Mark Anderson, Paul A. Whiting, Paul S. O'Toole, Robert V. Hetzel, Scott Doro, Christopher J. |
| description | OBJECTIVES:To determine whether Hounsfield units (HU) measured on perioperative computed tomographic (CT) scans are associated with radiographic outcomes and reoperations after femoral neck fracture fixation.
DESIGN:Retrospective cohort study.
SETTING:Level I trauma center.
PATIENTS:One hundred fourteen patients age ≥18 years who presented to a Level I trauma center who underwent surgical fixation of intracapsular femoral neck fracture and had perioperative CT scans and adequate follow-up.
INTERVENTION:None.
MAIN OUTCOME MEASUREMENTS:Screw penetration, femoral neck shortening >5 mm, revision surgery.
RESULTS:Median follow-up was 23 months. HU measurement of the femoral head was significantly associated with screw penetration and femoral neck shortening but not revision surgery. Patients with middle femoral head HU measurements |
| doi_str_mv | 10.1097/BOT.0000000000001843 |
| format | Article |
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DESIGN:Retrospective cohort study.
SETTING:Level I trauma center.
PATIENTS:One hundred fourteen patients age ≥18 years who presented to a Level I trauma center who underwent surgical fixation of intracapsular femoral neck fracture and had perioperative CT scans and adequate follow-up.
INTERVENTION:None.
MAIN OUTCOME MEASUREMENTS:Screw penetration, femoral neck shortening >5 mm, revision surgery.
RESULTS:Median follow-up was 23 months. HU measurement of the femoral head was significantly associated with screw penetration and femoral neck shortening but not revision surgery. Patients with middle femoral head HU measurements <146 had 17 times (95% CI4.32-78.9, P < 0.001) increased odds of screw penetration. Greater than 5 mm shortening was seen in Patients with HU <212.5 in the low head section by an odds ratio of 7.8 (95% CI2.15-33.0, P = 0.014).
CONCLUSION:Outcome differences regarding screw penetration and femoral neck shortening related to the HU or densities of femoral head and neck at the time of fracture are significant. These findings can help the clinician with developing a treatment plan for either arthroplasty or fixation of a femoral neck fracture based on objective bone quality measurements rather than relying on an arbitrary age recommendation.
LEVEL OF EVIDENCE:Diagnostic Level II. Development of diagnostic criteria.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/BOT.0000000000001843</identifier><identifier>PMID: 32433076</identifier><language>eng</language><publisher>United States: Journal of Orthopaedic Trauma</publisher><subject>Adolescent ; Adult ; Bone Screws ; Femoral Neck Fractures - diagnostic imaging ; Femoral Neck Fractures - surgery ; Fracture Fixation, Internal ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome</subject><ispartof>Journal of orthopaedic trauma, 2020-12, Vol.34 (12), p.632-638</ispartof><rights>Journal of Orthopaedic Trauma</rights><rights>Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4013-7c243009e36a871d17d5c9137765513e7c4492f4a76d897f259d96ffe293e6e53</citedby><cites>FETCH-LOGICAL-c4013-7c243009e36a871d17d5c9137765513e7c4492f4a76d897f259d96ffe293e6e53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32433076$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lund, Erik A.</creatorcontrib><creatorcontrib>Samtani, Rahul</creatorcontrib><creatorcontrib>Winston, Mark</creatorcontrib><creatorcontrib>Anderson, Paul A.</creatorcontrib><creatorcontrib>Whiting, Paul S.</creatorcontrib><creatorcontrib>O'Toole, Robert V.</creatorcontrib><creatorcontrib>Hetzel, Scott</creatorcontrib><creatorcontrib>Doro, Christopher J.</creatorcontrib><title>Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation</title><title>Journal of orthopaedic trauma</title><addtitle>J Orthop Trauma</addtitle><description>OBJECTIVES:To determine whether Hounsfield units (HU) measured on perioperative computed tomographic (CT) scans are associated with radiographic outcomes and reoperations after femoral neck fracture fixation.
DESIGN:Retrospective cohort study.
SETTING:Level I trauma center.
PATIENTS:One hundred fourteen patients age ≥18 years who presented to a Level I trauma center who underwent surgical fixation of intracapsular femoral neck fracture and had perioperative CT scans and adequate follow-up.
INTERVENTION:None.
MAIN OUTCOME MEASUREMENTS:Screw penetration, femoral neck shortening >5 mm, revision surgery.
RESULTS:Median follow-up was 23 months. HU measurement of the femoral head was significantly associated with screw penetration and femoral neck shortening but not revision surgery. Patients with middle femoral head HU measurements <146 had 17 times (95% CI4.32-78.9, P < 0.001) increased odds of screw penetration. Greater than 5 mm shortening was seen in Patients with HU <212.5 in the low head section by an odds ratio of 7.8 (95% CI2.15-33.0, P = 0.014).
CONCLUSION:Outcome differences regarding screw penetration and femoral neck shortening related to the HU or densities of femoral head and neck at the time of fracture are significant. These findings can help the clinician with developing a treatment plan for either arthroplasty or fixation of a femoral neck fracture based on objective bone quality measurements rather than relying on an arbitrary age recommendation.
LEVEL OF EVIDENCE:Diagnostic Level II. Development of diagnostic criteria.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Bone Screws</subject><subject>Femoral Neck Fractures - diagnostic imaging</subject><subject>Femoral Neck Fractures - surgery</subject><subject>Fracture Fixation, Internal</subject><subject>Humans</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0890-5339</issn><issn>1531-2291</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtP3DAURi1UBMPjH1SVl92E-pU4XsKIFCQELIZ1ZJwbxsWJg53w-Pd1GIoqFuCN5etzv2sdI_SdkiNKlPx1crU6Iv8tWgq-hRY05zRjTNFvaEFKRbKcc7WL9mL8k6CSMLaDdjkTnBNZLJA_jtEbq0fre-xbfA3B-gFCKjwCXvpumEZo8Mp3_i7oYf2Cz_zUx9aCa_BNb8eIdd_gSls3BZgTKuh80A5fgrnHVdBmnC8q-_w64wBtt9pFOHzb99FNdbpanmUXV7_Pl8cXmRGE8kya9EJCFPBCl5I2VDa5UZRLWeQ55SCNEIq1QsuiKZVsWa4aVbQtMMWhgJzvo5-b3CH4hwniWHc2GnBO9-CnWDNB8lmBKBMqNqgJPsYAbT0E2-nwUlNSz6rrpLr-qDq1_XibMN120Lw3_XObgHIDPHk3Qoj3bnqCUK9Bu3H9Vbb4pHXGkoT0zYQRytIpm0uc_wXz7Jnq</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Lund, Erik A.</creator><creator>Samtani, Rahul</creator><creator>Winston, Mark</creator><creator>Anderson, Paul A.</creator><creator>Whiting, Paul S.</creator><creator>O'Toole, Robert V.</creator><creator>Hetzel, Scott</creator><creator>Doro, Christopher J.</creator><general>Journal of Orthopaedic Trauma</general><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20201201</creationdate><title>Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation</title><author>Lund, Erik A. ; Samtani, Rahul ; Winston, Mark ; Anderson, Paul A. ; Whiting, Paul S. ; O'Toole, Robert V. ; Hetzel, Scott ; Doro, Christopher J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4013-7c243009e36a871d17d5c9137765513e7c4492f4a76d897f259d96ffe293e6e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Bone Screws</topic><topic>Femoral Neck Fractures - diagnostic imaging</topic><topic>Femoral Neck Fractures - surgery</topic><topic>Fracture Fixation, Internal</topic><topic>Humans</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lund, Erik A.</creatorcontrib><creatorcontrib>Samtani, Rahul</creatorcontrib><creatorcontrib>Winston, Mark</creatorcontrib><creatorcontrib>Anderson, Paul A.</creatorcontrib><creatorcontrib>Whiting, Paul S.</creatorcontrib><creatorcontrib>O'Toole, Robert V.</creatorcontrib><creatorcontrib>Hetzel, Scott</creatorcontrib><creatorcontrib>Doro, Christopher J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lund, Erik A.</au><au>Samtani, Rahul</au><au>Winston, Mark</au><au>Anderson, Paul A.</au><au>Whiting, Paul S.</au><au>O'Toole, Robert V.</au><au>Hetzel, Scott</au><au>Doro, Christopher J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>34</volume><issue>12</issue><spage>632</spage><epage>638</epage><pages>632-638</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>OBJECTIVES:To determine whether Hounsfield units (HU) measured on perioperative computed tomographic (CT) scans are associated with radiographic outcomes and reoperations after femoral neck fracture fixation.
DESIGN:Retrospective cohort study.
SETTING:Level I trauma center.
PATIENTS:One hundred fourteen patients age ≥18 years who presented to a Level I trauma center who underwent surgical fixation of intracapsular femoral neck fracture and had perioperative CT scans and adequate follow-up.
INTERVENTION:None.
MAIN OUTCOME MEASUREMENTS:Screw penetration, femoral neck shortening >5 mm, revision surgery.
RESULTS:Median follow-up was 23 months. HU measurement of the femoral head was significantly associated with screw penetration and femoral neck shortening but not revision surgery. Patients with middle femoral head HU measurements <146 had 17 times (95% CI4.32-78.9, P < 0.001) increased odds of screw penetration. Greater than 5 mm shortening was seen in Patients with HU <212.5 in the low head section by an odds ratio of 7.8 (95% CI2.15-33.0, P = 0.014).
CONCLUSION:Outcome differences regarding screw penetration and femoral neck shortening related to the HU or densities of femoral head and neck at the time of fracture are significant. These findings can help the clinician with developing a treatment plan for either arthroplasty or fixation of a femoral neck fracture based on objective bone quality measurements rather than relying on an arbitrary age recommendation.
LEVEL OF EVIDENCE:Diagnostic Level II. Development of diagnostic criteria.</abstract><cop>United States</cop><pub>Journal of Orthopaedic Trauma</pub><pmid>32433076</pmid><doi>10.1097/BOT.0000000000001843</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Bone Screws Femoral Neck Fractures - diagnostic imaging Femoral Neck Fractures - surgery Fracture Fixation, Internal Humans Retrospective Studies Tomography, X-Ray Computed Treatment Outcome |
| title | Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation |
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