Correlation analysis between combined deflection angle and osteonecrosis of femoral head after femoral neck fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUO Congcong ¹ , DONG Yiping ¹ , YUAN Qiang ² , ZHANG Ning ³ ,  ZHANG Ying ²

1. Graduate School of Henan University of Traditional Chinese Medicine, Zhengzhou Henan, 450046, P. R. China;
2. The Fifth Department of Hip, Luoyang Orthopedic-Traumatological of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P. R. China;
3. Graduate School of Hunan University of Traditional Chinese Medicine, Changsha Hunan, 410208, P. R. China;

Corresponding author：

ZHANG Ying, Email: xylrw5@163.com

Keywords：

Femoral neck fracture; combined deflection angle; prediction of osteonecrosis of the femoral head

DOI：

10.7507/1002-1892.202311094

Video：

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Objective To evaluate the correlation between pelvic incidence (PI) angle, hip deflection angle (HDA), combined deflection angle (CDA) and osteonecrosis of the femoral head (ONFH) after femoral neck fracture, in order to explore early predictive indicators for ONFH occurrence after femoral neck fracture. Methods A study was conducted on patients with femoral neck fractures who underwent cannulated screw internal fixation between December 2018 and December 2020. Among them, 208 patients met the selection criteria and were included in the study. According to the occurrence of ONFH, the patients were allocated into ONFH group and non-NOFH group. PI, HDA, and CDA were measured based on the anteroposterior X-ray films of pelvis and axial X-ray films of the affected hip joint before operation, and the differences between the two groups were compared. The receiver operating characteristic curve (ROC) was used to evaluate the value of the above imaging indicators in predicting the occurrence of ONFH. Results Among the 208 patients included in the study, 84 patients experienced ONFH during follow-up (ONFH group) and 124 patients did not experience ONFH (non-ONFH group). In the non-ONFH group, there were 59 males and 65 females, the age was 18-86 years (mean, 53.9 years), and the follow-up time was 18-50 months (mean, 33.2 months). In the ONFH group, there were 37 males and 47 females, the age was 18-76 years (mean, 51.6 years), and the follow-up time was 8-45 months (mean, 22.1 months). The PI, HDA, and CDA were significantly larger in the ONFH group than in the non-ONFH group (P<0.05). ROC curve analysis showed that the critical value of PI was 19.82° (sensitivity of 40.5%, specificity of 86.3%, P<0.05); the critical value of HDA was 20.94° (sensitivity of 77.4%, specificity of 75.8%, P<0.05); and the critical value of CDA was 39.16° (sensitivity of 89.3%, specificity of 83.1%, P<0.05). Conclusion There is a correlation between PI, HDA, CDA and the occurrence of ONFH after femoral neck fracture, in which CDA can be used as an important reference indicator. Patients with CDA≥39.16° have a higher risk of ONFH after femoral neck fracture.

Citation： LUO Congcong, DONG Yiping, YUAN Qiang, ZHANG Ning, ZHANG Ying. Correlation analysis between combined deflection angle and osteonecrosis of femoral head after femoral neck fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 298-302. doi: 10.7507/1002-1892.202311094 Copy

1.	Nikolopoulos KE, Papadakis SA, Kateros KT, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury, 2003, 34(7): 525-528.
2.	Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res, 1980, (152): 162-172.
3.	Barnes R, Brown JT, Garden RS, et al. Subcapital fractures of the femur. A prospective review. J Bone Joint Surg (Br), 1976, 58(1): 2-24.
4.	Viganò M, Pennestrì F, Listorti E, et al. Proximal hip fractures in 71, 920 elderly patients: incidence, epidemiology, mortality and costs from a retrospective observational study. BMC Public Health, 2023, 23(1): 1963.
5.	Zhang Y, Yuan Q, Wei Q, et al. Combined deflection angle classification: a novel typing system of adult femoral neck fracture. Orthop Surg, 2023, 15(3): 839-850.
6.	O’Connor MI, Switzer JA. AAOS Clinical practice guideline summary: management of hip fractures in older adults. J Am Acad Orthop Surg, 2022, 30(20): e1291-e1296.
7.	中华医学会骨科学分会关节外科学组. 股骨头坏死临床诊疗规范. 中国矫形外科杂志, 2016, 24(1): 49-54.
8.	Zheng J, Wang H, Gao Y, et al. A study on the evaluation of a risk score of osteonecrosis of the femoral head based on survival analysis. J Arthroplasty, 2021, 36(1): 62-71.
9.	刘冰川, 孙川, 邢永, 等. 中青年股骨颈骨折内固定术后发生缺血性股骨头坏死的相关因素. 北京大学学报(医学版), 2020, 52(2): 290-297.
10.	Théron J. Superselective angiography of the hip. Technique, normal features, and early results in idiopathic necrosis of the femoral head. Radiology, 1977, 124(3): 649-657.
11.	Liu Y, Li M, Zhang M, et al. Femoral neck fractures: prognosis based on a new classification after superselective angiography. J Orthop Sci, 2013, 18(3): 443-450.
12.	Konishiike T, Makihata E, Tago H, et al. Acute fracture of the neck of the femur. An assessment of perfusion of the head by dynamic MRI. J Bone Joint Surg (Br), 1999, 81(4): 596-599.
13.	Morimoto M, Takahashi Y, Kubo T, et al. Prognostic value of dynamic MRI positive enhancement integral color mapping in osteosynthesis of undisplaced femoral neck fractures. J Orthop Sci, 2017, 22(4): 722-725.
14.	Moons KG, Altman DG, Reitsma JB, et al. New guideline for the reporting of studies developing, validating, or updating a multivariable clinical prediction model: the TRIPOD Statement. Adv Anat Pathol, 2015, 22(5): 303-305.
15.	Cui S, Zhao L, Wang Y, et al. Using Naive Bayes Classifier to predict osteonecrosis of the femoral head with cannulated screw fixation. Injury, 2018, 49(10): 1865-1870.
16.	Wang H, Wu W, Han C, et al. Prediction model of osteonecrosis of the femoral head after femoral neck fracture: machine learning-based development and validation study. JMIR Med Inform, 2021, 9(11): e30079.
17.	Cong B, Zhang H. The association between three-dimensional measurement of posterior tilt angle in impacted femoral neck fractures and osteonecrosis of the femoral head. BMC Musculoskelet Disord, 2023, 24(1): 758.
18.	Shin WC, Moon NH, Jang JH, et al. Three-dimensional analyses to predict surgical outcomes in non-displaced or valgus impaction fractures of the femoral neck: A multicenter retrospective study. Orthop Traumatol Surg Res, 2019, 105(5): 991-998.

1. Nikolopoulos KE, Papadakis SA, Kateros KT, et al. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury, 2003, 34(7): 525-528.
2. Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res, 1980, (152): 162-172.
3. Barnes R, Brown JT, Garden RS, et al. Subcapital fractures of the femur. A prospective review. J Bone Joint Surg (Br), 1976, 58(1): 2-24.
4. Viganò M, Pennestrì F, Listorti E, et al. Proximal hip fractures in 71, 920 elderly patients: incidence, epidemiology, mortality and costs from a retrospective observational study. BMC Public Health, 2023, 23(1): 1963.
5. Zhang Y, Yuan Q, Wei Q, et al. Combined deflection angle classification: a novel typing system of adult femoral neck fracture. Orthop Surg, 2023, 15(3): 839-850.
6. O’Connor MI, Switzer JA. AAOS Clinical practice guideline summary: management of hip fractures in older adults. J Am Acad Orthop Surg, 2022, 30(20): e1291-e1296.
7. 中华医学会骨科学分会关节外科学组. 股骨头坏死临床诊疗规范. 中国矫形外科杂志, 2016, 24(1): 49-54.
8. Zheng J, Wang H, Gao Y, et al. A study on the evaluation of a risk score of osteonecrosis of the femoral head based on survival analysis. J Arthroplasty, 2021, 36(1): 62-71.
9. 刘冰川, 孙川, 邢永, 等. 中青年股骨颈骨折内固定术后发生缺血性股骨头坏死的相关因素. 北京大学学报(医学版), 2020, 52(2): 290-297.
10. Théron J. Superselective angiography of the hip. Technique, normal features, and early results in idiopathic necrosis of the femoral head. Radiology, 1977, 124(3): 649-657.
11. Liu Y, Li M, Zhang M, et al. Femoral neck fractures: prognosis based on a new classification after superselective angiography. J Orthop Sci, 2013, 18(3): 443-450.
12. Konishiike T, Makihata E, Tago H, et al. Acute fracture of the neck of the femur. An assessment of perfusion of the head by dynamic MRI. J Bone Joint Surg (Br), 1999, 81(4): 596-599.
13. Morimoto M, Takahashi Y, Kubo T, et al. Prognostic value of dynamic MRI positive enhancement integral color mapping in osteosynthesis of undisplaced femoral neck fractures. J Orthop Sci, 2017, 22(4): 722-725.
14. Moons KG, Altman DG, Reitsma JB, et al. New guideline for the reporting of studies developing, validating, or updating a multivariable clinical prediction model: the TRIPOD Statement. Adv Anat Pathol, 2015, 22(5): 303-305.
15. Cui S, Zhao L, Wang Y, et al. Using Naive Bayes Classifier to predict osteonecrosis of the femoral head with cannulated screw fixation. Injury, 2018, 49(10): 1865-1870.
16. Wang H, Wu W, Han C, et al. Prediction model of osteonecrosis of the femoral head after femoral neck fracture: machine learning-based development and validation study. JMIR Med Inform, 2021, 9(11): e30079.
17. Cong B, Zhang H. The association between three-dimensional measurement of posterior tilt angle in impacted femoral neck fractures and osteonecrosis of the femoral head. BMC Musculoskelet Disord, 2023, 24(1): 758.
18. Shin WC, Moon NH, Jang JH, et al. Three-dimensional analyses to predict surgical outcomes in non-displaced or valgus impaction fractures of the femoral neck: A multicenter retrospective study. Orthop Traumatol Surg Res, 2019, 105(5): 991-998.

Chinese Journal of Reparative and Reconstructive Surgery

Correlation analysis between combined deflection angle and osteonecrosis of femoral head after femoral neck fracture

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