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Femoral shaft displacement and Winquist classification provide predictive characteristics for combined femoral neck and femoral shaft fractures.
Quinn, Matthew S; Byrne, Rory A; Albright, J Alex; Morrissey, Patrick; Barhouse, Patrick S; Ge, Jonathan; Johnson, Joey P; Evans, Andrew.
Afiliación
  • Quinn MS; Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA.
  • Byrne RA; Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA.
  • Albright JA; Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA. Electronic address: James_Albright@brown.edu.
  • Morrissey P; Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA.
  • Barhouse PS; Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
  • Ge J; Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
  • Johnson JP; Heersink School of Medicine at the University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
  • Evans A; Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA.
Injury ; 55(8): 111633, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38823096
ABSTRACT

OBJECTIVES:

The goal of this study is to establish radiographic features and characteristics of patient injury in cases of femoral shaft fractures that predict the presence of ipsilateral femoral neck fractures (IFNFs).

METHODS:

Patient data was retrospectively assessed from a single level I trauma center through the electronic health record using (Current Procedural Terminology) CPT codes for both isolated and combined ipsilateral femoral shaft and neck fractures. Demographic information, injury characteristics, and independently reviewed radiographic features were collected and compared against the same information from a group of isolated femoral shaft fractures. Multivariable logistic regression was performed to identify risk factors for concomitant IFNFs and their respective odds ratios. A probability algorithm for assessing ipsilateral femoral neck fractures based on independent multivariate predictors was constructed and used.

RESULTS:

A total of 113 patients with either isolated femoral shaft fractures or combined femoral shaft and IFNF (n = 33) met inclusion criteria and were identified for this study. Fracture displacement was most strongly associated with increased risk of combined injury with an aOR of 25.64 (95 %CI = 5.96-110.28) for every 100 % displacement. Motorcycle crash (MCC) was the mechanism associated with the highest risk of combined injury, with an aOR of 9.85 (95 % CI = 1.99-48.74). Combined injury was also correlated with lower Winquist score and presentation with a closed fracture, with aORs of 0.38 (95 %CI = 0.21 - 0.68) and 11.61 (95 %CI = 1.93-69.94), respectively. Presence of at least 3 of the statistically significant variables produced a positive predictive value (PPV) of ≥ 89 % for combined femoral shaft and IFNF.

CONCLUSIONS:

Identification of combined femoral shaft and IFNF is of critical importance when caring for orthopedic trauma patients. While diagnosis remains a challenging task, MCC mechanism, >100 % fracture displacement, and lower Winquist classification were found to be associated with combined injuries. The combination of these variables might assist in predicting the probability of combined injury and potentially guide decision making on the appropriateness of obtaining single sequence MRI or implementing prophylactic femoral neck fixation. LEVEL OF EVIDENCE Level III.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Centros Traumatológicos / Fracturas del Fémur / Fracturas del Cuello Femoral Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Injury Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Centros Traumatológicos / Fracturas del Fémur / Fracturas del Cuello Femoral Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Injury Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Países Bajos