Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration.

BACKGROUND: Intracapsular femoral neck fractures are associated with high rates of nonunion. We aimed to identify risk factors for nonunion in patients with both displaced and nondisplaced intracapsular femoral neck fractures treated with three 7-mm parallel cannulated screws, placed in either a triangle or an inverted triangle configuration, using failure of fixation as the primary outcome. METHODS: Clinical and radiographic data for patients with intracapsular femoral neck fractures treated with either triangle fixation (one proximal screw and two distal screws) or inverted triangle fixation (two proximal screws and one distal screw), between January 1, 2000, and July 30, 2009, were analyzed. RESULTS: A total of 202 patients, seventy-six men and 126 women with an average age (and standard deviation) of 64.53 ± 15.81 years (range, nineteen to ninety-three years), were included in the analysis. Union occurred in 158 patients, and nonunion occurred in forty-four. There were no differences between the union and nonunion groups with respect to age, sex, fracture side, fracture angle, fracture level, or estimated bone density. There were significant differences in fracture type, fixation configuration, reduction quality, and screw-tip subchondral purchase between patients with and without union. The estimated odds ratio for fracture nonunion was 2.93 (95% confidence interval [CI], 1.08, 7.96) in subjects with displaced fractures compared with those without displaced fractures (p = 0.035), 18.92 (95% CI, 1.91, 187.09) in subjects with borderline and unacceptable reduction compared with those with anatomic reduction (p = 0.012), and 2.92 (95% CI, 1.27, 6.69) for internal fixation with a triangle configuration compared with fixation with an inverted triangle configuration (p = 0.010). CONCLUSIONS: Screw fixation with a triangle configuration, a displaced fracture, and poor reduction are risk factors for nonunion in intracapsular femoral neck fractures treated with fixation with multiple screws.

Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients: a comparison of suture and screw fixation technique.

BACKGROUND: Extreme tensile force to the anterior cruciate ligament results in an avulsion of the tibial eminence and it was believed to be more common in skeletally immature adolescent than adult. The purpose of this study is to compare the clinical results of both screw and suture fixation for surgical treatment of anterior tibial eminence fractures in skeletally mature patients. METHODS: A retrospective review was conducted on patients from 2002 to 2009 who sustained fractures of the anterior tibial eminence and were treated with arthroscopic-assisted fixation using either cannulated screws (25 patients) or Ethibond sutures (23 patients). Follow-up assessment included function evaluation, ligament laxity, and range of motion. RESULTS: Seventy-five percent of the anterior tibial eminence fractures resulted from traffic-related injuries in this study. Median operating time was 75 minutes in screw fixation group and 92 minutes in suture fixation group (p = 0.006). The objective International Knee Documentation Committee (IKDC) results for patients were 23 A, 2 B, and no C or D in screw fixation group and 16 A, 4 B, 3 C, and no D (p = 0.040) in suture fixation group. The KT-1000 side-to-side difference was greater than 5 mm in two patients (8%) in the screw fixation group and in three patients (13%) in the suture fixation group (p = 0.058). Among patients in screw fixation group, two (8%) patients had grade 1 pivot shift and 2 (8%) patients had grade 2 pivot shift. Among patients in suture fixation group, five (22%) patients had grade 1 pivot shift, three (13%) patients had grade 2 pivot shift, and 1 (9%) patient had grade 3 pivot shift (p = 0.037). CONCLUSIONS: Significant better IKDC objective evaluation, lower glide pivot shift phenomenon, and shorter operating time requirement in screw fixation group with respect to suture fixation group were shown in our study although the other functional knee scores (Lysholm score, Tegner activity level, and the IKDC subjective score) and KT-1000 manual side-to-side difference only revealed a trend with better clinical results in screw fixation group than in suture fixation group rather than significant difference.