Biomechanical factors and failure of transcervical hip fracture repair.
OBJECTIVE
To assess the association between biomechanical measurements (bone quality of the femoral neck, comminution, fracture angle, and fracture level) and the likelihood of fixation failure among patients who have a multiple screw stabilisation of an intracapsular hip fracture.


METHODS
A cohort study of 139 Washington State residents greater than 60 years of age who sustained a fall-related transcervical hip fracture treated from 1990 to 1996 inclusive. Measurements of bone quality, fracture angle, fracture level, and comminution were taken from perioperative X-rays. The outcome measure was clinical failure of the internal fixation procedure within 12 months of hospital discharge, as measured by readmission for further surgery to that hip.


RESULTS
Of the four biomechanical aspects examined, only bone quality, as measured by presence of an ICD code for osteoporosis, was significantly associated with risk of subsequent hospitalisation for revision surgery (adjusted hazard ratio 7.7, 95% CI 1.8-32.8).


CONCLUSIONS
A diagnosis code for osteoporosis was related to the outcome of intracapsular fractures repaired with multiple pins. Other biomechanical measurements from diagnostic X-rays were not related to the need for further surgery.
Spangler
L
L
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.
Cummings
P
P
Tencer
A F
AF
Mueller
B A
BA
Mock
C
C
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D015519:Bone Density / Q000502:physiology; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000592:standards*; D006620:Hip Fractures / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000503:physiopathology; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D017211:Treatment Failure