title: Femoral neck fracture after removal of the compression hip screw from healed intertrochanteric fractures.
abstract: OBJECTIVE
  To evaluate the incidence of femoral neck fracture (FNF) after removal of a compression hip screw (CHS) without trauma and to determine the risk factors for this type of fracture.
  
  
  METHODS
  Retrospective study of consecutive patient series.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Sixty-seven patients with a mean age of 65.3 years (45 women and 22 men).
  
  
  METHODS
  A total of 67 implants were removed in the presence of bony consolidation of the fracture site; most of them were due to hardware pain.
  
  
  METHODS
  The incidence of FNF after a CHS removal, clinical parameters (age, gender, bone mineral density, body mass index, and fracture stability), and radiologic parameters (the femoral neck-shaft angle, femoral neck width, distance between thread of lag screw, and neck cortex). Univariate analysis was performed for those parameters of the fracture group and the nonfracture group. To assess which variables were associated with FNF, a multiple logistic regression was used.
  
  
  RESULTS
  Six (9.0%) FNFs occurred within 1 month after a CHS removal. The mean anterior and lateral neck widths were significantly smaller, and the mean anterior and inferior thread-to-cortex distances were significantly shorter in the fracture group compared with the nonfracture group. The risk factor significantly associated with FNF was the inferior thread-to-cortex distance (odds ratio, 0.462; 95% confidence interval, 0.217-0.988).
  
  
  CONCLUSIONS
  CHS should not be removed routinely due to the risk of FNF. Furthermore, attention should be paid to at-risk patients with a hip screw positioned close to the inferior femoral neck cortex.
  
  
  METHODS
  Prognostic level II.
authors.affiliation: *Department of Orthopedic Surgery, Seoul National University Boramae Hospital, Seoul, Korea; and †Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Pil Whan
authors.initials: PW
authors.lastname: Yoon
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Kwon
authors.forename: Jeong Joon
authors.initials: JJ
authors.lastname: Yoo
authors.forename: Hee Joong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Kang Sup
authors.initials: KS
authors.lastname: Yoon
mesh_terms: D000368:Aged; D001863:Bone Screws / Q000706:statistics & numerical data*; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery*; D017102:Fracture Healing; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D016016:Proportional Hazards Models; D011859:Radiography; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome