title: The clinical significance of impaction at the femoral neck fracture site in the elderly.
abstract: BACKGROUND
  Factors influencing clinical outcomes of osteosynthesis for elderly patients with Garden stage I and II femoral neck fractures are not well understood.
  
  
  METHODS
  To determine the factors influencing the clinical outcomes of in situ osteosynthesis in non-displaced femoral neck fractures in the elderly, radiographs and clinical data of patients were retrospectively analyzed. The subjects were 49 patients with femoral neck fractures (Garden stages I and II), who underwent osteosynthesis, with correctly inserted screws and with more than 2 years of follow up. The relationships between preoperative anteroposterior X-ray parameters including Garden stage, the presence or absence of spikes, the Singh grade, the Garden alignment index, the degree of impaction at the fracture site (the capital impaction index) and postoperative outcomes were analyzed.
  
  
  RESULTS
  Among the 49 cases, there were eight unsuccessfully treated patients, two with non-union and six with late segmental collapse. The "without spikes" fracture type (P < 0.05) and the degree of capital impaction when the capital impaction index (P < 0.0001) was greater than the mean plus the standard deviation, were significantly associated with unsuccessful outcomes.
  
  
  CONCLUSIONS
  Excessive shortening at the fracture site on the anteroposterior radiograph in the femoral neck fracture of Garden stages I and II can be used to predict poor outcomes from in situ osteosynthesis.
authors.affiliation: Department of Orthopaedic Surgery, Takayama Red Cross Hospital, Takayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Kei
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Masuda
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Miyata
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Hori
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shimizu
authors.forename: Masato
authors.initials: M
authors.lastname: Maeda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D015588:Observer Variation; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors