title: The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study.
abstract: We have studied the effect of shortening of the femoral neck and varus collapse on the functional capacity and quality of life of patients who had undergone fixation of an isolated intracapsular fracture of the hip with cancellous screws. After screening 660 patients at four university medical centres, 70 patients with a mean age of 71 years (20 to 90) met the inclusion criteria. Overall, 66% (46 of 70) of the fractures healed with > 5 mm of shortening and 39% (27 of 70) with > 5 degrees of varus. Patients with severe shortening of the femoral neck had significantly lower short form-36 questionnaire (SF-36) physical functioning scores (no/mild (<5 mm) vs severe shortening (> 10 mm); 74 vs 42 points, p < 0.001). A similar effect was noted with moderate shortening, suggesting a gradient effect (no/mild (< 5 mm) vs moderate shortening (5 to 10 mm); 74 vs 53 points, p = 0.011). Varus collapse correlated moderately with the occurrence of shortening (r = 0.66, p < 0.001). Shortening also resulted in a significantly lower EuroQol questionnaire (EQ5D) index scores (p = 0.05). In a regression analysis shortening of the femoral neck was the only significant variable predictive of a low SF-36 physical functioning score (p < 0.001).
authors.affiliation: University of Minnesota, 2450 Riverside Avenue S, R200, Minneapolis, Minnesota 55454, USA. zlowo001@umn.edu
authors.forename: M
authors.initials: M
authors.lastname: Zlowodzki
authors.forename: O
authors.initials: O
authors.lastname: Brink
authors.forename: J
authors.initials: J
authors.lastname: Switzer
authors.forename: S
authors.initials: S
authors.lastname: Wingerter
authors.forename: J
authors.initials: J
authors.lastname: Woodall
authors.forename: B A
authors.initials: BA
authors.lastname: Petrisor
authors.forename: P J
authors.initials: PJ
authors.lastname: Kregor
authors.forename: D R
authors.initials: DR
authors.lastname: Bruinsma
authors.forename: M
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016896:Treatment Outcome