title: The effect of renal function on surgical outcomes of intracapsular hip fractures with osteosynthesis.
abstract: BACKGROUND
  Chronic kidney disease (CKD) affects many physiologic systems, including bone quality, nutrition, and cardiovascular condition. Femoral neck fractures in patients on dialysis are associated with frequent complications and a high risk of mortality. However, the effect of CKD on clinical outcomes of patients with hip fractures treated with osteosynthesis remains unclear.
  
  
  METHODS
  One hundred and thirty patients with 130 femoral neck fractures treated with internal fixation were divided into two groups and the data were then analyzed. Group 1 consisted of 98 patients (98 hip fractures) with normal renal function (estimated glomerular filtration rate, or eGFR, ≥60 ml/min/1.73 m(2)). Group 2 was composed of 32 patients (32 hip fractures) with CKD (eGFR <60 ml/min/1.73 m(2)) without dialysis. Clinical outcomes as well as early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were then compared.
  
  
  RESULTS
  In Group 1, 32 complications (32.6%) occurred in 98 hips, including 5 cases of nonunion and 16 cases of osteonecrosis. In Group 2, 24 complications (75%) developed in 32 hips; these included 8 cases of nonunion and 3 cases of osteonecrosis. The mean duration of follow-up was 32 months. The overall mortality rate was 11.5%. No difference was noted in early, late, or overall mortality rate between two groups. Patient with CKD had a higher nonunion rate (OR = 5.9, P = 0.023). Meanwhile, CKD and displaced fracture pattern were independent predictors for revision surgery (OR = 3.0, P = 0.032; OR = 6.9, P = 0.001, respectively).
  
  
  CONCLUSIONS
  Osteosynthesis is a safe and effective treatment for femoral neck fractures; however, patients with femoral neck fracture and CKD have a higher risk of nonunion and subsequent surgical revision.
  Prognostic studies, Level III.
authors.affiliation: Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, Chang Gung University, No 6, West Section, Chia Pu Road, Puzih, Chia-Yi Hsien, 613, Taiwan, 8902078@cgmh.org.tw.
authors.forename: Liang-Tseng
authors.initials: LT
authors.lastname: Kuo
authors.forename: Su-Ju
authors.initials: SJ
authors.lastname: Lin
authors.forename: Wei-Hsiu
authors.initials: WH
authors.lastname: Hsu
authors.forename: Kuo-Ti
authors.initials: KT
authors.lastname: Peng
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lin
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000209:etiology / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult