Is Disuse Osteopenia a Favorable Prognostic Sign After Femoral Neck Fracture?. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Ting, Beverlie L.; Heng, Marilyn; Vrahas, Mark S.; Rodriguez, Edward K.; Harris, Mitchel B.; Weaver, Michael J.
• Is Part Of: Journal of orthopaedic trauma. Volume 30:Issue 9(2016)
• Publication Date: 2016-09
• Subjects: femoral neck fracture -- hip fracture -- fracture -- avascular necrosis -- osteonecrosis -- AVN; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000635
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: Avascular necrosis (AVN) of the femoral head is a devastating complication following fixation of femoral neck fractures in younger adults. In this study, we investigate the prognostic utility of disuse osteopenia. Design: Retrospective study. Setting: Three academic Level 1 trauma centers. Patients: One hundred twenty patients younger than 60 years treated for a femoral neck fracture. Intervention: N/A. Main Outcome Measures: The presence of sclerosis or osteopenia, compared to the contralateral femoral head, was measured 6 weeks from injury both subjectively and using a novel radiographic measure, the relative density ratio (RDR). The outcome measure was radiographic development of AVN. Results: The presence of relative sclerosis was associated with AVN and overall treatment failure. Patients with subjective relative sclerosis had a 12.6 (95% confidence interval, 2.9–61.3; P < 0.001) times higher odds of developing AVN. Multiple logistic regression showed that for every 0.10 increase in the RDR, there was a 5.2 increase in the odds (95% confidence interval, 2.1–26.9; P = 0.009) of developing AVN. Patients with an RDR of ≥1.2 have an 80% probability of AVN, whereas those with an RDR ⩽0.8 have a <1% probability of developing AVN. Conclusions: Disuse osteopenia detected on 6-week radiographs is a favorable prognostic sign following fixation of femoral neck fractures. Patients who have relative sclerosis of the femoral head at 6-week follow-up are at a higher risk of developing AVN. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.